Neurological examination

Question 1

Observation?

Answer 1

Bilaterally for wasting (lower motor neuron)]
Any involuntary movements in legs
Chorea, tics
More discrete, (resting tremors, fasciculations)\

Question 2

Gait

Answer 2

Looking for hip, foot drop,

wobbling, wide based gait (ataxia)

Plantarflexion S1
Dorsi selective L5

Also testing balance and coordination

Question 3

Reflexes

Answer 3

Deep tendons reflexes are involuntary responses relayed over as 2 sensory and motor neurons

Each reflex involves specfic spinal segments to help locate pathological lesion

Question 4

Reflex Grading

Answer 4

0 Absent
1+Diminshed
2+ normal
3+ Hyperactive without clonus
4+ Hyperactive with clonus

Question 5

Reflex Myotome

Answer 5

Knee L3/4
Ankle S1

Question 6

Reflex Myotome

Answer 6

Knee L3/4
Ankle S1

Question 7

Babkinski repsone L5

Answer 7

pathological reflexes indicates brain or cord lesion

Question 8

Clonus

Answer 8

indicates brain cord lesion and present if foot moves rapidly after stimulus is halted

Question 9

Motor system assessment

Answer 9

Strength grades as per resisted isometric testing
Graded 0-5
Tone- certain amount of resistance to passive movement.
Increased tone (rigidity) or decreased tone (Flaccidity)

Question 10

Voluntary Movement callled?

Answer 10

paresis

Question 11

Motor Strength Grading

Answer 11

5 Normal: Complete ROM against gravity with full resistance
4: Good Complete ROM against gravity with some resistance
3: Fair: Complete ROM against gravity with no resistance active ROM
2: Poor: Complete ROM with some assistance and gravity elimanted
1: Trace: Evidence of slight muscular contraction, no joint motion
0 Zero: No evidence of mm contraction

Question 12

Myotome Nerve Root

Answer 12

L1/2 Hip Flexion
L3/4 Knee Extension
L4/5 Knee Flexion
L5 Big toe Extension
S1/2 Ankle Plantarflexion

Question 13

Coordination requires?

Answer 13

Motor System strength
Cerebellum (steady/posture/rhythmic)
Vestibular system (ear)-balance and coordinating head, eye, body movements
Sensory- proprioception (position sense)

Question 14

Coordination of the Lower Limb

Answer 14

Rapid Alternating Movements
feet- tap foot on examiners= dysdiadhockinesia

Point to Point Testing:

Heel to shin testing
Look for overshooting (dysmetria)

Question 15

Sensory Testing (Spinothalamic tracts)-
test dermatomes to screen nerve roots)

Answer 15

pain and temperature
Light touch

Question 16

Posterior Columns test

Answer 16

vibration- nerve root distribution
position sense

Question 17

Dermatomes vs Cutaneous

Answer 17

Dermatomes: spinal pattern of supply
Cutaneous nerve supply represents which is made up of multiple spinal levels

Question 18

Pain/Nociception (spinothalamic tract)
can also do temp as well

Answer 18

sharp/dull

Question 19

Light touch testing ( spinothalamic tract and dorsal columns)

Answer 19

cotton bud

Question 20

Vibration Testing (dorsal columns)

Answer 20

tuning fork

L4: Big Toe
L5: Middle toe
S1: little toe