Comprehensive Osteopathic Medical Licensing Examination (COMLEX USA) Practice

What is the DTR grading for total paralysis?

1. DTR Grade 1

2. DTR Grade 2

3. DTR Grade 3

4. DTR Grade 4

The correct answer is: DTR Grade 4

Deep tendon reflex (DTR) grading is used to assess the functionality of the reflex arc and neurological status. In this grading system, a completely absent reflex response indicates a severe impairment of the neural pathways involved in reflex activity. Total paralysis, signifying a complete loss of voluntary and reflexive movement in a muscle group, aligns with the absence of deep tendon reflexes. This absence is categorized as DTR Grade 0. However, when considering the options provided, DTR Grade 4 typically reflects a hyperactive response, indicating an overactive reflex mechanism, often seen in conditions such as upper motor neuron lesions. While none of the grades explicitly refer to total paralysis, DTR Grade 4 is the highest grade reflective of an exaggerated reflex response, which could suggest a substantial neurological impairment. This is markedly different from grades 1 through 3, which indicate varying degrees of reflex strength, from diminished (Grade 1) to normal (Grade 2) and brisk (Grade 3). Therefore, while the correct answer reflects a high-grade reflex that potentially signifies significant neurogenic factors, it is essential to understand that total paralysis would often be documented as absent reflex activity, which might not have been an option in the choices presented.