Raras

Question 1

Man with distal weakness of both hands and atrophy of thenar (median innervated) and hypothenar (ulnar innervated eminences).

Answer 1

Syringomyelia.

Question 2

Answer 2

THEY ASK QUESTION OF WHAT INERVES WHAT

Question 3

What nerve is affected? Man after left elbow injury: Weakness of long flexors of the thumb and index finger. Unable to do pronation.

Answer 3

AIN Anterior interosseous. (branch of median nerve).
Flexor pollicis longus ( long flexor of thumb)
Radial part of flexor digitorum profundus (flexor of index middle fingers)
Pronator quadratus (forearm pronation resulting palm of hand facing down)

Question 4

Bilateral median nerve palsy. Atrophy of ……

Answer 4

Thenar eminence

Question 5

Bilateral ulnar nerve palsy. Atrophy of …

Answer 5

Hypothenar eminence

Question 6

Brainstem infarction = bilateral limb weakness. TRUE OR FALSE

Answer 6

FALSE! Always contralateral limb weakness. Bilateral = NO BRAINSTEM

Question 7

Multiple sclerosis = bilateral symptoms. TRUE OR FALSE

Answer 7

FALSE. (less probably). Usually weakness exaggerated reflexes and decreased sensation.

Question 8

Man weak wrist flexion + small muscles of his hands are wastes. Lesion of what nerve?

Answer 8

Right Ulnar nerve at elbow.

Question 9

Most of small hand muscles (dorsal and palmar interossei, lumbrical m of 4 and 5, hypothenar eminence) are innervated by …..

Answer 9

Ulnar nerve

Question 10

Wrist flexor (flexor carpi ulnaris) is innervated distally. TRUE OR FALSE

Answer 10

FALSE!!!
Lesions in ELBOW!!! produce weakness. Small muscles would be affected if lession in Wrist.
ELBOW: FLEXION OF WRIST + SMALL MUSCLES
WRIST: SMAL MUSCLES

Question 11

Median nerve innervates Flexor Carpi Radialis, another flexor of the wrist. NOT the small muscles of the hand. TRUE OR FALSE

Answer 11

TRUE

Question 12

Nerve incharge of innerve forearm supinator muscles and thumb and finger extensors

Answer 12

Radial nerve.

Question 13

Nerve incharge of innervation of interosseous muscles of the hand? (dorsal interossei and palmar interossei)

Answer 13

ULNAR NERVE
DORSAL ABDUCT AND PALMAR ADDUCT

Question 14

Lesions of which nerve can lead to wrist drop?

Answer 14

Radial nerve at the Elbow. (wrist drop=problem with extension)

Question 15

Woman 27 typist. Right wrist pain and numbness of index, middle and radial half of the ring fingers. Unable to do opposition of the thumb and little fingers of the right side. Most likley d(x)?

Answer 15

CTS.
Median nerve. First 3 digits and the radial half of the fourth.

Question 16

CTS pain is worse at night and often awaken the pt. Worse with activities or arm raising. (typing reading driving). Can develop difficulty in holding objects, turning keys, buttoning, etc.

Answer 16

TRUE

Question 17

Tendonitis is not associated with sensory disturbances

Answer 17

FALSE

Question 18

Answer 18

remember sensory

Question 19

35 yo woman, decreased ability to hold small object between right thumb and index finger. Unable to properly hold the keys. Which conditions should have led to this?

Answer 19

Ulnar nerve injury.
Lateral-Key pinch (adductor pollicis and dorsal interosseous muscle of the index finger innervated by Ulnar)

Question 20

Pt incapable of doing OK sign (tip to tip approximation). Which conditions should have led to this?

Answer 20

AIN injury

Question 21

A 12 yo cutting his left wrist with a pocketknife. 2 cm laceration at the base of the of the thenar eminence. To test motor injury of median nerve:

Answer 21

Oppose the thumbs and the little finger!

