Neurology Flashcards
1
Q
7 s/s of stroke ?
A
- SUDDEN numbness or weakness of face, arm or leg
- confusion, dizziness
- trouble speaking or understanding speech
- trouble seeing out of one or both eyes
- trouble walking
- loss of balance or coordination
- severe headache with no known cause
2
Q
4 non-modifiable risk factors for stroke?
A
- age (doubles after 55)
- M>F
- family Hx
- previous stroke or TIA
3
Q
6 modifiable risk factors for stroke?
A
- HTN
- cardiac disease
- DM
- hypercholesterolemia
- smoking
- increased BMI
4
Q
_______ stroke = caused by thrombosis, embolism or lacunar infant
A
ischemic
5
Q
What is the area called post ischemic stroke that is supplied by collaterals, so has the possibility of preservation?
A
ischemic penumbra
6
Q
2 types of neurons that are especially sensitive to ischemia ?
A
- cerebellum
2. hippocampal
7
Q
Post ischemic stroke, there is release of _____ , ___, edema , and O2 free radicals leading to degeneration
A
glutamate; calcium
8
Q
TPA should be administered within ___ hours of stroke n order to be effective
A
3
9
Q
_______ stroke caused by aneurysm or AV malformation
A
hemorrhagic
10
Q
Majority of hemorrhagic strokes occur in what 2 areas ?
A
- cerebral cortex
2. basal ganglia
11
Q
Hemorrhagic strokes have better long term prognosis compared to ischemic (T/F)
A
TRUE
12
Q
ABCD score for prediction of progression and risk of recurrence ?
A
A = age B = blood pressure C = clinical features D = duration
13
Q
____ matter is capable of functional reorganization
A
grey
14
Q
What is a sign that the pyramidal motor output is intact post stroke ?
A
if they can move their fingers !
15
Q
_____ stroke is very disabling as it takes out the ascending AND descending tracts
A
brainstem
16
Q
2 ways TBI can be classified ?
A
- open
2. closed
17
Q
TBI: Coup = _____ mechanical injury
A
primary
18
Q
TBI: coutracroup = ______ mechanical injury
A
secondary
19
Q
Countracoup injury can include ____ and ______
A
ischemia; edema
20
Q
_____ ______ _____ = sheering / tearing from rotational forces in areas of density change (grey –> white matter)
A
diffuse axonal injury
21
Q
After a TBI, blood flow is usually less than ___% of original injury
A
50
22
Q
______ hematoma is associated with skull # 90% of the time
A
epidural
23
Q
Epidural hematomas are almost always in what 2 areas?
A
- temporal
2. tempoparietal
24
Q
Epidural hematoma = (arterial/ venous) bleed
A
arterial
25
Subdural hematoma = often requires _____ intervention
surgical
26
Subdural hematoma = (arterial / venous) bleed
venous
27
_______ hematoma = bleeding between arachnoid and pia, often fatal
subarachnoid
28
_______ hematoma = most common, bleed under the pia
intracranial
29
Normal ICP?
0-10mmHg
30
___mmHg ICP is usually the cut off, anything over __mmHg for over for 5 mins is really bad
15; 20
31
ICP most commonly monitored using ________ drain
extraventricular
32
When working with a pt with an EVD, you have to close ____ to avoid back flow of large amounts of fluid back into pt!
stopcock
33
MAP/ICP
| (cerebral perfusion pressure) you want between __-___mmHg!
70-100
34
Keep head of bed at ___ degree to keep MAP at least __ mmHg!
30; 80
35
3 signs of basal skull #?
1. blood or CSF out of nose/ears
2. raccoon eyes
3. battle sign (bruising over mastoid)
36
_____ aphasia = injury to frontal lobe
Brocas
37
_____ aphasia = injury to parietal or temporal
Wernickes
38
Comprehensive and receptive aphasia = injury to _____ lobe
temporal
39
Apraxia = damage to _____ lobe
parietal
40
_____ lobe = more damaged in contra-coup than coup injury
occipital
41
When suctioning an individual with a TBI, pre and post O2 should be at ___% and only suction for ___ s
100;10
42
______ positioning = indicates brain stem damage and lesions in cerebellum
decerebrate
43
________ posturing = EXTENSION of both UE and LE
decerebrate
44
_______ posturing = arms flexed, legs extended, damage to areas including cerebral hemisphere, thalamus, cord, CTS tract
decorticate
45
3 Rx for decerebrate/ decorticate positioning ?
1. ICP < 15mmHg!
2. regular 2 hour turns
3. log roll alignment for head
46
Make sure tube feeds are off __ minutes prior to mobilizing
20
47
3 issues to be aware of when first mobilizing acute neuro pt ?
