Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
140 Cards in this Set
- Front
- Back
|
Post-acute recovery of TBI is most commonly limited by what?
|
Personality and behavioral impairment
|
|
|
What is a primary feature of short-wave diathermy?
|
It produces both direct and reflex blood flow increase
|
|
|
The most reliable sign for the detection of inflammatory arthritis is?
|
synovial swelling
|
|
|
What condition is a contraindication for intraarticular steroid injection?
|
bacteremia
|
|
|
What is the most important risk factor for stroke?
|
Age
|
|
|
The incidence of stroke in blacks is how many times more common than in whites?
|
2x
|
|
|
At what age does risk from stroke double each decade after this age?
|
55
|
|
|
What is the size of lacunar strokes (in mm)?
|
less than 15mm
|
|
|
In what brain areas are lacune infarcts seen?
|
putamen, pons, thalamus, caudate, internal capsule
|
|
|
An occlusion of what artery can produce transient monocular blindness (amaurosis fugax)?
|
ICA
|
|
|
What is the most common cause of occlusion of superior division of MCA?
|
embolus
|
|
|
What 2 areas does the superior division of the MCA serve?
|
rolandic and prerolandic areas
|
|
|
What are the 6 presenting signs of a superior division of MCA infarct?
|
1.contralateral sensory and motor deficits
2.head and eyes deviated to side of infarct 3. Left sided lesion - initially global aphasia then Broca's aphasia 4. Right sided lesion - deficits with spatial perception, hemineglect, constructional apraxia, dressing apraxia 5.Muscle tone initially decreases, then increases. 6. LOC is uncommon. |
|
|
An ACA infarct presents with what what 4 symptoms?
|
aphasia, paraplegia, incontinence, and personality dysfunction.
|
|
|
Occlusion of one anterior cerebral artery distal to anterior communicating artery results in what 2 primary symptoms?
|
1. contralateral weakness and sensory loss, affecting mainly distal contralateral leg.
2. gait apraxia |
|
|
What 2 structures are supplied by the interpeduncular branches of the PC?
|
1. CN3 - oculo-motor nerve
2. CN4 - trochlear nerve |
|
|
What is the name and description of the occlusion of interpeduncular branches of the PCA?
|
Weber's syndrome - oculomotor palsy with contralateral hemiplegia and palsies of vertical gaze (trochlear nerve)
|
|
|
In PCA occlusions, there is a noted absence of what symptoms?
|
Cortical signs - suchas aphasiasor cognitive deficits
|
|
|
What is the most commonly occluded artery in Wallenberg's Syndrome?
|
Vertebral arteries
|
|
|
What is Lateral Medullary Syndrome also know as?
|
Wallenberg's Syndrome
|
|
|
Wallenberg's syndrome can be due to the occlusion of what 5 arteries?
|
vertebral arteries
posterior inferior cerebellar artery superior lateral medullay artery middle lateral medullary artery inferior lateral medullary artery |
|
|
Name 3 major ipsilateral symptoms of Wallenberg's syndrome.
|
1.Horner's syndrome (ptosis, anhydrosis, and miosis)
2. decrease in pain and temp sense of face 3. ataxia (patient falls to side of lesion) |
|
|
What is a contralateral symptom of Wallenberg's syndrome?
|
decreased pain and temperature on contralateral body
|
|
|
What areas of the body DO NOT have weakness in Wallenberg's syndrome?
|
no facial or extremity weakness
|
|
|
Nuclei of what 2 cranial nerves are located in forebrain?
|
CN1 and CN2
|
|
|
Spinal division of what cranial nerve arises from ventral horn of cervical segments C1-6?
|
CN 11
|
|
|
Medial medullary syndrome is caused by occlusion one of what 2 arteries?
|
vertebral arteries and anterior spinal artery
|
|
|
What are the main symptoms of medial medullary syndrome?
|
1. ipsilateral hypoglossal palsy (with deviation toward side of lesion
2. contralateral hemiparesis 3. contralateral lemniscal sensory loss (proprioception and position sense) |
|
|
What are the main symptom of locked-in syndrome?
|
tetraparesis
|
|
|
What 3 functions are spared in locked-in syndrome?
|
1. vertical eye movement
2. fully conscious 3. blinking |
|
|
Full consciousness in locked-in syndrome is due to the sparing of what area?
