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Medical SLP > Module 7 > Flashcards

Module 7 Flashcards

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USMLE® Step 1 flashcards
1
Q 
The brain's blood dependence: 
brain cells depend on: 
blood supplies brain cells with: 
blood also removes ? from? 
the cells of the brain have no mechanism to ? they have complete dependence on
A

uninterrupted and oxygenated blood

nutrition

  • glucose
  • oxygen

metabolic waste (carbon dioxide) from nerve cells

-store glucose or oxygen for later consumption/ blood flow

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2
Q

brain blood flow and stroke

-without adequate blood supply, the brain can only function ? before the cell bodies are

interruption of blood flow for 4-6 minutes results in?

  • damage occurs to the ?
  • the area that surrounds the core infarct is called the
  • neurons in the area of the prenumbra may survive for about ? without alternate circulation, and up to ? if there is some degree of collteral blood supply
A

for a few minutes/ cell bodies are irreversibly damaged

irreversible brain damage

  • core cells that are the center of where the infarction occured
  • ischemic penumbra

20 minutes/ 6-8 hours

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3
Q

Acute stroke:
two types
ischemic: inadequate blood flow to the brain results in ?

hemmorhagic:
- rupture of a blood vessel
- blood which is toxic to brain tissue
- blood also causes swelling of ? swelling can further restrict ?
- issue with tissue damage and potential increasedintra cranial pressure due to the ? as well as ?

A

damage to the brain tissue

causes bleeding in the brain

  • collects in brain tissue
  • brain tissue/ blood flow to other neighboring brain tissue
  • bleed itself/ swelling as a reaction to the blood
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4
Q

Comprehensive Stroke Center:
hospital certified by the ?
Early management of acute ischemic stroke: a guideline for ?
this designation/certificated is given to center that are able to:
.. and… treat all strokes utilizing ?
-provide ? for blood clot removal
-provide

A

American Heart Association/american stroke association stroke leadership council

healthcare professionals from the american heart association/american stroke association

  • quickly and effectively/ medications to resolve blood clots
  • catheter based procedures
  • neurosurgical services
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5
Q

Treatment for ischemia in the brain:
what restores blood flow:
-
-

A

tPA (tissue plasminogen activator) - drug

thrombectomy: procedure (vascular/neurosurgery) - larger clot in larger vessel

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6
Q 
Tissue plasminogen activator: 
tPA (generic name is ? ) approved by FDA in ? 
-dissolves blood clots that are 
-given to patients via 
-administered within ? 
limits risk of ? 
....
consider timing of
A 
alteplase/ 1996 
blocking blood flow to the brain 
- IV 
-3 hours of symptoms onset 
-brain damage and functional impairment 
-hemorrhage (risk and contraindication) 
-SLP intervention
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7
Q

Thrombectomy:
in some hospitals can be completed up to? (if imaging shows ?)
-more typically, the window is … from symptom onset (with assumption that damage to neural tissue will not be improved by ?)
time of onset is tricky calculaton
-…. onset
-variation in ?

A

24 hours after onset of ischemic stroke ( there would be therapeutic benefit)

6 hours (intervention)

unwitnessed
A&P of individual patients

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8
Q

Thoughts about stroke and COVID-19:
risk of worse outcomes with COVID-19 patients with history of ?
risk of stroke with COVID:
-two studies ad meta-analysis suggests that stroke is associated with ?

covid-19 itself may contribute to development of?
-prevalence of ischemic stroke is ?
true association remains ?
further investigation and more consistent covid screening ?
consider the non-COVID patient: risk of greater ? lasting deficits from stroke as patients are less likely to ?

A

stroke

2.5 fold increase in likelihood of severe COVID-19 with a trend in increased mortality

vascular events
-1.6%
unclear
-needed

injury/ seek medical treatment due to COVID

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9
Q

Acute Ischemic Stroke and COVID-19 an analysis of 27, 676 patients:
investigated ?
patients with covid with or without ischemic stroke and
acute ischemic stroke patients with and without ?

A

risk factors, comorbidities and outcomes between

covid

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10
Q

total of 103 patients developed ? among 8136 patients with covid

among all patients with covid the proportion of patients with hypertension, diabetes, hyperlipidemia, atrial fib, and congestive heart failure ?

acute ischemic stroke was associated with discharge to ?

A

acute ischemic stroke

was significantly higher among those with acute ischemic stroke

destination other than home or death

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11
Q

Acute ischemic stroke was infrequent in patients with ? and usually occurs in the presence of other ?

the risk of discharge to destination other than home or death increased 2-fold with occurence of ?