1. hypermetabolism
2. DVT
3. PE
48
Rx for contractures?
1. place muscles in lengthened position 20 mins - 12 hours / day
2. resting splints
3. splitning, casting and passive ROM
49
Most common TBI?
Concussion!
50
Sleep disturbance, irritability, dizziness, irritability, memory and visual changes are all s/s of?
concussion
51
_____ ______ syndrome = rare and fatal uncontrolled swelling of brain due to minor 2nd blow before initial symptoms are resolved
second impact
52
____ _______ syndrome = persistent symptoms of concussion
post concussion
53
Grade __ concussion = NO LOC; dazed
1
54
Grade __ concussion = NO LOC; period of confusion and does NOT recall event
2
55
Grade __ concussion = LOC for short time, NO memory of event, requires eval ASAP
3
56
3 categories of GCS?
1. eye opening
2. motor response
3. verbal response
57
GCS is out of ___ points
15
58
Racho levels of cognition = good predictors of ____ outcome post injury, 1-__ scale
functional; 10
59
Most common cause of traumatic SCI?
falls
60
Majority of traumatic SCI lead to _____
quadriplegia
61
Age range where traumatic SCI occur?
between 18-35
62
Majority of non traumatic SCI result in _____
paraplegia
63
Age range for non traumatic SCI?
50-60+ years
64
2 situations where SCI would get surgery?
1. unstable # or soft tissue injury
| 2. neuro symptoms worsening
65
________ = pathology of the SC
myelopathy
66
______ _____ = temp suppression of all reflex activity below level of injury
spinal shock
67
Spinal shock can last weeks to months (T/F)
TRUE
68
Lumbar _______ = helps to decompress the CE/roots
laminectomy
69
Goals of acute SCI = keep MAP between __ - __ mmHg
80-100
70
Post SCI, ANS is interrupted leading to altered regulation of __,__ and ___
BP;HR;temp
71
3 symptoms of spinal shock?
1. areflexia
2. flaccid paralysis below level of lesion
3. loss of sensation below level of lesion
72
Thought that return of the ____ reflex marks beginning of spinal resolution
sacral
73
______ shock = bodies reaction to sudden loss of sympathetic control
neurogenic
74
Neurogenic shock occurs with injuries above ___
T6
75
3 symptoms of neurogenic shock?
1. dec vasomotor tone = hypotension and hypothermia despite normal blood volume
2. bradycardia (due to unopposed vagal stimulation of heart)
3. can lead to metabolic issues
76
For "spine unstable" orders, PT must do what 4 things?
1. maintain neutral spine at all times
2. bed rest
3. HOB at 0 deg
4. 2-3 person turns at all times
77
For spine stable but requires protection, PT must maintain _____ spine at all times
neutral
78
In the "spine stable" phase the pt can turn independently w/ neutral alignment and mob / rehab begins (T/F)
TRUE
79
With spine stable - no restrictions, pt may do all movements of spine within comfort limits (T/F)
TRUE
80
What for changes in ___ when first mobilizing pts with stable spines/ no restrictions
BP
81
SCI classification is important to define ____ and _____ of injury
level; extent
82
What does the sensory exam of SCI classification include?
1. 28 dermatomes w/ bony landmarks
| 2. light tough and pin prick tested at each point
83
What is the reference for normal when testing dermatomes for SCI classification?
skin on cheek
84
Grade __ sensory exam for SCI classification = absent
0
85
Grade __ sensory exam for SCI classification = altered, including hyperesthesia
1
86
Grade __ sensory exam for SCI classification = normal
2
87
Pin prick response can be what 3 things?
1. normal
2. impaired
3. absent
88
If _____ is present pt has sensory incomplete injury ASIA B
DAP (deep anal pressure)
89
ASIA motor exam includes __ bilateral myotomes
10
90
ASIA motor exam = start at grade __ and watch for compensation
3
91
Are +/- used in myotomes for ASIA ?
NO
92
ASIA: C__ = shoulder ABD/elbow FLEXORS
5
93
ASIA: C__ = wrist extensors
6
94
ASIA: C__ = elbow extensors
7
95
ASIA: C__ = thumb ext/ulnar deviation / long finger flexors
8
96
ASIA: T__ = finger abductors
1
97
If ___ _____ ______ is present = motor INCOMPLETE ASIA C
voluntary anal contraction
98
ASIA level of lesion - most ____ segment with normal sensory and motor function on both sides of body
CAUDAL
99
ASIA sensory level = most caudal segment with bilateral score of ___ for both light tough and pin prick
2
100
ASIA motor level = most caudal segment with a grade greater than or equal to ___ provided ALL segments above are grade __
3;5
101
Pinprick preservation (LE and sacral) within __ hours = good prognosis of motor function to return and ability to ____
72; walk
102
Complete SCI = no sensory or motor function preserved in sacral segments S__-__
4-5
103
Zone of partial preservation in complete SCI?
