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CPA Exam > Upper and Lower Limb Exam > Flashcards

Upper and Lower Limb Exam Flashcards

1
Q

Define muscle tone

A

The amount of tension in a muscle

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2
Q

What are muscles in a constant state of?

A

Partial contraction

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3
Q

Why do muscles give a constant tone at rest?

A

This is because muscles are in a constant state of partial contraction

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4
Q

What will a patient experience if they have a lower motor neurone lesion?

A

Hypotonia

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5
Q

What are the lower motor neurons of the spinal segmental neurons influenced by?

A

Impulses from the cerebral cortex, midbrain, pons and medulla

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6
Q

What is a lower motor neuron lesion?

A

A breach/disruption in the spinal segmental reflex arc

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7
Q

What are supra-spinal neurons called?

A

Upper Motor Neurons

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8
Q

What is the effect of impulses from upper motor neurons on lower motor neurons?

A

The impulses from the upper motor neurons have an inhibitory effect on the lower motor neurons

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9
Q

What happens if the higher cerebral control is disrupted, as in an UMN lesion/problem?

A

The inhibition is lost and the muscle tone is exaggerated you will experience hypertonia (sometimes spasticity).

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10
Q

What should you always ask about in assessing the tone?

[3]

A

Ask about any pain in the shoulder, elbow or wrist

Ask the patient to relax “go floppy”, and test for tone at the relevant joints, remember to compare Left vs Right each time.

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11
Q

What scale is used for noting the strength/power?

A

A numerical scale used - Medical Research Council (MRC) Muscle Power scale.

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12
Q

What is the MRC Muscle Power Scale for muscle strength? (0/5)

A

No movement

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13
Q

What is the MRC Muscle Power Scale for muscle strength? (1/5)

A

Barest flicker of movement of the muscle, though not enough to move the structure to which it’s attached

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14
Q

What is the MRC Muscle Power Scale for muscle strength? (2/5)

A

Voluntary movement which is not sufficient to overcome the force of gravity. For example, the patient would be able to slide their hand across a table but not lift it from the surface.

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15
Q

What is the MRC Muscle Power Scale for muscle strength? (3/5)

A

Voluntary movement capable of overcoming gravity, but not any applied resistance. For example, the patient could raise their hand off a table, but not if any additional resistance were applied.

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16
Q

What is the MRC Muscle Power Scale for muscle strength? (4/5)

A

Voluntary movement capable of overcoming “some” resistance

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17
Q

What is the MRC Muscle Power Scale for muscle strength? (5/5)

A

Normal strength

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18
Q

’+’ and ‘-‘ can be used indicate what in the MRC Muscle Power scale?

A

More subtle descriptions of power (e.g., 4+ or 4- , 3+ or 3-, etc.) For instance if a patient can overcome “moderate but not full resistance”, it might be graded as 4+

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19
Q

How do you assess for power?

A

To assess for power you will ask your colleague to perform each movement at these joints in turn. You (as examiner) will resist the movement by applying an opposing force and estimate the power of the contracting muscle/s. You will also need to isolate and stabilize the joint to accurately measure the power, for instance when testing ankle dorsiflexion you free hand will be stabilizing the leg at the malleoli.

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20
Q

Define a reflex

A

A reflex is an involuntary response to a stimulus.

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21
Q

What does a reflex depend on?

A

This depends on the integrity of the reflex arc

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22
Q

What does a reflex pathway typically consist of?

A

afferent (sensory) neurones conveying impulses from sensory receptors in the muscle spindle to the spinal cord (CNS)
efferent (motor) neurones running from the anterior grey columns of the spinal cord (CNS) to the effector organ which is the limb muscle.

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23
Q

What are the 2 types of reflex arc?

A

The reflex arc may be monosynaptic or multi synaptic

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24
Q

What are most myotonic reflex arcs?

A

Monosynaptic

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25
Q

What happens when the tendon of a muscle is tapped with a tendon hammer?

A

It causes stretching of the muscle spindles. This stimulus travels to the spinal cord, which then stimulates the efferent motor neurons in the anterior grey columns (horns). This results in involuntary contraction of the main muscle whose tendon was stretched by tapping.

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26
Q

What can you do in order to help elicit reflexes from completely normal individuals?

A

Apply “reinforcement” to those individuals. For example, you will ask the patient either clench the teeth or squeeze an object in the contralateral (other) hand while you directly test the reflex on the limb to be tested.

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27
Q

What should always be done with regard to reflexes in order to increase the relevance of findings?

A

The reflexes should ALWAYS be compared on both sides, left and right, as a difference comparatively may increase the relevance of the finding.

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28
Q

What does the reflex arc in the spinal cord play an important role in?

A

Maintaining muscle tone

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29
Q

What is muscle tone needed for?

A

Maintaining normal body posture

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30
Q

What is the law of reciprocal innervation on reflex skeletal muscle activity?

A

In the same limb the flexor and extensor muscles cannot contract simultaneously.

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31
Q

What is the implication of the law of reciprocal innervation on afferent nerves responsible for flexor reflex muscle action?

A

The afferent nerves responsible for flexor reflex muscle action must have branches to synapse with the extensor motor neurons of the same limb to inhibit the extensor muscle contraction.

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32
Q

What do abnormally exaggerated myotonic reflexes lead to a clinical picture of?

A

An upper motor neurone lesion

33
Q

What happens if there is disorder in any of the components of the reflex arc (muscle spindles, afferent sensory neurones, efferent motor neurones and the effector organs - the muscle itself)?