|
reticular activating system
|
|
|
Where is the lesion is locked-in syndrome?
|
bilateral lesions of the ventral pons
|
|
|
What artery is occluded in locked-in syndrome?
|
basilar artery
|
|
|
Dysarthria - clumsy hand syndrome is due to lesions in what two areas?
|
Basis pontis and internal capsule
|
|
|
Most ruptured aneurysms causing subarachnoid hemorrhage occur where?
|
anterior part of circle of Willis
|
|
|
What is a commonly compressed nerve in SAH?
|
CN 3 - oculomotor nerve
|
|
|
What are 3 signs of CN3 involvement in SAH?
|
1. Deviation of ipsilateral eye to lateral side due to unopposed lateral rectus muscle
2. Ptosis 3. mydriasis -(dilated pupil) due to interuption of parasympathetic fibers 2. |
|
|
In treatment of hemorrhagic CVA, ICP should be kept below what level?
|
less than 20mmHG
|
|
|
What percentage of patients with TIA will go on to have a completed stroke if untreated i one month? one year?
|
5%/14%
|
|
|
A-fib increases chance of stroke by how many times?
|
5x
|
|
|
DM increases risk of CVA by how many times?
|
2x
|
|
|
What sleep disorder increases chance of stroke?
|
sleep apnea
|
|
|
What 4 systemic diseases with hypercoagulable states increases risk of CVA?
|
1. elevated RBCs/hemoticrit/fibrinogen
2. Protein S and C deficiences 3. Sicke cell anemia 4. Cancer |
|
|
What heart disorder increases risk of CVA?
|
patent foramen ovale
|
|
|
What geographic area of US is associated with increased risk of stroke?
|
southeastern US
|
|
|
What percentage of cardiogenic emboligo to the brain?
|
75%
|
|
|
What is the most common type of CVA (thrombotic, embolic, lacunar, or hemorrhagic?
|
thrombotic (35%)
|
|
|
What type of stroke usually occurs during sleep?
|
thrombotic
|
|
|
What type of stroke usually occurs while awake?
|
embolic
|
|
|
Are AVMs usually low or high pressure systems?
|
low pressure
|
|
|
What is the most common location of for a hypertensive intracerebral hemorrhage?
|
Putamen
|
|
|
What are two common presenting symptoms of putamen hemorrhage?
|
hemiplegia due to compression of internal capsule and vomiting
|
|
|
What are two common symptoms of a pons hemorrhage?
|
small pupils (1mm) and decerebrate rigidity
|
|
|
What two types of CVAs present suddenly?
|
embolic and SAH
|
|
|
What type of stroke is commonly preceded by a TIA?
|
thrombotic
|
|
|
What type of stroke occurs during strenous activity?
|
SAH
|
|
|
What color is seen on CT of brain immediately following what type of CVA
|
white/hemorrhagic
|
|
|
What type of imaging study is used for detection of patent foramen ovale?
|
Transthoracic or transespophogeal echocardiography
|
|
|
Name two favored antihypertensive agents in CVA management
|
IV labetolol and enalapril
|
|
|
What are the SBP/DBP parameters of treating HTN during stroke
|
>180/>105
|
|
|
What IV antiHTN agent does not cause cerebral vasodilation?
|
IV labetolol
|
|
|
What is the formula for CPP?
|
CPP=MAP-ICP
|
|
|
CPP should remain above what level to insure cerebral blood flow?
|
>60mm
|
|
|
What 6 conditions exacerbate ICP?
|
hypoxia
hypotension hypovolemia hyperthermia hypercarbia acidosis |
|
|
What calcium channel blocker decreases cerebral vasospasms after SAH and improves outcome afer SAH?
|
nimodipine
|
|
|
"Uses spiral and diagonal components of movement rather than traditional movements in cardinal planes of motion, with the goal of facilitating movement patterns that will have more functional relevance that the traditional techniqueof strengthening individual muscle groups" describes what CVA training technique?
|
Propioceptive Neuromuscular Faciliation (PNF)
|
|
|
"The goal is to normalize tone, to inhibit primitive patterns of movement, and to facilitate automatic, voluntary reactions as well as subsequent normal movement patterns" describes what CVA rehab technique?
