Module 7

Question 1

The brain's blood dependence: 
brain cells depend on: 
blood supplies brain cells with: 
blood also removes ? from? 
the cells of the brain have no mechanism to ? they have complete dependence on

Answer 1

uninterrupted and oxygenated blood

nutrition

• glucose
• oxygen

metabolic waste (carbon dioxide) from nerve cells

-store glucose or oxygen for later consumption/ blood flow

Question 2

brain blood flow and stroke

-without adequate blood supply, the brain can only function ? before the cell bodies are

interruption of blood flow for 4-6 minutes results in?

• damage occurs to the ?
• the area that surrounds the core infarct is called the
• neurons in the area of the prenumbra may survive for about ? without alternate circulation, and up to ? if there is some degree of collteral blood supply

Answer 2

for a few minutes/ cell bodies are irreversibly damaged

irreversible brain damage

• core cells that are the center of where the infarction occured
• ischemic penumbra

20 minutes/ 6-8 hours

Question 3

Acute stroke:
two types
ischemic: inadequate blood flow to the brain results in ?

hemmorhagic:
- rupture of a blood vessel
- blood which is toxic to brain tissue
- blood also causes swelling of ? swelling can further restrict ?
- issue with tissue damage and potential increasedintra cranial pressure due to the ? as well as ?

Answer 3

damage to the brain tissue

causes bleeding in the brain

• collects in brain tissue
• brain tissue/ blood flow to other neighboring brain tissue
• bleed itself/ swelling as a reaction to the blood

Question 4

Comprehensive Stroke Center:
hospital certified by the ?
Early management of acute ischemic stroke: a guideline for ?
this designation/certificated is given to center that are able to:
.. and… treat all strokes utilizing ?
-provide ? for blood clot removal
-provide

Answer 4

American Heart Association/american stroke association stroke leadership council

healthcare professionals from the american heart association/american stroke association

• quickly and effectively/ medications to resolve blood clots
• catheter based procedures
• neurosurgical services

Question 5

Treatment for ischemia in the brain:
what restores blood flow:
-
-

Answer 5

tPA (tissue plasminogen activator) - drug

thrombectomy: procedure (vascular/neurosurgery) - larger clot in larger vessel

Question 6

Tissue plasminogen activator: 
tPA (generic name is ? ) approved by FDA in ? 
-dissolves blood clots that are 
-given to patients via 
-administered within ? 
limits risk of ? 
....
consider timing of

Answer 6

alteplase/ 1996 
blocking blood flow to the brain 
- IV 
-3 hours of symptoms onset 
-brain damage and functional impairment 
-hemorrhage (risk and contraindication) 
-SLP intervention

Question 7

Thrombectomy:
in some hospitals can be completed up to? (if imaging shows ?)
-more typically, the window is … from symptom onset (with assumption that damage to neural tissue will not be improved by ?)
time of onset is tricky calculaton
-…. onset
-variation in ?

Answer 7

24 hours after onset of ischemic stroke ( there would be therapeutic benefit)

6 hours (intervention)

unwitnessed
A&P of individual patients

Question 8

Thoughts about stroke and COVID-19:
risk of worse outcomes with COVID-19 patients with history of ?
risk of stroke with COVID:
-two studies ad meta-analysis suggests that stroke is associated with ?

covid-19 itself may contribute to development of?
-prevalence of ischemic stroke is ?
true association remains ?
further investigation and more consistent covid screening ?
consider the non-COVID patient: risk of greater ? lasting deficits from stroke as patients are less likely to ?

Answer 8

stroke

2.5 fold increase in likelihood of severe COVID-19 with a trend in increased mortality

vascular events
-1.6%
unclear
-needed

injury/ seek medical treatment due to COVID

Question 9

Acute Ischemic Stroke and COVID-19 an analysis of 27, 676 patients:
investigated ?
patients with covid with or without ischemic stroke and
acute ischemic stroke patients with and without ?

Answer 9

risk factors, comorbidities and outcomes between

covid

Question 10

total of 103 patients developed ? among 8136 patients with covid

among all patients with covid the proportion of patients with hypertension, diabetes, hyperlipidemia, atrial fib, and congestive heart failure ?

acute ischemic stroke was associated with discharge to ?

