PNS

Question 1

Testing gait

Answer 1

Normal
Tandem- tight rope

Question 2

Testing coordination

Answer 2

Finger to nose
Romberg’s sign/pronator drift- feet together, arms in front. Close eyes for 30s, looking for wobbling and pronation of hands
Heel/shin test- second stage, rub heel on shin
Dysdiadochokinesis- clap whilst turning hand. Diadochokinetic- ability to turn hand

Question 3

Gait

Answer 3

• Waddling- developmental dysplasia
• Spastic- cerebral palsy, MS
• Shuffling- PD
• Steppage- spinal injury, PD, MS
• Scissor- MS, cerebral palsy

Question 4

Assessing tone

Answer 4

1. Wrist- flex/ext
2. Elbow- flex/ext
3. Shoulder- abd/add
4. Hips- roll
5. Knee- flexion

Question 5

Clonus

Answer 5

Rhythmic oscillating stretch reflex, related to upper motor neuron lesion, dorsi foot quickly to elicit a response

Question 6

Myotome grades

Answer 6

• No visible contraction- 0
• Flicker but no movement- 1
• Jt movement when gravity eliminated- 2
• Movement against gravity- 3
• Movement against resistance but weaker than normal- 4
• Normal power- 5

Question 7

Upper myotome tests

Answer 7

• C1- pressure to forehead, pushing forward
• C2- against back of head, trying to push backward
• C3- unilateral SB- resist
• C4- trap shrug
• C5- bring arms out and push down
• C6- elbow extension
  C7- elbow flexion
• C8- thumb ext
• T1- finger add/abdthumb ext

Question 8

Lower myotomes

Answer 8

Supine
L2- knee to hand- flex
L3- knee under leg, trying to get them to extend
L4- dorsi flex and invert, resisting pulling foot back to normal
L5- bring toes up- trying to pull hallux down
S1- plantar flex
S2- heel to bum

Question 9

Deep tendon reflex grading

Answer 9

• Absent- 0
• Hyporeflexia- 1
• Normal- 2
• Hyperreflexia- 3
• Brisk/clonus- 4

Question 10

Upper reflexes

Answer 10

C5- find bicep tendon (resist bicep curl), place thumb over, hit. +ve- flinch of wrist
C6- supinator
C7- triceps- hang arm, tap over tendon

Question 11

Lower reflexes

Answer 11

L4- hit patella tendon (can be seated, or resting leg on your leg whilst prone)
S1- Achilles, PF (bring leg into FADIR ish shape, dorsiflex foot)

Question 12

Babisnki

Answer 12

Carve medial foot, apply reasonable pressure

Question 13

Dermatomes

Answer 13

• Ability to recognise touch- dorsal column
• Sense P- spinal thalamic- feel it? differentiate it?
• Close eyes
• Follow dermatome map
  Dorsal- cotton wool- touch
  Spinothalamic- pain- soft/sharp

Question 14

Vibration and Jt position sense- dorsal column

Answer 14

• Hallux
• Medial malleoli
• Tibial tuberosity
• Patella
• ASIS
• Thumb/index IP
• Radial styloid
• Olecranon
• Acromion
• Diabetics lack sensation as it affects the dorsal column

Question 15

Proprioception

Answer 15

• Close eyes
• Dorsi or plantar flex hallux, ask Px which movement is being performed

Question 16

Meningeal irritation test

Answer 16

• Triad- fever, rigidity, headaches
• L’Hermittes- flex head whilst supine
• Brudzinski’s sign- hips will flex whilst head is flexed (+ve)
• Kernig’s- flex knee + hip to 90, straighten, +ve spinal P

Question 17

Hypogeusia

Answer 17

Loss of taste