A

cardiovascular risk factors

acute ischemic stroke in patients with COVID 19

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12
Q 
Stroke - intervention/facilities:
... care
Subacute care: 
depends upon ? 
-consider 
-... patients 
sadly, can depend upon 
options: 
... rehab 
-... rehab 
long-term ? 
home (... considerations) 
-
-
A

acute care

level of function

  • rehab needs
  • ambulatory patients

finances

acute rehab (inpatient rehab) 
-sub-acute rehab (SNF) 
-care facility (frequently SNF first) 
(safety considerations) 
-home health 
-outpatient rehab services
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13
Q

Brain tumors:
a neoplasm is an area of uncontrolled ?
tumors result from an improper expression of ? and a decrease in expression of ?
-angiogenesis also promotes ? this is the formation of new blood vessels which promotes?
tumors in the brain can be ?
metastatic tumors in the brain are frequently metastasis of cancers including ?
they can also come from ? and from ?
spread results from cells traveling through the ?

A

growth of body tissue/ includes the glia

oncogenes (coding proteins involved with cellular growth) / tumor supressor genes

tumor growth / growth of tumor tissue

primary or metastatic

breast, lung, colon/ lymphomas and melanoma

lymphatic system or blood vessels

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14
Q 
Neuroglial cells- functions 
astrocytes (CNS)
-form a complete ? 
-contribute to the blood-brain barrier by restricting ? 
form ?

Oligodendrocytes:
form ? around axons in the CNS

microglia:
migrate to a site of ?

ependymal cells:
form the ?

Schwann cells (PNS) 
-form the ? 
constitute ... around fibers in the PNS
A

lining around the surface of the brain

  • permeability of ionic substances across the blood vessels
  • scars around a cerebral infarct

myelin sheaths

brain lesion and engulf cellular debris to remove it

membranous lining of the ventricular cavity

myelin sheath around axons in the PNS
fibrous connective tissue

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15
Q 
Brain Tumors Can Be: 
are staged in grades (1-4)
Grade 1: 
Grade II: 
Grade III: 
Grade 4:
A

non-cancerous or very slow growing
cancerous but slow growing (cells look closer to normal)
cancerous y grow faster than grade 1 and II (more cell abnormalities)

fast growing with greater cell abnormalities (may also have necrotic tissue; develop own blood vessels, spread to other parts of brain)

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16
Q

Brain Tumour Types:
astrocytoma:
arise from
the worst brain tumour is the ?

ependymoma:
arise from

oligodendroglioma:
arise from ? frequently found in ?

A 
astrocytes 
Glioblastoma (GBM) - a type of astrocytoma

ependymal cells lining the ventricles

oligodendrocytes - frequently found in the frontal region of the adult brain

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17
Q

Brain Tumors (Non-malignant)
Meningioma: arises from ?
usually ?

Acoustic neuroma (vestibular ? ) 
arise from the ? and are typically located at the

symptoms can include: and can cause other ?
-…,…,…
cause ?

Pituitary adenomas:
cause ? and can produce ? due to ?

A

meninges
non-malignant

schwannoma
-nerve sheath/ cerebllopontine angle

impaired hearing acuity and equilibrium / other deficits (tumour and post-op)
-facial weakness, dysphagia, dysphonia
hydrocephalus (obstruct fourth ventricle)

hormonal dysfunction / visual deficits / compression of optic chiasm

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18
Q 
Diagnosis and TX planning: 
... planning is frequently completed at a ? 
typically conducted ?
include: 
-
-
-
-
-
-
-
A

medical/surgical / neuro tumour board meeting
weekly

  • neuroradiologist
  • pathologist
  • medical oncology
  • radiation oncology
  • neurosurgery
  • neurology
  • mid-level providers
  • SLP
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19
Q

Treatment options:
medical ?
-

radiation?

  • … therapy
  • several ?

neuro?

all of the

what will?

… of the above

A

oncology
-chemotherapy

radiation oncology

  • radiation therapy
  • several types

neurosurgery

  • all of the above
  • timing be?
  • none of the above
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20
Q 
SLP role:
Communication ? and swallowing ? 
pre-treatment ? 
post-surgery 
intervention during ? as needed
post-treatment ? 
-treatment as 
-...
participation in ?
A 
function
baseline measures 
functional measures 
medical and radiation oncology treatment, as needed
functional meaurements 
-appropriate 
-education 
awake craniotomy
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21
Q 
Dementia: 
an ? term 
a group of disorders that affect 
affects: 
-
-
-

2 types:
… dementia
… dementia
…

A

umbrella term
brain function

  • thinking
  • behavior
  • ability to complete ADL

cortical dementia (alzheimers)
sub-cortical dementia (Parkinsons dementia)
combo

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22
Q

Types of dementia:

alzheimers:
- the most common
- accounts for ?

