Stroke QBANK Flashcards
A 36 year-old female presents to your neurotoxin clinic for evaluation of botulinum toxin for her cervical dystonia. On examination, her head is rotated to the right, and her left ear is tilted toward her left shoulder. What muscles are implicated in this scenario?
Left sternocleidomastoid, left splenius capitis, left levator scapula
Global aphasia involves impairments in which of the following?
Repetitiion, Comprehension, Fluency
A 60 year-old male is brought to the ED with sudden-onset right hemiparesis, right facial droop, and on further evaluation is noted to have impaired fluency, intact comprehension, and intact repetition. This patient’s language disorder can be classified as:
Transcortical motor aphasia
In order to preserve brain health and function in stroke/TBI patients, intracranial pressure (ICP) is best kept at what level?
< 20 mmHg
-Normal patients typically have an ICP of 2-5 mmHg. Remember, CPP = MAP - ICP
A 65 year-old male presents with the chief complaint of hand tremors. On initial exam you note his hands are rested comfortably in his lap; however, when you ask the patient to hold out his arms in front of him and keep them in place, his hands fluctuate rhythmically in the air in front of him as he struggles to keep them in place with his arms outstretched. What is the best initial treatment for this patient?
Propranolol is an effective treatment for this patient with essential tremors.
A 42-year-old female with a history of subarachnoid hemorrhage related to aneurysm rupture 6 weeks ago is noted to be taking amantadine for neurostimulation, melatonin to aid in sleep/wake cycle preservation, and nimodipine for prevention of cerebral vasospasm. She is progressing well in her therapies and is scheduled to discharge home in the next week with close physiatry and neurosurgical follow up. How long is nimodipine recommended following a subarachnoid hemorrhage?
Following aneurysmal subarachnoid hemorrhage, 21 days of nimodipine is recommended to prevent cerebral vasospasm and subsequent cerebral infarction.
A 64 year-old male with a history of hypertension and diabetes mellitus was found by his spouse down on the floor of their bathroom. In the ED the patient is noted to be incontinent of urine. Strength testing reveals intact right upper and lower limb strength, strength of 4/5 throughout the left upper limb, and flaccid left lower limb. Where is the most likely site of the lesion?
Anterior cerebral artery (ACA) strokes produce contralateral lower > upper limb weakness along with incontinence. If bilateral ACA stroke occurs, usually the patient demonstrates bilateral lower limb weakness along with impaired executive function +/- personality deficits.
A 75 year-old male is seen in follow-up for a stroke resulting in left lower limb weakness and spasticity. On examination, when you rapidly perform range of motion at his left knee from flexion to extension, you note resistance to movement throughout most of the range of motion, but the limb is still easily ranged. What is this patient’s Modified Ashworth Score (MAS) of his left hamstrings?
The MAS scale grades velocity-dependent resistance to passive range of motion of a joint, and is scored as follows. 0: no resistance; limb is easily moved throughout its entire ROM. 1: There is a catch and release at the very end of ROM, but the limb is easily ranged. 1+: There is a catch and resistance that exist for < 50% of the ROM, but the limb is easily ranged. 2: There is a catch and resistance that exist for > 50% of the ROM, but the limb is easily ranged. 3: There is resistance to ROM for most of the ROM, and the limb is very difficult to range. 4: The limb is rigid and not moveable.
Patients with multiple sclerosis (MS) may classically demonstrate which of the following abnormalities upon workup?
Patients with MS may demonstrate presence of oligoclonal IGg bands in the CSF, which are markers of CSF inflammation.
A 77 year-old female with a past medical history of atrial fibrillation and breast cancer status-post chemotherapy presents to your skilled nursing rehabilitation facility for functional restoration following an acute ischemic stroke. She complains of more severe right upper extremity weakness along with right lower extremity weakness. On examination, when she speaks, her words are very slow to be spoken and are uttered only after great effort and concentration from the patient. She follows commands accurately. She is alert and oriented to person, place, time, and situation. Her right upper extremity strength is 2/5 throughout, and her right lower extremity strength is 4/5 throughout. Which of the following is the most likely diagnosis?
MCA strokes cause upper limb greater than lower limb weakness, while ACA strokes cause lower limb greater than upper limb weakness. The dominant hemisphere, which is the left hemisphere in most individuals, contains higher-order language processing centers, and is classically affected in a left MCA stroke
A 48 year-old female complains of urinary incontinence. She is currently undergoing rehabilitation in a skilled nursing facility and reports having urinary incontinence episodes several times throughout the day. She undergoes urodynamic studies which demonstrate that upon filling the bladder with a small amount of fluid, there is early, strong contraction of the detrusor muscle, leading to bladder emptying. Which of the following diagnoses is most likely to cause these results along with the patient’s symptoms?
This patient suffers from classic upper motor neuron (spastic) bladder syndrome. In patients with upper motor neuron injury (for example, due to multiple sclerosis, stroke, spinal cord injury, etc.) the bladder may fill up with a small amount of urine, causing hyperreflexic bladder muscle (detrusor) spastic activation, leading to spastic emptying of the bladder. This is also referred to as a “failure to store” bladder. Cauda equina syndrome is a lower motor neuron injury, and would be expected to produce a flaccid bladder (storing large urine volumes with failure to empty).
