Ch.4 Screening Cognition & Comm Exam Prep

Chapter 4: Screening of Attention, Cognition, Perception, and Communication

Mary T. Blackinton, PT, EdD, GCS, CEEAA

Lisa K. Kenyon, PT, DPT, PhD, PCS

Dennis W. Fell, PT, MD

Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST

Multiple Choice

1. “Alert and Oriented times 3” is an inappropriate description of cognition because:

A. It is misunderstood by other health professionals

B. It is outside the scope of physical therapist practice

C. The phrase does not indicate what specific aspects of orientation have been tested

D. It ignores aspects of cognition, such as language and reasoning

2. Patient 1 reports being concerned because ever since her husband died she is becoming forgetful; Patient 2 was late to her appointment because she got lost going home from her church; and Patient 3 has had a very sudden onset of hallucinating. What is the best hypothesis for each patient given this information?

A. Patient 1 may be in delirium, Patient 2 may have cognitive loss, and Patient 3 may have depression

B. Patient 1 may have cognitive loss, Patient 2 may have depression, Patient 3 may be in delirium

C. Patient 1 may have depression, Patient 2 may have cognitive loss, and Patient 3 may be in delirium

D. Patient 1 may have depression, Patient 2 may have delirium, Patient 3 may have cognitive loss

3. In what order should a therapist assess cognition, attention, and arousal?

A. Arousal, attention, cognition

B. Arousal, cognition, attention

C. Attention, arousal, cognition

D. Cognition, arousal, attention

4. A patient was being seen in an in-patient setting. The patient appeared very sleepy; his therapist had to speak loudly and gently shake him in order to keep him awake during the bedside session. While documenting, this level of arousal should be described as:

A. Alert

B. Lethargic

C. Obtunded

D. Coma

5. A patient in early to midstages of Alzheimer disease has been referred to physical therapy for gait training. Which of the following describes the MOST appropriate motor learning approach to having the patient stand?

A. Give the patient short, specific instructions to follow; demonstrate while talking: for example, “Scoot to the edge, push from the chair, stand up”; limit the number of repetitions to avoid fatigue.

B. Say “let’s go” while motioning the person to stand; use many repetitions to encourage implicit learning

C. Put a mirror in front of the patient and ask her to stand up and walk to the door, using many repetitions to encourage learning

D. Do not say anything and gently grab the patient by the arms and lift her to stand and walk, and continue to walk until she is tired

6. A patient was transferred to a skilled nursing facility while still on a ventilator. He is awake, and the medical record indicates he communicates via gestures or nodding. Which of the following tests/measures would BEST assess sustained attention in this patient?

A. Ask him to count backward by 3’s from 50

B. The “A-Test” for vigilance

C. The digit repetition test

D. Ask him to write his name and address

7. Which of the following tests/measures is BEST used as a quick bedside assessment scale to describe cognitive function in people with an acute concussion or brain injury?

A. Cognitive Log (Cog-Log)

B. Mini-Mental State Examination

C. Moss Attention Rating Scale

D. Montreal Cognitive Assessment

8. What is the advantage of using the Montreal Cognitive Assessment (MoCA) compared to the Mini-Mental State Examination (MMSE)?

A. The MoCA is shorter and takes less time

B. The MoCA is more commonly used than the MMSE

C. The MoCA is more sensitive to both mild cognitive impairment and dementia

D. The MoCA is easier to perform than the MMSE

9. Which of the following patients is at GREATEST risk for delirium?

A. A 43 year-old male, 48 hour status post-rotator cuff repair who is taking analgesic medication for pain

B. A 72 year-old female, 3 days post-cataract surgery being seen in outpatient physical therapy for balance retraining

C. A 37 year-old male 24 hours post-coronary artery bypass surgery recovering in the cardiac intensive care unit

D. A 66 year-old female, type I diabetes with a 4 year history of renal failure and dialysis, 24 hours after kidney transplant

10. Which of the following strategies would BEST help a patient who has difficulty paying attention?

A. Constantly quiz the patient during treatment with questions like “what day is today?” or “what should you do next”?

B. Provide intensive input to the patient, bombarding him/her with visual and tactile stimuli to improve attention

C. In a quiet environment, ask the patient to pay attention to one aspect of the skill, such as “step on the BLUE footprints”

D. Use auditory stimulation, such as the patient’s favorite music, to help stimulate movement and attention

11. A patient is suspected of having unilateral spatial neglect (USN) because he often ignores the food on the left side of his plate. An appropriate tool to test for USN is:

A. Albert’s Cancellation Test

B. Testing whether patient can point to body parts.

C. Montreal Cognitive Assessment

D. Visual Discrimination Testing

12. A therapist has a hard time understanding a patient who speaks in irregular bursts, slurring her words quickly as follows: where-ish-da-banket? This type of speech difficulty can be characterized as:

A. Broca’s aphasia

B. Wernicke’s aphasia

C. Ataxic dysarthria

D. Flaccid dysarthria

13. Examination and intervention are ideally provided when an infant is in which of the following behavioral states?

A. Active asleep

B. Sleep-wake transition

C. Quiet alert

D. Active alert

14. During an examination of an infant, the therapist notes that the infant’s eyelids are fluttering and partially open. The infant’s breathing is shallow and rapid while variable extremity movements are observed. Occasionally, the infant exhibits a grimacing expression. Based on these observations, the infant is MOST likely in which of the following behavioral states?

A. Active sleep

B. Sleep-wake transition

C. Quiet alert

D. Active alert

15. The Denver Developmental Screening Test II (Denver) is a norm-referenced tool designed to screen children from birth to which of the following ages?

A. 4 years, 6 months

B. 5 years, 6 months

C. 6 years, 6 months

D. 7 years, 6 months