D443 Health Assessment - Set 5 - Part 3

Correct Answer: Parkinsonian (festinating) gait

Small shuffling steps, stooped posture, decreased arm swing, and hesitant initiation of movement characterize a Parkinsonian or festinating gait. Ataxic gait is wide-based and staggering, typically from cerebellar dysfunction; steppage gait involves exaggerated hip and knee flexion to clear a foot drop; and antalgic gait is a limp adopted to avoid pain in a weight-bearing limb. Because of the shuffling, stooped, hypokinetic pattern, this is a Parkinsonian gait.

Correct Answer: Phalen test

The Phalen test involves holding the wrists in forced flexion (backs of hands pressed together) for about 60 seconds; reproduction of numbness or tingling in the median nerve distribution is a positive result suggesting carpal tunnel syndrome. The Tinel sign involves tapping over the median nerve at the wrist, while the McMurray and Lachman tests assess the knee for meniscal and anterior cruciate ligament integrity. Because the wrist-flexion maneuver is described, this is the Phalen test.

Correct Answer: The anterior cruciate ligament

Pulling the tibia anteriorly while stabilizing the femur, as in the anterior drawer or Lachman test, assesses the integrity of the anterior cruciate ligament; excessive forward movement suggests a tear. The menisci are evaluated with the McMurray test, the patellar tendon is assessed by the patellar reflex and palpation, and the collateral ligaments are tested with varus and valgus stress. Because anterior tibial translation is being measured, the anterior cruciate ligament is the target structure.

Correct Answer: The spinothalamic tract (pain and temperature)

Testing the ability to distinguish sharp from dull stimuli assesses superficial pain sensation, which travels via the spinothalamic tract. The dorsal columns carry proprioception and vibration, tested with position sense and a tuning fork; the corticospinal tract carries voluntary motor commands; and cerebellar pathways govern coordination. Because sharp versus dull discrimination reflects pain sensation, the spinothalamic tract is the pathway being evaluated.

Correct Answer: Vibration sense carried by the dorsal columns

Applying a vibrating tuning fork to a bony prominence and asking when the vibration ceases tests vibration sense, which is carried by the dorsal columns of the spinal cord along with proprioception. Two-point discrimination measures the ability to feel two separate points, pain sensation travels via the spinothalamic tract, and stereognosis is the ability to identify an object by touch. Because vibration perception is being tested, the dorsal column pathway is the correct answer.

Correct Answer: Moro (startle) reflex

The Moro or startle reflex is elicited by a sudden change in head position or a loud noise, producing symmetric extension and abduction of the arms followed by adduction, and it is normally present in infants until about 4 to 6 months of age. The rooting reflex is turning the head toward a cheek stimulus, the tonic neck reflex is the fencing posture with head rotation, and the Babinski is a plantar response. Because of the described startle pattern, the Moro reflex is correct. Note that the Moro reflex normally disappears by about 4 months, so persistence beyond that warrants evaluation.

Correct Answer: Asking open-ended questions about the patient's health beliefs and practices without judgment

Cultural competence involves recognizing each patient as an individual and asking open-ended, nonjudgmental questions to understand their unique health beliefs and practices rather than making assumptions. Stereotyping based on ethnic group, dismissing traditional practices, or routinely using family members as interpreters (which risks inaccuracy and breaches of confidentiality) all undermine culturally sensitive care. Because eliciting the patient's own perspective respectfully is central to cultural competence, asking open-ended questions is the best action.

Correct Answer: Slowed reaction time and slightly diminished deep tendon reflexes

Normal aging is commonly associated with slowed reaction and processing time and a mild, symmetric reduction in deep tendon reflexes, often with ankle reflexes being the first to diminish. Acute confusion over hours suggests delirium, unilateral facial droop with slurred speech suggests a stroke, and a positive Babinski sign in an adult indicates an upper motor neuron lesion. Because slowed reactions and mildly reduced reflexes are expected with age, that finding represents a normal change.

Correct Answer: Age-related decreases in muscle mass, joint cartilage, and elasticity of connective tissue

With normal aging, muscle mass and strength decline (sarcopenia), joint cartilage thins, and connective tissue loses elasticity, all of which reduce range of motion and slow movement, commonly producing mild stiffness without acute inflammation. Acute inflammation, systemic infection, or fracture would typically present with pain, swelling, warmth, or trauma history. Because the changes are gradual and painless, they reflect expected age-related musculoskeletal changes rather than pathology.

Correct Answer: Flight of ideas

Flight of ideas is a thought-process abnormality in which the patient rapidly shifts from one topic to another, often with loose or superficial connections, making the conversation hard to follow; it is frequently seen in mania. Confabulation is the fabrication of events to fill memory gaps, perseveration is the repetition of a word or idea, and concrete thinking is literal interpretation. Because the patient rapidly moves between unrelated topics, flight of ideas is the correct term.