Neurodegenerative Diseases/SCI

Question 1

What is Huntington’s disease?

Answer 1

Slowly progressive, hereditary neurodegenerative disorder that causes cognitive,
psychiatric, and motor problems

Classified as:
*Genetic brain disorder
○ Progressive breakdown of brain cells
○ Deteriorates physical and mental abilities
○ No cure
○ Can affect personality, relationships, ability to work, manage household tasks,
finances
*Loss of ability to walk, speak, eat; full time care required

Question 2

A 45-year-old patient diagnosed with Huntington’s disease is experiencing early cognitive, psychiatric, and motor impairments, which are beginning to impact their ability to manage household tasks and personal finances. Which of the following occupational therapy interventions would best address the patient’s current and future needs as the disease progresses?

A. Focus solely on memory exercises and cognitive retraining to maintain financial independence long-term

B. Prioritize progressive motor exercises to prevent further physical decline without considering cognitive or emotional needs

C. Implement a combination of task simplification for household management, adaptive equipment for mobility, and caregiver training, along with emotional support resources

D. Provide minimal intervention now and prepare for intensive physical therapy only when the patient reaches the advanced stages of the disease

Answer 2

Correct Answer:

C. Implement a combination of task simplification for household management, adaptive equipment for mobility, and caregiver training, along with emotional support resources.

Question 3

What is Parkinson’s Disease?

Answer 3

• Loss of cells in the substantia nigra. The substantia nigra cells produce dopamine, a chemical messenger responsible for transmitting signals within the brain that allow for coordination of movement.
• Loss of dopamine causes neurons to fire without normal control, leaving patients less able to direct or control their movement

Question 4

Which of the following are motor symptoms of Parkinson’s disease?

A) Bradykinesia
B) Anosmia
C) Freezing of Movement
D) Postural Instability

Answer 4

A, C, D

Parkinson’s Motor Symptoms
○ Bradykinesia
○ Rigidity
○ Tremor
○ Postural Instability
○ Gait complications
○ Freezing of Movement

Question 5

A 68-year-old patient with Parkinson’s disease is experiencing bradykinesia, rigidity, tremor, postural instability, and episodes of freezing during gait, which interfere with daily activities and mobility. What would be the most effective combination of interventions to help the patient manage these motor symptoms and maintain functional independence?

A. Focus on strengthening exercises alone to reduce rigidity and improve muscle tone

B. Teach the patient compensatory strategies, such as the use of external cues (e.g., rhythmic counting or visual markers) to assist with gait and reduce freezing, along with exercises for balance and postural control

C. Advise the patient to perform all daily activities seated to avoid postural instability and prevent falls

D. Emphasize hand exercises exclusively to decrease tremor, without addressing gait or postural instability

Answer 5

B. Teach the patient compensatory strategies, such as the use of external cues (e.g., rhythmic counting or visual markers) to assist with gait and reduce freezing, along with exercises for balance and postural control.

Question 6

A 65-year-old client with Parkinson’s disease demonstrates non-motor symptoms, including executive dysfunction, REM sleep behavior disorder, and sensory deficits such as anosmia. The client has reported difficulty with household management tasks and experiences frequent mood fluctuations that interfere with their daily routine and social interactions. Which of the following interventions would most effectively target the client’s non-motor symptoms, supporting both safety and functional engagement?

A. Introduce cognitive aids such as memory notebooks to improve executive function, create a sleep hygiene program to address REM sleep behavior disorder, and incorporate strategies to enhance olfactory cues for meal preparation.

B. Use cognitive-behavioral therapy (CBT) techniques independently to manage mood fluctuations and delegate all complex household tasks to a caregiver for improved safety.

C. Focus on physical exercises to enhance motor function, implement daily journaling for mood tracking, and recommend frequent breaks during tasks to improve focus and engagement.

D. Design a structured daily schedule with visual prompts to aid in task completion, introduce relaxation techniques to manage mood and improve sleep quality, and recommend compensatory safety strategies in the kitchen given the anosmia.

Answer 6

D. Design a structured daily schedule with visual prompts to aid in task completion, introduce relaxation techniques to manage mood and improve sleep quality, and recommend compensatory safety strategies in the kitchen given the anosmia.

Question 7

Which of the following are non-motor symptoms for Parkinson?

A) Autonomic
B) Cognitive
C) Neuropsych
D) Sleep Dysfunction
E) Sensory Deficits

Answer 7

All of the above

Non-Motor Symptoms
○ Autonomic
○ Cognitive
■ Executive Dysfunction
■ Dementia ○ Neuropsych
■ Mood Disorders ○ Sleep Dysfunction
■ REM Behavioral Disorder ○ Sensory Deficits
■ Anosmia

Question 8

A 52-year-old client diagnosed with Huntington’s disease is being evaluated using the Unified Huntington’s Disease Rating Scale (UHDRS). The occupational therapist uses this assessment to gather information across multiple domains impacted by the disease. Which of the following areas are included in the UHDRS to provide a comprehensive evaluation of the client’s symptoms?