|
Neurodevelopmental technique or Bobath approach
|
|
|
"Uses primitive synergystic patterns in training in an attempt to improve motor contral thourgh central facilitation" describes what school of stroke rehab?
|
Brunnstrom
|
|
|
What approach is the opposite of the Bobath approach and why?
|
Brunnstrom, which is to promote primitive synergystic patterns.
|
|
|
What CVA rehab approach uses "modification of muscle tone and voluntary motor activity using cutaneous sensorimotor stimulation?
|
Sensorimotor/Rood approach
|
|
|
During what phase of CVA recovery do most patients develop shoulder pain?
|
spastic phase
|
|
|
What is the most common type of RSD in CVA recovery?
|
shoulder hand syndrome
|
|
|
CRPS type I is also known as what?
|
RSD or causalgia
|
|
|
During what stage of RSD does bone demineralization occur?
|
Stage 3
|
|
|
What is the most consistent early diagnostic clinical finding in shoulder hand syndrome?
|
shoulder pain with ROM
pain with wrist dorsiflexion and edema pain with MCP/PIP flexion and edema |
|
|
A stellate ganglion block used to treat CRPS I/RSD shoulder hand syndrome is considered successful when what develops?:
|
ipsilateral Horners syndrome and alleviation of sympathetically mediated pain
|
|
|
EMG/NCS in brachial plexus injury in CVA recovery shows what findings?
|
lower motor neuron findings
|
|
|
Shoulder subluxation in CVA shows what 2 exam findings?
|
acromio-humeral separation
flaccid |
|
|
Rotator cuff tear in CVA shows what 3 exam findings?
|
+ abduction test
+ drop arm test flaccid or spastic |
|
|
CRPS Type 1 ishoulder pain in CVA shows what 3 exam findings?
|
MCP compression test
skin color changes flaccid or spastic |
|
|
What are 3 exam findings of frozen shoulder in CVA?
|
external rotation less than 15 degrees
early decrease in scapular motion spastic |
|
|
What are 3 exam findings of impingement syndrome in CVA?
|
pain with abduction of 70-90 degrees
end-range pain with forward flexion spastic |
|
|
What are 2 findings of biceps tendinitis in stroke?
|
+ yergason test
flaccid or spastic |
|
|
How is frozen shoulder in stroke diagnosed?
|
arthogram
|
|
|
How is RSD of the shoulder diagnosed in CVA? Name two
|
3 phase bone scan
stellate ganglion block |
|
|
Inferior subluxation of shoulder in CVA is diagnosed using what two diagnostic tests?
|
x-ray in standing position
scapular plane view |
|
|
What are two treatment for CVA shoulder subluxation?
|
FES
sling when upright |
|
|
Treatment of rotator cuff tear impingment syndrome, and frozen shoulder in CVA can be aided by what technique?
|
reduction of rotator cuff tone
|
|
|
What is the incidence of bowel dysfunction in CVA?
|
31%
|
|
|
Dysphagia is most common in CVA affecting what brain area?
|
brainstem
|
|
|
What is the most common cause of dysphagia in stroke?
|
delayed pharyngeal swallow
|
|
|
To be considered "aspiration" there must be penetration below what structure?
|
true vocal cords (vocal folds)
|
|
|
What is the incidence of aspiration in CVA?
|
40-70%?
|
|
|
How is aspiration most reliably diagnosed?
|
videofluoroscopic swallowing study
|
|
|
What are 6 predictors of aspiration during the bedside exam?
|
abnormal cough
cough after swallow dysphonia dysarthria abnormal gag reflex voice change after swallow |
|
|
What are 7 risk factors of aspiration pneumonia?
|
1.decreased level of conciousness
2. tracheostomy 3. emesis 4. reflux 5. NGT 6. dysphagia 7. prolonged pharyngeal transit time |
|
|
What are the 3 phases of swallowing?
|
oral
pharyngeal esophogeal |
|
|
During what swallowing phase does elevation of the soft palate take place?
|
oral phase
|
|
|
The oral phase of swallowing requires what 3 functions?
|
lip closure
mobile tongue muscles of mastication |
|
|
What 3 problems are seen in the oral phase of swallowing?
|
drooling
pocketing head tilt |
|
|
How long does the pharyngeal phase of swallowing last?
|
0.6-1 sec
|
|
|
During what phase is aspiration most likely to occur?
