S1_L1: Neurological Examination in PT Practice Flashcards

1
Q

TRUE OR FALSE: Coma (Deep coma) has a sleep-wake cycle and can determine day from night.

A

False

Vegetative state has a sleep-wake cycle. In a coma, the eyes are closed with absence of sleep-wake cycles and no evidence of a contingent relationship between the patient’s behavior and the environment (Braddom).

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2
Q

Level of consciousness where the individual responds to loud shaking voices and painful stimuli. They need constant, repeated stimulation to cooperate and maintain consciousness.

A

Obtunded

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3
Q

Level of consciousness where the individual sleeps (easily falls asleep) when not stimulated but is easily aroused. They are drowsy and inattentive. The patient may have difficulty in focusing or maintaining attention on a question or task.

A

Lethargic

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4
Q

Individuals in a stupor respond to painful stimuli, such as rubbing what 2 body structures using the tip of the thumb, IP joint or PIP joint of index finger or other fingers?

A
  1. glabella
  2. sternum
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5
Q

TRUE OR FALSE: Coma and vegetative states are both lacking in response to any kind of stimulus.

A

True

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6
Q

Musical quality / component of speech and the ability to differentiate declarative from interrogative statements

A

Prosody

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7
Q

The quality of speech
and the ability to express or answer without hesitation; when a question is given, pt can answer properly.

A

Fluency

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8
Q

Denial & lack of awareness of the presence or severity of one’s paralysis; pt still uses the affected side because they think that there’s no problem with that side.

A

Anosognosia

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9
Q

Neglect in your environment / surroundings

A

Hemispace

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10
Q

Lack of awareness of the body structure and relationship of body parts to oneself or to others. A lack of proprioception may underlie or compound this disorder.

A

Somatoagnosia / Autotopagnosia / Body Agnosia

(Other two names source: O’Sullivan, 6th ed)

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11
Q

TRUE OR FALSE: Right and Left Discrimination must be assessed prior to Somatoagnosia Testing.

A

False

Somatoagnosia is assessed first.

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12
Q

The inability to register & integrate stimuli & perceptions from one side of the body, which is not due to sensory loss.

A

Unilateral neglect / Unilateral spatial neglect / Hemi-inattention / Hemineglect / Unilateral visual inattention

Additional: The pt is aware that they have a problem on one side of the body, and they sometimes forget but does not deny that they have a problem on one side of the body.

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13
Q

TRUE OR FALSE: A left sided hemispheric stroke (or the affected hemiplegic side) commonly has a perceptual deficit or problem in body scheme.

A

False, it’s the R. If L sided, aphasic problem (language affectation).

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14
Q

A language examination is not complete without each of the 7 components of language. Enumerate all 7.

A
  1. Fluency
  2. Prosody
  3. Repetition
  4. Naming
  5. Comprehension
  6. Reading
  7. Writing
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15
Q

Enumerate the components of language assessed by PTs to determine the type of aphasia

A
  1. Fluency
  2. Comprehension
  3. Repetition
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16
Q

Asking the patient to subtract the following consecutively: 30-5, 25-6, 19-4, 15-5

A. Attention span
B. Concentration span

A

B. Concentration span

The above test is known as serial subtraction.

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17
Q

Asking the patient to count from 20 backwards until reaching 0.

A. Attention span
B. Concentration span

A

B. Concentration span

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18
Q

Asking the patient to spell the word “money” backwards

A. Attention span
B. Concentration span

A

B. Concentration span

Note: When the 1st try is wrong, try once more to determine if it was an honest mistake or impaired. Also, let the patient spell the word correctly first then backwards.

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19
Q

The amount of time it took for the patient to finish a task

A. Attention span
B. Concentration span

A

A. Attention span

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20
Q

The number of times the patient reached for the pencil

A. Attention span
B. Concentration span

A

A. Attention span

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21
Q

Which of the following disorders is a result from oculomotor damage?
A. Myopia
B. Anosmia
C. Exotropia
D. Esotropia
E. Wasting of the temporalis muscle

A

C. Exotropia

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22
Q

How far should the Snellen chart be placed away from the patient in assessing visual acuity? (for far vision)

A

6 feet

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23
Q

How far should the Snellen chart be placed away from the patient in assessing visual acuity? (for near vision)

A

14 inches

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24
Q

The corneal reflex is a sensitive test for what cranial nerve damage?