A. Motor function, cognitive ability, behavioral symptoms, and functional capacity.

B. Motor function, sensory processing, social skills, and vocational skills.

C. Cognitive processing, sensory integration, visual-perceptual skills, and ADL performance.

D. Physical strength, vocational interests, emotional resilience, and memory recall.

Answer 8

Correct Answer:
A. Motor function, cognitive ability, behavioral symptoms, and functional capacity.

Explanation:
Huntington’s Disease Rating Scale (UHDRS)
○ Motor
■ Oculomotor function
■ Dysarthria
■ Chorea
■ Dystonia
■ Gait
■ Postural stability ○ Cognitive
■ Verbal Fluency
■ Symbol Digit Modalities
■ Stroop Interference Test
○ Behavioral
■ Depressed mood
■ Apathy
■ Suicidal thoughts
■ Anxiety
■ Delusions
■ Hallucinations
○ Functional
■ Independence scale
■ Functional capacity
■ Functional assessment

Question 9

Which of the following treatment approaches is commonly used to manage symptoms and improve quality of life for individuals with Huntington’s and Parkinson’s disease?

A) Medications to manage movement and psychiatric symptoms.

B) Physical therapy (PT), occupational therapy (OT), exercise, speech therapy, and swallowing therapy to improve mobility, communication, and nutrition.

C) Social support interventions to help individuals cope with change, manage crises, and address difficult behaviors.

D) All of the above.

Answer 9

Correct Answer:
D) All of the above.

Explanation:
A comprehensive approach for managing Huntington’s and Parkinson’s disease includes medications to address both movement and psychiatric symptoms, rehabilitation therapies like PT, OT, exercise, speech therapy, and swallowing therapy to improve functional abilities, as well as social support to help patients and families cope with the emotional and behavioral challenges of these diseases.

Question 10

For a client with Parkinson’s disease experiencing postural instability, tremors, and cognitive decline, which combination of interventions would best address both the motor and cognitive symptoms?

A. Medications to control motor symptoms, social support for coping with cognitive changes, and physical therapy for balance.

B. Exercise to improve strength, cognitive training exercises, and nutritional counseling to support general health.

C. Medication for movement symptoms, occupational therapy to enhance daily functioning, and social support for managing behavioral challenges.

D. Speech therapy for communication, occupational therapy for daily tasks, and an individualized exercise program to support mobility.

Answer 10

Correct Answer:
C. Medication for movement symptoms, occupational therapy to enhance daily functioning, and social support for managing behavioral challenges.

Question 11

A client with Parkinson’s disease (PD) is receiving gait training to improve mobility. Which of the following visual cues have been shown to improve gait speed, stride length, and/or stride frequency in individuals with PD?

A) Transverse lines that increase gait speed and stride length.

B) Participants’ footprints that increase gait speed and stride length.

C) Rhythmic flashing light that lowers stride frequency and increases stride length.

D) All of the above.

Answer 11

Correct Answer:
D) All of the above.

Explanation:
Use of Visual Cues in PD
○ Transverse lines –
■ Increased gait speed
■ Increased stride length
○ Participants’ footprints –
■ Increased gait speed
■ Increased stride length
○ Rhythmic flashing light –
■ Lowered stride frequency

Question 12

Visual cues are effective in improving gait performance in individuals with Parkinson’s disease because they:

A) Improve kinesthetic feedback and increase reliance on automatic motor control by stimulating the basal ganglia.

B) Function primarily as “static cues” that only provide step length markers without influencing motor control.

C) Provide “static cues” that act as markers for step length and “dynamic cues” that enhance optic flow, bypassing the damaged basal ganglia circuitry.

D) Only reduce the need for goal-directed motor control while bypassing the basal ganglia circuitry.

Answer 12

C) Provide “static cues” that act as markers for step length and “dynamic cues” that enhance optic flow, bypassing the damaged basal ganglia circuitry.

Explanation:
Why Visual Cues Work -
○ Function as ”static cues” – markers of step length
○ Function as “dynamic cues” – optic flow
○ Decrease reliance on impaired kinesthetic feedback
○ Switch from automatic to goal-directed motor control
○ Bypass damaged basal ganglia circuitry

Question 13

When developing an intervention plan for a client with Parkinson’s disease, which of the following treatment approaches is most likely to yield the greatest benefits for improving motor function and overall well-being?

A) Encouraging participation in regular physical activity focused solely on aerobic exercise.

B) Focusing exclusively on flexibility exercises to improve range of motion.

C) Recommending strength training exercises as the sole form of physical activity.

D) Incorporating complex, multimodal exercise routines with an interpersonal component to promote motor control, balance, and social interaction.

Answer 13

D) Incorporating complex, multimodal exercise routines with an interpersonal component to promote motor control, balance, and social interaction.

Treating Parkinson’s disease
○ Recommendations to engage in regular physical activity *complex, multimodal
forms of exercise with an interpersonal component may confer the broadest
benefits.

