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Neuromuscular Physical Therapy > Examination > Flashcards

Examination Flashcards

1
Q

If a patient can open eyes and look at examiner, respond to questions BUT falls asleep easily, their classification would be..

A

“lethargy”

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2
Q

IF a patient can open eyes look at examiner BUT responds slowly and is confused, they would be classified as..

A

“obtundation”

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3
Q

IF a patient can only be aroused from sleep with a painful stimulus..

A

stupor

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4
Q

IF a patietn cannot be aroused with NO response to external stimuli or environment, their classification of consciousness would be..

A

coma

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5
Q

what are classified as “vegetative functions”

A

respiration, HR, BP, digestion

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6
Q

IF a patient has return of sleep/wake cycles, normalization of vegetative functions and lack of cognitive responsiveness their classification of consciousness is..

A

unresponsive vigilance (vegetative) state

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7
Q

the classification for “persistent vegetative state” is ..

A

more than 1 year for TBI & more than 3 mos for anoxic brain injury

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8
Q

IF your patient has severely altered consciousness with minimal but definite evidence of self or environmental awareness, their classification of consciousness is..

A

minimally conscious state

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9
Q

what score on the GCS would classify someone as having a moderate brain injury?

A

9-12

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10
Q

what is the difference between immediate recall vs. recent memory?

A

Immediate recall - name 3 items preveiously presented after a brief (i.e. 5 min) interval; Recent memory - short term recalling RECENT EVENTS

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11
Q

to test LENGTH of attn span, use..

A

digit span retention test (want 7 numbers in order presented)

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12
Q

to test SUSTAINED attention, determine..

A

time on task & freq of redirection

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13
Q

to test for DIVIDED ATTN, you should assess (2)

A
  1. ability of dual task control 2. perseveration (mental inertia - getting STUCK on a task)
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14
Q

to test FOCUSED attn, you should assess

A

impact of environmental and internal detractors on attn

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15
Q

to test the higher cognitive function of CALCULATION..

A

serial 7 test (count backward from 100 by 7)

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16
Q

to test SEQUENCING, you should look at ability to..

A

order components of cognitive or functional task (assess if cueing is necessary)

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17
Q

If a pulse is fine/barely perceptivle, it is classified as

A

“thready”

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18
Q

what score on the MMSE would classify someone as moderate cognitive impairment?

A

16-20

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19
Q

what score on the MMSE classifies someone as having severe cognitive impairment?

A

15 or less

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20
Q

how many levels does the Rancho scale have?

A

8 levels

I - no response

II & III - decreased levels of response

IV, V, VI - confused

VII & VIII - appropriate levels (VII is automatic, VIII is purposeful)

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21
Q

the final level on the Rancho scale of cognitive function is..

A

VIII - appropriate and purposeful

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22
Q

“Non fluent aphasia” is ..

A

Broca’s motor aphasia/expressive aphasia

  • central language disorder
  • speech is awkward, restricted, interrupted, and produced with effort

-result of : lesion to the LEFT hemisphere at Broca’s area

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23
Q

“verbal apraxia” is..

A

when patients have impairment of volitional articulartory control 2/2 a cortical, dominant hemisphere lesion

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24
Q

“dysarthria” is..

A

weakness, paralysis or incoordination of the motor-speech system (respiration, articulation, phonation and movements of the jaw and tongue)

