S2_L2: Examination of the TMJ and Cervical Spine

Question 1

match the MUSCLE PRODUCING MOVEMENTS
(can have multiple answers)

1. Depression
2. Elevation
3. Protrusion
4. Retraction

A. lateral pterygoid
B. masseter
C. temporalis
D. posterior fibres of temporalis
E. medial pterygoid

Answer 1

1. A
2. B, C, E
3. A, E
4. D

Question 2

modified T/F

Lateral or side to side movement uses the CL lateral pterygoid & IPSI medial pterygoid

Right lateral deviation uses the left lateral pterygoid and right medial pterygoid.

Answer 2

TT

Question 3

which of the ff are true about TMJ/jaw joint

A. synovial joint that allows the complex movement necessary for life (eating, sucking, drinking)

B. Joint between condylar head of the mandible & mandibular fossa of the temporal bone

C. This system is made up of the TMJ, teeth, & soft tissue & plays a role in breathing, eating & speech

D. All of the above

Answer 3

D.

Question 4

which of the ff are part of the CLINICAL EXAMINATION OF TMJ, EXCEPT:

A. Symmetry of the face should be recorded

B. Look for any deviation of mandible

C. The maximum interincisal opening of mouth should determined

D. Lateral mandibular ROM is determined by asking the patient to
occlude the teeth and then slide the jaw in both directions (normal = 10mm)

E. None of the above

Answer 4

E

Question 5

modified T/F

Pretragus palpation is where the patient is requested to slowly open and close the mouth while doctor bilaterally palpates pretragus depression with index fingers.

Intra-auricular palpation is done by inserting small finger into ear canal and pressing anteriorly to detect tenderness, clicking and crepitus.

Answer 5

TT

Question 6

the ff are the correct, EXCEPT:

A. Opening mouth is between 40-50mm

B. Protrusion/retraction between
8-10mm

C. Lateral deviation while opening
(S or C curve)

D. Lateral excursion of mouth (8-10mm)

E. None of the above

Answer 6

E

Question 7

which of the ff are Causes for TMJ disorders

A. Opening the mouth too wide (common)

B. Bruxism - grinding of teeth caused by stress which can be a congenital problem

C. Malocclusion - teeth is no longer aligned/complete

D. All of the above

Answer 7

D

Question 8

the ff are Causes for TMJ disorders, EXCEPT:

A. Stress- Both physical and psychological stress can produce abnormal pressure on the TMJ disc causing TMJ disorders.

B. Trauma - Any injury that results in bleeding into the joints can even cause
Ankylosis of the jaw.

C. Arthritis / Hypermobility in older people

D. None of the above

Answer 8

D

Question 9

match if primary/secondary sx

1. Pain in the joints associated with jaw movements.
2. Frequent headaches
3. Limited range of vertical mouth opening
4. Dizziness, disorientation
5. Noises in the joints associated with jaw movements (clicking, snapping,
   crunching, etc.)

A. PRIMARY SYMPTOMS
B. SECONDARY SYMPTOMS

Answer 9

1. A
2. B
3. A
4. B
5. A

Question 10

match if primary/secondary sx

1. Earaches
2. Intermittent “locking” episodes.
3. Neck/shoulder pain
4. Facial pain and muscle fatigue
5. Sensitive teeth
6. Depression

A. PRIMARY SYMPTOMS
B. SECONDARY SYMPTOMS

Answer 10

1. B
2. A
3. B
4. A
5. B
6. B

Question 11

modified T/F

The cervicoencephalic or cranioverterbral , the upper cervical
spine consisting of C1 and C2 vertebrae.

The cervicobrachial , the lower cervical spine consisting of C3 to C7 vertebrae.

Answer 11

TT

Question 12

the ff are part of the 5 Ds, EXCEPT:

1. Dizziness
2. Dysarthria (difficulty talking)
3. Dysphagia (difficulty swallowing)
4. Diplopia (double vision)
5. Drop attack
6. Dyspareunia

Answer 12

6. Dyspareunia

Question 13

The injuries in the cervicoencephalic area have the following signs an
symptoms, EXCEPT:

A. Headache & Irritability

B. Fatigue & Vertigo

C. Poor concentration

D. Hypertonia of sympathetic nervous system

E. None of the above

Answer 13

E

Question 14

Which of the ff symptoms related to vertebral artery included

A. Vertigo & Nausea

B. Tinnitus & Visual disturbances

C. Drop attacks (falling without fainting)

D. Stroke & Death (rare)

E. All of the above

Answer 14

E

Question 15

T/F

Pathology in the lower cervical spine leads to: Neck/Arm pain, Headaches, Restricted ROM, Paraesthesia, Radicular signs

Answer 15

T

Question 16

which of the ff are active movements of the cervical spine

A. Flexion/Extension

B. Side flexion & Rotation towards left and right

C. Combined & Repetitive movements

D. Sustained positions

E. All of the above

Answer 16

E

Question 17

which of the ff are the passive movements and its normal end feel

A. Flexion –tissue stretch

B. Extension – tissue stretch

C. Side flexion right and left – tissue stretch

D. Rotation right and left – tissue stretch

E. All of the above

Answer 17

E.