Question 14

When developing an occupational therapy intervention plan for a client with Parkinson’s disease, which home modification strategy is most likely to improve safety, independence, and overall quality of life?

A) Installing grab bars and ensuring adequate lighting in key areas to improve safety during mobility and reduce fall risk.

B) Redesigning the home to include a more minimalist aesthetic, prioritizing visual appeal over functionality.

C) Focusing on high-tech smart home devices that require complex learning, disregarding the client’s cognitive abilities.

D) Making changes to the home environment to promote relaxation and stress reduction, without addressing mobility or physical safety concerns.

Answer 14

Correct Answer:
A) Installing grab bars and ensuring adequate lighting in key areas to improve safety during mobility and reduce fall risk.

Question 15

When working with a client with Parkinson’s disease (PD), which of the following interventions would most effectively improve daily physical performance, participation in meaningful activities, and overall quality of life, while considering the impact of PD-related nonmotor symptoms (e.g., cognitive impairment, depression)?

A) Focus solely on medication management for movement symptoms, ignoring the impact of nonmotor dysfunction on daily activities.

B) Implement targeted external cues, such as visual or auditory prompts, to regulate movement during daily activities and provide social support through group therapy sessions with other individuals living with PD.

C) Design a physical exercise routine that includes only high-intensity aerobic activity, disregarding cognitive or emotional factors.

D) Recommend complete lifestyle changes, including dietary restrictions, without addressing mobility, cognitive, or social needs.

Answer 15

B) Implement targeted external cues, such as visual or auditory prompts, to regulate movement during daily activities and provide social support through group therapy sessions with other individuals living with PD.

Correct Answer:
B) Implement targeted external cues, such as visual or auditory prompts, to regulate movement during daily activities and provide social support through group therapy sessions with other individuals living with PD.

Question 16

A 28-year-old patient is diagnosed with transverse myelitis, resulting in inflammation and damage to the spinal cord. Which of the following causes of spinal cord dysfunction is most associated with infections like transverse myelitis?

A) Neoplasm
B) Infections such as syphilis or transverse myelitis
C) Spinal cord abscess
D) ALS (Amyotrophic Lateral Sclerosis)

Answer 16

Correct Answer:
B) Infections such as syphilis or transverse myelitis

Rationale:
Transverse myelitis is an inflammatory condition of the spinal cord often linked to viral or bacterial infections. Syphilis can also cause spinal cord damage. Neoplasms and ALS are not typically caused by infections, while spinal cord abscesses are another form of infection that could lead to similar symptoms.

Question 17

A patient presents with a mass located near the spinal cord that is exerting pressure on the cord, leading to weakness and sensory changes in the affected areas. This mass is identified as a tumor. Which of the following conditions is this most likely to be?

A) Spinal cord abscess
B) Thrombosis
C) Spondylitic OA
D) Neoplasm (Tumor)

Answer 17

D) Neoplasm (Tumor)

Rationale:
A neoplasm, or tumor, can put direct pressure on the spinal cord, leading to neurological symptoms such as weakness and sensory changes. Spinal cord abscesses can cause similar symptoms, but they are typically due to infection rather than a mass. Spondylitic OA involves degenerative changes in the spine, and thrombosis refers to a blood clot, neither of which are directly related to tumor growth.

Question 18

A 35-year-old patient with a history of motor neuron disease is experiencing progressive muscle weakness, especially in the extremities. They are also reporting difficulty with speech and swallowing. Which of the following conditions is most likely related to their spinal cord dysfunction?

A) ALS (Amyotrophic Lateral Sclerosis)
B) Transverse Myelitis
C) Syphilis
D) Spondylitic OA

Answer 18

Correct Answer:
A) ALS (Amyotrophic Lateral Sclerosis)

Rationale:
ALS is a neurological disease that affects motor neurons, causing progressive weakness, loss of motor function, and symptoms like difficulty with speech and swallowing, which aligns with the patient’s presentation. Transverse myelitis and syphilis can also affect the spinal cord, but they typically present with different patterns of symptoms. Spondylitic OA affects the spine but is less likely to cause the same pattern of motor neuron dysfunction.

Question 19

A 45-year-old patient is diagnosed with a spinal cord condition that is linked to the development of a blood clot which then cuts off the blood supply to the spinal cord. Which of the following terms describes the mechanism that leads to spinal cord ischemia in this patient?

A) Embolus
B) Spondylitic osteoarthritis
C) Thrombosis
D) Spinal cord abscess

Answer 19

Correct Answer:
C) Thrombosis

Rationale:
Thrombosis refers to the formation of a blood clot that obstructs the blood supply to the spinal cord, leading to ischemia and potential spinal cord damage. An embolus is a clot that becomes lodged in a vessel, whereas spondylitic OA involves degeneration of spinal structures, and a spinal cord abscess is an infection.

