Neurology

Question 1

Scapulothoracic elevation

Answer 1

Superior trapezius, levator scapulae, rhomboids

Question 2

Scapulothoracic Depression

Answer 2

Inferior trapezius, pectoralis minor, serratus anterior

Question 3

Scapulothoracic Protraction

Answer 3

Pectoralis minor, serratus anterior

Question 4

Scapulothoracic Retraction

Answer 4

Rhomboids, middle trapezius, latissimus dorsi

Question 5

Scapulothoracic Rotation

Answer 5

Glenoid fossa faces upwards or downwards as scapula rotates

Superior trapezius, inferior trapezius, serratus anterior - up

Pectoralis minor, latissimus dorsi, rhomboids and levator scapulae - down

Question 6

Scapulothoracic movements

Answer 6

Elevation 
Depression
Protraction
Retraction
Rotation

Question 7

Glenohumeral flexion

Answer 7

Pectoralis major, deltoid (anterior fibres)

Question 8

Glenohumeral extension

Answer 8

Deltoid (posterior fibres)

Question 9

Glenohumeral abduction

Answer 9

Supraspinatus initially and then central deltoid

Question 10

Glenohumeral adduction

Answer 10

Pectoralis major, latissimus dorsi

Question 11

Glenohumeral internal rotation

Answer 11

Subscapularis

Question 12

Glenohumeral external rotation

Answer 12

Infraspinatus

Question 13

Glenohumeral movements

Answer 13

Flexion
Extension
Abduction
Adduction
Internal and external rotation

Question 14

Elbow joint flexion

Answer 14

Biceps, brachialis, brachioradialis (pronator teres)

Question 15

Elbow joint extension

Answer 15

Triceps

Question 16

Radio-ulnar joint supination

Answer 16

Supinator, Biceps

Question 17

Radio-ulnar joint pronation

Answer 17

Pronator quadratus, Pronator teres

Question 18

Radio-ulnar movements

Answer 18

Supination and pronation

Question 19

Muscle power scale

Answer 19

0/5: no movement

1/5: Barest flicker of movement of the muscle, though not enough to move the structure to which it’s attached

2/5: Voluntary movement which is not sufficient to overcome the force of gravity.

3/5: Voluntary movement capable of overcoming gravity, but not any applied resistance.

4/5: Voluntary movement capable of overcoming “some” resistance

5/5 Normal strength

Question 20

Atrophy

Answer 20

Lower motor neurone lesion

Question 21

Muscle tone

Answer 21

Amount of tension in muscle

Question 22

Reflex

Answer 22

Spinal segmental reflex arc

Question 23

Biceps tendon reflex

Answer 23

C5 & C6

Question 24

Triceps tendon reflex

Answer 24

C7 & C8

Question 25

Brachioradialis (supinator) reflex

Answer 25

C5 & C6

Question 26

Reflex grading

Answer 26

``` 0 - absent 1+ - decreased 2+ - normal 3+ - hyper-reflexic 4+ - clonus ```

Question 27

Upper Brachial injury

Answer 27

Extreme lateral flexion of the head Stretch on upper roots (C5 & C6) and or superior trunk Erb's palsy

Question 28

Lower Brachial injury

Answer 28

When upper limb is pulled superiorly Stretch on lower roots (C8 & T1) and or inferior trunk Klumpke’s Palsy Small muscles of the hand are affected May get clawed hand and wasting

Question 29

Musculocutaneous

Answer 29

Stab wound to upper arm Lateral forearm sensory loss Weak elbow flexion Weak wrist supination Absent bicep reflex Wasting of Biceps

Question 30

Axillary

Answer 30

Fracture of surgical head of humerus Compression injury from shoulder dislocation or crutches in armpit Sergeant’s patch Markedly weak shoulder abduction (15-90 degrees) Weak shoulder flexion, extension and external rotation Wasting of Deltoid

Question 31

Median

Answer 31

Supra condylar fracture of humerus Compression in carp Median distribution of hand and thenar eminence ``` Weak forearm pronation Weak wrist flexion Weak wrist abduction Weak finger flexion (DIP joint of ring and littler finger preserved) Weak thumb abduction and opposition ``` Wasting of anterior forearm Wasting of thenar eminence Hand of Benediction (on attempted finger flexion)

Question 32

Radial

Answer 32

Fracture of proximal/shaft humerus, proximal radius Compression from crutches on armpit sleeping on arm or armpit on chair (Saturday night palsy) Posterior arm and forearm Radial area of hand Weak elbow extension Absent triceps reflex Weak wrist extension Weak finger MCP joint extension ``` Wasting of triceps and posterior compartment of forearm Wrist drop (on attempted wrist extension) ```

Question 33

Ulnar

Answer 33

Medial epicondylar fracture Compression at Guyons tunnel in wrist Ulnar distribution of hand and hypothenar eminence Weak wrist flexion Weak wrist adduction Weak finger flexion of ring and little finger at the MCP and DIP joints Weak extension at the IP joints in ring and little finger Weak finger abduction, adduction and opposition ``` Wasting of hypothenar eminence and intrinsic muscles of hand Claw Hand (on attempted finger flexion) ```

Question 34

Hip joint movements

Answer 34

Flexion extension Abduction adduction Medial lateral rotation Circumduction

Question 35

Knee joint

Answer 35

Flexion extension | Slight medial and lateral rotation

Question 36

Ankle joint

Answer 36

Dorsi and plantarflexion

Question 37

Intertarsal joints

Answer 37

Inversion eversion | Supination pronation

Question 38

Tarsometatarsal movements

Answer 38

Limited sliding

Question 39

Metatarsalphalangeal movements

Answer 39

Flexion extension | Limited other

Question 40

Interphalangeal movements

Answer 40

Flexion extension

Question 41

Trendelenburg test

Answer 41

First the subject is asked to stand on both legs. Both right and left pelvis should remain at same level without any tilt. The examiner should stand behind the subject and feel their pelvis. Then ask the subject to raise one leg off the ground. The pelvis should remain horizontal on one leg. If the pelvis on the unsupported side drops downward then the Trendelenberg test is said to be positive. A positive test indicates a loss or weakness of the motor function of the hip abductors in the leg the subject is standing on.

Question 42

Femoral nerve injury

Answer 42

L2-4 Quadriceps paralysis Weakness of knee Difficulty up or down stairs Anterior and medial thigh, medial side of leg, medial border of foot - big toe

Question 43

Obturator nerve injury

Answer 43

L2-4 Paralysis of all adductors Insignificant loss on medial side of thigh

Question 44

Common fibular nerve injury

Answer 44

L4-S2 Foot extensor and evertors paralysed Foot drop Anterior and lateral side of leg and dorsum of foot

Question 45

Tibial nerve injury

Answer 45

L4-S3 Hamstring and all muscles of back of leg and sole of foot Foot in dorsiflexion and everted Sole of foot

Question 46

Sciatic nerve injury

Answer 46

Hamstring and all muscle below the knee are paralysed Knee flexion Plantarflexed Below knee except on narrow area except on medial and big toe

Question 47

Sciatica

Answer 47

Pain from lower back into buttock, posterior/lateral thigh into leg