A

There will be complete absence (areflexia) of reflexes

34
Q

What is areflexia suggestive of?

A

A lower motor neurone lesion

35
Q

How do you test for a reflex?

A

To test for a reflex you will need to ensure that the relevant limb is completely relaxed, you will then attempt to elicit the reflex by tapping the relevant tendon with a tendon hammer.

36
Q

Define a dermatome

A

An area of skin supplied by a single spinal nerve root of the spinal cord segment

37
Q

Define a myotome

A

A region of skeletal muscle supplied by a single spinal nerve root of the spinal cord segment

38
Q

What do adjacent dermatomes on the skin e.g. C4, C5 and C6 do considerably?

A

Overlap

39
Q

What is the implication of the overlap of adjacent dermatomes?

A

Loss of a single spinal nerve root may not produce any detectable sensory loss in that dermatome.

40
Q

How many dermatomes must be affected in order to detect a significant sensory loss?

A

At least 3 adjacent dermatomes should be affected

41
Q

Where across the limb is there no overlap?

A

Across the axial lines of the limb e.g. C4 and T2 or C5 and T1

42
Q

What do peripheral nerves carry?

A

Peripheral nerves carry nerve components from several spinal segments (or roots) to muscles and skin areas.

43
Q

Why may damage to a peripheral nerve result in a wide ranging effects on more than one dermatomal area or myotomes?

A

Since peripheral nerves carry nerve components from several spinal segments (or roots) to muscles and skin areas.

44
Q

What is used to elicit light touch sensation on the upper limb dermatomal areas?

A

A wisp of cotton wool

45
Q

What is the first stage of an examination of sensation?

A

You will first demonstrate light touch with a wisp of cotton wool to your colleague by touching normal area of skin, just above the clavicle or over sternum.

46
Q

What is the second stage of an examination of sensation?

A

Then ask your colleague to close the eyes while you examine individual dermatomal areas methodically, and find out whether they could feel the touch sensation as normal, dull or none at all.

47
Q

What is the third stage of an examination of sensation?

A

Repeat the test on the opposite limb and compare.

48
Q

Which upper limb region corresponds to dermatome C4

A

Shoulder

49
Q

Which upper limb region corresponds to dermatome C5

A

Lateral side of arm

50
Q

Which upper limb region corresponds to dermatome C6

A

Lateral side of forearm and thumb

51
Q

Which upper limb region corresponds to dermatome C7

A

Middle and ring finger

52
Q

Which upper limb region corresponds to dermatome C8

A

Medial side of hand, forearm and little finger

53
Q

Which upper limb region corresponds to dermatome T1

A

Medial side of forearm and arm

54
Q

Which upper limb region corresponds to dermatome T2

A

Axilla

55
Q

Which dermatomal segments correspond to the musculocutaneous nerve?

A

C5, 6 & 7

56
Q

Which dermatomal segments correspond to the median nerve?

A

C5-8, T1

57
Q

Which dermatomal segments correspond to the radial nerve?

A

C5-8, T1

58
Q

Which dermatomal segments correspond to the ulnar nerve?

A

C(7)8, T1

59
Q

Which lower limb region corresponds to dermatome L1

A

Area over inguinal ligament

60
Q

Which lower limb region corresponds to dermatome L2

A

Lateral side of thigh

61
Q

Which lower limb region corresponds to dermatome L3

A

Lower medial side of thigh

62
Q

Which lower limb region corresponds to dermatome L4

A

Medial side of leg, medial foot and great toe

63
Q

Which lower limb region corresponds to dermatome L5

A

Lateral side of leg, mid dorsum of foot and middle three toes

64
Q

Which lower limb region corresponds to dermatome S1

A

Little toe, lateral fool and sole foot print area (where you stand)

65
Q

Which lower limb region corresponds to dermatome S2

A

Back of upper leg and whole thigh

66
Q

Which lower limb region corresponds to dermatome S3

A

Area over gluteal fold (where you sit)

67
Q

Which dermatomal segments correspond to the posterior rami (over the buttock region)?

A

L1-L3 & S1-S3

68
Q

Which dermatomal segments correspond to the obturator nerve?

A

L2, L3, L4

69
Q

Which dermatomal segments correspond to the femoral nerve?

A

L2, L3, L4

70
Q

Which dermatomal segments correspond to the common fibular (part of sciatic nerve)?

A

L4, L5, S1, S2

71
Q

Which dermatomal segments correspond to the tibial (part of sciatic nerve)?

A

L4, L5, S1, S2, S3

72
Q

Which of the following signs would point towards a upper motor neuron lesion?


Hypotonia
Hyperreflexia
Fasciculations
Muscle atrophy

A

Hyperreflexia

73
Q

Which dermatome is tested on the medial aspect of the leg?

L2
L3
L4
L5

A

L4

74
Q

Which nerve root is tested in the suprinator reflex?

C6
C7
C8
T1
T2
A

C6

75
Q

In which joint do you check for clonus?

Wrist
Elbow
Hip
Knee
Ankle
A

Ankle

76
Q

Which nerve is responsible for finger extension?

Auxillary
Musculocutaneous
Radial
Ulnar
Median
A

Radial

77
Q

Which nerve roots are tested in the biceps reflex?

A

C5 & C6

78
Q

Which nerve roots are tested in the triceps reflex?

A

C7 & C8

CPA Exam (6 decks)

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