Question 20

A 60-year-old patient with a history of chronic back pain presents with progressive weakness in the lower extremities, difficulty breathing, and reduced sensation below the waist. The physician suspects a neurological condition affecting the spinal cord. Given the following potential causes, which of the following conditions is most likely to contribute to the patient’s symptoms based on the presentation of weakness, sensory loss, and breathing difficulty?

A) Hemorrhage resulting in ischemia or pressure on the cord

B) Spinal cord abscess due to bacterial infection

C) Thrombosis, leading to the development of a blood clot cutting off blood supply to the cord

D) Spondylitic osteoarthritis (OA) of the spine causing mechanical compression

Answer 20

Correct Answer:
A) Hemorrhage resulting in ischemia or pressure on the cord

Rationale:
Hemorrhage can lead to spinal cord ischemia or pressure, causing neurological deficits such as weakness, sensory loss, and difficulty breathing, particularly if the hemorrhage is in the cervical or upper thoracic region. The other options (abscess, thrombosis, spondylitic OA) may contribute to similar symptoms but are less likely to cause the same acute, widespread neurological dysfunction in this context.

Question 21

A 40-year-old patient presents with a spinal cord injury following a motor vehicle accident (MVA). Upon examination, the patient demonstrates weakness and loss of sensation below the waist. The physician suspects the injury is related to the disruption of the vertebrae and ligamentous surfaces in the cervical region. Given the following injury mechanisms, which of the following types of fractures is most likely associated with this scenario?

A) Fracture dislocation
B) Compression fracture
C) Hyperextension fracture
D) Compression fracture with dislocation

Answer 21

Correct Answer:
A) Fracture dislocation

Rationale:
A fracture dislocation is typically associated with the disruption of vertebrae and the alteration of ligamentous surfaces, as described in the injury mechanism of the motor vehicle accident. A compression fracture refers to the crushing of one or more vertebrae, while a hyperextension fracture involves the disruption of anterior ligaments, but the posterior ligaments remain intact.

Question 22

A 25-year-old patient presents with a spinal injury following a fall. The X-ray reveals a compression fracture without dislocation, causing a crushing of one or more vertebrae. The physician suspects that an additional ligamentous injury has occurred due to the mechanism of injury. Based on the following injury types, which of the following is most likely to have occurred alongside the compression fracture?

A) Hyperextension fracture, where anterior ligaments are disrupted while posterior ligaments remain intact

B) Fracture dislocation, involving disruption of the vertebrae and alteration of the ligamentous surfaces

C) Compression fracture with dislocation, causing complete disruption of vertebrae and ligaments

D) Spondylitis, involving inflammation of the spinal joints

Answer 22

Correct Answer:
A) Hyperextension fracture, where anterior ligaments are disrupted while posterior ligaments remain intact

Rationale:
The patient’s injury mechanism, involving a compression fracture without dislocation, is consistent with a hyperextension fracture. In a hyperextension injury, the anterior ligaments of the spine are disrupted, but the posterior ligaments remain intact. This is a common type of injury seen in situations such as whiplash. Fracture dislocations and spondylitis do not match the characteristics described in the case.

Question 23

Which of the following accurately describes the categories of the American Spinal Injury Association (ASIA) classification system for spinal cord injuries?

A) Complete Injury involves full preservation of sensory and motor function below the level of the lesion, with no loss of function at sacral segments.

B) Level of Lesion is determined by the lowest level at which an innervated muscle shows greater than 3/5 strength.

C) Zone of Partial Preservation refers to the complete loss of function below the level of injury, with no preserved dermatome or myotome.

D) Level of Lesion is determined by the level at which complete motor and sensory loss occurs, and the Zone of Partial Preservation involves intact motor or sensory function below the lesion.

Answer 23

Correct Answer:
B) Level of Lesion is determined by the lowest level at which an innervated muscle shows greater than 3/5 strength.

Rationale:
The ASIA classification system is used to assess spinal cord injuries based on motor and sensory function.

*Complete Injury refers to the total loss of motor and sensory function below the level of the lesion, including the sacral segments.

• Level of Lesion is determined by the lowest level of the body where a muscle has greater than 3/5 strength, indicating preserved motor function.
• Zone of Partial Preservation refers to a situation where some motor or sensory function is preserved below the injury site but is less than 3/5.

Thus, options A and C are incorrect, and option D partially explains the system but lacks accuracy.

Question 24

Which of the following statements accurately describes the ASIA Impairment Scale for grading the degree of spinal cord injury?

A) A (Complete) indicates no sensory or motor function preserved below the neurological level, including the sacral segments S4-5.

B) B (Incomplete) indicates no motor function is preserved below the neurological level, but sensory function is preserved through the sacral segments S4-5.

C) C (Incomplete) indicates motor function is preserved below the neurological level, but the majority of key muscles below the level have a muscle grade greater than 3/5.

D) D (Incomplete) indicates motor function is preserved below the neurological level, and the majority of key muscles below the level have a muscle grade less than 3/5.

E) E (Normal) indicates normal sensory function but absent motor function below the neurological level.