Answer 10

acute ischemic stroke

was significantly higher among those with acute ischemic stroke

destination other than home or death

Question 11

Acute ischemic stroke was infrequent in patients with ? and usually occurs in the presence of other ?

the risk of discharge to destination other than home or death increased 2-fold with occurence of ?

Answer 11

cardiovascular risk factors

acute ischemic stroke in patients with COVID 19

Question 12

Stroke - intervention/facilities:
... care
Subacute care: 
depends upon ? 
-consider 
-... patients 
sadly, can depend upon 
options: 
... rehab 
-... rehab 
long-term ? 
home (... considerations) 
-
-

Answer 12

acute care

level of function

• rehab needs
• ambulatory patients

finances

acute rehab (inpatient rehab) 
-sub-acute rehab (SNF) 
-care facility (frequently SNF first) 
(safety considerations) 
-home health 
-outpatient rehab services

Question 13

Brain tumors:
a neoplasm is an area of uncontrolled ?
tumors result from an improper expression of ? and a decrease in expression of ?
-angiogenesis also promotes ? this is the formation of new blood vessels which promotes?
tumors in the brain can be ?
metastatic tumors in the brain are frequently metastasis of cancers including ?
they can also come from ? and from ?
spread results from cells traveling through the ?

Answer 13

growth of body tissue/ includes the glia

oncogenes (coding proteins involved with cellular growth) / tumor supressor genes

tumor growth / growth of tumor tissue

primary or metastatic

breast, lung, colon/ lymphomas and melanoma

lymphatic system or blood vessels

Question 14

Neuroglial cells- functions 
astrocytes (CNS)
-form a complete ? 
-contribute to the blood-brain barrier by restricting ? 
form ? 

Oligodendrocytes:
form ? around axons in the CNS

microglia:
migrate to a site of ?

ependymal cells:
form the ?

Schwann cells (PNS) 
-form the ? 
constitute ... around fibers in the PNS

Answer 14

lining around the surface of the brain

• permeability of ionic substances across the blood vessels
• scars around a cerebral infarct

myelin sheaths

brain lesion and engulf cellular debris to remove it

membranous lining of the ventricular cavity

myelin sheath around axons in the PNS
fibrous connective tissue

Question 15

Brain Tumors Can Be: 
are staged in grades (1-4)
Grade 1: 
Grade II: 
Grade III: 
Grade 4:

Answer 15

non-cancerous or very slow growing
cancerous but slow growing (cells look closer to normal)
cancerous y grow faster than grade 1 and II (more cell abnormalities)

fast growing with greater cell abnormalities (may also have necrotic tissue; develop own blood vessels, spread to other parts of brain)

Question 16

Brain Tumour Types:
astrocytoma:
arise from
the worst brain tumour is the ?

ependymoma:
arise from

oligodendroglioma:
arise from ? frequently found in ?

Answer 16

astrocytes 
Glioblastoma (GBM) - a type of astrocytoma

ependymal cells lining the ventricles

oligodendrocytes - frequently found in the frontal region of the adult brain

Question 17

Brain Tumors (Non-malignant)
Meningioma: arises from ?
usually ?

Acoustic neuroma (vestibular ? ) 
arise from the ? and are typically located at the 

symptoms can include: and can cause other ?
-…,…,…
cause ?

Pituitary adenomas:
cause ? and can produce ? due to ?

Answer 17

meninges
non-malignant

schwannoma
-nerve sheath/ cerebllopontine angle

impaired hearing acuity and equilibrium / other deficits (tumour and post-op)
-facial weakness, dysphagia, dysphonia
hydrocephalus (obstruct fourth ventricle)

hormonal dysfunction / visual deficits / compression of optic chiasm

Question 18

Diagnosis and TX planning: 
... planning is frequently completed at a ? 
typically conducted ?
include: 
-
-
-
-
-
-
-

Answer 18

medical/surgical / neuro tumour board meeting
weekly

• neuroradiologist
• pathologist
• medical oncology
• radiation oncology
• neurosurgery
• neurology
• mid-level providers
• SLP

Question 19

Treatment options:
medical ?
-

radiation?

• … therapy
• several ?

neuro?

all of the

what will?

… of the above

Answer 19

oncology
-chemotherapy

radiation oncology

• radiation therapy
• several types

neurosurgery

• all of the above
• timing be?
• none of the above

Question 20

SLP role:
Communication ? and swallowing ? 
pre-treatment ? 
post-surgery 
intervention during ? as needed
post-treatment ? 
-treatment as 
-...
participation in ?

