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Written Prep > Neurology > Flashcards

Neurology Flashcards

1
Q

7 s/s of stroke ?

A
  1. SUDDEN numbness or weakness of face, arm or leg
  2. confusion, dizziness
  3. trouble speaking or understanding speech
  4. trouble seeing out of one or both eyes
  5. trouble walking
  6. loss of balance or coordination
  7. severe headache with no known cause
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2
Q

4 non-modifiable risk factors for stroke?

A
  1. age (doubles after 55)
  2. M>F
  3. family Hx
  4. previous stroke or TIA
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3
Q

6 modifiable risk factors for stroke?

A
  1. HTN
  2. cardiac disease
  3. DM
  4. hypercholesterolemia
  5. smoking
  6. increased BMI
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4
Q

_______ stroke = caused by thrombosis, embolism or lacunar infant

A

ischemic

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5
Q

What is the area called post ischemic stroke that is supplied by collaterals, so has the possibility of preservation?

A

ischemic penumbra

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6
Q

2 types of neurons that are especially sensitive to ischemia ?

A
  1. cerebellum

2. hippocampal

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7
Q

Post ischemic stroke, there is release of _____ , ___, edema , and O2 free radicals leading to degeneration

A

glutamate; calcium

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8
Q

TPA should be administered within ___ hours of stroke n order to be effective

A

3

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9
Q

_______ stroke caused by aneurysm or AV malformation

A

hemorrhagic

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10
Q

Majority of hemorrhagic strokes occur in what 2 areas ?

A
  1. cerebral cortex

2. basal ganglia

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11
Q

Hemorrhagic strokes have better long term prognosis compared to ischemic (T/F)

A

TRUE

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12
Q

ABCD score for prediction of progression and risk of recurrence ?

A 
A = age 
B = blood pressure 
C = clinical features 
D = duration
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13
Q

____ matter is capable of functional reorganization

A

grey

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14
Q

What is a sign that the pyramidal motor output is intact post stroke ?

A

if they can move their fingers !

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15
Q

_____ stroke is very disabling as it takes out the ascending AND descending tracts

A

brainstem

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16
Q

2 ways TBI can be classified ?

A
  1. open

2. closed

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17
Q

TBI: Coup = _____ mechanical injury

A

primary

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18
Q

TBI: coutracroup = ______ mechanical injury

A

secondary

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19
Q

Countracoup injury can include ____ and ______

A

ischemia; edema

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20
Q

_____ ______ _____ = sheering / tearing from rotational forces in areas of density change (grey –> white matter)

A

diffuse axonal injury

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21
Q

After a TBI, blood flow is usually less than ___% of original injury

A

50

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22
Q

______ hematoma is associated with skull # 90% of the time

A

epidural

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23
Q

Epidural hematomas are almost always in what 2 areas?

A
  1. temporal

2. tempoparietal

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24
Q

Epidural hematoma = (arterial/ venous) bleed

A

arterial

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25
Q

Subdural hematoma = often requires _____ intervention

A

surgical

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26
Q

Subdural hematoma = (arterial / venous) bleed

A

venous

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27
Q

_______ hematoma = bleeding between arachnoid and pia, often fatal

A

subarachnoid

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28
Q

_______ hematoma = most common, bleed under the pia

A

intracranial

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29
Q

Normal ICP?

A

0-10mmHg

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30
Q

___mmHg ICP is usually the cut off, anything over __mmHg for over for 5 mins is really bad

A

15; 20

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31
Q

ICP most commonly monitored using ________ drain

A

extraventricular

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32
Q

When working with a pt with an EVD, you have to close ____ to avoid back flow of large amounts of fluid back into pt!

A

stopcock

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33
Q

MAP/ICP

(cerebral perfusion pressure) you want between __-___mmHg!

A

70-100

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34
Q

Keep head of bed at ___ degree to keep MAP at least __ mmHg!

A

30; 80

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35
Q

3 signs of basal skull #?

A
  1. blood or CSF out of nose/ears
  2. raccoon eyes
  3. battle sign (bruising over mastoid)
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36
Q

_____ aphasia = injury to frontal lobe

A

Brocas

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37
Q

_____ aphasia = injury to parietal or temporal

A

Wernickes

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38
Q

Comprehensive and receptive aphasia = injury to _____ lobe

A

temporal

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39
Q

Apraxia = damage to _____ lobe

A

parietal

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40
Q

_____ lobe = more damaged in contra-coup than coup injury

A

occipital

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41
Q

When suctioning an individual with a TBI, pre and post O2 should be at ___% and only suction for ___ s

A

100;10

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42
Q

______ positioning = indicates brain stem damage and lesions in cerebellum

A

decerebrate

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43
Q

________ posturing = EXTENSION of both UE and LE

A

decerebrate

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44
Q

_______ posturing = arms flexed, legs extended, damage to areas including cerebral hemisphere, thalamus, cord, CTS tract

A

decorticate

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45
Q

3 Rx for decerebrate/ decorticate positioning ?

A
  1. ICP < 15mmHg!
  2. regular 2 hour turns
  3. log roll alignment for head
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46
Q

Make sure tube feeds are off __ minutes prior to mobilizing

A

20

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47
Q

3 issues to be aware of when first mobilizing acute neuro pt ?

A
  1. hypermetabolism
  2. DVT
  3. PE
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48
Q

Rx for contractures?

