NIH Stroke Scale: A Comprehensive Guide for Assessing Stroke Patients, Exams of Very large scale integration (VLSI)

Download NIH Stroke Scale: A Comprehensive Guide for Assessing Stroke Patients and more Exams Very large scale integration (VLSI) in PDF only on Docsity!

Answers

How many items on the NIH stroke scale? - correct answer 11 NIH Stroke scale is - correct answer an 11-item clinical evaluation instrument widely used in clinical trials and practice to assess neurologic outcome and degree of recovery from stroke. NIH Stroke Scale is used to quantify the effects of acute cerebral ischemia on levels of ... (7 items) - correct answer levels of: consciousness vision motor function (facial and extremities) cerebellar function sensation language extinction or inattention NIH SS is used to measure patient's status after a stroke and to assess the outcome after - correct answer treatment

Answers

Should the patient be coached? Should you go back and rethink a particular assessment? - correct answer NO Having what when using NIH scale is important? - correct answer reference materials DO NOT RATE what you think the patient wants to do or what you think they can do, RATE ONLY - correct answer rate only what they actually do use patient"s first response? - correct answer YES - DO NOT USE SUMMARY OF RESPONSES re ataxia score 1-if real weak, assume ataxia score is... 2-if they can hold leg or arm up w/ minimal drift but are all over place when trying finger to nose test, that's probably...

3. Important to know if ataxia is present or not and if present in _____ or _______ limbs
4. if patient very weak or paralyzed, the ataxia score is...

correct answer 1) 0

Answers

2. ataxia
3. 1 or 2
4. 0 You should only score loss of sensation if you can really demonstrate... - correct answer that they have loss of sensation if patient has sensory loss from neuropathy, do you count thatt? - correct answer no, but you do if there's loss on top of the neuropathy aphasia is difficult because it can take a while to go through the battery and it can be subjective as to whether it is one of which classification? - correct answer mild, mod, severe start to recognise aphasia when you meet them and start talking and you don't get a history of... - correct answer what happened dysarthria is interesting because there are many cultural things about slurred ________? - correct answer speech.

Answers

Score is associated with prognosis? - correct answer YES Is NIH scale a measure of disability? - correct answer NO. The NIH scale is a measure of impairments. The NIH scale creates a common currency so that everybody understands the patient's level of... - correct answer deficit, by giving a number that communicates to other professionals how sick the patient is how much time to budget to perorm NIH scale - correct answer 7-10 mins What effort should be recorded? Do not do what? - correct answer The patient's first effort. Don't go back and change scores. IMPORTANT CONVENTIONS IN ADMINISTRATION: Administer scale items in their exact ______ -Avoid ______ing patient -Accept patient's _______ effort

Answers

-Score only what the patient _______ -Be consistent -Include all _________s into scoring, including those that may be from _________s ______s - correct answer -order -coaching -first -does -Be consistent -previous strokes ITEM 1a and how to get it - correct answer -examiner's overall impression of patient alertness -ask 2-3 questions about circumstances of admission, stimuate patient by patting or tapping, occasionally pinching NIH Item 1a Scoring: 0 1 2 3 - correct answer -Alert

Answers

-Not alert, aroused w/ minor verbal stim -Not alert, requires strong or painful stim -Only reflexive movements or totally unresponsive ITEM 1a - patient w/ 3 on this item is generally considered to be in... 3 is scored ONLY if patient makes no movement other than.... - correct answer a coma reflexive posturing in response to noxious stimulation If difficult to determine 1 vs 2 in item 1a, continue with...

correct answer medical hx qs until confident in assigning a score - THIS IS ONLY TIME IN NIH scale where you can go back EVEN IF PRESENTED WITH OBSTACLES OR BARRIERS, YOU MUST CHOOSE A - correct answer SCORE NIH Item 1B based on responses to two items: When?

