Neuro Dx

Question 1

L5 NR Evaluation

Answer 1

Disc Level (L4)

MM:

• foot dorsiflexion: tibialis anterior and extensor hallicus longus
• big toe dorsiflexion: extensor hallicus longus (deep fibular/peroneal nn)
• toes 2,3,4 dorsiflexion: extensor digitorum longus&brevis (deep f/p)
• hip and pelvis abduction: gluteus medius & minimus (superior gluteal)

Reflex: none

Sensation: lateral leg, dorsum of foot and middle three toes

Question 2

L4-L5-S1 Dermatome Evaluation

Answer 2

L4 right: L4 left
L5 right: L5 left
S1 right: S1 left

L4 right: L5 right
L5 right: S1 right

L4 left: L5 left
L5 left: S1 left

Question 3

Jendrassik Maneuver

AKA Reinforcement Test

Answer 3

pt hooks hands/feet together and pulls on clenched hands or feet at the moment the reflex is performed

Question 4

Uvular/Palateal Reflex

Answer 4

Raising of the uvula upon phonation or touching with a tongue depressor

Question 5

Interscapular Reflex

Answer 5

Drawing inward of scapula when skin or interscapular space is irritated

Question 6

Abdominal Reflex

Answer 6

Umbilicus deviation to stroked side.

Absence is only normal if bilateral (Beevor Sign)

Question 7

Plantar Reflex

Answer 7

Plantarflexion (curling) of toes upon stroking sole of foot

Question 8

Fakuda Step Test

Answer 8

pt marches in place, eyes closed, for 50 steps
( + ) a turning to one side
( i ) vestibular lesion on the side of rotation

Question 9

Barognosis

Answer 9

Ask pt to identify difference between two same sized objects of different weight

Evaluating integrity of somatosensory cortex

Question 10

Schaefer Sign

Answer 10

Squeezing of achilles tendon to elicit Babinski’s (alternative)

Question 11

Ankle Clonus

Answer 11

Continued involuntary contraction (sustained plantar flexion) of foot upon quick
forcible dorsiflexion of the foot

Question 12

Pallesthesia of foot

Answer 12

Place handle of vibrating 128Hz fork on joint line of lower extremity

Utilize 3 distal interphalangeal joints, if abnormal, continue to evaulate proximally until normal finding is achieved at base of 5th metatarsal, or medial and lateral malleoli.

Ask pt to identify when he or she feels vibration and when dr has stopped the vibration

( + ) inability to identify
( i ) dorsal column involvment

Question 13

C4-C5-C6 Dermatome Eval

Answer 13

C4 right: C4 left
C5 right: C5 left
C6 right: C6 left

C4 right: C5 right
C5 right: C6 right

C4 left: C5 left
C5 left: C6 left

Question 14

Fajersztajn Test
AKA Well-Leg-Raising Test of Fajersztajn
AKA Cross-over Sign

Answer 14

pt supine, dr performs SLR on UNAFFECTED leg to 75* or until produces pain down affected leg

if NO PAIN, examiner dorsiflexes foot

( + ) pain down affected leg (cross-over sign)
( i ) medial disc protrusion

( + ) decrease in pain down affected leg
( i ) lateral disc protrusion

Question 15

Extraocular Movements
(Cardinal fields)

Evaluating CN III, IV, VI
(oculomotor, trochlear, abducens)

Answer 15

observe pts eyes for normal conjugate/parallel movements of eyes and nystagmus as you have them follow finger or pencil while making wide “H” in the air

(CN4/IV) Trochlear = down and in
(CN6/VI) Abducens = lateral
(CN3/III) Oculomotor = all others

Question 16

Apraxia

Answer 16

Following complex motor commands,

“pretend to comb your hair”, “pretend to brush your teeth”

Question 17

Diadochokinesia:

Patting Test/Supination-Pronation Test

Answer 17

Coordination - testing cerebellum

Question 18

Dysmetria:

Heel-shin/Index Finger Test

Answer 18

coordination - testing cerbellum

Question 19

Direct Light Reflex

Answer 19

Ipsilateral pupillary constriction when light is shined in the eye
A: Optic
IC: Midbrain
E: Oculomotor (ipsilateral)

Question 20

Indirect Light Reflex

Answer 20

Contralateral pupillary constriction when light is shined in the eye

A: Optic
IC: Midbrain
E: Oculomotor (contralateral)

Question 21

Glabella AKA McCarthy

Answer 21

Contraction of orbicularis occuli muscle upon percussion of supraorbital ridge (glabella)

Question 22

Test Visual Acuity

Answer 22

screen by reading print
screen with shapes and/or colors

Evaluate optic nerve CN II

Question 23

Evaluate Facial Nerve ( CN VII)

Answer 23

Ask pt about change sin taste sensations sweet, salty andsour in anterior two thirds of tongue

Inspect face:

• raise eyebrows
• close eyes tightly
• show teeth
• puff out cheeks
• smile
• frown

Question 24

Evaluate Vestibulo-Cochlear Nerve

Answer 24

Finger Rub/Whisper test - sensory cochlear portion

assess hearing by rubbing fingers together near the EAM , find maximal distance sound can be heard

Question 25

Rinne Test

Answer 25

tuning fork to mastoid bone for bone conduction, begin counting. pt tells you when sound isno longer heard, then move to EAM without touching pt Normal: air conduction 2x as long as bone Conduction Deafness/Sensorineural deafness

Question 26

Evaluate Hypoglossal Nerve

Answer 26

Inspect tongue for: atrophy, fasciculations, deviation Have pt stick out tongue and test bilateral with tongue depressor, or use tongue in cheek method unilateral paralysis = protruded tongue deviates to involved side

Question 27

Fromet Paper Sign

Answer 27

( + ) The patient is seen to flex the thumb thereby recruiting the median nerve to compensate for apparent weakness ( i ) Ulnar nerve paralysis (weakness or palsy of the adductor pollicus muscle)

Question 28

L’Hermitte Sign

Answer 28

pt sitting or supine, examiner passively flexes patient's head to the chest ( + ) Electric shock-like sensations down the spine and/or through extremities. ( i ) Dural irritation, severe spinal cord injury or degeneration.

Question 29

Turyn

Answer 29

( + ) Pain in the gluteal region or radiating sciatic pain. | ( i ) Sciatic radiculopathy

Question 30

LIndner Sign

Answer 30

pt supine, examiner flexes patient's head toward the chest. ( + ) Pain along sciatic distribution or sharp, diffuse pain (leg) ( i ) Sciatic radiculopathy

Question 31

Roo's/EAST

Answer 31

( + ) ischemic pain, heaviness of the arms, or numbness and tingling of the hand. ( i ) Thoracic outlet syndrome on side involved (Evan’s considers this test to be most accurate for TOS evaluation)

Question 32

Adson's

Answer 32

( + ) Pain and/or paresthesia, decreased or absent pulse amplitude, pallor. ( i ) Compression of the neurovascular bundle by scalenus anticus or cervical rib.

Question 33

Halstead

Answer 33

( + ) Pain and/or paresthesia, decreased or absent pulse amplitude, pallor. ( i) Compression of the neurovascular bundle by scalenus anticus or cervical rib.

Question 34

Costoclavicular/Eden's

Answer 34

( + ) pain and/or paresthesia, decreased or absent pulse amplitude, pallor. ( i ) compression of the neurovascular bundle between the clavicle and 1st rib.

Question 35

Hyperabduction/Wright's

Answer 35

( + ) pain and/or paresthesia, decreased or absent pulse amplitude, pallor. ( i ) compression of the axillary artery by pectoralis minor or coracoid process, Thoracic outlet syndrome.