Answer 24

Correct Answer:
A) A (Complete) indicates no sensory or motor function preserved below the neurological level, including the sacral segments S4-5.

Rationale:
The ASIA Impairment Scale is used to classify spinal cord injuries based on sensory and motor function:

A (Complete) means no sensory or motor function is preserved in the sacral segments S4-5.

B (Incomplete) means sensory function is preserved but no motor function below the neurological level, with preservation extending to the sacral segments.

C (Incomplete) indicates motor function is preserved but with the majority of muscles below the injury level having a grade of less than 3/5.

D (Incomplete) means motor function is preserved and the majority of key muscles below the injury level have a grade of 3/5 or higher.

E (Normal) means both sensory and motor functions are normal.

Question 25

A patient presents with a diagnosis of Central Cord Syndrome. Which of the following characteristics is most commonly associated with this condition?

A) The upper limbs are more affected than the lower limbs.
B) Bowel, bladder, and sexual functions are typically impaired.
C) The condition is usually caused by compression fractures at T12-L2.
D) It primarily affects the lower limbs, with the upper limbs being less involved.
E) The condition is exclusively caused by a direct blow to the cervical spine.

Answer 25

Correct Answer:
A) The upper limbs are more affected than the lower limbs.

Rationale:
Central Cord Syndrome typically occurs in the cervical region and is characterized by greater involvement of the upper limbs compared to the lower limbs. Bowel, bladder, and sexual functions are usually preserved. The condition is often caused by hyperextension injuries, hemorrhage, or edema, rather than by compression fractures or direct trauma to the cervical spine.

Question 26

A patient is diagnosed with Brown-Séquard Syndrome following a gunshot wound to the spinal cord. Which of the following clinical features would be most consistent with this condition?

A) Sensory loss only, with no motor impairment.
B) Loss of motor function and sensory loss on both sides of the body.
C) Loss of proprioception and pain sensation on the ipsilateral side.
D) No loss of motor or sensory function, only bowel and bladder impairment.
E) Loss of motor function and proprioception on the ipsilateral side and loss of pain and temperature on the contralateral side.

Answer 26

Correct Answer:
E) Loss of motor function and proprioception on the ipsilateral side and loss of pain and temperature on the contralateral side

Rationale:
Brown-Séquard Syndrome is characterized by a hemisection of the spinal cord, resulting in loss of motor function and proprioception on the ipsilateral (same) side and loss of pain and temperature sensation on the contralateral (opposite) side of the body. It is often caused by penetrating trauma such as gunshot wounds or stabbing injuries.

Question 27

A patient presents with anterior cord syndrome after a flexion injury. Which of the following symptoms would most likely be observed?

A) Loss of proprioception and pain sensation on both sides of the body.
B) Preservation of proprioception but loss of pain and temperature sensation and motor function.
C) Loss of proprioception and motor function, but preserved pain and temperature sensation.
D) No motor or sensory impairments, but decreased reflexes.
E) Complete paralysis and loss of sensation on both sides of the body.

Answer 27

Correct Answer:
B) Preservation of proprioception but loss of pain and temperature sensation and motor function.

Rationale:
In anterior cord syndrome, proprioception is typically preserved because it is carried in the dorsal column, while pain and temperature sensation and motor function are lost due to damage to the anterior spinal cord structures. This syndrome is often caused by occlusion of the anterior spinal artery or flexion injuries.

Question 28

A patient with posterior cord syndrome presents with preserved motor function but loss of light touch and proprioception. Which of the following best describes the cause and symptoms of this condition?

A) Often caused by trauma, with motor function loss and preserved sensory function.
B) Results in an areflexic bladder, bowel, and lower limbs, with preserved proprioception.
C) Rarely caused by trauma, typically resulting from disease or tumors, with preserved motor function and loss of light touch and proprioception.
D) Typically caused by flexion injuries, with loss of motor function and sensation on both sides of the body.
E) Caused by gunshot wounds, leading to sensory loss on the ipsilateral side and motor loss on the contralateral side.

Answer 28

Correct Answer:
C) Rarely caused by trauma, typically resulting from disease or tumors, with preserved motor function and loss of light touch and proprioception.

Rationale:
Posterior cord syndrome is typically caused by disease or tumors rather than trauma. It is characterized by preserved motor function while losing light touch and proprioception due to damage to the dorsal columns.

Question 29

A patient diagnosed with cauda equina syndrome presents with an areflexic bladder, bowel, and lower limbs. Which of the following is the most accurate description of this condition?

A) Injury occurs below the L1-L2 region, affecting the lumbosacral nerve roots, resulting in an areflexic bladder, bowel, and lower limbs.
B) Injury occurs above the L1-L2 region, leading to upper limb dysfunction.
C) It is characterized by preserved sensory function but complete loss of motor function in the lower limbs.
D) The condition primarily affects the upper limbs and results in loss of fine motor control.
E) Cauda equina syndrome is caused by a spinal cord tumor that compresses the lower spinal cord regions.

