Neuromuscular Midterm Test

Front 1

How many primary care visits per year are due to dizziness?

Back 1

8 million

Front 2

What percent of the population will c/o of at least one episode of dizziness in their lifetime?

Back 2

42%

Front 3

Vestibular pathology causes what percent of dizziness in those over 65?

Back 3

38%

Front 4

What percent of dizziness is caused by BPPV?

Back 4

20-30%

Front 5

Is dizziness more prevelant in men or women?

Back 5

Women

Front 6

What percent of community dwelling elderly over 65 fall each year?

Back 6

30%

Front 7

Full vestibular recovery is dependent on what?

Back 7

Movement

Front 8

Does endolymph have more sodium or potassium?

Back 8

Potassium

Front 9

Does perilymph have more sodium or potassium?

Back 9

Sodium

Front 10

What type of accelaration do the semi-circular canals detect?

Back 10

Angular

Front 11

in the horizontal canal, is the kinocilium closer to the canal or the utricle?

Back 11

Utricle

Front 12

In the vertical canals is the kinocilium closer to the utricle or the canal?

Back 12

Canal

Front 13

What kind of nystagmus will you see in paretic lesions?

Back 13

Slow drift to lesion side and corrective jerk to the uninvolved side

Front 14

What kind of nystagmus will you see with an irritative lesion?

Back 14

Slow push to uninvolved side and quick jerk back to irritated side.

Front 15

Is an inner ear infection an example of a paretic or irritative lesion?

Back 15

Paretic

Front 16

Are BPPV and Menier's disease examples of paretic or irritative lesions?

Back 16

Irritative

Front 17

What is Alexander's Law?

Back 17

Gaze towards fast phase of nystagmus intensifies the nystagmus

Front 18

Describe what nystagmus you would see with a left paretic lesion

Back 18

Slow drift left, quick beat right, intensifies with gaze to the right

Front 19

What is Ewald's Law?

Back 19

Eye/head movement occur in the plane of the canal being simulated (Horizontal motion produces horizontal eye movement, motion horizontal right creates right beating nystagmus). Excitatory inputs are more effective than inhibitory inputs.

Front 20

Which test is used in the clinical application of Ewald's 2nd law?

Back 20

Head jerk and look for corrective saccade.

Front 21

With the head thrust test, will you see corrective saccade when moving the head to the paretic side or uninvolved side?

Back 21

Paretic

Front 22

What is Flouren's Law

Back 22

Horizontal Canal = Horizontal Nystagmus Toward
Posterior Canal = Rightward Torsional / Upbeat
Anterior Canal = Rightward Torsional / Downbeat

Front 23

What is Vestibular Ocular Reflex?

Back 23

Gaze is stable during head motions

Front 24

What type of acceleration do the utricle and saccule detect?

Back 24

Linear

Front 25

Does the utricle detect horizontal or vertical acceleration?

Back 25

Horizontal

Front 26

Does the saccule detect horizontal or vertical acceleration?

Back 26

Vertical

Front 27

Normal response to OTR?

Back 27

Head Tilt Left = Left Eye Elevates and intorts while right eye lowers and extorts.

Front 28

What are the 3 major pathways of the VSR?

Back 28

Lateral vestibular nucleus, medial/superior descending vestibular nucleus, all nuclei

Front 29

Describe the Lateral Vestibular Nucleus Pathway

Back 29

Info from otoliths/cerebellum to Lateral Vestibulospinal Tract (Antigravity Postural Motor Control)

Front 30

Describe the Medial/Superior Descending Vestibular Nuclei Pathway

Back 30

Info from canals to medial vestibulospinal tract and descends only through the cervical spinal cord in the MFL (Cervical axial musculature)

Front 31

Describe the All Nuclei Pathway

Back 31

To the reticulospinal tract and descends to all other sensory and motor systems involved with balance

Front 32

Which vertigo lasts seconds to minutes?

Back 32

BPPV

Front 33

Which type of vertigo lasts hours to days?

