Hypertonia
To reduce flexion hypertonicity at the elbow following a stroke, the muscles to be considered for botulinum toxin injection include the biceps brachii, brachialis, and
A. Pectoralis Major B. Teres Major C. Coracobrachialis D. Brachioradialis
D. Brachioradialis
True or False: Ultrasound can be used over metal implants
True
Generally diagnostic US is considered completely safe as is low intensity therapeutic ultrasound. The theoretical risk of energy conversion to heat has not been shown to be of great concern clinically. Additonally, MRI and CT can be greatly distorted by metalic implants, so use of ultrasound for diagnosis around metal implant can be particularly helpful
True or False: Use of ultrasound to guide injections has been show to have superiority in therapeutic success of those injections over landmark guided injections
True
A patient with cerebral palsy has a more marked increase in muscle tone. Their arm encounters noticeable resistance through most of the range, but you can still easily push the joint to its full extension. What Modified ashworth score does this exam correlate with?
MAS 2
Which electrodiagnostic technique is most useful in diagnosing a radiculopathy? A. Nerve conduction study B. Late responses C. Needle electromyography D. Repetitive nerve stimulation
C. Needle EMG
When a patient with recent onset of hemiplegia shows progressive motor recovery from Brunnstrom Stage 1 to Brunnstrom Stage 3, what do you expect? A. Decreasing tone and increasing isolated voluntary movements B. Unchanged tone and increasing isolated voluntary movements C. Decreasing tone and increasing synergistic movements D. Increasing tone and increasing synergistic movements
D. Increasing tone and increasing synergistic movements
Which musculoskeletal disorder is most appropriately treated with ultrasound?
A. Greater Trochanteric Bursist following hip replacement B.Postlaminectomy Syndrome C. Lateral Hamstring Tendinitis at the muscle origin D. Plantar fasciitis associated with peripheral neuropathy
C. Lateral Hamstring Tendinitis at the muscle origin
You are performing an ultrasound of the rotator cuff and notice a anechoic area in the midsubstance of the supraspinatus tendon. What is important to rule out as the cause of this abnormality prior to diagnosing pathology?
Anisotropy
A patient with multiple sclerosis has a slight increase in muscle tone. When you quickly straighten their arm, you feel a minimal catch-and-release or tiny resistance right at the very end of the range of motion. What Modified Ashworth Score does this exam correlate with?
MAS 1
A patient with restrictive lung disease and mild scoliosis from Duchenne muscular dystrophy (DMD) develops nocturnal hypoventilation. What is the initial treatment?
A. Incentive spirometry every four hours B. Tracheostomy and nocturnal mechanical ventilation with positive pressure C. Nocturnal supplemental low-flow oxygen D. Nocturnal noninvasive positive airway pressure and short periods of daytime hyperinsufflation
D. Nocturnal noninvasive postivie airway pressure and short periods of daytime hyperinsufflation.
A patient with a recent traumatic brain injury (TBI) developed right lower extremity spasticity and knee flexion contracture which has been treated unsuccessfully with range of motion (ROM) and positioning. What is the next step in the management of this patient?
A. Additonal ROM B. Serial Casting C. E-Stim D. Surgical tendon lenthening
B. Serial Casting
Of the options listed, this the next step least invasive but possibly effective. Botox followed by serial casting would also be reasonable.
Which therapeutic modality combines a biologically active substance with a coupling medium and uses ultrasound to force the active material into tissue? A. Diathermy B. Iontophoresis C. Phonophoresis D. Fluidotherapy
C. Phonophoresis
When performing an out of plane ultrasound guided injection, what do you expect the needle to look like when it comes into view on your screen?
A white dot
As opposed to a line with possible reverberation on an in-plane injection
How many different scores are there in the Modified Ashworth scale?
6
0-4 with 1+ as an option
A patient with vocal changes in additon to dysphagia could benefit more from which of the two major swallow study techniques?
FEES, as this could directly visualize vocal cord dysfunction in addition to swallowing mechanics
A patient who sustained a stroke presents with spasticity in the wrist flexors which has been treated with botulinum toxin. Which modality will be most effective when applied to the wrist extensors?
A. Massage B. Ultrasound C. Muscle Cooling D. E-Stim
E-Stim
Synergistic Action: While the botulinum toxin targets and reduces the hypertonicity and spasticity of the wrist flexors, electrical stimulation active on the wrist extensors forces a targeted muscle contraction. [1, 2, 3]
Combating Antagonist Inhibition: Minimizing the opposing force of the flexors creates a critical therapeutic window. Applying NMES/FES during this window facilitates motor relearning, improves active range of motion, and enhances overall hand function (such as grasp and release tasks
What is the preferred imaging technique to rule out Osgood-Schlatter disease?
A. Conventional radiography
B. Arthrography
C. Ultrasonography
D. Magnetic resonance imaging
A. Conventional Radiography
A lateral knee X-ray of Osgood-Schlatter disease shows soft-tissue swelling and bone fragmentation at the tibial tuberosity
When you choose a high frequency probe for an ultrasound injection, you sacrifice _____ for superficial ____.
depth for superficial resolution
Low frequency probes have greater penetration, but the resolution will not be as crisp.
A patient with late-stage stroke displays a considerable increase in muscle tone making passive extension difficult to perform, although reaching the end-range is still technically possible. What Modified Ashworth Score does this exam correlate with?
MAS 3
For patients with brain injuries who manifest agitation, carbamazepine is used because of its
A. Mood-Stabilizing effect B. Anticonvulsant effect C. sedative effect D. anti-anxiety effect
A. Mood-Stablizing effect
Brain injuries can damage the frontal lobes and limbic system, leading to sudden emotional outbursts, irritability, and aggression.
Oxcarbazepine is frequently substituted for carbamazepine in younger cohorts due to a more favorable safety profile and less severe cognitive impact
Which clinical disorder is most likely to produce detrusor hyperreflexia? A. Poliomyelitis B. Multiple sclerosis C. Tabes dorsalis D. Muscular dystrophy
Upper Motor Neuron!
You are performing an in-plane ultrasound guided injection with a curvilinear probe and you see only part of your needle despite being right aligned with it. Why can you only see part of it and how can you ensure your needle tip is visualized?
The wide spread of the beam from the curvilinear probe causes the sound beams to bounce off at angles that do not reach the probe to pick them back up. You want to heel-toe the transducer to see other parts of the needle and ensure you visualize the tip!
C. Zero reflection and 100% transmission
Meaning practically, you won't be able to see a boundary between the two on ultrasound
A patient with an incomplete spinal cord injury shows a slight increase in tone. When you move their arm, you feel a catch or resistance followed by minimal resistance through less than half of the range of motion. What Modified Ashworth Score does this exam correlate with?
MAS 1+
Which clinical feature puts a patient with a traumatic brain injury (TBI) at greatest risk for developing posttraumatic epilepsy?
A. Penetrating injury B. Intracranial hematoma C. Subdural hematoma D. Prolonged coma
A. Penetrating Injury