Nervous System examination

Question 1

what is an upper motor neuron lesion

Answer 1

between brain and the spinal cord

causes weakness, disuse atrophy

no fasciculation

hyper reflexia

hypertonia

Question 2

what is a lower motor neuron lesion

Answer 2

between the ventral horn to periphery

causes weakness and atrophy

causes fasciculations

causes hyporeflexia

causes hypotonia

Question 3

how do you assess gait and coordination

Answer 3

look at stance

test Gait by walking

Tandem Gait

Romberg sign

pronator drift

finger nose test

heel and shin test

Question 4

how to assess tone

Answer 4

flex and extend wrist

flex and extend elbow

shoulder abduction and adduction

hip role

knee flexion

clonus

Question 5

assess upper myotomes

Answer 5

C1-2- flex and extend head against resistance
C3-4 side bend head against resistance
C4 - shrug shoulder against resistance
C5 - arms out - abduct and adduct
C6 - bicep curl and tricep exted
C7 - wrist flexion and extension
C8 - put fingers in between patients fingers, ask them to squeeze
T1 - thumb extension

Question 6

assess lower myotomes

Answer 6

L2-3 hip flexion
L4-5 Hip extension
L3-4 Knee extension (kick the door)
L5-S1 Knee flexion (heel to bum)
L4-5 Dorsi flex foot
S1-2 Plantar flex foot
L5-S1 inversion
L4 eversion

Question 7

deep tendon reflexes

Answer 7

C5 - biceps distal tendon
C7 - Triceps tendon
C6 - brachioradialis
L4 patella tendon
S1 achilles or plantar fascia

Question 8

superficial reflexes

Answer 8

umbilical - patella hammer away from corners of belly button - should shy away or unphased
Babibski - run hammer down outside foot and down medial line - toes should flex

Question 9

dermatomes

Answer 9

test by soft sharp - work down dermatomes path

Question 10

vibration and joint position sense

Answer 10

can you feel vibrations:
on toes
medial malleolus
tibial tuberosity
ASIS
tip of forefinger
radial styloid
olecranon
acromion

Question 11

vibration and joint position sense

Answer 11

can you feel vibrations:
on toes
medial malleolus
tibial tuberosity
ASIS
tip of forefinger
radial styloid
olecranon
acromion

Question 12

meningeal irritation testing

Answer 12

L’hermitte - bring head to flexion
Kernigs - Hip flexed, knee at 90, extend knee, look for diffused pain

brudzinski - hip flexing in L’hermitte test is brudzinski sign