90 Questions
Which type of aphasia involves patients who can speak but do not make sense?
Wernicke's aphasia
In which brain region is the lesion typically located for patients with Broca's (expressive) aphasia?
Inferior frontal gyrus
What type of aphasia results from a lesion involving the superior temporal gyrus or adjoining parietal cortex?
Wernicke's aphasia
Which term is associated with Broca's aphasia as a mnemonic for remembering the lesion location?
Bark-Broca
When is aphasia likely to occur according to the provided information?
When the dominant hemisphere is affected
Patients with Wernicke's aphasia typically have difficulty with:
Understanding written or verbal language
What is the typical pattern of upper motor neuron deficits from lesions in the cerebral cortex?
Decreased muscle tone initially, then increased tone (spasticity) develops
Why does hyperglycemia and fever worsen brain injury due to ischemia?
Due to the cascade of cerebral ischemia
In LMNL, what is a characteristic feature related to muscle tone?
Hypotonia
What is a key difference between the impact of lesions in the cerebral cortex and those in the internal capsule?
All fibers on one side of the body are affected in the internal capsule
What does a transient ischemic attack (TIA) involve?
Blood flow is restored before significant infarction develops
What distinguishes an ischemic stroke from a hemorrhagic stroke?
Differentiated by non-contrast head CT
Which of the following best describes the communication characteristics of patients with Wernicke's aphasia?
They have difficulty understanding written or verbal language.
In Broca's aphasia, patients are unable to:
Express spoken words.
Where is the typical anatomical localization of lesions for patients with Wernicke's aphasia?
Temporal-Parietal region
What distinguishes Broca's aphasia from Wernicke's aphasia in terms of speech ability?
Patients with Broca's aphasia can speak fluently but make no sense.
Which region of the brain is affected in patients with Broca's aphasia according to the provided information?
Frontal lobe
What clinical deficit is common between patients with upper motor neuron lesions and those with lower motor neuron lesions?
Muscle atrophy
What is a common feature of upper motor neuron lesions in the cerebral cortex?
Initial decrease in muscle tone
What is the significant difference between resistance in biceps and triceps muscles in upper motor neuron lesions?
Biceps show resistance in LMNL but not UMNL
Which characteristic is associated with LMNL rather than UMNL?
Muscle atrophy
Why does resistance typically occur in quads but not hamstrings in UMNL?
Nerve distribution differences
What is a distinguishing factor between the impact of lesions in the internal capsule versus the cerebral cortex?
Specific fibers for leg and foot versus face and arm
What is a characteristic symptom associated with a transient ischemic attack (TIA)?
Restoration of blood flow before significant infarction occurs
Which type of aphasia results from a lesion in the superior temporal gyrus or adjoining parietal cortex according to the information provided?
Wernicke's aphasia
What communication characteristics are typically observed in patients with Broca's aphasia?
Speaking without coherence or fluency
In upper motor neuron lesions, what is a common clinical manifestation related to muscle tone?
Hyperreflexia
What is a distinguishing feature between Broca's aphasia and Wernicke's aphasia?
Ability to speak fluently
What clinical deficit is commonly observed in lower motor neuron lesions?
Fasciculations
Which brain region is associated with Broca's aphasia based on the provided information?
Inferior frontal gyrus
What is the characteristic muscle tone change seen in upper motor neuron lesions?
Initial hypotonia, later spasticity
Which type of stroke involves the death of brain tissues within 4-10 minutes of zero cerebral blood flow?
Ischemic stroke
Why does resistance occur in 'anti-gravity' muscles in upper motor neuron lesions?
Increased signals from the brain
What differentiates transient ischemic attacks (TIAs) from ischemic strokes?
Extent of brain tissue damage
In LMNL, what is a common feature related to muscle atrophy?
Involuntary twitching
What role does perfusion imaging play in the diagnosis of ischemic strokes?
Depict ischemic penumbra
What is the main purpose of using soft tissue treatment techniques before starting DMFR or HVLA for lumbar vertebrae dysfunction?
To engage the myofascial layer to influence local and surrounding structures
When applying Direct Myofascial Release (DMFR) to a lumbar somatic dysfunction, what should be done after moving the planes of motion into restriction?
Release and reassess the restriction
During muscle energy technique for Type I lumbar somatic dysfunction, where should the patient place their hands?
Right hand behind the neck and left hand on the right elbow
What is a relative contraindication for applying Direct Myofascial Release (DMFR) to lumbar somatic dysfunctions?
