Neuro

Question 1

LMN signs?

Answer 1

Wasting / fasciculation
Hypotonia
Weakness
Reduced reflexes

Question 2

UMN signs?

Answer 2

Increased tone
Spasticity
Weakness
Brisk reflexes / upgoing planter reflex

Question 3

Hip flexion - which myotome?

Answer 3

L2/L3

Question 4

Hip extension - which myotome?

Answer 4

L4/L5

Question 5

Knee extension - which myotome?

Answer 5

L3/L4

Question 6

Knee flexion - Which myotome?

Answer 6

L5/S1

Question 7

Ankle dorsiflexion - Which myotome?

Answer 7

L4/L5

Question 8

Ankle plantar flexion - Which myotome?

Answer 8

S1/S2

Question 9

Big toe extension - Which myotome?

Answer 9

L5

Question 10

Patellar reflex - which nerve root?

Answer 10

L3/L4

Question 11

Ankle reflex - which nerve root?

Answer 11

S1/S2

Question 12

Babinski reflex interpretation?

Answer 12

Big toe upwards - UMN
big toe curled in - normal

Question 13

Which dermatome do you test at the knee (medial)?

Answer 13

L3

Question 14

Which dermatome do you test at the pinky toe (lateral foot)?

Answer 14

S1

Question 15

Where do you test for the L2 dermatome?

Answer 15

anterior lateral thigh

Question 16

Where do you test for the L4 dermatome?

Answer 16

anterior medial calf

Question 17

Where do you test for the L5 dermatome?

Answer 17

anterior lateral calf, or base of first and second toe
web spaces on dorsal aspect of foot

Question 18

Where do you test for:
- S2
- S3
-S4/5
dermatomes?

Answer 18

• S2 = Popliteal fossa
• S3 = central bum
• S4/5 = perianal area

Question 19

Which tuning fork size to use to assess vibration sensation in lower limb?

Answer 19

518Hz

Question 20

Causes of bilateral upper motor neurone lesion?

Answer 20

• MS
• motor neurone disease (normal sensation)
• Myelopathy - cord compression

Question 21

Shoulder abduction - Which myotome?

Answer 21

C5

Question 22

Elbow flexion - Which myotome?

Answer 22

C6

Question 23

Elbow extension - Which myotome?

Answer 23

C7

Question 24

Wrist extension - Which myotome?

Answer 24

C7

Question 25

Finger extension - Which myotome?

Answer 25

C7

Question 26

Finger flexion and thumb extension - Which myotome?

Answer 26

C8

Question 27

Finger abduction - Which myotome?

Answer 27

T1

Question 28

Thumb abduction - Which myotome?

Answer 28

T1

Question 29

Biceps reflex - which nerve root?

Answer 29

C5/6

Question 30

Supinator reflex - which nerve root?

Answer 30

C4/6

Question 31

Triceps reflex - which nerve root?

Answer 31

C7

Question 32

Which dermatome is the deltoid muscle badge zone?

Answer 32

C5

Question 33

Which dermatome is the palmer aspect of the thumb?

Answer 33

C6

Question 34

Which dermatome is the palmer aspect of the middle finger?

Answer 34

C7

Question 35

Which dermatome is the palmer aspect of the pinkie finger?

Answer 35

C8

Question 36

Which dermatome is the medial forearm?

Answer 36

T1

Question 37

Which tuning fork do you use to assess vibration sensation in upper limb?

Answer 37

128Hz

Question 38

What is CN II and how do you test it?

Answer 38

Optic A - acuity (Snellen, ishihara etc) F - Fields (inattention, fields, blind stop) R - Reflexes (accommodation, direct/consensual, swinging) O - Opthalmoscopy

Question 39

What are CN III, IV and VI and how do you test them?

Answer 39

Oculomotor, trochlear and abducens - inspect for strabismus, ptosis, nystagmus - H-test - Saccades test

Question 40

Which extra-ocular muscle does CN4 supply?

Answer 40

superior oblique

Question 41

Which extra-ocular muscle does CN6 supply?

Answer 41

lateral rectus

Question 42

if an eye cannot move laterally then there is a lesion in which CN?

Answer 42

CN 6

Question 43

if an eye cannot move inferiorly when facing medially then there is a lesion in which CN?

Answer 43

CN 4

Question 44

If the eye rests in an 'down and out' position then lesion may be where?

Answer 44

CN 3

Question 45

What is CN V and how do you test it?

Answer 45

Trigeminal - Sensory - opthalmic, maxillary and mandibular distributions - motor - clench jaw and feel bulk - power - open jaw against resistance - corneal reflex and Jaw jerk

Question 46

What is CN VII and how do you test it?

Answer 46

Motor - raise eyebrows, scrunch up eyes, purse lips, show teeth, puff out cheeks Others - taste in anterior 2/3rds of tongue

Question 47

What is Webers test?

Answer 47

Use 512Hz tuning fork and place om patients forehead - ask if either side if lounder.

Question 48

What is Rinne's test?

Answer 48

use 512Hz tuning fork and place at mastoid process - when patient cant hear then bring infront of ear (normal = air conduction is louder)

Question 49

Which cranial nerve root does uvula deviation indicate?

Answer 49

CN 10 (Vagus) - away from site of lesion.

Question 50

What is CN IX and X and how do you test it?

Answer 50

IX - glossopharyngeal X - vagus inspect - ask patient to say Ahh Motor - assess speech, cough and swallow other - gag reflex and taste on posterior 1/3rd of tongue

Question 51

What is CN XI and how do you test it?

Answer 51

Accessory - Inspect - sternocleidomastoid/trapezius wasting - motor - turn head against resistance + shrug shoulders

Question 52

What is CN XII and how do you test it?

Answer 52

Hypoglossal - tongue for muscle wasting / fasiculations - motor - stick out tone (deviates towards lesions) - power - tongue against cheek

Question 53

How do you differentiate between LMN and UMN lesions in cranial nerve exam?

Answer 53

UMN - spares the forehead as bilateral innervation

Question 54

Causes of unilateral facial nerve lesions?

Answer 54

- Bells palsy - Ramsay Hunt - SOL - Lyme disease - Nerve infiltration (TB, sarcoid, lymphoma) - parotid tumour

Question 55

Causes of Bilateral Facial nerve lesions?

Answer 55

Lyme disease Sarcoidosis Guillain-Barre Amyloidosis

Question 56

Clinical features of parkinsons?

Answer 56

Rigidity Tremor Bradykinesa Postural instability