Thursday, November 20, 2014

D. Pronator drift

During a neurologic examination, you ask a patient to stand with both arms fully extended and parallel to the ground with his eyes closed for 10 seconds.

What is the name of this test?
A. Babinski sign
B. Dysdiadochokinesis
C. Lhermitte symptom
D. Pronator drift
E. Romberg sign

The answers is D: The ability to perform a thorough

neurologic examination is an important skill for all internists to master. A careful
neurologic examination can localize the site of the lesion and is important in directing
further workup. The components of the neurologic examination include mental status,
cranial nerves, motor, sensory, gait, and coordination. The motor examination is further
characterized by appearance, tone, strength, and reflexes. Pronator drift is a useful tool for
determining if upper extremity weakness is present. In this test, an individual is asked to
stand with both arms fully extended and parallel to the floor while closing his or her eyes. If
the arms flex at the elbows or fingers or there is pronation of the forearm, this is considered
a positive test. Other tests of motor strength include tests of maximal effort in a specific
muscle or muscle group. Most commonly this type of strength testing is graded from 0 (no
to 5 (full power) with varying degrees of weakness noted against resistance.
However, many individuals find it more practical to use qualitative grading of strength,
such as paralysis, severe weakness, moderate weakness, mild weakness, or full strength.
Babinski sign is a sign of upper motor neuron disease above the level of the S1 vertebra
and is characterized by paradoxical extension of the great toe with fanning and extension
of the other toes as well. Dysdiadochokinesis refers to the inability to perform rapid alternating
movements and is a sign of cerebellar disease. Lhermitte symptom causes electric
shock–like sensations in the extremities associated with neck flexion. It has many causes
including cervical spondylosis and multiple sclerosis. Romberg sign is performed with an
individual standing with feet together and arms at the side. The individual is then asked
to close his or her eyes. If the individual begins to sway or fall, this is considered a positive
test and is a sign of abnormal proprioception.


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