Mehlman Upper limb n. surg: axillary, median

Question 1

Axillary. innervation of what?

Answer 1

main innervation of deltoid.

Question 2

Axillary. adbudction?

Answer 2

abduction of arm 15-90 degrees.

Question 3

Axillary. usmle wants to know, that deltoid has origin on the ………. and axillary nerve origin….

Answer 3

that deltoid has origin on the lateral clavicle and axillary nerve origin innervating it is at C5-C6.

Question 4

that deltoid has origin on the lateral clavicle and axillary nerve origin innervating it is at C5-C6?

Answer 4

Axillary.

Question 5

Abduction of arm 15-90 degrees?

Answer 5

axillary

Question 6

Axillary. palsy caused by what fracture?

Answer 6

SURGICAL neck of humerus fracture

Question 7

Axillary. vignette will often say ,,flattened deltoid” or ,,loss of sensation over lateral upper arm/deltoid”.

Answer 7

.

Question 8

Median. innervation of what?

Answer 8

lateral 3 and a half fingers/thenar pad, and lateral forearm.

Question 9

lateral 3 and a half fingers/thenar pad, and lateral forearm?

Answer 9

Median.

Question 10

Median. does what with thumb?

Answer 10

abduction

Question 11

Median. in contrast, what does thumb adduction?

Answer 11

ulnar

Question 12

Median. sensation over thenar region. what answer usmle wants?

Answer 12

palmar cutaneous branch of MEDIAN NERVE.

Question 13

Median. palsy caused by what?

Answer 13

Supracondylar fracture of humerus OR ,,distal shaft fracture”.

Question 14

Supracondylar fracture of humerus (buzzy) OR ,,distal shaft fracture (sounds non-specific)”.?

Answer 14

Median –> palsy.

Question 15

Median. carpal tunel syndrome caused by….

Answer 15

entrapment of median nerve

Question 16

Median. carpal tunel syndrome CP?

Answer 16

paresthesia/numbness lateral to hand/thenar region

Question 17

Median. carpal tunel syndrome causes?

Answer 17

repetitive movements of hand;
hypothyroidism (GAG depositions); acromegaly (growth of tendons); pregnancy (edema)

Question 18

Median. carpal tunel syndrome bilateral in what?

Answer 18

construction workers using jackhammer

Question 19

Median. carpal tunel syndrome. next best step Dx?

Answer 19

next best step: ,,electrophysiological testing” and ,,electromyography and nerve conduction studies”

Question 20

Median. carpal tunel syndrome. Tx is very HY. first step?

Answer 20

use wrist pads when using computer, if not listed –> choose wrist splint.

Question 21

Median. carpal tunel syndrome. Tx is very HY. is immobilization is not effective –> next step Tx?

Answer 21

Triamcinolone (corticoisteroid) injection into carpal tunel

This provides relief for about one month and delays the need for surgery in severe cases for about one year.

Question 22

Median. carpal tunel syndrome. Tx is very HY. What is always wrong answer?

Answer 22

NSAIDS and surgery (endoscopic + open nerve decompression).

Question 23

Median. Flick sign?

Answer 23

patient awakens in pain and shakes out hand to relieve Sx –> 93% sensitive and 96% specific for CTS.

Question 24

Median. patient awakens in pain and shakes out hand to relieve Sx –> 93% sensitive and 96% specific for CTS?

Answer 24

Flick sign

Question 25

Median. Phalen maneuver?

Answer 25

flexion of the wrist to 90 degrees for one minute elicits Sx.

Question 26

Median. flexion of the wrist to 90 degrees for one minute elicits Sx?

Answer 26

Phalen maneuver

Question 27

Median. Tinel sign?

Answer 27

tapping over the carpal tunnel induces Sx.

Question 28

Median. tapping over the carpal tunnel induces Sx?

Answer 28

tapping over the carpal tunnel induces Sx.

Question 29

Median. Median nerve compression test (Durkan test)?

Answer 29

compression of carpal tunnel with the thumbs for 30 seconds elicits Sx.

Question 30

Median. compression of carpal tunnel with the thumbs for 30 seconds elicits Sx?

Answer 30

Median nerve compression test (Durkan test)