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Anatomy |! NBME-Clinical |! Correlates |!
Exam |! with |! precise |! |! answers
Where |! does |! the |! spinal |! cord |! end? |! - |! Correct |! answer |! ✔L2- |! Adults L3-Kids Where |! is |! a |! needle |! inserted |! for |! a |! lumbar |! puncture? |! - |! Correct |! answer |! ✔L3/L4 |! or |! L4/L5 |! at |! the |! level |! of |! the |! horizontal |! line |! through |! upper |! points |! of |! iliac |! crests |! (supracristal |! plane |! LV4) As |! you |! are |! doing |! a |! lumbar |! puncture, |! what |! is |! the |! needle |! passing |! through |! from |! superficial |! to |! deep? |! - |! Correct |! answer |! ✔Skin--> |! Fat--> |! Supraspinous |! Ligament--> |! Interspinous |! Ligament--> |! Ligamentum |! Flava--> |! Epidural |! Fat |! + |! Veins--> |! Dura--> |! Subarachnoid |! space Where |! does |! the |! dural |! sac |! end |! caudally? |! - |! Correct |! answer |! ✔S Where |! does |! herniation |! of |! the |! disc |! typically |! occur? |! - |! Correct |! answer |! ✔Lumbar: |! L4/L5 |! or |! L5/S Cervical: |! C5/C6 |! or |! C6/C7 |! (ppl |! under |! 50) Symptoms |! of |! a |! herniated |! intervertebral |! disc? |! - |! Correct |! answer |! ✔Back |! pain |! that |! radiates |! down |! to |! lower |! limb
Pain |! begins |! after |! lifting |! something |! heavy T |! or |! F: |! Herniated |! lumbar |! disc |! compresses |! the |! nerve |! root |! one |! number |! ABOVE |! - |! Correct |! answer |! ✔FALSE: |! A |! herniated |! lumbar |! disc |! compresses |! the |! nerve |! root |! BELOW Ex: |! Herniation |! of |! L4/L5 |! compresses |! the |! L5 |! nerve |! root T |! or |! F: |! Lower |! limb |! reflexes |! are |! decreased |! on |! the |! side |! of |! a |! herniated |! disc |! - |! Correct |! answer |! ✔TRUE ex: |! Patellar |! reflex |! will |! be |! affected |! with |! herniation |! of |! IV |! discs |! L2/L3 |! or |! L3/L Achilles |! reflex |! affected |! by |! herniation |! of |! L5/S What |! is |! Kyphosis? |! - |! Correct |! answer |! ✔Exaggerated |! thoracic |! curvature |! (concave |! anterior) Ex: |! Hunchback |! of |! Notre |! Dame! Kyphosis |! can |! cause |! what |! dx? |! - |! Correct |! answer |! ✔Osteoporosis |! in |! the |! elderly -multiple |! compression |! fracture |! of |! vertebral |! bodies)
Medial |! Epicondyle -Ulnar |! N What |! is |! the |! most |! common |! fracture |! of |! the |! forearm? |! - |! Correct |! answer |! ✔Transverse |! fracture |! within |! the |! distal |! 2cm |! of |! the |! radius Most |! common |! after |! age |! 50 What |! is |! Smith's |! Fracture? |! - |! Correct |! answer |! ✔Results |! from |! a |! fall |! or |! blow |! on |! the |! dorsal |! aspect |! of |! the |! flexed |! wrist Produces |! ventral |! angulation |! of |! the |! wrist Distal |! fragment |! of |! the |! radius |! is |! ANTERIORLY |! displaced What |! is |! Colle's |! Fracture? |! - |! Correct |! answer |! ✔Results |! from |! forced |! extension |! of |! the |! hand, |! usually |! as |! a |! result |! of |! trying |! to |! ease |! a |! fall |! by |! outstretching |! the |! upper |! limb Dorsally- |! "dinner |! fork |! deformity" |! The |! ulnar |! styloid |! process |! is |! broken |! off OUCH! What |! is |! a |! scaphoid |! fracture? |! - |! Correct |! answer |! ✔Results |! from |! a |! fall |! onto |! palm |! when |! hand |! is |! abducted Pain |! on |! lateral |! side |! of |! wrist, |! especially |! during |! wrist |! extension |! and |! abduction
