Upper/lower Limb

Question 1

What is the effect on tone after an upper motor neurone lesion?

Answer 1

Hypertonia

Question 2

What is the effect on tone after a lower motor neurone lesion?

Answer 2

Hypotonia

Question 3

For shoulder abduction, what myotomes and muscles are involved?

Answer 3

C5 and deltoid muscles

Question 4

For shoulder adduction, what myotomes and muscles are involved?

Answer 4

C6/C7 and teres major/ latissimus dorsi/ pectoralis major

Question 5

For elbow flexion, what myotomes and muscles are involved?

Answer 5

C5/C6 and biceps brachii

Question 6

For elbow extension, what myotomes and muscles are involved?

Answer 6

C7 and triceps brachii

Question 7

For wrist flexion, what myotomes and muscles are involved?

Answer 7

C6/C7 and flexors of wrist

Question 8

How is power scored?

Answer 8

MRC Muscle Power Scale

Question 9

What myotomes are involved in the biceps reflex?

Answer 9

C5, C6

Question 10

What myotomes are involved in the triceps reflex?

Answer 10

C7,C8

Question 11

What myotomes are involved in the supinator reflex?

Answer 11

C6

Question 12

Where is the biceps tendon found?

Answer 12

Medial aspect of antecubital fossa

Question 13

Where is the triceps tendon found?

Answer 13

Superior to Olecranon process of ulna

Question 14

Where is brachioradialis tendon found ( for supinator reflex) ?

Answer 14

Posterolateral aspect of wrist - 4 inches from base of thumb

Question 15

What is the effect on reflexes after a lower motor neurone lesion?

Answer 15

Areflexia

Question 16

What is the effect on reflexes after a upper motor neurone lesion?

Answer 16

Hyperreflexia

Question 17

Where is the C5 dermatome found?

Answer 17

Lateral aspect of lower edge of deltoid muscle ( regimental patch)

Question 18

Where is the C6 dermatome found?

Answer 18

Palmar side of thumb

Question 19

Where is the C7 dermatome found?

Answer 19

Palmar side of middle finger

Question 20

Where is C8 dermatome found?

Answer 20

Palmar side of little finger

Question 21

Where is T1 dermatome found?

Answer 21

Medial aspect of antecubital fossa proximal to medial epicondyle

Question 22

Where is T2 dermatome found?

Answer 22

Axilla

Question 23

What spinal nerve roots are involved in the patellar reflex?

Answer 23

L2-L4

Question 24

What spinal nerve roots are involved in the Achilles reflex?

Answer 24

S1-S2

Question 25

Where is the L2 dermatome found?

Answer 25

Lateral aspect of thigh

Question 26

Where is the L3 dermatome found?

Answer 26

Lower medial aspect of thigh

Question 27

Where is the L4 dermatome found?

Answer 27

Medial aspect of leg, medial foot and great toe ( REMEMBER- L3 to the knee, L4 to the floor!)

Question 28

Where is L5 dermatome found?

Answer 28

Lateral aspect of leg , mid dorsum of foot, middle three toes

Question 29

Where is the S1 dermatome found?

Answer 29

Little toe, lateral foot and sole of foot

Question 30

Where is the S2 dermatome found?

Answer 30

Back of upper leg and thigh

Question 31

What action at the hip joint does the psoas major and iliacus allow? What nerve is involved?

Answer 31

Flexion, femoral nerve

Question 32

At the hip joint, what action does the gluteus maximus allow? What nerve is involved?

Answer 32

Extension, inferior gluteal nerve

Question 33

At the hip joint, what action does the gluteus medius and minimus allow? What nerve is involved?

Answer 33

Abduction , superior gluteal nerve

Question 34

At the hip joint, what action do the muscles adductor longus/ brevis/ Magnus allow? What nerve is involved?

Answer 34

Adduction, obturator nerve

Question 35

What action does the obturator externus muscles allow?

Answer 35

Internal rotation

Question 36

What action does the obturator internus, Piriformis, gemellus muscles and quadratus femoris allow?

Answer 36

External rotation

Question 37

What Test is used to assess the hip abductors?

