DEFENSOR CHAP 60 DIAGNOSTICS

Question 1

A thorough examination of the motor system includes an assessment of

Answer 1

muscle size and tone

as well as strength,

coordination, and

balance.

Question 2

in examining motor system

Any evidence of atrophy or invol untary movements (___________) is noted.

Answer 2

tremors, tics

Question 3

(the tension present in a muscle at rest)

Answer 3

Muscle tone

Question 4

Abnormalities in tone include

_____ (increased muscle tone),

_____ (resistance to passive stretch), and

flaccidity:

Answer 4

spasticity

rigidity

flaccidity

Question 5

______ tests muscle strength.

Answer 5

Assessing the patient’s ability to flex or extend the extremities against resistance

Question 6

____ is seen as pronation of the palm, indicating a subtle. weakness that may not have been detected on the resistance examination

Answer 6

drift

Question 7

Clinicians use a _______ to rate muscle strength.

Answer 7

5-point scale

Question 8

A _ indicates full power of contraction against gravity and resistance or normal muscle strength

Answer 8

5

Question 9

_ indicates fair but not full strength against gravity and a moderate amount of resistance or slight weakness;

Answer 9

4

Question 10

_ indicates just sufficient strength to overcome the force of gravity or moderate weakness;

Answer 10

3

Question 11

_ indicates the ability to move but not to overcome the force of gravity or severe weakness;

Answer 11

2

Question 12

_ indicates minimal contractile power (weak muscle contraction can be palpated but no movement is noted) or very severe weakness;

Answer 12

1

Question 13

_ indicates no movement

Answer 13

0

Question 14

when recording muscle strength, a _____ is used as a precise form to document findings.

Answer 14

stick figure

Question 15

_____ influence on the motor system is reflected in balance control and coordination.

Answer 15

Cerebellar and basal ganglia

Question 16

The _____ is a screening test for balance that can be done with the patient seated or standing. The patient can be seated or stand with feet together and arms at the side, first with eyes open and then with both eyes closed for 20 seconds

Answer 16

Romberg test

Question 17

slight swaying is normal, but a loss of balance is abnormal and is considered a ______

Answer 17

positive Romberg test.

Question 18

cerebellar tests for balance in the patient who is ambulatory include

Answer 18

hopping in place,

alternating knee bends,

and heel-to-toe walking

Question 19

A ____ is used to elicit a deep tendon reflex.

Answer 19

reflex hammer

Question 20

The handle of the reflex hammer is held loosely between the _____, allowing a full swinging motion.

Answer 20

thumb and index finger

Question 21

if the reflexes are symmetrically diminished or absent, the examiner may use _____ of other muscle groups to increase reflex activity.

Answer 21

isometric contraction

Question 22

The absence of reflexes is significant, although _____ may be normally absent in older adults.

Answer 22

ankle jerks (Achilles reflex)

Question 23

Deep tendon reflex responses are often graded on a scale of ____ with ____considered normal

Answer 23

0 to 4+,

2+

Question 24

Some examiners prefer to use the terms ____, _____, and ____ when describing reflexes.

Answer 24

present,

absent,

and diminished

Question 25

The examiner supports the patient's arm and identifies the triceps tendon by palpating ______ above the elbow.

Answer 25

2.5 to 5 cm (1 to 2 inches)

Question 26

examples of deep tendon reflexes

Answer 26

biceps reflex triceps reflex patellar reflex

Question 27

in achilles reflex If the examiner cannot elicit the ankle reflex and suspects that the patient cannot relax, the patient is instructed to ____

Answer 27

kneel on a chair or similar elevated, flat surface.

Question 28

When reflexes are hyperactive, a movement called ____ may be elicited.

Answer 28

clonus

Question 29

Deep tendon reflexes are graded on a scale of __

Answer 29

0-4:

Question 30

No response reflex

Answer 30

0

Question 31

Diminished (hypoactive) reflex

Answer 31

1+

Question 32

Normal reflex

Answer 32

2+

Question 33

Increased (may be interpreted as normal) reflex

Answer 33

3+

Question 34

Hyperactive (hyperreflex a)

Answer 34

4+

Question 35

in documenting reflexes The arrow points _____ if the plantar response is normal and ____ if the response is abnormal

Answer 35

downward upward

Question 36

Women who are premenopausal are advised to practice effective _____ before and for several days after any diagnostic procedure using contrast,

Answer 36

contraception

Question 37

BUN (Blood Urea Nitrogen): ____ Creatinine: ___ for males and ____for females.

