CVA

Question 1

A 68 y/o hemiplegic patient presents with contralateral grasp reflex, sucking reflex, gegenhalten and gait apraxia. What structure is involved?
a. MCA
b. PCA
c. ACA
d. ICA

Answer 1

c. ACA

Question 2

Slight increase in muscle tone, manifested by a catch followed by minimal resistance throughout the remainder of the range of motion.
a. 1
b. 1+
c. 2
d. 3
e. 4

Answer 2

b. 1+

Question 3

Non-fatigable clonus, less than 10 seconds when maintaining pressure, at a precise angle
a. 1
d. 4
b. 2
e. none of these
c. 3

Answer 3

e. none of these

Question 4

Strongest component of UE flexor synergy?
a. Elbow flexion
b. Forearm supination
c. Finger flexion
d. Shoulder ER

Answer 4

a. Elbow flexion

Question 5

This is a syndrome caused by lesions to the thalamus
a. Kluver Bucy
c. Rathke
b. Germann’s
d. Dejerine-Rousy

Answer 5

d. Dejerine-Rousy

Question 6

Hemiballismus is a movement disorder involving the :
a. Basal ganglia
b. subthalamic nucleus
c. Posterior limb of internal capsule
d. corpus callosum
e. Pyramidal tract

Answer 6

b. subthalamic nucleus

Question 7

Involuntary, but slower, twisting movements causing transient, odd and unnatural posturing, most evident in distal parts:
a. Tremor
d. Hyperkinesia
b. Chorea
e. Hypoclonus
c. Athetosis

Answer 7

c. Athetosis

Question 8

The patient presents with flaccidity and there is no activation of the limb at all. You know that the pt is in this level of brunstromm stages of motor recovery
a. Stage I
b. Stage II
c. Stage III
d. Stage IV
e. Stage V

Answer 8

a. Stage I

Question 9

A patient presents with complete tetraplegia and locked in syndrome after sustaining CVA. The patient is unable to speak, but cognitively remains intact. The Most likely artery involved with the CVA is the:
a. Anterior cerebral artery
b. Middle cerebral artery
c. Posterior cerebral artery
d. Vertebral-basilar artery

Answer 9

d. Vertebral-basilar artery

Question 10

A pure sensory stroke is most likely with damage to which of the following structures?
a. Internal capsule
b. Thalamus
c. Hippocampus
d. Globus pallidus
e. Pons

Answer 10

b. Thalamus

Question 11

Occlusion of the posterior inferior cerebellar artery (PICA) will damage all of the following structures, EXCEPT:
a. Corticospinal tracts
b. Nucleus and descending tracts of CN V
c. Nucleus ambiguous
d. Lateral spinothalamic tracts
e. Spinocerebellar tract

Answer 11

a. Corticospinal tracts

Question 12

Modifiable Risk Factors for Stroke include the following, except:
a. HTN
b. Hypercholesterolemia
c. Race
d. Atrial Fibrillations
e. Smoking

Answer 12

c. Race

Question 13

Memory impairment results from occlusion of what artery?
a. ACA
d. ICA
b. MCA
e. lenticulostriate
c. PCA

Answer 13

c. PCA

Question 14

Occlusion of the main trunk of the left middle cerebral artery usually results in the following deficits
I. Hemianesthesia
II. Expressive aphasia
III. Receptive aphasia
IV. Hemiplegia
a. I, II and III
d. only IV
b. I and III
e. all of these
c. II and IV

Answer 14

e. all of these

Question 15

Involvement of this artery results in bilateral but symmetrical corticospinal and cerebral signs:
a. PCA
c. VBA
b. ICA
d. ACA

Answer 15

c. VBA

Question 16

Following occlusion of the anterior cerebral artery the greatest amount of motor deficit is found in the
a. Contralateral arm
b. Contralateral leg
c. Ipsilateral arm
d. Ipsilateral leg
e. Involvement will be equally severe in both legs

Answer 16

b. Contralateral leg

Question 17

A posterior circulation stroke involves the
a. Parietal lobe
b. Frontal lobe
c. Basal ganglia
d. Brainstem

Answer 17

d. Brainstem

Question 18

A patient develops hoarseness, ataxia, mild right hemiparesis and diplopia. The most likely stroke lesion is:
a. Lenticulostriate artery – basal ganglia infarction
b. Brainstem infarction – VBA territory
c. Left cerebral – ACA territory
d. Left cerebral – MCA territory

Answer 18

b. Brainstem infarction – VBA territory

Question 19

In a CVA patient, if the greatest amount of deficit is in the contralateral arm and face, most probably the occlusion is in the:
a. ACA
d. ant. Cerebellar artery
b. MCA
e. VBA
c. PCA

Answer 19

b. MCA

Question 20

A cerebral infarction of the middle cerebral artery would probably cause all of the following symptoms, EXCEPT:
a. Aphasia
b. Ipsilateral Horner’s syndrome
c. Hemianopsia
d. Contralateral hemiplegia