Question 18

which of the ff are in their correct DTR

A. Biceps reflex (C5-C6)

B. Brachioradialis reflex(C5-C6)

C. Triceps reflex(C7-C8)

D. Jaw Jerk ( Cranial nerve V)

E. All of the above

Answer 18

E

Question 19

match the ff myotome

1. Neck Flexion
2. Neck side flexion
3. Shoulder elevation
4. Shoulder abduction / shoulder lateral rotation

A. C1-C2
B. C3 and CN 9
C. C4 and CN 9
D. C5

Answer 19

1. A
2. B
3. C
4. D

Question 20

match the ff myotome

1. Elbow flexion and / or wrist extension
2. Elbow extension and / or wrist flexion
3. Thumb extension and / or ulnar deviation
4. Abduction and / or adduction of hand intrinsics

A. C6
B. C7
C. C8
D. T1

Answer 20

1. A
2. B
3. C
4. D

Question 21

match the ff special test

1. Involves much more extension
2. Press on the head in neutral, in extension & rotation, (+) if with pain & sx of nerve root compression
3. Decompress through lifting head
4. AKA bakody sign
5. Tapping on the site & watch for sx or sensitivity

A. Spurling’s test
B. Maximum Cervical Compression Test
C. Distraction Test
D. Shoulder Abduction (Relief) Test
E. Tinel’s Sign

Answer 21

1. B
2. A
3. C
4. D
5. E

Question 22

modified T/F

Bikele’s Sign is where the pt abducts shoulders moving towards Sh horizontal abduction then straighten arm & move toward supination.

It tests the sensitivity of brachial plexus & (+) means neurologic signs of brachial plexus problems

Answer 22

TT

Question 23

modified T/F

Brachial Plexus Tension Test is when pt is asked to raise both hands up & move towards the head by flexing the elbow

(+) means a neurologic sign of tension on brachial plexus

Answer 23

TT

Question 24

match the ULTT
(can have multiple answers)

Shoulder
1. depression & abduction (10-90°), hand to ear

2. depression & abduction (10°)
3. depression & abduction (110°)

Elbow
4. Flexion

5. Extension

A. ULTT1
B. ULTT2
C. ULTT3
D. ULTT4

Answer 24

1. D
2. B,C
3. A
4. D
5. A,B,C

Question 25

match the ULTT (can have multiple answers) forearm 1. supination 2. pronation fingers & thumb 3. flexion 4. extension Cervical spine 5. contralateral side flexion A. ULTT1 B. ULTT2 C. ULTT3 D. ULTT4

Answer 25

1. A,B,D 2. C 3. C 4. A,B,D 5. ALL

Question 26

match the ULTT (can have multiple answers) nerve bias 1. median nerve, anterior interosseous nerve, C5-C7 2. radial nerve 3. ulnar nerve, C8 & T1 nerve roots 4. median, musculocutaneous, axillary nerve shoulder 5. lateral rotation 6. medial rotation A. ULTT1 B. ULTT2 C. ULTT3 D. ULTT4

Answer 26

1. A 2. C 3. D 4. B 5. B,D 6. C

Question 27

modified T/F on Tests for Upper Motor Neuron Lesion (Cervical Myelopathy) Romberg’s Test is where you ask the pt to stand on both leg & close eyes/ ask pt to stand on one leg to test for balance & proprioception Lhermitte’s Sign is when you passively chin tuck & lift 1 leg up of the pt & (+) if there's shooting pain on spine which is a test for the irritation mainly of the dura

Answer 27

TT

Question 28

modified T/F Tests for Vascular Signs (Vascular “Clearing” Tests) are Vertebral Artery (Cervical Quadrant) Test & Naffziger’s Test Naffziger’s Test is where you compress on the scalene & see if pt would have some form of vascular clearing sx like dizziness, nausea, headache

Answer 28

TT

Question 29

modified T/F Tests for Vertigo and Dizziness are Temperature (Calorie) Test & Dizziness Test Dizziness test is when you place heat on one of the mastoids & see if pt gets dizzy

Answer 29

TF Temperature test is when you place heat on one of the mastoids & see if pt gets dizzy

Question 30

which of the ff are Signs and symptoms of cervical instability A. Severe muscle spasm B. Patient does not want to move head (esp. into flexion) C. Lump in throat D. Lip or facial paraesthesia E. All of the above

Answer 30

E.

Question 31

which of the ff are Signs and symptoms of cervical instability A. Severe headache & Dizziness B. Vomiting & Nausea C. Soft end Feel D. Nystagmus & Pupil changes E. All of the above

Answer 31

E

Question 32

which of the ff are tests for cervical instability A. Pettman’s Distraction Test B. Sharp – Purser Test C. Anterior Shear or Sagittal Stress Test D. Lateral Flexion Alar ligament Stress Test E. All of the above

Answer 32

E.

Question 33

modified T/F Roos Test is when pt tries to abduct & depress shoulder/scapula then opens & closes the hand, (+) sign if pt can't tolerate position for a long time due to the compression of the thoracic outlet Adson Maneuver is when pt is asked to extend 1 arm & PT would hold on the pt's pulse, (+) sign if there's diminishing pulse

Answer 33

TT

Question 34

match the ff on where they're palpated 1. Facet joints of cervical vertebrae 2. Mastoid process 3. Temporomandibular joints 4. Mandible 5. Supraclavicular Fossa A. Anterior B. Posterior C. Lateral

Answer 34

1. B 2. B 3. C 4. C 5. A

Question 35

match the ff on where they're palpated 1. Paranasal sinuses 2. First three ribs 3. External occipital protuberance 4. Spinous processes 5. Carotid Arteries A. Anterior B. Posterior C. Lateral

Answer 35

1. A 2. A 3. B 4. B 5. C

Question 36

match the ff on where they're palpated 1. Transverse processes of cervical vertebrae 2. Lymph nodes 3. Hyoid bone 4. Thyroid cartilage 5. First cricoids ring A. Anterior B. Posterior C. Lateral

Answer 36

1. C 2. C 3. A 4. A 5. A