Neurological

Question 1

upper and lower limb examinations can be split into what categories?

Answer 1

tone
power
reflexes
sensation

Question 2

when you see hypotonia in a patient, it’s due to?

Answer 2

breach/disruption in the spinal segmental reflex arc and the simple spinal reflexes are not functioning
LMN (lower motor neuron) lesion

Question 3

The impulses from the upper motor neurons have a _______ effect on the lower motor neurons.

Answer 3

inhibitory

Question 4

If the higher cerebral control is disrupted, as in an UMN lesion, muscle tone is exaggerated you will experience?

Answer 4

hypertonia

sometimes spasticity

Question 5

where do you test for tone in the upper limb?

Answer 5

shoulder
elbow
wrist

Question 6

what scale is used for noting strength/power in muscle?

Answer 6

Medical Research Council (MRC) Muscle Power scale.

Question 7

what is 0/5 on the MRC muscle power scale?

Answer 7

no movement

Question 8

what is 1/5 on the MRC muscle power scale?

Answer 8

Barest flicker of movement of the muscle, though not enough to move the structure to which it’s attached

Question 9

what is 2/5 on the MRC muscle power scale?

Answer 9

Voluntary movement which is not sufficient to overcome the force of gravity.

Question 10

what is 3/5 on the MRC muscle power scale?

Answer 10

Voluntary movement capable of overcoming gravity, but not any applied resistance

Question 11

what is 4/5 on the MRC muscle power scale?

Answer 11

Voluntary movement capable of overcoming “some” resistance

Question 12

what is 5/5 on the MRC muscle power scale?

Answer 12

Normal strength

Question 13

what signs can be used to indicate more subtle descriptions of power?

Answer 13

+/-

Question 14

how to assess power

Answer 14

resist the movement by applying an opposing force and estimate the power of the contracting muscle/s. You will also need to isolate and stabilize the joint to accurately measure the power

Question 15

where to assess for power in the upper limb?

Answer 15

shoulder abduction and adduction
elbow flexion and extension
wrist flexion

Question 16

are most of the myotactic reflexes monosynaptic or multisynaptic?

Answer 16

monosynaptic

Question 17

When the tendon of a muscle is tapped with a tendon hammer, why does it elicit a reflex?

Answer 17

causes stretching of the muscle spindles > stimulus travels to spinal cord > stimulates efferent motor neurons in anterior grey columns (horns) > involuntary contraction of the main muscle

Question 18

how to apply reinforcement to individuals to elicit reflexes

Answer 18

clench the teeth or squeeze an object in the contralateral (other) hand while you directly test the reflex on the limb to be tested

Question 19

law of reciprocal innervation

Answer 19

afferent nerves responsible for flexor reflex muscle action must have branches to synapse with the extensor motor neurons of the same limb to inhibit the extensor muscle contraction

Question 20

abnormally exaggerated myotatic reflexes lead to a clinical picture of?

Answer 20

upper motor neuron lesion

Question 21

If there is disorder in any of the components of the reflex arc (muscle spindles, afferent sensory neurones, efferent motor neurones and the effector organs, what will happen to the reflexes?

Answer 21

areflexia (complete absence)

Question 22

areflexia is suggestive of?

Answer 22

lower motor neuron lesion

Question 23

how to test for a reflex

Answer 23

ensure that the relevant limb is completely relaxed, you will then attempt to elicit the reflex by tapping the relevant tendon with a tendon hammer

Question 24

what reflexes are there to test in the upper limb?

Answer 24

Biceps (C5, C6)
Triceps (C7, C8)
Suprinator (C6)

Question 25

define dermatome

Answer 25

area of skin supplied by a single spinal nerve root of the spinal cord segment

Question 26

define myotome

Answer 26

group of muscles innervated by the ventral root a single spinal nerve

Question 27

on the skin of the upper limb do dermatomes overlap?

Answer 27

yes considerably

Question 28

where is there no overlap of dermatomes?

Answer 28

across axial lines

Question 29

how many dermatomes need to be affected in order to detect a significant sensory loss?

Answer 29

three adjacent dermatomes

Question 30

where to test for sensation in the upper limb? pair them with the relevant nerve root

Answer 30

``` Shoulder (C4) Lateral aspect of the arm (C5) Lateral aspect of forearm (C6) Middle finger (C7) Little finger (C8) Medial aspect of forearm (T1) Axilla (T2) ```

Question 31

musculocutaneous nerve supplies what dermatomal segment?

Answer 31

C5, C6, C7

Question 32

median nerve supplies what dermatomal segment?

Answer 32

C6-8, T1

Question 33

radial nerve supplies what dermatomal segment?

Answer 33

C5-C8, T1

Question 34

ulnar nerve supplies what dermatomal segment?

Answer 34

C7, C8, T1

Question 35

what do you test for tone in the lower limb?

Answer 35

hip knee ankle clonus

Question 36

what do you test for power in the lower limb?

Answer 36

Hip flexion and extension Knee flexion and extension Ankle dorsiflexion and plantarflexion

Question 37

what reflexes do you test in the lower limb? pair with relevant spinal roots

Answer 37

Patellar (L2, L3, L4) | Achilles (S1, S2)

Question 38

where do we test for sensation in the lower limb? pair with relevant spinal roots

Answer 38

Lateral aspect of thigh (L2) Lower medial aspect of thigh (L3) Medial aspect of leg, medial foot and great toe (L4) Lateral side of leg, mid dorsum of foot and middle three toes (L5) Little toe, lateral foot and sole of foot (S1) Back of upper leg and thigh (S2)

Question 39

posterior rami nerve supplies what dermatomal segment?

Answer 39

L1-L3 | S1-S3

Question 40

obturator nerve supplies what dermatomal segment?

Answer 40

L2, L3, L4

Question 41

femoral nerve supplies what dermatomal segment?

Answer 41

L2, L3, L4

Question 42

common fibular (part of sciatic) nerve supplies what dermatomal segment?

Answer 42

L4, L5, S1, S2

Question 43

tibular (part of sciatic nerve) nerve supplies what dermatomal segment?

Answer 43

L4, L5, S1, S2, S3