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Z Year3 Clinical Examinations > Upper Limb Neuro Exam > Flashcards

Upper Limb Neuro Exam Flashcards

1
Q

What are you looking for on general inspection?

A
  1. scars
  2. wasting of muscles
  3. tremor
  4. fasciculations
  5. pseudoathetosis
  6. chorea
  7. myoclonus
  8. tardive dyskinesia
  9. hypomimia
  10. ptosis and frontal balding
  11. Opthalmoplegia
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2
Q

What scars are you looking for?

A

previous spinal, axillary or upper limb surgery

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3
Q

What would wasting of muscles suggest?

A

LMN lesions or disuse atrophy

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4
Q

What are fasciculations?

A

small, local, involuntary muscle contraction and relaxation which may be visible under the skin

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5
Q

What are fasciculations associated with?

A

lower motor neuron pathology (e.g. amyotrophic lateral sclerosis)

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6
Q

What is pseudoathetosis?

A

abnormal writhing movements (typically affecting the fingers) caused by a failure of proprioception

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7
Q

What is chorea?

A

brief, semi-directed, irregular movements that are not repetitive or rhythmic but appear to flow from one muscle to the next

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8
Q

When may chorea usually be present?

A

Huntington’s disease

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9
Q

What is myoclonus?

A

brief, involuntary, irregular twitching of a muscle or group of muscles

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10
Q

What is persistent widespread myoclonus associated with?

A

several specific forms of epilepsy (e.g. juvenile myoclonic epilepsy)

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11
Q

What is tardive dyskineasia?

A

involuntary, repetitive body movements which can include protrusion of the tongue, lip-smacking and grimacing

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12
Q

When might people experience tardive dyskineasia?

A

secondary to treatment with neuroleptic medications including antipsychotics and antiemetics

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13
Q

What is hypomimia?

A

reduced degree of facial expression

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14
Q

What is hypomimia associated with?

A

Parkinson’s disease

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15
Q

What is ptosis and frontal balding associated with?

A

myotonic dystrophy

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16
Q

What is ophthalmoplegia?

A

weakness or paralysis of one or more extraocular muscles responsible for eye movements

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17
Q

What can opthalmoplegia be caused by?

A

lots esp multiple sclerosis and myasthenia gravis

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18
Q

What objects do you look for around the bed?

A
  1. walking aids

2. prescription

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19
Q

What would pronator drift indicate?

A

contralateral pyramidal tract lesion

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20
Q

What is spasticity associated with?

A

pyramidal tract lesions (e.g. stroke)

21
Q

What is rigidity associated with?

A

extrapyramidal tract lesions (e.g. Parkinson’s disease)

22
Q

What does spasticity and rigidity both involve?

A

increased tone

23
Q

What is the difference between spasticity and rigidity?

A

s is velocity dependent so faster move limb worse it is and r is velocity independent

24
Q

What are two main subtypes of rigidity?

A
  1. Cogwheel rigidity (parkinson’s)

2. lead pipe rigidity (neuroleptic malignant syndrome)

25
Q

What myotome and muscle is assessed in shoulder abduction?

A
  1. C5 (axillary nerve)

2. Deltoid and other should abductors

26
Q

What myotome and muscles assessed in shoulder adduction?

A
  1. C6/7 (thoracodorsal nerve)

2. Teres major, latissimus dorsi and pectroalis major

27
Q

What myotome and muscles are assessed in elbow flexion?

A
  1. C5/6 (musculocutaenous and radial nerve)

2. Biceps brachii, coracobrachialis and brachialis

28
Q

What myotome and muscle is assessed in elbow extension?

A
  1. C7 (radial nerve)

2. Triceps brachii

29
Q

What myotome and muscle is assessed in wrist extension?

A
  1. C6 (radial nerve)

2. Extensors of the wrist

30
Q

What myotome and muscle is assessed in wrist flexion?

A
  1. C6/C7 (median nerve)

2. Flexors of the wrist

31
Q

What myotome and muscles are assessed in finger extension?

A
  1. C7 (radial nerve)

2. Extensor digitorum

32
Q

What myotome and muscle is assessed in finger abduction?

A
  1. T1 (ulnar nerve)

2. First dorsal interosseus and abductor digiti minimi

33
Q

What myotome and muscle is assessed in thumb abduction?

A
  1. T1 (median nerve)

2. Abductor pollicis brevis

34
Q

What is the pattern of muscle weakness like in UMN lesions?

A
  1. ‘pyramidal’ pattern of weakness that disproportionately affects upper limb extensors and lower limb flexors
  2. upper limb extensors are weaker than flexors in an upper limb neurological assessment
35
Q

What is the pattern of weakness in LMN lesions?

A

focal pattern of weakness, with only the muscles directly innervated by the damaged neurones affected

36
Q

What is the reinforcement manoeurve?

A

asking the patient to clench their teeth together whilst you simultaneously tap the tendon (if reflex absent)

37
Q

What does the biceps reflex test?

A

C5/C6

38
Q

What does the supinator (brachioradialis) reflex test?

A

C5/C6

39
Q

What does the triceps reflex test?

A

C7

40
Q

What does hyperreflexia usually result from?

A

UMN lesion

41
Q

What is hyporeflexia usually associated with?

A

LMN lesions

42
Q

What are reflexes like in cerebellar disease?

A
  1. ‘pendular’

2. Less brisk and slower in their rise and fall

43
Q

What does light touch sensation test?

A
  1. dorsal columns

2. spinothalamic tracts

44
Q

What does pin prick (pain) sensation test?

A

spinothalamic tracts

45
Q

What do you do if loss of sensation is notes distally?

A

test for “glove” distribution of sensory loss (associated with peripheral neuropathy) by moving distal to proximal

46
Q

What does vibration sensation test?

A

dorsal columns

47
Q

What does proprioception test?

A

dorsal column

48
Q

What are the different patterns of sensory loss?

A
  1. mononeuropathies
  2. peripheral neuropathy
  3. radiculopathy
  4. spinal cord damage
  5. thalamic lesions
  6. myopathies

Z Year3 Clinical Examinations (33 decks)

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