CVA part 1 Flashcards
Changes in muscle strength due to weakness is considered a
a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke
primary impairment
Changes in muscle activation is considered a
a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke
primary impairment
Abnormal tone in stroke patients is considered a
a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke
primary impairment
Sensory and perceptual issues are considered a
a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke
primary impairment
Cognitive, speech, emotional, behavioral problems are classified as
a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke
primary impairment
There is no weakness on the ipsilateral side (true/false)
false
Weakness is usually more proximal than distal (true/false)
false
This abnormal tone is seen due to cerebral shock initially
a. Hypertonicity
b. Spasticity
c. Hypotonicity
d. Tone
hypotonicity
This type of abnormal tone may persist with lesions to the primary motor cortex or cerebellum
a. Hypertonicity
b. Spasticity
c. Hypotonicity
d. Tone
hypotonictiy
This type of abnormal tone emerges in up to 90% of patients
a. Hypertonicity
b. Spasticity
c. Hypotonicity
d. Tone
hypertonicity
This type of abnormal tone is the greatest in antigravity and distal muscles
a. Hypertonicity
b. Spasticity
c. Hypotonicity
d. Tone
hypertonicity
Tone is defined as
a. The tension attained at any moment between the origin and the insertion of a muscle.
b. The sensation of [increased] resistance felt as one manipulates a joint through a range of motion, with the subject attempting to relax.
c. a velocity-dependent increase in the tonic stretch reflex with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex as one component of the upper motor neuron syndrome.
The tension attained at any moment between the origin and the insertion of a muscle.
Hypertonicity is defined as
a. The tension attained at any moment between the origin and the insertion of a muscle.
b. The sensation of [increased] resistance felt as one manipulates a joint through a range of motion, with the subject attempting to relax.
c. a velocity-dependent increase in the tonic stretch reflex with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex as one component of the upper motor neuron syndrome.
The sensation of [increased] resistance felt as one manipulates a joint through a range of motion, with the subject attempting to relax.
Spasticity is defined as
a. The tension attained at any moment between the origin and the insertion of a muscle.
b. The sensation of [increased] resistance felt as one manipulates a joint through a range of motion, with the subject attempting to relax.
c. a velocity-dependent increase in the tonic stretch reflex with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex as one component of the upper motor neuron syndrome.
a velocity-dependent increase in the tonic stretch reflex with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex as one component of the upper motor neuron syndrome.
What is the most common type of stroke?
a. hemorrhage
b. cerebral infarction
c. unspecified
d. none of the above
cerebral infarction
What are possible risk factors for stroke?
hypertension
heart disease
diabetes
smoking, obesity, diet, physical inactivity, excess alcohol
The most common sign of stroke is
a. dropping off the face
b. arm weakness or numbness
c. numbness or weakness
d. visual changes
numbness or weakness
FASTER stands for
facial drooping or numbness arm weakness or numbness stability talking eyes react
Sudden severe headaches with no known cause is an early sign of stroke (true/false)
true
This type of stroke is from either a thrombus or embolism
a. hemorrhagic stroke
b. TIA
c. ischemic stroke
d. sudden stroke
ischemic stroke
A blood clot ischemia causing stroke is defined as a
a. ischemic stroke
b. thrombus
c. embolism
d. hemorrhagic stroke
thrombus
A blood clot which breaks off and travels elsewhere is defined as
a. ischemic stroke
b. thrombus
c. embolism
d. hemorrhagic stroke
embolism
A rupture of a weakened blood vessel is classified as a
a. hemorrhagic stroke
b. TIA
c. ischemic stroke
d. sudden stroke
hemorrhagic stroke
Takes several hours and is in process, TIA comes before it
a. infarction
b. thrombus
c. embolism
d. hemorrhagic
thrombus
This type of stroke is of the internal carotid plaque and it indicates that cardiovascular disease is present
a. infarction
b. thrombus
c. embolism
d. hemorrhagic
embolism
Causes of this type of stroke could be an increased intracranial pressure or cuts off blood supply
a. infarction
b. thrombus
c. embolism
d. hemorrhagic
hemorrhagic stroke
The brain requires low energy and high metabolic reserves (true/false)
false
high energy
low metabolic reserves
What can alter the pH and blood concentrations of O2 and CO2?
vasoconstriction and dilation
Where does the blood supply for the brain come from?
internal carotid
vertebral arteries
What artery receives a majority of blood for the brain?
internal carotid
Internal carotid splints into _ and _ carotid arteries
middle
anterior
The vertebral artery arises from a branch of the _
subclavian
The basilar artery comes from the _ artery and splits to form _ cerebral and the _ part of the circle of willis
vertebral
posterior
posterior
Which artery within the circle of willis is often affected with stroke?
