Lower Limb Examination

Question 1

What are the steps in lower limb examination?

Answer 1

1. General observation
2. Assess gait
3. Inspection
4. Tone
5. Power
6. Reflexes
7. Coordination
8. Sensation

Question 2

What should be looked for on general examination in lower limb examination?

Answer 2

Clues such as wheelchair, orthoses or splints, helmet, or dysmorphic features

Question 3

What should you inspect in lower limb examination?

Answer 3

Legs and spine

Question 4

In what position should you inspect a child in lower limb examination?

Answer 4

Child lying on the bed

Question 5

What should you look for on inspection in lower limb examination?

Answer 5

• Posture
• Contractures
• Muscle bulk, wasting, and (pseudo)hypertrophy
• Involuntary muscles and fasciculations
• Scars

Question 6

How should you assess tone in lower limb examination?

Answer 6

• Roll legs from side to side, taking note of movement of foot at the ankle
• Place palmar surfaces of both your hands under the childs thighs and lift them slightly off the bed, then let them fall
• Flex and extend at the hip, knee, and ankle joints
• Asses for clonus

Question 7

How should you assess for clonus?

Answer 7

Rapidly dorsiflexing the foot

Question 8

What is considered abnormal regarding clonus?

Answer 8

More than 3 beats

Question 9

What nerves provide hip flexion?

Answer 9

L1 and 2

Question 10

What nerves provide hip extension?

Answer 10

L5 and S1

Question 11

What nerves provide ankle dorsiflexion?

Answer 11

L4

Question 12

What nerves provide ankle plantar flexion?

Answer 12

S1 and 2

Question 13

What reflexes should be tested in lower limb examination?

Answer 13

• Knee
• Ankle
• Plantar

Question 14

What nerves are responsible for knee reflex?

Answer 14

L3 and 4

Question 15

What nerves are responsible for ankle reflex?

Answer 15

S1 and 2

Question 16

What is an abnormal plantar (Babinski) reflex?

Answer 16

The great toe going up and therefore the toes to be splayed

Question 17

How is the Babinski reflex elicited?

Answer 17

Stroking lateral aspect of the sole of the foot and medially across the ball of the foot

Question 18

When is a positive Babinski a normal finding?

Answer 18

In infants

Question 19

How should you test co-ordination in lower limb examination?

Answer 19

Heel-shin test (ask to run heel of one foot down the shin of the other)

Question 20

What modalities need to be tested when testing sensation?

Answer 20

• Light touch
• Vibration
• Joint proprioception

Question 21

What dermatome does L1 supply?

Answer 21

Upper outer thigh

Question 22

What dermatome does L2 supply?

Answer 22

Middle anterior thigh

Question 23

What dermatome does L3 supply?

Answer 23

Anterior knee

Question 24

What dermatome does L4 supply?

Answer 24

Medial calf

Question 25

What dermatome does L5 supply?

Answer 25

Lateral calf

Question 26

What dermatome does S1 supply?

Answer 26

Sole of the foot

Question 27

What dermatome does S2 supply?

Answer 27

Strip up posterior calf and thigh