Fracture |! may |! not |! show |! on |! X-Ray |! for |! 2-3 |! weeks Deep |! tenderness |! present |! in |! the |! anatomical |! snuffbox Proximity |! fragment |! may |! undergo |! avascular |! necrosis |! since |! blood |! is |! interrupted What |! is |! a |! boxer's |! fracture? |! - |! Correct |! answer |! ✔Neck |! of |! the |! metacarpal |! bones |! are |! fractured |! in |! fistfights Typically, |! fractures |! of |! 2nd |! and |! 3rd |! metacarpals |! in |! professional |! boxers Fractures |! of |! 5th |! and |! sometimes |! 4th |! metacarpals |! in |! unskilled |! fighters What |! is |! Mallet/Baseball |! Finger? |! - |! Correct |! answer |! ✔Due |! to |! DIP |! joint |! forced |! into |! hyperflexion Ex: |! When |! baseball |! is |! miscaught |! or |! a |! finger |! is |! jammed |! into |! a |! base |! pad Causes |! avulsion |! of |! the |! attachment |! of |! the |! extensor |! digitorum |! tendon |! to |! the |! base |! of |! the |! distal |! phalynx--> |! person |! can't |! extend |! the |! DIP |! joint What |! are |! the |! rotator |! cuff |! muscles |! and |! what |! do |! they |! do? |! - |! Correct |! answer |! ✔SITS Supraspinatus Infraspinatus
What |! is |! subacromial |! bursitis? |! - |! Correct |! answer |! ✔Inflammation |! of |! the |! subacromial |! bursa |! due |! to |! calcific |! supraspinatus |! tendinitis Causes |! a |! painful |! arc |! of |! abduction Subacromial |! bursitis |! shares |! the |! same |! symptoms |! as |! what? |! - |! Correct |! answer |! ✔Inflammation |! of |! trauma |! of |! Supraspinatus |! tendon (Causes |! painful |! arc |! of |! abduction) What |! is |! student's |! elbow? |! - |! Correct |! answer |! ✔AKA |! Subcutaneous |! Olecranon |! Bursitis Olecranon |! bursa |! separated |! the |! olecranon |! from |! the |! skin. Repeated |! excessive |! pressure |! and |! friction |! may |! cause |! bursa |! to |! be |! inflammed What |! is |! tennis |! elbow/lateral |! epicondylitis? |! - |! Correct |! answer |! ✔Due |! to |! repeated |! flexion |! and |! extension |! of |! wrist |! (backhand |! anyone?) Results |! in |! the |! strain |! of |! the |! common |! EXTENSOR |! tendon |! and |! inflammation |! of |! the |! lateral |! epicaondyle Pain |! is |! felt |! over |! the |! lateral |! epicondyle |! and |! radiates |! down |! to |! posterior |! aspect |! of |! forearm
Pain |! is |! felt |! when |! opening |! a |! door |! or |! lifting |! a |! glass What |! muscles |! are |! affected |! in |! tennis |! elbow/lateral |! epicondylitis? |! - |! Correct |! answer |! ✔Extensor |! Carpi |! Radialis |! Longus |! & |! Brevis Extensor |! Digitorum Extensor |! Digiti |! Minimi Extensor |! Carpi |! Ulnaris What |! is |! medial |! epicondylitis/golfer's |! elbow? |! - |! Correct |! answer |! ✔AKA |! Golfer's |! Elbow Inflammation |! of |! the |! common |! FLEXOR |! tendon |! where |! it |! originates |! on |! the |! medial |! epicondyle |! of |! the |! humerus What |! muscles |! are |! affected |! in |! medial |! epicondylitis? |! - |! Correct |! answer |! ✔Pronator |! Teres Flexor |! Carpi |! Radialis Palmaris |! Longus Flexor |! Carpi |! Ulnaris What |! arteries |! contrbute |! to |! the |! anastomoses |! around |! the |! scapula? |! - |! Correct |! answer |! ✔Blockage |! of |! the |! subclavian |! or |! axillary |! artery |! can |! be |! bypassed |! by |! anastamoses |! between |! branches |! of |! the |! Thyrocervical |! and |! Subscapular |! arteries:
What |! is |! carpal |! tunnel |! syndrome? |! - |! Correct |! answer |! ✔Results |! from |! a |! lesion |! that |! reduces |! the |! size |! of |! the |! carpal |! tunnel |! (infection. |! fluid |! retention, |! dislocation |! of |! lunate |! bone) Median |! nerve |! is |! most |! affected Results |! in: -Pins |! and |! needles |! of |! the |! lateral |! 3.5 |! digits |! (because |! 1/2 |! LOAF) -Palm |! sensation |! is |! NOT |! affected |! because |! superficial |! palmar |! cutaneous |! branch |! passes |! superficial |! to |! the |! tunnel -Apehand |! deformity= |! absence |! of |! opposition |! o |! thumb What |! muscles |! attach |! to |! the |! proximal |! and |! distal |! interphalangeal |! joints? |! How |! do |! you |! test |! the |! FDP? |! - |! Correct |! answer |! ✔FDS |! flexes |! PIP FDP |! flexes |! DIP--to |! test, |! stabilize |! in |! extension |! the |! PIP |! joint |! so |! now |! you |! can |! isolate |! the |! flexion |! of |! the |! DIP What |! is |! Upper |! Brachial |! Palsy? |! - |! Correct |! answer |! ✔Injury |! of |! upper |! roots |! and |! trunk Results |! from |! excessive |! increase |! in |! the |! angle |! between |! the |! neck |! and |! shoulder |! Affects |! C5 |! and |! C6 |! roots |! of |! superior |! trunk May |! occur |! from |! birth |! injury |! from |! forceful |! pulling |! of |! head
What |! is |! Erb-Duchenne |! Palsy? |! - |! Correct |! answer |! ✔AKA |! Upper |! Brachial |! Palsy Paralysis |! of |! the |! muscles |! of |! the |! shoulder |! and |! arm |! supplied |! by |! C5 |! and |! C6 |! (upper |! trunk |! of |! brachial |! plexus) Combo |! lesions |! of |! axillary, |! suprascapular |! and |! musculocutaneous |! nerves |! with |! loss |! of |! the |! shoulder |! and |! anterior |! arm |! muscles Results |! in |! "waiter's |! tip" |! hand: -Adducted |! shoulder -Medially |! rotated |! arm -Extended |! elbow -Loss |! of |! sensation |! in |! lateral |! aspect |! of |! upper |! limb What |! is |! lower |! brachial |! palsy? |! - |! Correct |! answer |! ✔AKA |! Klumpke |! Paralysis Injury |! of |! LOWER |! roots |! and |! trunk |! of |! brachial |! plexus |! (C8 |! and |! T1 |! roots |! or |! inferior |! trunk) May |! occur |! when |! upper |! limb |! is |! suddenly |! pulled |! superiorly |! i.e. |! when |! falling |! or |! thoracic |! outlet |! syndrome |! at |! birth What |! specific |! symptoms |! are |! seen |! in |! Lower |! Brachial |! Palsy |! (Klumpke |! Paralysis)? |! - |! Correct |! answer |! ✔ALL |! intrinsic |! muscles |! of |! the |! hand |! are |! supplied |! by |! C8 |! and |! T Get |! a |! combo |! lesion |! of |! ulnar |! n |! (claw |! hand) |! and |! median |! n |! (ape |! hand) Loss |! of |! sensation |! in |! medial |! aspect |! of |! upper |! limb |! + |! medial |! 1.5 |! fingers
-Best |! treatment= |! hip |! replacement What |! is |! avascular |! necrosis |! of |! the |! femoral |! head? |! - |! Correct |! answer |! ✔Transcervical |! fracture |! disrupts |! blood |! supply |! to |! head |! of |! femur |! via |! retinacular |! arteries |! (from |! medial |! circumflex |! femoral |! artery--> |! Avascular |! Necrosis |! of |! Femoral |! Head |! if |! blood |! supply |! through |! the |! ligament |! of |! the |! head |! is |! insufficient How |! can |! the |! sciatic |! nerve |! become |! injured? |! What |! are |! common |! outcomes? |! - |! Correct |! answer |! ✔Caused |! by |! improper |! placement |! of |! gluteal |! injection |! or |! posterior |! hip |! dislocation Results |! in: Weakened |! hip |! extension |! and |! knee |! flexion Footdrop |! (lack |! of |! dorsiflexion) Flail |! foot |! (lack |! of |! both |! dorsiflexion |! and |! plantar |! flexion) What |! is |! a |! posterior |! hip |! dislocation? |! - |! Correct |! answer |! ✔Most |! common |! and |! occur |! in |! head |! on |! collisions |! causing |! the |! knee |! to |! hit |! the |! dashboard |! and |! dislocate |! the |! hip |! when |! the |! femoral |! head |! is |! forced |! out |! of |! the |! acetabulum Joint |! capsule |! ruptures |! inferiority |! and |! posteriorly |! (fracture |! of |! ischium). |! Head |! of |! femur |! passes |! through |! and |! enters |! capsule |! (tearing |! of |! ischiofemoral |! ligament) |! and |! over |! the |! posterior |! margin |! of |! the |! acetabulum |! onto |! the |! lateral |! surface |! of |! the |! ilium, |! shortening |! and |! medial |! rotating |! the |! limb
How |! does |! a |! superior |! gluteal |! nerve |! injury |! occur |! and |! what |! are |! the |! symptoms? |! - |! Correct |! answer |! ✔Injured |! during |! surgery, |! posterior |! dislocation |! of |! the |! hip |! or |! poliomyelitis Causes |! paralysis |! of |! the |! gluteus |! medius |! and |! minimus= |! inability |! to |! pull |! the |! pelvis |! up |! and |! abduct |! the |! thigh What |! is |! Trandelenburg |! sign |! and |! how |! is |! it |! tested? |! - |! Correct |! answer |! ✔Used |! for |! confirmation |! of |! superior |! gluteal |! nerve |! injury If |! injured |! on |! R |! side, |! the |! L |! pelvis |! falls |! downward |! when |! raising |! the |! L |! foot |! off |! the |! ground The |! side |! is |! contralateral |! to |! nerve |! injury What |! happens |! in |! injury |! of |! the |! inferior |! gluteal |! nerve? |! What |! causes |! it? |! - |! Correct |! answer |! ✔Weakened |! hip |! extension |! (gluteus |! maximus)--most |! noticeable |! when |! climbing |! stairs |! or |! standing |! from |! seated |! position Cause: |! posterior |! hip |! dislocation, |! or |! surgery |! in |! this |! area What |! causes |! injury |! to |! the |! obturator |! nerve? |! What |! are |! the |! outcomes? |! - |! Correct |! answer |! ✔Cause: |! Anterior |! hip |! dislocation, |! radical |! retropubic |! prostatectomia Results |! in: Difficulty |! adducting |! thigh |! (i.e. |! crossing |! legs) Decreased |! sensation |! over |! upper |! medial |! thigh
Why |! is |! a |! femoral |! hernia |! dangerous? |! - |! Correct |! answer |! ✔The |! hernial |! sac |! may |! become |! strangulated An |! aberrent |! obturator |! artery |! is |! also |! vulnerable |! during |! surgical |! repair |! of |! the |! hernia What |! is |! the |! Unhappy |! Triad? |! - |! Correct |! answer |! ✔The |! lateral |! side |! of |! the |! knee |! is |! struck |! more |! often Unhappy |! Triad |! of |! athletic |! injuries: Tibial |! (medial) |! Collateral |! Ligament Medial |! meniscus ACL What |! is |! the |! function |! of |! the |! tibial |! (medial) |! collateral |! ligament? |! - |! Correct |! answer |! ✔Limits |! extension |! and |! abduction |! of |! the |! leg |! at |! the |! knee T |! or |! F: |! The |! tibial |! (medial) |! collateral |! ligament |! blends |! with |! the |! capsule |! and |! firmly |! attaches |! to |! the |! medial |! meniscus |! - |! Correct |! answer |! ✔TRUE What |! is |! the |! action |! of |! the |! fibular |! (lateral) |! ligament? |! - |! Correct |! answer |! ✔Limits |! extension |! and |! adduction |! and |! leg |! at |! the |! knee T |! or |! F: |! The |! fibular |! (lateral) |! collateral |! ligament |! blends |! with |! the |! joint |! capsule |! and |! attaches |! to |! the |! lateral |! meniscus |! - |! Correct |! answer |! ✔FALSE