Answer 29

Correct Answer:
A) Injury occurs below the L1-L2 region, affecting the lumbosacral nerve roots, resulting in an areflexic bladder, bowel, and lower limbs.

Rationale:
Cauda equina syndrome occurs due to injury to the lumbosacral nerve roots below the L1-L2 level, causing an areflexic bladder, bowel, and loss of function in the lower limbs. This syndrome often results from trauma or other structural issues that affect the nerve roots.

Question 30

A patient with conus medullaris syndrome exhibits an areflexic bladder, bowel, and lower limbs. What distinguishes this condition from cauda equina syndrome?
A) Cauda equina syndrome causes preserved reflexes, while conus medullaris syndrome causes loss of all reflexes.
B) Conus medullaris syndrome is caused by a spinal cord tumor, while cauda equina syndrome results from trauma.
C) Conus medullaris syndrome typically affects the upper limbs, while cauda equina syndrome affects the lower limbs.
D) Conus medullaris syndrome involves the sacral cord and lumbar nerve roots and may have preserved sacral reflexes, while cauda equina syndrome involves the lumbosacral nerve roots and is always areflexive.
E) Conus medullaris syndrome involves the cervical region and is characterized by loss of motor function and sensation.

Answer 30

Correct Answer:
D) Conus medullaris syndrome involves the sacral cord and lumbar nerve roots and may have preserved sacral reflexes, while cauda equina syndrome involves the lumbosacral nerve roots and is always areflexive.

Rationale:
Conus medullaris syndrome affects the sacral cord and lumbar nerve roots, leading to an areflexic bladder, bowel, and lower limbs. However, some sacral reflexes, such as the bulbocavernosus or micturition reflexes, may remain intact. In contrast, cauda equina syndrome primarily involves the lumbosacral nerve roots and is typically areflexive.

Question 31

A patient presents with a reddened area on their skin that does not fade when pressure is relieved. There is the presence of a blister and the area is painful. What stage of decubitus ulcer (pressure sore) is this patient most likely experiencing?

A) Stage 1: Skin is reddened and fades quickly, skin blanches to pressure.

B) Stage 2: Skin is reddened and does not fade when pressure is relieved, presence of blister, painful.

C) Stage 3: Skin is broken or reddened, no blanching to pressure, possible drainage, evidence of ischemic damage.

D) Stage 4: Complete ulceration, loss of blood supply due to prolonged pressure on bony prominence.

Answer 31

Correct Answer:
B) Stage 2: Skin is reddened and does not fade when pressure is relieved, presence of blister, painful.

Rationale:
Stage 2 decubitus ulcers involve redness that does not fade upon pressure relief, often accompanied by blisters or potential breaks in the skin. The site may be painful, and the skin still blanches when pressure is applied. This description matches the features of Stage 2 pressure sores.

Question 32

Which of the following descriptions accurately corresponds to the stages of decubitus ulcers (pressure sores)?

A) Stage 1: Skin is reddened and fades quickly, skin blanches to pressure.
B) Stage 2: Skin is reddened and does not fade when pressure is relieved, possible blister or break, may be painful.
C) Stage 3: Skin is broken or reddened, no blanching to pressure, may have drainage, signs of ischemic damage to underlying tissue.
D) Stage 4: Complete ulceration, loss of blood supply to an area due to prolonged pressure on bony prominence.

Answer 32

All of the above

Question 33

A patient recently sustained a spinal cord injury and their caregiver is seeking advice on pressure ulcer prevention. What is the most effective initial strategy for preventing pressure sores?

A) Instruct the caregiver to change the patient’s position every 8 hours.
B) Teach the caregiver about proper turning schedules, including repositioning the patient every 2 hours in bed and every 15-20 minutes in a wheelchair.
C) Recommend a daily skin check once in the morning and once in the evening.
D) Suggest using a standard mattress for the patient’s bed.

Answer 33

Correct Answer:
B) Teach the caregiver about proper turning schedules, including repositioning the patient every 2 hours in bed and every 15-20 minutes in a wheelchair.

Rationale:
Proper turning schedules and regular weight shifts are crucial for preventing pressure ulcers. The patient should be repositioned every 2 hours in bed and perform pressure reliefs every 15-20 minutes while seated in a wheelchair.

Question 34

Precautions During Treatment
You are working with a patient in a wheelchair, and you observe them sitting with poor posture, slumping and leaning to one side. What is the potential risk of this posture?

A) It may increase the risk of pressure ulcer formation, especially on the sacrum.
B) It will improve comfort and circulation.
C) It will help with muscle strengthening in the lower extremities.
D) It will prevent pressure sores from forming.

Answer 34

Correct Answer:
A) It may increase the risk of pressure ulcer formation, especially on the sacrum.

Rationale:
Slumping or slouching can quickly lead to skin breakdown, especially on bony prominences such as the sacrum. Maintaining proper posture is essential for preventing pressure ulcers.