dermatomes or myotomes below the motor level that remain partially innervated
104
The most caudal segment with some _____ defines extent of ZPP (within __ segments below injury)
sensory; 3
105
What is spared in anterior cord syndrome?
dorsal column
106
_____ cord syndrome = loss of vibration and proprioception below level of injury
post
107
______ _____ syndrome = most common, usually hypertension, UE motor + sensory more impaired than LE
central cord
108
Brown sequard = IPSI loss of ____ and _____ ; CONTRA loss of ___ and___ a few levels BELOW lesion
motor; DCML; pain; temp
109
___ _____ syndrome = AREFLEXIVE and FLACCID B/B
CE
110
SC terminates at L__ - L __
1-2
111
_____ _____ injuries can affect both conus and root resulting in varied neuro picture
conus medullaris (mixture of UMN and LMN lesion)
112
_______ spinothalamic tract = pain and temp
lateral
113
_____ spinothalamic tract = crude touch + pressure
ant
114
____ _____ = FINE touch, stereognosis and vibration
dorsal columns
115
_______ corticospinal = the 90% that cross in the pyramid motor
lateral
116
____ corticospinal = the 10 % that cross at the level of the innervations motor
anterior
117
C__ - T__ = non functional cough
4;1
118
T__-T__ = poor cough
2;4
119
T__-T__ = weak cough
5;10
120
T___ cough and below is normal
11
121
C_ = level pts need to breathe independently
4
122
T__ and below = normal vital capacity
11
123
C_-C_ = innervates accessory mm of breathing
2-7
124
C_- C_ = innervated diaphragm
3-5
125
T__-T_- = intercostals
1;11
126
T__ - L __ = abs
6-1
127
Possible movements C1-C4?
neck, slight shoulder retraction and adduction
128
Muscles fully innervated C1-C3?
1. SCM
2. neck extensors
3. neck flexors
129
Muscles partially innervated C3-5?
1. lev scap
2. diaphragm
3. supraspinatus
4. infraspinatus
130
Muscle fully innervated C2-4?
Traps
131
Muscle partially innervated C4-C5?
rhomboids
132
C5 injury = sig imbalance around _____ girdle
shoulder
133
Possible movement with C5 injury ?
1. shoulder abd , flex, ex
2. elbow flexion and supination
3. scapular add and abd
134
Muscles fully innervated with C5 injury ?
all C4 mm plus..
1. diaphragm
2. rhomboids
3. lev scap
135
Muscles partially innervated with C5 injury ?
1. deltoid
2. biceps
3. brachioradialis
4. teres minor
136
C5 injury = at risk for what contracture?
elbow bc unopposed antagonist
137
C5 injury may be able to use tenodesis grip with forearm supination ad pronation (T/F)
TRUE
138
C__ = first level of SCI to have potential to live alone in the community w/out care
6
139
C6 possible movements ?
1. radial wrist ext and some horizontal adduction
2. can extend elbow in some positions using ER of shoulder
3. tenodesis grip
140
Lats, serratus and pecs allow weight bearing through UE in C6 injury (T/F)
TRUE
141
C7-8 patterns of weakness?
limited grasp and release dexterity due to lack of intrinsic mm of hand
142
Triceps allow independent transfers for C7-8 injuries and individuals with this injury are mostly independently for ADLs (T/F)
TRUE
143
T1-T9 injuries = resp function is compromised above T__
6
144
Need brace and grade __ quads to walk w/o KAFO when L2-L5
3
145
L2-L5 will have _____ bladder and bowel and ___ paralysis
areflexive ; flaccid
146
Sympathetic chain?
T1-L1
147
Sympathetic NS _____ HR and blood flow to skeletal muscles
increases
148
Sympathetic NS _____ bronchial muscles
relaxes
149
Parasympathetic NS ____ HR and contractility
decreases
150
Parasympathetic NS ____ blood flow and smooth mm
increases
151
Parasympathetic NS ____ bronchial muscles
contracts
152
Injuries above T6: parasympathetic NS is _____
unopposed
153
With injuries above T6, HR response is due to ____ withdrawal rather than sympathetic drive
bagal
154
Injuries above T6 = blunting of HR often only __ - __ bpm
110;120
155
_____ _____ caused by massive sympathetic discharge from a noxious or non-noxious stimulus below level of SCI (with injuries ABOVE T__)
autonomic dysreflexia; T6
156
5 S/S of AD?
1. increase BP 20-30mmHg from normal
2. bradycardia
3. severe headache
4. dilated pupils
5. flushed sweating skin ABOVE level of injury; cool dry skin BELOW level of injury
157
5 common causes of AD?
