CVA part 1 Flashcards by Heather Stephens

Changes in muscle strength due to weakness is considered a

a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke

primary impairment

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Changes in muscle activation is considered a

a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke

primary impairment

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Abnormal tone in stroke patients is considered a

a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke

primary impairment

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Sensory and perceptual issues are considered a

a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke

primary impairment

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Cognitive, speech, emotional, behavioral problems are classified as

a. Primary impairment
b. Secondary impairment
c. Direct problem
d. Indirect effect of stroke

primary impairment

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There is no weakness on the ipsilateral side (true/false)

false

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Weakness is usually more proximal than distal (true/false)

false

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This abnormal tone is seen due to cerebral shock initially

a. Hypertonicity
b. Spasticity
c. Hypotonicity
d. Tone

hypotonicity

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This type of abnormal tone may persist with lesions to the primary motor cortex or cerebellum

a. Hypertonicity
b. Spasticity
c. Hypotonicity
d. Tone

hypotonictiy

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This type of abnormal tone emerges in up to 90% of patients

a. Hypertonicity
b. Spasticity
c. Hypotonicity
d. Tone

hypertonicity

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This type of abnormal tone is the greatest in antigravity and distal muscles

a. Hypertonicity
b. Spasticity
c. Hypotonicity
d. Tone

hypertonicity

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Tone is defined as

a. The tension attained at any moment between the origin and the insertion of a muscle.
b. The sensation of [increased] resistance felt as one manipulates a joint through a range of motion, with the subject attempting to relax.
c. a velocity-dependent increase in the tonic stretch reflex with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex as one component of the upper motor neuron syndrome.

The tension attained at any moment between the origin and the insertion of a muscle.

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Hypertonicity is defined as

The sensation of [increased] resistance felt as one manipulates a joint through a range of motion, with the subject attempting to relax.

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Spasticity is defined as

a velocity-dependent increase in the tonic stretch reflex with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex as one component of the upper motor neuron syndrome.

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What is the most common type of stroke?

a. hemorrhage
b. cerebral infarction
c. unspecified
d. none of the above

cerebral infarction

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What are possible risk factors for stroke?

hypertension
heart disease
diabetes
smoking, obesity, diet, physical inactivity, excess alcohol

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The most common sign of stroke is

a. dropping off the face
b. arm weakness or numbness
c. numbness or weakness
d. visual changes

numbness or weakness

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FASTER stands for

facial drooping or numbness
arm weakness or numbness 
stability 
talking
eyes
react

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Sudden severe headaches with no known cause is an early sign of stroke (true/false)

true

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This type of stroke is from either a thrombus or embolism

a. hemorrhagic stroke
b. TIA
c. ischemic stroke
d. sudden stroke

ischemic stroke

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A blood clot ischemia causing stroke is defined as a

a. ischemic stroke
b. thrombus
c. embolism
d. hemorrhagic stroke

thrombus

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A blood clot which breaks off and travels elsewhere is defined as

a. ischemic stroke
b. thrombus
c. embolism
d. hemorrhagic stroke

embolism

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A rupture of a weakened blood vessel is classified as a

a. hemorrhagic stroke
b. TIA
c. ischemic stroke
d. sudden stroke

hemorrhagic stroke

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Takes several hours and is in process, TIA comes before it

a. infarction
b. thrombus
c. embolism
d. hemorrhagic

thrombus

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This type of stroke is of the internal carotid plaque and it indicates that cardiovascular disease is present a. infarction b. thrombus c. embolism d. hemorrhagic

embolism

Causes of this type of stroke could be an increased intracranial pressure or cuts off blood supply a. infarction b. thrombus c. embolism d. hemorrhagic

hemorrhagic stroke

The brain requires low energy and high metabolic reserves (true/false)

false high energy low metabolic reserves

What can alter the pH and blood concentrations of O2 and CO2?

vasoconstriction and dilation

Where does the blood supply for the brain come from?

internal carotid | vertebral arteries

What artery receives a majority of blood for the brain?

internal carotid

Internal carotid splints into _ and _ carotid arteries

middle | anterior

The vertebral artery arises from a branch of the _

subclavian

The basilar artery comes from the _ artery and splits to form _ cerebral and the _ part of the circle of willis

vertebral posterior posterior

Which artery within the circle of willis is often affected with stroke?

