Anatomy test 1- clinical cases questions/answers

Larry is 12 a years-old boy, he presents to the Emergency Room after suffering an injury to his right shoulder. He injured his shoulder falling off his skateboard onto the cement pavement. On examination, you noted his right injured shoulder was significantly lower than his left and that he was holding/supporting his arm by his elbow. X-rays were negative for any fractures. His pain was localized over his right AC Joint and surrounding tissues. You are most concerned that he suffered injury to which of the following ligaments: Correct answer- Coracoclavicular Beatrice Long, a 77 year-old female with a 20 year history of rheumatoid arthritis presents to the orthopedic clinic. She has been on steroid medication for ~ 10 years to help control chronic arthritis in her joints. 3 months ago, she had a cortisone injection into her right shoulder to help alleviate serve pain and inflammation. Beatrice explains to her orthopedic physician that while attempting to lift a heavy box yesterday, she felt something "give-way" in her right shoulder area. She also complains that now she feels a "lump' in the middle of her upper arm. Correct answer- torn biceps muscle Whalen, a 30 year-old man is inebriated and falls asleep on a park bench on Franklin Street in Chapel Hill. When he awakes, he realizes he had been sleeping there for nearly 6 hours. Aside from a terrible headache...Whalen immediately notices he is having trouble moving his right hand and wrist. After removing his sweatshirt, he notices his hand falls down and he is unable to lift it up straight. Which of the following nerves was most likely compressed/damaged with his arm lying against the hard wooden bench for 6 hours? Correct answer- radial sheryl diggins: On examination, the physician detects some muscle weakness in flexion and supination of her left elbow (forearm). In addition, there is a loss of sensation along the lateral aspect of her left forearm. The physician is concerned that Sheryl may have damaged a nerve when she dislocated her shoulder. what nerve is damaged? Correct answer- musculotaneous A 45 year-old male patient (Walter) is brought into the ER with a suspected neck injury following an automobile accident in which he was rear-ended. The patient presents with a cervical collar placed on his neck by the paramedics at the scene of the accident. His vital signs are stable and he is alert and cooperative. The patient relates he is "experiencing pain in his neck." Your initial concern is that he may have suffered a "whiplash" type injury of the cervical region. Based on this clinical scenario, which of the following ligaments is mostly likely stretched or torn? Correct answer- anterior logitudinal. common fractures or dislocations in cervical vertebrae A 19 year-old male presents to the emergency room after an altercation in a night-club on Franklin Street. The man suffered a stab wound to his right axilla. The patient suffers a lesion of the musculocutaneous nerve in his axilla. Which of the following best describes the loss of function? Correct answer- weakened flexion and supination of the forearm & loss of sensation along the lateral forearm Damage to the suprascapular nerve proximal to the suprascapular notch would result in difficulty with which of the following movements of the arm Correct answer- Initiating abduction and external (lateral) rotation Connie is a 7 day-old baby when examined by her pediatrician. The parents are concerned because Connie does not appear to be using her left arm (as compared to her right). Connie was delivered vaginally without apparent complications. Parents relate "she seems to cry/fuss when we change her shirt and/or move her left arm." Correct answer- broken clavicle at birth A 74 year-old man (Paul) returns to his oncologist for continued evaluation and treatment of advanced prostate cancer. Paul relates that he has been struggling with increasing pain/discomfort in his back for the past few weeks (especially when standing or sitting). Although his physician considers that the back pain may be a normal consequence of Paul's age, examination and imaging studies confirm that his prostate cancer has spread to his vertebral column. The probably route of metastasis is identified as the vertebral venous plexus, which Correct answer- is a valve-less system of veins that interconnects the venous drainage along the vertebral column A 54 year old construction worker (Henry) presents to the orthopedic clinic complaining of recent onset of debilitating pain in his lower back which radiates down into his lower leg. The patient relates that pain decreases when he lies down but increases when he coughs or sneezes. He denies any recent trauma or injury to his back or leg. Imaging studies (MRI) are shown below. Correct answer- herniated disc, s1 nerve compressed Which of the following muscles laterally rotates the scapula? Correct answer- serratus anterior CC: 38 year-old man presents to the clinic complaining of weakness in his right arm. He relates he is having trouble/difficulty combing his hair and reaching over his head. PMH: Dennis denies any medical problems and takes no medications. His only encounter with hospitals and doctors was last year after he fell on the ice and broke his right arm. His medical record indicates he suffered a right proximal humeral fracture PE: Exam reveals visually prominent clavicle, acromion, and head of the humerus on the right. Decrease strength on abduction, flexion, and extension of right arm/shoulder Correct answer- axillary nerve palsy/damage RC Hobbs, a 45 year-old ex-minor league baseball pitcher (currently a successful business man) visits his orthopedist and complains of pain in his right shoulder for the past few weeks. Hobbs relates that he suffered from right shoulder pain off-and-on throughout his 6 year pitching career but has remained pain free for nearly 20 years. He recently joined a local gym and began lifting weights every day in an attempt to get "back in shape." Hobbs explains that he has trouble sleeping on his right shoulder and pain when he extends his arm to lift anything. "Ice and aspirin help reduce the pain." Correct answer- Suprapinatus tendon causing problem Damage to which of the following nerves would affect flexion of the distal interphalangeal joint (DIPJ) of digits 4 & 5 Correct answer- ulnar A physician asks a patient to "spread your finger apart" while he attempts to prevent them from doing so. The physician is testing the functionality of which of the following nerves? Correct answer- ulnar ulnar radial medial nerves Correct answer- ulnar is top and bottom pinky and half of ring. medial is under palm, radial is top rest. A 19-year-old female is admitted to the emergency room after a motorcycle accident. During the physical exam, multiple skin lacerations on her back are discovered. Pain from lacerations or irritations to the skin of the back is conveyed to the spinal cord via which of the following structures Correct answer- dorsal ramus of spinal nerve A vascular surgeon is operating and repairing a large and life-threatening thoracic aortic aneurysm. In order to properly repair the defect, the surgeon clamps the aorta during the surgery in order to reduce the bleeding at the surgical site. He is able to successfully repair the aorta within two hours. Several days post-operatively, the nurses discover that the patient cannot feel (loss of sensation) or move (loss of motor control) his legs. Correct answer- Ischemia to a portion of the spinal cord Next year on your inpatient clinical service, you are requested to perform a lumbar spinal tap on a patient with suspected meningitis. What is the correct order of tissues/ligaments that the needle would traverse in order to collect a sample of the CSF? Correct answer- Needle is inserted through the: Skin Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural Space Finally through the dura & arachnoid membranes into the subarachnoid space where CSF can be aspirated Lets return to Walter...now a 48 year-old man that suffered a previous whiplash injury. He visits his physician assistant 3 year after his whiplash injury and complains of recent onset pain/discomfort in his neck and tingling/ numbness in his right shoulder and arm. His physician assistant suspects he might have developed a herniated disc due to the auto accident. MRI scan reveals a posterolateral prolapsed disc between C5 and C6. Correct answer- c6