1. urinary or colon irritation
2. wound
3. tight clothing
4. sex, pregnancy, labour
5. dx or therapeutic interventions!
158
4Rx /prevention for AD ?
1. place client in upright position
2. remove noxious stimulus (if necessary use antihypertensive drugs)
3. good B/B routines
4. ski and nail care
159
_____ _____ = sudden drop of 20mmHg of systolic BP or 10mmHg diastolic BP
orthostatic hypotension
160
4S/S of orthostatic hypotension?
1. asymptomatic!
2. dizziness, fainting
3. light headedness
4. headache
161
2 Rx for orthostatic hypotension?
1. mobilize SLOWLY
| 2. use compression stockings or binders
162
Signs of DVT / PE?
sudden LE swelling and inc in temp
163
PE in SCI: tachycardia may be masked by _______ dominance
parasympathetic
164
2 main CI for heterotrophic ossification?
1. FORCED PROM
| 2. serial casting
165
6 S/S of heterotrophic ossification?
1. pain
2. inc spasticity
3. warmth, low grade fever
4. erythema
5. local swelling
6. sudden dec ROM with an abnormal of hard end feel
166
3 Rx for heterotrophic ossification ?
1. PROM within tolerable range
2. meds
3. Sx
167
Large incidence of # in SCI due to __, esp in LE
OP
168
______ ______ ______ = formation of an abnormal tubular cavity in the SC
post traumatic syringomyelia
169
Post traumatic syringomyelia: ____ tethers/scars to the arachnoid blocking CSF flow
dura
170
Post traumatic syringomyelia: CSF is forced into the SC progressively enlarging the ____, leads to compression of card + _____ supply
cyst; vascular
171
Post traumatic syringomyelia: can occur years after the original injury (T/F)
TRUE
172
Post traumatic syringomyelia: look for _____ or increasing ______ of the injury
differences; presentation
173
2 tests for spasticity?
1. modified ashworth
| 2. tardieu
174
________ = velocity dependent resistance to passive stretch
spasticity
175
3 clinical characteristics of spasticity?
1. inc mm tone / firmness
2. inc stretch reflexes
3. uncontrolled movement's
176
3 pros of spasticity?
1. maintain mm bulk, venous return, useful for transfers, moving limbs
2. reflex erection can be achieved
3. acts as a warning sign
177
4 cons of spasticity?
1. lead to contractures
2. possibly painful
3. positioning difficulties
4. fatigue
178
2 meds for spasticity?
1. intrathecal baclofen
| 2. botox
179
Spastic bladder = injuries _____ the conus
above
180
With _____ bladder, messages will continue to travel bw bladder and SC since REFLEX ARC is still intact
spastic
181
Bladder management for spastic bladder?
1. may be triggered by "tapping"
| 2. either intermittent catheters or condom/ Foley drainage
182
Flaccid bladder = injury below T__
12
183
With flaccid bladder, messaged don't travel between SC and bladder since the ___ _____ is damaged
reflex center
184
Flaccid bladder: bladder loses ability to empty ______
reflexively
185
Flaccid bladder: bladder will continue to fill and MUST be _______
catheterized
186
Spastic bowel: peristalsis and reflex propulsion is still intact; reflex contraction of sphincter can lead to ___ ____ !
stool retention
187
Spastic bowel: can be trained to void (T/F)
true
188
Flaccid bowel = risk of ______
incontinennce
189
UMN lesion sexual health: Above T___ = reflex and spontaneous erection, no ______, fertility reduced
12; ejaculation; reduced
190
LMN lesion sexual health: below T ___ = _______ erection possible, reflex erection / ejaculation NOT possible
12; psychogenic
191
3 types of pain experienced by the SCI population?
1. neuropathic pain
2. nociceptive pain
3. chronic pain
192
______ pain in SCI = due to damage to NS
neuropathic
193
Rx for SCI neuropathic pain?
Meds
194
Nociceptive pain in SCI: ESP in ______!
shoulder
195
Chronic pain = pain lasting longerthan __ months; ___ SCI have chronic pain
3; 2/3
196
Stages of wounds in SCI?
1-4
197
5 descriptions for wounds?
1. location
2. size
3. wound base / edge
4. surrounding skin
5. stage photos
198
5 ways to prevent wounds ?
