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Grades of deep tendon reflexes

 Which of the following grades of deep tendon reflexes best describes a patient with transient
and intermittent clonus?
  • a.Grade 0
  • b.Grade 1+
  • c.Grade 2+
  • d.Grade 3+
  • e.Grade 4+

The answer is (e).
Clonus is rapidly alternating involuntary contraction and relaxation of skeletal muscle. Using a reflex hammer deep tendon reflex (DTR) response is graded on a scale from 0 to 4+:

In a normal person, when a muscle tendon is tapped briskly, the muscle immediately contracts due to a two-neuron reflex arc involving the spinal or brainstem segment that innervates the muscle. The afferent neuron whose cell body lies in a dorsal root ganglion innervates the muscle or Golgi tendon organ associated with the muscles; the efferent neuron is an alpha motoneuron in the anterior horn of the cord.

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