Answer 37

7 to 20 mg/dL 0.6 to 1.2 mg/dL males 0.5 to 1.1 mg/dL females

Question 38

_____ uses a narrow x-ray beam to scan body parts in successive layers.

Answer 38

Computed tomography (CT) scanning

Question 39

The images provide cross-sectional views of the brain, distinguishing differences in tissue densities of the skull, cortex, subcortical struc-tures, and ventricles.

Answer 39

Computed tomography (CT) scanning

Question 40

in ct scanning An ____ may be used to highlight differences further.

Answer 40

intravenous (IV) contrast agent

Question 41

in ct scanning the image is displayed on an ____ or television monitor and is photographed and stored digitally

Answer 41

oscilloscope

Question 42

____ is quick and painless and uses a small amount of radiation to produce images; it has a high degree of sensitivity for detecting lesions.

Answer 42

CT scanning

Question 43

Abnormalities detected on brain CT include

Answer 43

tumor or other masses, infarction, hemorrhage,

Question 44

____ allows visualization of blood vessels; in some situations, this eliminates the need for formal angiography.

Answer 44

CT angiography

Question 45

The injection of a water-soluble iodinated contrast agent into the ______ through lumbar puncture improves the visualization of the spinal and intracranial contents on these images.

Answer 45

subarachnoid space

Question 46

The ______, has largely replaced myelography as a diagnostic procedure for the diagnosis of herniated lumbar discs.

Answer 46

CT scan, along with magnetic resonance imaging (MRI)

Question 47

in CT scan Preparation includes ___ about the need to lie quietly throughout the procedure. A review of ____ may be helpful for patients with claustrophobia. _____ can be used if agitation, restlessness, or confusion interferes with a successful study.

Answer 47

educating the patient relaxation techniques Sedation

Question 48

If a contrast agent is used, the patient must be assessed before the CT scan for an ____

Answer 48

iodine/shellfish allergy,

Question 49

A suitable IV line for contrast injection and a period of fasting (_____) are required prior to the study.

Answer 49

usually 4 hours

Question 50

_____ is also encouraged after IV contrast to facilitate contrast clearance through the kidney.

Answer 50

Fluid intake

Question 51

____ uses a powerful magnetic field to obtain images of different areas of the body.

Answer 51

MRI

Question 52

The magnetic field causes the _____ within the body to align like small magnets in a magnetic held.

Answer 52

hydrogen nuclei (protons)

Question 53

An ____ can be performed with or without a contrast agent and can identify a cerebral abnormality earlier and more clearly than other diagnostic tests

Answer 53

MRI scan

Question 54

MRI is particularly useful in the diagnosis of ____, ____, and ____ and does not involve ionizing radiation.

Answer 54

brain tumor, stroke, and multiple sclerosis

Question 55

why is MRI limited in emergency scenarios

Answer 55

it may take an hour or more to complete

Question 56

The patient is assessed for implants containing metal (e.g., ____.

Answer 56

aneurysm clips, intrauterine devices) artificial heart valves,

Question 57

No metal objects may be brought into the room where the MRI is located; this includes

Answer 57

oxygen tanks, IV poles, ventilators, or even stethoscopes.

Question 58

MRI Patients may experience claustrophobia while inside the narrow tube; _____ may be prescribed in. these circumstances.

Answer 58

sedation

Question 59

____ are less claustrophobic than the other devices and are available in many locations.

Answer 59

"Open" MRI machines`

Question 60

___ is a computer-based nuclear imaging technique that produces images of actual organ functioning.

Answer 60

PET scan

Question 61

In PET scan The patient either inhales a _____ that emits positively charged particles.

Answer 61

radioactive gas or is injected with a radioactive substance

Question 62

in PET scan the resultant gamma rays can be detected by a scanning device that produces a series of _____ at various levels of the brain.

Answer 62

two-dimensional views

Question 63

PET permits the measurement of ______ and thus indirectly evaluates brain function.

Answer 63

blood flow, tissue composition, and brain metabolism

Question 64

brain is one of the most metabolically active organs, consuming ___ of the glucose the body uses

Answer 64

80%

Question 65

__ is useful in showing metabolic changes in the brain (Alzheimer's disease, locating lesions (brain, tumor, epileptogenic lesions), identifying blood flow and oxygen metabolism in patients with strokes, distinguishing tumor from areas of necrosis, and revealing biochemical abnormalities associated with mental illness.

Answer 65

PET

Question 66

what complications may occur in PET scan

Answer 66

dizziness, lightheadedness, headache)

Question 67

____ is a three-dimensional imaging technique that uses radionuclides and instruments to detect single photons.

Answer 67

SPECT

Question 68

It is a perfusion study that captures a moment of cerebral blood flow at the time of injection of a radionuclide.

