Peripheral nerve system - LL

Question 1

How would you explain this exam to your patient?

Answer 1

Hello, my name is ……. I am a first year PA student.
Can I take your full name and DOB please?
How would you like to be addressed?
Today I have been asked to perform an exam of the nerve of your legs. This will involve me looking at your legs, moving them as well as assessing sensation and reflexes.
Would it be okay to examine you this way?
Before i begin, are you in any pain or discomfort.

Question 2

What do you look for when conducting a general inspection?

Answer 2

• Sticks
• Walking frames
• Medication
• Scars
• Involuntary movements
• Muscle wasting
• Fasciculations

Question 3

What structure do you follow when performing this exam?

Answer 3

• Tone
• Power
• Coordination
• Sensation
• Reflexes

Question 4

How do you assess tone of the lower legs?

Answer 4

• Leg roll
• Knee drop
• Ankle clonus

Question 5

How do you assess power of the lower legs?

Answer 5

• Up
• Down
• In
• Out
• Bend knee -> towards bottom
• Straighten leg

All above with resistance

Question 6

How do you assess sensation of the lower legs?

Answer 6

• Light touch
• Pin prick
• Vibration
• Propioception

Question 7

Which dermatomes do you check sensation on?

Answer 7

L2 
L3 
L4 
L5
S1
S2

Question 8

How do you assess propioception in lower limb?

Answer 8

Move the toe up and down and ask the patient where it is

Make sure the patient’s eyes are closed

Question 9

How many reflexes are there for lower limb?

Answer 9

3

• Knee jerk
• Ankle reflex
• Babinski reflex

Question 10

What examination would you offer after this exam?

Answer 10

Vascular examination