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Clinical Reasoning > Midterm > Flashcards

Midterm Flashcards

1
Q

Neurological Patient Exam? (12)

A
  1. DT Reflexes
  2. Tone
  3. Clonus, Babinski
  4. MMT
  5. ROM
  6. Sensation – light touch, sharp/dull
  7. Proprioception
  8. Kinesthesia
  9. Coordination
  10. Balance
  11. Posture
  12. Functional assessment: bed mobility, sit -> stand, stair negotiation, transfers, gait, w/c mobility
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2
Q

MS Presentation? (12)

A
  • Paresthesias, pain, numbness
  • Weakness
  • Fatigability
  • Intention tremor
  • Ataxia
  • Spastic paraplegia
  • Dysarthria
  • Emotional lability
  • Visual impairment
  • Impaired balance
  • Incoordination
  • Contractures
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3
Q

MS considerations? (3)

A

Fatigue easily, side effects of disease modifiers, chronic

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4
Q

Parkinson’s Presentation? (21)

A
  • PIGD: Postural instability gait disturbance
  • Rigidity
  • Akinesia – difficulty initiating movement
  • Bradykinesia – decreased torque production, difficulty changing direction, terminating movement
  • Resting tremor
  • Motor planning deficits
  • Decreased trunk rotation and reciprocal arm swing
  • Difficulty performing simultaneous and sequential movements
  • Pill rolling tremor
  • Flexed, stooped posture
  • Impaired balance 2/2 impaired anticipatory and automatic postural responses
  • Frequent falls
  • Dysphagia/dysarthria
  • Fatigue
  • Masked face
  • Freezing episodes
  • Contractures common
  • Shuffling, festinating gait
  • Loss of heel-toe pattern
  • Decreased single limb support
  • Orthostatic hypotension
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5
Q

PD considerations? (7)

A

Fatigue easily, difficulty sustaining activity, repetitive tasks begin strong but become weaker, weaker as the day goes on, orthostatic hypotension, respiratory issues, L-dopa and drug holidays

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6
Q

TBI Presentation? (16)

A
  • Altered level of consciousness/coma
  • Abnormal tone
  • Abnormal posturing – decorticate/decerebrate rigidity
  • Abnormal reflexes
  • Paralysis
  • Incoordination/ataxia
  • Balance deficits
  • Motor control deficits
  • Impaired sensation and proprioception
  • Apraxia
  • Spatial neglect
  • Somatagnosia
  • Right-left discrimination
  • Hemianopsia/cortical blindness
  • Orientation, memory, attention deficits
  • Perseveration
  • Impairments of executive functions
  • Aphasias
  • Dysarthria
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7
Q

Ranchos Los Amigos Levels of Cognitive Functioning? (8)

A 
I.     No response
II.   Generalized response
III.  Localized response
IV.  Confused-agitated
V.   Confused-inappropriate
VI.  Confused-appropriate
VII. Automatic-appropriate
VIII. Purposeful-automatic
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8
Q

TBI considerations? (4)

A

how long were they in a coma for? Secondary impairments (contractures, skin breakdown, heterotrophic ossification)

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9
Q

SCI Presentation? (6)

A
  • Tetra/paraplegia
  • Postural hypotension
  • Autonomic dysreflexia (autonomic reflex causing BP to skyrocket)
  • Impaired temperature control
  • Spasticity
  • Pulmonary impairment
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10
Q

ASIA A?

A

A = Complete

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11
Q

ASIA B?

A

B = Sensory Incomplete: Sensory but not motor function is preserved below the neurological level and includes the sacral segments AND no motor function is preserved more than three levels below the motor level on either side of the body.

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12
Q

ASIA C?

A

C = Motor Incomplete: Motor function is preserved below the NLI and more than ½ of the key muscles below the NLI have a grade less than 3 OR voluntary anal contraction.

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13
Q

ASIA D?

A

D = Motor Incomplete: Motor function is preserved below the NLI and at least ½ of the key muscles below the NLI have a grade equal or less than 3.

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14
Q

ASIA E?

A

E = Normal

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15
Q

SCI considerations? (6)

A

Pressure sores, DVT, contractures, pain, osteoporosis, heterotopic ossification

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16
Q

Neuropathic dysfunction presentation? (14)

A

weakness, atrophy, cramping with fatigue, decreased DTRs, hypotonicity/flaccidity, hypo/hyperesthesias, parasthesias, dysesthesia, impaired position sense, vibration, pinprick, and temperature

17
Q

DM presentations? (7)

A
  • Distal extremities mainly affected
  • Decreased sensation
  • Dysesthesia
  • S&S begin in feet
  • Stocking & glove neuropathy
  • Loss of position sense, vibration, pain, and temperature
  • Pain
18
Q

DM consideration?

A

DM neuropathies may be due to uncontrolled blood sugar (ask pt. about lifestyle, med compliance, etc.)

19
Q

CMT presentation? (10)

A
  • Involves mainly peroneal nerve
  • Affects muscles in foot and lower leg mainly
  • Distal symmetric muscle weakness: DF and evertors most affected
  • Footdrop gait
  • Atrophy
  • Decreased DTRs
  • Pes Cavus
  • Hammer toes
  • Loss of proprioception in feet and ankles
  • UEs become involved with disease progression
20
Q

CMT consideration?

A

Slowly progressive disease, weakness and contracture lead to gait abnormalities, fall, difficulties manipulating objects in hands

21
Q

GBS presentation? (10)

A
  • Rapidly evolving, symmetrical ascending weakness/flaccidity
  • Areflexia
  • Varies from mild distal Le weakness to total paralysis of peripheral, axial, facial, extraocular muscles
  • Autonomic impairments: impaired CO, arrhythmias, unstable BP, impaired venous return
  • Distal hyperesthesia
  • Paresthesia
  • Numbness
  • Impaired vibration and position sense
  • Stocking and glove pattern
  • Pain
22
Q

GBS considerations? (3)

A

Increasing weakness can last 2-3 months, LT tibialis anterior weakness, fatigue/poor endurance

23
Q

MG presentation? (8)

A
  • Fluctuating weakness and fatigability
  • Repetition of activity causes fatigue
  • Rest restores muscle activity
  • Cranial muscles, especially extraocular mm, affected first
  • Proximal muscles affected more than distal
  • Unstable, waddling gait
  • Dysarthria/dysphagia
  • No sensory involvement
24
Q

MG consideration?

A

Repetition of activity causes fatigue, pt. needs to take breaks.

25
Q

ALS presentation? (12)

A
  • Spasticity
  • Hyperreflexia
  • Muscle weakness
  • Atrophy
  • Cramps
  • Fasciculations
  • Hypotonicity
  • Hyporeflexia
  • Asymmetrical muscle loss
  • Distal muscles affected more than proximal
  • Dysarthria
  • No sensory involvement

Clinical Reasoning (1 decks)

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