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Neuromuscular Physical Therapy > Examination > Flashcards

Examination Flashcards

1
Q

If a patient can open eyes and look at examiner, respond to questions BUT falls asleep easily, their classification would be..

A

“lethargy”

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2
Q

IF a patient can open eyes look at examiner BUT responds slowly and is confused, they would be classified as..

A

“obtundation”

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3
Q

IF a patient can only be aroused from sleep with a painful stimulus..

A

stupor

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4
Q

IF a patietn cannot be aroused with NO response to external stimuli or environment, their classification of consciousness would be..

A

coma

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5
Q

what are classified as “vegetative functions”

A

respiration, HR, BP, digestion

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6
Q

IF a patient has return of sleep/wake cycles, normalization of vegetative functions and lack of cognitive responsiveness their classification of consciousness is..

A

unresponsive vigilance (vegetative) state

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7
Q

the classification for “persistent vegetative state” is ..

A

more than 1 year for TBI & more than 3 mos for anoxic brain injury

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8
Q

IF your patient has severely altered consciousness with minimal but definite evidence of self or environmental awareness, their classification of consciousness is..

A

minimally conscious state

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9
Q

what score on the GCS would classify someone as having a moderate brain injury?

A

9-12

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10
Q

what is the difference between immediate recall vs. recent memory?

A

Immediate recall - name 3 items preveiously presented after a brief (i.e. 5 min) interval; Recent memory - short term recalling RECENT EVENTS

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11
Q

to test LENGTH of attn span, use..

A

digit span retention test (want 7 numbers in order presented)

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12
Q

to test SUSTAINED attention, determine..

A

time on task & freq of redirection

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13
Q

to test for DIVIDED ATTN, you should assess (2)

A
  1. ability of dual task control 2. perseveration (mental inertia - getting STUCK on a task)
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14
Q

to test FOCUSED attn, you should assess

A

impact of environmental and internal detractors on attn

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15
Q

to test the higher cognitive function of CALCULATION..

A

serial 7 test (count backward from 100 by 7)

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16
Q

to test SEQUENCING, you should look at ability to..

A

order components of cognitive or functional task (assess if cueing is necessary)

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17
Q

If a pulse is fine/barely perceptivle, it is classified as

A

“thready”

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18
Q

what score on the MMSE would classify someone as moderate cognitive impairment?

A

16-20

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19
Q

what score on the MMSE classifies someone as having severe cognitive impairment?

A

15 or less

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20
Q

how many levels does the Rancho scale have?

A

8 levels

I - no response

II & III - decreased levels of response

IV, V, VI - confused

VII & VIII - appropriate levels (VII is automatic, VIII is purposeful)

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21
Q

the final level on the Rancho scale of cognitive function is..

A

VIII - appropriate and purposeful

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22
Q

“Non fluent aphasia” is ..

A

Broca’s motor aphasia/expressive aphasia

  • central language disorder
  • speech is awkward, restricted, interrupted, and produced with effort

-result of : lesion to the LEFT hemisphere at Broca’s area

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23
Q

“verbal apraxia” is..

A

when patients have impairment of volitional articulartory control 2/2 a cortical, dominant hemisphere lesion

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24
Q

“dysarthria” is..

A

weakness, paralysis or incoordination of the motor-speech system (respiration, articulation, phonation and movements of the jaw and tongue)

-can be from damange to the PNS or CNS

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25
Q

“fluent aphasia”

A

Wernicke’s aphasia/receptive aphasia

-spontaneous speech is preserved,flowing smoothly, but auditory comprehension is impaired

-central language disorder : posterior first temporal gyrus of the left hemisphere

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26
Q

to test CN II..

A

test visual acuity

1. central : test at 20 ft, both eyes separately

  1. Visual fields: test peripheral vision
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27
Q

to test CN V…

A
  1. sensation of the face
  2. corneal reflex
  3. temporal and masseter ms (have pt clench teeth, hold against resistance)
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28
Q

what is Rinne’s test?

A

testing conduction of air vs. bone –

-place vibrating tuning fork on mastoid bone, then close to ear canal; sound should be heard longer thru air vs bone

CONDUCTIVE LOSS: if sound heard thru bone is equal to or longer than air

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29
Q

HTN classification:

A

>140 mmHg SBP , >90 mmHg

30
Q

NORMAL DBP response to exercise is:

A

it remains the same or decreases moderately (a widening of pulse pressure)

31
Q

IF a pt has increasing ICP, you should examine for HR & BP HOW??

A

changes in HR or BP may occur later with increasing intercranial pressure

32
Q

what is the abnormal respiration that accompanies damage to the upper pons?

A

apneustic breathing - marked by prolonged inspiration

33
Q

What score on the POMA would make someone a HIGH falls risk? And what is the maximum score?

A

POMA is out of 28 (BEST score)

-high risk : <19

-moderate risk : 19-24

34
Q

BBS : scored out of –

-“high risk” of falls :

A

max score is 56

-High risk <45

35
Q

adults should be able to perform a forward reach of about ..

A

>10 inches

36
Q

What does the Balance Efficacy Scale measure?

A

examines level of self-confidence when performing functional tasks encountered in daily life

-score each from 0-100%

37
Q

What is a ventriculography?

A

x-rays of the skull after air is injected into ventricles

-particularly useful with increased ICP

38
Q

what does a myelography tell you?

