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MY NPTE > Neuro > Flashcards

Neuro Flashcards

1
Q

Dysdiadocokinesia

A

inability to perform rapid alternating movements

indicative of cerebellum involvement

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2
Q

Dysmetria

A

decreased ability to judge distance

impaired with

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3
Q

Dysarthria

A

motor deficit of muscles of speech and breathing

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4
Q

WC management for high cervical tetraplegia

A

Dependent

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5
Q

Anterior cord syndrome

A

Bilateral loss of lateral corticospinal tracts (motor) and spinothalamic tract (pain and temp)

Proprioception and vibration intact (DCML)

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6
Q

Common MOI anterior cord syndrome

A

Cervical hyperflexion

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7
Q

Brown Sequard Syndrome

A

Ipsilateral loss of motor (lateral corticospinal) and propricoception/vibration (DCML)
Contralateral loss of pain, temp (lateral spinothalamic) crude touch (anterior spinothalamic)

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8
Q

MOI for central cord syndrome

A

Cervical hyperextension

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9
Q

Posterior cord syndrome

A

Bilateral loss of DCML (proprioception, vibration, 2 point discrimination)

Motor function (lateral corticospinal) and pain/temp/light touch (lateral spinothalamic) preserved

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10
Q

Dermatome C5

A

Anterolateral shoulder

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11
Q

Dermatome C6

A

anterior arm, thumb, index finger

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12
Q

Dermatome C7

A

Middle finger

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13
Q

Dermatome C8

A

Medial arm and forearm + little finger

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14
Q

Brachial plexus arises from

A

C5-T1

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15
Q

With posteriorly herniated discs, the affected nerve root is above/below the vertebral segment

A

Below

ex. L4/L5 posterior herniation = L5 impairments

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16
Q

With lateral/posterolateral herniated discs, the affected nerve root is above/below the vertebral segment

A

above

ex. L4/L5 disc = L4 impairments

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17
Q

Thoracic dermatome landmarks:

T4
T6
T10
T12

A

T4- nipples
T6- xiphoid process
T10- umbillicus
T12- pubis

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18
Q

Dermatome L1

A

greater trochanter, over inguinal/groin

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19
Q

Dermatome L2

A

Anterior thigh to knee

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20
Q

Dermatome L3

A

Anterior thigh to medial knee/lower leg

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21
Q

Dermatome L4

A

Patella to medial malleolus to big toe

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22
Q

Dermatome L5

A

Lateral leg (fibular head) and dorsum of foot (

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23
Q

Dermatome S1

A

Lateral 5th digit and plantar aspect of foot

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24
Q

C1/2 myotome

A

cervical flexion/extension/rotation

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25
Q

C3 myotome

A

cervical lateral flexion

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26
Q

C4 myotome

A

shoulder elevation (upper trap/levator)

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27
Q

C5 myotome

A

shoulder abduction (deltoid, supraspinatus)
elbow flexion (biceps)

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28
Q

C6 myotome

A

wrist extension (extensor carpi radialis)

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29
Q

C7 myotome

A

Elbow extension (triceps)
Wrist flexion (flexor carpi radialis)

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30
Q

C8 myotome

A

Thumb extension (EPL)
IP flexion (FDProfundus)

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31
Q

T1 myotome

A

Finger abduction (dorsal interossei)

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32
Q

L1-2 myotome

A

Hip flexion (iliopsoas)

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33
Q

L3 myotome

A

Knee extension (quads)

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34
Q

L4 myotome

A

Ankle dorsiflexion/inversion (TibA)

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35
Q

L5 myotome

A

Great toe extension (EHL)

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36
Q

S1 myotome

A

plantarflexion (gastroc)
eversion (peroneals)

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37
Q

S2 myotome

A

knee flexion (hamstrings)

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38
Q

S3-4 myotome

A

anal wink

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39
Q

SLR will test what myotomes

A

L1-4
(hip flexion + knee extension)

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40
Q

Walking on toes will test what myotomes

A

S1

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41
Q

Anterior spinothalamic tract

A

crude touch (general, non-discriminative touch) and pressure

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42
Q

Lateral spinothalamic tract

A

pain and temperature

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43
Q

Ascending sensory pathways

A

Spinothalamic tracts
DCML

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44
Q

Where is crude touch found vs fine touch

A

Crude (non-discriminative) - anterior spinothalamic
Fine (localization) - DCML

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45
Q

A delta fibers transmit …

A

sharp pain

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46
Q

C fibers transmit …

A

poor localized, dull pain

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47
Q

A-alpha fibers transmit …

A

motor and proprioception
LARGEST AND FASTEST

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48
Q

A-beta fibers transmit …

A

touch

these are faster than A delta which is why you rub your toe after you stump it

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49
Q

A-gamma fibers transmit

A

muscle spindles

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50
Q

Deep sensory receptors

A

posture, position sense, proprioception, muscle tone, and speed and direction of movement

