Neurology Exam (Lower Limb)

Intro

Candidate introduces self with full name and role

Adheres to appropriate infection control measures

Asks patient if they are in any pain prior to beginning examination

Gains consent

Initial Inspection

Adequately exposes the patient

Identifies findings around the examination space

Comments on patients appearance from the end of the bed

Peripheral Exam

Inspects muscles for fasciculation, tremor, dyskinesia, myoclonus & wasting

Tests gait

Tests heel to toe gait

Performs Romberg’s test

Motor

Performs screening movements

Tests tone - leg roll / leg drop

Tests tone - checks for ankle clonus

Rates power /5 for each joint level

Hip flexion (L2 + iliofemoral nerve)

Hip extension (inferior gluteal nerve)

Knee extension (L3 + femoral nerve)

Knee flexion (sciatic nerve)

Ankle dorsiflexion (L4 + deep peroneal nerve)

Great toe extension (L5)

Ankle plantarflexion (S1 + tibial nerve)

Test lower limb reflexes

Knee jerk
Achilles
Babinski

Sensory

Tests sharp/dull sensation with a neurotip

Tests light touch sensation with cotton wool

Tests vibration sense with a tuning fork

Tests proprioception

Offers to test temperature

Special Tests

Test coordination with heel to shin test

Complete Examination

Prompts patient to redress

Summarises by stating they would complete a full neurological exam including cranial nerves, review the patients notes, and offers to discuss with senior

Diagnosis and Interpretation

Requests appropriate investigation (Bedside, Bloods, Imaging, Special tests)

Gives appropriate differential

Management

Offers an appropriate management plan

Submit