1. regular skin checks
2. change position regularly
3. skin care
4. exercise and eating well for skin health
5. no smoking
199
SCI and Exercise: decreased _______ impact so HR and BP (will/will not) have normal responses
sympathetic
200
Can use what 2 outcome measures for SCI and exercise?
1. RPE
| 2. Borg
201
Watch for ______ ______ when someone with a SCI is exercising !
orthostatic hypotension
202
SCI respiration = _______ breathing pattern
paradoxical
203
What position does the ideal length/tension relationship of diaphragm occur in?
LYING
204
Individuals with SCI: VC ______ from supine to sitting
DECREASES
205
SCI and respiration: DECREASE in all lung volumes except ______ volume
residual
206
_____ _____ disease is a major cause of death in people with SCI surviving 30+ years
cardio vascular
207
____ ______ myocardial atrophy seen in SCI
left ventricular
208
__x higher rate of bladder cancer in people with SCI
100
209
Epithelial tumour =?
carcinoma
210
Mesenchymal tumour =?
sarcoma
211
_______ = undifferentiated loose connective tissue from the mesoderm
sarcoma
212
Glial tumour = ?
glioma
213
Lymphoid tumour = ?
lymphoma
214
Hematopoietic tumour = ?
leukemia
215
Melanocytic tumour = ?
melanoma
216
4 types of lung carcinoma ?
1. squamous metaplasia
2. squamous dysplasia
3. carcinoma in situ
4. invasive carcinoma
217
____ cancer = 2nd cause of death
colon
218
With breast ca, there are ____ and _____ risk factors
hormonal; genetic
219
4 Rx for prostate cancer ?
1. sx
2. external beam radiation
3. brachytherapy
4. androgen deprivation therapy
220
5 common paediatric cancers?
1. acute lymphocytic leukaemia
2. non-Hodgkins and Hodgkins lymphoma
3. brain
4. small round blue cell
5. sarcoma
221
Paediatric bone based sarcoma = ________ or _____ sarcoma
osteosarcoma; Ewings
222
Most common form of skin cancer?
BCC
223
BCC has ___ risk of spreading, and is translucent and red in colour
LOW
224
______ = solid skin tumour, often volcano shaped
SCC
225
SCC has ___ risk for spreading
HIGH
226
Most dangerous form of skin cancer?
malignant melanom a
227
ABCD rule for melanoma?
1. asymmetry
2. border
3. colour
4. diameter
228
Duchennes muscular dystrophy = __ linked mutation on chromosome 21
X
229
What protein is not produced in individuals with Duchennes muscular dystrophy, leading to tissue that is prone to damage and necrosis ?
dystrophin
230
DMD = muscles cells replaced by fat ad CT, progressive ________ muscle wasting
symmetrical
231
______ signs = classic sign in DMD
gowers
232
Calf pseudohypertrophy caused by what in DMD?
fat and CT
233
6 S/S of DMD?
1. proximal muscle weakness
2. waddling gait
3. toe walking
4. lordosis
5. difficulty standing and climbing stairs, frequent falls
6. lower IQ
234
Avoid ________ exercises in DMD?
eccentric
235
3 Rx for DMD?
1. exercise by maintaining strength and balance
2. resp therapy
3. prevention of contractors, seating, equipment
236
Most common type of muscular dystrophy after DMD?
myotonic
237
Spinal muscular atrophy = skeletal muscles weaken when _____ horn degenerates
anterior
238
4 S/S of spinal muscular atrophy ?
1. hypotonia
2. dec function
3. weakness
4. fatigue
239
Weakness seen in spinal muscular atrophy = ________ and _____ to ______
symmetrical; proximal to distal
240
ALS affects both UMN and LMN (T/F)
TRUE
241
Bc ALS affects both UMN and LMN, you can have ____ and ____ paresis
flaccid; spastic
242
ALS: paresis in a ____ muscle group; corresponding muscle groups are ________ distributed
single; asymmetrically
243
ALS: metabolic involvement of the ______ (papery, fragile, cold)
skin
244
ALS: gradual involvement of _____ muscle (bulbar muscle = MAJOR concern)
striated
245
3 muscle groups spared in ALS?
1. cardiac
2. occular
3. urethral and anal sphincter
246
Essential tremor is usually evoked by ______ movement; caused by increased ______ activity
voluntary; thalamus
247
______ = involuntary, sustained muscle contractions, writhing
dystonia
248
_______ disease = chronic neurodegenerative disease in basal ganglia
parkinsons
249
PD = decreased _______ produced by the substance nigra
dopamine
250
Dopamine usually inhibits ___, without dopamine = excessive______ output
ACh; excitatotory
251
Classic 4 S/S of PD?