A 72 year-old male is found to have sudden-onset bilateral lower extremity weakness, incontinence, and is socially disinhibited and saying inappropriate things to hospital staff. Where is the most likely location of the lesion?
Classically a bilateral ACA stroke will affect enough frontal lobe tissue that executive function becomes impaired, and patients will demonstrate this via social disinhibition, personality deficits, etc.
A 68 year-old male is hospitalized for sudden-onset left hemiparesis. On exam you notice his right eye appears to be looking down and to the right. His sensation and coordination are otherwise intact. What is the most likely diagnosis?
Weber (medial midbrain) syndrome is caused by an interruption of the medial midbrain’s blood supply, As we are in the midbrain, medially we have the CN 3 nucleus, thus causing an ipsilateral CN 3 pals
A patient suffers a stroke. Their deficits include complete tetraplegia and nonverbal status. On further examination, you notice the patient moving their eyes up and down frantically. Which of the following arteries is most likely affected to the greatest degree?
Basilar artery - Locked-In Syndrome is essentially basilar artery occlusion syndrome.
Approximately 2 months after an ischemic stroke while in acute rehab, a patient develops shoulder pain on his hemiparetic side. He also notices some swelling in his hand, allodynia in the entire upper extremity, and increased sweating even at rest in the affected extremity. To confirm the diagnosis, the patient has an injection of local anesthetic under fluoroscopic guidance which completely relieves his pain for a period of time. What signs are expected with correct placement of the local anesthetic?
gold standard for this diagnosis is a stellate ganglion block, which should result in an ipsilateral Horner’s syndrome if successful localization.
A lesion of the arcuate fasciculus will cause what type of aphasia, and is this a fluent or non-fluent aphasia?
Conduction, fluent
In the Brunnstrom stages of recovery from hemiparetic stroke, at what stage does the patient develop peak spasticity?
3
An 82 year-old male develops sudden-onset left hemiparesis. On physical exam, he fails to direct his gaze across to the left side of midline. At rest he looks toward his right side. He has a left facial droop. He has impaired sensation to light touch and pinprick over his left upper and lower limbs. When asked to move his left arm, he raises his right arm in the air. His speech is fluent, and he follows all commands. Where is the most likely site of the lesion?
Right MCA
A 42 year-old female is evaluated in your inpatient rehabilitation unit. Therapists are concerned that her tremors are interfering with her functional progress. On examination, you notice no tremor at rest, but when you ask her to point to different pictures on a board in front of her, her aim is poor and she often misses her target, overshooting and undershooting it. The therapists have tried wrist weights, and these have not benefited her. What is the next best step for treating her tremor?
Clonazepam has been shown in the literature to be effective for cases of intention tremor.
A 45 year-old male is seen in your outpatient clinic, presenting with gradual-onset involuntary writhing movements of his left arm. He says a similar thing happened to his father when he was in his 50s. How would you characterize these movements based on the description?
Choreoathetosis
A patient with aphasia demonstrates intact fluency and comprehension, but cannot repeat phrases. What type of aphasia does this patient have?
Conduction
The most likely cause of a subarachnoid hemorrhage is which of the following?
Rupture of a saccular (berry) aneurysm at the anterior communicating artery
What is the most common type of stroke out of the following options?
Thrombotic
You are following up on a 78 year-old male recovering from a right middle cerebral artery ischemic stroke. He has been progressing in physical therapy and occupational therapy at your rehabilitation facility. He currently requires minimum assistance with upper body dressing. One barrier preventing further progress with independent dressing is his left upper limb spasticity. You recently increased his baclofen dose from 10 milligrams twice daily to 10 milligrams three times daily. In order to monitor his clinical response to the baclofen increase, you decide to check on his left wrist flexion spasticity. During velocity-driven passive left wrist extension which is easily performed, his left wrist flexors exhibit a catch and release at the end of the range of motion. Which of the following best represents the patient’s Modified Ashworth Scale (MAS) score of spasticity in the left wrist flexors?
1
In order to participate in constraint-induced movement therapy (CIMT) a patient must demonstrate which of the following?
At least 10 degrees of active wrist extension
A 63 year-old male presents following a cerebrovascular insufficiency event. He exhibits right hemiparesis, and his left eye appears to be gazing down and out (inferiorly and laterally). His left eyelid droops. There is no aphasia or cognitive deficit. Which of the following is the most likely diagnosis?
Weber syndrome (medial midbrain lesion
All of the following are classified as movement disorders except:
Hemiparesis is weakness on one entire side of the body; it does not imply a movement disorder. Ataxia, hemiballismus, and akathisia are all classified as movement disorders.
In order to maintain blood flow throughout the brain, cerebral perfusion pressure (CPP) is best kept at what level?
> 60 mmHg
CPP = MAP - ICP
Dystonia is defined as which of the following?
Involuntary abnormal muscle contractions resulting in abnormal posturing
A 51 year-old male presents to the ED with acute neurologic deficits. He has intact fluency, repetition, and comprehension. He complains of diplopia and unsteadiness when walking. On exam you determine he has a left visual field cut. What is the most likely diagnosis?
Right PCA stroke
You are reviewing a speech language pathologist note during your morning chart review, prior to rounding. The note states that the patient demonstrates multiple examples of semantic paraphasias during the therapy session. Which of the following is an example of a semantic paraphasia?
Patient calls a pencil a pen
