Upper neuro exam

Question 1

What is chorea?

Answer 1

brief irregular movements that are not repetitive or rhythmic

often in patients with Huntington’s disease

Question 2

What is opthalmoplegia?

Answer 2

wide range of neurological disorders

e.g. MS and myasthenia gravis

Question 3

What is pronator drift?

What does the outcome mean?

Answer 3

assesses mild upper limb weakness and spasticity

1. hold arms out in front with palms upwards
   look for signs of pronation
2. no pronation, ask patients to close their eyes and observe again

Interpretation=
pronation with(out) downward movement= pronator drift= contralateral pyramidal tract lesion
(UMN lesion= supinator muscles in forearm are weak)

Question 4

How do you test for tone in muscle groups?

Answer 4

support arm

relax patient and fully control their movement (elbow= flexion and extension, shoulder and wrist= circumduction)

feel for:
-spasticity, rigidity, cogwheeling, hypotonia

Question 5

Spasticity vs rigidity?

Answer 5

spasticity= pyramidal tract lesions (stroke)
(faster move limb= worse + linked weakness)

rigidity= extrapyramidal tract lesions (parkinson’s disease)
(same feeling if move limb rapidly or slowly- velocity independent)

**both increased tone

Question 6

What type of rigidity is linked to parkinson’s disease?

Answer 6

cogwheel

tremor superimposed on hypertonia, resulting in intermittent increases in tone during movement of limb

Question 7

What is lead pipe rigidity? What is it associated with?

Answer 7

increased tone throughout the movement of the muscle

linked to: neuroleptic malignant syndrome

Question 8

Shoulder abduction test

Answer 8

C5

flex elbow and abduct shoulders to 90˚
apply downward resistance on lateral side of upper arm

Question 9

Shoulder adduction test

Answer 9

C6/7

adduct shoulder to 45˚ bringing elbows closer to body
apply upward resistance on medial side of upper arm

Question 10

Elbow flexion test

Answer 10

C5/6

flex elbow
apply resistance by pulling the forearm whilst stabilising shoulder joint

Question 11

Elbow extension test

Answer 11

C7

elbow flexed
apply resistance by pushing the forearm towards patient + stabilise shoulder joint

Question 12

Wrist extension test

Answer 12

C6

hold arm out in front of them with their palms facing downwards
make a fist and extend their wrist joints, keep their wrists in this position whilst apply resistance

Question 13

Wrist flexion test

Answer 13

C6/7

patient still holding arms out in front of them
flex their wrist joints and keep position whilst you apply resistance

Question 14

Finger extension test

Answer 14

C7

hold fingers out straight whilst you apply downwards resistance

Question 15

Finger abduction test

Answer 15

T1

abduct fingers against resistance

Question 16

Thumb abduction test

Answer 16

T1

patient to turn their hand over so their palm is facing upwards and to position their thumb over midline of palm
apply downward resistance with own thumb

Question 17

patterns of muscle weakness

UMN vs LMN

Answer 17

UMN:
pyramidal pattern of weakness disproportionately affects upper limb extensors and lower limb flexors

LMN:
focal pattern of weakness, only muscles directly innervated damaged neurone affected

Question 18

MRC muscle power assessment scale:

Answer 18

0- no contraction
1- flicker or trace of contraction
2- active movement, with gravity eliminated
3- active movement against gravity
4- active movement against gravity and resistance
5- normal power

Question 19

1. biceps reflex C5/6
2. supinator reflex C5/6
3. triceps reflex C7

Answer 19

1. thumb of non-dominant hand over tendon and then tap thumb with tendon hammer
2. locate brachioradialis reflex (4 inches proximal to base thumb) tap with tendon hammer
3. relax triceps tendon, 90˚ flexion on their lap/support patient’s forearm
   (triceps tendon= superior to olecranon process of ulna, tap with hammer)

Question 20

hyperreflexia vs hyporeflexia

Answer 20

hyperreflexia:
UMN lesions

hyporeflexia:
LMN lesions

pendular (less brisk and slower in their rise and fall):
cerebellar disease

Question 21

How to examine sensation?

Answer 21

1. check one modality from dorsal columns and spinothalamic tracts
2. eyes closed for assessment
3. normal sensation on patient’s sternum
4. upper limb dermatomes compare L and R

Question 22

Arm dermatomes?

C5-T1

Answer 22

C5: lateral aspect of lower edge of deltoid muscle
C6: palmar side of the thumb
C7: palmar side of middle finger
C8: palmar side of little finger
T1: medial aspect antecubital fossa (proximal to medial epicondyle of humerus)

Question 23

Types of sensation tests

Answer 23

light touch sensation
(DCML and spinothalamic tracts)

pin-prick sensation
(spinothalamic tracts)

vibration sensation
(DCML)
-use tuning fork

Question 24

What do you examine after sensation?

Answer 24

proprioception

at interphalangeal joint of thumb

Question 25

How to these present:

• mononeuropathies
• peripheral neuropathy
• radiculopathy
• spinal cord damage
• thalamic lesions
• myopathies

Answer 25

• localised sensory disturbance in area
• symmetrical sensory deficits glove and stocking distribution in peripheral limbs
• nerve root damage= sensory disturbances associated dermatomes
• sensory loss at and below
• contralateral sensory loss
• symmetrical proximal muscle weakness

Question 26

What does finger to nose test tell us?

Answer 26

cerebellar pathology:

1. dysmetria: lack of coordination of movement. Clinically this results in the patient missing the target by over/undershooting
2. intention tremor: a broad, coarse, low-frequency tremor that develops as a limb reaches the endpoint of a deliberate movement. =tremor that becomes apparent as the patient’s finger approaches yours. Be careful not to mistake an action tremor (which occurs throughout the movement) for an intention tremor

(both present= ipsilateral cerebellar pathology)

Question 27

What is dysdiadochokinesia?

Answer 27

inability to perform rapid, alternating movements

feature of ipsilateral cerebellar pathology

(cerebellar ataxia if movements appear slow and irregular)