1. bradykinesia
2. resting tremor
3. rigidity
4. postural instability
252
Rigidity = velocity ________ resistance to passive stretch
INDEPENDENT
253
PD = tremor due to MEDS (T/F)
TRUE
254
2 outcome measures for PD?
1. UPDRS
| 2. Hoens and Yar
255
_____ _____ = atrophy of basal ganglia structures, personality disorder, dementia
huntington's chorea
256
_____ _____ = inflammatory disease; fatty myelin sheaths around brain + SC are damaged
myelin sheath
257
MS leads to _____ and ______ of the myelin sheath
demyelination; scarring
258
Typical onset for MS dx?
20-40 y
259
4 types of MS?
1. relapsing remitting
2. primary progressive
3. secondary progressive
4. progressive relapsing
260
_____ ______ = new/old symptoms resurface or worsen; full or partial recovery b/w relapses
relapsing remitting
261
______ _____ = gradual or worsening of symptoms overtime; may stabilize but no remission
primary progressive
262
_______ _______ = begins as relapsing remitting; steadily worsens; does not re-myelinate
secondary progressive
263
______ ______ = some degree of recovery between flares
progressive relapsing
264
5 early symptoms of MS?
1. muscle weakness
2. optic neuritis; diplopia
3. sensory changes
4. b/b incontinence
5. vertigo
265
2 side effects of MS meds?
1. heat intolerance
| 2. photosensitivity
266
CI/ precautions to exercise in pts with MS?
1. heat
2. fatigue
3. pregnancy
267
______ disease = from bacterium Borrelia burgdorferi, mimics other diseases like MS, fibromyalgia, chronic fatigue, GBS
Lyme
268
4 stages of Lyme disease ?
1. localized presentation (flu - like)
2. neuro, MSK and cardiac symptoms
3. may have Bell's palsy
4. final stage = long term neuro + arthritis, cognitive deficits
269
_____ ____ ____ = antibody mediated demyelination of schwann cells in PNS from spinal nerves > terminating fibers
GBS
270
GBS: onset to peak = __ weeks
4
271
GBS = rapid _______ motor weakness and _____ sensory loss
ascending; distal
272
GBS = _____ and _____ pattern of loss; absent DTR and may require mechanical ventilation
stocking; glove
273
4 PT Rx for GBS?
1. joint protection
2. chest Rx
3. strength
4. ROM
274
_________ = infectious diseases (bacterial or viral) that causes inflammation in the meninges of the brain and SC
meningitis
275
Meningitis = ___-___ barrier can break down and release infection into blood stream; _____ response leads to edema in the brain and subsequent increase in ICP
blood-brain; immune
276
3 types of meningitis ?
1. aseptic
2. TB
3. bacterial
277
______ sign= involuntary flexion of hips and knees when neck is passively flexed
Brudzinski's sign
278
_____ sign = painful knee extension from position of hip and knee flexion
Kernigs
279
______ = infection (primary or secondary) of the brain + SC or brain parenchyma
encephalitis
280
Enchephalitis tends to affect the ______ and _____ lobes
frontal; temporal
281
Meningitis and encephalitis management?
investigate ASAP
282
Long term brain damage due to encephalitis and meningitis can occur in mere ____
hours
283
Creutzfeldt Jakob disease = caused by ______; incubates __ - __ years, cannot make a dx until death
prions; 5-8
284
Post-polio syndrome attacks neurons in _____ and _____ horn cells
brainstem; anterior
285
Post polio syndrome - death of motor neurons, ones that survive sprout new terminals to make up for loss, resulting in ______ _____ _____
enlarged motor units
286
After years of having post polio syndrome = high metabolic stress on larger motor neuron, = muscle _____ and ______
weakness; paralysis
287
Chronic and acute alcohol poisoning effects ______ receptors
GABA
288
______cerebellum lesions = vestibular control of HEAD and BODY position; gait and trunk ataxia
archi
289
Archicerebellum lesions = pt will fall _____ side of lesion
TOWARDS
290
______cerebellum lesions = effects synergy of agonist/ antagonist/ postural correction; hypotonia, trunk ataxia and ataxic gait
paleo
291
Paleocerebellum lesions = will lose _____ activity and have jerky movements
core
292
_____cerebellum lesions = coordination of fine skilled movements; intention tremor, dysdiadochokinesia, dysmetria and dssynergia
neo
293
Neocerebellum lesions = errors in _____ and loss of ___ coordination
timing; fine
294
3 tests for cerebellar lesions?
