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NPTE NM > Examination > Flashcards

Examination Flashcards

1
Q

LOC - obtundation =

A

can open eyes, look at examiner
but responds slowly and is confused
demonstrates dec alertness and interest in environment

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2
Q

LOC - stupor =

A

can be aroused from sleep only with painful stimuli
verbal responses are slow or absent
pt returns to unresponsive state when stimuli are removed
demonstrates minimal awareness of self and environment

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3
Q

LOC - unresponsive vigilance (vegetative) state =

A

characterized by return of sleep/wake cycles, normalization of vegetative functions (resp, HR, BP, digestion) and lack of cog responsiveness (can be aroused but is unaware)

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4
Q

LOC - persistent vegetative state =

A

a state lasting over 1 year for TBI and over 3 months for anoxic brain injury

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5
Q

LOC - minimally conscious state =

A

a state characterized by severely altered consciousness with minimal but definite evidence of self or environmental awareness `

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6
Q

GCS - relates

A

consciousness to three elements of response
Eye opening, motor response, and verbal response
Scored from 3 to 15

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7
Q

GCS - severe brain injury, mod and min

A 
severe = 1 to 8
mod = 9 to 12
minor = 13 to 15
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8
Q

Memory - immediate recall

A

name three items previously presented after a brief interval of about 5 min

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9
Q

Memory - recent memory (short term)

A

recall recent events - what did you have for breakfast

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10
Q

Memory - remote memory (long term)

A

recall past events - where were you born

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11
Q

Mini mental state exam (MMSE) - screening test for

A

cog dysfunction

includes screening items for orientation, registration, attn, calculation, recall and language

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12
Q

MMSE - scoring

A

max is 30
mild impairment = 21-24
mod = 16-20
severe = 15 or less

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13
Q

LOCF - rancho los amigos levels of cog function - assesses

A

cognitive recovery from TBI

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14
Q

LOCF - scoring

A 
8 levels of bx 
1 = no response
2 and 3 = decreased response
4, 5, 6 = confused 
7, 8 = appropriate automatic, purposeful
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15
Q

vital signs - resp - cheyne stokes respiration is what

A

a period of apnea lasting 10-60 sec followed by gradual inc depth and freq of respirations
Accompanies depression of frontal lobe and diencephalic dysfunction

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16
Q

vital signs - resp - hyperventilation

A

inc rate and depth of resp

Accompanies dysfunction of lower midbrain and pons

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17
Q

vital signs - resp - apneustic breathing

A

abnormal resp marked by prolonged inspiration

Accompanies damage to upper pons

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18
Q

Exam for CNS infection or meningeal irritation - neck mobility test

A

supine, flex neck to chest
pos - neck pain with limitation and guarding of head flexion due to spasm of post neck mm
can result from meningeal inflammation, arthritis, or neck injury

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19
Q

Exam for CNS infection or meningeal irritation - Kernig’s sign

A

Supine, flex hip and knee fully to chest and then extend knee
Pos - causes pain and inc resistence to extending knee due to spasm of hamstring
when bilateral - suggests meningeal irritation

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20
Q

Exam for CNS infection or meningeal irritation - Brudzinski’s sign

A

Supine, flex knee to chest
Pos - causes flexion of hips and knees (drawing up)
Suggests meningeal irritation

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21
Q

Perceptual function - test for homonomous hemianopsia

A

loss of half of visual field in each eye - contralateral to side of lesion
Slowly bring two fingers from behind head and have them tell you when and where fingers first appear

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22
Q

Perceptual function - body scheme/body image disorders - body scheme disorder =

A

somatognosia

have pt identify body parts or their relationship to each other

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23
Q

Perceptual function - body scheme/body image disorders - visual spatial neglect =

A

unilateral neglect

determine whether pt ignores one side of body and stimuli coming from that side

24
Q

Perceptual function - body scheme/body image disorders - right/left discrimination disorder =

A

have pt identify r and l sides of his or her own body and PT body

25
Q

Perceptual function - body scheme/body image disorders - anosognosia =

A

severe denial, neglect, or lack of awareness of severity of condition
determine whether pt shows severe impairments in neglect and body scheme

26
Q

Perceptual function - spatial relations syndromes - figure ground discrimination

A

have pt pick out an object from an array of objects (brake from rest of wheelchair)

27
Q

Perceptual function - spatial relations syndromes - form constancy

A

have pt pick out an a object from an array of similarly shaped, but different sized objects (large block from group of blocks)

28
Q

Perceptual function - spatial relations syndromes - spatial relations

A

have pt duplicate a pattern of two or three blocks

29
Q

Perceptual function - spatial relations syndromes - position in space

A

have pt demonstrate difference limb positions (put your arm OH, put your foot underneath chair)

