TBI AND MS Flashcards
A PT employed in an acute care facility attempts to identify standardized instrument to measure consciousness. The most appropriate standardized tool to be used is:
a. Barthel index
b. Mini mental state examination
c. Glasgow state examination
d. Glasgow coma scale
e. Ranchos Los Amigos
d. Glasgow coma scale
A patient experiences an electric shock-like sensation throughout the body upon neck flexion. This is termed:
a. Brudzinski
b. Lhermitte’s sign
c. Kernig
d. NOTA
e. Hoover’s sign
b. Lhermitte’s sign
Plaques in MS commonly occur in the ffg sites, except:
a. Periventricular white matter
b. Cervical S.C.
c. Optic nerve
d. NOTA
d. NOTA
If the patient presents with alteration of pulse, respiration and blood pressure, which structures will probably be herniated?
a. cerebellar tonsils
b. cerebral peduncles
c. vestibular nuclei
d. occipital lobe
a. cerebellar tonsils
Which of the ffg causes transient worsening of symptoms in patients with MS?
a. dehydration
b. fatigue
c. heat
d. B & C
d. B & C
What is the most common location of heterotropic ossification (HO) after traumatic brain injury (TBI)?
a. shoulder
b. knee
c. hip
d. elbow
a. shoulder
Plasticity in response to one training experience can enhance the acquisition of similar behaviors
a. specificity
b. use it and improve it
c. transference
d. interference
e. none of these
c. transference
Traumatic brain injuries (TBI) in elderly patients are most frequently due to:
a. falls
b. motor vehicle accidents
c. alcohol (ETOH) abuse
d. assault
a. falls
This is NOT a feature of multiple sclerosis:
a. clear mentation
b. diplopia
c. muscle weakness
d. prominent fatigue
e. optic neuritis
a. clear mentation
Exert their effects by inhibiting leukocyte proliferation, modulating cytokine production, and inhibiting T-cell migration across BBB, preventing disability in MS patients:
a. Natalizumab
b. Cyclophosphamide
c. Methotrexate
d. Interferon Beta
e. Glatiramer Acetate
d. Interferon Beta
In decerebrate posturing, there is:
a. flexion of the upper and lower extremities
b. extension of the upper and flexion of the lower extremities
c. flexion of the upper and extension of the lower extremities
d. extension of the upper and lower extremities
d. extension of the upper and lower extremities
Of the following disorders of conscious ness, which would have the best prognosis?
a. coma
b. vegetative state
c. minimally conscious state
d. none of the above
c. minimally conscious state
Uncal herniation would cause compression of:
a. cranial nerve (CN) III
b. CN I
c. CN VII
d. CN X
a. cranial nerve (CN) III
Which of the following tests is most useful for evaluation of memory loss?
a. Mini Mental Status Examination (MMSE)
b. Galveston Orientation and Amnesia Test (GOAT)
c. Ranchos Los Amigos Scale
d. Glasgow Coma Scale (GCS)
b. Galveston Orientation and Amnesia Test (GOAT)
A clinical feature of normal pressure hydrocephalus (NPH), EXCEPT:
a. memory impairment
b. urinary incontinence
c. ataxic gait
d. all of the above
e. none of these
e. none of these
According to the Glasgow Coma Scale (GCS), a severe brain injury would be:
a. 13 to 15
b. 0 to 2
c. 8 to 12
d. 3 to 7
d. 3 to 7
Coup-countercoup injuries in traumatic brain injuries are typically concentrated in:
a. frontal and parietal lobes
b. frontal and temporal lobes
c. occipital and parietal lobes
d. subcortical structures
b. frontal and temporal lobes
Severity of brain injury is most reliably indicated by:
a. presence of seizure
b. presence of vomiting
c. chronic neck pain
d. length of coma and amnesia
d. length of coma and amnesia
Which is the best study for locating white matter plaque in multiple sclerosis or vascular infarcts?
a. computed tomography (CT)
b. electroencephalogram (EEG)
c. magnetic resonance imaging (MRI)
d. lumbar puncture (LP)
c. magnetic resonance imaging (MRI)
Which of the following is true about GCS in TBI?
a. a GCS of 2 is a severe injury
b. a GCS of 8 is a moderate injury
c. a GCS of 10 is a moderate injury
d. a GCS of 12 is a mild injury
c. a GCS of 10 is a moderate injury
Which of the following is not true about diffuse axonal injury (DAI)?
a. primarily occurs at the grey matter
b. only seen in TBI
c. responsible for loss of consciousness (LOC)
d. occurs from acceleration-deceleration and rotational forces
e. none of the above
a. primarily occurs at the grey matter
A 28-year-old woman after MVA sustained a TBI. The impact of injury was to the right side of her head, and she now has visual changes consistent with an oculomotor cranial nerve dysfunction. What would the ocular exam demonstrate?
a. dilation of the ipsilateral pupil
b. constriction of the ipsilateral pupil
c. dilation of the contralateral pupil
d. constriction of the contralateral pupil
a. dilation of the ipsilateral pupil
The TBI patient is in a heightened state of activity. Behavior is bizarre and nonpurposeful. Unable to cooperate directly with treatment efforts. Confabulation may present. Verbalizations are incoherent and inappropriate. This is the RLA level of:
a. generalized response
b. confused-inappropriate
c. confused-agitated
d. confused-appropriate
c. confused-agitated
Severe TBI presents with which of the following characteristics?
a. initial GCS 13 to 15
b. no focal neurological deficit
c. negative CT and/or MRI
d. loss of consciousness, if any, 30 mins or more
d. loss of consciousness, if any, 30 mins or more
Most distinguishing feature of TBI?
