Comp Exam Flashcards
1
Q
Scapula Spasticity Pattern
A
retraction
downward rotation
2
Q
Shoulder Spasticity Pattern
A
adduction and IR
depression
3
Q
Elbow Spasticity Pattern
A
Flexion
4
Q
Forearm spasticity pattern
A
pronation
5
Q
Wrist spasticity pattern
A
flexion
adduction
6
Q
Hand spasticity pattern
A
finger flexion
clenched fist
thumb adducted in palm
7
Q
Pelvis spasticity pattern
A
retraction (hip hiking)
8
Q
Hip spasticity pattern
A
adduction
IR
extension
9
Q
Knee spasticity pattern
A
extension
10
Q
Foot and ankle spasticity pattern:
A
plantarflexin inversion equinocarus toe claw toe curls
11
Q
UE flexion synergy pattern:
A
scapular retraction/elevation, shoulder abduction, ER, elbow flexion, forearm supination, wrist and finger flexion
12
Q
UE extension synergy pattern:
A
scapular protraction, shoulder adduction, IR, elbow extension, forearm pronation, wrist and finger flexion
13
Q
LE flexion synergy pattern:
A
hip flexion, abduction, ER, knee flexion, ankle dorsiflexion and inversion
14
Q
LE extension synergy pattern:
A
hip extension, adduction, IR, knee extension, ankle plantarflexion and inversion
15
Q
BERG balance low fall risk
A
41-56
16
Q
BERG balance moderate fall risk:
A
21-40
17
Q
BERG balance high fall risk
A
0-20
18
Q
ACA stroke:
A
contralateral hemiparesis of mainly LE
contralateral hemisensory loss mainly LE
urinary incontinence
problems with bimanual tasks. apraxia
19
Q
MCA stroke:
A
contralateral spastic hemiparesis and sensory loss of face, UE and LE with face and UE more involved broca's or nonfluent aphasia wernicke's or fluent aphasia global aphasia neglect contralateral homonymous hemianopsia
20
Q
PCA stroke:
A
contralateral homonymous hemianopsia visual agnosia dylexia memory defect topographic disorientation
21
Q
Stage 1 motor recovery:
A
initial flaccidity, no voluntary movement
22
Q
Stage 2:
A
emergence of spasticity, hyperreflexia, syngeries
23
Q
Stage 3:
A
voluntary movement possible, only in synergies, spasticity strong
24
Q
Stage 4:
A
voluntary control in isolated joint movement emerging, decline of spasicity and syngergies
25
Stage 5:
increasing voluntary control out of syngery
| coordination deficit present
26
Stage 6:
control and coordination near normal
27
Typical right sided CVA:
apraxia, impulsive, neglect
28
Typical left sided CVA:
aphasia, overly cautious
29
Synergy:
stereotyped set of movements that occur in response to a stimulus or voluntary movement
30
Associated reaction:
stereotyped movements in which effortful use of one extremity influences the posture and tone of another
31
CIMT criteria:
10 degrees active wrist extension
thumb abduction
finger extension
32
Mild TBI
```
LOC: 0-30 mins
alteration of consciousness: less than 24 hours
amnesia: less than 1 day
GCS 13-15
imagining: normal
```
33
Moderate TBI:
```
LOC: more than 30 mins, less than24 hours
Alteration of consciousness: > 24 hours
amnesia: >1 day < 7 days
GCS: 9-12
imaging: normal or abnormal
```
34
Severe TBI
```
LOC: > 24 hours
Alteration of consciousness: > 24 hours
Amnesia: > 7 days
GCS: < 9
Imaging: normal or abnormal
```
35
Stage progression following diffuse axonal injury?