A
  1. place muscles in lengthened position 20 mins - 12 hours / day
  2. resting splints
  3. splitning, casting and passive ROM
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49
Q

Most common TBI?

A

Concussion!

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50
Q

Sleep disturbance, irritability, dizziness, irritability, memory and visual changes are all s/s of?

A

concussion

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51
Q

_____ ______ syndrome = rare and fatal uncontrolled swelling of brain due to minor 2nd blow before initial symptoms are resolved

A

second impact

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52
Q

____ _______ syndrome = persistent symptoms of concussion

A

post concussion

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53
Q

Grade __ concussion = NO LOC; dazed

A

1

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54
Q

Grade __ concussion = NO LOC; period of confusion and does NOT recall event

A

2

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55
Q

Grade __ concussion = LOC for short time, NO memory of event, requires eval ASAP

A

3

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56
Q

3 categories of GCS?

A
  1. eye opening
  2. motor response
  3. verbal response
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57
Q

GCS is out of ___ points

A

15

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58
Q

Racho levels of cognition = good predictors of ____ outcome post injury, 1-__ scale

A

functional; 10

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59
Q

Most common cause of traumatic SCI?

A

falls

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60
Q

Majority of traumatic SCI lead to _____

A

quadriplegia

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61
Q

Age range where traumatic SCI occur?

A

between 18-35

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62
Q

Majority of non traumatic SCI result in _____

A

paraplegia

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63
Q

Age range for non traumatic SCI?

A

50-60+ years

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64
Q

2 situations where SCI would get surgery?

A
  1. unstable # or soft tissue injury

2. neuro symptoms worsening

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65
Q

________ = pathology of the SC

A

myelopathy

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66
Q

______ _____ = temp suppression of all reflex activity below level of injury

A

spinal shock

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67
Q

Spinal shock can last weeks to months (T/F)

A

TRUE

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68
Q

Lumbar _______ = helps to decompress the CE/roots

A

laminectomy

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69
Q

Goals of acute SCI = keep MAP between __ - __ mmHg

A

80-100

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70
Q

Post SCI, ANS is interrupted leading to altered regulation of __,__ and ___

A

BP;HR;temp

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71
Q

3 symptoms of spinal shock?

A
  1. areflexia
  2. flaccid paralysis below level of lesion
  3. loss of sensation below level of lesion
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72
Q

Thought that return of the ____ reflex marks beginning of spinal resolution

A

sacral

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73
Q

______ shock = bodies reaction to sudden loss of sympathetic control

A

neurogenic

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74
Q

Neurogenic shock occurs with injuries above ___

A

T6

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75
Q

3 symptoms of neurogenic shock?

A
  1. dec vasomotor tone = hypotension and hypothermia despite normal blood volume
  2. bradycardia (due to unopposed vagal stimulation of heart)
  3. can lead to metabolic issues
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76
Q

For “spine unstable” orders, PT must do what 4 things?

A
  1. maintain neutral spine at all times
  2. bed rest
  3. HOB at 0 deg
  4. 2-3 person turns at all times
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77
Q

For spine stable but requires protection, PT must maintain _____ spine at all times

A

neutral

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78
Q

In the “spine stable” phase the pt can turn independently w/ neutral alignment and mob / rehab begins (T/F)

A

TRUE

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79
Q

With spine stable - no restrictions, pt may do all movements of spine within comfort limits (T/F)

A

TRUE

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80
Q

What for changes in ___ when first mobilizing pts with stable spines/ no restrictions

A

BP

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81
Q

SCI classification is important to define ____ and _____ of injury

A

level; extent

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82
Q

What does the sensory exam of SCI classification include?

A
  1. 28 dermatomes w/ bony landmarks

2. light tough and pin prick tested at each point

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83
Q

What is the reference for normal when testing dermatomes for SCI classification?

A

skin on cheek

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84
Q

Grade __ sensory exam for SCI classification = absent

A

0

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85
Q

Grade __ sensory exam for SCI classification = altered, including hyperesthesia

A

1

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86
Q

Grade __ sensory exam for SCI classification = normal

A

2

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87
Q

Pin prick response can be what 3 things?

A
  1. normal
  2. impaired
  3. absent
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88
Q

If _____ is present pt has sensory incomplete injury ASIA B

A

DAP (deep anal pressure)

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89
Q

ASIA motor exam includes __ bilateral myotomes

A

10

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90
Q

ASIA motor exam = start at grade __ and watch for compensation

A

3

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91
Q

Are +/- used in myotomes for ASIA ?

A

NO

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92
Q

ASIA: C__ = shoulder ABD/elbow FLEXORS

A

5

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93
Q

ASIA: C__ = wrist extensors

A

6

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94
Q

ASIA: C__ = elbow extensors

A

7

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95
Q

ASIA: C__ = thumb ext/ulnar deviation / long finger flexors

A

8

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96
Q

ASIA: T__ = finger abductors

A

1

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97
Q

If ___ _____ ______ is present = motor INCOMPLETE ASIA C

A

voluntary anal contraction

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98
Q

ASIA level of lesion - most ____ segment with normal sensory and motor function on both sides of body

A

CAUDAL

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99
Q

ASIA sensory level = most caudal segment with bilateral score of ___ for both light tough and pin prick

A

2

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100
Q

ASIA motor level = most caudal segment with a grade greater than or equal to ___ provided ALL segments above are grade __

A

3;5

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101
Q

Pinprick preservation (LE and sacral) within __ hours = good prognosis of motor function to return and ability to ____

A

72; walk

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102
Q

Complete SCI = no sensory or motor function preserved in sacral segments S__-__

A

4-5

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103
Q

Zone of partial preservation in complete SCI?