-can be from damange to the PNS or CNS

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25
"fluent aphasia"
**Wernicke's aphasia**/receptive aphasia **-****spontaneous speech is preserved,**flowing smoothly, but **_auditory comprehension is impaired_** -central language disorder : posterior first temporal gyrus of the **left hemisphere**
26
to test CN II..
test **visual acuity** **1. central :** test at 20 ft, both eyes separately 2. **Visual fields: test peripheral vision**
27
to test CN V...
1. sensation of the face 2. corneal reflex 3. temporal and masseter ms (have pt clench teeth, hold against resistance)
28
what is Rinne's test?
testing conduction of air vs. bone -- -place vibrating tuning fork on mastoid bone, then close to ear canal; **sound should be heard longer thru air vs bone** **CONDUCTIVE LOSS: if sound heard thru bone is equal to or longer than air**
29
HTN classification:
\>140 mmHg SBP , \>90 mmHg
30
NORMAL DBP response to exercise is:
it **remains the same or decreases moderately** (a widening of pulse pressure)
31
IF a pt has **increasing ICP**, you should examine for HR & BP HOW??
**changes in HR or BP may occur later** with increasing intercranial pressure
32
what is the **abnormal respiration** that accompanies **damage to the upper pons?**
**apneustic breathing -** marked by **prolonged inspiration**
33
What score on the POMA would make someone a HIGH falls risk? And what is the maximum score?
POMA is out of 28 (BEST score) -**high risk : \<19** **-**moderate risk : 19-24
34
BBS : scored out of -- -"high risk" of falls :
max score is 56 -**High risk \<45**
35
adults should be able to perform a forward reach of about ..
\>10 inches
36
What does the **Balance Efficacy Scale** measure?
examines **level of self-confidence** when performing functional tasks encountered in daily life -score each from 0-100%
37
What is a **ventriculography?**
x-rays of the skull after air is injected into ventricles -particularly useful with increased ICP
38
what does a **myelography** tell you?
takes x-rays of the **spine** after air is injected into subarachnoid space - shows **abnormalities in subarachnoid space** - IF dye is used instead of air, may result in meningeal irritation
39
how soon can an MRI detect a cerebral edema?
30 min after vascular occlusion
40
what is the advantage of using an MRA vs a typical cerebral angiography?
An angiography uses radiation (x-ray of carotid/vertebral arteries in brain), and MRA is more sensitive
41
How does a PET scan work? -what is it used for?
Positron emission tomography - radioisotopes are inhaled or injected and emissions are measured with a gamma ray detector system - **images cerebral blood flow & brain metabolism**
42
ECG = ? -useful for imaging what?
echoencephalogram; US/doppler techniques -**images lumen of carotid artery & analyzes FLOW, detects plaques in carotid arteries** **ALSO measures position and shifts of midline structures** (ie tumors or hematomas)
43
what are the 4 purposes of a Lumbar Puncture?
1. withdraw CSF for chemical analysis OR cytological exam; 2. measure ICP and spinal fluid dynamics 3. injection of contrast medium for radiological exam 4. injection of therapeutic agents (tx of CA/meningitis)
44
what are some **possible complications of a lumbar puncture?**
severe HA (CSF leakage - relieved by LYING DOWN), infection, epidural hematoma & uncal herniation
45
elevated proteins in the CSF could be indicative of..
inflammation or tumors
46
When using an EMG to examine muscle activity in someone with a LMN injury, what do you expect to find?
Motor unit potentials (MUPs) are **decreased** but overall configurations remain normal -could also see **continuous fasciculations**, **fibrillations (present about 1-3 weeks after denervation)** **IF partial LMN lesion:** only fibrillation and fasciculation potentials, COMPLETE LMN lesions show only fibrillation potentials
47
which type of meningitis is more extreme in its presentation?
the **bacterial** meningitis makes a patient **sicker and works faster** ## Footnote **-**
48
how is **bacterial meningitis** treated?
via antibacterial therapy (antibiotic, antipyretic); also maintain fluid and electrolyte balance
49
what is the name for "sever infection and inflammation of the brain"
encephalitis
50
what is a brain absess?
infectious process in which there is a collection of **pyogenic material in the brain parenchyma**
51
what are the signs and symptoms of a **brain absess?**
HA, fever, brainstem compression, focal signs CN II and VI
52
what is AIDS dementia complex?
confusion and memory loss/disorientation
53
motor deficits associated with AIDS:
**ataxia,** weakness, tremor, loss of fine motor coordination; also experience **peripheral neuropathy:** hypersensitivity, pain, sensory loss
54
If a patient has an MCA stroke, you would expect (LE or UE) to be more affected?
UE more affected
55
If a patient has contralateral sensory loss and transient contralateral hemiparesis, you would expect them to have a lesion involving the ..
PCA
56
a "pure motor" stroke is called ---- & the lesion is located ----
lacunar stroke (contralateral hemi UE&LE); lesioni in internal capsule - posterior limb
57
what are the characteristics of a midbrain lesion stroke?
contralateral hemiparesis, possible CN III palsy (oculomotor n.)
58
if a patient has motor speech involvement after a stroke, they most likely have involvement of what artery?
either MCA or ACA
59
locked - in syndrome occurs as a result of a lesion to..
the **pons (pontine lesion)**
60
If a patient exhibits cerebellar ataxia or nystagmus after a stroke, you can reasonably suspect a lesion..
in the **pons** (a pontine lesion ipsilateral to the side of the nystagmus/ataxia) OR the **medulla** -can be medial or lateral inferior pontine syndrome, or lateral medullary (**Wallenberg's syndrome)**
61
If a patient has paralysis of the right side of their tongue (tongue deviates to the R when protruded), you can reasonably assume their lesion is..
a **medial medullary lesion**
62
IF a patient has **perceptual deficits,** you would expect them to have a lesion of the .. lobe
**parietal lobe of the non-dominant hemisphere**
63
cerebral thrombosis vs cerebral embolism:
**thrombosis:** formation/development of blood clot/thrombus within cerebral arteries **embolism:** traveling bits of matter (thrombi, tissue, fat, bacteria) that produce occlusion and infarction in the cerebral arteries
64
What are the typical **behaviors** of a patient who has had a **left hemispheric stroke?**
slow, cautious, hesitant, insecure
65
what are the **behaviors** typical of a patient with a **right hemispheric stroke?**
impulsive, quick, indifferent; exhibit poor judgment & safety
66
In patients with knee hyperextension post-CVA, the most likely causes are: (2)
1. weak knee extensors (knee flexes in stance --\> compensatory locking of knee in hyperextension) 2. spastic quadriceps
67
"equinus gait" means..
the **heel does not touch down**
68
the stroke impact scale provides an assessment of..
physical and social functioning post-stroke
69
isokinetic training is useful post-stroke to improve..
1. timing deficits, 2. velocity control of movement
70
what type of cueing is suggested for patients with right hemispheric lesions (R CVAs)?
**verbal cues**; demonstrations or gestures may confuse patients with visuospatial deficits
71

Neuromuscular Physical Therapy (7 decks)

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