Week 2- Upper Quarter Screening Examination

Question 1

How to test CN I

Answer 1

Assess ability to smell common scents

Question 2

How to test CN II

Answer 2

Have patient read an eye chart

Question 3

How to test CN III

Answer 3

Assess pupil constriction as a reaction to light

Question 4

How to test CN IV

Answer 4

Ask patient to follow finger moving downward and inward

Question 5

How to test CN V

Answer 5

• Test sensation of face and cheeks as well as corneal reflex
• Clench teeth

Question 6

How to test CN VI

Answer 6

Ask patient to follow finger moving away from midline

Question 7

How to test CN VII

Answer 7

• Assess symmetry and smoothness of facial expression

- Test taste on anterior 2/3 of tongue

Question 8

How to test CN VIII

Answer 8

• Rub fingers by each ear (should hear both equally)

- Balance test

Question 9

How to test CN IX

Answer 9

Assess gag reflex and taste on posterior tongue

Question 10

How to test CN X

Answer 10

Ask patient to say “ah” and watch for elevation of soft palate

Question 11

How to test CN XI

Answer 11

Muscle test trapezius

Question 12

How to test CN XII

Answer 12

• Ask patient to stick tongue out

- Tongue will deviate toward injured side

Question 13

Arteries used in vascular screen

Answer 13

• Carotid
• Brachial
• Radial

Question 14

Clearing tests for shoulder

Answer 14

• Hand behind back (w/ overpressure)

- Hand behind head (w/ overpressure)

Question 15

Clearing tests for neck

Answer 15

• Flexion
• Extension
• Sidebending
• Observe eyes
• Rotation
• Quadrant (combined)
• ALL WITH OR WITHOUT OVERPRESSURE

Question 16

Purpose of upper rib cage clearing tests

Answer 16

Test for presence of 1st rib hypomobility in patients with brachialgia

Question 17

Describe the upper rib cage clearing test

Answer 17

• Cervical Rotation-Latereal Flexion (CRLF) test is performed sitting
• C-spine is passively and maximally rotated away from the side being tested
• While in this position, spine is gently flexed, moving the ear toward the test

Question 18

What is a positive upper rib cage clearing test?

Answer 18

Lateral flexion movement is blocked

Question 19

Thoracic region clearing tests

Answer 19

• Flexion
• Extension
• Rotation
• Sidebending
• WITH OR WITHOUT OVERPRESSURE

Question 20

When is a upper quarter neuro screen required?

Answer 20

For patients who:

• Exhibit upper quarter pain w/ symptoms extending into the scapula or upper extremity past acromion
• Patient w/ upper quarter symptoms of questionable origin

Question 21

Upper quarter myotomes

Answer 21

• Cervical flexion or rotation: C1
• Cervical extension: C2
• Cervical lateral flexion: C3
• Shoulder shrug: C4
• Shoulder abduction; *elbow flexion: C5
• Elbow flexion; *Wrist extension: C6
• Elbow extension: C7
• Thumb extension or finger flexors; *Long Finger flexion: C8
• Finger abduction; *5th digit abduction: T1

Question 22

Upper quarter dermatomes

Answer 22

• C2: Occiput
• C3: Lateral neck
• C4: Shoulder
• C5: Lateral epicondyle
• C6: Dorsum of thumb
• C7: Dorsum of middle finger
• C8: Dorsum of pinky
• T1: Medial epicondyle

Question 23

Upper quarter DTRs

Answer 23

• Biceps
• Brachioradialis
• Triceps

Question 24

Biceps reflex

Answer 24

• C5

- Musculocutaneous n.

Question 25

Brachioradialis reflex

Answer 25

• C6

- Radial n.

Question 26

Triceps reflex

Answer 26

• C7

- Radial n.

Question 27

Grading for reflexes

Answer 27

• 4+ : Very brisk response; associated w/ clonus
• 3+ : Brisk response; possibly hyperreflexive
• 2+ : Normal, average response
• 1+ : Low, normal response
• 0 : No response
• 1+(R) : Absent response which appears with reinforcement
• 0(R): No response even with reinforcement

Question 28

Upper motor neuron signs

Answer 28

2/3:

• • Babinski sign
• • Hoffman’s reflex
• • IVS