posterior cerebral artery

the anterior cerebral artery is a branch off of the _ _

internal carotid artery

The anterior cerebral artery supplies _ and _ parts of the brain

medial | anterior

The medial and anterior parts of the brain that are supplied by the anterior cerebral artery include

frontal lobe parietal lobe basal ganglia internal capsule

The most common sign of anterior cerebral artery syndrome is a. urinary incontinence b. contralateral sensory loss c. contralateral hemiplegia/paresis d. contralateral grasp reflex

contralateral hemiplegia/paresis

``` Signs and symptoms of contralateral hemiplegia/paresis LE paralysis contralateral sensory loss of the LE urinary incontinence apraxia abulia (kinetic mutism) contralateral grasp reflex, sucking reflex ``` a. anterior cerebral artery syndrome b. middle cerebral artery syndrome c. posterior cerebral artery syndrome d. medial medullary syndrome

anterior cerebral artery syndrome

Which artery comes off the vertebral and basilar arteries and supplies the occipital and medial and temporal lobes?

posterior cerebral artery

This artery supplies the brainstem, midbrain and innervates the thalamus

posterior cerebral artery

``` Signs and symptoms of contralateral homonymous hemianopsia bilat homonymous hemianopsia visual agnosia prosopagnosia dyslexia without agraphia, anomia, and color discrimination problems memory defect topographic disorientation ``` a. anterior cerebral artery syndrome b. middle cerebral artery syndrome c. posterior cerebral artery syndrome d. medial medullary syndrome

posterior cerebral artery | peripheral territory

Which territory of the posterior cerebral artery shows more profound effects? a. central territory b. anterior territory c. peripheral territory d. posterior territory

central territory

Post stroke thalamic pain syndrome is a (primary/secondary) effect from the (thalamus/temporal lobe)

primary | thalamus

Ipsilateral oculomotor with contralateral hemiplegia is called

Webers Syndrome

``` Signs and symptoms of central post-stroke thalamic pain sensory impairments involuntary movements contralateral hemiplegia/paresis webers syndrome paresis of vertical eye movements ``` a. posterior cerebral artery, central territory b. middle cerebral artery syndrome c. posterior cerebral artery, peripheral territory d. medial medullary syndrome

posterior cerebral artery | central territory

The _ artery comes off the internal carotid artery and supplies the lateral side of hemispheres and the subcortical area of the brain

middle cerebral

The most common type of stroke occurs in which artery? a. anterior cerebral artery b. posterior cerebral artery c. middle cerebral artery d. internal carotid artery

middle cerebral artery

The most common sign or symptom of a MCA stroke is a. motor speech impairment b. contralateral hemisensory loss of the UE and face more than the LE c. perceptual deficits d. contralateral hemiplegia/paresis of the UE and face more than the LE

contralateral hemiplegia/paresis of the UE and face more than the LE

The MCA supplies the (middle/lateral) side of the brain so it affects the (UE/LE) more

lateral | UE

The ACA supplies the (middle/lateral) side of the brain so it affects the (UE/LE) more

medial | LE

If there is a lesion in the dominant hemisphere it will affect a. vision b. speech c. perception d. memory

speech

If there is a lesion in the nondominant hemisphere it will affect a. vision b. speech c. perception d. memory

perception

A patient has speech problems, which side is their dominant side? Which side is where the stroke occured?

right | left

A patient has perceptual problems and presents with left sided hemiplegia, which side is their dominant side? Which side did the stroke occur on?

right | right

``` Signs and symptoms of contralateral hemiplegia/paresis - UE/face more than LE contralateral hemisensory loss - UE/face more than LE motor speech impairment receptive speech impairment global aphasia perceptual deficits limb-kinetic apraxia contralateral homonymous hemianopsia loss of conjugate gaze to opposite side ataxia of contralateral limbs pure motor hemiplegia ``` a. anterior cerebral artery syndrome b. middle cerebral artery syndrome c. posterior cerebral artery syndrome d. medial medullary syndrome

middle cerebral artery

A focal presentation or a small vessel disease can be classified as a. Brainstem stroke b. hemorrhagic stroke c. TIA d. lacunar syndromes

lacunar syndromes

What is seen with lacunar syndromes?

dysarthrial clumsy hand syndrome ataxic hemiparesis dystonia/involuntary movements

with lacunar syndromes you will see only _ signs

physical

Lacunar syndromes also shows perceptual, visual or language signs (true/false)

false

This type of stroke shows ipsilateral and contralateral signs a. anterior cerebral artery b. middle cerebral artery c. hemorrhagic d. vertebrobasilar artery syndrome

vertebrobasilar artery

Locked in syndrome medial medullary syndrome lateral medullary syndrome are the most common in:

vertebrobasilar artery syndrome

A presentation of reserved consciousness and sensation but not able to move, except for blinking and eye movements a. locked-in syndrome b. medial medullary syndrome c. lateral medullary syndrome d. lacunar syndrome

locked in syndrome

A presentation of ipsilateral paralysis of the tongue and contralateral hemiplegia and impaired tactile and proprioception a. locked-in syndrome b. medial medullary syndrome c. lateral medullary syndrome d. lacunar syndrome

medial medullary syndrome

What is the most frequent reason for death with stroke?

cerebral edema

What areas are more susceptible to ischemia?

