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Question 1

Deep tendon reflexes: limb positions

Answer 1

1. limbs relaxed and symmetric position
2. important to compare each reflex immediately with it’s contralateral counterpart so that asymmetries can be detected.
3. if you cannot elicit a reflex, you can sometimes being it out by reinforcement procedures

Question 2

reinforcement DTR

Answer 2

Have patient gently contract the muscle being tested by raising the limb very slightly, or have them concentrate on forcefully contracting a different muscle group just at the moment when the reflex is tested

Question 3

clonus

Answer 3

This is a repetitive vibratory contraction of the muscle that occurs in response to muscle and tendon stretch.

Question 4

Deep tendon reflexes are often rated according to the following scale:

Answer 4

0: absent reflex
1+: trace, or seen only with reinforcement
2+: normal
3+: brisk
4+: nonsustained clonus (i.e., repetitive vibratory movements)
5+: sustained clonus

Question 5

normal/abnormal DRS ratings

Answer 5

normal: 1+, 2+, or 3+

unless they are asymmetric or there is a dramatic difference between the arms and the legs.

Abnormal: 0, 4+, or 5+

Question 6

Deep tendon reflexes may be diminished by:

Answer 6

1. Abnormalities in muscles, sensory neurons, lower motor neurons, and the neuromuscular junction
2. Acute upper motor neuron lesions
3. Mechanical factors such as joint disease

Question 7

Abnormally increased reflexes are associated with

Answer 7

upper motor neuron lesions.

Question 8

Plantar response is tested by

Answer 8

Tested by scraping an object across the sole of the foot beginning from the heel, moving forward toward the small toe, and then arcing medially toward the big toe.

Question 9

normal pantar response

Answer 9

downward contraction of the toes

Question 10

abnormal plantar response

Answer 10

babinski sign

Question 11

babinksi sign is characterized by

Answer 11

up-going toe and fanning outward of the other toe

Presence of Babinski’s sign is always abnormal in adults, but it is often present in infants, up to the age of about 1 year.

UMN lesion anywhere along CST

Question 12

finger flexors

Answer 12

Finger flexor reflexes can help demonstrate hyperreflexia in upper extremities

Test fingers by tapping gently on palm with reflex hammer

Question 13

heightened finger reflex

Answer 13

hoffman’s sign– UMN lesion

Question 14

hoffman sign

Answer 14

You can elicit this sign by holding the patient’s middle finger loosely and flicking the fingernail downward, causing the finger to rebound slightly into extension. If the thumb flexes and adducts in response, Hoffmann’s sign is present.

Hoffmann’s sign UMN lesion affecting the hands.

Question 15

The intermediate gray contains

Answer 15

1. interneurons,
2. preganglionic sympathetic neurons at spinal cord levels T1 through L2
3. preganglionic parasympathetics at sacral levels 2, 3, and 4.

Question 16

The anterior (ventral) horn contains

Answer 16

cell bodies of lower motor neurons that innervate skeletal muscle. The anterior horn is found throughout the spinal cord.

Question 17

The posterior (dorsal) horn contains

Answer 17

neuronal cell bodies important for sensing pain and temperature. The dorsal horn is also found throughout the spinal cord.

Question 18

The preganglionic parasympathetics arise from the ____

Answer 18

brainstem (CN III, VII, IX and X) and from the sacral levels 2, 3 and 4.

At the sacral level, the cell bodies of these preganglionics are found in the intermediate grey of the spinal cord.