A neurologist is examining a patient

A neurologist is examining a patient. She takes the patient’s middle finger and flicks the distal phalanx, her thumb contracts in response. What sign has been elicited?

1.Chvostek’s
2.Glabellar
3.Hoffman’s
4.Tinel’s
5.Babinksi’s

View explanation

The neurologist has elicited a positive Hoffman’s reflex © suggestive of upper motor neurone disease. It would have been negative if the thumb had not contracted in response to flicking the patient’s distal phalanx. Chvostek’s sign (A) is contraction of the face on stimulation of the facial nerve over the masseter. This is seen in hypocalcaemia. The glabellar tap (B) is an insensitive test for parkinsonism where the doctor taps above the bridge of the nose and the patient continues to blink. A normal response is to desensitize to the stimulus and stop blinking. Tinel’s sign (D) can be elicited by tapping a nerve such as the ulnar nerve at the elbow, resulting in a tingling sensation in the distribution of the nerve. This is a sign of nerve compression. It is also useful in carpal tunnel syndrome by tapping over the median nerve at the wrist. Babinski’s reflex (E) is extension and outward fanning of the toes in response to a firm stimulus of the outer soles. It is suggestive of upper motor neurone disease.