Question 22

Three muscles of the thenar area:

Answer 22

Abductor pollicis brevis
Flexor pollicis brevis

Opponents pollicis (this one gets affected if wrist injury)

Question 23

What two actions of the thenar eminence are okay if damage in the WRIST

Answer 23

Abduction and flexion! (they have counterparts originating in the forearm!!!!)

Question 24

Extension of thumb and fingers, what nerve

Answer 24

Radial nerve

Question 25

Wrist flexion, what nerves are involved

Answer 25

Flexor Carpi radialis (median) and flexor carpi ulnaris ( unlar). In Forearm!

Question 26

Adduction of thumb (adductor pollicis) and other fingers (palmar interosseous muscles). What nerve is involved?

Answer 26

Ulnar nerve.

Question 27

Midshaft humerus fracture, most likely finding?

Answer 27

Inability to extend the thumb. RADIAL NERVE INJURY AND PLASY ( MOST COMMON NERVE INJURY INVOLVING FRACT OF LONG BONES)

Question 28

Proximal radial injury ...

Answer 28

Wrist drop and decreased thumb extension

Question 29

Sensory disturbance associated with midshaft humerus fracture?

Answer 29

decreased sensation of dorsum of hand

Question 30

Fractures of the humeral neck?

Answer 30

Paresthesia over deltoid area. AXILLARY NERVE

Question 31

Sciatic nerve injury SYMP

Answer 31

Absent or weak ankle reflex !!! (most important) Paralysis of the hamstring muscles (knee flexion weakness) and all muscles below knee. All sensation of the leg except the medial aspect impaired.

Question 32

Weakness of the foot dorsiflexion and eversion. What nerve

Answer 32

CPN

Question 33

Weakness of the foot plantar flexion and inversion. What nerve?

Answer 33

Tibial nerve

Question 34

Most common injured lower extremity nerve in pt undergoing lithotomy

Answer 34

CPN (Tibialis anterior, extensor digitorum longus, extensor hallucis longus peroneous tertius pereneous longus peroneous brevis

Question 35

What are the key neurological symptoms associated with vitamin D deficiency?

Answer 35

Progressive paresthesia (pins and needles) in extremities. Difficulty walking or gait disturbances. Positive Romberg test indicating sensory ataxia. Decreased sensation to pain, temperature, vibration, and touch. Brisk deep tendon reflexes and possible extensor plantar response due to hypocalcemia-induced neuromuscular irritability.

Question 36

What laboratory findings confirm a diagnosis of vitamin D deficiency?

Answer 36

Low serum 25-hydroxyvitamin D (<20 ng/mL indicates deficiency). Low serum calcium (hypocalcemia). Low serum phosphate. Elevated parathyroid hormone (PTH) (secondary hyperparathyroidism). Elevated alkaline phosphatase in cases of osteomalacia.

Question 37

What is the pathophysiological mechanism behind brisk reflexes in vitamin D deficiency?

Answer 37

Severe vitamin D deficiency leads to hypocalcemia, which increases neuromuscular excitability. This manifests as brisk deep tendon reflexes and may cause signs of upper motor neuron involvement, such as extensor plantar response (Babinski sign).

Question 38

What are the main treatment options for vitamin D deficiency?

Answer 38

Cholecalciferol (Vitamin D3) supplementation: 50,000 IU weekly for 6–8 weeks for severe deficiency, followed by 800–2,000 IU daily for maintenance. Calcium supplementation if hypocalcemia is present. Treat any underlying causes (e.g., malabsorption, poor dietary intake). Regular monitoring of vitamin D, calcium, and PTH levels.

Question 39

What are the complications of untreated vitamin D deficiency?

Answer 39

Osteomalacia in adults, leading to bone pain and fractures. Hypocalcemia, causing tetany, seizures, and cardiac arrhythmias. Neuromuscular symptoms, including progressive weakness and gait abnormalities. Long-term complications include osteoporosis and increased risk of falls and fractures.

Question 40

3RD nerve palsy w Pupil involvement. Most common etiology?

Answer 40

Aneurysmal compression

Question 41

3RD nerve palsy with NO Pupil involvement. Most common etiology?

Answer 41

ISCH- Dbt M!!! HTA ADVANCED AGE