Answers

-What about patient - correct answer -month of year -patient's age ITEM 1B SCORING 0 1 2 - correct answer -answers both qs correctly -answers 1 q correctly OR patients unable to communicate d/t intubation, oral-tracheal trauma, severe dysarthria from any cause, language barrier, or any issue not secondary to aphasia -answers neither question correctly --> a 3 on 1a must be a 2 on 1b A patient that cannot speak but is otherwise able to communicate can be allowed to convey the answer how?

correct answer writing If the patient answers incorrectly first and then corrects self, how is the answer scored? - correct answer it is still scored as incorrect

Answers

What if patient gives DOB as answer to question asking for their age? How is this scored? Is there credit for partial answers that are close like being off a month when answering what month it is? - correct answer This is scored as a WRONG answer. NO NIH 1C is what? Make sure to position what in testable position - correct answer Commands Eyes and Hands NIH 1C ask patient to do how many actions and what are they? - correct answer 3 commands "close your eyes for me" "now open them" "now make a fist with your hand" NIH 1C - may I repeat the commands? May I encourage? May I pantomime command?

Answers

May I hold up arm for hand to make fist? - correct answer Yes, you can repeat command ONCE. No, no encouragement or coaching. Yes, you should try and pantomime command so that patient receives verbal and visual input. Yes, can hold up arm for hand command NIH scale 1C scoring: 0 1 2 - correct answer 0 - both tasks performed correctly 1 - one task performed correctly 2 - neither task if performed correctly Can a friend/family member translate w/ NIH commands?

correct answer Yes NIH scale 1C -for patient who has comprehension deficit and perform incorreclty, what is scored? - correct answer 2

Answers

NIH scale 1C -for patient who gives a real attempt but not completed due to weakness, is credit given? - correct answer yes, give credit but ONLY score the first attempt NIH scale Number 2 item is... - correct answer Best Gaze what does the best gaze item test? - correct answer voluntary horizontal eye movements does NIH scale #2 measure distortions in vertical gaze, nystagmus or schew deviation - correct answer NO, NIH scale #2 does not measure these visual issues NIH scale # -first test, noting what? -second test - correct answer -look at position of eyes at rest, noting spontaneous eye movements to left or right -then move finger or other target from side to side and ask patient to track MOVING EYES ONLY, being sure to keep asking patient to follow the target

Answers

If patient does not accurately follow finger, a stronger test is needed USE what other tests? - correct answer oculocephalic maneuver, eye fixation or tracking of the examiner's face Item 2 - if patient has ocular rotary problems, such as strabismus, but leaves mid-line in attempt to look both left and right, what should the response be considered? - correct answer normal Item 2 Best Gaze Scoring 0 1 2 - correct answer 0 - normal 1 - partial gaze palsy 2- forced deviation If there is a conjugate deviation of eyes that can be overcome with voluntary or reflexive activity, score a - correct answer 1

Answers

If patient has isolated cranial nerve paralysis such as ocular motor or abducens palsy, score a - correct answer 1 Best Gaze - score a 2 if - correct answer there is forced deviation or total gaze paresis not overcome by the oculocephalic maneuver conjugate lateral deviation not overcome with reflexive movements, score a - correct answer 2 tonic deviation such that eyes cannot be moved, score a - correct answer 2 can a patient who scores a 3 on 1a LOC have palsy that can be overcome by moving head? if so, what should be performed? - correct answer yes use oculocephalic maneuver and score the result should caloric testing be used - correct answer No, tests involving water in the ear should not be used for eye tests

Answers

in aphasic patients, is gaze testable? what makes it easier to study? - correct answer yes, establish eye contact and move around the bed, just as with confused patients should patients with ocular trauma, bandages, pre- existing blindness, other disorders of visual acuity or fields be tested? if so, what should they be tested with? - correct answer yes they should be tested with reflexive movements and scored. NIH scale item 3 is - correct answer VISUAL FIELDS for item 3, have patient look where and tell them what should both eyes be open? - correct answer patient is to look in examiner's eyes and they are to be told that peripheral vision is being tested and that I may move a finger to the right, a finger to the left, or both - COVER ONE EYE when performing item 3, ask patient to do what - correct answer count fingers in all four quadrants

