S1_L1: Neurological Examination in PT Practice Flashcards
TRUE OR FALSE: Coma (Deep coma) has a sleep-wake cycle and can determine day from night.
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).
Level of consciousness where the individual responds to loud shaking voices and painful stimuli. They need constant, repeated stimulation to cooperate and maintain consciousness.
Obtunded
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.
Lethargic
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?
- glabella
- sternum
TRUE OR FALSE: Coma and vegetative states are both lacking in response to any kind of stimulus.
True
Musical quality / component of speech and the ability to differentiate declarative from interrogative statements
Prosody
The quality of speech
and the ability to express or answer without hesitation; when a question is given, pt can answer properly.
Fluency
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.
Anosognosia
Neglect in your environment / surroundings
Hemispace
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.
Somatoagnosia / Autotopagnosia / Body Agnosia
(Other two names source: O’Sullivan, 6th ed)
TRUE OR FALSE: Right and Left Discrimination must be assessed prior to Somatoagnosia Testing.
False
Somatoagnosia is assessed first.
The inability to register & integrate stimuli & perceptions from one side of the body, which is not due to sensory loss.
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.
TRUE OR FALSE: A left sided hemispheric stroke (or the affected hemiplegic side) commonly has a perceptual deficit or problem in body scheme.
False, it’s the R. If L sided, aphasic problem (language affectation).
A language examination is not complete without each of the 7 components of language. Enumerate all 7.
- Fluency
- Prosody
- Repetition
- Naming
- Comprehension
- Reading
- Writing
Enumerate the components of language assessed by PTs to determine the type of aphasia
- Fluency
- Comprehension
- Repetition
Asking the patient to subtract the following consecutively: 30-5, 25-6, 19-4, 15-5
A. Attention span
B. Concentration span
B. Concentration span
The above test is known as serial subtraction.
Asking the patient to count from 20 backwards until reaching 0.
A. Attention span
B. Concentration span
B. Concentration span
Asking the patient to spell the word “money” backwards
A. Attention span
B. Concentration span
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.
The amount of time it took for the patient to finish a task
A. Attention span
B. Concentration span
A. Attention span
The number of times the patient reached for the pencil
A. Attention span
B. Concentration span
A. Attention span
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
C. Exotropia
How far should the Snellen chart be placed away from the patient in assessing visual acuity? (for far vision)
6 feet
How far should the Snellen chart be placed away from the patient in assessing visual acuity? (for near vision)
14 inches
The corneal reflex is a sensitive test for what cranial nerve damage?
Trigeminal nerve (CN V; ophthalmic division)
Additional: The corneal reflex is actually the most sensitive test for CN V
It is the afferent arm of the gag reflex
Glossopharyngeal nerve (CN IX)
It is the efferent arm of the gag reflex
Vagus nerve (CN X)
If you have ® hypoglossal nerve injury, the tongue will deviate towards what side?
Right side
If you have (L) vagus nerve injury, the uvula will deviate towards what side?
Right side
If these tests are intact, all other combined cortical sensations are intact. What are those tests?
- 2-point discrimination
- Stereognosis
If you have (R) vagus nerve injury, the uvula will deviate towards what side?
Left
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.
True
Source: Braddom, 6th ed
Normal values for 2-point discrimination on the fingertips
3-5 mm
Normal values for 2-point discrimination on the dorsum of the hand
20-30 mm
Normal values for 2-point discrimination on the palms
8-15 mm
In 2-point discrimination, the normal values of the fingertips compared to the palms is smaller. What topographic representation is the reason for this?
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.
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?
Extinction phenomenon
Additional: Even if you stimulate higher areas, the pt still cannot feel the distal stimulus
Determine the corresponding nerve roots of the following superficial reflexes
- Lower abdominal reflex
- Anal reflex
- Plantar scratch/reflex
- Upper abdominal reflex
A. T8-T10
B. T10-T12
C. L2-S1
D. S2-S4
- B
- D
- C
- A
Determine the corresponding nerve roots of the following superficial reflexes
- Brachioradialis Reflex
- Patellar Reflex
- Biceps, Brachialis Reflex
- Ankle (Achilles) Reflex
- Triceps Reflex
A. C5-C6
B. C5-C6 / C6-C7
C. C6-C7 / C7-C8
D. L2-L4
E. S1
- B
- D
- A
- E
- C
The most important sensory test when the patient has a stroke or brain problem.
Combined cortical
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
B. Conductive hearing loss
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
B. Conductive hearing loss
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
C. Sensorineural hearing loss
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
C. Sensorineural hearing loss
___ hearing loss is associated with affectation of the outer or middle ear.
Conductive