A

Trigeminal nerve (CN V; ophthalmic division)

Additional: The corneal reflex is actually the most sensitive test for CN V

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25
Q

It is the afferent arm of the gag reflex

A

Glossopharyngeal nerve (CN IX)

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26
Q

It is the efferent arm of the gag reflex

A

Vagus nerve (CN X)

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27
Q

If you have ® hypoglossal nerve injury, the tongue will deviate towards what side?

A

Right side

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28
Q

If you have (L) vagus nerve injury, the uvula will deviate towards what side?

A

Right side

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29
Q

If these tests are intact, all other combined cortical sensations are intact. What are those tests?

A
  1. 2-point discrimination
  2. Stereognosis
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30
Q

If you have (R) vagus nerve injury, the uvula will deviate towards what side?

A

Left

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31
Q

TRUE OR FALSE: Atrophy of the trapezius can be observed by a loss of the C-shaped contour with more of an L-shaped contour.

A

True

Source: Braddom, 6th ed

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32
Q

Normal values for 2-point discrimination on the fingertips

A

3-5 mm

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33
Q

Normal values for 2-point discrimination on the dorsum of the hand

A

20-30 mm

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34
Q

Normal values for 2-point discrimination on the palms

A

8-15 mm

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35
Q

In 2-point discrimination, the normal values of the fingertips compared to the palms is smaller. What topographic representation is the reason for this?

A

Sensory homunculus

Note: According to the drawing of the homunculus, the representation of the hand is larger than the fingertips, therefore it has more sensory receptors.

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36
Q

During double simultaneous stimulation, there is an absence of the distal extremity sensation while simultaneously applying proximal and distal sensations. This abnormality is known as the?

A

Extinction phenomenon

Additional: Even if you stimulate higher areas, the pt still cannot feel the distal stimulus

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37
Q

Determine the corresponding nerve roots of the following superficial reflexes

  1. Lower abdominal reflex
  2. Anal reflex
  3. Plantar scratch/reflex
  4. Upper abdominal reflex

A. T8-T10
B. T10-T12
C. L2-S1
D. S2-S4

A
  1. B
  2. D
  3. C
  4. A
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38
Q

Determine the corresponding nerve roots of the following superficial reflexes

  1. Brachioradialis Reflex
  2. Patellar Reflex
  3. Biceps, Brachialis Reflex
  4. Ankle (Achilles) Reflex
  5. Triceps Reflex

A. C5-C6
B. C5-C6 / C6-C7
C. C6-C7 / C7-C8
D. L2-L4
E. S1

A
  1. B
  2. D
  3. A
  4. E
  5. C
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39
Q

The most important sensory test when the patient has a stroke or brain problem.

A

Combined cortical

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40
Q

Pt has L hearing loss based on the hearing assessment before the Weber’s & Rinne’s Tests. During the Rinne’s test, pt reported they heard more vibration sounds when PT placed the tip of the tuning fork on the mastoid process.

A. Normal hearing
B. Conductive hearing loss
C. Sensorineural hearing loss

A

B. Conductive hearing loss

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41
Q

Pt has L hearing loss based on the hearing assessment before the Weber’s & Rinne’s Tests. During the Weber’s test, pt reported that the sound is louder on the L than the R.

A. Normal hearing
B. Conductive hearing loss
C. Sensorineural hearing loss

A

B. Conductive hearing loss

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42
Q

Pt has L hearing loss based on the hearing assessment before the Weber’s & Rinne’s Tests. During the Rinne’s test, pt reported they heard vibration sounds when PT placed the tip of the tuning fork on the mastoid process. When PT placed the tip near the ear, pt said that they heard vibration sounds but the sound immediately disappeared.