Answers

Item 3 - if a patient scored 3 on item 1a, they are tested for 3 using what? and what is it? - correct answer bilateral threat NIH scale 3 scoring: 0 1 2 3 - correct answer 0- no visual loss, upper and lower visual fields are normal 1- clear cut asymetry, including quadrantanopia or partial hemianopia 2-complete hemianopia 3-bilateral hemianopia (blindness of any cause including cortical blindness) item 3: if patient has severe monocular visual loss d/t intrinsic eye disease and visual fields in other eye are normal, examiner should score as - correct answer normal

Answers

if there is unilateral blindness or enucleation, what is scored - correct answer visual fields in the remaining eye arbitrary rule that if they extinguish even if intact to confrontation, visual field item is scored as a... - correct answer 1 NIH item 4 is... - correct answer facial palsy in NIH #4,you ask patient - correct answer "show me your teeth," if no teeth in say "show me your gums" "open and close your eyes" - can say "squeeze eyes shut as hard as you can" "raise the eyebrows" or "lift up your eyebrows as much as you can" for NIH 4, where MUST patient look? - correct answer directly at examiner NIH 4: for aphasic, poorly responsive or noncomprehending patient, use what kind of stimulus?

Answers

If using this stimulus, what is the basis for the scoring? - correct answer noxious -the symmetry of the grimace NIH Item #4 Scoring 0 1 2 3 - correct answer 0 - normal symmetrical movement 1 - minor paralysis such as a flattened nasolabial fold or mild asymmetry while smiling - proper score if function is less than clearly normal 2-paralysis of the lower face - appropriate for clear cut upper motor neuron facial palsy 3- complete paralysis of the upper and lower face - appropriate score for obtunded or comatose patient or one with unilateral-lower motor neuron facial weakness decreased spontaneous and forced facial movements are most prominent at what location? - correct answer the mouth if there is a clear cut asymmetry of the smile, the score is... -

Answers

correct answer two, all other subtle asymmetries are scored as a one score of 3 re: face is reserved for unusual complete paralysis seen with some strokes of what kind? - correct answer some brain stem strokes NIH scale item 5 is... - correct answer Item 5 - Motor Arm what is proper positioning for item 5 motor arm movement? - correct answer extend arms 90 deg if sitting OR 45 deg if supine item 5 leg test always in what position and how many deg

correct answer leg motor test supine and extended 30 deg for item 5 motor arm, score a drift if arm does when and when? - correct answer if arm falls before 10 seconds as you count down out loud

Answers

for motor leg, score a drift if leg does what and when - correct answer if leg falls before 5 seconds motor items: begin counting when? - correct answer immediately at the release of the limb how should the examiner be counting down? why? - correct answer verbally and with fingers in full view of the patient, so the patient receives verbal and visual input watch for what upon release of the limb? what to consider about this? - correct answer watch for an initial dip after release of the limb, only score abnormal if there is a downward drift after the dip each arm is tested in turn beginning with the... - correct answer non-paretic arm when testing arms, what position for palms? - correct answer down can limbs be tested simultaneously? - correct answer NO

Answers

in what cases are the motor items not scored? - correct answer only in the case of amputation or joint fusion of the shoulder or hip, BUT A WRITTEN NOTE OF THIS MUST BE NOTED - IF advised to score 9, do not use in calculating score Use what in voice when talking to aphasic patients? what else can be used - correct answer urgency in voice pantomime if patient has restricted limb function due to arthritis or non-stroke related limitations, does a score still need to be given? - correct answer yes - use best judgment to determine between effect of stroke and any other cause Scale item 5 has how many sections? What are they? - correct answer 2, 5a and 5b NIH scale item 5 scoring 0 1 2

