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1 Medicine > Neurology Peripheral Examination > Flashcards

Neurology Peripheral Examination Flashcards

1
Q

what should be looked at on inspection of upper limbs

A

symmetry, muscle wasting, fasciculations
abnormal posturing
pronator drift

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2
Q

what does muscle wasting and fasciculations suggest?

A

LMN lesion

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3
Q

what is the posture of a UMN lesion?

A

shoulder adduction

elbow/wrist flexed, pronated

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4
Q

what is an example of a UMN lesion?

A

stroke

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5
Q

how do you test for pronator drift?

A

ask patient to stretch arms out in front of them
palms facing upwards
close eyes and keep arms there
if hands drift down and protate= positive result

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6
Q

what is pronator drift a sign of?

A

UMN lesion

contralateral pyramidal tract lesion

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7
Q

what does supinator catch in the wrist suggest?

A

early sign of increased tone

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8
Q

what is power graded out of?

A

5

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9
Q

what phrases are best to use when testing power?

A

push me away

pull me towards you

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10
Q

what should be tested in upper limb power?

A 
shoulder abduction 
elbow flexion 
elbow extension
wrist flexion 
wrist extension 
finger flexion
finger extension
finger abduction
finger adduction 
thumb abduction 
thumb opposition
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11
Q

how should each movement of power be tested?

A

compare immediately with the other side for each movement

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12
Q

what root and nerve allow shoulder abduction?

A

C5

axillary nerve

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13
Q

what root and nerve allow elbow flexion?

A

C5/C6

musculocutaneous

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14
Q

what root and nerve allow elbow extension?

A

C7

radial

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15
Q

what root and nerve allow wrist extension?

A

C6, C7

radial

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16
Q

what root and nerve allow finger extension?

A

C7

radial

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17
Q

what root and nerve allow finger flexion?

A

C8

median and ulnar

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18
Q

what root and nerve allow thumb abduction/ opposition?

A

T1

median

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19
Q

what root and nerve allow finger abduction/adduction?

A

T1

ulnar

20
Q

what root causes the biceps reflex?

A

C5/C6

21
Q

what root causes the triceps reflex?

A

C7

22
Q

what root causes the supinator jerk?

A

C5/C6

23
Q

how should the biceps reflex be tested?

A

strike thumb over tendon

24
Q

how should triceps and supinator reflex be tested?

A

strike directly

25
Q

what should be tested on coordination?

A

piano playing- hold hands out and wiggle fingers
hand slapping test for dysdiadokinesis
finger nose test

26
Q

what does piano playing sign show?

A

difficult in UMN lesion

parkinson’s

27
Q

what do hand slapping test and finger nose test check for ?

A

cerebellar ataxia

28
Q

how do you check the sensation

A

first with cotton wool (light touch) then neurotip (Pain)
with eyes closed
move from side to side- does it feel same on both sides

29
Q

where should upper limb sensation be checked and what are the roots?

A 
above shoulder tip (C4)
regimental badge area (C5)
tip of thumb (C6)
tip of the middle finger (C7)
tip of the little finger (C8)
medial mid-forearm (T1)
30
Q

how do you check vibration sensation?

A

patient close their eyes
let know when detect vibration
use sternal reference point
place on finger distal interphalangeal joint
say yes when feel it and when it stops- stop it yourself
only move proximally if cannot feel the sensation
repeat on other arm

31
Q

what should you do with the neurotip after use?

A

sharps bin

32
Q

what should you offer to do after testing for other sensations?

A

temperature sensation using hot and cold test tubes

33
Q

which tuning fork is used to test vibration?

A

128 Htz- “128 lets vibrate”

34
Q

how do you test joint position sensation?

A

use middle finger DIP joint
immobilise middle phalynx with one hand
hold distal finger by sides
show movement first then close eyes and tell if finger move up or down or not sure
randomly move finger up or down 3-4 times
repeat other arm

35
Q

when is vibration sense lost

A

lost early in peripheral neuropathy

36
Q

what are the concluding remarks on further examinations of upper limb neurology?

A

i would like to perform a more detailed examination of the neurology of the hands, then go on to complete a full neurological examination
investigation: nerve condution studies, imaging (CT or MRI)

37
Q 
what are the clinical examination features in a LMN lesion?
 tone
 power
 reflexes
 plantar coordination
 other features
A 
tone normal or decreased 
power decreased
reflexes reduced
plantars down
co-ordination normal
muscle wasting and fasciculation
38
Q 
what are the clinical examination features in a UMN lesion?
 tone
 power
 reflexes
 plantar coordination
 other features
A 
tone increased (spastic)
power decreased
reflexes brisk 
plantars up
coordination decreased
clonus
39
Q 
what are the clinical examination features in a extrapyramidal lesion?
 tone
 power
 reflexes
 plantar coordination
 other features
A 
tone increased (rigid)
power normal
reflexes normal
plantars down
coordination decreased
resting tremor, bradykinesia, postural instability
40
Q 
what are the clinical examination features in a cerebellar lesion?
 tone
 power
 reflexes
 plantar coordination
 other features
A 
tone decreased
power normal
reflexes normal
plantars down
coordination very low 
intention tremor, nystagmus, cerebellar speech
41
Q

what is a grade 5 power

A

normal

full power against resistance

42
Q

what is a grade 4 power

A

reduced power

able to move against some resistnace

43
Q

what is a grade 3 power

A

able to move against gravity

unable to move against resitance

44
Q

what is a grade 2 power

A

unable to move against gravity

able to move if gravity eliminated

45
Q

what is a grade 1 power

A

visible flicker of muscle contraction but no movement across joint

46
Q

what is a grade 0 power

A

no muscle contraction

1 Medicine (10 decks)

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