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OSCE - examinations > Neurological exam > Flashcards

Neurological exam Flashcards

1
Q

How would you start an upper limb neurological examination?

A

Inspection:

  1. Scarring, symmetry
  2. Wasting
  3. Abnormal and involuntary movements
  4. Fasciculations
  5. Tremor

Look for UMN lesion posture

Pronator drift

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2
Q

What is the UMN posture?

A

Shoulders adducted, elbow and wrist flexed, pronated

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3
Q

How would you assess tone in an upper limb neurological examination?

A

“Let your arm go floppy”

  1. Flex/extend elbow
  2. Flex/extend wrist
  3. Pronate/supinate
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4
Q

What is increased tone a sign of?

A

UMN

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5
Q

How would you assess power in an upper limb neurological examination?

A

Ask patient to push away and pull towards; grade power out of 5

  1. Shoulder abduction - C5
  2. Shoulder adduction - C6/C7
  3. Elbow flexion - C5/C6
  4. Elbow extension - C7
  5. Wrist extension - C6
  6. Wrist flexion - C6/C7
  7. Finger extension - C7
  8. Index finger
  9. Little finger
  10. Thumb abduction - C8/T1
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6
Q

How would you assess reflexes in an upper limb neurological examination?

A
  1. Bicep jerk - C5/C6
  2. Tricep jerk - C7
  3. Supinator jerk - C5/C6
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7
Q

What is an increased reflex a sign of?

A

UMN

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8
Q

What is an absent reflex a sign of?

A

LMN

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9
Q

How would you assess sensation in an upper limb neurological examination?

A

Say yes when I touch the skin

  1. Above the shoulder tip - C4
  2. Deltoid area - C5
  3. Lateral forearm/thumb - C6
  4. Middle finger - C7
  5. Little finger/medial forearm - C8
  6. Medial arm - T1

Vibration sense
Joint sensation

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10
Q

Where would you check for vibration sense in upper neurology?

A

Bone prominence on thumb, then radial styloid, then olecranon, then shoulder

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11
Q

How would you assess coordination in an upper limb neurological examination?

A
  1. Piano playing (difficult in Parkinson’s)
  2. Hand slapping (cerebellar ataxia)
  3. Finger-nose test (cerebellar ataxia)
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12
Q

What causes an intention tremor?

A

Cerebellar lesion

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13
Q

What is the grading of power list?

A

5 - normal: full power against resistance
4 - reduced: able to move against some resistance
3 - able to move against gravity; unable to move against resistance
2 - Unable to move against gravity, but can move when gravity is eliminated
1 - visible flicker of muscle contraction, but no movement across joint
0 - no muscle contraction

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14
Q

What is Erb’s palsy?

A

C5-C7 lesion, often dude to shoulder dystocia during childbirth

Sensory loss down lateral arm and in “waiter’s tip” position

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15
Q

What is Klumpke’s palsy?

A

C8-T1 lesion, due to excessive arm traction during childbirth

Sensory loss on medial forearm and hand
Complete claw hand
Wasting of small muscles in hand
Horner’s may co-exist

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16
Q

How would you start a lower limb neurological examination?

A

Inspection

  1. SSWIFT
  2. Abnormal posturer: UMN posture or foot drop
  3. Soft tissue damage due to sensory loss: blisters, ulcers
17
Q

What is the UMN position for the lower limb?

A

Hip and knee extended, foot plantarflexed and inverted

18
Q

How would you assess tone in a lower limb neurological examination?

A

Let leg go floppy

  1. Leg roll
  2. Leg left (can reveal hypertonia if leg stays straight)
  3. Ankle movement + dorsiflexion
19
Q

What can sudden dorsiflexion reveal?

A

Increased clonus: UMN lesion

20
Q

How would you assess power in a lower limb neurological examination?

A
  1. Hip flexion - L1/L2
  2. Hip extension - L5/S1
  3. Knee flexion - S1/L5
  4. Knee extension - S3/S4
  5. Ankle dorsiflexion - L4
  6. Ankle plantarflexion - S1
  7. Big toe extension - L5
21
Q

How would you assess reflexes in a lower limb neurological examination?

A
  1. Knee jerk - L3/L4
  2. Ankle jerk - S1
  3. Plantar flexion (Babinski) - S1
22
Q

How would you assess sensation in a lower limb neurological examination?

A
  1. Anterolateral medial thigh - L2
  2. Medial thigh above the knee - L3
  3. Medial malleolus - L4
  4. Dorsal 1st web space - L5
  5. Lateral heel - S1

Vibration - big toe

Joint sensation

23
Q

Where would you check for vibration sense in lower neurology?

A

Big toe
Medial malleolus
Tibial tuberosity
ASIS

24
Q

What special tests would you do for lower limb neurology?

A
  1. Romberg’s (sensory ataxia due to proprioceptive loss)
  2. Straight leg raise (L5/S1 nerve impingement)
  3. Femoral stretch test (L4 nerve root impingement)
25
Q

What investigations would you suggest after a lower limb neurology exam?

A
  1. Asses gait
  2. Full neurological examination
  3. Spastic paralysis: assess thorax sensation
  4. Flaccid paralysis: check for saddle anaesthesia
  5. Nerve conduction studies, CT head, MRI spine
26
Q

What investigations would you suggest after an upper limb neurology exam?

A
  1. Full neurological examination
  2. Detailed examination of the hands
  3. Nerve conduction studies, CT head, MRI spine
27
Q

What are the causes of spastic paraparesis (bilateral UMN lesion)?

A
  1. Sagittal sinus lesion
  2. Bilateral strokes
  3. Cord trauma
  4. Intrinsic cord disease
  5. Cord compression
28
Q

What are the causes of flaccid paralysis (bilateral LMN signs)?

A
  1. Polio
  2. Motor peripheral neuropathy (Guillan-Barre, lead poisoning)
  3. Mixed peripheral neuropathy
29
Q

What is the cause of mixed upper and lower lesion signs?

A

Motor neutron disease !

30
Q

What are causes of unilateral leg weakness?

A

UMN: stroke, tumour, MS

LMN: root lesion, nerve lesion

31
Q

What are causes of sensory peripheral neuropathy?

A

DM

Uraemia (renal failure)

32
Q

What are causes of motor peripheral neuropathy?

A

Guillan-Barre

Lead poisoning

33
Q

What are causes of sensory AND motor peripheral neuropathy?

A 
Charcot-marie-Tooth
B12 or folate deficiency 
Thiamine deficiency
Alcohol
Vasculitis/SLE
34
Q

What are causes of a positive Romberg’s test?

A
  1. Dorsal column loss: syphilis, cord degeneration, MS

2. Sensory peripheral neuropathy

35
Q

What are signs of amyotrophic lateral sclerosis (MND)?

A 
Weakness
Wasting
Fasciculations 
Spasticity 
Brisk reflexes
36
Q

What are the causes of foot drop?

A 
Common peroneal nerve palsy
Stroke 
L4/L5 lesion
MND
Charcot-Marie-Tooth syndrome

OSCE - examinations (13 decks)

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