hippocampus | cerebellar cortex

Hypoxia due to a stroke results in

neural shock to nerve fibers

Within the first _ it is critical to reverse the ischemic cascade a. 3 hours b. few minutes c. 4 hours d. 3-4 days

4 hours

Cerebral edema occurs within the first _ a. 3 hours b. few minutes c. 4 hours d. 3-4 days

3-4 days

Recovery happens once _ decreases

cerebral edema

Which type of imaging ruls out tumor, abscess or hemorrhage? a. CT scan b. MRI c. PET d. Doppler

CT scan

Which type of imaging can see an infarction within 2-6 hours of stroke and picks up smaller lesions? a. CT scan b. MRI c. PET d. Doppler

MRI

Which type of imaging looks at flow velocity and plaque formation of blood? a. CT scan b. MRI c. PET d. Doppler

Doppler

TPA is contraindicated with _ stroke

hemorrhage

TPA must be given within a. 3-4 mins b. 3-4 hours c. 3-4 days d. at any time

3-4 hours

This is a clot dissolving enzyme intended to reverse and halt ischemic cascade, it greatly reduces the risk of disability and death

TPA

Anticoagulants and antiplatelet drugs are contraindicated (true/false)

false

What is the average length of stay in the hospital after a ischemic stroke? a. 7 days b. 2-4 days c. 1-2 weeks d. 2-4 weeks

2-4 days

What is the average length of stay in the hospital after a hemorrhagic stroke? a. 7 days b. 2-4 days c. 1-2 weeks d. 2-4 weeks

7 days

What is the average length of stay for inpatient rehabilitation? a. 7 days b. 2-4 days c. 1-2 weeks d. 2-4 weeks

2-4 weeks

Which type of facility is recommended for older patients on medicare or those who need to go slower over a longer period of time? a. acute care b. home health c. inpatient rehab d. SNF/long term care

SNF/long term care

The most spontaneous recovery occurs due to

cerebral edema decreasing

The spontaneous recovery process due to a decrease in cerebral edema happens over a. the first week b. the first 2-3 weeks c. the first 3-6 months d. after 3-5 hours

the first 2-3 weeks

Motor recovery is the greatest in _ a. the first-week b. the first 2-3 weeks c. 3-6 months d. after 3-5 hours

3-6 months

In what type of stroke is the spontaneous recovery process is the greatest? a. ischemic stroke b. thrombislm stroke c. emoblic stroke d. brainstem stroke

embolic stroke

What percentage of patients are walking after stroke? a. 58% b. 80% c. 99% d. 25%

80%

What percentage of patients are independent with ADL's? a. 58% b. 80% c. 30-60% d. 25%

58%

What percentage of patients have a non-functional arm? a. 58% b. 80% c. 30-60% d. 25%

30-60%

Weakness is a (direct/indirect) effect with stroke

direct

Velocity dependent increase in muscle tone with increased resistance to stretch a. spasticity b. rigidity c. hypertonia d. hypotonia

spasticity

The longer and quicker the stretch, the stronger there resistance of the muscle a. spasticity b. rigidity c. hypertonia d. hypotonia

spasticity

spasticity occurs as a result of a (UMN/LMN) syndrome

UMN

involuntary movements resulting from activity occurring in other parts of the body a. clonus b. associated reactions c. posturing d. tone

associated reactions

cyclical, spasmodic alternation of muscular contraction and relaxation in response to sustained stretch of a spastic muscle a. clonus b. associated reactions c. posturing d. tone

clonus

Patient shows stiffness and resistance to movement that is independent of velocity of movement a. spasticity b. rigidity c. hypertonia d. hypotonia

rigidity

resistance to passive movement is diminished, stretch reflexes are dampened or absent, and limbs are easily moved a. spasticity b. rigidity c. hypertonia d. hypotonia

hypotonia

acute UMN lesions can produce temporary hypotonia which can be called

spinal shock or cerebral shock

A patient seems to rely more on their uninvolved arm, has learned nonuse of their involved arm, and has increasingly more spasticity. What type of impairment is this? a. primary impairment b. secondary impairment c. composite impairment d. undesirable compensatory patterns

undesirable compensatory problems

A patient has problems with muscle shortening, a loss of joint motion and is in an acute hypotonic position. Which composite impairment are they demonstrating? a. atypical movements b. undesirable compensations c. movement deficits d. unbalanced muscle return

movement deficits

A patient is demonstrating timing and sequencing problems with muscle activation and shows some synergy patterns. Which composite impairment are they demonstrating? a. atypical movements b. undesirable compensations c. movement deficits d. unbalanced muscle return

atypical movements

This type of impairment arises from either movement deficits or atypical movements

undesirable compensations

A patient relies on their uninvolved arm and leg demonstrates asymmetrical postural trunk movements, and has learned nonuse of their UE. Which composite impairment are they showing? a. atypical movements b. undesirable compensations c. movement deficits d. unbalanced muscle return

undesirable compensations