Clinical correlates exam 1

Question 1

Laminectomy

Answer 1

a surgery to enlarge spinal canal by removing spinous processes and their corresponding lamina; used to remove pressure on spinal cord and nerves that may cause pain, numbness, etc.

Question 2

Hangman’s fracture

Answer 2

Fracture of both pedicles at C2 caused by hyperextension of neck.

Question 3

Lumbar spinal stenosis

Answer 3

narrowing of vertebral foramen, compressing spinal roots. This causes pain and numbness in lower back to legs and make walking difficult. Implications: sometimes treated with decompressive laminectomy.

Question 4

Intervertebral disc herniation

Answer 4

Typically occurs at lumbar levels (L4-L5 or L5-S1); Disk slips occur posteriorly due to narrow size of posterior longitudinal ligament; occurs when nucleus pulposis protrudes into or through the annulus fibrosis into the vertebral canal and compresses the spinal cord or nerve roots

Question 5

Triangle of auscultation

Answer 5

Allows lung sounds to be heard clearly because no muscle intervenes between skin and rib cage; bounded by the trapezius, latissimus dorsi and medial edge of the scapula

Question 6

Lumbar spinal puncture

Answer 6

Spinal puncture (spinal tap) – needle inserted between two vertebrae and into subarachnoid space to remove CSF; can help diagnose infections (meningitis, CNS infections, MS) and detect bleeding and hemorrhaging or cancer of brain or spinal cord. Inject anesthetic or chemotherapy. Introduce dye. Needle must penetrate through skin, fat, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, subdural space, and arachnoid mater to reach the subarachnoid space.

Question 7

Whiplash:

Answer 7

Overextension of anterior longitudinal ligament

Question 8

Spondylolysis and the “Scotty dog” phenomenon?

Answer 8

● Spondylolysis: when fractures of the interarticular parts of the vertebral laminae “Pars Interarticularis” cause displacement/dislocation of the vertebrae; common at L5 vertebra
● Scotty dog – normal appearance of lumbar spine as viewed by oblique radiography. The transverse process is the nose, the pedicle forms the eye, the inferior articular facet forms the front leg, the superior articular facet forms the ear, and the pars interarticularis forms the neck of the dog. When spondylolysis occurs, a break will be visible on the “neck” of the scotty dog.

Question 9

Spondylolisthesis:

Answer 9

caused by spondylolysis in which vertebrae becomes weakened and a vertebra will slip anteriorly from the other vertebrae where they are no longer aligned. Common at L4/L5

Question 10

Lumbar triangle of Petit:

Answer 10

Site for hernias of retroperitoneal contents through posterior abdominal wall; bordered by the latissimus dorsi, external obliques, and iliac crest

Question 11

Vertebral artery atherosclerosis

Answer 11

plaques cause its narrowing and occlusion; the tortuous course of the vertebral artery causes the patients with atherosclerosis may become dizzy and experience other symptoms of brainstem ischemia when the neck is rotated or when chiropractic manipulation is conducted.

Question 12

Lordosis:

Answer 12

excessive lumbar inward curvature “lowerdosis”

Question 13

Kyphosis

Answer 13

excessive thoracic outward curvature

Question 14

Scoliosis

Answer 14

lateral curvature of vertebral column

Question 15

Crush fracture:

Answer 15

crushing of vertebral body

Question 16

Lumbar spinal puncture

Answer 16

withdraw CSF from subarachnoid space; done by inserting needle between L4 and L5 vertebral levels (found by tracing iliac crest medially). This penetrates the supraspinous, interspinous ligaments, and ligamentum flavum. “pop “ is the needle penetrating the dura mater.