A

dermatomes or myotomes below the motor level that remain partially innervated

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104
Q

The most caudal segment with some _____ defines extent of ZPP (within __ segments below injury)

A

sensory; 3

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105
Q

What is spared in anterior cord syndrome?

A

dorsal column

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106
Q

_____ cord syndrome = loss of vibration and proprioception below level of injury

A

post

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107
Q

______ _____ syndrome = most common, usually hypertension, UE motor + sensory more impaired than LE

A

central cord

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108
Q

Brown sequard = IPSI loss of ____ and _____ ; CONTRA loss of ___ and___ a few levels BELOW lesion

A

motor; DCML; pain; temp

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109
Q

___ _____ syndrome = AREFLEXIVE and FLACCID B/B

A

CE

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110
Q

SC terminates at L__ - L __

A

1-2

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111
Q

_____ _____ injuries can affect both conus and root resulting in varied neuro picture

A

conus medullaris (mixture of UMN and LMN lesion)

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112
Q

_______ spinothalamic tract = pain and temp

A

lateral

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113
Q

_____ spinothalamic tract = crude touch + pressure

A

ant

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114
Q

____ _____ = FINE touch, stereognosis and vibration

A

dorsal columns

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115
Q

_______ corticospinal = the 90% that cross in the pyramid motor

A

lateral

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116
Q

____ corticospinal = the 10 % that cross at the level of the innervations motor

A

anterior

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117
Q

C__ - T__ = non functional cough

A

4;1

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118
Q

T__-T__ = poor cough

A

2;4

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119
Q

T__-T__ = weak cough

A

5;10

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120
Q

T___ cough and below is normal

A

11

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121
Q

C_ = level pts need to breathe independently

A

4

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122
Q

T__ and below = normal vital capacity

A

11

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123
Q

C_-C_ = innervates accessory mm of breathing

A

2-7

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124
Q

C_- C_ = innervated diaphragm

A

3-5

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125
Q

T__-T_- = intercostals

A

1;11

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126
Q

T__ - L __ = abs

A

6-1

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127
Q

Possible movements C1-C4?

A

neck, slight shoulder retraction and adduction

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128
Q

Muscles fully innervated C1-C3?

A
  1. SCM
  2. neck extensors
  3. neck flexors
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129
Q

Muscles partially innervated C3-5?

A
  1. lev scap
  2. diaphragm
  3. supraspinatus
  4. infraspinatus
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130
Q

Muscle fully innervated C2-4?

A

Traps

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131
Q

Muscle partially innervated C4-C5?

A

rhomboids

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132
Q

C5 injury = sig imbalance around _____ girdle

A

shoulder

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133
Q

Possible movement with C5 injury ?

A
  1. shoulder abd , flex, ex
  2. elbow flexion and supination
  3. scapular add and abd
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134
Q

Muscles fully innervated with C5 injury ?

A

all C4 mm plus..

  1. diaphragm
  2. rhomboids
  3. lev scap
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135
Q

Muscles partially innervated with C5 injury ?

A
  1. deltoid
  2. biceps
  3. brachioradialis
  4. teres minor
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136
Q

C5 injury = at risk for what contracture?

A

elbow bc unopposed antagonist

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137
Q

C5 injury may be able to use tenodesis grip with forearm supination ad pronation (T/F)

A

TRUE

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138
Q

C__ = first level of SCI to have potential to live alone in the community w/out care

A

6

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139
Q

C6 possible movements ?

A
  1. radial wrist ext and some horizontal adduction
  2. can extend elbow in some positions using ER of shoulder
  3. tenodesis grip
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140
Q

Lats, serratus and pecs allow weight bearing through UE in C6 injury (T/F)

A

TRUE

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141
Q

C7-8 patterns of weakness?

A

limited grasp and release dexterity due to lack of intrinsic mm of hand

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142
Q

Triceps allow independent transfers for C7-8 injuries and individuals with this injury are mostly independently for ADLs (T/F)

A

TRUE

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143
Q

T1-T9 injuries = resp function is compromised above T__

A

6

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144
Q

Need brace and grade __ quads to walk w/o KAFO when L2-L5

A

3

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145
Q

L2-L5 will have _____ bladder and bowel and ___ paralysis

A

areflexive ; flaccid

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146
Q

Sympathetic chain?

A

T1-L1

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147
Q

Sympathetic NS _____ HR and blood flow to skeletal muscles

A

increases

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148
Q

Sympathetic NS _____ bronchial muscles

A

relaxes

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149
Q

Parasympathetic NS ____ HR and contractility

A

decreases

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150
Q

Parasympathetic NS ____ blood flow and smooth mm

A

increases

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151
Q

Parasympathetic NS ____ bronchial muscles

A

contracts

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152
Q

Injuries above T6: parasympathetic NS is _____

A

unopposed

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153
Q

With injuries above T6, HR response is due to ____ withdrawal rather than sympathetic drive

A

bagal

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154
Q

Injuries above T6 = blunting of HR often only __ - __ bpm

A

110;120

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155
Q

_____ _____ caused by massive sympathetic discharge from a noxious or non-noxious stimulus below level of SCI (with injuries ABOVE T__)

A

autonomic dysreflexia; T6

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156
Q

5 S/S of AD?

A
  1. increase BP 20-30mmHg from normal
  2. bradycardia
  3. severe headache
  4. dilated pupils
  5. flushed sweating skin ABOVE level of injury; cool dry skin BELOW level of injury
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157
Q

5 common causes of AD?

