Neuro

Question 1

Broca vs Wernicke’s area

Answer 1

Broca - controls motor aspects of speech

Wernicke - language comprehension

Question 2

S&S meningeal irritation/brain infection

Answer 2

1) impaired neck mobility - stiffness and pain w/ limitation and guarding into neck flexion (kernig’s sign and/or brudzinski’s sign)
2) irritability, visual discomfort w/ bright light
3) altered level of consciousness; sleepiness, can progress to coma
4) severe headache, N&V
5) altered vital signs, high fever
6) generalized weakness

Question 3

S&S of increased intracranial pressure/cerebral edema and brain herniation

Answer 3

1) altered level of consciousness - progresses from restlessness and confusion to decreasing level of consciousness
2) altered vital signs (increased systolic BP, widening pulse pressure and bradycardia, periods of apnea, Cheyne-Stokes respirations; elevated temp)
3) headache
4) vomiting
5) pupillary changes (CN 3 signs - unequal pupils, slow reaction to light)
6) papilledema at entrance to eye
7) progressive impairment of motor function
8) seizures

Question 4

homonymous hemianopsia

Answer 4

loss of 1/2 of visual field in each eye
- contralateral to side of cerebral hemisphere lesion

Question 5

bitemporal hemianopsia

Answer 5

loss of outer 1/2 of both the R and L visual field (loss of peripheral vision)
- occurs w/ damage to optic chiasm

Question 6

body scheme disorder (somatognosia) - how to test

Answer 6

have pt ID body parts or their relationship to each other

Question 7

visual spatial neglect (unilateral neglect) - how to test

Answer 7

determine whether pt ignores 1 side of body and stimuli coming from that side

Question 8

R/L discrimination disorder - how to test

Answer 8

have pt ID R and L side of body

Question 9

anosopgnosia - how to test

Answer 9

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

Question 10

figure-ground discimination - how to test

Answer 10

have pt pick out an object from an array of objects

Question 11

form constancy - how to test

Answer 11

have pt pick out an object from an array of similarly shaped but different sized objects

Question 12

spatial relations - how to test

Answer 12

have pt duplicate a pattern of 2 or 3 blocks

Question 13

position in space - how to test

Answer 13

have pt demonstrate different limb positions

Question 14

topographical disorientation - how to test

Answer 14

determine whether pt can navigate a familiar route on his or her own

Question 15

depth and distance imperceptions - how to test

Answer 15

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

Question 16

vertical disorientation - how to test

Answer 16

determine whether pt can accurately ID when something is upright (hold a cane upright)

Question 17

ideomotor vs ideational apraxia

Answer 17

ideomotor - pt can’t perform task on command but can do the test when left on own

ideational - pt can’t perform task at all

Question 18

Decerebrate vs Decorticate
- which patients will have which posturing?

Answer 18

Decerebrate - rigid ext of all 4 limbs and trunk/neck
- seen in comatose pt w/ brainstem lesions between superior colliculus and vestibular nucleus

Decorticate - increased tone and sustained posturing of UE in flexion and LE in ext
- seen in comatose pt w/ lesions above superior colliculus

Question 19

opisthotonos

Answer 19

prolonged, severe spasm of muscles, causing the head, back, and heels to arch backwards; arms and hands are held rigidly flexed

Question 20

risk factors for stroke

Answer 20

• atherosclerosis
• HTN
• cardiac disease
• DM
• TIA

Question 21

sequential recovery stages of a stroke

Answer 21

Stage 1 - initial flaccidity, no voluntary movement

Stage 2 - emergence of spasticity, hyperreflexia, synergies

Stage 3 - voluntary movement possible, but only in synergies; spasticity strong

Stage 4 - voluntary control in isolated joint movements emerging, corresponding decline of spasticity and synergies

Stage 5 - increasing voluntary control out of synergy; coordination deficits present

Stage 6 - control and coordination near normal

Question 22

Guidelines to promote learning w/ R hemiplegia

Answer 22

• develop an appropriate communication base: words, gestures, pantomime; assess level of understanding
• give frequent feedback and support
• do not underestimate ability to learn

Question 23

Guidelines to promote learning w/ L hemiplegia

Answer 23

• use verbal cues; demonstrations or gestures may confuse patients w/ visuospatial deficits
• give frequent feedback: focus on slowing down and controlling movement
• focus on safety (pt may be impulsive)
• avoid environmental clutter
• do not overestimate ability to learn

Question 24

locomotor training for individuals w/ incomplete injury

Answer 24

high intensity, high frequency training
- 4-5 days per wk
- 20-30 min
- 8-12 weeks

Question 25

Hoehn and Yahr stages

Answer 25

1 - minimal or absend disability, unilateral symptoms
2 - minimal bilateral or midline involvement, no balance involvement
3 - impaired balance, some restrictions in activity
4 - All symptoms present and severe; stands and walks only w/ assistance
5 - confinement or bed or wheelchair

Question 26

Red flags for Parkinson’s Disease

Answer 26

MONITOR ADVERSE DRUG EFFECTS
- Sinemet long term side effects - N&V, OH, cardiac arrhythmias, involuntary movements, psychoses

• monitor on/off phenomenon

Question 27

Myasthenia gravis is typically seen in who?

Answer 27

females 20-30 and = in men and women 60-80

Question 28

Primary impairment reported by patients w/ myasthenia gravis

Answer 28

fatigue or weakness w/ sustained activity

Question 29

massed vs distributed practice

Answer 29

massed - rest time is less than practice

distributed - practice time is less than rest time

Question 30

feedback given after every trial improves _______, while variable feedback improves __________

Answer 30

every trial - improves performance

variable feedback improves learning and retention

Question 31

stupor vs obtundation

Answer 31

stupor - aroused from sleep only w/ painful stimuli; minimal awareness of self and environment (not interacting w/ staff)

obtundation - pt can open eyes, responds to staff but is confused

Question 32

Chorea-type movements are related to a pathological condition of

Answer 32

basal ganglia

Question 33

stages of learning

Answer 33

• cognitive stage
• associative stage
• autonomous stage

Question 34

cognitive stage interventions

Answer 34

Cues, instructions, and guidance are provided by the therapist, and demonstration is used

Question 35

associative stage interventions

Answer 35

• pt able to refine strategy

less feedback required

Problem-solving independent from the therapist’s feedback is characteristic of the associative stage of learning.

Exploration of different strategies with little or no input from the therapist

Question 36

autonomous stage interventions

Answer 36

there tend to be fewer errors, greater consistency and improved performance. Less feedback is required, but improvement occurs more slowly

Question 37

the acquisition phase of performance tends to correlate with the ________ stage. The retention phase aligns more with the _________ phase and the transfer phase tends to relate to the _____________ stage

Answer 37

acquisition phase w/ cognitive stage

retention phase w/ associative phase

transfer phase w/ autonomous stage

Question 38

Massed practice may be more beneficial for _________________, but distributed practice tends to be better for _____________ and ______________

Answer 38

massed practice - rapid skill acquisition

distributed practice - skill retention and long-term learning

Question 39

Constant practice tends to help with the acquisition of skills ________ on whereas variable practice increases the _________, which increases its ________

Answer 39

constant practice - early on
- practicing the same skill over and over under same conditions

variable practice - increases the adaptability, or the generalization of a skill, which increases its transferability