Answer 20

b. Ipsilateral Horner’s syndrome

Question 21

The patient had a stroke resulting to (L) hemiplegia, which of the following is a manifestation of this type of stroke?
a. Depression
b. Difficulty in speech
c. Apraxia
d. Lack of insight

Answer 21

d. Lack of insight

Question 22

The ff are manifestations of ICA stroke, except:
a. Aphasia
b. Dysarthria
c. One-sided weakness
d. Monocular blindness
e. None of these

Answer 22

b. Dysarthria

Question 23

You are performing a neurological evaluation on a patient that has vascular injury with the following impairments: loss of consciousness, coma, inability to speak and hemiplegia. Based on this information, which of the following areas does this vascular injury occur?
a. ACA
c. PCA
b. MCA
d. VBA

Answer 23

d. VBA

Question 24

In lateral medullary (wallenburg syndrome), all of the following can be seen, except:
a. Decreased in pain and temperature sensation on the ipsilateral side of the face
b. Decreased pain and temperature on the contralateral body
c. Decreased muscle strength on the contralateral side
d. Ptosis, anhidrosis and miosis on the ipsilateral side

Answer 24

c. Decreased muscle strength on the contralateral side

Question 25

The artery involved in wallenburg syndrome: a. Superior cerebellar artery b. Anterior inferior cerebellar artery c. Posterior inferior cerebellar artery d. Vertebrobasilar artery e. None of these

Answer 25

c. Posterior inferior cerebellar artery

Question 26

Pure motor stroke is involvement of: a. Anterior limb of the internal capsule b. Posterior limb of the internal capsule c. Thalamus d. Subthalamic nucleus

Answer 26

b. Posterior limb of the internal capsule

Question 27

In weber syndrome, where is the lesion? a. Tegmentum of the brainstem b. Basal midbrain c. Lateral pons d. Basal pons

Answer 27

b. Basal midbrain

Question 28

A 60-year-old male suddenly becomes ill during a meeting and is taken to the emergency room. The patient is later diagnosed with CVA involving a portion of the left middle cerebral artery. Which impairments would be expected based on the patient’s medical diagnosis? 38 a. Impaired right upper extremity motor function, impaired speech, and impaired right upper extremity sensation b. Impaired right lower extremity motor function, impaired speech and impaired spatial awareness c. Impaired left upper extremity function, impaired left upper extremity sensation, and impaired spatial awareness d. Impaired left lower extremity motor function, impaired speech, impaired spatial awareness

Answer 28

a. Impaired right upper extremity motor function, impaired speech, and impaired right upper extremity sensation

Question 29

A patient presents to the emergency department with ptosis, anhidrosis, and miosis on the left side of his face. He has difficulty walking and recently fell to his left side. On physical exam, there is decrease in pain and temperature sensation on the left side of his face and on the right side of his body. There is no muscle weakness. He most likely has: a. Lateral medullary syndrome b. Medial medullary syndrome c. Benedikt d. Weber syndrome

Answer 29

a. Lateral medullary syndrome

Question 30

The most common type of lacunar stroke: a. Pure motor hemiplegia b. Sensori-motor c. Ataxic hemiparesis d. Pure sensory e. Dysarthria clumsy hand

Answer 30

a. Pure motor hemiplegia

Question 31

All of the following are true about broca’s aphasia, except: a. Patient’s has poor writing ability b. Good reading comprehension c. Patient can easily comprehend verbal commands d. Lesion is in third frontal convolution e. None of these

Answer 31

e. None of these

Question 32

More marked increase in muscle tone through most of the range of motion but joint is easily moved. a. 1 b. 1+ c. 2 d. 3 e. 4

Answer 32

c. 2

Question 33

It is characterized by sudden severe headache, often described as “the worst headache of my life,” with or without focal neurologic deficit, and often with altered mental status a. Subararachnoid hemorrhage b. Atherothrombotic stroke c. Cardioembolic stroke d. Lacunar Stroke e. Intracerebral Aneurysm

Answer 33

a. Subarachnoid hemorrhage

Question 34

The following are manifestations of the Lateral Medullary Syndrome or Wallenberg syndrome, EXCEPT: a. Ipsilateral Horner syndrome b. loss of ipsilateral pain and temperature c. ipsilateral impaired sensation of face d. Ipsilateral limb ataxia e. None of these

Answer 34

b. loss of ipsilateral pain and temperature

Question 35

All are classic lacunar syndrome, except: a. Pure motor hemiparesis b. Pure hemisensory c. Sensori-motor stroke d. Clumsy hand-dysarthria e. Ataxia with crural paresis

Answer 35

e. Ataxia with crural paresis

Question 36

All of the following are true about locked in syndrome except: a. CST are affected on both sides b. Long tracts of cranial nerve are also affected bilaterally c. Pt may be in COMA d. Cognition is spared e. NOTA