Answer 20

function
baseline measures 
functional measures 
medical and radiation oncology treatment, as needed
functional meaurements 
-appropriate 
-education 
awake craniotomy

Question 21

Dementia: 
an ? term 
a group of disorders that affect 
affects: 
-
-
-

2 types:
… dementia
… dementia
…

Answer 21

umbrella term
brain function

• thinking
• behavior
• ability to complete ADL

cortical dementia (alzheimers)
sub-cortical dementia (Parkinsons dementia)
combo

Question 22

Types of dementia:

alzheimers:
- the most common
- accounts for ?

.. dementia:
second most
-accounts for

Lewy body:
accounts for

frontotemporal:
accounts for

other

Answer 22

form of dementia
40-70%

vascular dementia

• common from
• 15-25%

2-20%

2-4%

brain injury 
ETOH
HIV
PD
HD
creutzfeldt jakob

Question 23

Role of SLP:
communication:
assessment of
educate?

-to maximize
intervention with SLP should be ?

Swallowing: 
assessment of ? 
-may be best to ask what will be 
-establish 
consider 
treatment may be ? due to ?

Answer 23

current function
-medical professionals and family members

strategies
-environmental
-comm. function
relatively short in duration

• current function
• done regarding results
• least restrictive PO diet
• patient and family wishes
• limited / cognitive comm. dysfunction

Question 24

Tube feeding in severe dementia: 
main results:
-no .. trials identified 
-seven 
-six assessed ? 
-the other study assessed ?
there's was no evidence of increased ? 
none of these studies examined ? and there was no evidence of benefit in terms of ? 

authors conclusions:
despite the very large number of patients receiving this intervention there is insufficient evidence to suggest that enteral tube feeding is ?
data are lacking on adverse effects of ?

Answer 24

randomised controlled trials identified

• observational controlled studies identified
• mortality
• nutritional outcomes
• survival in patients receiving enteral tube feeding
• QoL nutritional status or prevalence of pressure ulcers

beneficial in patients with advanced dementia

-this intervention

Question 25

``` What is delirium: a state of characteristics of delirium include: difficulty difficulty confused about hallucinations - ... that are not develops over a short has ? ```

Answer 25

``` severe confusion -thinking clearly -to attend -situation/circumstances hearing or seeing things not present ``` period of time fluctuating symptoms

Question 26

ICU Delirium: approx. ... patients in the ICU experience delirium approx. ona. ventilator experience delirium (while on or immediately following) linked to negative ? increased? decreased ? and greater ?

Answer 26

2/3 7/10 medical outcomes n(increases LOS in ICU and Hospital) , costs, survival, long-term cognitive dysfunction

Question 27

``` Advice for PT and family/friends speak? use ? remind patient of talk about bring ? decorate room with provide patient with if your loved one has delirium you might be asked to ? ```

Answer 27

``` calmly/simple words or phrases day and date family and friends glasses/hearing aids calendars, posters, family pictures favorite music/tv delirium/ sit and help calm them ```

Question 28

Delirium prevention and Management: delirium is one area that is part of a larger there are specific components of care that include care programs include: -.. assessment and management -reducing ? to allow for electing the best ... for individual pt's delirium? early engaging with

Answer 28

overall care plan in ICU delirium in plan of care implemented ``` pain sedatives/ awakening and spontaneous breathing -analgesics/pain meds -prevention, assessment, mgmt mobility/exercise family members ```

Question 29

``` Post intensive care syndrome: physical, psychological, and cognitive symptoms that persist ? physical symptoms include: - -.. difficulty -... and ... ``` ``` psychological symptoms can include: - - - - ```

Answer 29

after critical illness - weakness and balance issues - breathing difficulty - pain and numbness anxiety depression PTSD Sleep disturbance

Question 30

Cog. Symptoms of PICS: difficulty w/ memory increased

Answer 30

concentration.attention deficits processing time

Question 31

Traumatic Injury: Traumatic injury is a term which refers to ? which require ? the insult may cause system shock called ? may require immediate ?

Answer 31

physical injuries of sudden onset and severity/ immediate medical attention/ shock trauma/ resuscitation and interventions to save life and limb

Question 32

``` Metabolic, endocrine and immunologic response to trauma: body response to trauma includes: ... an increase in use of increased increased development of -higher blood glucose levels have been found to be associated with ? ```