1. coordination
2. Romberg sign
3. falling to side of lesions
295
Romberg sign = if similar imbalance eyes ___ and ____ likely cerebellar in origin
open; closed
296
4 S/S of cerebellar lesions ?
1. lurching gait, falling to side of lesion, stiff legged
2. intention tremor, disdiadochokinesia, nystagmus; dysmetria
3. cerebellar ataxia
4. hypotonia, dysphonia or dysarthria
297
Pt's with cerebellar lesion will have _____ knee jerk
pendular
298
7 potential causes of dizziness?
1. CV
2. neurological
3. visual
4. psychogenic
5. cervicogenic
6. meds
7. vestibular
299
3 functions of vestibular system?
1. gaze stabilization
2. postural stabilization
3. resolution of sensory motor mismatch
300
Names of semicircular canals?
1. horizontal
2. anterior
3. posterior
301
Fx of semicircular canals?
gaze/angular displacement of head
302
Semicircular canals: mouvement of _____ will deflect hair cells and excite or inhibit neurons (CN___)
endolymph; VIII
303
How many otoliths?
2
304
_____ = detects HORIZONTAL plane motion in vestibular system
utricle
305
______ detects saggital plane motion in vestibular system
saccule
306
_____ = subjective experience of nystamus aka room spinning around you
vertigo
307
____ = discrepancy bw R and L, patient can't work out where they are in space
dizziness
308
_____ = blurred vision
oscillopsia
309
BPPV = 90% present with crystal in ______ SCC; 80% = ______ (free floating in canal)
posterior; canalisthiasis
310
S/S of ____ = brief (<30s) delayed transient vertigo with looking up and down, rolling to that side of bed etc
BPPV
311
Ax for BPPV?
Dix Hallpike
312
CIs for Dix Hallpike?
1. cervical spine instability
2. VBI
3. Arnold Chiari malformation
4. acute whiplash
5. RA
6. prolapsed IV disc w/ radiculopathy
7. cervical myelopathy
313
Most common Rx for BPPV?
Modified Epley Maneuver
314
_______ disease = over accumulation of endolymph
Meniere's
315
4 S/S of Meniere's disease?
1. episodic vertigo
2. tinnitus
3. fullness of ears
4. hearing loss
316
VOR is deficient in both UVL and BVL (T/F)
TRUE
317
5 acute S/S of UVL?
1. spontaneous nystagmus away from affected ear
2. reduced VOR
3. vertigo
4. dizziness
5. oscillopsia
318
4 chronic symptoms of UVL?
1. dizziness
2. oscillopsia
3. imbalance
4. symptoms worse after rapid head movement
319
4 Ax for UVL?
1. head thrust
2. dynamic visual acuity test
3. balance and gait ax
4. dix hall pike
320
Is there dizziness or vertigo with BVL?
NO
321
BVL usually caused by ______ drugs like gentamicin
ototoxic
322
2 S/S of BVL?
1. dec balance with eyes closed
| 2. oscillopsia
323
3 type of tests to include in balance ax of BVL?
1. static
2. dynamic
3. composite
324
5 potential causes of central vestibular disorders?
1. stroke
2. TBI
3. MS
4. tumour
5. neurodegenerative diseases
325
Rx for central vestibular disorders based on ______
neuroplasticity
326
Motion sensitivity Rx = __ - __ weeks of sensorimotor mismatch exercises
8-12
327
Cervicogenic dizziness is a Dx of ______
exclusion
328
______ _____ = intracranial tumour of myelin around CN VIII
acoustic neuroma
329
Acoustic neuroma or vestibular schwannoma is common later in life (50-60) that causes ______ vestibular loss
central
330
Diabetic neuropathy can be focal or diffuse, involving the ____ or ____ PNS
somatic; autonomic
331
Diabetic neuropathy presentation?
symmetrical distal pattern
332
Diabetic neuropathy = loss of ______ and _______ fibers
myelinated; unmyelinated
333
4 S/S of diabetic neuropathy?
1. burning pain
2. symmetrical sensory changes
3. can be slow or rapid onset
4. paresthesia
334
Diabetic neuropathy = minimal _____ weakness
motor
335
4 Rx for diabetic neuropathy?
1. control hyperglycaemia
2. symptom management
3. skin care checks!
4. exercises
336
CRPS = possible result of dysfunction in _____ or _____ NS
central; peripheral
337
CRPS = ________ facilitation
sympathetic
338
5 presentations of CRPS?
1. change in skin colour / temp
2. intense burning pain
3. skin sensitivity
4. sweating
5. swelling
339
When does CRPS usually occur after?
trauma or immobilization
340
Stage __ CRPS = 0-3 months, puffy swelling, redness, warm
1
341
Stage __ CRPS = 3-6 months, increased pain and stiffness, firm edema, cyanosis, atrophy, osteopenia
2
342
Stage __ CRPS = 6 months +, tight smooth, glossy pale skin
3
343
Rx for CRPS?