It |! does |! NOT |! blend |! to |! capsule |! or |! attach |! to |! lateral |! menicus What |! test |! is |! performed |! to |! check |! the |! ACL? |! - |! Correct |! answer |! ✔Anterior |! Drawer |! Sign Tibia |! is |! pulled |! forward |! excessively |! on |! femur What |! test |! is |! performed |! to |! check |! the |! PCL? |! - |! Correct |! answer |! ✔Posterior |! Drawer |! Sign Tibia |! is |! pushed |! backward |! excessively |! on |! femur What |! is |! prepatellar |! bursitis? |! - |! Correct |! answer |! ✔The |! prepatellar |! bursa |! between |! the |! superficial |! surface |! of |! patella |! and |! skin |! becomes |! inflammed Where |! are |! intra-articular |! injections |! in |! the |! knee |! administered? |! - |! Correct |! answer |! ✔Suprapatellar |! bursa |! is |! the |! superior |! extension |! of |! synovial |! cavity |! between |! distal |! end |! of |! femur |! and |! quadriceps |! muscle |! and |! tenson The |! knee |! jerk/patellar |! reflex |! tests |! which |! spinal |! nerves? |! - |! Correct |! answer |! ✔L2-L4 |! (Femoral |! N) What |! type |! of |! ankle |! sprain |! is |! most |! common? |! Which |! ligament |! is |! injured? |! - |! Correct |! answer |! ✔Inversion Twisting |! of |! the |! plantarflexed |! foot Lateral |! ligament |! is |! injured
Point |! tenderness |! at |! proximal |! attachment |! of |! plantar |! aponeurosis |! to |! the |! medial |! tubercle |! of |! the |! calcaneus |! and |! on |! the |! medial |! surface |! of |! this |! bone Inability |! to |! stand |! on |! toes |! is |! caused |! by |! what |! nerve |! lesion? |! - |! Correct |! answer |! ✔Tibial |! Nerve |! Injury Tibial |! nerve |! injury |! causes |! what? |! - |! Correct |! answer |! ✔Occurs |! in |! popliteal |! fossa Results |! in: Loss |! of |! plantar |! flexion |! of |! foot |! (mainly |! gastrocnemius |! and |! soleus) Weakened |! inversion |! (tibialis |! posterior) Causes |! calcaneovalgus Inability |! to |! stand |! on |! toes Loss |! of |! sensation |! and |! paralysis |! of |! intrinsic |! muscles |! of |! the |! sole |! of |! the |! foot Contents |! of |! the |! popliteal |! fossa |! (superficial |! to |! deep, |! also |! works |! as |! lateral |! to |! medial): |! - |! Correct |! answer |! ✔Tibial |! N Popliteal |! V Popliteal |! A "North |! Vietnamese |! Army" |! (Lateral |! to |! Medial) What |! are |! the |! 2 |! terminal |! branches |! of |! the |! tibial |! nerve? |! - |! Correct |! answer |! ✔Medial |! plantar |! nerve Lateral |! plantar |! nerve
What |! does |! the |! medial |! plantar |! nerve |! innervate? |! - |! Correct |! answer |! ✔Abductor |! hallucis Flexor |! hallucis |! brevis Flexor |! digitorum |! brevis 1st |! lumbrical Skin |! of |! medial |! 3.5 |! digits What |! does |! the |! lateral |! plantar |! nerve |! innervate? |! - |! Correct |! answer |! ✔ALL |! INTRINSIC |! plantar |! muscles |! which |! aren't |! innervated |! by |! medial |! plantar |! nerve Skin |! of |! lateral |! 1.5 |! digits A |! unique |! clinical |! presentation |! of |! breast |! carcinoma |! is: |! - |! Correct |! answer |! ✔Dimpling |! of |! the |! skin. The |! tumor |! grows |! and |! attaches |! to |! suspension |! (Cooper's) |! ligaments. |! This |! causes |! the |! ligaments |! to |! shorten |! leading |! to |! dimpling |! of |! the |! skin. Describe |! the |! path |! of |! most |! lymph |! drainage |! in |! the |! breast: |! - |! Correct |! answer |! ✔This |! applies |! to |! >75% |! of |! breast |! lymph |! drainage |! (especially |! the |! lateral |! quadrant): Pectoral |! Nodes--> |! Axillary |! Nodes