A
  1. urinary or colon irritation
  2. wound
  3. tight clothing
  4. sex, pregnancy, labour
  5. dx or therapeutic interventions!
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158
Q

4Rx /prevention for AD ?

A
  1. place client in upright position
  2. remove noxious stimulus (if necessary use antihypertensive drugs)
  3. good B/B routines
  4. ski and nail care
159
Q

_____ _____ = sudden drop of 20mmHg of systolic BP or 10mmHg diastolic BP

A

orthostatic hypotension

160
Q

4S/S of orthostatic hypotension?

A
  1. asymptomatic!
  2. dizziness, fainting
  3. light headedness
  4. headache
161
Q

2 Rx for orthostatic hypotension?

A
  1. mobilize SLOWLY

2. use compression stockings or binders

162
Q

Signs of DVT / PE?

A

sudden LE swelling and inc in temp

163
Q

PE in SCI: tachycardia may be masked by _______ dominance

A

parasympathetic

164
Q

2 main CI for heterotrophic ossification?

A
  1. FORCED PROM

2. serial casting

165
Q

6 S/S of heterotrophic ossification?

A
  1. pain
  2. inc spasticity
  3. warmth, low grade fever
  4. erythema
  5. local swelling
  6. sudden dec ROM with an abnormal of hard end feel
166
Q

3 Rx for heterotrophic ossification ?

A
  1. PROM within tolerable range
  2. meds
  3. Sx
167
Q

Large incidence of # in SCI due to __, esp in LE

A

OP

168
Q

______ ______ ______ = formation of an abnormal tubular cavity in the SC

A

post traumatic syringomyelia

169
Q

Post traumatic syringomyelia: ____ tethers/scars to the arachnoid blocking CSF flow

A

dura

170
Q

Post traumatic syringomyelia: CSF is forced into the SC progressively enlarging the ____, leads to compression of card + _____ supply

A

cyst; vascular

171
Q

Post traumatic syringomyelia: can occur years after the original injury (T/F)

A

TRUE

172
Q

Post traumatic syringomyelia: look for _____ or increasing ______ of the injury

A

differences; presentation

173
Q

2 tests for spasticity?

A
  1. modified ashworth

2. tardieu

174
Q

________ = velocity dependent resistance to passive stretch

A

spasticity

175
Q

3 clinical characteristics of spasticity?

A
  1. inc mm tone / firmness
  2. inc stretch reflexes
  3. uncontrolled movement’s
176
Q

3 pros of spasticity?

A
  1. maintain mm bulk, venous return, useful for transfers, moving limbs
  2. reflex erection can be achieved
  3. acts as a warning sign
177
Q

4 cons of spasticity?

A
  1. lead to contractures
  2. possibly painful
  3. positioning difficulties
  4. fatigue
178
Q

2 meds for spasticity?

A
  1. intrathecal baclofen

2. botox

179
Q

Spastic bladder = injuries _____ the conus

A

above

180
Q

With _____ bladder, messages will continue to travel bw bladder and SC since REFLEX ARC is still intact

A

spastic

181
Q

Bladder management for spastic bladder?

A
  1. may be triggered by “tapping”

2. either intermittent catheters or condom/ Foley drainage

182
Q

Flaccid bladder = injury below T__

A

12

183
Q

With flaccid bladder, messaged don’t travel between SC and bladder since the ___ _____ is damaged

A

reflex center

184
Q

Flaccid bladder: bladder loses ability to empty ______

A

reflexively

185
Q

Flaccid bladder: bladder will continue to fill and MUST be _______

A

catheterized

186
Q

Spastic bowel: peristalsis and reflex propulsion is still intact; reflex contraction of sphincter can lead to ___ ____ !

A

stool retention

187
Q

Spastic bowel: can be trained to void (T/F)

A

true

188
Q

Flaccid bowel = risk of ______

A

incontinennce

189
Q

UMN lesion sexual health: Above T___ = reflex and spontaneous erection, no ______, fertility reduced

A

12; ejaculation; reduced

190
Q

LMN lesion sexual health: below T ___ = _______ erection possible, reflex erection / ejaculation NOT possible

A

12; psychogenic

191
Q

3 types of pain experienced by the SCI population?

A
  1. neuropathic pain
  2. nociceptive pain
  3. chronic pain
192
Q

______ pain in SCI = due to damage to NS

A

neuropathic

193
Q

Rx for SCI neuropathic pain?

A

Meds

194
Q

Nociceptive pain in SCI: ESP in ______!

A

shoulder

195
Q

Chronic pain = pain lasting longerthan __ months; ___ SCI have chronic pain

A

3; 2/3

196
Q

Stages of wounds in SCI?

A

1-4

197
Q

5 descriptions for wounds?

A
  1. location
  2. size
  3. wound base / edge
  4. surrounding skin
  5. stage photos
198
Q

5 ways to prevent wounds ?

