Blue Boxes

Question 1

bicipital myotatic reflex

Answer 1

deep tendon reflex routinely tested
patient has relaxed limb passively pronated and partially extended at elbow
examiner’s thumb placed at biceps tendon
reflex hammer tapped on base of nail bed
normal (+) response = involuntary contraction of biceps
confirms integrity of musculocutaneous nerve and C6 and C6 spinal cord segments
abnormal (-) response = excessive, diminished, or prolonged response possibly indicating CNS or PNS disease or metabolic disorders (thyroid disease)

Question 2

biceps tendinitis

Answer 2

inflammation of tendon of long head of biceps resulting from microtears when the musculotendinous unit is acutely loaded and associated with degeneration of tendon, vascular disruption, and inflammatory repair response
result of: repetitive microtrauma (throwing, raquet sports)
symptoms: shoulder pain
exam: tenderness and crepitus (crackling)

Question 3

biceps tendinosis

Answer 3

degeneration within the tendon’s collagen causing disorganization of collagen in response to poor vascularization, chronic overuse, or aging
NO INFLAMMATORY RESPONSE
result of: repetitive microtrauma (throwing, raquet sports)
symptoms: shoulder pain
exam: tenderness and crepitus (crackling)

Question 4

dislocation of tendon of long head of biceps brachii

Answer 4

causes pain, sensation of popping or catching felt during arm rotation
dislocation from the intertubercular sulcus in the humerus
young people during traumatic separation of the proximal epiphysis of the humerus
older people with history of biceps tendinitis

Question 5

rupture of tendon of long head of biceps brachii

Answer 5

caused by wear and tear of inflamed tendon as it moves back and forth in the intertubercular sulcus of the humerus (forceful flexion or prolonged tendonitis)
repetitive overhead motion (swimmers, baseball pitchers)
usually >35 yo
traumatic rupture associated with a snap or pop
muscle forms ball in anterior distal arm (popeye deformity)

Question 6

interruption of blood flow in brachial artery

Answer 6

measures blood pressure
hemostasis during surgery - medial to humerus because arterial anatomoses around elbow. provide collateral circulation.
sudden complete occlusion or laceration of brachial artery creates surgical emergency because paralysis of muscles results from ischemia of elbow and forearm within a few hours (up to 6 hours)

Question 7

ischemic compartment syndrome

Answer 7

caused by occlusion or laceration to brachial artery after 6 hours. fibrous scar tissue replaces necrotic tissue and causes involved muscles to shorten permanently, producing flexion deformity.
loss of hand power.

Question 8

midhumeral fracture

Answer 8

may injure radial nerve in radial groove of humeral shaft. Not likely to paralyze triceps because of the high origin of the nerves to two of three heads.

Question 9

supra-epicondylar fracture

Answer 9

fracture of the distal part of the humerus near the supra-epicondylar ridges. bone may be displaced anteriorly or posteriorly. muscles pull distal over proximal fragments, shortening limb. may cause nerve or brachial vessel damage.

Question 10

injury to musculocutaneous nerve

Answer 10

usually inflicted by a knife
causes paralysis of the coracobrachialis, biceps brachii, and brachialis.
weak flexion at flenohumeral joint. flexion of elbow joint and supination of forearm are weakened, but not lost.
loss of sensation on the lateral surface of forearm supplied by lateral cutaneous nerve of forearm.

Question 11

injury to radial nerve

Answer 11

causes paralysis of triceps, brachioradialis, supinator, and extensor muscles of wrist and fingers.
loss of sensation in skin.
exam: wrist drop

Question 12

venipuncture in cubital fossa

Answer 12

select median cubital vein from cephalic vein to basilic vein

Question 13

vertebral body osteoporosis

Answer 13

common metabolic bone disease detected during routine radiographic studies
net demineralization of the bones caused by a disruption of the normal balance of calcium deposition and resorption
quality of bone is reduced and atrophy of skeletal tissue occurs
most affected areas: neck of the femur, bodies of vertebrae, metacarpals, and radius
early: diminished radiodensity of trabecular bone of vertebral bodies causing thinned cortical bone to appear prominent
late stage: compression fractures and increased thoracic kyphosis

Question 14

laminectomy

Answer 14

surgical excision of one or more spinous processes and the adjacent supporting vertebral laminae
done to gain access to the vertebral canal for exposure to spinal cord or roots of spinal nerves
purpose: relieve pressure on the spinal cord or nerve roots caused by tumor, herniated disc, or bony hypertrophy

Question 15

dislocation of cervical vertebrae

Answer 15

requires less force than fracture
slight dislocation without damaging spinal cord
severe dislocations or fracture dislocations can injure spinal cord
“facet jumping” (locking of displaced articular process) will not self-reduce

Question 16

jefferson (burst) fracture

Answer 16

fracture of atlas (C1)
caused by vertical compressing forces (hitting head on the bottom of pool)
dimension of bony ring increases
rupture of transverse ligament may cause spinal cord injury

Question 17

hangman’s fracture

Answer 17

40% of cervical vertebral injuries
usually in bony column formed by the superior and inferior articular processes of the axis
AKA traumatic spondylolysis of C2
caused from hyperextension of the head on the neck
results in quadriplegia or death

Question 18

whiplash injury

Answer 18

hyperextension of the head and neck

Question 19

fractures of the dens

Answer 19

common axis injury (40-50%)

results from horizontal blow to the head or from complication of osteopenia

Question 20

lumbar spinal stenosis

Answer 20

narrow vertebral foramen in one or more lumbar vertebrae
may be hereditary anomaly that makes person more vulnerable to age-related degenerative changes
treatment: decompressive laminectomy

Question 21

cervical rib

Answer 21

common anomaly in 1-2% of people
rib at C7, normally becomes a small part of transverse process
may cause thoracic outlet syndrome by pressing on subclavian artery or inferior trunk of the brachial plexus

Question 22

caudal epidural anesthesia or analgesia

Answer 22

anesthetic or analgesic agents are injected into the fat of the sacral canal that surrounds the proximal portions of the sacral nerves.
sacral hiatus is located between the sacral cornua and inferior to the S4 spinous process or median sacral crest
sensation lost inferior to the epidural block

Question 23

injury of coccyx

Answer 23

fall on buttocks or childbirth
surgical removal of fractured bone may be required if there is dislocation
may be followed by coccygodynia

Question 24

hemisacralization

Answer 24

L5 is partly incorporated into the sacrum

Question 25

sacralization of the L5 vertebra

Answer 25

L5 is completely incorporated into the sacrum

L5-S1 is strong, L4-L5 degenerates and is painful

Question 26

lumbarization of S1 vertebra

Answer 26

S1 is separated from sacrum and fused with L5 vertebra

Question 27

effect of aging on vertebrae
birth-5yo
5 yo-13 yo
18-25
middle age and older

Answer 27

birth-5yo body of vertebra increases in height threefold
5-13 yo increases 45-50%
18-25 longitudinal growth completed
middle age and older: decrease in bone density and strength. vertebrae concave, IV discs convex.
osteophytes develop

Question 28

spina bifida occulta

Answer 28

neural arches of L5 and/or S1 fail to develop normally and fuse posterior to vertebral canal (24% of population)
small dimple with tuft of hair at lower back

Question 29

spina bifida cystica

Answer 29

one or more vertebral arches may fail to develop completely, associated with meningocele and/or meningomyelocele

Question 30

aging of IV discs

Answer 30

nuclei pulposi dehydrate and lose elastin and proteoglycans while gaining collagen
lose turgor
increase size with age –> increasingly convex
AP diameter increases, height increases