A

takes x-rays of the spine after air is injected into subarachnoid space

  • shows abnormalities in subarachnoid space
  • IF dye is used instead of air, may result in meningeal irritation
39
Q

how soon can an MRI detect a cerebral edema?

A

30 min after vascular occlusion

40
Q

what is the advantage of using an MRA vs a typical cerebral angiography?

A

An angiography uses radiation (x-ray of carotid/vertebral arteries in brain), and MRA is more sensitive

41
Q

How does a PET scan work?

-what is it used for?

A

Positron emission tomography

  • radioisotopes are inhaled or injected and emissions are measured with a gamma ray detector system
  • images cerebral blood flow & brain metabolism
42
Q

ECG = ?

-useful for imaging what?

A

echoencephalogram; US/doppler techniques

-images lumen of carotid artery & analyzes FLOW, detects plaques in carotid arteries

ALSO measures position and shifts of midline structures (ie tumors or hematomas)

43
Q

what are the 4 purposes of a Lumbar Puncture?

A
  1. withdraw CSF for chemical analysis OR cytological exam;
  2. measure ICP and spinal fluid dynamics
  3. injection of contrast medium for radiological exam
  4. injection of therapeutic agents (tx of CA/meningitis)
44
Q

what are some possible complications of a lumbar puncture?

A

severe HA (CSF leakage - relieved by LYING DOWN), infection, epidural hematoma & uncal herniation

45
Q

elevated proteins in the CSF could be indicative of..

A

inflammation or tumors

46
Q

When using an EMG to examine muscle activity in someone with a LMN injury, what do you expect to find?

A

Motor unit potentials (MUPs) are decreased but overall configurations remain normal

-could also see continuous fasciculations, fibrillations (present about 1-3 weeks after denervation)

IF partial LMN lesion: only fibrillation and fasciculation potentials, COMPLETE LMN lesions show only fibrillation potentials

47
Q

which type of meningitis is more extreme in its presentation?

A

the bacterial meningitis makes a patient sicker and works faster

-

48
Q

how is bacterial meningitis treated?

A

via antibacterial therapy (antibiotic, antipyretic); also maintain fluid and electrolyte balance

49
Q

what is the name for “sever infection and inflammation of the brain”

A

encephalitis

50
Q

what is a brain absess?

A

infectious process in which there is a collection of pyogenic material in the brain parenchyma

51
Q

what are the signs and symptoms of a brain absess?

A

HA, fever, brainstem compression, focal signs CN II and VI

52
Q

what is AIDS dementia complex?

A

confusion and memory loss/disorientation

53
Q

motor deficits associated with AIDS:

A

ataxia, weakness, tremor, loss of fine motor coordination; also experience peripheral neuropathy: hypersensitivity, pain, sensory loss

54
Q

If a patient has an MCA stroke, you would expect (LE or UE) to be more affected?

A

UE more affected

55
Q

If a patient has contralateral sensory loss and transient contralateral hemiparesis, you would expect them to have a lesion involving the ..

A

PCA

56
Q

a “pure motor” stroke is called —- & the lesion is located —-

A

lacunar stroke (contralateral hemi UE&LE); lesioni in internal capsule - posterior limb

57
Q

what are the characteristics of a midbrain lesion stroke?

A

contralateral hemiparesis, possible CN III palsy (oculomotor n.)

58
Q

if a patient has motor speech involvement after a stroke, they most likely have involvement of what artery?

A

either MCA or ACA

59
Q

locked - in syndrome occurs as a result of a lesion to..

A

the pons (pontine lesion)

60
Q

If a patient exhibits cerebellar ataxia or nystagmus after a stroke, you can reasonably suspect a lesion..

A

in the pons (a pontine lesion ipsilateral to the side of the nystagmus/ataxia) OR the medulla

-can be medial or lateral inferior pontine syndrome, or lateral medullary (Wallenberg’s syndrome)

61
Q

If a patient has paralysis of the right side of their tongue (tongue deviates to the R when protruded), you can reasonably assume their lesion is..

A

a medial medullary lesion

62
Q

IF a patient has perceptual deficits, you would expect them to have a lesion of the .. lobe

A

parietal lobe of the non-dominant hemisphere

63
Q

cerebral thrombosis vs cerebral embolism:

A

thrombosis: formation/development of blood clot/thrombus within cerebral arteries

embolism: traveling bits of matter (thrombi, tissue, fat, bacteria) that produce occlusion and infarction in the cerebral arteries

64
Q

What are the typical behaviors of a patient who has had a left hemispheric stroke?

A

slow, cautious, hesitant, insecure

65
Q

what are the behaviors typical of a patient with a right hemispheric stroke?

A

impulsive, quick, indifferent; exhibit poor judgment & safety

66
Q

In patients with knee hyperextension post-CVA, the most likely causes are: (2)

A
  1. weak knee extensors (knee flexes in stance –> compensatory locking of knee in hyperextension)
  2. spastic quadriceps
67
Q

“equinus gait” means..

A

the heel does not touch down

68
Q

the stroke impact scale provides an assessment of..

A

physical and social functioning post-stroke

69
Q

isokinetic training is useful post-stroke to improve..

A
  1. timing deficits,
  2. velocity control of movement
70
Q

what type of cueing is suggested for patients with right hemispheric lesions (R CVAs)?

A

verbal cues; demonstrations or gestures may confuse patients with visuospatial deficits

71
Q
A

Neuromuscular Physical Therapy (7 decks)

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