Upper Limb Neuro OSCE

Question 1

how to start exam?

Answer 1

introduce self, identify pt, explain and check for pain.
ask which hand is dominant

Question 2

what are you looking for on inspection?

Answer 2

posture, wasting, tremor, fasciculations, involuntary movements

Question 3

what is the first thing you assess?

Answer 3

Tone: move each joint passively- normal even or uneven resistance? spastisity, rigidity, hypertonia, hypotonia

Question 4

is spasticity or rigidity velocity dependent?

Answer 4

spasticity is velocity dependent.

Question 5

assessing power

Answer 5

pronator drift (umn lesion)

Question 6

assessing power: shoulders

Answer 6

flexion
extension
abduction- deltoid(c5, axillary)
adduction- lat dorsi, teres major, pec major (c6/7, thoracodorsal)

Question 7

assessing power: elbows

Answer 7

Flexion- biceps brachii, coroacobrachialis and brachialis (c5/6, musculocutaneous and radial)
extension- triceps brachii (c7, radial)
pronation
supination

Question 8

assessing power: wrist

Answer 8

extension- extensors of wrist (c6)
flexion- flexors of wrist (c6/7, median and ulnar)

Question 9

assessing power: fingers

Answer 9

extension- extensor digtorum (c7, radial nerve)
abduction- first doral interosseous, abductor digiti minimi (t1)

Question 10

assessing power: thumb

Answer 10

abduction- abductor pollicis brevis (t1)

Question 11

which reflexes are tested

Answer 11

biceps, triceps and supinator/ brachioradialis

Question 12

what can you ask pt to do if reflex isnt happening

Answer 12

clench teeth.

Question 13

how to assess coordination

Answer 13

finger to own nose (eyes closed)
finger to examiners finger back to nose (eyes open)
thumb to each fingertip rapidly
dysdiadochokinesis

Question 14

ways to assess sensation

Answer 14

cotton wool (light touch)
pin prick (pain)
vibration
temperature

Question 15

which tract is light touch identified by?

Answer 15

dorsal column and spinothalamic

Question 16

which tract is pain identified by?

Answer 16

spinothalamic

Question 17

which tract is vibration identified by?

Answer 17

dorsal column

Question 18

which tract is temperature identified by?

Answer 18

spinothalamic

Question 19

which dermatome is the deltoid innervated by?

Answer 19

c4

Question 20

which dermatome is the skin over the triceps and biceps innervated by?

Answer 20

c5

Question 21

which dermatome is the inner arm to thumb?

Answer 21

c6

Question 22

which dermatome is the palm and three fingers

Answer 22

c7

Question 23

which dermatome is the pinky finger up inner elbow?

Answer 23

c8

Question 24

which dermatome is the inner arm above elbow?

Answer 24

t1

Question 25

which nerves does the biceps reflex involve?

Answer 25

c5/6

Question 26

which nerves does the triceps reflex involve?

Answer 26

c7

Question 27

which nerves does the supinator reflex involve?

Answer 27

c5/6

Question 28

how can you test proprioception?

Answer 28

move thumb up and down with pt eyes closed and have them identify the position