Sprain/strain
In muscle energy technique for lumbar somatic dysfunctions, where should the physician stand in relation to the rotational component of the dysfunction?
Opposite side
What is a key step when utilizing post-isometric relaxation in muscle energy technique for Type I lumbar dysfunction?
Hold the position for a specific duration
How long should the isometric contraction be maintained during the osteopathic technique for Type II Dysfunction Example: L2 ERRSR Post-Isometric Relaxation?
5-7 seconds
In the Non-specific Supine Lumbar Roll osteopathic technique, what does the physician instruct the patient to do after maintaining isometric contraction?
Sit up
What is the role of the physician's left hand during the lateral recumbent lumbar HVLA technique?
Repositioning the patient's trunk
What should the patient gently pull backward in the lateral recumbent lumbar HVLA technique?
Right shoulder
In the Non-specific Supine Lumbar Roll osteopathic technique, what is the purpose of monitoring the transverse processes of L2 and L3?
Localize flexion and extension
During the Type II Dysfunction Example: L2 ERRSR Post-Isometric Relaxation, what should be monitored to localize side bending and rotation?
Spinous processes of L2 and L3
Which type of barrier does the physician reposition the patient's trunk to the edge of in both osteopathic techniques described?
Flexion barrier
What is instructed to be maximally improved at the dysfunctional segment after repeating steps 6 to 8 in both osteopathic techniques?
Range of motion
During both osteopathic techniques, what is the least amount necessary to produce a palpable muscle twitch at the segmental level being monitored?
Minimal force
What distinguishes Type II Dysfunction Example: L2 ERRSR Post-Isometric Relaxation from Non-specific Supine Lumbar Roll in terms of patient position during treatment?
Seated vs. supine position
What is the purpose of the rotational movement described in the text during the HVLA technique?
To take up further rotational slack between L4 and L5
In the HVLA technique for L5/S1 radiculitis, what is the significance of flexing the patient's hips and knees until L5 is fully flexed in relation to S1?
To take up rotational slack
Why does the physician place the caudad forearm in a line between the patient's PSIS and greater trochanter during the HVLA technique?
To introduce separation of L5 and S1 on the left side
What does it mean for the physician to deliver an impulse that separates L5 from S1 during the HVLA technique?
To distract or gap L5 and S1
What is the role of reassessing the severity of radicular symptoms after performing the HVLA technique for L5/S1 radiculitis?
To determine effectiveness of the technique
Which action by the physician helps create joint gapping between L5 and S1 during the HVLA technique?
Introducing a separation of L5 and S1 on the left side
Where is the urethra located in the penis?
In the ventral midline of the shaft
What covers the glans in uncircumcised men?
Prepuce of foreskin
Which structure forms the ejaculatory duct?
Seminal vesicle
What is the function of the epididymis in relation to sperm?
Storage, maturation, and transport of sperm
Where is the external inguinal ring located?
Directly above the pubic tubercle
Which structure forms the majority of the scrotum's underlying structure?
Dartos muscle
What is the function of the vas deferens in relation to sperm?
Transportation of sperm to prostate
What is the primary function of the seminal vesicle in male reproduction?
Formation of seminal fluid
Where is an indirect inguinal hernia most likely to develop?
At the internal inguinal ring
Which structure is responsible for separating each testis into distinct compartments within the scrotum?
Tunica vaginalis
For a dysfunction at L1 on L2, what is required in order to treat the dysfunction?
L1 must move through its restrictive barrier while L2 is held stable in neutral or carried through the ease of L1
In the lateral recumbent lumbar technique, what placement and thrust would make the technique not follow the definition of the dysfunction?
Placing the rotational component off the table and thrusting from below towards its barrier
In treating a Type I (Neutral) Dysfunction at L5, which technique is emphasized?
Long-lever, rotational/side-bending emphasis
What is one crucial step in determining the effectiveness of a lateral recumbent lumbar technique for Type II (Non-neutral) Dysfunction?
Reassessing intersegmental motion at the level of the dysfunctional segment
In an HVLA technique for Type I Dysfunction, how is the shoulder usually moved during the impulse thrust?
Slightly cephalad
What is emphasized in HVLA for Type II (Non-neutral) Dysfunction at L4?
Long-lever, rotational/side-bending emphasis
What is the best position for examining the male genitalia to allow for better assessment of hernias or varicocele?
Standing position
What is the white cheesy material that may accumulate under the foreskin known as?
Smegma
What should a physician do if a patient reports a discharge from the male genitalia that is not visible during examination?
