Neuro OSCE 3 Flashcards
Axillary nerve testing
-C5,6
- Deltoid (C5 myotome)
- Teres minor: shoulder ext. rot
- Triceps (C7 myotome)
-Regimental badge skin (C5 dermatome)
Musculocutaneous nerve testing
C5,6,7
- Biceps brachii (C6 myotome)
- Brachialis: ebow flexion thumbs up
- Coracobrachiais: adduct + flex arm 120o
-Lateral antebrachial cutaneous nerve skin (C6 dermatome sauf hand)
Median nerve testing
C6-T1
- Pronation (teres, quadratus)
- Lateral wrist flexors (C7 myotome)
- Lateral 2 fingers flexor digit superficialis (check video)
- Ochsner’s clasp test: index sticks out if lesion at cubital fossa or above; last 4 digit sheeths connected
- Lateral lumbricals fing 2 & 3: flex MCP, extend IP (separatly tested)
- Opponens pollicis
- Abductor pollux brevis
- Flexor pollux brevis (check video)
- Pamar cutaneous n. (no carpal tunnel)
- Digital cutaneous n. (Check photo)
Radial nerve testing
C5-T1
- Triceps+anconeus (supinated extension) (C7my)
- Brachioradialis: thumbs up flexion
- Wrist extensors (C6my)
- Hand extensors: finger extension (C7my)
- Posterior cutaneous n. arm
- Superficial branch radius
- snuff box
-wrist drop*
Ulnar nerve testing
C8-T1
- Medial wrist flexors (C7my)
- Abductor dig.min.: flex & oppose
- Flexor dig.min: flex at MCPJ
- Abd. dig.min
- 3&4th lumbricals: flex MCPJ, ext. IPJ
- Dorsal interosseous muscles: abduct fingers
- Palmar interosseous: adduct (**is it all fingers?) (Tmy)
- Adductor pollux
- Flexor pollux
- Froments’s sign: thumb flexes = +ve = lost thumb adductors
-Medial forearm, dorsal, anterior medial 1 1/2 fingers & palm
Brachial plexus examination
- pain or weakness in shoulder and arm
- severe pain if root avulsion
- neural cause if: dull, vague, not related to movement, worse at night, no tenderness
- orthopaedic if: pain on movement, inflammation, joint deformity, tenderness
- supraclavicular most common
- infraclav less severe = C ribs
- rhomboids spared bc C5 nerve root
- causes: inflammation, autoimmune, radiotherapy, cancer, trauma
- Erb’s palsy: C5,6, lost shaoulder abduction, elbow flexion, supination, wrist flexion (waiter’s tip), lateral arm sensory loss
- Klumpke syndrome: C8-T1, lost wrist flexors, intrinsic hand (claw hand and horner’s syndrome
Lateral femoral cutaneous nerve testing
L2-3
-only sensory
- trapped btw inguinal lig & ASIS
- meralgia parasthetica
Femoral nerve testing
L2, 3, 4
- Iliacus: hip flexion (L1/2my)
- Quad femoris: knee extension (L3my)
- Anterior femoral cutaneous n.
- Saphenous n.
Obturator nerve testing
L2,3,4
- Obturator externus: hi adduction (L2/3my)
- Terminal branches sensory (groin)
Sciatic nerve testing
L4,5 S1,2,3
- Hamstrings & add. mag.: knee flexion, hip extension
- No sensory
- divides into Common peroneal and Tibial nerve
Common Peroneal nerve testing
L4-S2
SUPERFICIAL BRANCH
- Fib. Long & brevis: eversion (S1my)
- Sensory (lateral shin)
DEEP BRANCH
- Tib. Ant.: dorsiflex, invert
- Ext. hallux long.