Question 35

While working with a patient in a wheelchair, you notice that their knees are pressing against the sides of the chair, and their foot straps appear tight. What should you check next?

A) Ensure the patient is wearing shoes to protect their feet.
B) Check the patient’s posture and reapply splints.
C) Assess for any clothing wrinkles or tight leg straps that could increase pressure.
D) Increase the frequency of position changes.

Answer 35

Correct Answer:
C) Assess for any clothing wrinkles or tight leg straps that could increase pressure.

Rationale:
Tight leg straps, clothing wrinkles, or improper positioning can increase the risk of pressure ulcers. It is important to address these issues during treatment to avoid skin breakdown.

Question 36

When applying splints to a patient, what is the recommended action to ensure pressure ulcer prevention?

A) Ensure splints are applied loosely to prevent skin irritation.
B) Only apply splints for short periods during therapy.
C) Remove splints periodically and check for pressure areas.
D) Keep splints on at all times for continuous support.

Answer 36

Correct Answer:
C ) Remove splints periodically and check for pressure areas.

Rationale:
It is important to remove splints periodically to check for pressure areas and prevent skin breakdown, particularly in areas where the splint may exert prolonged pressure.

Question 36

You are using hot packs during therapy with a patient. What is the most important precaution to take to prevent injury?

A) Use hot packs for extended periods to maximize their therapeutic effect.
B) Ensure the temperature of the hot pack is set to the highest setting.
D) Guard against burns by monitoring the hot pack’s temperature and checking the patient’s skin frequently.
C) Apply the hot pack over clothing to reduce the risk of burns.

Answer 36

Correct Answer:
D) Guard against burns by monitoring the hot pack’s temperature and checking the patient’s skin frequently.

Rationale:
Hot packs should be applied with caution to prevent burns. Monitoring the temperature and checking the skin regularly helps protect the patient from potential thermal injuries.

Question 37

Which of the following interventions is most likely to help reduce symptoms of dizziness, light-headedness, and loss of consciousness in individuals with postural hypotension during daily activities?

A) Abdominal binder
B) Long TEDS (Compression stockings)
C) Graded sitting angle and elevating lower extremities
D) Bringing the patient slowly upright
E) All of the above

Answer 37

E) All of the above

Question 38

Your patient is experiencing symptoms of dizziness, light headedness,
loss of consciousness, nausea, pallor. What do you suspect your patient to have?

A) High blood pressure
B) orthostatic hypotension
C) Hypotonia
D) postural hypotension

Answer 38

D) postural hypotension

Question 39

Which of the following is most likely to trigger autonomic dysreflexia in individuals with spinal cord injuries?

A) Tight clothing
B) Bladder or bowel distention
C) Skin irritation from pressure sores
D) Kink in a Foley catheter
E) All of the above

Answer 39

Answer:
E) All of the above

This answer reflects the various potential triggers of autonomic dysreflexia that may require attention during occupational therapy interventions to prevent episodes.

Question 40

Which of the following interventions is most effective in managing autonomic dysreflexia in individuals with spinal cord injuries?

A) Lying the patient down to alleviate symptoms
B) Increasing physical activity immediately
C) Keeping the patient in a supine position
D) Restricting fluid intake
E) Checking bladder and bowel status regularly

Answer 40

E) Checking bladder and bowel status regularly

This answer highlights the importance of addressing potential triggers, such as bladder or bowel distention, which is essential in managing autonomic dysreflexia.

Question 41

Your patient is experiencing symptoms of sudden onset of pounding headache, sweating, nausea, bradycardia high blood pressure (more so than normal). What do you suspect your patient to have?

A) High blood pressure
B) orthostatic hypotension
C) Autonomic Dysreflexia
D) postural hypotension

Answer 41

C) Autonomic Dysreflexia

Question 42

Which of the following is an appropriate management strategy for a patient with an upper motor neuron (UMN) bladder (spastic bladder) due to a spinal cord injury above T12?

A) Straining and using the Crede maneuver
B) Intermittent catheterization and reflex emptying techniques (Tapping the abdomen and pulling pubic hair)
C) Use of external devices for bladder control
D) restricted fluid intake
E) Both B and D

Answer 42

Answer:
E) Both B and D

Question 43

Which of the following interventions is most appropriate for managing bowel function in individuals with an upper motor neuron (UMN) injury (reflexive functioning)?

A) Manual extraction and use of stool softeners
B) Bowel training program with suppository insertion followed by digital stimulation
C) Positioning on a commode for prolonged periods
D) Enemas and use of external devices for control
E) Both B and D

Answer 43

Answer:
B) Bowel training program with suppository insertion followed by digital stimulation

This answer emphasizes the bowel management strategies specifically for UMN injuries, including the use of suppositories and digital stimulation to encourage reflexive bowel emptying.

Question 44

Which of the following interventions is most appropriate for managing bowel function in individuals with an upper motor neuron (LMN) injury (reflexive functioning)?