Answer 36

e. NOTA

Question 37

Brunstromm stage of motor recovery where in there is prominence of spasticity and the patient voluntarily moves the limb, but ms activation is all within the synergy patterns: a. Stage I b. Stage II c. Stage III d. Stage IV e. Stage V

Answer 37

c. Stage III

Question 38

Your 25 y/o patient presents with seizure, migraine & hemorrhage. Hemorrhage was found to be between cerebral arteries and veins. Knowing this presentation you opt to check the patient’s chart for his diagnosis. It is noted in the chart that this patient has: a. Saccular Berry Aneurysm b. Arteriovenous Malformation c. Subarachnoid Hemorrhage d. Embolic Stroke

Answer 38

b. Arteriovenous Malformation

Question 39

Most common site of hypertensive hemorrhagic stroke a. putamen b. thalamus c. caudate d. lentiform nucleus e. globuspallidus

Answer 39

a. putamen

Question 40

Occurs in the presence of thromobolitic disease and is the result of temporary ischemia in the brain and surrounding tissues. Symptoms do not last long and do not show changes on CT scan or MRI: a. Reversible Ischemic Neurologic Deficit b. Complete Stroke c. Stroke in Evolution d. Transient Ischemic Attack e. NOTA

Answer 40

d. Transient Ischemic Attack

Question 41

A patient cannot find his dentures when they are on his crowded bedside table. His visual acuity tests at 20/20 with the Snellen eye chart. The PT suspects problems with: a. Figure-ground discrimination b. Body scheme awareness c. Agraphia d. Vertical orientation

Answer 41

a. Figure-ground discrimination

Question 42

A px status post CVA has (R) hemisphere damage & a resultant (L) hemiplegia. W/c of the ff. presentation is NOT typical w/ this kind of px? a. Poor judgment c. Quick b. Impulsive d. Overly cautious

Answer 42

d. Overly cautious

Question 43

The Most common site of occlusion in stroke: a. MCA b. ACA c. PCA d. Anterior communicating artery

Answer 43

a. MCA

Question 44

Common sites of occlusion in thrombotic stroke except: a. Common carotid artery b. MCA c. Lenticulostriate artery d. VBA e. None of these

Answer 44

c. Lenticulostriate artery

Question 45

A patient experienced a cerebrovascular accident (right CVA) 2 weeks ago. The patient has motor and sensory impairments primarily in the left lower extremity; the left upper extremity shows only mild impairment. There is some confusion and perseveration. Based on these findings, what type of stroke syndrome does this patient present with? a. Posterior cerebral artery stroke b. Internal carotid syndrome c. Anterior cerebral artery syndrome d. Middle cerebral artery syndrome

Answer 45

c. Anterior cerebral artery syndrome

Question 46

A patient recovering from stroke demonstrates dyspraxia. On what should physical therapy intervention optimally focus? a. Reeducation of weak muscles using isokinetics before activity practice b. Compensatory training strategies with maximum use of environmental cues c. Task-specific practice of familiar activities progressing from parts to whole d. Maximum use of manual facilitation of movements and new tasks

Answer 46

c. Task-specific practice of familiar activities progressing from parts to whole

Question 47

A patient incurred a right CVA 1 month ago and demonstrates moderate spasticity in the left upper extremity (predominantly increased flexor tone). The major problem at this time is a lack of voluntary movement control. There is minimal active movement, with ¼ inch subluxation of the shoulder. What initial treatment activity is the BEST choice for this patient? a. Sitting, left active shoulder protraction with extended elbow and shoulder flexed to 90o b. Sitting, weight bearing on extended left upper extremity, weight shifting c. Quadruped, rocking from side to side d. PNF D2 flexion pattern, left upper extremity

Answer 47

b. Sitting, weight bearing on extended left upper extremity, weight shifting

Question 48

During an initial interview and history, a patient with a right CVA seems unconcerned about obvious paralysis of the left arm and leg. When the therapist asks the patient to describe what happened, the patient says “I must have slept wrong and my arm and leg fell asleep.” The patient further tells the therapist, “My family put me in this place so they could go on vacation.” Which type of perceptual disorder BEST characterizes the patient’s responses? a. Anosognosia b. Prosopagnosia c. Spatial relations disorder d. Somatoagnosia

Answer 48

a. Anosognosia

Question 49

Examination of a patient recovering from stroke reveals a loss of pain and temperature sensation on the left side of the face along with loss of pain and temperature sensation on the right side of the body. All other sensations are normal. What is the likely location of the lesion? a. Right cerebral cortex or internal capsule b. Midbrain c. Left cerebral cortex or internal capsule d. Left posterolateral medulla

Answer 49

d. Left posterolateral medulla

Question 50

A patient recovering from stroke presents with predominant involvement of the contralateral lower extremity and lesser involvement of the contralateral upper extremity. These clinical manifestations are characteristic of which cerebral syndrome? a. Basilar artery syndrome b. Anterior cerebral artery syndrome c. Posterior cerebral artery syndrome d. Middle cerebral artery syndrome

Answer 50

b. Anterior cerebral artery syndrome