PACS Exam 3 IOs (generated)

What movements are associated with the TMJ joint?

Jaw opening, jaw closing, protrusion, retrusion, lateral crossbite.

What movements are associated with the cervical spine (C-spine)?

Flexion, hyperextension, left and right rotation, lateral bending.

What movements are associated with the thoracic spine (T-spine)?

Minor flexion and extension, left and right rotation.

What movements are associated with the lumbar spine (LS-spine)?

Flexion, hyperextension, lateral bending, left and right rotation.

What are the shoulder joint movements?

Flexion, hyperextension, abduction, adduction, external rotation, internal rotation, protraction, retraction, shrug.

What movements are associated with the elbow joint?

Flexion, hyperextension, pronation, supination.

What movements are associated with the wrist?

Flexion, hyperextension, radial deviation, ulnar deviation.

What movements occur at the finger MCP joints?

Flexion, hyperextension, abduction, adduction.

What movements occur at the PIP and DIP joints?

Flexion and extension.

What movements are associated with the hip joint?

Flexion, hyperextension, abduction, adduction, external rotation, internal rotation.

What movements are associated with the knee joint?

Flexion and hyperextension.

What movements occur at the tibiotalar joint?

Dorsiflexion and plantar flexion.

What movements occur at the subtalar joint?

Inversion and eversion.

What is the average age at which bone growth is completed?

About 20 years, when the last epiphysis closes.

At what age is peak bone mass typically achieved?

Around 35 years of age.

What skeletal changes occur in the elderly?

Kyphosis, osteoporosis, increased bone resorption, loss of bone density, and deterioration of cartilage.

What is crepitus?

A grating sound or sensation felt when irregular bony surfaces rub together.

What is the difference between active range of motion (AROM) and passive range of motion (PROM)?

AROM is when the patient moves the joint themselves, while PROM is when the examiner moves the joint passively.

What is the significance of measuring active and passive ranges of motion?

Differences can indicate intra-articular vs. extra-articular problems.

What is the normal range of the elbow carrying angle?

5 to 15 degrees laterally.

What is cubitus valgus?

A lateral carrying angle exceeding 15 degrees.

What are Heberden's nodes?

Hard bony overgrowths along the distal interphalangeal joints.

What are Bouchard's nodes?

Hard bony overgrowths along the proximal interphalangeal joints.

What is a swan neck deformity?

A bending in of the base of the finger, straightening of the middle joint, and bending in of the outermost joint.

What is the clinical significance of subcutaneous nodules on the forearm?

They may indicate rheumatoid nodules or gouty tophi.

What is the role of a goniometer in measuring joint range of motion?

To precisely measure the angle of joint flexion and extension.

What is the grading scale for muscle strength?

0 to 5 scale, where grade 3 or less indicates disability.

What condition is associated with spindle-shaped fingers?

Spindle-shaped fingers are associated with the acute stage of rheumatoid arthritis (RA).

What is the expected angle range between the femur and tibia?

The expected angle between the femur and tibia is less than 15 degrees.

Define genu valgum.

Genu valgum is a variation in lower leg alignment characterized by knock-knees.

Define genu varum.

Genu varum is a variation in lower leg alignment characterized by bowlegs.

Differentiate between pes varus and pes valgus.

Pes varus refers to in-toeing, while pes valgus refers to out-toeing.

What is heel pronation?

Heel pronation, or overpronation, occurs when the outer edge of the heel hits the ground first, and the foot rolls inward onto the arch.

Describe the normal longitudinal arch of the foot.

The normal longitudinal arch is formed by the calcaneus and the metatarsals and may flatten with weight bearing.

What is pes planus?

Pes planus is a condition where the foot remains flat even when not bearing weight.

What is pes cavus?

Pes cavus is a condition characterized by a high instep, also known as clawfoot.

How is leg length measured?

Leg length is measured from the anterior superior iliac spine to the medial malleolus, crossing the knee on the medial side.

How is arm length measured?

Arm length is measured from the acromion process through the olecranon process to the distal ulnar prominence.

