ممرض يقيم منعكسات الأوتار، وكانت +٤ مع رمع في الكاحل. ماذا يدل؟

Testing deep tendon reflexes, the nurse finds 4+ with ankle clonus. What does this indicate?

1. Total absence of reflexes in the limbs
2. Peripheral nerve weakness only
3. Completely normal reflexes, meaning nothing
4. Hyperreflexia, suggesting a central lesion

Answer: D) Hyperreflexia, suggesting a central lesion. Reflex grading: 0 absent, 2+ normal, 4+ very brisk with clonus. Hyperreflexia with clonus indicates upper motor neuron disease, or may accompany pre-eclampsia and hypomagnesaemia.