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OSCEs > Upper limb neuro > Flashcards

Upper limb neuro Flashcards

1
Q

How do you start the exam?

A 
Wash hands
Intro
Patient details
Consent
Exposure
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2
Q

What should you ask patient before beginning?

A

Any pain?

Which hand is dominant?

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3
Q

What do you look for on inspection?

A 
Posture
Wasting
Tremor
Fasciculations
Involuntary movements
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4
Q

What are the UMN lesion signs on inspection?

A

No fasciculation or wasting

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5
Q

What are the LMN lesion signs on inspection?

A

Wasting

Fasciculation

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6
Q

How do you assess tone?

A 
Hold patients hand and elbow
Move wrist
Pronate and supinate
Move elbow
Move shoulder
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7
Q

What are you assessing for in tone?

A

Smoothness
Ridigity
Spasticity
Flaccidness

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8
Q

What is the difference between rigidity and spasticity?

A

Spasticity is worse the quicker you move the limb

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9
Q

What does spasticity indicate?

A

UMN lesion

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10
Q

What does rigidity indicate?

A

Extrapyramidal lesion (parkinsonism)

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11
Q

What does flaccidness indicate?

A

LMN lesion

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12
Q

What is a sign specific to parkinsonism?

A

Cogwheeling (ratchet like stop start movements)

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13
Q

Describe the MRC grading system

A 
5 = full power
4 = reduced power resistance (- and +)
3 = movement against gravity
2 = movement with no gravity
1 = muscle flicker
0 = no muscle constraction
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14
Q

What action is myotome c5?

A

Bicep reflex

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15
Q

What action is myotome c6?

A

Bicep reflex

Supinator reflex

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16
Q

What action is myotome c7?

A

Tricep reflex

17
Q

How do you test for pronator drift?

A

Patient hold both arms out palms down with eyes closed.. look for pronator drift

18
Q

How do you test shoulder power?

A

Don’t let me push your shoulders down (C5)

Don’t let me pull your arms away (C6/7)

19
Q

How do you test for elbow power?

A

Don’t let me pull your arm away (C5/6)

Don’t let me push against your arm (C7)

20
Q

How do you test for forearm/wrist power?

A

Cock your wrists dont let me pull them down (C6)

Point your wrists down and dont let me pull them up (C6/7)

21
Q

How do you test for finger power?

A

Don’t let me push your straight fingers down (C7)

Don’t let me push your splayed fingers together (T1)

22
Q

How do you test thumb abduction?

A

Point your thumbs to ceiling and don’t let me push them down (C8/T1)

23
Q

What power sign shows an UMN lesion?

A

Pyramidal weakness (bent arms flexed legs)

24
Q

What power sign shows an LMN lesion?

A

Proximal weakness in muscle disease

Distal weakness in peripheral neuropathy

25
Q

How do you test peripheral nerve supply with the thumb

A

Palmar abduction (median)
Adduction (ulnar)
Opposition (median)

26
Q

What reflexes do you test?

A

Biceps
Tendons
Supinator

27
Q

What are the reflex signs for UMN lesion?

A

Brisk or exaggerated

28
Q

What are the reflex signs for a LMN lesion?

A

Reduced or absent

29
Q

How do you test for coordination?

A 
Finger to nose test (cerebellar pathology)
Dysdiadochokinesia (cerebellar ataxia)
Fine movement (fingers to thumb rapidly)
30
Q

Where do you test each dermatome?

A 
C5 - laterally in line with armpit
C6 - tip of the thumb
C7 - tip of first finger
C8 - tip of the little finger
T1 - medial elbow
31
Q

How do you test light touch?

A

Use cotton wool
Test on sternum
Compare left to right

32
Q

How do you test vibration sensation?

A

Ask patient to close eyes
Place 128hz tuning fork on sternum
Test on distal interphalangeal joint of forefinger

33
Q

How do you test proprioception?

A

Show them thumb moving up and down
Move thumb up or down and ask which
Move proximally if they can’t identify

34
Q

What do you state you would test?

A

Pin prick

Temperature

35
Q

What else do you test for sensation?

A

Cortical localisation
2 point discrimination
Graphaesthesia

36
Q

How do you test cortical localisation?

A

Place key or coin in hand with eyes close and ask to identify

37
Q

How do you test 2 point discrimination?

A

With calipers at a set distance on tip of finger

38
Q

How do you test for graphaesthesia?

A

Write number on palm with point (eyes closed)

39
Q

How do you finish the exam?

A

Thank patient
wash hands
present

OSCEs (13 decks)

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