Neurological 2

Question 1

What is the MRC grading system of motor power?

Answer 1

5/5 = movement against gravity with full power against resistance
4/5 = movement against gravity with reduced power against resistance. Grades 4-, 4 and
4+ indicate reduced power but the presence of movement against slight, moderate and
strong resistance respectively.
3/5 = movement against gravity only without applied resistance
2/5 = muscle contraction with active movement only when gravity is eliminated
1/5 = flicker of muscle contraction seen, no movement
0/5 =no muscle contraction

Question 2

What is pronator drift?

Answer 2

Get patient to stretch out arms in a supine manner, close their eyes and keep their arms still
Examine by gently tapping one of patients hands
Should be automatically corrected and position maintained; if one arm tends to pronate and drift downwards = contralateral UMN lesion

Question 3

What are the different types of hypertonic muscle tones?

Answer 3

Spasticity = velocity and direction dependent ‘spastic catch’ upon moving fast

Rigidity = velocity and direction independent

Question 4

What are the general things to do when testing sensation?

Answer 4

Always start with somewhere central ie sternum first that has no sensory loss and get patient to compare
Also compare left with right.
If deficiency found, move distal-proximal on skin or joint until test is positive ie small jumps with neurotip point to detect ‘glove’ sensory loss

Question 5

Name 3 types of gait

Answer 5

Hemiplegic - unilateral weakness on affected side stroke
Scissoring - cerebral palsy, spinal cord damage
Steppage - bilateral foot drop - neuropathy
Parkinsonian - struggle to initiate, loss of arm swing and tremor on one side, small shuffling gait, stooped posture

Question 6

What is ankle clonus?

Answer 6

foot lifted off bed and leg supported then foot sharply dorsiflexed, a beating (+5) of the foot is a positive sign for a UMN lesion

Question 7

What are the nerve roots you are testing during power testing of the upper limb?

Answer 7

Shoulders - abd - C5, add - C6/7 
Elbow - flex - C5/6 , ext - C7 
Wrists - flex - C6 , ext - C6/7 
Fingers - flex/ext - C7, abd - T1 
Thumb - palmar abd - C8/T1-median, add – ulnar, opposition – median

Question 8

What are the nerve roots you are testing during the power testing of the lower limb?

Answer 8

Hip – flex – L1/2, ext – L5/S1, abd – L4/5, add – L2/3
Knee – flex – S1, ext – L3/4
Ankle – dorsiflex – L4, plantarflex –S1/2
Big toe – dorsi/plantarflex – L5

Question 9

What are the nerve roots you are testing during reflex testing of the upper limb?

Answer 9

Biceps – C5/6 – musculocutaneous
Triceps – C6/7/8 – radial
Supinator – C5/6 – radial

Question 10

What are the nerve roots you are testing during reflex testing of the lower limb?

Answer 10

Quadriceps (knee jerk) – L3/4 – femoral

Gastrocnemius (ankle jerk) –S1 (+L5/S2) – posterior tibial

Question 11

What does a positive Babinski sign mean?

Answer 11

UMN lesion in corticospinal tract

Question 12

Which tract carries soft touch?

Answer 12

Dorsal columns

Question 13

Which tract carries pain/pin prick?

Answer 13

Spinothalamic

Question 14

Which tract carries proprioception?

Answer 14

Dorsal columns

Question 15

Which tract carries vibration?

Answer 15

Dorsal columns

Question 16

Which tract carries temperature?

Answer 16

Spinothalamic

Question 17

What do patterns of weakness suggest?

Answer 17

Proximal = muscular
Distal = nerve
Look for symmetry/asymmetry
Is the weakness due to an isolated lesion of central lesion/nerve root/nerve/muscle?

Question 18

What makes reflexes ‘brisk’?

Answer 18

More forceful than the other side
A widening of the reflex zone (area needed to hit to initiate)
A spread of the reflex response (i.e. knee jerk initiates hip reflex)

Question 19

What are the differences in presentation between an UMN lesion and a LMN lesion?

Answer 19

Upper = CNS = increased spastic tone and deep tendon reflexes, pyramidal pattern of weakness, no atrophy or fasciculations
LMN = PNS = decreased tone, deep tendon reflexes and muscle mass, peripheral pattern of weakness, fasciculations