A
  1. regular skin checks
  2. change position regularly
  3. skin care
  4. exercise and eating well for skin health
  5. no smoking
199
Q

SCI and Exercise: decreased _______ impact so HR and BP (will/will not) have normal responses

A

sympathetic

200
Q

Can use what 2 outcome measures for SCI and exercise?

A
  1. RPE

2. Borg

201
Q

Watch for ______ ______ when someone with a SCI is exercising !

A

orthostatic hypotension

202
Q

SCI respiration = _______ breathing pattern

A

paradoxical

203
Q

What position does the ideal length/tension relationship of diaphragm occur in?

A

LYING

204
Q

Individuals with SCI: VC ______ from supine to sitting

A

DECREASES

205
Q

SCI and respiration: DECREASE in all lung volumes except ______ volume

A

residual

206
Q

_____ _____ disease is a major cause of death in people with SCI surviving 30+ years

A

cardio vascular

207
Q

____ ______ myocardial atrophy seen in SCI

A

left ventricular

208
Q

__x higher rate of bladder cancer in people with SCI

A

100

209
Q

Epithelial tumour =?

A

carcinoma

210
Q

Mesenchymal tumour =?

A

sarcoma

211
Q

_______ = undifferentiated loose connective tissue from the mesoderm

A

sarcoma

212
Q

Glial tumour = ?

A

glioma

213
Q

Lymphoid tumour = ?

A

lymphoma

214
Q

Hematopoietic tumour = ?

A

leukemia

215
Q

Melanocytic tumour = ?

A

melanoma

216
Q

4 types of lung carcinoma ?

A
  1. squamous metaplasia
  2. squamous dysplasia
  3. carcinoma in situ
  4. invasive carcinoma
217
Q

____ cancer = 2nd cause of death

A

colon

218
Q

With breast ca, there are ____ and _____ risk factors

A

hormonal; genetic

219
Q

4 Rx for prostate cancer ?

A
  1. sx
  2. external beam radiation
  3. brachytherapy
  4. androgen deprivation therapy
220
Q

5 common paediatric cancers?

A
  1. acute lymphocytic leukaemia
  2. non-Hodgkins and Hodgkins lymphoma
  3. brain
  4. small round blue cell
  5. sarcoma
221
Q

Paediatric bone based sarcoma = ________ or _____ sarcoma

A

osteosarcoma; Ewings

222
Q

Most common form of skin cancer?

A

BCC

223
Q

BCC has ___ risk of spreading, and is translucent and red in colour

A

LOW

224
Q

______ = solid skin tumour, often volcano shaped

A

SCC

225
Q

SCC has ___ risk for spreading

A

HIGH

226
Q

Most dangerous form of skin cancer?

A

malignant melanom a

227
Q

ABCD rule for melanoma?

A
  1. asymmetry
  2. border
  3. colour
  4. diameter
228
Q

Duchennes muscular dystrophy = __ linked mutation on chromosome 21

A

X

229
Q

What protein is not produced in individuals with Duchennes muscular dystrophy, leading to tissue that is prone to damage and necrosis ?

A

dystrophin

230
Q

DMD = muscles cells replaced by fat ad CT, progressive ________ muscle wasting

A

symmetrical

231
Q

______ signs = classic sign in DMD

A

gowers

232
Q

Calf pseudohypertrophy caused by what in DMD?

A

fat and CT

233
Q

6 S/S of DMD?

A
  1. proximal muscle weakness
  2. waddling gait
  3. toe walking
  4. lordosis
  5. difficulty standing and climbing stairs, frequent falls
  6. lower IQ
234
Q

Avoid ________ exercises in DMD?

A

eccentric

235
Q

3 Rx for DMD?

A
  1. exercise by maintaining strength and balance
  2. resp therapy
  3. prevention of contractors, seating, equipment
236
Q

Most common type of muscular dystrophy after DMD?

A

myotonic

237
Q

Spinal muscular atrophy = skeletal muscles weaken when _____ horn degenerates

A

anterior

238
Q

4 S/S of spinal muscular atrophy ?

A
  1. hypotonia
  2. dec function
  3. weakness
  4. fatigue
239
Q

Weakness seen in spinal muscular atrophy = ________ and _____ to ______

A

symmetrical; proximal to distal

240
Q

ALS affects both UMN and LMN (T/F)

A

TRUE

241
Q

Bc ALS affects both UMN and LMN, you can have ____ and ____ paresis

A

flaccid; spastic

242
Q

ALS: paresis in a ____ muscle group; corresponding muscle groups are ________ distributed

A

single; asymmetrically

243
Q

ALS: metabolic involvement of the ______ (papery, fragile, cold)

A

skin

244
Q

ALS: gradual involvement of _____ muscle (bulbar muscle = MAJOR concern)

A

striated

245
Q

3 muscle groups spared in ALS?

A
  1. cardiac
  2. occular
  3. urethral and anal sphincter
246
Q

Essential tremor is usually evoked by ______ movement; caused by increased ______ activity

A

voluntary; thalamus

247
Q

______ = involuntary, sustained muscle contractions, writhing

A

dystonia

248
Q

_______ disease = chronic neurodegenerative disease in basal ganglia

A

parkinsons

249
Q

PD = decreased _______ produced by the substance nigra

A

dopamine

250
Q

Dopamine usually inhibits ___, without dopamine = excessive______ output

A

ACh; excitatotory

251
Q

Classic 4 S/S of PD?