a. diffuse axonal injury
b. contusions
c. hypoxic-ischemic injury
d. increased intracranial pressure
a. diffuse axonal injury
A physical therapist is working with a patient recovering from TBI (Rancho Los Amigos Levels of Cognitive Functioning Scale Level VII). The best test to determine if this patient demonstrates progression to open skills is to have the patient walk in which environment?
a. in the hallway
b. across the busy hospital lobby
c. in the patient’s room
d. in the patient’s home
b. across the busy hospital lobby
In TBI, DIA is responsible for the initial LOC. The most commonly affected area is the:
a. Corpus callosum
b. Periventricular region
c. Brainstem
d. Thalamus
e. Cerebellar tracts
a. Corpus callosum
The Ranchos Los Amigos “confused-appropriate” level of cognitive functioning is described as:
a. The patient follows commands inconsistently
b. The patient has some goal directed behavior under direction
c. The patient’s behavior is appropriate but somewhat robotic
d. The patient is confused and amnestic
b. The patient has some goal directed behavior under direction
A 25-year-old male patient suffered from TBI. The patient reacts to stimuli in non-specific/stereotypic limited response. What RLA level of cognitive functioning does the patient have?
a. I
b. II
c. III
d. IV
b. II
A patient has brain injury for the past two weeks PT evaluation shows that he can open his eyes upon command, localized pain and utter inappropriate words. The severity of this injury is:
a. mild
b. moderate
c. severe
d. normal
e. A and B
b. moderate
A physical therapist reviews the medical record of a patient recently admitted to an inpatient rehabilitation hospital. The patient sustained a traumatic head injury in a MVA five weeks ago. The medical record indicates that the patient is often disoriented and can frequently become agitated with little provocation. The MOST appropriate location for the therapist to make initial contact with the patient is:
a. in the patient’s room
b. in the PT gym
c. in a private treatment room
d. in the PT waiting room
a. in the patient’s room
This is characteristic of mild TBI
a. post traumatic amnesia of 24 minutes
b. none of these
c. loss of consciousness of 30 hours
d. initial GCS of 10-13
a. post traumatic amnesia of 24 minutes
A GCS of 7 would indicate:
a. automatic appropriate
b. lower good recovery
c. purposeful appropriate
d. death
e. none of these
b. lower good recovery
Brain herniation at foramen magnum, a progression of uncal herniation. This causes neck pain, stiffness, flaccidity, coma, and alteration of pulse, RR and BP.
a. uncal
b. tonsillar
c. central
d. central and tonsillar
b. tonsillar
Normal ICP
a. <20 mmHg
b. >20 mmHg
c. 4-15 mmHg
d. 3 mmHg
c. 4-15 mmHg
Charcots triad EXCEPT:
a. scanning speech
b. resting tremor
c. intention tremor
d. nystagmus
b. resting tremor
Malignant MS
a. disease in which the patient remains fully functional in all neurological systems 15 years after onset
b. rapid severe progression with relapses over period of time
c. Marburg dse
d. AOTA
c. Marburg dse
This is NOT a common impairment in Multiple Sclerosis:
a. ataxia
b. spasticity
c. fatigue
d. deafness
d. deafness
The most common cranial nerve involved in multiple sclerosis is:
a. CN II
b. CN X
c. CN I
d. CN VI
a. CN II
The most common clinical course/pattern of multiple sclerosis is:
a. relapsing-remitting with incomplete remissions
b. benign
c. relapsing-remitting with complete remission
d. primary progressive
a. relapsing-remitting with incomplete remissions
The following are factors considered in poor prognosis of multiple sclerosis, EXCEPT:
a. age of onset is less than 40 years old
b. multiple system involvement at onset
c. cerebellar involvement
d. none of these
a. age of onset is less than 40 years old
The Disability Scale used in assessing patients with Multiple Sclerosis:
a. Kurtzke
b. Rancho Los Amigos
c. Karnoffsky
d. FIM
a. Kurtzke
Poor prognosis in a patient with MS:
a. female
b. <35 years old
c. polysymptomatic
d. initial sensory signs of optic neuritis
e. slow disease progression
c. polysymptomatic
Characterized by progression of disability from onset, without plateaus or remissions or with occasional plateaus and temporary minor improvements. Patient does not experience acute attacks.
a. Relapsing-Remitting MS
b. Primary Progressive
c. Secondary Progressive
d. Progressive Relapsing
e. Marburg
b. Primary Progressive
Hypersensitivity to minor stimuli
a. Dysesthetic limb
b. Hyperpathia
c. Lhermitte’s sign
d. AOTA
b. Hyperpathia
Most important diagnostic tool in TBI
a. CT Scan
b. NCM
c. MRI
d. Plaques
a. CT Scan
Least common type of MS?
a. RRMS
b. PPMS
c. SPMS
d. PRMS
d. PRMS
Failure to drive specific brain functions can lead to functional degeneration
a. Use it or lose it
b. Use it and improve it
c. Transference
d. Interference
e. None of these
a. Use it or lose it
What is the Glasgow Coma Scale (GCS) for someone who withdraws from pain, is confused, and opens eyes to pain?
a. 6
b. 8
c. 10
d. 12
c. 10
A PT Intern was instructed to provide in-patient treatment to patient with MS. However, the students failed to read the diagnosis and has provided treatment plan as per ordered only. The student performed exercises with the patient in a humid environment and continues until the treatment is done since patient claims to be fine. Hours after the treatment, nurse’s station calls the department to inform that the patient has high grade fever. The patient is most likely experiencing what?
a. heat exhaustion
b. pseudoexacerbation
c. Uthoff’s symptoms
d. progressive MS
c. Uthoff’s symptoms