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51
Q

Mechanoreceptors

A

detect touch such as vibration and pressure

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52
Q

Chemoreceptors

A

detect changes in chemical composition to regulate cardiovascular and respiratory functions

ex. taste buds, aortic buds

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53
Q

Thermoreceptors

A

nerve cell endings that regulate changes in body temperature

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54
Q

Dorsal horn =

A

sensory

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55
Q

Ventral horn =

A

motor

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56
Q

To be classified as a stroke, how long do symptoms have to last?

A

24 hours

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57
Q

Characteristics of L-sided stroke

A

cautious, careful
speech and language impairments including motor of speech or expressing (Brocas) and difficulty comprehending/utilizing cues (Wernickes area)

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58
Q

Characteristics of R-sided stroke

A

quick, impulsive, poor judgement
visual perceptual deficits (pushers)
difficulty with perception of emotions

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59
Q

Patient with L sided stroke will have difficulty with visual or verbal cues

A

verbal

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60
Q

Patient with right-sided stroke will have difficulty with visual or verbal cues

A

visual
due to visual-spatial deficits

best to approach with direct verbal cues

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61
Q

What is the best approach/cues for a patient with R R-sided stroke

A

direct verbal cues

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62
Q

What is the best approach/cues for a patient with L-sided stroke

A

body language, hand gestures, facial expressions

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63
Q

MCA stroke deficits

A

UE>LE

contralateral motor and sensory loss
aphasia if dominant hemisphere impacted

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64
Q

ACA stroke deficits

A

LE>UE
contralateral motor and sensory loss

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65
Q

PCA stroke deficits

A

contralateral homonymous hemianopsia (loss of visual field of each eye)
contralateral sensory loss
involuntary movements (chorea, athetosis, hemiballism, tremor) - PCA affects more the cerebellum

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66
Q

Bells Palsy vs Trigeminal neuralgia differential

A

Trigeminal neuralgia
-painful
-decreased sensation in CN V distribution (forehead, cheek, maxilla)
-weakness of temporalis and masseter muscles
?
-exacerbated with stress or cold, better with relaxation

Bells palsy
-compression of the facial nerve in temporal bone
- deficits include anterior taste 2/3 tongue, ipsilateral weakness of facial muscles (frontalis, inability to smile, puff cheeks, raise eyebrows, close eye (orbicularis oculi))
-no pain, just paralysis
-Excessive tearing due to dry eye, loss of salivation control
-no sensory deficits

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67
Q

Triggers for trigeminal neuralgia

A

stress or cold

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68
Q

CVA vs Bells Palsy

A

CVA is quicker onset, typically only lower part of face is affected vs Bells palsy which is entire hemi paralysis

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69
Q

Brunnstrum stages of recovery

A

Stage 1- flaccidity, no volitional movement
Stage 2- emerging spasticity
Stage 3- peak spasticity, voluntary movement within synergy**
Stage 4- decreased spasticity, voluntary movement outside of synergy** or partial synergies
Stage 5- movement out of synergy and individual joints, but no coordination
Stage 6- near normal control, full spectrum of movements
Stage 7- normal

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70
Q

Stage 1 Brunnstrum

A

Flaccidity - initial phase of shock w/ no active movement or tone

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71
Q

Stage 2 Brunnstrum

A

Emergence of Spasticity - small involuntary movements occur + development of basic limb synergy pattern

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72
Q

Stage 3 Brunnstrum

A

peak spasticity, peak synergy
Voluntary movement within the synergy
basically the worst phase

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73
Q

Flexor synergy pattern UE

A

Scapula elevation and retraction
Shoulder abduction and ER
Elbow flexion
Wrist flexion and supination
Finger flexion/adduction

think about trying to scratch your own armpit

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74
Q

Stage 4 Brunnstrum

A

decline in spasticity, decline in synergy
Voluntary movement out of synergy

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75
Q

Stage 5 Brunnstrum

A

movement out of synergy , lack of coordination

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76
Q

Stage 6 Brunnstrum

A

near normal function

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77
Q

Stage 7 Brunnstrum

A

normal

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78
Q

Extensor synergy pattern UE

A

Scapula depression and protraction
Shoulder IR and adduction
Elbow extension
Wrist pronation and extension
Finger flexion/adduction