A. Normal hearing
B. Conductive hearing loss
C. Sensorineural hearing loss

A

C. Sensorineural hearing loss

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43
Q

Pt has L hearing loss based on the hearing assessment before the Weber’s & Rinne’s Tests. During the Weber’s test, pt reported that they heard sounds in the R ear, while nothing was heard in the L ear.

A. Normal hearing
B. Conductive hearing loss
C. Sensorineural hearing loss

A

C. Sensorineural hearing loss

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44
Q

___ hearing loss is associated with affectation of the outer or middle ear.

A

Conductive

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45
Q

___ hearing loss is associated with affectation of the inner ear to the nerves, up to the brain. A problem with the transition of sound results.

A

Sensorineural

45
Q

What is the landmark/structure where the base of the tuning fork is placed while inquiring whether sound remains central or referred to one side in the Weber’s test?

A

Vertex of the skull

46
Q

The efferent arm of the corneal reflex

A

Facial nerve (CN VII)

47
Q

Determine the corresponding nerve affectation of the following conditions

  1. Myopia
  2. Horizontal diplopia
  3. Vertical diplopia
  4. Esotropia
  5. Exotropia

A. Optic nerve (CN II)
B. Oculomotor nerve (CN III)
C. Trochlear nerve (CN IV)
D. Abducens nerve (CN VI)

A
  1. A
  2. D
  3. C
  4. D
  5. B
48
Q

Determine the corresponding description of the following conditions

  1. Double vision
  2. External strabismus
  3. Near-sightedness
  4. Internal strabismus
  5. Dilation of pupils

A. Myopia
B. Diplopia
C. Mydriasis
D. Esotropia
E. Exotropia

A
  1. B
  2. E
  3. A
  4. D
  5. C
49
Q

Determine the corresponding description of the following conditions

  1. Affectation of lateral rectus
  2. Constriction of pupil
  3. Affectation of medial rectus
  4. Far-sightedness
  5. Unequal pupils

A. Esotropia
B. Anisocoria
C. Presbyopia
D. Miosis
E. Exotropia

A
  1. A
  2. D
  3. E
  4. C
  5. B
49
Q

Direct pupillary light reflex was performed. The L eye was in contact with the light. The L and R eyes did not constrict. This observation is due to a problem in which structure/s?
A. L oculomotor nerve
B. R oculomotor nerve
C. L optic nerve or (B) oculomotor nerves
D. R optic nerve or (B) oculomotor nerves
E. No affectation

A

C. L optic nerve or (B) oculomotor nerves

50
Q

Direct pupillary light reflex was performed. The L eye was in contact with the light. The L and R eyes both constricted. This observation is due to a problem in which structure/s?
A. L oculomotor nerve
B. R oculomotor nerve
C. L optic nerve or (B) oculomotor nerves
D. R optic nerve or (B) oculomotor nerves
E. No affectation

A

E. No affectation

51
Q

Direct pupillary light reflex was performed. The L eye was in contact with the light. The L eye did not constrict, while the R eye constricted. This observation is due to a problem in which structure/s?
A. L oculomotor nerve
B. R oculomotor nerve
C. L optic nerve or (B) oculomotor nerves
D. R optic nerve or (B) oculomotor nerves
E. No affectation

A

A. L oculomotor nerve

52
Q

Direct pupillary light reflex was performed. The L eye was in contact with the light. The L eye constricted, while the R eye did not constrict. This observation is due to a problem in which structure/s?
A. L oculomotor nerve
B. R oculomotor nerve
C. L optic nerve or (B) oculomotor nerves
D. R optic nerve or (B) oculomotor nerves
E. No affectation

A

B. R oculomotor nerve

53
Q

Direct pupillary light reflex was performed. The R eye was in contact with the light. The L and R eyes did not constrict. This observation is due to a problem in which structure/s?
A. L oculomotor nerve
B. R oculomotor nerve
C. L optic nerve or (B) oculomotor nerves
D. R optic nerve or (B) oculomotor nerves
E. No affectation