|
pharyngeal phase
|
|
|
With the initiation of what phase is breathing inhibited?
|
pharyngeal phase
|
|
|
What 4 functions are required for the pharyngeal phase?
|
tongue elevation
soft palate elevation laryngeal elevation pharyngeal constriction and cricopharyngeal relaxation |
|
|
Coordinated pharyngeal constriction and cricopharyngeal relaxation facilitate what swallowing activity?
|
bolus transport into the esophagus
|
|
|
What 6 problems can be seen in the pharyngeal phase?
|
food sticking
choking coughing aspiration wet/gurgling voice nasal regurgitation |
|
|
Food sticking can be seen in what two phases?
|
pharyngeal and esophogeal phases
|
|
|
Soft palate elevation in seen in what two phases
|
oral and pharyngeal phases
|
|
|
How does soft palate elevation prevent aspiration?
|
closes off the nasal cavity to prevent regurgitation into the nasopharynx
|
|
|
Folding of the epiglottis and vocal cord adduction are seen in what phase?
|
Pharyngeal
|
|
|
How long does the esophogeal phase last?
|
6-10 sec
|
|
|
What two functions are required for the esophogeal phase?
|
cricopharyngeal contraction
coordinated peristaltis and LES relaxation |
|
|
What are two problems seen in the esophogeal phase?
|
hearburn
food sticking |
|
|
What are two compensatory strategies in the treatment of dysphagia?
|
chin tuck
head rotation |
|
|
In the head rotation strategy for dysphagia the head should be turned to what side?
|
paretic side
|
|
|
Name 4 fluent aphasias.
|
Wernickes
Transcortical sensory conduction anomia |
|
|
Name 4 nonfluent aphasias
|
Brocas
Transcortical motor Global mixed transcortical |
|
|
Where is the lesion in Wernicke's aphasia?
|
posterior part of superior temporal gyrus of dominant hemisphere
|
|
|
Name 4 characterstics of Wernicke's aphasia
|
1. fluent speech
2. impaired comprehension 3. word deafness and alexia and agraphia 4. paraphasias and neologisms |
|
|
Where is the lesion in conduction aphasia?
|
parietal operculum
|
|
|
What are 4 characteristics of conduction aphasia?
|
fluent
preserved comprehension impaired repetition literal paraphasias |
|
|
What is melodic intonation therapy?
|
recruits right hemisphere for using melodies or rhythms
|
|
|
For what type of aphasia is melodic intontation therapy helpful?
|
Broca's (nonflueint)
|
|
|
During what time period after stroke with aphasia is there most improvement?
|
2-3 months
|
|
|
What twi errors in speech are associated with Wernicke's and Transcortical sensory?
|
jargon and neologisms
|
|
|
In what apahasia is echolalia noted occasionally?
|
Transcortical sensory
|
|
|
In what aphasia is there preserved comprehension but nonfluent speech?
|
Broca's.
|
|
|
In what 3 aphasias is paraphasia seen?
|
Wernicks's, Broca's, Conduction aphasia
|
|
|
What aphasias usually occur due to lesions on the left side?
|
Wernicke's, Broca's, Global, Conduction,
|
|
|
There is a higher risk for depression with lesion in what area?
|
left frontal lesion
|
|
|
What medication is helpful in post-stroke depression?
|
methylphenidate
|
|
|
Post-stroke seizures are more likely to occur with lesions in what two areas?
|
hemorrhages in parietal or
temporal areas |
|
|
What are two risk factors of post-stroke seizures/
|
cortical lesions
paresis |
|
|
What is the most common type of post-stroke seizure?
|
tonic-clonic
|
|
|
Do early (<2 weeks) or late onset seizures have more chance of recurring?
|
late onset
|
|
|
What is the mortality range of CVA in first year after stroke?
|
25-40%
|
|
|
What is the range of likelilhood another stroke within first year?
|
12-25%
|
|
|
What are risk factors for 30-day mortality from stoke?
|
DM
elevated blood sugar in nondiabetics EKG abnormalities brainstem involvment admission from nursing home severity age hemorrhagic CAD |
|
|
What percent of CVA patients are institutionlized?
|
26%
|
|
|
What are for negative factors for return to work after stroke?
|
low barthel index (0--100 scale)
aphasia prior alcohol use prolonged rehab length of stay |