Strip or milk the shaft of the penis
What is the normal location of the urethral meatus during male genitalia examination?
Tip of the glans
Which structure should be palpated on the superior posterior surface of each testicle during examination?
Epididymis
How can abnormal swelling of the testicles during examination be further evaluated?
Transillumination
What is the first priority when stroke is suspected in a patient?
Assess airway and blood pressure
What is the blood pressure threshold that should prompt a reduction in patients with suspected stroke?
220/120 mmHg
What is the primary reason for lowering blood pressure in stroke patients?
To decrease cardiac work
When should supplemental oxygen be recommended in acute stroke cases?
If SaO2 is below 92%
Which vessels are typically involved in large-vessel intracranial occlusion in ischemic stroke?
Basilar artery
What is the primary benefit of endovascular mechanical thrombectomy in acute stroke patients?
Vascular recanalization
In what time range from onset of stroke does IV thrombolytics show benefits to clinical outcomes?
$0-5$ hours
What is the primary concern associated with giving IV thrombolytics to stroke patients?
Greater risk of intracranial hemorrhage
What is the primary factor that can improve outcomes from endovascular therapy?
$<1$ hour from arrival to vessel opening
What is the recommended range for maintaining blood glucose levels in patients with acute ischemic stroke?
$140-180$ mg/dL
Study Notes
Aphasia
- Broca's (expressive) aphasia:
- Caused by lesions in the frontal lobe, specifically the posterior aspect of the inferior frontal gyrus
- Patients are unable to express spoken words
- "Can't bark out their thoughts"
- Wernicke's (receptive) aphasia:
- Caused by lesions in the temporal-parietal region, specifically the superior temporal gyrus or adjoining parietal cortex
- Patients cannot understand written or verbal language
- Can speak but do not make sense
- Aphasia only occurs when the dominant hemisphere is affected
Upper Motor Neuron (UMNL) vs. Lower Motor Neuron (LMNL) Lesions
- Upper Motor Neuron (UMNL) Lesions:
- Characterized by clumsiness to a greater degree than a loss of power
- Babinski sign is present immediately
- Decreased muscle tone initially, but increased tone (spasticity) develops later
- Spasticity is a unidirectional increase in muscular tone in "anti-gravity" muscles
- Resistance in biceps (not triceps) and quads (not hamstrings)
- Little or no atrophy
- Lower Motor Neuron (LMNL) Lesions:
- Characterized by loss of power to a greater degree than clumsiness
- Hypotonia
- Muscle atrophy
- Muscle fasciculations (involuntary twitching)
Upper Motor Neuron Deficits in Cerebral Cortex vs. Internal Capsule
- Cerebral Cortex:
- Specific fibers destined for one part of the body (e.g., leg and foot, but not face and arm)
- Contralateral effects
- Fibers are spread far apart
- Internal Capsule:
- All fibers on one side of the body
- Contralateral effects
- Fibers travel in a compact bundle
Transient Ischemic Attacks (TIAs) and Strokes
- Transient Ischemic Attacks (TIAs):
- Episodes of stroke symptoms that last less than 24 hours
- Blood flow is restored to ischemic tissue before significant infarction develops
- Ischemic Stroke:
- Caused by a lack of adequate blood flow
- Cerebral blood flow of zero causes death of brain tissues within 4-10 minutes
- Ischemic penumbra: ischemic tissue that can become restored surrounding a central area of infarction
- Treatment of Acute Ischemic Stroke:
- Do ABC's (Airway, Breathing, Circulation)
- Treat hyper/hypoglycemia
- Perform non-contrast head CT
- 6 Treatment Types:
- Medical support
- IV thrombolysis
- Endovascular revascularization
- Antithrombotic treatment
- Neuroprotection
- Stroke centers and rehabilitation
Osteopathic Techniques
- Non-specific Supine Lumbar Roll (5238):
- HVLA technique
- Given a segmental definition
- Lateral Recumbent Lumbar HVLA (5239):
- HVLA technique
- Given a segmental definition
- Direct Myofascial Release (DMFR) (5236):
- Physiology: engage myofascial layer to influence local and surrounding ligaments, articular processes, vasculature, and lymphatics
- Indications: restricted tissue, areas of hypertonicity, prominent tight-loose asymmetry of tissue
- Contraindications: sprain/strain, fracture, malignancy, osteopetrosis or osteopenia, infection
- Steps:
- Find dysfunction
- Move all planes of motion into restriction