A) Manual extraction and use of stool softeners
B) Bowel training program with suppository insertion followed by digital stimulation
C) Positioning on a commode
D) Use of enemas
E) Both A, C, D

Answer 44

E) Both A, C, D

Question 45

During the recovery phase of spinal shock, which of the following is most likely to occur as reflex activity below the level of injury returns?

A) Hyperactive spinal reflexes may return
B) Flaccid paralysis becomes more pronounced
C) Sensory function is immediately restored
D) Muscle spasticity completely resolves
E) Reflex activity remains completely absent

Answer 45

A) Hyperactive spinal reflexes may return

Question 46

Which of the following is the most important intervention for improving respiratory function and managing complications in individuals with cervical and high thoracic spinal cord injuries?

A) Pulmonary toilet (respiratory therapy) to maintain clear airways
B) Quad coughing education for caregivers to assist with clearing the airways
C) Monitoring vital capacity to assess respiratory function, especially in cervical lesions
D) Positioning techniques and diaphragmatic breathing exercises to support inspiration
E) All of the above

Answer 46

E) All of the above

This answer highlights the comprehensive approach necessary to manage respiratory function and prevent complications in individuals with cervical and high thoracic spinal cord injuries, addressing pulmonary therapy, caregiver education, vital capacity monitoring, and supportive positioning techniques.

Question 47

Which of the following interventions is most effective in managing spasticity and preventing contractures in individuals with spinal cord injuries, especially those with higher and incomplete lesions?

A) Active range of motion (AROM) exercises
B) Electrical stimulation of affected muscles
C) Splinting, positioning, and passive range of motion (PROM)
D) Heat therapy to reduce muscle tone
E) Deep tissue massage for muscle relaxation

Answer 47

Answer:
C) Splinting, positioning, and passive range of motion (PROM)

This answer emphasizes the use of splinting, positioning, and PROM to manage spasticity and prevent contractures, which are crucial in individuals with higher and incomplete spinal cord lesions.

Question 48

Which of the following is most important in supporting the psychosocial adjustment and adaptation of individuals with spinal cord injuries?
A) Providing support from healthcare professionals and a strong family network
B) Encouraging independence in daily activities to reduce dependency
C) Fostering open communication about grief, denial, and depression
D) Focusing only on physical rehabilitation to avoid overwhelming the individual
E) Ignoring discussions about future concerns like family, work, and social relationships

Answer 48

A) Providing support from healthcare professionals and a strong family network

This answer emphasizes the critical role of healthcare professionals and family in the psychosocial adaptation process for individuals with SCI, addressing emotional responses and future life adjustments.

Question 49

Which of the following is most accurate regarding sexual health and fertility in biological females with spinal cord injuries?

A) Orgasm is not possible following spinal cord injury, regardless of lesion level

B) Fertility is not affected, and pregnancy is not possible for individuals with spinal cord injuries

C) Phantom orgasm can occur due to reassignment of the sexual response to areas unaffected by the injury

D) Loss of pelvic sensation prevents vaginal delivery in all cases of spinal cord injury

E) Menstruation does not resume following spinal shock in individuals with spinal cord injuries

Answer 49

Answer:
C) Phantom orgasm can occur due to reassignment of the sexual response to areas unaffected by the injury

This answer reflects the potential for sexual response adaptations, such as phantom orgasm, in individuals with spinal cord injuries, and highlights the complexity of sexual health and fertility in this population.

Question 50

Which of the following is most accurate regarding sexual function in biological males with spinal cord injuries?

A) Psychogenic erections can still occur if the injury is below T11
B) Reflexogenic erections are unlikely to occur in men with injuries at T10 or above
C ) Men with injuries above T11 will experience both psychogenic and
reflexogenic erections
D) Ejaculation is possible in most men with lower-level incomplete spinal cord injuries, but rare in those with complete upper-level injuries
E) Reflexogenic erections are solely controlled by psychological stimuli

Answer 50

D) Ejaculation is possible in most men with lower-level incomplete spinal cord injuries, but rare in those with complete upper-level injuries

This answer reflects the distinction in sexual function between psychogenic and reflexogenic erections and emphasizes the variability of ejaculation based on injury level.

Question 51

Which of the following is a key consideration when selecting a contraceptive method for individuals with spinal cord injuries?

A) Oral contraceptives are generally considered the safest option for individuals with SCI, as they carry no risk of inflammation or blood clots.
B) Diaphragms, spermicides, and condoms are ideal for individuals with impaired hand dexterity due to their ease of use.
C) Intra-uterine devices (IUDs) are a safe option despite the possibility of undetected complications, as they cannot be felt by those with sensory impairments.
D) The choice of contraceptive method should be discussed with a physician due to the risks associated with certain methods, such as blood clots and difficulty with manual methods.
E) Women with SCI should avoid discussing contraceptive methods with their physician, as most methods are equally effective regardless of physical limitations.

Answer 51

D) The choice of contraceptive method should be discussed with a physician due to the risks associated with certain methods, such as blood clots and difficulty with manual methods.