Question 17

Caudal epidural:

Answer 17

anesthesia administered into lowest portion of epidural space by penetrating sacrococcygeal ligament which covers the sacral hiatus. Sacral cornua used as bony landmark to administer

Question 18

Winged scapula”:

Answer 18

serratus anterior (powerful protractor) paralyzed due to damage of long thoracic nerve (from spinal nerve roots C5/C6/C7), causes inability to hold scapula in place and it retracts/looks like a wing

Question 19

Quadrangular space:

Answer 19

Box of PCANs” contains the Posterior Humeral Circumflex Artery and the Axillary Nerve

Question 20

Clavicular fractures: Why is the medial clavicular fragment often elevated after a clavicle fracture? Why does shoulder drop occur with a clavicular fracture?

Answer 20

The clavicle is commonly fractured by indirect force transmitted from an outstretched arm to the shoulder during a fall or a blow to the forearm while outstretched. Since the weakest part of the clavicle is at the junction of its middle and lateral thirds, a fracture results in the elevation of the medial clavicular fragment by the upward pull of the sternocleidomastoid muscle (SCM). The trapezius is now unable to hold up the lateral fragment given the weight of the upper limb, so the shoulder drops. Can result in pulmonary embolism (blood clots in subclavian vein), brachial artery embolism (blood clots in subclavian artery), or damage to inferior trunk of brachial plexus.

Question 21

Lymph node removal:

Answer 21

: two nerves at risk- long thoracic nerve and thoracodorsal nerve. Breast cancer: excision and pathological analysis of axillary lymph nodes is often necessary. Because axillary lymph nodes are arranged and receive lymph (and cancer cells) in a specific order, removing and excising lymph nodes in that order is important in determining how far the cancer has metastasized.

Question 22

Dermatome

Answer 22

a strip of skin innervated by one spinal cord level

Question 23

C2 dermatome

Answer 23

Top and back of skull

Question 24

C3 dermatome

Answer 24

Upper neck (turtleneck)

Question 25

C4 dermatome

Answer 25

lower neck (collar of shirt)

Question 26

T4 dermatome

Answer 26

Nipple

Question 27

t7 dermatome

Answer 27

xiphoid

Question 28

t10 dermatome

Answer 28

umbilicus/appendix

Question 29

L4 dermatome

Answer 29

knee

Question 30

Cutaneous innervation:

Answer 30

a strip of skin that is innervated by one peripheral nerve; may or may not include more than one spinal cord level

Question 31

Upper limb stenosis

Answer 31

anastomoses provide alternate routes to supply blood

Question 32

Subclavian Vein puncture

Answer 32

catheter placed into subclavian vein by puncturing axillary vein and advancing it medially. Axillary vein is inferior and anterior to axillary artery, the target for central lines.

Question 33

Fracture of the surgical neck of the humerus:

Answer 33

posterior humeral circumflex artery are affected and axillary nerve (innervates deltoid and teres minor). Therefore abduction and lateral rotation are impaired.

Question 34

Fracture of humeral shaft:

Answer 34

damages radial nerve inside radial groove and deep brachial artery/profunda brachii

Question 35

Spiral fracture of humerus:

Answer 35

result of a fall on the outstretched hand. Impairs radial n. and deep brachial artery.

Question 36

Fracture of distal humerus:

Answer 36

damage of median nerve

Question 37

Fracture at radial groove:

Answer 37

damage of radial nerve and deep brachial vein (profunda brachii)

Question 38

Transverse fracture of humeral shaft:

Answer 38

MARMU nerves can be damaged; results from a direct blow to the arm

Question 39

Avulsion of greater tubercle of humerus:

Answer 39

SIT muscles of rotator cuff all attach here (subscalularis, lesser tubercle of humerus

Question 40

Intercondylar fracture

Answer 40

olecranon of elbow is driven into humerus, separating humerus

Question 41

Supracondylar fracture:

Answer 41

fracture directly superior to epicondyles. Compresses median nerve and brachial artery.

Question 42

Lymphangitis

Answer 42

caused by an infection of the upper limb. results in enlarged, tender and inflamed axillary lymph nodes. The humeral group is first to be involved.

Question 43

Lymphedema:

Answer 43

caused by lymphatic drainage of the upper limb may be impeded after removal of axillary lymph nodes or swelling as a result of accumulated lymph in the subcutaneous tissue

Question 44

. Biceps reflex: a positive response that confirms integrity of what nerve and what spinal cord levels?

