Neuro exam - upper and lower limb

Question 1

When inspecting for upper and lower limb exam, what would you consider looking for?

Answer 1

• Skeletal deformity
• Wasting
• Irregular movements
• Fasiculations
• Tremors

Question 2

What are the core components to upper/ lower limb examination?

Answer 2

• Inspection
• Tone
• Power
• Coordination
• Reflexes
• Sensation

Question 3

How would you assess tone in the lower limb?

Answer 3

• Tone - roll leg from side to side
• Spasticity - Brisk knee raise
• Clonus

Question 4

How many beats of clonus would indicate an UMN lesion?

Answer 4

> 5 beats

Question 5

What are the 5 grades of the MRC power scale?

Answer 5

• 5 - full power
• 4 - some resistance
• 3 - gravity
• 2 - gravity eliminated
• 1 - flicker of movement
• 0 - nothing

Question 6

How would you assess power in upper/lower limbs?

Answer 6

One joint at a time and compare sides

Question 7

What spinal level is hip flexion?

Answer 7

L2/3

Question 8

What spinal level is hip extension?

Answer 8

L4/5

Question 9

What spinal level is knee extension?

Answer 9

L3/4

Question 10

What spinal level is ankle dorsiflexion?

Answer 10

L4/5

Question 11

What spinal level is knee flexion?

Answer 11

L5/S1

Question 12

What spinal level is plantar flexion?

Answer 12

S1/2

Question 13

What spinal level is big toe extension?

Answer 13

Purely L5

Question 14

What reflexes would you assess in the lower limb, and what spinal levels are they associated with?

Answer 14

• Patellar - L3/4 kick in the door
• Ankle jerk - S1/2 buckle my shoe
• Babinskis

Question 15

How would you assess lower limb coordination?

Answer 15

Heel-to-shin test

Question 16

What would inability to perform heel to shin test due to ataxia indicate?

Answer 16

Cerebellar pathology

Question 17

What would you assess in when assessing sensation in upper/lower neurological examination?

Answer 17

• Dorsal columns - light touch, vibration, proprioception
• Spinothalamic tracts - pain, temperature

Question 18

How would you assess pain and light touch?

Answer 18

Pin (spinothalamic) and cotton wool (dorsal column) respectively

Question 19

How would you assess sensation in somoene who you suspect has distal sensory loss, or glove and stocking distribution, or a sensory level?

Answer 19

In a straight line from distal to proximal

Question 20

How would you assess sensory distribution if you suspected nerve/nerve root pathology?

Answer 20

Test dermatomes +/- peripheral nerves

Question 21

How would you assess tone in the upper limbs?

Answer 21

• Pronator drift
• Isolate each joint
  
  • Shoulder
  • Elbow
  • Forearm
  • Wrist

Question 22

What would pronator drift with distal flexion indicate?

Answer 22

Pyramidal weakness on contraleteral side

Question 23

What would an upward drift on pronator drift testing indicate?

Answer 23

Cerebellar pathology

Question 24

WHat spinal level is shoulder abduction?

Answer 24

C5

Question 25

What spinal level is elbow flexion?

Answer 25

C6

Question 26

What spinal level is elbow extension?

Answer 26

C7

Question 27

What spinal level is wrist extension?

Answer 27

C7

Question 28

What spinal level is finger extension?

Answer 28

C7

Question 29

What spinal level is finger flexion?

Answer 29

C8

Question 30

What spinal level is finger abduction?

Answer 30

T1

Question 31

What spinal level is thumb abduction?

Answer 31

T1

Question 32

What spinal level is the biceps reflex?

Answer 32

C5/6 - pick up sticks

Question 33

What spinal level is the triceps tendon reflex?

Answer 33

C7/8 - push in the gate

Question 34

What spinal level is the supinator reflex?

Answer 34

C5/6

Question 35

What coordination tests would you do as part of your upper limb neuro exam?

Answer 35

* **Finger to nose** * **Dysdiadochokinesia**

Question 36

What additional tests would you perform in a lower limb exam that you wouldn't in an upper limb exam?

Answer 36

* **Clonus** * **Babinski's** * **Gait analysis**

Question 37

What muscles does the median nerve supply?

Answer 37

* **L**ateral two **l**umbricals * **O**pponens pollicis * **A**bductor pollicis brevis * **F**lexor pollicis brevis

Question 38

What muscles does the ulnar nerve supply?

Answer 38

* **Adductor pollicis** * **Lumbricals medial two** * **Palmar and dorsal interossei**