Answer 68

SPECT

Question 69

____ is useful in detecting the extent and location of abnormally perfused areas of the brain, thus allowing detec-tion, localization, and sizing of stroke (before it is visible by CT scan); localization of seizure foci in epilepsy; detection of tumor progression (Fischbach & Fischbach, 2018); and evaluation of perfusion before and after neurosurgical procedures.

Answer 69

SPECT

Question 70

____ and ____ are contraindications to SPECT.

Answer 70

Pregnancy and breast-feeding

Question 71

_____ is an x-ray study of the cerebral circulation with a contrast agent injected into a selected artery.

Answer 71

Cerebral angiography

Question 72

A valuable tool in investigating vascular disease or anomalies, it is used to determine vessel patency, identify presence of collateral circulation, and provide detail on vascular anomalies that can be used in planning interventions.

Answer 72

cerebral angiography

Question 73

Cerebral angiograms are performed by threading a catheter through the _____ in the groin or the ____ of the wrist and up to the desired vessel.

Answer 73

femoral artery radial artery

Question 74

Prior to the angiography, the patient's ____and _____ should be checked to ensure the kidneys will be able to excrete the contrast agent.

Answer 74

blood urea nitrogen and creatinine

Question 75

in cerebral angiography pulses are marked with a _____.

Answer 75

felt-tip pen

Question 76

during the cerebral angiogram process pt is told to expect a brief feeling of _____ contrast agent is injected.

Answer 76

warmth in the face, behind the eyes, or in the jaw and a metallic taste

Question 77

in cerebral angiography A catheter is introduced into the femoral artery, flushed with _____, and filled with contrast agent.

Answer 77

heparinized saline

Question 78

cerebral angiography ____ is used to guide the catheter to the appropriate vessels.

Answer 78

Fluoroscopy

Question 79

cerebral angiography Signs of these complications include .

Answer 79

new onset of alterations in the level of consciousness, weakness on one side of the body, motor or sensory deficits, and speech disturbances

Question 80

_____ is an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture.

Answer 80

myelogram

Question 81

After myelography, the patient lies in bed with the head of the bed elevated ____ degrees.

Answer 81

30 to 45

Question 82

myelography The patient is advised to remain in bed in the recommended position for ____ after testing.

Answer 82

4 to 24 hours

Question 83

myelogram Complications that may occur include

Answer 83

nausea , vomiting, headache,

Question 84

_____ flow studies use ultrasound imagery and _____ of arterial blood flow to evaluate carotid and deep orbital circulation.

Answer 84

Noninvasive carotid Doppler measurements

Question 85

uses the same noninvasive techniques as carotid flow studies but records the blood flow velocities of the intracranial vessels.

Answer 85

Transcranial. Doppler

Question 86

An ____represents a record of the electrical activity generated in the brain

Answer 86

electroencephalogram (EEG)

Question 87

in EEG The amplified activity of the neurons between any two of these electrodes is recorded on continuously moving paper; this record is called the _____

Answer 87

encephalogram.

Question 88

An _____ is obtained by inserting needle electrodes into the skeletal muscles to measure changes in the electrical potential of the muscles

Answer 88

electromyogram (EMG)

Question 89

An ___ is useful in determining the presence of neuromuscular disorders and myopathies.

Answer 89

EMG

Question 90

A ____ is carried out by inserting a needle into the lumbar subarachnoid space to withdraw CSF

Answer 90

lumbar puncture (spinal tap)

Question 91

indications of lumbar puncture

Answer 91

obtain CSF for examination, to measure and reduce CSF pressure, to determine the presence or absence of blood in the CSF,

Question 92

in lumbar puncture The needle is inserted into the _____ in the widest intervertebral spaces; between the ____, _____, or _____ lumbar vertebrae

Answer 92

subarachnoid space second and third, the third and fourth, or fourth and fifth

Question 93

The CSF should be ____

Answer 93

clear and colorless.

Question 94

______ may indicate a subarachnoid hemorrhage.

Answer 94

Pink, blood-tinged, or grossly bloody CSF

Question 95

in lumbar puncture headache is caused by _____ at the puncture site

Answer 95

CSF leakage

Question 96

Post-lumbar puncture headache may be avoided if a small-Gauge needle (_____) is used

Answer 96

22 gauge

Question 97

A post-lumbar puncture headache is usually managed with ____

Answer 97

analgesic agents, encouraging hydration, ingestion of caffeine, and lying supine