Answer 44

Musculocutaneous nerve; C5, C6, C7

Question 45

Why is the cubital fossa a common site for sampling and transfusion of blood?

Answer 45

The median cubital vein lies superior to the bicipital aponeurosis and is a good site for extraction of blood.

Question 46

Compression of the axillary artery

Answer 46

necessary when profuse bleeding occurs; the distal segment can be palpated in the inferior lateral wall of the axilla. It may also be compressed at its origin, with pressure in the angle between sternocleidomastoid and the clavicle.

Question 47

Wounds in the axilla

Answer 47

often involve the axillary vein due to its exposed position and are particularly dangerous because of profuse bleeding and the risk of air emboli (bubbles) entering the blood.

Question 48

Upper/superior brachial plexus injury:

Answer 48

C5&6. Result from excessive angle between neck and shoulder. ● Erb Duchenne's palsy- paralysis of deltoid, biceps, brachialis. Waiter's tip position results: limb hangs by side in medial rotation, elbow extended, arm adducted. 22. Lower/inferior brachial plexus injury

Question 49

Lower/inferior brachial plexus injury:

Answer 49

upper limb pulls superiorly, injuries C8 and T1. | ● Claw hand results, also known as Klumpke Paralysis

Question 50

Damage to coracoid process, what muscles will be affected?

Answer 50

Coracobrachialis ● Short head of biceps brachii ● Pectoralis minor

Question 51

Crutches paralysis:

Answer 51

can injure the RADIAL nerve leading to wrist drop and other signs of typical radial nerve damage

Question 52

Cubital Fossa/Forearm 1. Volkmann's ischemic contracture:

Answer 52

permanent flexion of wrist (claw) caused by a supracondylar fracture that leads to the puncturing of the brachial artery, which causes ischemia (loss of blood flow) in the forearm muscles and their permanent contracture.

Question 53

Colles fracture

Answer 53

complete fracture of radius 2 cm from wrist resulting from excessive extension/trying to break a fall

Question 54

Dinner fork deformity:

Answer 54

distal end of broken radius in Colles fracture will project dorsally causing a curvature of the forearm just proximal to the wrist

Question 55

Cubital fossa as common site of transfusion of blood:

Answer 55

median cubital vein is easy to access. Connects cephalic vein and basilic vein, sitting above the bicipital aponeurosis

Question 56

Fracture of radius:

Answer 56

damage to radial artery, anterior/posterior interosseous nerve (due to the interosseous membrane damage); damage to radial nerve, musculocutaneous nerve (lateral cutaneous antebrachial n.)

Question 57

Fracture of ulna:

Answer 57

damage to ulnar artery, anterior/posterior interosseous artery (due to the interosseous membrane damage); damage ulnar nerve, median nerve

Question 58

Anatomical snuff box:

Answer 58

: contains the radial artery; lateral boundary formed by abductor pollicis longus and extensor pollicis brevis; medial boundary formed by extensor pollicis longus.

Question 59

Fractured elbow:

Answer 59

fracture of olecranon

Question 60

Clinical testing: Axillary n.:

Answer 60

resisted shoulder abduction (test deltoid) and lateral rotation of shoulder (test teres minor)

Question 61

Clincially testing musculocutaneous n

Answer 61

.: weak flexion of the elbow and no cutaneous sensation on lateral forearm

Question 62

Clinically testing radial nerve

Answer 62

inability to extend the wrist, resulting in wrist drop

Question 63

Clinically testing median nerve

Answer 63

flexion of interphalangeal joints is lost (due to superficialis PIP flexion, and profundus DIP flexion only for lateral digits). When attempting to make a fist, fingers 2&3 remain extended (aka Hand of Benediction). Can’t make the "ok" sign, it looks like a "pinch" due to inability to flex IP joints in forefinger and thumb

Question 64

Clinically testing ulnar n

Answer 64

most commonly damaged at funny bone (medial epicondyle). When attempting to flex wrist, wrist will be drawn to lateral side. When attempting to make a fist, fingers 4&5 remain extended, but also cannot extend due to lack of innervation to lumbricals. Results in claw hand.