Answer 37

Trendelenburg Test

Question 38

What would a positive trendelenburg test show?

Answer 38

If there’s weakness in hip abductors, will be unable to stabilise hip on that side. Pelvis will sag towards unsupported side.

Question 39

What movement at the ankle joint do the muscles tibialis anterior, EHL, EDL allow? What nerve is involved?

Answer 39

Dorsiflexion, deep peroneal nerve

Question 40

What nerve is involved in plantarflexion?

Answer 40

Tibial nerve

Question 41

At what joint does inversion of the ankle take place?

Answer 41

Subtalar joint

Question 42

What manoeuvre can patients do to elicit a stronger patellar reflex?

Answer 42

Jendrassik manoeuvre ( clench teeth + flex both sets of fingers in hook form)

Question 43

Describe the motor and sensory loss after a femoral nerve lesion.

Answer 43

Motor loss- quadriceps paralysis - weakness of knee , difficulties climbing up and down stairs Sensory loss- anterior and medial thigh, medial leg, medial foot

Question 44

Describe the motor and sensory loss after an obturator nerve lesion?

Answer 44

Motor loss- paralysis of adductors , cross legging affected Sensory loss- pelvis diseases, ovarian tumours can cause medial thigh pain

Question 45

Describe the motor and sensory loss after a common peroneal nerve lesion?

Answer 45

Motor loss- Foot drop ( extensors and Evertors paralysed ) Sensory loss- anterior and lateral leg, dorsum of foot

Question 46

Describe the motor and sensory loss after a tibial nerve lesion?

Answer 46

Motor loss- Hamstring muscles , posterior leg muscles and sole of foot Sensory loss- sole of foot

Question 47

What injuries could affect the whole sciatic nerve?

Answer 47

Pelvic fracture, hip joint dislocation, penetrating injuries

Question 48

What is the motor effect after a whole sciatic nerve injury?

Answer 48

Paralysis of Hamstrings + muscles below knee Knee flexion affected

Question 49

What happens to the foot after a whole sciatic nerve injury?

Answer 49

Foot drop

Question 50

What is the sensory loss after a whole sciatic nerve injury?

Answer 50

Loss below knee except narrow area on medial leg and foot ( saphenous nerve area)

Question 51

What is sciatica and what causes it?

Answer 51

Pain radiating from posterior back into buttock , posterior/lateral thigh and into leg Caused by herniated lumbar intervertebral disc which compresses on L5-S1 part of sciatic nerve

Question 52

Name the borders of the femoral triangle?

Answer 52

Superior- inguinal ligament Medial- Adductor longus Lateral- Sartorius

Question 53

What is the dermatome region for L1?

Answer 53

Area of inguinal ligament

Question 54

What is the dermatome region for S3?

Answer 54

Gluteal fold area

Question 55

What is compartment syndrome?

Answer 55

Pressure in muscle compartment becomes very high —> venous drainage gets blocked —>muscle ischaemia and death can arise

Question 56

Give some causes of compartment syndrome?

Answer 56

Fractures, burns, infections, prolonged limb compression

Question 57

What are the 6 symptoms associated with compartment syndrome?

Answer 57

The 6 Ps - Pallor - Pain - Paraesthesia - Pulselessness - Paralysis - Perishingly cold

Question 58

On examination, what would you see for compartment syndrome?

Answer 58

Swollen limb, passive movement painful

Question 59

How would you treat compartment syndrome?

Answer 59

Relieve pressure by 1) removing all dressings/casts/splints 2) Open fasciotomy- surgically open skin and deep fascia along length of muscle compartment

Question 60

At what vertebral level is an epidural injection given in an adult?

Answer 60

L4-L5

Question 61

When would you deliver a lumbar epidural injection?

Answer 61

- child birth - back pain/ sciatica

Question 62

Give 3 abnormalities of tone you can assess at each joint.

Answer 62

- Spasticity - Rigidity - Cogwheeling hypotonia

Question 63

What spinal level is lumbar puncture performed at?

Answer 63

L3/L4

Question 64

What is lumbar puncture used to diagnose?

Answer 64

Meningitis, bleed