A

D. R optic nerve or (B) oculomotor nerves

54
Q

Direct pupillary light reflex was performed. The R eye was in contact with the light. The L eye constricted, while the R eye did not constrict. This observation is due to a problem in which structure/s?
A. L oculomotor nerve
B. R oculomotor nerve
C. L optic nerve or (B) oculomotor nerves
D. R optic nerve or (B) oculomotor nerves
E. No affectation

A

B. R oculomotor nerve

55
Q

Direct pupillary light reflex was performed. The R eye was in contact with the light. The L eye did not constrict, while the R eye constricted. This observation is due to a problem in which structure/s?
A. L oculomotor nerve
B. R oculomotor nerve
C. L optic nerve or (B) oculomotor nerves
D. R optic nerve or (B) oculomotor nerves
E. No affectation

A

A. L oculomotor nerve

56
Q

The afferent arm of pupillary light reflex

A

Optic nerve (CN II)

57
Q

The efferent arm of pupillary light reflex

A

Oculomotor nerve (CN III)

58
Q

The pupillary light reflex is the pupillary constriction of the ipsilateral eye when exposed to light. Ipsilateral pupillary constriction is d/t what structure?

A

Edinger-Westphal nucleus of the oculomotor nerve

59
Q

The pupillary light reflex is the pupillary constriction of the ipsilateral eye when exposed to light. Contralateral pupillary constriction is d/t the Consensual Light Reflex via what pathway?

A

Optic-Oculomotor Pathway

60
Q

Determine the corresponding descriptions of the following conditions

  1. absent sense of smell
  2. distorted sense of smell
  3. perception of smell without any stimulus
  4. decreased sense of smell
  5. perception of bad smell
  6. increased sense of smell

A. Dysosmia
B. Cacosmia
C. Hyperosmia
D. Hyposmia
E. Parosmia
F. Anosmia

A
  1. F
  2. A
  3. E
  4. D
  5. B
  6. C
61
Q

Enumerate all cranial nerves involved in the parasympathetic system

A
  1. Oculomotor nerve (CN III)
  2. Facial nerve (CN VII)
  3. Glossopharyngeal nerve (CN IX)
  4. Vagus nerve (CN X)
62
Q

Enumerate all cranial nerves that are mixed (sensory and motor)

A
  1. Trigeminal nerve (CN V)
  2. Facial nerve (CN VII)
  3. Glossopharyngeal nerve (CN IX)
  4. Vagus (CN X)
63
Q

The ability to visually distinguish a figure from the background in which it is embedded. It interferes with the patient’s ability to locate important objects that are not prominent in a visual array.

A

Figure-Ground Discrimination
Source: O’Sullivan, 6th ed

64
Q

TRUE OR FALSE: Body scheme refers to a postural model of the body including the relationship of the body parts to each other and the relationship of the body to the environment.

A

True
Source: O’Sullivan, 6th ed

65
Q

Automatic response that helps maintain balance when the body’s center of mass is displaced to restore and maintain balance. For example, an individual was hit and they are moving towards their right. Their body will automatically move towards the left to avoid falling.

A

Equilibrium Reflex

66
Q

TRUE OR FALSE: Physiologic Reflexes are normal reflexes in adults and should exist even when you get older.

A

True

67
Q

Automatic response to protect the body from potential harm or injury. It causes extension of the limbs to break the fall and minimize injury.

A

Protective Extension Reflex

68
Q

Pt is fluent, but comprehension and repetition are impaired.
A. Anomia
B. Conduction
C. Transcortical sensory
D. Wernicke’s

A

D. Wernicke’s

69
Q

Passively flexing the shoulder will elicit extension of the fingers. This is the treatment used for flexor synergy.
A. Sterling’s Phenomenon
B. Raimiste’s Phenomenon
C. Marie-Foix Phenomenon (Bechterev’s)
D. Soque’s Phenomenon
E. Homolateral Synkinesis

A

D. Soque’s Phenomenon

70
Q

PT will resist shoulder abduction on the unaffected side, then there will be an associated abduction on the affected side.
A. Sterling’s Phenomenon
B. Raimiste’s Phenomenon
C. Marie-Foix Phenomenon (Bechterev’s)
D. Soque’s Phenomenon
E. Homolateral Synkinesis