Question 65

Thumb testing radial

Answer 65

sensory to back of thumb

Question 66

clinically testing thumMedian:

Answer 66

see if patient can oppose thumb

Question 67

clinical testing ulnar thumb

Answer 67

hold an piece of paper between thumb and indicis, test grip

Question 68

Upper Limb Joints 1. Shoulder separation:

Answer 68

disruption of the AC joint and coracoclavicular ligament. This results in the glenohumeral joint completely dropping from the shoulder

Question 69

Shoulder dislocation:

Answer 69

most commonly anterior due to lack of anterior support. Posterior side reinforced by rotator cuff. Superiorly reinforced by coracoacromial ligament. Suprascapular artery and nerve are often injured

Question 70

. What is the sternoclavicular (SC) joint and does it commonly dislocate?

Answer 70

● Clavicle, manubrium, and 1st costal cartilage ● Elevation of clavicle to 60° and anterior/posterior movement to 30° ● Anterior and posterior sternoclavicular ligaments ● Articular disc separates the joint into 2 compartments ● SC joint doesn't commonly dislocate- the clavicle will usually break

Question 71

Tennis elbow:

Answer 71

lateral epicondylitis (strained and inflamed)

Question 72

Golfer's elbow:

Answer 72

medial epicondylitis (strained and inflamed)

Question 73

Little league elbow:

Answer 73

medial epicondyle apophysitis"): growth plate injury at the medial epicondyle due to overuse/throwing 7

Question 74

Nursemaid's elbow:

Answer 74

annular ligament slips off of radial head and becomes trapped between radial head and capitulum of humerus.

Question 75

Knuckles:

Answer 75

formed from heads of metacarpals of digits 2-5

Question 76

Compartment inflammation

Answer 76

Midpalmar space is continuous with the anterior forearm via the carpal tunnel; midpalmar spaces are potential spaces deep in the palm between the long flexor tendons and the fascia over the deep palmar muscles

Question 77

. Fractured scaphoid:

Answer 77

most commonly fractured bone of the hand; occurs from fall on palm of the hand while hand is outstretched. Avascular necrosis (death of bone due to lack of blood supply) may occur to proximal fragment of bone resulting from lack of blood supply

Question 78

Dupuytren contracture

Answer 78

shortening/thickening of palmar fascia resulting in flexion of digits 4 and 5

Question 79

Carpal Tunnel:

Answer 79

compression of the median nerve resulting in excessive motion of flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis. Often caused by a dislocation of lunate

Question 80

Lunate dislocation

Answer 80

: lunate pushed out of floor in carpal tunnel, toward the palm. May compress median nerve, causing carpal tunnel; commonly occurs in auto accidents or a fall from a great height

Question 81

Claw hand:

Answer 81

Ulnar nerve compression: damaged ulnar nerve results from inability to extend digits 4 and 5 due to lack of innervation to lumbricals, which also hyperextends MP joints

Question 82

Mallet/baseball finger

Answer 82

rupture of extensor tendons in the DIP;Unopposed action of flexor digitorum profundus produces “mallet finger” in which the distal phalanx remains flexed

Question 83

. Benediction hand

Answer 83

damage to median nerve, resulting in extended digits at 1-3 at MP joint (lumbricals affected) and IP joints (flexors affected)

Question 84

Wrist drop

Answer 84

: caused by damage of radial nerve and lack of extensor muscles

Question 85

Hamate fracture

Answer 85

ulnar nerve and ulnar artery affected

Question 86

Abnormal Blastocysts:

Answer 86

Trophoblast is defective and could not produce sufficient hCG to maintain corpus luteum.

Question 87

Hydatidiform Moles:

Answer 87

Trophoblast develops and forms placental membranes with little or no embryonic tissue. Moles secrete high levels of hCG and appear “grape-like.”

