Neuroanatomy
This is how Cranial Nerve III is tested.
pupillary reflex ( look at pupillary constriction), eyelid opening (check for Ptosis), H-test ( specifically up/down/directly medial)
Ischemia in the posterolateral thalamus may be caused by which cerebral artery? What could this result in? (Describe the patient presentation)
1. PCA
2. Pusher syndrome ( pushing to the weak side)
A 1-month-old child who is supine, has their head passively flexed. What is the expected extremity response in a typically developing child? What reflex is this consistent with?
BUE extremity flexion, (same pattern in lower extremities) --> TLR
What is the MOST common diagnosis if the Physical Therapist Assistant observes a 10 year old boy attempt to move from the floor to a standing position by pushing downward on his legs with his hands to straighten his knees?
Duchenne's Muscular Dystrophy.
This is the Gower's Sign
A patient with a status post tibial fracture is now having difficulty moving their right ankle. The ankle appears red and painful upon palpation. What is the physical therapist assistant MOST likely suspecting?
Deep Vein Thrombosis
These cranial nerves only have an efferent function.
Oculomotor (III)
Trochlear (IV)
Abducens (VI)
Accessory (XI)
Hypoglossal (XII)
A PTA was testing for spasticity of the quadriceps. The PTA found a "More marked increase in muscle tone through most of the range of motion, but affected part easily moved". How would you describe the MAS testing procedure? and what would you have scored this finding?
1. Check available PROM for both knee ext/flex
2. Quick passive motion into knee FLEXION
3. MAS = 2
A physical therapist assistant would expect to see this reflex on the ipsilateral leg after pinching an infant's toe.
They would also see this reflex on the contralateral limb.
Flexion withdrawal reflex
Crossed Extension Reflex
What impairments are commonly seen in a child with ataxic cerebral palsy? How would describe their gait deficits?
Low postural tone, loss of coordination. They usually demonstrate a diplegic distribution, with the trunk and lower extremities most severely affected. Ataxic movements are jerky and irregular. In gait and standing, a wide base of support is used as a compensation for a lack of static postural control
A patient is being seen for right knee arthritis, and has hx of COPD, HTN, high cholesterol, congestive heart failure, osteoporosis, and a history of falls. The patient presents bilateral lower extremity swelling. What is the MOST likely reason for this presentation?
R sided Congestive Heart Failure
A patient with a neurologic injury reports numbness, and loss of light touch sensation in the left 5th digit. Which spinal nerve root is MOST likely affected, and what spinal tract carries that information
C8 - Dorsal Column Medial Lemniscus (DCML)
A thrombus in which of the following cerebral arteries is MOST associated with cerebrovascular accidents resulting in unilateral neglect? (Name artery and side)
Right middle cerebral artery ( specifically supply to the R Parietal lobe)
What is the typical gross motor presentation of a 6 month old?
Able to sit alone in supported (UE) ring sitting
Unilateral reaching in prone
Able to roll from prone to supine, supine to prone
Type of grasp: Palmar
This describes a finding that would be MOST expected in a child with T8 spina bifida.
Deep Tendon Reflex of 3+ or 4+
UMN Lesions in the LEs
UEs would not be affected
A physical therapist assistant is working with a 7 year old child with Down Syndrome. In the middle of the treatment session the child reports that his head hurts and he feels dizzy. Upon examination the child demonstrate hyperreflexia. What is the appropriate response of the PTA?
Call 911 as the child may have atlantoaxial dislocation
A patient presents with a lesion to the Right Vagus nerve. When assessing the nerve, what are the findings that the examiner should expect.
uvula deviates to the left
The use of a thrombolytic agent _(what's the most common one)_ would be considered a contraindication in which type of stroke?
Hemorrhagic stroke (increases hemorrhaging)
This med tPA is indicated for Ischemic stroke. How many hours must this med be administered within?
A child extends their upper extremities forward in response to an anterior perturbation. This is the response the child would demonstrate.
Protective reaction
NOT righting response, equilibrium reaction, moro reflex
This clinical presentation/condition would MOST likely have serial casting as an important intervention.
Hypertonic plantarflexors ( seen in conditions with spastic diplegia)
Not for hypotonia or contractures. why?
A PTA is working in Outpatient PT with a patient to address patellofemoral pain syndrome. The patient reports that the exercises have been difficult because she constantly feels short of breath with movement. She reports a recent history of experiencing fatigue, dizziness, and palpitations when she walks for more than 5 minutes. Mary’s skin looks paler than usual, and reports that her hands and feet have been unusually cold. She also mentions that her menstrual cycle has been unusually heavy.
What should the PTA do? What are you suspecting?
Patients with Anemia will need close and ongoing monitoring of their heart rate, oxygen saturation levels, and dyspnea levels during exercise sessions.
Check vitals and Lab values ( if applicable). Modify exercise, or terminate session (use clinical judgement) but patient needs to schedule f/u appt with MD ASAP. Urgent care if they are unable to see their PCP.
Monitoring: Close monitoring of vitals and symptoms during and after exercise to avoid overexertion. Ensure adequate rest periods. Exercise intensities can be self-assessed by perceived exertion levels or by taking heart rate levels during the exercise program
The PTA treats a patient who has had a cerebellar lesion/stroke. These coordination impairments are expected to be observed with this condition. (Name the specific impairments)
Bonus Q: Which artery supplies/gives rise to the AICA and PICA ( blood supply to the cerebellum)? What other S&S would you expect this patient to have that has a large lesion in this vessel?
Dysmetria (timing, force, extent, direction of limb movement, unable to reach target), nystagmus (gaze-evoked, eyes drift involuntarily to neutral), dysdiadochokinesia (inability to perform rapid alternating movements)
The VBA --> the 5 D's
A patient with L MCA might present with these clinical findings. List at least 2.
Aphasia, face and UE involvement > LE involvement
1. This is the resting cervical position in a patient with left sided torticollis.
2. What muscle is the major contributor to this condition?
Left side-bend, Right rotation and flexion
SCM.
Which of the following signs and symptoms is MOST consistent with Spinal Muscular Atrophy (SMA)?
Progressive weakness with eventual respiratory failure
A patient performing a warm-up on the upper extremity ergometer complains of sharp chest pains. What is the MOST likely a cause of this symptom? What should the PTA do?
Angina
If patient has meds-- > take them
If symptoms do not resolve with rest within 10 min ---> emergency