What is the normal limit for discrepancy in limb length and circumference?

A discrepancy of no more than 1 cm in length and circumference between matching extremities is considered normal.

What does the Mini Mental Status Exam measure?

The Mini Mental Status Exam measures orientation, registration, attention and calculation, recall, ability to follow commands, and language.

What is the difference between a full mental status exam and a Mini Mental Status exam?

A full mental status exam (MoCA) is broader and has higher sensitivity and specificity compared to the Mini Mental Status exam.

What should be assessed in a patient's grooming during a mental status evaluation?

Assess the patient's hygiene, grooming, and appropriateness of dress for age and season.

What might poor hygiene and inappropriate dress indicate?

Poor hygiene and inappropriate dress may indicate depression, a psychiatric disorder, or dementia.

What does body language indicate in a mental status evaluation?

Body language, such as posture and eye contact, can indicate emotional state and potential neurological conditions.

What is the Glasgow Coma Scale used for?

The Glasgow Coma Scale is used to quantify the level of consciousness after an acute brain injury or medical condition.

What are signs of cognitive impairment?

Signs include significant memory loss, confusion, impaired communication, and hazardous behavior.

What does an inability to describe similarities or differences in analogies indicate?

It may indicate a lesion of the left or dominant cerebral hemisphere.

What is the significance of abstract reasoning in a mental status exam?

Inability to explain a proverb or metaphor may indicate poor cognition, dementia, or brain damage.

What should be evaluated in a patient's attention span?

Evaluate by asking the patient to follow a short set of commands or recite the days of the week.

What is a sign of impaired arithmetic skills?

Impairment may be associated with depression, cognitive impairment, or diffuse brain disease.

What does aphasia indicate in a mental status evaluation?

Aphasia indicates a speech disorder that can be either receptive or expressive, often resulting from neurological damage.

What types of memory should be evaluated in a mental status exam?

Immediate recall, recent memory, and remote memory should be evaluated.

What does loss of immediate and recent memory with retention of remote memory suggest?

It suggests dementia.

What is remote memory?

The ability to recall verifiable past events or information, such as a sibling's name or high school attended.

What is the purpose of the Mini Mental State Examination (MMSE)?

To assess cognitive function changes over time.

What is the maximum score on the MMSE?

30 points

What score on the MMSE may be associated with dementia?

A score less than 20

Define confusion in the context of altered mental status.

Inability to think or reason in a focused, clear manner.

What characterizes lethargy?

The individual falls asleep without repeated stimulation.

What is delirium?

Fluctuating acute confusion.

What is stupor?

A state requiring vigorous and/or painful physical stimulation to be awakened.

What does coma indicate?

The individual cannot be aroused by any stimulus and shows no response to the environment.

What are the types of activities of daily living (ADLs) dependent on mental status?

Shopping, cooking, managing medications, managing personal finances, communication, and remembering appointments.

What can cause aphasia?

Facial muscle or tongue weakness or neurologic damage to brain regions controlling speech and language.

What are the characteristics of Broca's aphasia?

Impaired speech flow with laborious effort to speak; comprehension is fair to good.

What characterizes Wernicke's aphasia?

Fluent speech with inappropriate word usage; comprehension is impaired.

What is global aphasia?

Aphasia that is both expressive and receptive, with severely impaired comprehension and expression.

What are the maximum and minimum possible scores on the Glasgow Coma Scale?

Maximum score is 15; minimum score is 3.

What does decorticate posturing indicate?

Injury to the corticospinal tracts above the brainstem.

What does decerebrate posturing indicate?

Injury to the brainstem.

What is hemiplegia associated with?

Damage to the internal carotid artery (ICA), middle cerebral artery (MCA), or anterior cerebral artery (ACA).

What is delirium characterized by?

Impaired cognition, arousal, consciousness, mood, and behavioral dysfunction of acute onset.

What defines dementia?

A chronic, slowly progressive disorder of failing memory, cognitive impairment, and personality changes, often beginning after age 60.

What is depression in the context of mental health?