A

A. Sterling’s Phenomenon

71
Q

Passively flexing the toes on the affected side will elicit massive flexion of the entire lower extremity on the affected side.
A. Sterling’s Phenomenon
B. Raimiste’s Phenomenon
C. Marie-Foix Phenomenon (Bechterev’s)
D. Soque’s Phenomenon
E. Homolateral Synkinesis

A

C. Marie-Foix Phenomenon (Bechterev’s)

72
Q

PT will resist hip abduction of the unaffected side, then there will be an associated hip abduction on the affected side. This can be done in sitting or supine.
A. Sterling’s Phenomenon
B. Raimiste’s Phenomenon
C. Marie-Foix Phenomenon (Bechterev’s)
D. Soque’s Phenomenon
E. Homolateral Synkinesis

A

B. Raimiste’s Phenomenon

73
Q

Passively flexing / extending the UE on the affected side will elicit flexion / extension of the LE ipsilaterally.
A. Sterling’s Phenomenon
B. Raimiste’s Phenomenon
C. Marie-Foix Phenomenon (Bechterev’s)
D. Soque’s Phenomenon
E. Homolateral Synkinesis

A

E. Homolateral Synkinesis

74
Q

TRUE OR FALSE: The stimulus for homolateral synkinesis may be done on the affected LE.

A

False, it’s always done on the UE

75
Q

Non-equilibrium testing grade described as: Minimal impairment: Able to accomplish activity, slightly less than normal control, speed, and steadiness
A. 4
B. 3
C. 2
D. 1
E. 0

A

B. 3

76
Q

Non-equilibrium testing grade described as: Moderate impairment: Able to accomplish activity; movements are slow, awkward, and unsteady
A. 4
B. 3
C. 2
D. 1
E. 0

A

C. 2

77
Q

Non-equilibrium testing grade described as: Severe impairment: able to only initiate activity without completion; movements are slow with significant unsteadiness, oscillation and/or extraneous movements
A. 4
B. 3
C. 2
D. 1
E. 0

A

D. 1

78
Q

Stimulus is stroking of lateral aspect of sole of foot (from little toe to great toe, brisk and firm)
A. Babinski
B. Chaddock
C. Oppenheim
D. Gordon
E. Piotrowski
F. Brudzinski

A

A. Babinski

79
Q

Stimulus is stroking of lateral side of foot beneath lateral malleolus
A. Babinski
B. Chaddock
C. Oppenheim
D. Gordon
E. Piotrowski
F. Brudzinski

A

B. Chaddock

80
Q

Stimulus is stroking of anteromedial surface of tibia/ shin in a downward direction, stopping at the ankle area
A. Babinski
B. Chaddock
C. Oppenheim
D. Gordon
E. Piotrowski
F. Brudzinski

A

C. Oppenheim

81
Q

Stimulus is squeezing of calf muscles firmly but only once
A. Babinski
B. Chaddock
C. Oppenheim
D. Gordon
E. Piotrowski
F. Brudzinski

A

D. Gordon

82
Q

Stimulus is percussion / tapping of the tibialis anterior muscle
A. Babinski
B. Chaddock
C. Oppenheim
D. Gordon
E. Piotrowski
F. Brudzinski

A

E. Piotrowski

83
Q

Stimulus is passive flexion of one lower limb (the unaffected side first)
A. Babinski
B. Chaddock
C. Oppenheim
D. Gordon
E. Piotrowski
F. Brudzinski

A

F. Brudzinski

84
Q

Positive response: dorsiflexion and supination of foot
A. Babinski
B. Chaddock
C. Oppenheim
D. Gordon
E. Piotrowski
F. Brudzinski

A

E. Piotrowski

85
Q

Positive response is flexion of opposite affected lower limb
A. Babinski
B. Chaddock
C. Oppenheim
D. Gordon
E. Piotrowski
F. Brudzinski

A

F. Brudzinski

86
Q

Stimulus is tapping of plantar surface of toes
A. Piotrowski
B. Brudzinski
C. Hoffman
D. Rossolimo
E. Schaeffer