- Fib. Tertius: dorsiflex, evert
- Sensory: thong
Tibial nerve testing
- Gastroch, plantaris, soleus: plantarflex, knee flex
- Popliteus: knee flexion
- Tib. Post: inversion, plantarflex, arch support
- Flex. Digit. Long., Hallux long.: toe flexion (S2my)
MEDIAL PLANTAR BRANCH
- Abduct. Hallux
- Flexor digit. Brevis
- Flexor hallux brevis
- Sensory (medial sole)
LATERAL PLANTAR BRANCH
- other foot muscles
- sensory (lateral sole)
Describe the stretch reflex that happens during deep tendon reflex testing
Hammer stretch muscle -> excites spindles -> motor synaptic response in SC -> contraction
Tells us if:
- afferent or efferent arc is intact (LMN)
- inhibitory effect of UMN is lost
List causes of hyperreflexia
- UMNL
- metabolic diseases
- electrolytic
- anxiety
- MS
List causes of hyporeflexia
- muscle
- sensory neuron
- LMNL
- NM junction
- acute UMNL
- joint disease
- hypothyroidism
Describe the Wexlers scale
0 to 5+
- 1+ to 3+ = normal
- asymmetry is not normal
Absent, trace, normal, brisk, clonus, sustained clonus
List Jendrassik Maneuvres
Pul hands Clench jaw, wrists Push feet together Turn head away Close eyes
List and do the Upper limb DTRs
Biceps (musculocutaneous, C5… also C6)
Brachioradialis (radial: C6… also C5)
Triceps (radial: C7… also C6,8)
List and do the Lower limb DTRs
Patellar (femoral: L4... also L2,3) Medial hamstring (L5) Achilles tendon (Tibial: S1.. also S2)
Abdominal Reflexes
-from all 8 quadrants
+ve = umbilicus moves towards stimulus
- postsynaptic motor reflex o skin
- dysfunction of: UMN, LMN, pyramidal tracts, or peripheral neuron
False +ve : obese, multiparous, older, surgery Hx
+ picture of what nerve is what quadrand
Plantar response test
Babinski sign
Kids under 1 yrs is normal
UMNL
Normal is plantar flexion or nothing
Finger flexor response
Hoffmann’s reflex
Hold middle phalange and flick nail down
+ve : thumb flex and adduct
UMNL
List things to observe in gait
Arm swing Falling Feet height Involuntary movements Knee bend Leg stiffness Leg trajectory Posture Sit to stand
List the gait tests
Tandem gait
Forced gait (hop single leg)
Walk on heels (L4-5)
Walk on toes (S1-2)
Hemiplegic gait
.
Diplegic gait
.
Cerebellar ataxic gait
.
Trendelemberg gait
.
High stepping gait
F
Antalgic gait
.
Tabetic gait
G
SSA gait
F
Basal ganglia lesion
.
Frontal lesion gait
H
March a petit pas
D
Apraxia gait
G
Romberg Test
.
Upper limb dysdiadokokinesia
.
Lower limb dysdiadokokinesia
G
Precision finger tap
.
Finger nose finger test
J
Heel-shin overshoot test
M
List the tests to do for Truncal ataxia
Tandom gait
Cant even romberg
List the tests to do for Appendicular ataxia
Upper limb dysdiadokokinesia
Lower limb dysdiadokokinesia
Precision finger tap
Finger-nose-finger test
Heel-shin overshoot
List the tests to do for Tabetic ataxia
- sensory exam
- joint position sense
- Romberg
List the tests to do for Vertiginous ataxia
- Romberg
- cerebellar signs: nystagmus, dysarthria (staccato), intention tremour, hypotonia (pendular reflex)
List the branches of the cervical plexus
SUPERFICIAL CUTANEOUS BRANCHES -Lesser occipital C2-3 -Great auricular C2-3 -Transverse cervical C2-3 -Supraclavicular C3-4 \+draw where each innervates
DEEP MOTOR BRANCHES:
- Phrenic C3-5 (diaphragm & pericardium)
- Ansa cervicalis C1-3 (infrahyoid m. -move hyoid down in speech)
Cremasteric reflex
.
Bulbospongious reflex
J
Saddle reflex
K