Feelings of sadness, loss, anger, or frustration that interfere with everyday life for an extended period.

What are the steps to properly assess mental status in a physical examination?

Observe physical appearance, investigate cognitive abilities, observe speech and language, and evaluate emotional stability.

How is motor strength assessed using the Grade 0 to 5 scoring system?

Grade 5/5 is normal; Grade 0/5 indicates no contractility.

What does a positive pronator drift test indicate?

Corticospinal tract dysfunction, such as a lesion.

What is the purpose of testing vibratory sense with tuning forks?

To assess proprioception of the posterior column.

What are the dermatomes for C3, C6, C7, C8, T4, T10, T12, L4, L5, and S1?

C3: Proximal neck; C6: Thumbs & index fingers; C7: Middle fingers; C8: Ring & pinkie fingers; T4: Nipple level; T10: Umbilicus; T12: Inguinal; L4: Medial foot; L5: Mid-dorsum foot; S1: Lateral foot.

What is the purpose of deep pressure sensation tests?

To evaluate deep pressure sensation, typically by squeezing muscles like the trapezius, calf, or biceps, where the patient should experience discomfort.

How is temperature sensation evaluated?

By rolling test tubes of hot and cold water against the skin in an unpredictable pattern and asking the patient to identify the temperature and location.

What is assessed during position sense testing?

The ability of the patient to identify the direction of movement of a joint, typically the great toe or a finger, when moved by the examiner.

What is stereognosis and what does it assess?

The ability to identify a familiar object by touch and manipulation, indicating intact sensory function; inability suggests a parietal lobe lesion.

What does point location testing involve?

Touching an area on the patient's skin and asking them to point to the area touched, ensuring no difficulty in localization.

How is 2-point discrimination tested?

By alternating touching the skin with one or both points of a paper clip or tongue blade, asking the patient how many points are felt.

What is the expected distance for 2-point discrimination on fingertips?

Two points are commonly felt when 2 to 8 mm apart.

What are the components of cerebellar function assessment?

Gait observation, heel-toe walking, point-to-point testing, heel-knee-shin test, fine motor coordination with coins, and rapid alternating movements.

What does the heel-toe walking test assess?

Coordination and balance, similar to a sobriety test.

What does the Romberg test evaluate?

Balance by having the patient close their eyes and stand with feet together; a positive sign indicates potential cerebellar ataxia or sensory loss.

What are the commonly tested deep tendon reflexes (DTRs)?

Biceps (C5, C6), Brachioradialis (C5, C6), Triceps (C6, C7, C8), Patellar (L2, L3, L4), Achilles (S1, S2).

What conditions may indicate absent or hyperactive deep tendon reflexes?

Absent reflexes may indicate neuropathy or lower motor neuron issues, while hyperactive reflexes suggest upper motor neuron lesions.

How is the grading of deep tendon reflexes performed?

On a scale from 0 to 4+: 0 - no response, 1+ - sluggish, 2+ - active, 3+ - brisk, 4+ - hyperactive with clonus.

What is the significance of tactile agnosia?

An inability to recognize objects by touch, indicating a possible parietal lobe lesion.

What is the extinction phenomenon in sensory testing?

Simultaneously touching two areas on each side of the body and asking the patient to identify the number and location of stimuli.

What does graphesthesia assess?

The ability to recognize figures drawn on the palm, indicating sensory function.

What is the expected distance for 2-point discrimination on the back?

A greater distance of 40 to 70 mm is expected for discrimination.

What is the purpose of assessing superficial touch?

To evaluate the ability to perceive light touch using a cotton wisp or fingertip without depressing the skin.

What is the role of the spinothalamic tract in sensory testing?

To assess superficial pain and touch, evaluating the patient's ability to distinguish between sharp and dull sensations.

What is the procedure for assessing vibration sensation?

Using a vibrating tuning fork on bony prominences and asking the patient to identify when and where they feel the vibration.

What does the heel-knee-shin test assess?

Fluidity and coordination of movement by having the patient move their heel up and down their shin.