A
  1. bradykinesia
  2. resting tremor
  3. rigidity
  4. postural instability
252
Q

Rigidity = velocity ________ resistance to passive stretch

A

INDEPENDENT

253
Q

PD = tremor due to MEDS (T/F)

A

TRUE

254
Q

2 outcome measures for PD?

A
  1. UPDRS

2. Hoens and Yar

255
Q

_____ _____ = atrophy of basal ganglia structures, personality disorder, dementia

A

huntington’s chorea

256
Q

_____ _____ = inflammatory disease; fatty myelin sheaths around brain + SC are damaged

A

myelin sheath

257
Q

MS leads to _____ and ______ of the myelin sheath

A

demyelination; scarring

258
Q

Typical onset for MS dx?

A

20-40 y

259
Q

4 types of MS?

A
  1. relapsing remitting
  2. primary progressive
  3. secondary progressive
  4. progressive relapsing
260
Q

_____ ______ = new/old symptoms resurface or worsen; full or partial recovery b/w relapses

A

relapsing remitting

261
Q

______ _____ = gradual or worsening of symptoms overtime; may stabilize but no remission

A

primary progressive

262
Q

_______ _______ = begins as relapsing remitting; steadily worsens; does not re-myelinate

A

secondary progressive

263
Q

______ ______ = some degree of recovery between flares

A

progressive relapsing

264
Q

5 early symptoms of MS?

A
  1. muscle weakness
  2. optic neuritis; diplopia
  3. sensory changes
  4. b/b incontinence
  5. vertigo
265
Q

2 side effects of MS meds?

A
  1. heat intolerance

2. photosensitivity

266
Q

CI/ precautions to exercise in pts with MS?

A
  1. heat
  2. fatigue
  3. pregnancy
267
Q

______ disease = from bacterium Borrelia burgdorferi, mimics other diseases like MS, fibromyalgia, chronic fatigue, GBS

A

Lyme

268
Q

4 stages of Lyme disease ?

A
  1. localized presentation (flu - like)
  2. neuro, MSK and cardiac symptoms
  3. may have Bell’s palsy
  4. final stage = long term neuro + arthritis, cognitive deficits
269
Q

_____ ____ ____ = antibody mediated demyelination of schwann cells in PNS from spinal nerves > terminating fibers

A

GBS

270
Q

GBS: onset to peak = __ weeks

A

4

271
Q

GBS = rapid _______ motor weakness and _____ sensory loss

A

ascending; distal

272
Q

GBS = _____ and _____ pattern of loss; absent DTR and may require mechanical ventilation

A

stocking; glove

273
Q

4 PT Rx for GBS?

A
  1. joint protection
  2. chest Rx
  3. strength
  4. ROM
274
Q

_________ = infectious diseases (bacterial or viral) that causes inflammation in the meninges of the brain and SC

A

meningitis

275
Q

Meningitis = ___-___ barrier can break down and release infection into blood stream; _____ response leads to edema in the brain and subsequent increase in ICP

A

blood-brain; immune

276
Q

3 types of meningitis ?

A
  1. aseptic
  2. TB
  3. bacterial
277
Q

______ sign= involuntary flexion of hips and knees when neck is passively flexed

A

Brudzinski’s sign

278
Q

_____ sign = painful knee extension from position of hip and knee flexion

A

Kernigs

279
Q

______ = infection (primary or secondary) of the brain + SC or brain parenchyma

A

encephalitis

280
Q

Enchephalitis tends to affect the ______ and _____ lobes

A

frontal; temporal

281
Q

Meningitis and encephalitis management?

A

investigate ASAP

282
Q

Long term brain damage due to encephalitis and meningitis can occur in mere ____

A

hours

283
Q

Creutzfeldt Jakob disease = caused by ______; incubates __ - __ years, cannot make a dx until death

A

prions; 5-8

284
Q

Post-polio syndrome attacks neurons in _____ and _____ horn cells

A

brainstem; anterior

285
Q

Post polio syndrome - death of motor neurons, ones that survive sprout new terminals to make up for loss, resulting in ______ _____ _____

A

enlarged motor units

286
Q

After years of having post polio syndrome = high metabolic stress on larger motor neuron, = muscle _____ and ______

A

weakness; paralysis

287
Q

Chronic and acute alcohol poisoning effects ______ receptors

A

GABA

288
Q

______cerebellum lesions = vestibular control of HEAD and BODY position; gait and trunk ataxia

A

archi

289
Q

Archicerebellum lesions = pt will fall _____ side of lesion

A

TOWARDS

290
Q

______cerebellum lesions = effects synergy of agonist/ antagonist/ postural correction; hypotonia, trunk ataxia and ataxic gait

A

paleo

291
Q

Paleocerebellum lesions = will lose _____ activity and have jerky movements

A

core

292
Q

_____cerebellum lesions = coordination of fine skilled movements; intention tremor, dysdiadochokinesia, dysmetria and dssynergia

A

neo

293
Q

Neocerebellum lesions = errors in _____ and loss of ___ coordination

A

timing; fine

294
Q

3 tests for cerebellar lesions?

