COMLEX USA Practice Exam 2025 – The All-in-One Guide to Master the Comprehensive Osteopathic Medical Licensing Exam

A DTR (deep tendon reflex) grade of 4 signifies an exaggerated reflex response, which indicates an upper motor neuron lesion or a neurological dysfunction. When the grading system for reflexes ranges from 0 to 4, a score of 4 is characterized by a brisk or hyperactive reaction to the stimulus applied, suggesting that the reflex arc is intact but the inhibition usually provided by descending pathways is impaired.

The grading scale often is defined as follows: a score of 0 indicates an absent reflex, a score of 1 signifies a hypoactive or diminished response, a score of 2 represents a normal reflex response, and a score of 3 indicates a brisk response that may still fall within the normal range but could also suggest some level of neurological significance. Hence, when a reflex is rated as a 4, it strongly indicates that there may be a pathological cause behind the exaggerated response, and further investigation into the underlying neurological health of the individual is warranted.