Answer 32

tachycardia use of oxygen respiratory rate insulin resistance fatal outcomes in trauma patients

Question 33

Trauma statistics: center for disease control 10 leading causes of death in 2017 ? in groups from ages 1 to 44 unintentional injury is ranked for persons from 45-64 years unintentional injury is ranked

Answer 33

1st 3rd

Question 34

History of Care for traumatic injury: care and transportation build from medical lessons learned from ? legislation in 1966: accidental death and disability: the neglected disease of modern society - advocated for strong govt. leadership to develop national highway safety act: provided funding from congress to reduce mortality from Illinois developed the first statewide ? which extended the knowledge gained at Cook county hospital in Chicago which was one o the first

Answer 34

1st and 2nd world wars trauma care as well as funding for research motor vehicular accidents trauma system/ first true trauma centre in the US

Question 35

The American Trauma System: designed to provide an ? Run at the state and local level with guidance by ? -geographic distribution of trauma system resources correlates with ? lower fatality rates seen in areas with more? care begins in the field with ? 4 levels of trauma center -level I trauma center: comprehensive regional resource providing ? typically located in ?

Answer 35

organized response to injury - national societies - outcomes/ clustered trauma centers emergency medical services personel I-IV -total care for every aspect of injury/large cities or densely populated areas

Question 36

Air Care: modern air medical transport began in ? with what program ? the first hospital-based air medical transport in US by 1990 there were more than ? in operation air care reduces the amount of ? to expidiate evacuation within? it is estimated that there are nearly ? annually with an additional 150,000 patient flown by ? each year in the US

Answer 36

1972/ Flight for life program at Anthony's hospital in Denver 170 air transport programs pre-hospital time / golden hour 400,000 helicopter transports /by fixed wing aircraft

Question 37

Air care flight physiology: oxygenation changes during ? (consideration for ... levels, which may result in need for ? prior to flight) a pneumothorax should be addressed prior to flight because of risk of ? penetrating ocular injuries should be transported at the ? due to the impact of intraocular pressure on the retina expansion and contraction of gasses also have painful ? sites impacted include the ? Gas within the body expands during? patients with abdominal trauma should have a ? in place to avoid any mechanical effects Temperature ? aircraft temperature is controlled but if there is failure of that system, a plan must be inplace as hypothermia has been found to dramatically increase ? also must consider the concern of the temperature of ? within aircraft

Answer 37

ascent from ground to higher altitudes/ hemoglobin levels/ blood transfusion expansion or development of a tension pneumothorax during flight lowest possible altitude mechanical effects on the body/ middle ear, teeth, sinuses, and GI tract / ascent/ NGT decreases with ascent/ mortality in trauma patients/ medications and supplies

Question 38

``` At the hospital: injuries include: known unknown -... issues that result from ? - other considerations: patient's ```

Answer 38

known injury unknown injury -fistulas life-saving treatment -intubation/extubation/tracheostomy patients past emdical and surgical hx

Question 39

``` impact of traumatic injury: patients require family academic / occupational need for ```

Answer 39

contiuum of care family impact impact of injuries ongoing support services

Question 40

Other factors: I... location of family

Answer 40

``` insurance injury (out of town, state, international travel) dynamics: discharge panning - need for 24 hour care ```

Question 41

``` SLP evaluation and intervention: deficits including: -disorders of -...impairment ...impairment ```

Answer 41

consciousness comm. impairment swallowing impairment

Question 42

``` Dysphagia assessment decision making: special considerations for this patient population: patient positioning: -unstable -external ``` aility to safely ? -... deficits ...fixators -... type and timing of ?

Answer 42

restrictions and limitations - spine - external ventricular drain (EVD) transport to radiology -cognitive comm. deficits external fixators -IVs and chest tubes dysphagia assessment

Question 43

Swan-Ganz Catheter: inserted into the right side of ? can measure ? measures pressure in the

Answer 43

heart to monitor heart functions - blood flow in the right atrium and right ventricle - pulmonary artery

Question 44

``` Dysphagia assessment decision making in trauma: what is the appropriate timing of the eval: -time of -medication -... factors -NGT to Small and large Ileus: obstruction of -post-surgical /? ```

Answer 44

``` day (alertness) delivery (pain and level of alertness) factors (is it safe to assess/safety for PO intake) -suction bowel issues -part of intestine opioid use ```

Question 45

``` Dysphagia Assessment decision making: which test provides the best ? FEES: contraindications include: ... fractures ability to ... (risk of bleeding) ``` ``` fluoroscopy tower versus C-arm -. - -transfer - ``` If MBS which contrast to utilize (whose decision) -... ...

