Lower Limb Neuro Exam 2

Question 1

What myotome is assessed in hip flexion?

Answer 1

L1/2 iliofemoral nerve

Question 2

What muscle is assessed in hip flexion?

Answer 2

iliopsoas

Question 3

What myotome is assessed in hip extension?

Answer 3

L5/S1/S2 (inferior gluteal nerve)

Question 4

What muscle is assessed in hip extension?

Answer 4

gluteus maximus

Question 5

What myotome is assessed for knee flexion?

Answer 5

S1 (sciatic nerve)

Question 6

What muscle is assessed in knee flexion?

Answer 6

hamstrings

Question 7

What myotome is assessed in knee extension?

Answer 7

L3/4 (femoral nerve)

Question 8

What muscles are assessed in knee extension?

Answer 8

quadriceps

Question 9

What myotome is assessed in ankle dorsiflexion?

Answer 9

L4/5 (deep peroneal nerve)

Question 10

What muscle is assessed in ankle dorsiflexion?

Answer 10

tibialis anterior

Question 11

What myotome is assessed in ankle plantarflexion?

Answer 11

S1/2 (tibial nerve)

Question 12

What muscle is assessed in ankle plantarflexion?

Answer 12

gastrocnemius, soleus

Question 13

What myotome is assessed in big toe extension?

Answer 13

L5 (deep peroneal nerve)

Question 14

What muscle is assessed in big toe extension?

Answer 14

extensor hallucis longus

Question 15

What is the pattern of muscle weakness in upper motor neurone lesions?

Answer 15

1. cause a ‘pyramidal’ pattern of weakness that disproportionately affects lower limb flexors and upper limb extensors
2. lower limb flexors are weaker than extensors in a lower limb neurological assessment

Question 16

What is the pattern of muscle weakness in lower motor neuron lesions?

Answer 16

focal pattern of weakness, with only the muscles directly innervated by the damaged neurones affected

Question 17

What does MRC 0 mean?

Answer 17

no contraction

Question 18

What is MRC 1?

Answer 18

flicker or trace of contraction

Question 19

What is MRC 2?

Answer 19

active movement with gravity eliminated

Question 20

What is MRC 3?

Answer 20

active movement against gravity

Question 21

What is MRC 4?

Answer 21

active movement against gravity and resistance

Question 22

What is MRC 5?

Answer 22

normal power

Question 23

What does the knee-jerk reflex test?

Answer 23

L3, L4

Question 24

What does the ankle-jerk reflex test?

Answer 24

S1

Question 25

What does the plantar reflex test?

Answer 25

L5, S1

Question 26

What is hyperreflexia associated with?

Answer 26

upper motor neuron lesions due to the loss of inhibition from higher brain centres which normally exert a degree of suppression over the lower motor neuron reflex arc.

Question 27

What are examples of upper motor lesions?

Answer 27

stroke, spinal cord injury

Question 28

What is hyporeflexia assoicted with?

Answer 28

lower motor neuron lesions due to loss of the efferent and afferent branches of normal reflex arc

Question 29

What are examples of LMN lesions?

Answer 29

e.g. brachial plexus pathology or other peripheral nerve injuries

Question 30

What are reflexes like in cerebellar disease?

Answer 30

1. pendular 2. means less brisk and slower in their rise and fall 3. sign is subjective and often reflexes appear to be ‘normal’ in cerebellar disease

Question 31

What does light tough sensation involve?

Answer 31

dorsal column and spinothalamic tracts

Question 32

What does pin prick sensation involve?

Answer 32

spinothalamic tract

Question 33

What does vibration sensation involve?

Answer 33

dorsal columns

Question 34

What tuning fork is used?

Answer 34

128hz

Question 35

What joint is vibration placed?

Answer 35

place onto the interphalangeal joint of the patient’s big toe

Question 36

If they can't identify when vibration starts and stops which joints do you check?

Answer 36

metatarsophalangeal joint of the big toe → ankle joint → knee joint until the patient is able to accurately identify vibration

Question 37

What does proprioception involve?

Answer 37

dorsal columns

Question 38

What can dysmetria (incoordination) suggest?

Answer 38

ipsilateral cerebellar pathology

Question 39

What are UMN signs in inspection?

Answer 39

no fasciculation or significant wasting (there may however be some disuse atrophy or contractures)

Question 40

What are the LMN signs for inspection?

Answer 40

wasting and fasciculation of muscles

Question 41

What are the UMN signs for tone?

Answer 41

increased (spasticity or rigidity) +/- ankle clonus

Question 42

What are the LMN signs for tone?

Answer 42

decreased (hypotonia) or normal

Question 43

What are the UMN signs on power?

Answer 43

classically a “pyramidal” pattern of weakness (extensors weaker than flexors in arms, and vice versa in legs)

Question 44

What are the LMN signs on power?

Answer 44

different patterns of weakness, depending on the cause (e.g. classically a proximal weakness in muscle disease, a distal weakness in peripheral neuropathy)

Question 45

What are UMN signs for reflexes?

Answer 45

exaggerated or brisk (hyperreflexia)

Question 46

What are LMN signs for reflexes?

Answer 46

reduced or absent (hyporeflexia or areflexia)

Question 47

What are UMN signs on plantar reflexes?

Answer 47

Upgoing/extensor (Babinski positive)

Question 48

What are LMN signs for plantar reflexes?

Answer 48

normal (downgoing/flexor) or mute (i.e. no movement)