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Anatomy
| Question | Answer |
|---|---|
| Anatomical location of Lumbar puncture for CSF collection | Between L3 and L5 |
| Meningeal layer for CSF access | Subarachnoid space (dural sac ends at S2) |
| Anatomical landmarks:for lumbar puncture | •Supraspinous ligament • Interspinous ligament • Ligamentum flavum |
| S1-S2 reflexes | Achilles |
| L3-L4 reflexes | Patellar |
| C5-C6 nerve root | Biceps |
| C7 nerve root | Triceps |
| Old obese patient presents with back pain that radiates down to the lower limb after lifting a box. | Most likely diminishes reflex region is the lumbar (L5 to S1) |
| 80 yo woman with acute onset of compression fracture causes what type of abnormal curvature? | Kyphosis of Thoracic Spine |
| 9 month pregnant female or an obese man present with what abnormal curvature? | Lordosis of Lumbar Spine |
| Pt is unable to move his arms up to his sides and has a flattened deltoid? | • Axillary nerve • Location: surgical neck of the humerus • Mechanism: anterior humerus dislocation |
| A patient is unable to extend hand with resistance, unable to grip appropriately? What nerve is affected? | Radial nerve • Location: midshaft fracture of the humerus • Other vignettes --> crutches, drunk-arm over-chair • Mechanism: compression of axilla, loss of sensation on dorsal hand |
| Pt has paresthesia and loss of sensation in the medial portion of the hand? | • Ulnar nerve • Location: fracture of medial epicondyle of humerus • Think: ‘funny bone’ |
| Surgical neck of humerus fracture or dislocation of humeral head. Which nerve affected? | Axillary (C5 and C6) |
| Midshaft of humerus fracture or Drunk pt or pt with crutches now has wrist drop. What nerve affected | Radial (C5 to T1) |
| Pt present with decreased grip strength and loss of sensation to posterior hand. What nerve affected? | Radial (C5 to T1) |
| Proximal: supracondylar humerus fracture | Median (C6-C8, T1) |
| Distal: Carpal tunnel or thenar eminence | Median (C6-C8, T1) |
| Distal: hook of hamate Hypothenar eminence FOSH fracture | Ulnar (C8, T1) |
| Proximal: medial epicondyle fracture | Ulnar (C8, T1) |
| Distal radius fractures | • Smith's fracture • Colles fracture |
| Smith fracture | Get dorsally hit at the wrist &Fragment gets displaced anteriorly |
| Colles Fracture | Get hit ventrally at the wrist when it is extended Buzz word is dinner fork • “Curved forearm” |
| Carpal fractures | •• Scaphoid: USMLE clues: • Tenderness in the anatomic snuff box • X-ray clear, however patient at risk for avascular necrosis •• Hamate: USMLE clues: • Ulnar nerve damage |
| Forearm fractures: | Radial head fracture |
| A child is on the playground and falls. He is holding his arm in an inferolateral placement. What is the likely diagnosis? | Clavicle Fracture |
| How many degrees of abduction is the supraspinatus muscle responsible for? | 0 to 15 degrees. |
| Supraspinatus muscle • What is the likely innervation? | Suprascapular nerve |
| 15 - 90 degrees abduction | Deltoid |
| 90 - 180 degrees | • Trapezius • Serratus anterior |
| A painter has increased pain when lifting his arm above his head. He has pain underneath the acromion. | Subacromial bursitis |
| Pt has left elbow swelling for the past few months. The swelling was worsened and became more painful. He has redness near his elbow. No fever. Elbow is tender to palpation. What is the likely diagnosis? | Olecranon bursitis |
| Pt plays tennis and it hurts when he is opening a door. | Lateral elbow / extensor tendon • Tennis elbow • Common extensor tendon. |
| Medial epicondyle pain | Medial flexor elbow • Golf elbow • Common flexor tendon |
| A child is in the park. He is playing and is noted to have trauma after he was pulled up by the arm by his family member to avoid oncoming traffic. What is the likely diagnosis? | Nursemaid’s elbow • Annular ligament tear at the radial neck |
| A patient presents after getting cut by an electrical saw. He is noted to have an injury to the brachial artery at the cubital fossa. What is the structure medial to the affected brachial artery? | Median nerve |
| Contents of the cubital fossa: | Lateral to medial: • Biceps brachii tendon • Brachial artery • Median nerve |
| Secretary who feels numb in her fingers mostly at night? • What is the diagnosis? • What nerve is compressed? • Where is she going to have paresthesia? | • Dx: Carpal tunnel syndrome • Nerve affected: Median • Lateral 3.5 digits is going to have paresthesia |
| A cyclist presents with numbness and tingling in the hand. He is noted to be unable to grip a piece of paper between his thumb and pinky. PE shows numbness in his medial 2 fingers. What is the likely affected structure? | Ulnar nerve |
| Compression of the ulnar nerve at the wrist relate to which bony structure? | • Hook of the hamate. |
| Excessive angle between neck & shoulder • Birth injury | • Erb Duchenne palsy • C5-C6 |
| Erb Duchenne Palsy | • C5-C6 Muscles affected • Deltoid • Infraspinatus • Biceps brachii |
| How is the waiter’s tip described? | Erb Duchenne Palsy • Adducted • Medially rotation • Extended and Pronated |
| Klumpke’s Paralysis | • What is the nerve plexus? --> C8-T1 Muscles affected? • Lumbricals • Interosseus • Thenar |
| How is the lesion Klumpke's Paralysis described? | • Ape hand • Claw hand • Horner’s syndrome |
| A 25 yo F presents with L arm pain. She says that after she cooks, she has decreased mobility of her L arm, and her extremity is pale and cool to the touch. She has been a non- smoker and has a normal lipid profile. What is the likely diagnosis? | Thoracic outlet syndrome |
| A patient is unable to abduct the arm above the horizontal. When pressing on the wall, a protrusion from the posterior mid back is noted. Which muscle is likely implicated? | • Long thoracic nerve --> serratus anterior. • Common vignettes: Stab wounds, axillary node dissection after mastectomy. |
| A patient has a STEMI with troponin elevation. He is emergently taken to the cath lab for PCI. What is the path of cannulation from the femoral artery? | • Femoral artery à external iliac à common iliac à aorta à coronary artery |
| Cardiac Catheterization • A patient has a STEMI with troponin elevation. He is emergently taken to the cath lab for PCI. What is the path of cannulation from the femoral artery? | • Femoral artery --> external iliac --> common iliac --> aorta --> coronary artery |
| • An elderly female presents after a fall in the nursing hope. She is noted to have pain in the groin area, and on exam her left femur is shorter than her right, and is laterally rotated. What is the likely diagnosis? | • Femoral neck fracture. |
| • What is the likely vascular complication if femoral neck fracture left untreated? | • Disruption of the medial circumflex femoral artery --> avascular necrosis. |
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