posterior cerebral artery
the anterior cerebral artery is a branch off of the _ _
internal carotid artery
The anterior cerebral artery supplies _ and _ parts of the brain
medial
anterior
The medial and anterior parts of the brain that are supplied by the anterior cerebral artery include
frontal lobe
parietal lobe
basal ganglia
internal capsule
The most common sign of anterior cerebral artery syndrome is
a. urinary incontinence
b. contralateral sensory loss
c. contralateral hemiplegia/paresis
d. contralateral grasp reflex
contralateral hemiplegia/paresis
Signs and symptoms of contralateral hemiplegia/paresis LE paralysis contralateral sensory loss of the LE urinary incontinence apraxia abulia (kinetic mutism) contralateral grasp reflex, sucking reflex
a. anterior cerebral artery syndrome
b. middle cerebral artery syndrome
c. posterior cerebral artery syndrome
d. medial medullary syndrome
anterior cerebral artery syndrome
Which artery comes off the vertebral and basilar arteries and supplies the occipital and medial and temporal lobes?
posterior cerebral artery
This artery supplies the brainstem, midbrain and innervates the thalamus
posterior cerebral artery
Signs and symptoms of contralateral homonymous hemianopsia bilat homonymous hemianopsia visual agnosia prosopagnosia dyslexia without agraphia, anomia, and color discrimination problems memory defect topographic disorientation
a. anterior cerebral artery syndrome
b. middle cerebral artery syndrome
c. posterior cerebral artery syndrome
d. medial medullary syndrome
posterior cerebral artery
peripheral territory
Which territory of the posterior cerebral artery shows more profound effects?
a. central territory
b. anterior territory
c. peripheral territory
d. posterior territory
central territory
Post stroke thalamic pain syndrome is a (primary/secondary) effect from the (thalamus/temporal lobe)
primary
thalamus
Ipsilateral oculomotor with contralateral hemiplegia is called
Webers Syndrome
Signs and symptoms of central post-stroke thalamic pain sensory impairments involuntary movements contralateral hemiplegia/paresis webers syndrome paresis of vertical eye movements
a. posterior cerebral artery, central territory
b. middle cerebral artery syndrome
c. posterior cerebral artery, peripheral territory
d. medial medullary syndrome
posterior cerebral artery
central territory
The _ artery comes off the internal carotid artery and supplies the lateral side of hemispheres and the subcortical area of the brain
middle cerebral
The most common type of stroke occurs in which artery?
a. anterior cerebral artery
b. posterior cerebral artery
c. middle cerebral artery
d. internal carotid artery
middle cerebral artery
The most common sign or symptom of a MCA stroke is
a. motor speech impairment
b. contralateral hemisensory loss of the UE and face more than the LE
c. perceptual deficits
d. contralateral hemiplegia/paresis of the UE and face more than the LE
contralateral hemiplegia/paresis of the UE and face more than the LE
The MCA supplies the (middle/lateral) side of the brain so it affects the (UE/LE) more
lateral
UE
The ACA supplies the (middle/lateral) side of the brain so it affects the (UE/LE) more
medial
LE
If there is a lesion in the dominant hemisphere it will affect
a. vision
b. speech
c. perception
d. memory
speech
If there is a lesion in the nondominant hemisphere it will affect
a. vision
b. speech
c. perception
d. memory
perception
A patient has speech problems, which side is their dominant side? Which side is where the stroke occured?
right
left
A patient has perceptual problems and presents with left sided hemiplegia, which side is their dominant side? Which side did the stroke occur on?
right
right
Signs and symptoms of contralateral hemiplegia/paresis - UE/face more than LE contralateral hemisensory loss - UE/face more than LE motor speech impairment receptive speech impairment global aphasia perceptual deficits limb-kinetic apraxia contralateral homonymous hemianopsia loss of conjugate gaze to opposite side ataxia of contralateral limbs pure motor hemiplegia
a. anterior cerebral artery syndrome
b. middle cerebral artery syndrome
c. posterior cerebral artery syndrome
d. medial medullary syndrome
middle cerebral artery
A focal presentation or a small vessel disease can be classified as
a. Brainstem stroke
b. hemorrhagic stroke
c. TIA
d. lacunar syndromes
lacunar syndromes
What is seen with lacunar syndromes?
dysarthrial clumsy hand syndrome
ataxic hemiparesis
dystonia/involuntary movements
with lacunar syndromes you will see only _ signs
physical
Lacunar syndromes also shows perceptual, visual or language signs (true/false)
false
This type of stroke shows ipsilateral and contralateral signs
a. anterior cerebral artery
b. middle cerebral artery
c. hemorrhagic
d. vertebrobasilar artery syndrome
vertebrobasilar artery
Locked in syndrome
medial medullary syndrome
lateral medullary syndrome
are the most common in:
vertebrobasilar artery syndrome
A presentation of reserved consciousness and sensation but not able to move, except for blinking and eye movements
a. locked-in syndrome
b. medial medullary syndrome
c. lateral medullary syndrome
d. lacunar syndrome
locked in syndrome
A presentation of ipsilateral paralysis of the tongue and contralateral hemiplegia and impaired tactile and proprioception
a. locked-in syndrome
b. medial medullary syndrome
c. lateral medullary syndrome
d. lacunar syndrome
medial medullary syndrome
What is the most frequent reason for death with stroke?
cerebral edema
What areas are more susceptible to ischemia?