30
Q

Perceptual function - spatial relations syndromes - topographical disorientation

A

determine whether pt can navigate a familiar route on his or her own (travel from room to PT clinic)

31
Q

Perceptual function - spatial relations syndromes - depth and distance imperceptions

A

determine whether pt can judge depth and distance (navigate stairs, and sit down in chair)

32
Q

Perceptual function - spatial relations syndromes - vertical disorientation

A

determine whether pt can accurately identify when something is upright (hold cane, ask pt when it is vertical)

33
Q

Perceptual function - Examine for agnosia

A

inability to recognize objects with one sensory modality while retaining ability to recognize same object with other sensory modality
Not clock but sight, but able to with sound of tick

34
Q

Perceptual function - Examine for apraxia

A

inability to perform voluntary, learned movementa in absence of loss of sensation, strength, coordination, attn, or comprehension
represents a breakdown in conceptual system or motor production system or both

35
Q

Perceptual function - ideomotor apraxia

A

pt cant perform task on command, but can do it when left alone

36
Q

Perceptual function - ideational apraxia

A

pt cant perform task at all, either on command or on own

37
Q

Examine motor function - spasticity

A

inc resistance to PROM - determine whether inc speed, inc the resistance
Spasticity is velocity dependent!

38
Q

Examine motor function - Additional signs of spastic hypertonia = clasp knife response

A

marked resistance to PROM suddenly gives way

39
Q

Examine motor function - Additional signs of spastic hypertonia = clonus

A

maintained stretch stimulus produces a cyclical, spasmodic contaction
common in PFs, wrist flexors, jaw

40
Q

Examine motor function - Additional signs of spastic hypertonia = hyperactive cutaneous reflexes, pos babinski

A

DF of great toe with fanning or other toes in response to stroking up lateral side of sole of foot - indicative of corticospinal tract disruption

41
Q

Examine motor function - Additional signs of spastic hypertonia = hyperreflexia

A

increased DTRs

42
Q

Examine motor function - Spasticity - Modified ashworth scale

A

6 grades
0 = no inc in mm tone
1 = slight inc in mm tone, minimal resistance at end ROM
1+ = slight inc in mm tone, minimal resistance through less than half of ROM
2 = more marked inc in mm tone through most of ROM, affected part easily moved
3 = considerable inc in mm tone, passive mvmnt difficult
4 = affected part rigid in flex or ext

43
Q

Examine motor function - Rigidity

A

inc resistance to PROM that is independent of velocity of movement

44
Q

Examine motor function - Rigidity - can be ___ or ___

A 
leadpipe = uniform throughout range
cogwheel = interrupted by series of jerks
45
Q

Examine motor function - Decerebrate rigidity/posturing

A

seen in comatose pts with brainstem lesions btw sup colliculus and vestibular nucleus
results in inc tone and sustained posturing in rigid extension of all four limbs and trunk/neck

46
Q

Examine motor function - Decorticate rigidity/posturing

A

seen in comatose pts with lesions above superior colliculus

results in inc tone and sustained posturing of upper limbs in flexion and lower limbs in extension

47
Q

Examine motor function - Opisthotonos

A

prolonged, severe spasms of mm causing head, back and heels to arch backward; arms and hands are rigidly flexed
Seen in severe meningitis, tetanus, epilepsy, and strychnine poisoning

48
Q

Examining reflexes - scoring scale

A 
0 = absent
1+ = tone change, no visible mvmnt in extremities 
2+ = visible mvmnt in extremities
3+ = exaggerated, full mvmnt in extrem
4+ = obligatory and sustained mvmnt, lasting over 30 sec
49
Q

Examine for involuntary movements - tics =

A

spasmodic contractions of specific muscles, commonly involving face, head, neck or shoulder mm

50
Q

Examine for involuntary movements - chorea =

A

relatively quick twitches or dancing movements

51
Q

Examine for involuntary movements - athetosis =

A

slow, irregular, twisting, sinous movements, occurring esp. in UE

52
Q

Examine for involuntary movements - tremor =

A

continuous quivering movements, rhythmic, oscillatory movement observed at rest (resting tremor)

53
Q

Examine for involuntary movements - myoclonus

A

single, quick jerk

54
Q

Examine balance - sensory organization test

A 
6 conditions
1 = EO, stable surface
2 = EC SS
3 = visual conflict (sway referenced vision using a moving surrounding screen) SS
4 = EO, moving surface 
5 = EC, MS
6 = visual conflict, moving surface
55
Q

Examining balance - modified clinical test for sensory interaction in balance (mCTSIB)

A 
4 conditions
EO SS
EC SS
EO FS (foam)
EC FS
Three 30 sec trials are used

NPTE NM (16 decks)

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