.. dementia:
second most
-accounts for

Lewy body:
accounts for

frontotemporal:
accounts for

other

A

form of dementia
40-70%

vascular dementia

  • common from
  • 15-25%

2-20%

2-4%

brain injury 
ETOH
HIV
PD
HD
creutzfeldt jakob
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23
Q

Role of SLP:
communication:
assessment of
educate?

-to maximize
intervention with SLP should be ?

Swallowing: 
assessment of ? 
-may be best to ask what will be 
-establish 
consider 
treatment may be ? due to ?
A

current function
-medical professionals and family members

strategies
-environmental
-comm. function
relatively short in duration

  • current function
  • done regarding results
  • least restrictive PO diet
  • patient and family wishes
  • limited / cognitive comm. dysfunction
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24
Q 
Tube feeding in severe dementia: 
main results:
-no .. trials identified 
-seven 
-six assessed ? 
-the other study assessed ?
there's was no evidence of increased ? 
none of these studies examined ? and there was no evidence of benefit in terms of ?

authors conclusions:
despite the very large number of patients receiving this intervention there is insufficient evidence to suggest that enteral tube feeding is ?
data are lacking on adverse effects of ?

A

randomised controlled trials identified

  • observational controlled studies identified
  • mortality
  • nutritional outcomes
  • survival in patients receiving enteral tube feeding
  • QoL nutritional status or prevalence of pressure ulcers

beneficial in patients with advanced dementia

-this intervention

25
Q 
What is delirium: 
a state of 
characteristics of delirium include:
difficulty 
difficulty 
confused about 
hallucinations - ... that are not 
develops over a short 
has ?
A 
severe confusion 
-thinking clearly 
-to attend
-situation/circumstances 
hearing or seeing things not present

period of time
fluctuating symptoms

26
Q

ICU Delirium:
approx. … patients in the ICU experience delirium

approx. ona. ventilator experience delirium (while on or immediately following)

linked to negative ? increased? decreased ? and greater ?

A

2/3

7/10

medical outcomes n(increases LOS in ICU and Hospital) , costs, survival, long-term cognitive dysfunction

27
Q 
Advice for PT and family/friends 
speak? use ? 
remind patient of 
talk about 
bring ? 
decorate room with 
provide patient with 
if your loved one has delirium you might be asked to ?
A 
calmly/simple words or phrases 
day and date 
family and friends 
glasses/hearing aids 
calendars, posters, family pictures 
favorite music/tv 
delirium/ sit and help calm them
28
Q

Delirium prevention and Management:
delirium is one area that is part of a larger
there are specific components of care that include
care programs include:
-.. assessment and management
-reducing ? to allow for
electing the best … for individual pt’s
delirium?
early
engaging with

A

overall care plan in ICU
delirium in plan of care implemented

pain 
sedatives/ awakening and spontaneous breathing 
-analgesics/pain meds 
-prevention, assessment, mgmt
mobility/exercise 
family members
29
Q 
Post intensive care syndrome: 
physical, psychological, and cognitive symptoms that persist ?
physical symptoms include: 
-
-.. difficulty 
-... and ...
psychological symptoms can include: 
-
-
-
-
A

after critical illness

  • weakness and balance issues
  • breathing difficulty
  • pain and numbness

anxiety
depression
PTSD
Sleep disturbance

30
Q

Cog. Symptoms of PICS:
difficulty w/
memory
increased

A

concentration.attention
deficits
processing time

31
Q

Traumatic Injury:
Traumatic injury is a term which refers to ? which require ? the insult may cause system shock called ? may require immediate ?