A
  1. coordination
  2. Romberg sign
  3. falling to side of lesions
295
Q

Romberg sign = if similar imbalance eyes ___ and ____ likely cerebellar in origin

A

open; closed

296
Q

4 S/S of cerebellar lesions ?

A
  1. lurching gait, falling to side of lesion, stiff legged
  2. intention tremor, disdiadochokinesia, nystagmus; dysmetria
  3. cerebellar ataxia
  4. hypotonia, dysphonia or dysarthria
297
Q

Pt’s with cerebellar lesion will have _____ knee jerk

A

pendular

298
Q

7 potential causes of dizziness?

A
  1. CV
  2. neurological
  3. visual
  4. psychogenic
  5. cervicogenic
  6. meds
  7. vestibular
299
Q

3 functions of vestibular system?

A
  1. gaze stabilization
  2. postural stabilization
  3. resolution of sensory motor mismatch
300
Q

Names of semicircular canals?

A
  1. horizontal
  2. anterior
  3. posterior
301
Q

Fx of semicircular canals?

A

gaze/angular displacement of head

302
Q

Semicircular canals: mouvement of _____ will deflect hair cells and excite or inhibit neurons (CN___)

A

endolymph; VIII

303
Q

How many otoliths?

A

2

304
Q

_____ = detects HORIZONTAL plane motion in vestibular system

A

utricle

305
Q

______ detects saggital plane motion in vestibular system

A

saccule

306
Q

_____ = subjective experience of nystamus aka room spinning around you

A

vertigo

307
Q

____ = discrepancy bw R and L, patient can’t work out where they are in space

A

dizziness

308
Q

_____ = blurred vision

A

oscillopsia

309
Q

BPPV = 90% present with crystal in ______ SCC; 80% = ______ (free floating in canal)

A

posterior; canalisthiasis

310
Q

S/S of ____ = brief (<30s) delayed transient vertigo with looking up and down, rolling to that side of bed etc

A

BPPV

311
Q

Ax for BPPV?

A

Dix Hallpike

312
Q

CIs for Dix Hallpike?

A
  1. cervical spine instability
  2. VBI
  3. Arnold Chiari malformation
  4. acute whiplash
  5. RA
  6. prolapsed IV disc w/ radiculopathy
  7. cervical myelopathy
313
Q

Most common Rx for BPPV?

A

Modified Epley Maneuver

314
Q

_______ disease = over accumulation of endolymph

A

Meniere’s

315
Q

4 S/S of Meniere’s disease?

A
  1. episodic vertigo
  2. tinnitus
  3. fullness of ears
  4. hearing loss
316
Q

VOR is deficient in both UVL and BVL (T/F)

A

TRUE

317
Q

5 acute S/S of UVL?

A
  1. spontaneous nystagmus away from affected ear
  2. reduced VOR
  3. vertigo
  4. dizziness
  5. oscillopsia
318
Q

4 chronic symptoms of UVL?

A
  1. dizziness
  2. oscillopsia
  3. imbalance
  4. symptoms worse after rapid head movement
319
Q

4 Ax for UVL?

A
  1. head thrust
  2. dynamic visual acuity test
  3. balance and gait ax
  4. dix hall pike
320
Q

Is there dizziness or vertigo with BVL?

A

NO

321
Q

BVL usually caused by ______ drugs like gentamicin

A

ototoxic

322
Q

2 S/S of BVL?

A
  1. dec balance with eyes closed

2. oscillopsia

323
Q

3 type of tests to include in balance ax of BVL?

A
  1. static
  2. dynamic
  3. composite
324
Q

5 potential causes of central vestibular disorders?

A
  1. stroke
  2. TBI
  3. MS
  4. tumour
  5. neurodegenerative diseases
325
Q

Rx for central vestibular disorders based on ______

A

neuroplasticity

326
Q

Motion sensitivity Rx = __ - __ weeks of sensorimotor mismatch exercises

A

8-12

327
Q

Cervicogenic dizziness is a Dx of ______

A

exclusion

328
Q

______ _____ = intracranial tumour of myelin around CN VIII

A

acoustic neuroma

329
Q

Acoustic neuroma or vestibular schwannoma is common later in life (50-60) that causes ______ vestibular loss

A

central

330
Q

Diabetic neuropathy can be focal or diffuse, involving the ____ or ____ PNS

A

somatic; autonomic

331
Q

Diabetic neuropathy presentation?

A

symmetrical distal pattern

332
Q

Diabetic neuropathy = loss of ______ and _______ fibers

A

myelinated; unmyelinated

333
Q

4 S/S of diabetic neuropathy?

A
  1. burning pain
  2. symmetrical sensory changes
  3. can be slow or rapid onset
  4. paresthesia
334
Q

Diabetic neuropathy = minimal _____ weakness

A

motor

335
Q

4 Rx for diabetic neuropathy?

A
  1. control hyperglycaemia
  2. symptom management
  3. skin care checks!
  4. exercises
336
Q

CRPS = possible result of dysfunction in _____ or _____ NS

A

central; peripheral

337
Q

CRPS = ________ facilitation

A

sympathetic

338
Q

5 presentations of CRPS?

A
  1. change in skin colour / temp
  2. intense burning pain
  3. skin sensitivity
  4. sweating
  5. swelling
339
Q

When does CRPS usually occur after?

A

trauma or immobilization

340
Q

Stage __ CRPS = 0-3 months, puffy swelling, redness, warm

A

1

341
Q

Stage __ CRPS = 3-6 months, increased pain and stiffness, firm edema, cyanosis, atrophy, osteopenia

A

2

342
Q

Stage __ CRPS = 6 months +, tight smooth, glossy pale skin

A

3

343
Q

Rx for CRPS?