Back 33

Acute unilateral vestibular loss

Front 34

What test can be used to test for Acute Unilateral Vestibular Loss?

Back 34

Head Thrust

Front 35

What are the primary treatments for Acute Unilateral Vestibular Loss?

Back 35

Adaptation, Habituation, Balance Reeducation

Front 36

What does alcohol do to the vestibular system?

Back 36

30 min to 3-4 hours, makes cupula float causing right beat nystagmus with head to right and left beat with head to the left.
3-5 hours = silent
5-10 hours = diffusion into endolymph, makeing cupula sink. Left beat with head to the right.

Front 37

What are the 5 Ds

Back 37

Drop, Dizziness, Diplopia, Dysarthria, Dysphagia

Front 38

3 tests of Extraocularm Eye Movement

Back 38

1 - Smooth Pursuit
2- Saccade
3 - Vestibular-Ocular Reflex Cancellation

Front 39

What is the head impulse test?

Back 39

Turn head for 30 seconds and look for nystagmus

Front 40

What is the dynamic visual acuity test?

Back 40

Test reading a chart while moving your head

Front 41

How many days do you need to be in a hospital for the SNF medicare benefits to kick in?

Back 41

3

Front 42

How many days will medicare benefits for SNF cover?

Back 42

100

Front 43

What is the percentage of medicare coverage for SNF stays?

Back 43

1st 20 days - 100%
Last 80 days - 80%

Front 44

What is a PPS?

Back 44

A system of billing in which the facility is paid a lump sum of money, out of which they pay each of their service providers.

Front 45

What is MDS?

Back 45

Minimum Data Set - Minimum of 73 pages of paperwork required to get paid by medicaid

Front 46

Who covers most services in a LTC? Who covers the medications and room and board in a LTC?

Back 46

Medicare Part B, Medicaid

Front 47

What is IDT?

Back 47

Interdisciplinary Team

Front 48

What is RUG?

Back 48

Resource Utilization Group. A way of determining how much a facility will be paid for each patient.

Front 49

How many minutes are the benchmark for the RUG?

Back 49

500 and 720

Front 50

What 3 items are used in calculating the RUG score?

Back 50

1- Therapy Minutes
2- Frequency of Therapy
3 - ADL Score

Front 51

Ultra High RUG category requires what?

Back 51

720 minutes, at least 5 days of 1 discipline and 3 days of another therapy, ADL score of A,B,C,L or X

Front 52

Very High RUG category requires what?

Back 52

500 minutes, At least 5 days of 1 discipline, A,B,C,L or X

Front 53

High RUG score requires what?

Back 53

325 minutes, At least 5 days of 1 discipline, A,B,C,L or X

Front 54

Medium RUG score requires what:

Back 54

150 minutes, At least 5 days of any combination of disciplines, A,B,C,L or X

Front 55

Low RUG score requires What?

Back 55

45 minutes, At least 3 days of any combination of disciplines, plus restorative nursing for at least 15 minutes per day for at least 6 days, A,B or X

Front 56

What is restorative nursing

Back 56

Used for maintenance of a patient's current functional level

Front 57

What are the 4 ADLs the RUG score takes into account?

Back 57

Bed Mobility, Transfers, Eating, Toileting

Front 58

What ADL score does each letter represent?

Back 58

A - 0-5 (Highest Functioning, minimal assistance)
B - 6-10 (Less functional, medium assistance)
C - 11-16 (Needs assistance from 2 or more staff members almost all of the time.
L - A or B score plus Tracheostomy or Ventilator
X - C score plus trachostomy or Ventilator

Front 59

What is an assessment period?

Back 59

A 7 day period in which to gather information

Front 60

What is an ARD?

Back 60

Assessment REference Date. A date set in which you look back on the last 7 days

Front 61

What are the 6 steps of Patient/Client Managament?

Back 61

1 - Examination
2 - Evaluation
3 - Diagnosis
4 - Prognosis
5 - Plan of Care
6 - Reexamination

Front 62

What are the 3 components of Examination?

Back 62

Patient History
Systems Review
Tests and Measures