Neuro Exam and Basic Neuro Tips

Question 1

Upper extremity reflexes

Answer 1

Biceps C5

Brachioradialis C6

Triceps C7

Finger Flexor C8/T1

Question 2

Lower extremity reflexes

Answer 2

Patella L4

Ankle jerk S1

Question 3

Three types of hypertonia

Answer 3

• Rigidity (will always be DIFFUSE! as in Parkinson’s)
• Spasticity (elicited by leg drop or elbow jerk – upper motor neuron sign that will be FOCAL)
• Gegenhalten or Paratonia (a bit of spasticity and rigidity without discernible pattern – seen in frontal lobe disorders)

Question 4

The rules for a good motor exam

Answer 4

• Divide muscles into big muscles and small muscles
• Always support the small muscles at the joint and exert oppositional force juxta-artcicularly
• Large muscles do not need support and oppositional force is exerted 1/3 down the joint proximally
• Always ensure that the muscle is engaged prior to testing strength (myofibrils are aligned)

Question 5

What the Babinski truly indicates

Answer 5

Loss of spinal inhibition of the spread of an S1 signal (sensory dermatome of lateral plantar surface) to L5 (toe extensors)

Question 6

Way to remember S1 and S2 distributions

Answer 6

You stand on your S1, you sit on your ASS2

Question 7

Upper lower motor neuron pattern of weakness

Answer 7

“Decorticate” posture

Question 8

Lower motor neuron pattern of weakness

Answer 8

Question 9

Scanning speech

Answer 9

A type of ataxic dysarthria in which spoken words are broken up into separate syllables, often separated by a noticeable pause, and spoken with varying force

This is a sign of cerebellar dysfunction

Question 10

Neuro exam changes in aging

Answer 10

Loss of distal deep tendon reflexes can be a normal consequence of aging and does not require additional workup if no other neurologic signs/symptoms are present

Question 11

What does pronator drift suggest?

Answer 11

An upper motor neuron injury

Question 12

Overcorrection on “palms up” test

Answer 12

• Patients with cerebellar problems may have upward or aimless drift on the “palms up” test (cerebellar drift)
• If this is seen, overcorrection may be further tested for:
  
  • Tap on the patient’s arms and see if they overcorrect by shooting above the original position
  • If positive, this is highly suggestive of a cerebellar etiology

Question 13

Parietal drift on “palms up” test

Answer 13

A unilatreal upward, outward drift is specific for a contralateral parietal lesion