What are the 3 important features for quality of weakness?
Bilateral vs unilateral Symmetrical vs asymmetrical Proximal vs distal
What does proximal muscle weakness suggest?
Primary muscle disorder affecting axial muscles
What questions should you ask for associated features of weakness?
Pain in muscles Sensory symptoms Vision Cognition Balance Falls
What associated features should you always ask about?
Weight loss Rigors Fever Loss of appetite
What does unilateral weakness suggest about location of pathology?
What does weakness of a myotome suggest about location of pathology?
Spinal root lesion
If someone has severe +++ muscle weakness, what is a good question to ask on Hx?
What is the order of events for motor exam of lower limb? (hint: inspection first)
Gait. Inspection. Tone. Power. Reflexes. Co-ordination.
When inspecting a limb for the motor exam, what are you looking for?
Scars, deformities, muscle bulk (atrophy), fasciculations.
How many beats is abnormal when looking for clonus?
>5 beats is abnormal
If someone has complete paralysis, what grade is their strength?
If someone has flickers of movement, what grade is their strength?
If someone has traces of contraction, what grade is their strength?
If someone has active movement with gravity eliminated, what grade is their strength?
If someone has active movement against gravity, what grade is their strength?
If someone has active movement against gravity and resistance, what grade is their strength?
If someone has normal power, what grade is their strength?
What are the 3 reflexes to test during the lower limb neuro exam?
Knee, ankle and Babinski
Which dermatomes does the knee jerk assess?
L2, 3 and 4
Which dermatomes does the ankle jerk assess?
Which dermatomes does plantar reflex assess?
L5, S1, S2
If someone has absent reflexes, what is their grade?
If someone has hypoactive reflexes, what is their grade?
If someone has normal reflexes, what is their grade?
If someone has hyperactive reflexes without clonus, what is their grade?
If someone has hyperactive reflexes with clonus, what is their grade?
Associated features for neurological symptoms?
Vision, hearing, pins and needles, weakness, facial droop,balance, falls, walking, memory, personality, speech
Associated features for cancer?
Pain, loss of weight, loss of appetite, fatigue, fever.
Associated features for cardiac issues?
Chest pain, SOB, palpitations, orthopnoea, cough
Associated features for respiratory issues?
Haemoptysis, pain on inspiration, cough, sputum, chest pain, SOB
Associated features for GI issues?
Nausea, vomiting, diarrhoea, constipation, bloating, flatus, stools, haematemesis
Associated features for infection?
Loss of weight, loss of appetite, fatigue, fever, night sweats, chills, shivering