Neurological Examination

Question 1

Signs of upper motor neuron lesions

Answer 1

Spastic paralysis
Hyper-reflexia
Clonus
LMN findings at level of injury due to damage of ventral root/nerve

Question 2

Signs of lower motor neuron lesions

Answer 2

Flaccid paralysis
Fasciculations
Atrophy
Hypo-reflexia and absent deep tendon reflexes

Question 3

What is the significance of “frog-legged” posture in infants?

Answer 3

Abducted hips suggests hypotonia

Question 4

What is the significance of the “cortical thumb sign” in infants?

Answer 4

Adduction and flexion posturing of the thumb with reduced spontaneous opening may be a sign of UMN lesion, especially if persisting beyond 4 months or in presence of other suggestive signs (essentially equivalent of upgoing plantar)

Question 5

What is opisthotonus? What are some causes in infants?

Answer 5

Persistent arching of the neck and trunk (activation of extensor muscles)
Due to bilateral cerebral cortical dysfunction
Causes include meningitis, tetanus, kernicterus

Question 6

What is athetosis? What are some causes?

Answer 6

Slow sinuous movement of the distal extremity (writhing movements)
Due to damage to basal ganglia
Causes include hypoxic-ischaemic encephalopathy (as in cerebral palsy), kernicterus

Question 7

What is pseudohypertrophy? When is it seen?

Answer 7

Muscle bulk in setting of weakness

Seen in Duchenne muscular dystrophy

Question 8

Normal motor development for newborn

Answer 8

Limbs flexed, symmetrical

Head lag on pulling up

Question 9

Normal gross motor development 6-8 weeks

Answer 9

Raises head to 45 degrees when prone (tummy time)

Question 10

Normal gross motor development 6-8 months

Answer 10

Sits without support (initially with a round back, then eventually with a straight back by 8 months)
Limit age: 9 months

Question 11

Normal gross motor development 8-9 months

Answer 11

Crawling

Question 12

Normal gross motor development 10 months

Answer 12

Cruises around furniture

Question 13

Normal gross motor development 12 months

Answer 13

Walks unsteadily – a broad gait, with hands apart

Limit age: 18 months

Question 14

Normal gross motor development 15 months

Answer 14

Walks steadily

Question 15

Normal gross motor development 2.5 years

Answer 15

Runs and jumps

Question 16

Normal vision and fine motor development 6 weeks

Answer 16

Fixes and follows

Limit age: 3 months

Question 17

Normal vision and fine motor development 4-6 months

Answer 17

Reaches out for toys
Palmar grasp
Limit age: 6 months

Question 18

Normal vision and fine motor development 7 months

Answer 18

Transfers toys from one hand to another

Limit age: 9 months

Question 19

Normal vision and fine motor development 10 months

Answer 19

Mature pincer grip

Limit age: 12 months

Question 20

Normal vision and fine motor development 16-18 months

Answer 20

Makes marks with crayons

Question 21

Normal vision and fine motor development for brick building over 14 months to 4 years

Answer 21

18 months: tower of 3
2 years: tower of 6
2.5 years: tower of 8 or train with 4 bricks
3 years: bridge (from a model)
4 years: steps (after demonstration)

Question 22

Normal vision and fine motor development for pencil skills over 2 years to 5 years (refers to age they can draw without seeing it done; can copy from 6 months earlier)

Answer 22

2 years: line
3 years: circle
3.5 years: cross
4 years: square
5 years: triangle

Question 23

Normal hearing, speech and language development for newborn

Answer 23

Startles to loud noises

Question 24

Normal hearing, speech and language development 3-4 months

Answer 24

Vocalises when alone or when spoken to, coos and laughs

Question 25

Normal hearing, speech and language development 7 months

Answer 25

Turns to soft sounds out of sight

Polysyllabic babble

Question 26

Normal hearing, speech and language development 7-10 months

Answer 26

Sounds used indiscriminately at 7 months

Sounds used discriminately to parents at 10 months

Question 27

Normal hearing, speech and language development 18 months

Answer 27

6-8 words

Is able to show two parts of the body (e.g. point to nose when asked)

Question 28

Normal hearing, speech and language development 20-24 months

Answer 28

Joins two or more words to make simple phrases

Question 29

Normal hearing, speech and language development 2.5-3 years

Answer 29

Talks constantly in 3-4 word sentences

Understands 2 joined commands

Question 30

Normal social, emotional and behavioural development 6 weeks

Answer 30

Smiles responsively

Limit age: 8 weeks

Question 31

Normal social, emotional and behavioural development 6-8 months

Answer 31

Puts food in their mouth

Question 32

Normal social, emotional and behavioural development 10-12 months

Answer 32

Waves goodbye, plays peek-a-boo

Question 33

Normal social, emotional and behavioural development 12 months

Answer 33

Drinks from a cup with two hands

Question 34

Normal social, emotional and behavioural development 18 months

Answer 34

Holds spoon and gets safely to mouth

Question 35

Normal social, emotional and behavioural development 18-24 months

Answer 35

Symbolic play

Limit age: 2-2.5 years

Question 36

Normal social, emotional and behavioural development 2 years

Answer 36

Toilet training: dry by day

Pulls off some clothing

Question 37

Normal social, emotional and behavioural development 2.5-3 years

Answer 37

Parallel play
Interactive play evolving
Takes turns