hippocampus
cerebellar cortex
Hypoxia due to a stroke results in
neural shock to nerve fibers
Within the first _ it is critical to reverse the ischemic cascade
a. 3 hours
b. few minutes
c. 4 hours
d. 3-4 days
4 hours
Cerebral edema occurs within the first _
a. 3 hours
b. few minutes
c. 4 hours
d. 3-4 days
3-4 days
Recovery happens once _ decreases
cerebral edema
Which type of imaging ruls out tumor, abscess or hemorrhage?
a. CT scan
b. MRI
c. PET
d. Doppler
CT scan
Which type of imaging can see an infarction within 2-6 hours of stroke and picks up smaller lesions?
a. CT scan
b. MRI
c. PET
d. Doppler
MRI
Which type of imaging looks at flow velocity and plaque formation of blood?
a. CT scan
b. MRI
c. PET
d. Doppler
Doppler
TPA is contraindicated with _ stroke
hemorrhage
TPA must be given within
a. 3-4 mins
b. 3-4 hours
c. 3-4 days
d. at any time
3-4 hours
This is a clot dissolving enzyme intended to reverse and halt ischemic cascade, it greatly reduces the risk of disability and death
TPA
Anticoagulants and antiplatelet drugs are contraindicated (true/false)
false
What is the average length of stay in the hospital after a ischemic stroke?
a. 7 days
b. 2-4 days
c. 1-2 weeks
d. 2-4 weeks
2-4 days
What is the average length of stay in the hospital after a hemorrhagic stroke?
a. 7 days
b. 2-4 days
c. 1-2 weeks
d. 2-4 weeks
7 days
What is the average length of stay for inpatient rehabilitation?
a. 7 days
b. 2-4 days
c. 1-2 weeks
d. 2-4 weeks
2-4 weeks
Which type of facility is recommended for older patients on medicare or those who need to go slower over a longer period of time?
a. acute care
b. home health
c. inpatient rehab
d. SNF/long term care
SNF/long term care
The most spontaneous recovery occurs due to
cerebral edema decreasing
The spontaneous recovery process due to a decrease in cerebral edema happens over
a. the first week
b. the first 2-3 weeks
c. the first 3-6 months
d. after 3-5 hours
the first 2-3 weeks
Motor recovery is the greatest in _
a. the first-week
b. the first 2-3 weeks
c. 3-6 months
d. after 3-5 hours
3-6 months
In what type of stroke is the spontaneous recovery process is the greatest?
a. ischemic stroke
b. thrombislm stroke
c. emoblic stroke
d. brainstem stroke
embolic stroke
What percentage of patients are walking after stroke?
a. 58%
b. 80%
c. 99%
d. 25%
80%
What percentage of patients are independent with ADL’s?
a. 58%
b. 80%
c. 30-60%
d. 25%
58%
What percentage of patients have a non-functional arm?
a. 58%
b. 80%
c. 30-60%
d. 25%
30-60%
Weakness is a (direct/indirect) effect with stroke
direct
Velocity dependent increase in muscle tone with increased resistance to stretch
a. spasticity
b. rigidity
c. hypertonia
d. hypotonia
spasticity
The longer and quicker the stretch, the stronger there resistance of the muscle
a. spasticity
b. rigidity
c. hypertonia
d. hypotonia
spasticity
spasticity occurs as a result of a (UMN/LMN) syndrome
UMN
involuntary movements resulting from activity occurring in other parts of the body
a. clonus
b. associated reactions
c. posturing
d. tone
associated reactions
cyclical, spasmodic alternation of muscular contraction and relaxation in response to sustained stretch of a spastic muscle
a. clonus
b. associated reactions
c. posturing
d. tone
clonus
Patient shows stiffness and resistance to movement that is independent of velocity of movement
a. spasticity
b. rigidity
c. hypertonia
d. hypotonia
rigidity
resistance to passive movement is diminished, stretch reflexes are dampened or absent, and limbs are easily moved
a. spasticity
b. rigidity
c. hypertonia
d. hypotonia
hypotonia
acute UMN lesions can produce temporary hypotonia which can be called
spinal shock or cerebral shock
A patient seems to rely more on their uninvolved arm, has learned nonuse of their involved arm, and has increasingly more spasticity. What type of impairment is this?
a. primary impairment
b. secondary impairment
c. composite impairment
d. undesirable compensatory patterns
undesirable compensatory problems
A patient has problems with muscle shortening, a loss of joint motion and is in an acute hypotonic position. Which composite impairment are they demonstrating?
a. atypical movements
b. undesirable compensations
c. movement deficits
d. unbalanced muscle return
movement deficits
A patient is demonstrating timing and sequencing problems with muscle activation and shows some synergy patterns. Which composite impairment are they demonstrating?
a. atypical movements
b. undesirable compensations
c. movement deficits
d. unbalanced muscle return
atypical movements
This type of impairment arises from either movement deficits or atypical movements
undesirable compensations
A patient relies on their uninvolved arm and leg demonstrates asymmetrical postural trunk movements, and has learned nonuse of their UE. Which composite impairment are they showing?
a. atypical movements
b. undesirable compensations
c. movement deficits
d. unbalanced muscle return
undesirable compensations