- Hold in restriction until release
- Reassess
- Muscle Energy (5237):
- Type I Dysfunction: L2 NSLRR
- Post-Isometric Relaxation:
- Patient is seated
- Physician stands to the side opposite the rotational component of the dysfunction
- Patient places the right hand behind the neck and the left hand on the right elbow
- Soft Tissue Treatment (5235):
- Given a segmental definition of a lumbar vertebra
- Techniques:
- Prone Pressure
- Prone Traction
- B/L Thumb Pressure
- Scissor Technique
- Prone Pressure with Counterleverage
- Lateral Recumbent Position
- Supine Extension
- Lon Lever Counterlateral with Knees### Osteopathic Manipulative Treatment (OMT)
- HVLA (High-Velocity, Low-Amplitude) technique for L4/L5 dysfunction:
- Patient's foot does not touch the floor
- Physician's cephalad hand is in the antecubital fossa of the patient's left arm
- Physician's caudad hand stabilizes L5
- Patient's shoulder and pelvis are axially rotated in opposite directions
- During exhalation, further rotational slack is taken up
- If necessary, physician can grasp the patient's right arm to draw the shoulder forward
- Impulse is delivered with the forearms, moving the shoulder slightly caudad and the pelvis and sacrum cephalad
GYN/GU Demo
- Normal external female genitalia:
- Labeling required
- Normal internal female genitalia:
- Labeling required
- 5 P's of sexual history:
- Describe the 5 P's
- Anatomy of male genitalia:
- Penis:
- Shaft formed by 3 columns of vascular erectile tissue
- Corpus spongiosum contains urethra
- 2 corpora cavernosa
- Urethra located in ventral midline of the shaft
- Testes:
- Paired ovoid glands
- Tunica albuginea (fibrous outer coating)
- Scrotum (loose, wrinkled pouch of skin and underlying dartos muscle)
- Tunica vaginalis (serous membrane covering the testes)
- Epididymis:
- On posterolateral surface of each testis
- Softer, comma-shaped
- Contain tightly coiled tubules
- Vas deferens:
- Firm muscular cord
- Ascends from scrotal sac into the pelvic cavity
- Merges with seminal vesicle to form the ejaculatory duct
- Spermatic cord:
- Vas deferens + blood vessels + nerves + muscle fibers
- Penis:
- Inguinal canal:
- Medial to and parallel to inguinal ligament
- Forms tunnel for vas deferens
- Internal inguinal ring (1 cm above midpoint of inguinal ligament)
- External inguinal ring (triangular slit-like structure palpable just above and lateral to pubic tubercle)
- Inguinal hernias:
- Occur when loops of bowel force their way through the inguinal canal
- Indirect inguinal hernia (develop at internal inguinal ring)
- Direct inguinal hernia (arise more medially due to weakness in the floor of the inguinal canal)
Rectum and Prostate
- Rectum:
- Lies against sacrum and coccyx
- Merges with short segment of anal canal
- Extends from rectosigmoid junction to anorectal junction
- External margin of anal canal is poorly demarcated
- Note direction of anal cavity
- Anorectal junction (pectinate line): boundary between somatic and visceral nerve supply
- Contains 3 inward foldings (valves of Houston)
- Prostate:
- Surrounds urethra
- Lies next to bladder outlet
- Small during childhood, increases 5-fold between puberty and 20 years old
- R/L lateral lobes lie anterior against rectal wall
- Palpable as rounded, heart-shaped structure
- Separated by shallow median sulcus or groove
- Anterior and central areas of prostate cannot be examined
General Notes on Segmental Definitions of the Lumbar Spine
- If the dysfunction is at L1, L1 is restricted on L2, and L2 is not dysfunctional under L1
- If the dysfunction is at L1, L1 is not dysfunctional as it relates to T12
- To treat a dysfunction of L1 on L2, L1 must move through its restrictive barrier (bind) while L2 is either held stable in neutral or carried through the described ease of L1
HVLA for Type I (Neutral) Dysfunction
- Long-lever, rotational/side-bending emphasis
- Step-by-step instructions for example: L5 NSLRR
HVLA for Type II (Non-neutral) Dysfunction
- Long-lever, rotational/side-bending emphasis
- Step-by-step instructions for example: L4 FRRSR
Learn about the differences between Broca's (expressive) aphasia and Wernicke's (receptive) aphasia, including communication characteristics and anatomic localizations of brain lesions. Understand the regions associated with speech deficits such as Temporal-Parietal regions.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