Question 88

. Ectopic pregnancy

Answer 88

Implantation outside the uterus. 95% occur in the uterine tube. Symptoms: signs/symptoms of pregnancy with abdominal pain and tenderness; treatment: laparoscopic operation to remove uterine tube containing the ectopic embryo

Question 89

Endovaginal sonography:

Answer 89

technique used to confirm ectopic pregnancy diagnosis

Question 90

Early Pregnancy factor

Answer 90

: immunosuppressive protein is detected by isolated maternal serum shortly after conception (36-48 hours after fertilization); this is the earliest available marker

Question 91

Pregnancy test

Answer 91

detects hCG; day 8 can be detected in maternal blood; day 10 can be detected in maternal urine

Question 92

Placenta Previa

Answer 92

When the blastocyst implants close to the internal os (opening) of the cervix. Presents as painless vaginal bleeding in the later stages of pregnancy. Increased risk with IVF

Question 93

Exocoelomic cysts

Answer 93

``` During formation of the definitive yolk sac, large portions of the primitive yolk sac (aka exocoelomic coelom) are pinched off in the chorionic cavity. ```

Question 94

Conjoined twins:

Answer 94

result from partial splitting of the primitive node and streak

Question 95

Sirenomelia

Answer 95

“mermaid syndrome”; insufficient mesoderm is formed in the caudal region of the embryo, lower limbs are fused together. Kidney and bladder development are affected so that many babies that are born with this condition will generally die within a few days of birth

Question 96

Sacrococcygeal Teratoma

Answer 96

: primitive streak doesn’t regress appropriately. remnants of the primitive streak in the sacrococcygeal area; commonly contain tissues derived from all 3 germ layers b/c primitive streak cells are pluripotent; most common tumor in newborns, 3-4x more likely in females than males

Question 97

Chordoma:

Answer 97

tumor that arises from remnants of notochord. Intracranially or sacrally; more common in adult men in their 50’s

Question 98

Gastroschisis

Answer 98

: abdominal wall defect, characterized by an opening in the abdominal wall of the fetus. Intestines and other abdominal organs herniate through a hole in the abdominal wall and spill out into the amniotic fluid around the fetus; if lateral folds don’t complete and form anterior abdominal wall in week 4

Question 99

. Chorionic villus sampling

Answer 99

: Needle aspiration (transabdominal or transvaginal) of chorionic villus tissue for genetic testing; performed at 10-12 weeks. Will tell whether embryo has severe chromosomal abnormalities or not. (prior to month 4, therefore all 4 layers of chorionic villi are present: syncytiotrophoblast, cytotrophoblast, extraembryonic mesoderm, fetal circulation

Question 100

. False knots

Answer 100

: When the umbilical vessels are longer than the umbilical cord so they commonly twist around each other and sometimes bend to form loops

Question 101

. Synctial knots

Answer 101

: In third trimester, large pieces of syncytiotrophoblast break off and enter intervillous spaces; these enter maternal circulation and are broken down in the lungs

Question 102

Amniocentesis

Answer 102

a hollow needle is inserted through the mother’s abdomen into the uterus and amniotic fluid is drawn for analysis; performed at 16-20 weeks.

Question 103

Amniotic bands/constriction ring syndrome:

Answer 103

amnion should be fused with chorion and pushed against uterine wall. Bands can come loose or tears in the amnion may result in amniotic bands that encircle the fetal limbs or digits resulting in deformities or amputations.

Question 104

Amniotic Fluid

Answer 104

30mL at 10 weeks and 1000mL at 37 weeks

Question 105

. Polyhydramnios

Answer 105

excess amniotic fluids ○ correlated with maternal diabetes and disorders of central nervous system and gastrointestinal tract (various atresias) ○ Fetus is prevented from swallowing amniotic fluid OR fetus has increased urine production. ○ Twinning also increases risk of polyhydramnios