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79
Q

Intervention techniques for spasticity/synergistic patterns

A

Low load resistance out of synergy
WB for extended period of time out of synergy
PNF out of synergy

Overall, early mobilization through stretching and ROM

80
Q

CNS vs PNS

A

CNS - brain and spinal cord
PNS - connects CNA to limbs; consists of all other peripheral nerves

81
Q

ANS

A

Technically part of the PNS

controls breathing, HR, digestion, salivation, etc

82
Q

Sympathetic nervous system neurotransmitter

A

norepinephrine and epinephrine

83
Q

Parasympathetic NS neurotransmitter

A

mostly AcH

84
Q

Lateral fissure

A

separates frontal from temporal and parietal lobes

85
Q

Dermatome C1

A

apex of skull

86
Q

Dermatome C2

A

back of head to temple to under chin

87
Q

Dermatome C3

A

upper shoulder, clavicle

88
Q

ASIA levels

A

A - full
B - motor paralysis, sensory intact
C - motor intact (less than 50% muscles 3/5)
D - motor intact (more than 50% muscles 3/5)
E - normal

89
Q

Pt displays smooth forehead on the L when smiling: is this stroke or Bells palsy

A

Bells palsy on the L

90
Q

PT treatment for Bells Palsy

A

In addition to corticosteriods (prednisone)

face sling
estim to increase muscle tone
functional retaining of other side of face
protect cornea

91
Q

Flexor synergy pattern LE

A

hip flexion, abduction and ER
knee flexion
ankle dorsiflexion and inversion
toe extension

92
Q

Extensor synergy pattern LE

A

hip extension, adduction, IR
knee extension
ankle plantarflexion and inversion
toe flexion

93
Q

Strongest component of UE extension synergy

A

shoulder adduction

94
Q

Strongest component of UE flexion synergy

A

elbow flexion

95
Q

Central cord syndrome

A

motor affected more than sensory
Distal components of UE > LE
hyperextension MOI

96
Q

Impairments with frontal lobe damage

A

decreased motor
contralateral paralysis
brocas aphasia
unstable emotions, decreased problem solving
inability to discriminate odors

97
Q

Impairments with parietal lobe damage

A

somatosensory impairments (asterognosis, agraphesthesia, extinction)
visual spatial
hearing impairments
taste impairments

98
Q

Grapesthesia

A

ability to understand/feel letters written on hand

99
Q

Red flags for concussion

A

different pupil size
N&V
loss of conciousness more than 30 seconds
headache worse over time
speech, numbness, decreased coordination
Change in behavior

100
Q

Common causes of seizures

A

drug withdrawal
degenerative brain diseases
electrolyte imbalances
infections

101
Q

Grand mal/generalized seizure

A

impacts all areas of the brain
loss of consciousness with stiffening followed by rhythmic movements of arms and legs
incontinence
eyes open
2-5 mins

102
Q

Petit mal/absense seizure

A

posture is normal – repetitive blinking or small movements may occur for a few seconds but may occur multiple x a day

103
Q

Status epilepticus

A

prolonged seizure or multiple seizures in a row with little recovery time for > 30 minutes requiring immediate medical attention as it is life threatening

104
Q

If you notice a patient start to have a seizure, what do you do?

A

loosen restrictive clothing
remove harmful hazards
do not restrain limbs
Establish airway - lay on side
wait for it to stop

105
Q

distributed or massed practice for patients with cerebellar damage (could prob translate to other brain injuries)

A

distributed since

106
Q

DTR for MS

A

hyperreflexic

107
Q

Symptoms of MS

A

double vision
fatigue
hypereflexia and spasticity/hypertonicity
decreased balance and coordination
decreased aerobic capacity and endurance

108
Q

Medical management of MS

A

immunosuppressant drugs sucha s adrenocorticotrophic hormone and corticosteroids such as prednisone, dexamethasone, methyprednisone

109
Q

Exercise considerations with MS

A

breaks for fatigue
when progressing, think about increasing duration before intensity

110
Q

Optimal scheduling for MS

A

mid morning or mid afternoon

111
Q

Hoehn and Yahr Scale

A

1-Unilateral disease with minimal to no dysfunction
2-Bilateral or midline impairment without balance dysfunction
3-Bilateral, impaired balance
4-all symptoms present, walk & stand with assistance
5-Confined to bed and wheelchair

112
Q

Hoehn and Yahr Scale 1

A

1-Unilateral disease with minimal to no dysfunction, some tremors or bradykinesia may be present