```
coma
unresponsive vigilance/vegetative state
confusional state
emerging independence
intellectual/social competence
```
36
Common levels of injury to spinal cord:
C5, C7, T12, L1
37
Level A:
complete
| no motor function below lesion
38
Level B;
incomplete
| sensory but not motor function is preserved below the neurological level
39
Level C:
incomplete
| motor function is preserved below neurological level and most key muscles have a muscle grade of less than 3
40
Level D:
incomplete
| motor function is preserved below neurological level and most key muscles have a muscle grade of greater than 3
41
Level E:
normal
42
Central Cord Lesion
UMN
Loss of bilateral pain and temp
Loss of bilateral motor function; primarily UE
Preservation of proprioception and discriminatory sensation
43
Brown-Sequard Syndrome
UMN
hemisection of spinal cord
Ipsilateral loss of tactile discrimination, pressure, vibration and proprioception
Ispilateral loss of motor function and spastic paralysis below level of lesion
Contralateral loss of pain and temp below level of lesion; at level of lesion bilateral loss
44
Anterior cord syndrome:
UMN
loss of bilateral motor function, spastic paralysis below level of lesion
loss of bilateral pain and temp
preservation of proprioception kinesthesia and vibration
45
Posterior cord syndrome:
UMN
bilateral loss of proprioception, vibration pressure and stereognosis and 2 pt discrmination (DCML)
preservation of motor function, pain, and light touch
46
Stage 1 (PD)
minimal or absent disability
| unilateral symptoms
47
Stage 2 PD
minimal bilateral or midline involvement
| no balance involvement
48
Stage 3 PD
impaired balance
| some restrictions in activity
49
Stage 4 PD
all symptoms present and severe
| stands and walks only with assistance
50
Stage 5 PD
confined to bed or w/c
51
Loss of archicerebellum (flocculonodular)
central vestibular symptoms: ocular dysmetria, poor eye pursuits, dysfunctional VOR, impaired hand eye coordination
gait and trunk ataxia
52
Lesion of paleocerebellum (anterior)
hypotonia
truncal ataxia: poor posture, wide BOS
ataxic gait
53
Lesion of neocerebellum
```
intention temor
dysdiadochokineisa
dysmetria
dyssynergia
errors in timming
```
54
Additional impairments in cerebellar lesions:
```
asthenia
hypotonia
motor learning impairments
cognition
emotion dysregulation
```
55
Bulbar palsy:
LMN affecting CN VII-XII
flaccid paralysis of pharynx and larynx
CN IX and X
56
Pseudo-bulbar palsy:
UMN
| spastic paralysis of pharynx and larynx
57
Bell's palsy:
loss of control of salivation and lacrimation
CN VII
drooping of corner of mouth, eyelids that don't close
58
Which cranial nerves should be examined in GBS?
VII, IX, X, XI, XII
59
Which cranial nerves should be examined in ALSS?
VII, IX, X, XI, XII
60
Stage I ALS:
early disease, mild focal weakness, asymmetrical distribution, symptoms of hand cramping and fasiculations
61
Stage II ALS:
moderate weakness in groups of muscles, some wasting of muscles
modified independent with AD
62
Stage III ALS
severe weakness of specific muscles, increasing fatigue, mild to moderate functional limitations
ambulatory
63
Stage IV ALS:
severe weakness and wasting of LEs, mild weakness if UEs, moderate assistance and AD required, wc
64
Stage V ALS:
progressive weakness with deterioration of mobility and endurance, increased fatigue, moderate to severe weakness of whole limbs and trunk; spasticity, hyperreflexia, loss of head control, max assist
65
Stage VI ALS:
bedridden, dependent in ADLs, FMS, progressive respiratory distress
66
C1-C4 w/c;
electric w/ tilt in space
| puff and sip
67
C5 w/c
shoulder function and elbow flexion
manual w/c with propulsion
may choose electronic w/c for energy conservation
68
C6 w/c
radial wrist extensors
manual w/c with friction surface hand rims
independent
69
C7 w/c
triceps
| same as C6 with increased propulsion
70
Gait for T6-T9:
bilateral KAFO
crutches, swing to
supervised ambulation for short periods
71
Gait for T12-L3:
```
independent in all ambulation on all surfaces and stairs
swing through or 4 pt pattern
bilateral KAFO and crutches
independent household ambulators
w/c community
```
72
Gait for L4-L5:
independent with bilateral AFOs and crutches or canes
independent community ambulators
may use w/c for high endurance
73
Peripheral vestibular symptoms:
sudden memorable onset
less than 24 hours
head movement provokes symptoms
more likely to have auditory involvement
74
Peripheral disorders:
```
vestibular neuritis
labyrninthitis
acoustic neuroma
meniere's disease
BBPV
toxicity
```
75
Vestibular neuritis
imbalance, nausea improving over 1-4 days
| head movement sensitivity
76
Labryinthitis
similiar to vestibular neuritis except with hearing loss before onset of vertigo
77
Acoustic neuroma
tumors from Schwann cells
progressive unilateral hearing loss or tinnutus without vestibular symptoms
balance issues mild and intermittent
78
Meniere's disease
postural imbalance,nystagmus, nausea, vomitting, hearling loss and aural fullness
vertigo will persist 30-42 hours
vestibular exercises not appropriate
79
BPPV
most common
| vertigo when head is turned
80
Central vestibular symptoms:
sudden onset of vertigo with one of D: diplopia, dysphagia, diaphoresis, dysarthria, drop attacks
vertigo lasts 24/7
81
Central vestibular disorders:
disequilibrium of aging
CVA
migraine
head trauma
82
Exam generalizations of peripheral symptoms:
direction fixed nystagmus-horizontal
abnormal VOR via head thrust
nystagmus more likely to be seen with fixation removed
nystagmus exacerbated when gazing in fast component (Alexander's law)
pursuit and saccade normal
nystagmus exacerbated post horizontal head shake (horizontal nystagmus)
83
Exam generalization of central symptoms:
```
direction change nystagmus
nystagmus seen with fixation
nystagmus to be pure vertical or torsional
nystagmus post shaking vertically
abnormal pursuit/ saccades
cannot walk or stand with assistance
```