A
  1. prevention and early detection
  2. early ROM
  3. edema management
  4. desensitization
  5. education
344
Q

_____ ______ = non progressive lesion of the brain, occurs before 2 years

A

cerebral palsy

345
Q

Low birth _____ and low _____ = risk factors for CP

A

weight; APGAR

346
Q

5 classifications of CP?

A 
1. spastic 
2 ataxic
3. dystonic
4. hypotonia 
5. athetoid
347
Q

4 types of spastic CP?

A
  1. monoplegia
  2. diplegia
  3. hemiplegia
  4. quadriplegia
348
Q

_______ CP = difficulty w/ stop/ start movements

A

spastic

349
Q

_______ CP = difficultly w/ rapid movements, coordinated gait, fine motor, balance

A

ataxic

350
Q

______ CP = increased tone and can’t relax mm easily; long sustained involuntary movements and postures

A

dystonic

351
Q

Dystonic CP = usually have limited ROM (T/F)

A

FALSE ; usually have full ROM

352
Q

______ CP = lack of tone; weakness

A

hypotonia

353
Q

_____ CP = writhing movement, snake like

A

athetoid

354
Q

2 possible pathologies leading to CP?

A
  1. intraventricular hemorrhage

2. periventricular leukomalacia

355
Q

5 risk factors for CP?

A
  1. 27-30 weeks gestation
  2. small for gestational age
  3. rupture of membranes
  4. intrauterine infection
  5. loss of autonomic regulation of CNS blood flow until full term
356
Q

Hip ______ = complications from CP

A

subluxation

357
Q

Suspect hip subluxation in client with CP when they cannot ABD leg more that _____ deg

A

45

358
Q

2 common muscles to get spasticity in CP?

A
  1. adductor longus

2. iliopsoas

359
Q

____ ____ = neural tube defect leading to vertebral and/or SC malformation

A

spina bifida

360
Q

Spina bifida _____ = no SC involvement, may be indicated by hair tuft

A

occulta

361
Q

Spina bifida _____ = visible or open lesion

A

cystica

362
Q

_________ = type of spina bifida that includes cyst w/ CSF; SC intact

A

meningocele

363
Q

_________ = type of spina bifida w/ cyst that includes CSF and herniated cord tissue

A

myelomeningocele

364
Q

Spina Bifida: Link b/w maternal decreased ____ ____ + infection + exposure to _______ such as alcohol

A

folic acid; teratogens

365
Q

Spina bifida: foot deformities, esp w/ L__ and L__ level

A

4;5!

366
Q

Spina bifida = decreased / absent ____

A

DTR

367
Q

Spina bifida = flaccid OR spastic mm (T/F)

A

TRUE

368
Q

4 PT Rx for spina bifida?

A
  1. ROM
  2. teach transfers
  3. equipment
  4. encourage awareness of sensory deficits
369
Q

Erbs palsy position?

A
  1. shoulder EXT/IR/ADD
  2. elbow EXT
  3. forearm PRONATION
  4. wrist/finger FLEX
370
Q

Is there sensory loss in Erbs palsy?

A

yes

371
Q

Is grasp intact in Erbs palsy?

A

yes

372
Q

Erbs palsy = C__ / C __ injury

A

5/6

373
Q

3 Rx for Erbs palsy?

A
  1. immobilization initially
  2. gentle ROM
  3. play exercises
374
Q

_____ palsy = claw hand

A

klumpkes

375
Q

Klumpkes palsy = effects C___/__/T__

A

7/8;1

376
Q

What does klumpkes palsy effect?

A

intrinsic hand muscles, flexors/extensors of the wrist and fingers

377
Q

Median nerve palsy = ____ hand

A

ape

378
Q

What nerves does median n palsy effect?

A

C6-8, T1

379
Q

Ape hand = no thumb _____ or _____

A

opposition; abduction

380
Q

________ ________ dementia = multiple small lesions secondary to poor blood flow (high BP)

A

vascular cognitive

381
Q

Vascular cognitive dementia leads to degeneration of _____ _____ lobes

A

medial temporal

382
Q

_____ = lowest level of consciousness

A

coma

383
Q

2 types of seizures?

A
  1. primary generalized seizure

2. partial seizure

384
Q

2 subtypes of primary generalized seizures?

A
  1. tonic-clonic

2. absence seizure

385
Q

Tonic clonic seizure = also known as ____ ____ seizures

A

grand mal

386
Q

____ ______ seizures = bilateral and symmetrical w/out local onset

A

primary generalized

387
Q

_____ _____ seizure = dramatic, whole body lasting for 2-5 minutes

A

tonic clonic

388
Q

______ seizure = brief, almost imperceptible LOC, can be up to 100/day

A

absence

389
Q

2 subtypes of partial seizures?

A
  1. simple partial

2. complex partial

390
Q

____ _____ seizure = usually one part of the body

A

simple partial

391
Q

Focal motor simple partial seizure = _____ activity on specific area of the body

A

clonic

392
Q

Focal motor w/ march simple partial seizure = orderly spread of march of ____ movements , can progress to whole side

A

clonic

393
Q

Temporal lobe seizure = ______ change in behaviour, complex _______

A

episodic; hallucinations

394
Q

______ partial seizure = simple partial seizure followed by impairment of consciousness

A

complex

Written Prep (9 decks)

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