1. prevention and early detection
2. early ROM
3. edema management
4. desensitization
5. education
344
_____ ______ = non progressive lesion of the brain, occurs before 2 years
cerebral palsy
345
Low birth _____ and low _____ = risk factors for CP
weight; APGAR
346
5 classifications of CP?
```
1. spastic
2 ataxic
3. dystonic
4. hypotonia
5. athetoid
```
347
4 types of spastic CP?
1. monoplegia
2. diplegia
3. hemiplegia
4. quadriplegia
348
_______ CP = difficulty w/ stop/ start movements
spastic
349
_______ CP = difficultly w/ rapid movements, coordinated gait, fine motor, balance
ataxic
350
______ CP = increased tone and can't relax mm easily; long sustained involuntary movements and postures
dystonic
351
Dystonic CP = usually have limited ROM (T/F)
FALSE ; usually have full ROM
352
______ CP = lack of tone; weakness
hypotonia
353
_____ CP = writhing movement, snake like
athetoid
354
2 possible pathologies leading to CP?
1. intraventricular hemorrhage
| 2. periventricular leukomalacia
355
5 risk factors for CP?
1. 27-30 weeks gestation
2. small for gestational age
3. rupture of membranes
4. intrauterine infection
5. loss of autonomic regulation of CNS blood flow until full term
356
Hip ______ = complications from CP
subluxation
357
Suspect hip subluxation in client with CP when they cannot ABD leg more that _____ deg
45
358
2 common muscles to get spasticity in CP?
1. adductor longus
| 2. iliopsoas
359
____ ____ = neural tube defect leading to vertebral and/or SC malformation
spina bifida
360
Spina bifida _____ = no SC involvement, may be indicated by hair tuft
occulta
361
Spina bifida _____ = visible or open lesion
cystica
362
_________ = type of spina bifida that includes cyst w/ CSF; SC intact
meningocele
363
_________ = type of spina bifida w/ cyst that includes CSF and herniated cord tissue
myelomeningocele
364
Spina Bifida: Link b/w maternal decreased ____ ____ + infection + exposure to _______ such as alcohol
folic acid; teratogens
365
Spina bifida: foot deformities, esp w/ L__ and L__ level
4;5!
366
Spina bifida = decreased / absent ____
DTR
367
Spina bifida = flaccid OR spastic mm (T/F)
TRUE
368
4 PT Rx for spina bifida?
1. ROM
2. teach transfers
3. equipment
3. encourage awareness of sensory deficits
369
Erbs palsy position?
1. shoulder EXT/IR/ADD
2. elbow EXT
3. forearm PRONATION
4. wrist/finger FLEX
370
Is there sensory loss in Erbs palsy?
yes
371
Is grasp intact in Erbs palsy?
yes
372
Erbs palsy = C__ / C __ injury
5/6
373
3 Rx for Erbs palsy?
1. immobilization initially
2. gentle ROM
3. play exercises
374
_____ palsy = claw hand
klumpkes
375
Klumpkes palsy = effects C___/__/T__
7/8;1
376
What does klumpkes palsy effect?
intrinsic hand muscles, flexors/extensors of the wrist and fingers
377
Median nerve palsy = ____ hand
ape
378
What nerves does median n palsy effect?
C6-8, T1
379
Ape hand = no thumb _____ or _____
opposition; abduction
380
________ ________ dementia = multiple small lesions secondary to poor blood flow (high BP)
vascular cognitive
381
Vascular cognitive dementia leads to degeneration of _____ _____ lobes
medial temporal
382
_____ = lowest level of consciousness
coma
383
2 types of seizures?
1. primary generalized seizure
| 2. partial seizure
384
2 subtypes of primary generalized seizures?
1. tonic-clonic
| 2. absence seizure
385
Tonic clonic seizure = also known as ____ ____ seizures
grand mal
386
____ ______ seizures = bilateral and symmetrical w/out local onset
primary generalized
387
_____ _____ seizure = dramatic, whole body lasting for 2-5 minutes
tonic clonic
388
______ seizure = brief, almost imperceptible LOC, can be up to 100/day
absence
389
2 subtypes of partial seizures?
1. simple partial
| 2. complex partial
390
____ _____ seizure = usually one part of the body
simple partial
391
Focal motor simple partial seizure = _____ activity on specific area of the body
clonic
392
Focal motor w/ march simple partial seizure = orderly spread of march of ____ movements , can progress to whole side
clonic
393
Temporal lobe seizure = ______ change in behaviour, complex _______
episodic; hallucinations
394
______ partial seizure = simple partial seizure followed by impairment of consciousness
complex