Answers

4 -

correct answer 0 - no drift 1 - drift: if arm jerks or drifts down to intermediate position without encountering support, such as a bed, before a full 10 seconds 2-some effort against gravity but the arm cannot get to or maintain the proper position and drifts down to some support 3-no effort against gravity and the arm falls 4-if patient is unable to make voluntary movements to differentiate between 3 and 4 on arm, you have to - correct answer encourage the patient and wait a second or two to observe movement in the paretic arm Any movement at all including small proximal movements such as shoulder shrug or hip flexion is enough to do what to the arm motor score? - correct answer lower from 4 to 3 a patient who scores 3 on 1a LOC is scored what on 5? - correct answer they are scored a 4

Answers

NIH scale item 6 is... - correct answer motor leg NIH scale item 6 scoring 0 1 2 3 4 - correct answer 0- no drift and leg holds 30 deg position for 5 seconds 1- if there is drift and leg falls before end of 5 sec period but does not hit support such as bed 2 - when there is some effort against gravity but leg falls to support within 5 sec 3- no effort against gravity and leg falls to support immediately but patient makes small movements such as hip flexion or adduction 4- if patient is unable to make voluntary movements what items are the most reproducible of the NIH scale? are they important to ultimate outcome? - correct answer 5 and 6 yes, they are the most imporant

Answers

watch limbs very carefully and compare to what to gauge whether the limb is drifting slightly? - correct answer compare to a marker behind the patient patients scoring a 3 on 1a are scored as what on item 6 - correct answer they are scored as a 4 NIH scale item is... - correct answer limb ataxia item 7 for limb ataxia is an assessment for evidence of... it attempts to distinguish a clinically significant incoordination from... - correct answer unilateral cerebellar lesion general weakness how do we perform item 7 tests - correct answer finger-nose-finger on both sides heel - shin on both sides finger nose finger - how - correct answer ask patient to touch my finger, their nose and my finger again, moving finger - enough times to thoroughly test for ataxia - THEN DO OTHER SIDE

Answers

heel-shin test - how - correct answer instruct patient to move one heel down and up shin of opposite leg - THEN DO OTHER SIDE which side gets tested first? - correct answer unaffected side if visual field defect, attempt to pefrom test where? - correct answer perform test in the intact visual field NIH scale item 7 scoring 0 - correct answer 0 - absent, there is normal coordination - movements well performed, smooth accurate and not clumsy 1 - if ataxia, dysmetria, or dyssynergia is present in 1 limb 2-if any are present in 2 limbs, both arms, both legs or an arm and a leg on the same side of the body - also score 2 if bilateral signs if significant weakness, assume ataxia is ... - correct answer 0

Answers

in the patient who cannot understand or is paralyzed, ataxia is scored as a ___ on this item - correct answer 0 item 7 is scored a 1 or 2 only if ataxia is both _______ and out of proportion to ________ - correct answer present weakness for item 7, patients scoring a 3 on item 1a are scored only if what is present, otherwise are scored as what? - correct answer ataxia otherwise 0 NIH scale item 8 is - correct answer sensory perception item 8 is tested using a series of... for the obtunded or aphasic patient, withdrawal from... - correct answer pin pricks noxious stimulus is used for item 8, what should be used? what should not be used? - correct answer safety or seamstress pin

Answers

DO NOT USE paperclips, broken sticks or ballpoint pins item 8: examine patient with pin in what areas of what? ask patient what? do eyes need to be closed ask patient if there is what between right and left sides - correct answer proximal portions of all 4 limbs ask if they feel the stimulus no, eyes do not need to be closed ask if there is asymmetry- DO NOT ASK IF SHARP OR DULL - as only to compare the sides and tell if there is a difference item 8 - in confused, obtunded or aphasic patients, look for symmetry of grimace in response to - correct answer noxious stimulus only sensation loss attributed to what is scored - correct answer stroke should we test as many body areas as needed to assess for hemisensory loss? what areas? - correct answer yes