A

D. Rossolimo

87
Q

Stimulus is pinching of Achilles tendon in middle third
A. Piotrowski
B. Brudzinski
C. Hoffman
D. Rossolimo
E. Schaeffer

A

E. Schaeffer

88
Q

Stimulus is tapping of nail bed of index, middle or ring finger (distal phalanx)
A. Piotrowski
B. Brudzinski
C. Hoffman
D. Rossolimo
E. Schaeffer

A

C. Hoffman

89
Q

Positive response is flexion of the distal phalanx of thumb
A. Piotrowski
B. Brudzinski
C. Hoffman
D. Rossolimo
E. Schaeffer

A

C. Hoffman

90
Q

Positive response is flexion of foot and toes
A. Piotrowski
B. Brudzinski
C. Hoffman
D. Rossolimo
E. Schaeffer

A

E. Schaeffer

91
Q

Positive response is plantarflexion of toes
A. Piotrowski
B. Brudzinski
C. Hoffman
D. Rossolimo
E. Schaeffer

A

D. Rossolimo

92
Q

Modified Ashworth Scale grade described as: More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved.
A. 0
B. 1
C. 1+
D. 2
E. 3
F. 4

A

D. 2

93
Q

Modified Ashworth Scale grade described as: Considerable increase in muscle tone, passive movement difficult
A. 0
B. 1
C. 1+
D. 2
E. 3
F. 4

A

E. 3

94
Q

Modified Ashworth Scale grade described as: Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
A. 0
B. 1
C. 1+
D. 2
E. 3
F. 4

A

C. 1+

95
Q

Modified Ashworth Scale grade described as: Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of ROM when the affected part(s) is moved in flexion or extension
A. 0
B. 1
C. 1+
D. 2
E. 3
F. 4

A

B. 1

96
Q

Modified Ashworth Scale grade described as: Affected part(s) rigid in flexion or extension
A. 0
B. 1
C. 1+
D. 2
E. 3
F. 4

A

F. 4

97
Q

Enumerate the characteristics of movement that PTs should take note of in functional muscle testing

A
  1. Body part being assessed
  2. Quality of the movement
  3. Quantity or number of trials
  4. Speed of the movement
  5. Duration of the movement
98
Q

Action with the strongest spasticity in UE flexion synergy

A

Elbow flexion

99
Q

Action with the strongest spasticity in LE flexion synergy

A

Hip flexion

100
Q

Action with the strongest spasticity in UE extension synergy

A

Forearm pronation

101
Q

Action with the strongest spasticity in LE extension synergy

A

Hip adduction, knee extension, ankle plantarflexion

102
Q

TRUE OR FALSE: Cauda equina syndrome will manifest with LMNL features.

A

True

103
Q

Pt is fluent and has comprehension, but has impaired repetition.
A. Anomia
B. Conduction
C. Transcortical sensory
D. Wernicke’s

A

B. Conduction

104
Q

Pt is fluent and has repetition, but has impaired comprehension.
A. Anomia
B. Conduction
C. Transcortical sensory
D. Wernicke’s

A

C. Transcortical sensory

105
Q

Pt is fluent, with intact repetition and comprehension.
A. Anomia
B. Conduction
C. Transcortical sensory
D. Wernicke’s

A

A. Anomia

106
Q

Pt has intact comprehension and repetition, but has impaired fluency.
A. Broca’s
B. Mixed transcortical
C. Global
D. Transcortical motor

A

D. Transcortical motor

107
Q

Pt has intact comprehension, but has impaired fluency and repetition.
A. Broca’s
B. Mixed transcortical
C. Global
D. Transcortical motor

A

A. Broca’s

108
Q

Pt has intact repetition, but impaired fluency and comprehension.
A. Broca’s
B. Mixed transcortical
C. Global
D. Transcortical motor

A

B. Mixed transcortical

109
Q

Pt has impaired fluency, comprehension, and repetition.
A. Broca’s
B. Mixed transcortical
C. Global
D. Transcortical motor

A

C. Global