113
Q

Hoehn and Yahr Scale 2

A

2-Bilateral or midline impairment WITHOUT balance dysfunction

114
Q

Hoehn and Yahr Scale 3

A

3-Bilateral, impaired balance

115
Q

Hoehn and Yahr Scale 4

A

4-all symptoms present, walk & stand with assistance

116
Q

Hoehn and Yahr Scale 5

A

5-Confined to bed and wheelchair

117
Q

Pathophysiology of PD

A

loss of dopamine (inhbitory) results in excessive Ach (excitatory) output from the basal ganglia = tremors, festinating

118
Q

Whats the importance of Hoehn and Yahr Scale 3

A

this is where BALANCE issues start

119
Q

Whats the importance of Hoehn and Yahr Scale 2

A

bilateral involment NO BALANCE

120
Q

Whats the importance of Hoehn and Yahr Scale 1

A

unilateral involvement

121
Q

“Off” time - parkinsons

A

when symptoms return between medication doses

think meds are wearing off

122
Q

Guillan Barre

A

caused by acute demyelination of peripheral nerves
distal to proximal weakness causing incoordination
diminished DTR (hyporeflexia)
motor>sensory loss

123
Q

Meineres disease

A

excess endolymph fluid causing hearing loss, tinnitus, increased pressure, vertigo

124
Q

Horizontal roll test

A

tests horizontal canal

125
Q

Habituation exercises

A

repetition of movements and positions that provoke dizziness with idea that graded exposure will increase tolerance

126
Q

Flaccid bladder vs spastic bladder

A

flaccid - failure to empty due to LMN injury - no messages between spine and bladder because nerves are damaged - bladder keeps filling because it is not getting signals to empty - thus leaking

spastic - unpredictable emptying due to overactive bladder secondary to lesion of SC at T12 or above - voluntary nerves do not work but reflexive ones do - thus unwanted voiding

127
Q

Above T12 spinal cord injury = spastic or flaccid bladder

128
Q

Below T12 spinal cord injury = spastic or flaccid bladder

129
Q

Good starting weight unloading with BWSTT

130
Q

What is more severe with GBS: Motor or sensory loss

A

Motor
most return to community ambulation within 6 months - 2 years

131
Q

Post polio

A

gradual onset
myalgias, hypersensitivity, fatigue, cold intolerance

132
Q

Labile HTN Post polio

A

Blood pressure fluctuates dramatically from normal to high

133
Q

Post polio affects motor or sensory

A

only motor

134
Q

Common symptoms with NMJ disorders (myasthenia gravis, botulinum toxin)

A

fatigue and weakness

135
Q

What is a muscle characteristic consistent with MG

A

fatigue
muscular strength worse w repeated contraction

136
Q

Etiology of MG

A

damage to post synaptic Ach receptors at NMJ

137
Q

MG patient population

A

females 20-30
men and women 60-80

138
Q

Generalized MG impacts what muscles

A

Extra-occular
Facial
muscle of mastication
proximal limb/girdle muscles

139
Q

Ice pack test

A

Application of an ice pack to eyelid for 2 minutes
reduction in ptosis (eye lid drooping) = myasthenia gravis

MG = post synaptic Ach disorder

140
Q

What is ptosis

A

eye lid drooping

141
Q

Are proximal or distal muscles more involved with MG

142
Q

Lambert Eaton vs MG

A

MG = proximal muscle weakness (post synaptic Ach disorder)
Lambert eaton = distal muscle weakness (pre synaptic Ach disorder)

143
Q

What is botulinum toxin?

A

binding presynaptically to Ach receptors to decrease muscle tone

144
Q

Are there reflex changes with MG?

145
Q

Myopathies affect on muscles

A

prox to distal weakness

146
Q

Non equilibrium coordination tests

A

usually performed in sitting

finger nose finger
heel shin
finger opposition
alternating pronation/supination

147
Q

Equilibrium coordination tests

A

in standing

romberg
walking
standing marching

148
Q

External intercostals innervation and importance

A

T1-T11
act to lift the ribs during inspiration

importance is that unless patient has a high thoracic injury - these muscles will always show partial innervation; unlike rectus which is innervated lower by T7-T12

149
Q

Rectus abdominus innervation

150
Q

Frenkels exercises

A

gradual progressive activities designed to increase coordination

151
Q

Chorea vs athetosis vs hemiballism

A

Chorea - nonrhythmic, rapid, jerking movements that typically impact the distal musculature and the face

Athetosis - nonrythmic, slow, constant writhing movements affecting distal muscles - basal ganglia lesion

Hemiballism - nonrhythmic, rapid, violent, flinging movement that typically occurs unilaterally involving the upper extremity - contralateral lesion in the area of the subthalamic nucleus.