A

physical injuries of sudden onset and severity/ immediate medical attention/ shock trauma/ resuscitation and interventions to save life and limb

32
Q 
Metabolic, endocrine and immunologic response to trauma: 
body response to trauma includes: 
...
an increase in use of 
increased 
increased 
development of 
-higher blood glucose levels have been found to be associated with ?
A

tachycardia
use of oxygen
respiratory rate
insulin resistance

fatal outcomes in trauma patients

33
Q

Trauma statistics:
center for disease control
10 leading causes of death in 2017 ?
in groups from ages 1 to 44 unintentional injury is ranked

for persons from 45-64 years unintentional injury is ranked

A

1st

3rd

34
Q

History of Care for traumatic injury:
care and transportation build from medical lessons learned from ?

legislation in 1966:
accidental death and disability: the neglected disease of modern society - advocated for strong govt. leadership to develop

national highway safety act: provided funding from congress to reduce mortality from

Illinois developed the first statewide ? which extended the knowledge gained at Cook county hospital in Chicago which was one o the first

A

1st and 2nd world wars

trauma care as well as funding for research

motor vehicular accidents

trauma system/ first true trauma centre in the US

35
Q

The American Trauma System:
designed to provide an ?
Run at the state and local level with guidance by ?
-geographic distribution of trauma system resources correlates with ? lower fatality rates seen in areas with more?

care begins in the field with ?
4 levels of trauma center
-level I trauma center: comprehensive regional resource providing ? typically located in ?

A

organized response to injury

  • national societies
  • outcomes/ clustered trauma centers

emergency medical services personel

I-IV

-total care for every aspect of injury/large cities or densely populated areas

36
Q

Air Care:
modern air medical transport began in ? with what program ? the first hospital-based air medical transport in US

by 1990 there were more than ? in operation

air care reduces the amount of ? to expidiate evacuation within?

it is estimated that there are nearly ? annually with an additional 150,000 patient flown by ? each year in the US

A

1972/ Flight for life program at Anthony’s hospital in Denver

170 air transport programs

pre-hospital time / golden hour

400,000 helicopter transports /by fixed wing aircraft

37
Q

Air care flight physiology:
oxygenation changes during ? (consideration for … levels, which may result in need for ? prior to flight)

a pneumothorax should be addressed prior to flight because of risk of ?

penetrating ocular injuries should be transported at the ? due to the impact of intraocular pressure on the retina

expansion and contraction of gasses also have painful ? sites impacted include the ? Gas within the body expands during? patients with abdominal trauma should have a ? in place to avoid any mechanical effects

Temperature ? aircraft temperature is controlled but if there is failure of that system, a plan must be inplace as hypothermia has been found to dramatically increase ? also must consider the concern of the temperature of ? within aircraft

A

ascent from ground to higher altitudes/ hemoglobin levels/ blood transfusion

expansion or development of a tension pneumothorax during flight

lowest possible altitude

mechanical effects on the body/ middle ear, teeth, sinuses, and GI tract / ascent/ NGT

decreases with ascent/ mortality in trauma patients/ medications and supplies

38
Q 
At the hospital: 
injuries include: 
known 
unknown 
-...
issues that result from ? 
-
other considerations: patient's
A

known injury
unknown injury
-fistulas

life-saving treatment
-intubation/extubation/tracheostomy

patients past emdical and surgical hx

39
Q 
impact of traumatic injury: 
patients require
family 
academic / occupational 
need for
A

contiuum of care
family impact
impact of injuries
ongoing support services

40
Q

Other factors:
I…
location of
family

A 
insurance 
injury (out of town, state, international travel) 
dynamics: discharge panning - need for 24 hour care
41
Q 
SLP evaluation and intervention: 
deficits including: 
-disorders of 
-...impairment 
...impairment
A

consciousness
comm. impairment
swallowing impairment

42
Q 
Dysphagia assessment decision making: 
special considerations for this patient population: 
patient positioning: 
-unstable 
-external

aility to safely ?
-… deficits
…fixators
-…

type and timing of ?

A

restrictions and limitations

  • spine
  • external ventricular drain (EVD)

transport to radiology
-cognitive comm. deficits
external fixators
-IVs and chest tubes

dysphagia assessment

43
Q

Swan-Ganz Catheter:
inserted into the right side of ?
can measure ?
measures pressure in the

A

heart to monitor heart functions

  • blood flow in the right atrium and right ventricle
  • pulmonary artery
44
Q 
Dysphagia assessment decision making in trauma: 
what is the appropriate timing of the eval: 
-time of
-medication 
-... factors 
-NGT to 
Small and large 
Ileus: obstruction of 
-post-surgical /?
A 
day (alertness) 
delivery (pain and level of alertness) 
factors (is it safe to assess/safety for PO intake) 
-suction 
bowel issues 
-part of intestine 
opioid use
45
Q 
Dysphagia Assessment decision making: 
which test provides the best ? 
FEES: 
contraindications include: 
... fractures 
ability to 
... (risk of bleeding) 
fluoroscopy tower versus C-arm 
-.
-
-transfer 
-