Answer 45

assessment nasal/facial participate/cooperate anticoagulation weight positioning transfer constraints cognition (Ranchos IV or lower-likely not) radiologist decision water-soluble barium

Question 46

Covid consideration: trauma is typically not an anecdotally a large number of patients have been admitted to the hospital status post fall/trauma have been found to be

Answer 46

elective hospitalization COVID positive

Question 47

``` Assessment: limited in acute care due to level of formal assessment may not be ? -length of time to -higher level tasks on ``` formal assessments include: SCATBI: CLQT: RBANS:

Answer 47

function/severity of injury possible - assess - assessment scales of cognitive ability in traumatic brain injury cognitive linguistic quick test repeatable battery for the assessment of neuropsychological status

Question 48

The montreal cognitive assessment a brief 30 question test that helps healthcare professionals detect ? allowing faster ? and patient ? MoCA is the most ? available for detecting ? measuring ? and multiple ? which are important components not measured by ?

Answer 48

COGNITIVE IMPAIRMENTS VERY EARLY ON / diagnosis/care sensitive test / alzheimers disease/ executive functions / cognitive domains/MMSE

Question 49

In 2003, after analysis of the 2000 study results, a few elements of the test were optimized and a new validation study was copleted in 2003-2004 which confirmed the test's discirminatory ability to distinguish ?

Answer 49

normal controls from subjects with mild cognitive impairment or mild alzheimers disease

Question 50

``` Cognistat: Standardized for ? -..,...,... how long to administer or less with? ``` ``` evaluates: - -..skills - - - ```

Answer 50

adolescents and adults stroke, TBI, dementia 15-20 or less with screening ``` language spatial skills reasoning memory calculations ```

Question 51

``` Mild TBI/Concussion identification of patient's who have potentially -nursing ? -may or may not involve imaging may be ``` mechanism to educate patients and families about mechanism to see these patients for athletes versus ? - different - pre-testing for athletes mayhave been

Answer 51

sustained a concussion -identifiers -loss of consciousness normal potential issues that may arise outpatient follow up non-athletes -referrals for outpatient completed

Question 52

``` Signs and symptoms of Mild TBI: social: interactions with maintaining difficulty with participating in -engaging in -difficulty taking perspective of ```

Answer 52

``` others a topic in convo word-finding in convo social roles as a spuse, parent, friend activities like work and school others ```

Question 53

``` Signs and symptoms of mild TBI: mental difficulty feeling difficulty with difficulty with difficulty with difficulty wih ```

Answer 53

``` concentrating slowed down or sluggish memory problem solving decision making multi-tasking and completing daily activities ```

Question 54

``` Signs and symptoms of mild TBI emotional: change in changes in - -emotional -easily -... ```

Answer 54

``` personality mood/sadness irritability outbursts overwhelmed nervousness ```

Question 55

``` Sign and symptoms of Mild TBI: physical ... loss of impaired slower .. or... blurry sleeping ```

Answer 55

``` headache balance coordintion/dizziness reaction time nausea or vomiting blurry vision difficulty ```

Question 56

The 3 ounce water test/challenge: initially information for swallow screening published in several other publications followed by ? lacked adequate ? debra suiter Ph.D. and steven leder Ph.D. completed further investigation of this screening and there is now a great deal of ? ``` use by use by initially used with ? subsequent investigations included varied ? not just ? includes other ? ```

Answer 56

1992 different authors/ sample size and lacked statistical power evidence available ``` slps nurses stroke patients populations stroke/ neurological and pulmonary disorder and specific surgeries ```

Question 57

Yale swallow protocol: brief ... exam .. water challenge

Answer 57

cognitive assessment oral mechanism exam 3 oz

Question 58

``` 3 oz water test: SLP involvement in developing and or maintaining typically completed by assess patient for ? - - administer ? -...sips ```

Answer 58

``` this screening program nursing appropriateness to administer PO -alertness intubation ``` 3 oz of water consecutive sips

Question 59

Performing RN stroke swallow screen: step 1 step 2 step 3

Answer 59

initial assessment swallow challenge documentation