152
Q

Chorea is common with what conditions

A

huntingtons disease and wilsons disease

153
Q

Wilsons disease

A

copper accumulation within liver

154
Q

Non fluent aphasia

A

Motor - Brocas - Expressive - frontal lobe

155
Q

Fluent aphasia

A

Comprehension - wernikes - parietal lobe

156
Q

What would you see with AIN lesion

A

patient not able to make “a ok” sign with their hand - DIP will extend and create a pulp to pulp grip instead of tip to tip

157
Q

Progression for NDT

A

work on tone first
then stability
then mobility

indicated for stroke or CP

158
Q

Progression for PNF

A

mobility
stability
controlled mobility
skill

159
Q

Branches of trigeminal nerve most commonly affected

A

maxillary and mandibular

160
Q

Jaw jerk reflex

A

tests trigeminal nerve

161
Q

CANS pneumonic Webers Test

A

Conductive loss
Affected ear

Normal ear
Sensironeural loss

162
Q

AC>BC w/ bilateral Weber

163
Q

AC>BC w/ lateralized Weber

A

sensironeural to side of lateralization

164
Q

Possible causes of conductive loss

A

ear wax
otitis (ear infection)
foreign body in ear canal
trauma to ear drum

165
Q

Anosogonia

A

brain doesnt understand your consition

Do you know what condition you have?

Ahhh no

166
Q

somatoagnosia

A

do not recognize your own body parts

167
Q

Grade 2 concussion

A

longer than 15 mins - some amnesia - no LOC

168
Q

Grade 1 concussion

A

symptoms resolve in 15 mins - no LOC

169
Q

Grade 3 concussion

170
Q

C1-C4 SCI outcomes

A

sip and puff for mobilty/power WC

dependent ADLs

if above C4 - ventilator

171
Q

C5 expected movements

A

3BIRDS

Biceps
Brachioradialis
Brachialis
Infraspinatus
Rhomboids
Delt
Supinator

172
Q

C5 transfer

A

assistance with slide board

173
Q

C5 mobility

A

power WC with joystick
manual - handrim projection or grip adaptation

174
Q

C6 muscles SCI

A

PET SLIP
Pec major
Extensors
Teres minor

Serratus
Lat
Infraspinatus
Pronator

175
Q

C6 SCI AD

A

Manual WC with friction or projection handrims

may require power for community d/t decreased stamina

176
Q

C6 transfer

A

IND with slide board

this contrasts from C5 which is maxA w/ slide board

177
Q

C7 muscles

A

FEET
Flexor carpi radialis
EPB
EPL
Extrinsic finger extensors

178
Q

C7 SCI AD

A

manual WC with normal handrims

179
Q

Modified ashworth scale 1

A

catch at end of ROM

180
Q

Modified ashworth scale 1+

A

catch through 1/2 ROM

181
Q

Modified ashworth scale 2

A

increase in tone through full ROM, still moved easily

182
Q

Modified ashworth scale 3

A

passive movement difficult

183
Q

Modified ashworth scale 4

184
Q

Visual agnosia

A

inability to recognize once familiar objects

185
Q

Nitrogycerin side effects/considerations

A

increases dizziness and fall risk d/t postural hypotenion

186
Q

ASIA designates what as the C5 myotome

A

elbow flexor

187
Q

Sensation scoring with ASIA scale

A

2 normal
1 dim
0 absent

188
Q

Best treatment approach with fluent aphasia

A

wernickes - struggle with comprehension so visual/tactile cues along with word repetition are most beneficial

189
Q

Best treatment approach with nonfluent aphasia

A

verbal cues since comprehension is intact and they just cant speak well

190
Q

PICA stroke

A

associated with wallenburg syndrome
balance/dizziness
facial numbness and pain/temp lack of sensaiton (trigeminal nerve)
hoarseness (CN IX) and trouble swallowing (CN X)
contralateral pain and temp loss (spinothalamic tract)

191
Q

How to read brain CT

A

looking from top down

cerebrum on top
cerebellem on bottom of image

192
Q

Pushers syndrome pushes to which side

193
Q

If pt had a stroke - which LE are they more likely to WB through

A

less involved

194
Q

Dominant hemisphere

A

Language and logical skills

195
Q

Non dominant hemisphere

A

Perception, arts

196
Q

Myasthenia gravis

MY NPTE (22 decks)

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