If MBS which contrast to utilize (whose decision)
-…
…

A

assessment

nasal/facial
participate/cooperate
anticoagulation

weight
positioning
transfer constraints
cognition (Ranchos IV or lower-likely not)

radiologist decision
water-soluble
barium

46
Q

Covid consideration:
trauma is typically not an

anecdotally a large number of patients have been admitted to the hospital status post fall/trauma have been found to be

A

elective hospitalization

COVID positive

47
Q 
Assessment: 
limited in acute care due to level of 
formal assessment may not be ? 
-length of time to 
-higher level tasks on

formal assessments include:
SCATBI:
CLQT:
RBANS:

A

function/severity of injury

possible

  • assess
  • assessment

scales of cognitive ability in traumatic brain injury
cognitive linguistic quick test
repeatable battery for the assessment of neuropsychological status

48
Q

The montreal cognitive assessment
a brief 30 question test that helps healthcare professionals detect ? allowing faster ? and patient ?

MoCA is the most ? available for detecting ? measuring ? and multiple ? which are important components not measured by ?

A

COGNITIVE IMPAIRMENTS VERY EARLY ON / diagnosis/care

sensitive test / alzheimers disease/ executive functions / cognitive domains/MMSE

49
Q

In 2003, after analysis of the 2000 study results, a few elements of the test were optimized and a new validation study was copleted in 2003-2004 which confirmed the test’s discirminatory ability to distinguish ?

A

normal controls from subjects with mild cognitive impairment or mild alzheimers disease

50
Q 
Cognistat: 
Standardized for ? 
-..,...,...
how long to administer 
or less with? 
evaluates: 
-
-..skills 
-
-
-
A

adolescents and adults
stroke, TBI, dementia

15-20 or less with screening

language 
spatial skills 
reasoning 
memory 
calculations
51
Q 
Mild TBI/Concussion 
identification of patient's who have potentially 
-nursing ?
-may or may not involve 
imaging may be

mechanism to educate patients and families about
mechanism to see these patients for

athletes versus ?

  • different
  • pre-testing for athletes mayhave been
A

sustained a concussion
-identifiers
-loss of consciousness
normal

potential issues that may arise
outpatient follow up

non-athletes
-referrals for outpatient
completed

52
Q 
Signs and symptoms of Mild TBI: 
social: 
interactions with 
maintaining 
difficulty with 
participating in 
-engaging in 
-difficulty taking perspective of
A 
others
a topic in convo 
word-finding in convo 
social roles as a spuse, parent, friend 
activities like work and school 
others
53
Q 
Signs and symptoms of mild TBI: 
mental
difficulty 
feeling 
difficulty with 
difficulty with 
difficulty with 
difficulty wih
A 
concentrating 
slowed down or sluggish 
memory 
problem solving 
decision making 
multi-tasking and completing daily activities
54
Q 
Signs and symptoms of mild TBI 
emotional: 
change in 
changes in 
-
-emotional 
-easily 
-...
A 
personality 
mood/sadness
irritability 
outbursts
overwhelmed 
nervousness
55
Q 
Sign and symptoms of Mild TBI: 
physical 
...
loss of 
impaired 
slower 
.. or... 
blurry 
sleeping
A 
headache 
balance 
coordintion/dizziness
reaction time 
nausea or vomiting 
blurry vision 
difficulty
56
Q

The 3 ounce water test/challenge:
initially information for swallow screening published in
several other publications followed by ? lacked adequate ?
debra suiter Ph.D. and steven leder Ph.D. completed further investigation of this screening and there is now a great deal of ?

use by 
use by 
initially used with ? 
subsequent investigations included varied ? 
not just ? includes other ?
A

1992

different authors/ sample size and lacked statistical power

evidence available

slps 
nurses
stroke patients 
populations 
stroke/ neurological and pulmonary disorder and specific surgeries
57
Q

Yale swallow protocol:
brief
… exam
.. water challenge

A

cognitive assessment
oral mechanism exam
3 oz

58
Q 
3 oz water test: 
SLP involvement in developing and or maintaining 
typically completed by 
assess patient for ?
-
-
administer ? 
-...sips
A 
this screening program 
nursing 
appropriateness to administer PO 
-alertness 
intubation

3 oz of water
consecutive sips

59
Q

Performing RN stroke swallow screen:
step 1
step 2
step 3

A

initial assessment
swallow challenge
documentation

Medical SLP (11 decks)

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