LOCO

Question 1

Name the stages of the brachial plexus

Answer 1

Nerves –> Trunks –> Divisions –> Chords –> Branches

Question 2

Name the branches of the brachial plexus (superior to inferior)

Answer 2

Musculocutaneous (C5-C7)
Axillary (C5-C6)
Median (C5 -T1)
Radial (C5-T1)
Ulnar (C8-T1)

Question 3

Name the motor and sensory innervations of the brachial plexus

Answer 3

Musculocutaneous:

• Motor: Brachialis, Biceps Brachii, Coracobrachialis
• Sens: Lateral cutaneous branch –> lateral anterior forearm

Axillary:

• Motor: Teres minor, Deltoid
• Sens: Superior lateral cutaneous –> Inferior region of the deltoid

Median:
- Motor: Most flexor muscles in the forearm, thenar muscle, two lateral lumbricals (1st and 2nd finger)
- Sens: Palmar cutaneous branch –> lateral palm
Digital cutaneous branch –> lateral 3.5 fingers on the anterior surface

Radial:

• Motor: Triceps brachii, muscles in posterior forearm (primarily wrist and finger extensors)
• Sens: Posterior aspect of arm and forearm, posterolateral aspect of hand

Ulnar:

• Motor: Remaining muscles of the hand, flexor carpi ulnaris and medial half of flexor digitorum profundus
• Sens: Anterior and posterior surfaces of the medial one and half fingers, and associated palm area

Question 4

Describe the bone healing process

Answer 4

Haematoma formation (Days 1 - 5)
fibrocartilaginous callus formation (Days 5 - 11)
Bony callus formation (Days 11 - 28)
Bone remodelling (Day 28 - months/years)

Question 5

from what lineage are osteoblasts and osteoclasts from

Answer 5

Osteoblasts - macrophage lineage (bone marrow)

Osteoclasts - Mesenchymal connective tissue precursor lineage

Question 6

What are the clinical symptoms of popliteal artery entrapment

Answer 6

Cold feet following exercise
Paraesthesia of the leg
Calf numbness

Question 7

What are the clinical symptoms of popliteal vein entrapment

Answer 7

Feeling of leg 'heaviness'
Lower leg cramping
Calf swelling
Calf skin discoloration
Deep vein thrombosis

Question 8

What kind of hereditary disease is Duchenne’s muscular dystrophy

Answer 8

X-linked Hereditary disease

Question 9

What are hallmark features of Rheumatoid Arthritis

Answer 9

Pain and stiffness in the joints which is worse in the mornings
Pain and stiffness lasts for more than an hour
Symmetrical distribution

Question 10

Systemic lupus erythematosus (SLE) diagnostic criteria and form of arthritis is likely

Answer 10

SOAP BRAIN MD

Serositis → pleuritis, pericarditis
Oral ulcers
Arthritis → e.g. Jaccoud’s arthritis
Photosensitivity
Blood Disorders → anaemia, thrombocytopenia, leucopenia, lymphopenia
Renal Disorder → proteinuria, glomerulonephritis,
Antinuclear Antibodies (ANA) - positive
Immunological disorder → Anti-dsDNA, Anti-Sm, Antiphospholipid antibodies
Neurological disorder → seizures, psychosis
Malar (Butterfly) Rash
Discoid Rash

Jaccoud’s arthritis/arthropathy

Question 11

What medication can cause Necrotising autoimmune myopathy

Answer 11

Statins (HMG-CoA reductase inhibitors)

Atorvastatin

Question 12

What are the stages of Perthes disease

Answer 12

Stage 1 ~ necrosis
Insufficient blood supply to femoral head causing ischaemia and subsequently necrosis
Femoral head begins to flatten
Crescent sign (subchondral translucency indicating susceptibility to fracturing) may be present on the femoral head

Stage 2 ~ fragmentation
Necrotic bone is re-absorbed and femoral hand flattens completely and fragments
Slight subluxation of femoral head out of acetabulum

Stage 3 ~ re-ossification
Growth of new bone to replace necrotic tissue

Stage 4 ~ healed
Femoral head has fully healed, however structural irregularities, such as enlargement or flattening of the femoral head, may be present

Question 13

What is club foot known as

Answer 13

Talipes equinovarus

Question 14

What are the features of Osteoarthritis in X-rays

Answer 14

Subchondral sclerosis
Subchondral cyst
Osteophytes
Joint space narrowing

Question 15

Signs and symptoms of Diffuse Idiopathic Skeletal Hyperostosis

Answer 15

Pain, especially in the neck or upper back
Stiffness, usually worse in the morning
Loss of range of motion in the back
Decreased mobility
Difficulty swallowing or a hoarse voice

Question 16

Name the tuli classification

Answer 16

Stage 1:
Neural deficit is not fully evident unless clinically tested by the clinician in which case the following may be observed: ankle clonus; exaggerated deep tendon reflexes; Babinski sign.

Stage 2:
Spasticity evident.
Patient suffers from motor deficit although they are still able to walk.

Stage 3:
Patient is bedridden.
Spastic paralysis in extension.

Stage 4:
Patient is bedridden.
Severe sensory loss with/without pressure sores.

Stage 5:
Patient is bedridden.
Severe sensory loss with/without pressure sores.
Bladder/bowel control may be affected.
Paraplegia may be evident.
Paralysis in flexion.

Question 17

Name the layers of epidermis from superficial to deep

Answer 17

Stratum corneum
Stratum lucidum (only in thick skin e.g. palm of hands and soles of feet)
Stratum granulosum
Stratum spinosum
Stratum basale

Question 18

Pott’s disease signs and symptoms

Answer 18

Symptoms:
Vertebral damage leading to an increased kyphotic deformity and subsequent back pain

Excessive spinal curvature can also compress spinal nerves which may lead to paraplegia

Systemic symptoms, such as malaise, fever, appetite loss. haemoptysis, night sweats and weight loss

Question 19

Pott’s disease radiograph findings

Answer 19

Paraspinal abscess formation

Widened superior mediastinum

Tracheal displacement anteriorly (seen on lateral-view)

Anterior wedging of the spine due to breakdown of vertebral endplates (seen on lateral-view)

Presence of gibbus deformity (a short segment of kyphosis in the thoracolumbar region) (seen on lateral-view)

Question 20

What is Boutonniere Deformity

Answer 20

Proximal interphalangeal (PIP) flexion and distal interphalangeal (DIP) hyperextension

Question 21

Name the points of attachment of the:
ACL
PCL
MCL
LCL

Answer 21

ACL - connects the lateral condyle of the femur to the intercondylar region of the tibia

PCL - attaches at the medial condyle of the femur to the intercondylar region of the posterior aspect of the tibia

MCL - connects the medial epicondyle of the femur to the medial condyle of the tibia

LCL - lateral epicondyle of the femur to the fibula head