Neuro Exam

Question 1

What is the main question asked when doing a neurological exam?

Answer 1

Where is the lesion? (CNS, PNS)

Question 2

What is the first sign of cauda equina?

Answer 2

Bladder retention

Question 3

When should you consider a neurologic exam prior to performing OMM? (2)

Answer 3

• Pain in the axial skeleton

- Evaluating a joint problem that has neurologic symptoms associated with it

Question 4

Is smooth or jagged (“give way”) weakness more concerning?

Answer 4

Smooth

Question 5

If a pt comes in with bilateral LE weakness, what should you ask?

Answer 5

Numbness/weakness in other parts of the body

Question 6

LMN lesions have what type of paralysis?

Answer 6

Flaccid

Question 7

UMN lesions have what type of paralysis?

Answer 7

Spastic

Question 8

True or false: it is okay to skip sections of the neuro exam if there are no symptoms in that area

Answer 8

False

Question 9

Fasciculations are indicative of UMN or LMN lesions? What are these?

Answer 9

UMN

Stimulation of motor units (LMN units)

Question 10

What are parkinsonian symptoms?

Answer 10

Resting tremors

Question 11

What are the characteristics of cerebellar walking?

Answer 11

Wide based gait

Question 12

Heel walking is checking for what spinal level?

Answer 12

L5

Question 13

Toe walking is checking which spinal level?

Answer 13

S1

Question 14

Romberg test is checking for what function?

Answer 14

Proprioception

Question 15

Sway and falling with closing eyes in Romberg is positive for what type problem?

Answer 15

Proprioception

Question 16

Sway and falling withOUT closing eyes in Romberg is positive for what type problem?

Answer 16

Cerebellar

Question 17

How do you test for Hoffman’s reflex?

Answer 17

Flipping the dorsal surface of the middle finger, and observing for contraction of the thumb and second digit

Question 18

What does Hoffman’s reflex check for?

Answer 18

UMN lesions

Question 19

What is clonus?

Answer 19

To and fro rhythmic oscillation of a body part. Hyperreflexia

Question 20

True or false: any clonus in mature individuals is abnormal

Answer 20

False- only sustained clonus

Question 21

What is abortive clonus?

Answer 21

Few oscillations when eliciting clonus

Question 22

What is the grade for hyperactive or hyperreflexia?

Answer 22

3/4

Question 23

What is the grade for hyperreflexia with sustained clonus?

Answer 23

4/4

Question 24

What is the root level for the biceps reflex? What is the peripheral nerve?

Answer 24

C5

Musculocutaneous n

Question 25

What is the root level for the brachioradialis reflex?

Answer 25

C6 | Radial n

Question 26

What is the root level for the triceps?

Answer 26

C7 | Radial n

Question 27

What is the root level for the quadriceps?

Answer 27

L4 | Femoral n

Question 28

What is the root level for the achilles tendon reflex?

Answer 28

S1 | Tibial n

Question 29

True or false: to test reflexes, you should flex or extend the joint to alter the tension

Answer 29

true

Question 30

What is a Jendrassik maneuver?

Answer 30

Distracting the individual while assessing reflexes

Question 31

What is a positive Babinski sign?

Answer 31

Extension of the great toe, and flaring of the remaining digits ("up going")

Question 32

What is the appropriate way to document a babinski sign?

Answer 32

Flexor or extensor response

Question 33

Which side of the foot should the babinski sign be started from? Why?

Answer 33

Lateral side of the plantar foot, otherwise may elicit the plantar grasp reflex, which may show as a down going Babinski

Question 34

Grade this muscle strength: FROM against gravity only

Answer 34

3

Question 35

Grade this muscle strength: FROM with gravity eliminated

Answer 35

2

Question 36

Grade this muscle strength: no joint motion, but a slight muscle contraction can be palpated or observed

Answer 36

1

Question 37

What causes the "give-way" weakness? (2)

Answer 37

- pain | - Not understanding physician

Question 38

What are the four muscles that you should not be able to overcome?

Answer 38

- Trapezius - Triceps - Quad extension - Gastrocnemius

Question 39

What are the ASIA sensory points?

Answer 39

A series of points to test, to check for spinal cord injury

Question 40

What are the common pitfalls of the neuro exam?

Answer 40

- Relying too much on the history | - Not having a reproducible way to elicit reflexes

Question 41

What does Tandem walking test for?

Answer 41

Cerebellum

Question 42

How do you ensure reproducibility with strength testing?

Answer 42

Overcome them for a few degrees

Question 43

If a patient has full strength, but only to a certain degree of flexion/extension, how should this be documented?

Answer 43

5/5 strength at (__) degrees of whatever

Question 44

Where is C3 sensation tested?

Answer 44

Supraclavicular fossa

Question 45

Where is C4 sensation tested?

Answer 45

Top of AC joint

Question 46

Where is C5 sensation tested?

Answer 46

Lateral antecubital fossa

Question 47

Where is C6 sensation tested?

Answer 47

Dorsal, proximal thumb

Question 48

Where is C7 sensation tested?

Answer 48

Dorsal, proximal middle finger

Question 49

Where is C8 sensation tested?

Answer 49

Dorsal, proximal 5th finger

Question 50

Where is T1 sensation tested?

Answer 50

Medial antecubital fossa

Question 51

Where is L2 sensation tested?

Answer 51

Medial anterior thigh

Question 52

Where is L3 sensation tested?

Answer 52

Medial, anterior knee

Question 53

Where is L4 sensation tested?

Answer 53

Medial malleolus

Question 54

Where is L5 sensation tested?

Answer 54

Medial dorsal foot

Question 55

Where is S1 sensation tested?

Answer 55

Inferior lateral malleolus

Question 56

Where is S3 sensation tested?

Answer 56

ITs

Question 57

What spinal level: shoulder abduction/elbow flexion

Answer 57

C5

Question 58

What spinal level: wrist extension

Answer 58

C6

Question 59

What spinal level: elbow extension

Answer 59

C7

Question 60

What spinal level: Long (3rd) finger flexion at the DIP

Answer 60

C8

Question 61

What spinal level: Finger abduction

Answer 61

T1

Question 62

What spinal level: hip flexion

Answer 62

L2

Question 63

What spinal level: Knee extension

Answer 63

L3

Question 64

What spinal level: ankle dorsiflexion

Answer 64

L4

Question 65

What spinal level: big toe extension

Answer 65

L5

Question 66

What spinal level: Ankle plantarflexion

Answer 66

S1

Question 67

Which has more prominent atrophy: UMN lesion, or a LMN lesion?

Answer 67

LMN

Question 68

Which has fasciculations: UMN or LMN lesions?

Answer 68

LMNs