Question 106

Oligohydramnios:

Answer 106

too little amniotic fluid ○ may result from failure of the fetal kidneys to form, poor fetal urine output or amniotic fluid leakage/rupture of membranes. ○ Severe oligohydramnios early in pregnancy is a risk factor for lung hypoplasia (lung underdevelopment)

Question 107

○ Category X drugs:

Answer 107

absolute contraindication in pregnancy; thalidomide, Coumadin, alcohol, etc.

Question 108

Category D drugs

Answer 108

definite evidence of risk to fetus; tetracycline, valium, etc

Question 109

Potter’s syndrome

Answer 109

fetal kidneys are absent → lungs don’t develop

Question 110

Single artery in umbilical cord:

Answer 110

1% of fetuses have this; increased risk for Down Syndrome

Question 111

Substances that DO NOT cross the placental membrane:

Answer 111

○ Maternally derived cholesterol, triglycerides, phospholipids ○ Protein hormones like insulin ○ IgD, IgE, IgM

Question 112

Erythroblastosis fetalis

Answer 112

severe fetal anemia. Baby “hydropic” or fluid-filled- like CHF ○ Results from Rh disease (Rh+ Dad and Rh- mom...second Rh+ baby is at risk) ○ maternal antibodies attacking Rh+ fetus ○ Prevention: Rhogam- dose of antibodies against the Rh protein ■ Given at 28 wks ■ After baby is born if it turns out to be Rh+ ■ After any bleeding in pregnancy- works up to 72 hours after bleeding

Question 113

Postpartum hemorrhage

Answer 113

can be caused by leaving maternal side segments of placenta | “cotyledons” behind after delivery; can exsanguinate in 10 minutes in brisk hemorrhage

Question 114

. Preimplantation Genetic Diagnosis

Answer 114

Used to detect a single gene defect or chromosomal anomalies or to identify sex of the embryo when a male embryo would be at risk of a serious X-linked disorder. This can be carried out after 3 days and NO LATER than 8-16 stage (early morula). Cells are still totipotent and it won’t injure the developing embryo.

Question 115

Accessory lumbar ribs:

Answer 115

most common type of accessory rib, harmless

Question 116

. Accessory cervical ribs

Answer 116

usually attached to C7, puts pressure on brachial plexus of nerves and subclavian artery; produces paralysis and anesthesia of the upper limb; develop from the costal processes of the C7 vertebra and may fuse with first rib

Question 117

Amelia

Answer 117

absence of limb

Question 118

Meromelia:

Answer 118

absence of part of a limb

Question 119

Phocomelia

Answer 119

hands and feet are attached to abbreviated arms and legs; seals flipper (results from exposure to thalidomide)

Question 120

Robert’s tetraphocomelia:

Answer 120

phocomelia that is genetic/inherited

Question 121

Polydactyly

Answer 121

extra digit. Results if there is an abnormal formation of a digital ray

Question 122

Syndactyly:

Answer 122

webbed digits. Results if apoptosis doesn’t fully occur between digital rays. Most common limb anomaly

Question 123

Upper limb buds rotate laterally 90

Answer 123

°, places thumb laterally. places flexor compartments | anteriorly and extensor compartments posteriorly

Question 124

Lower limb buds rotate: medially 90°,

Answer 124

°, places great toe medially. places extensor compartments | anteriorly and flexor compartments posteriorly

Question 125

AER (apical ectodermal ridge):

Answer 125

thickening of ectoderm on distal end of limb buds, signal growth in proximal to distal direction. Cells differentiate into cartilage and muscle. ○ During week 6, distal ends of limb buds flatten into hand and foot plates ○ Cell death occurs in AER → fingers and toes form, dividing plate into 5 parts ○ Condensation of mesenchyme forms digital rays ○ apoptosis of cells occurs between digital rays

Question 126

Multiple sclerosis

Answer 126

when your immune system attacks the myelin sheath in your CNS

Question 127

Guillan-bare

Answer 127

degenerate the Schwann cells

Question 128

Alzheimer’s disease:

Answer 128

one of the first signs of this disease is when there are disrupted neurofilaments lead to neurofilament tangles