Neurology - Limbs

Question 1

What 6 things are tested in a neurological examination of the limbs?

Answer 1

• inspection, tone, power, reflexes, co-ordination and sensation

Question 2

What do you look for on inspection of the arms in a neuro exam?

Answer 2

• deformity, wasting, asymmetry, rashes, fasciculations, scars

Question 3

How is tone assessed in the limbs?

Answer 3

• feel and move the joints of the arm/leg when floppy/relaxed

Question 4

Name some pathologies that increase tone.

Answer 4

• upper motor neurone lesions - brain tumour, stroke, trauma, haemorrhage, Parkinson’s (rigid or cog wheel rigidity), MS

Question 5

Name some pathologies that decrease tone.

Answer 5

• lower motor neurone - nerve palsy’s and neuromuscular junctions

Question 6

Which muscles/movements habe their power assessed in the arms?

Answer 6

• shoulder adduction and abduction, biceps, triceps, wrists, hands (including grip), fingers and thumb

Question 7

Which muscles/movements habe their power assessed in the legs?

Answer 7

• hip adduction and abduction, quads, hamstrings, dorsiflexion, plantar flexion and big toes

Question 8

Describe the MRC scoring system.

Answer 8

5 = hold up against resistance

4 = falls with heavy resistance

3 = able to move against gravity but not resistance

2 = movement but not against gravity

1 = muscle movement but limb doesn’t move

0 = no movement at all

Question 9

What reflexes should be checked on the arms?

Answer 9

• bicep, tricep, supinator

Question 10

What are hyperreflexia and hyporeflexia signs?

Answer 10

• hyperreflexia = upper motor neurone
• hyporeflexia = lower motor neurone

Question 11

How is co-ordination assessed in the arms?

Answer 11

• finger-to-nose test
• palm-to-palm to palm-to-knuckles test

Question 12

What is reduced co-ordination indictative of?

Answer 12

stroke, Parkinson’s, disc injuries, chronic alcoholism/cerebellum disease (intention tremor and and keep going past your finger)

Question 13

What tests are done to check sensation?

Answer 13

• test the dermatomes with their eyes closed, prick sensation with neuro-tips, peripheral neuropathy, vibration on bony prominences working up the arm with long tuning fork, temperature can be done of prick isn’t felt (spinothalamic track) and proprioception by moving joints from grip on sides (starting distally)

Question 14

What diseases can cause peripheral neuropathy?

Answer 14

• diabetes, alcoholism, post-chemo, B12 and folate deficiencies, hypothyroidism

Question 15

What do you look for on inspection of the legs?

Answer 15

• deformity, wasting, asymmetry, rashes, fasiculations, scars and gait via walking,

Question 16

Asides from walking, how can gait be assessed?

Answer 16

• heel to toe test, Trendelenburgs test, Romberg’s test (requires eyes and vestibular system to pass, if can’t stand with eyes shut vestibular system is damaged)

Question 17

What disease causes a shuffling gait?

Answer 17

Parkinson’s

Question 18

What does foot drop indicate?

Answer 18

• deep perineal nerve palsy

Question 19

What disease causes an atomic gait and/or really unsteady heel-to-toe?

Answer 19

• cerebellar disease
• can also occur when very drunk

Question 20

What disease causes a hemiplegic (straight leg) gait?

Answer 20

• stroke

Question 21

What reflexes are checked in the legs?

Answer 21

• knee jerk, foot drop and Babinski’s

Question 22

How is co-ordination assessed in the legs?

Answer 22

• heel along the leg from knee to shin and then up to hand

Question 23

What length tuning fork is used in limb examination?

Answer 23

128 Hz