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  • Question 1 - During a block dissection of the thigh, the sartorius muscle is identified. What...

    Incorrect

    • During a block dissection of the thigh, the sartorius muscle is identified. What is the nerve supply to this muscle?

      Your Answer: Posterior division of the femoral nerve

      Correct Answer: Anterior division of the femoral nerve

      Explanation:

      The superficial femoral nerve primarily provides cutaneous branches, but it also innervates the sartorius muscle.

      The Sartorius Muscle: Anatomy and Function

      The sartorius muscle is the longest strap muscle in the human body and is located in the anterior compartment of the thigh. It is the most superficial muscle in this region and has a unique origin and insertion. The muscle originates from the anterior superior iliac spine and inserts on the medial surface of the body of the tibia, anterior to the gracilis and semitendinosus muscles. The sartorius muscle is innervated by the femoral nerve (L2,3).

      The primary action of the sartorius muscle is to flex the hip and knee, while also slightly abducting the thigh and rotating it laterally. It also assists with medial rotation of the tibia on the femur, which is important for movements such as crossing one leg over the other. The middle third of the muscle, along with its strong underlying fascia, forms the roof of the adductor canal. This canal contains important structures such as the femoral vessels, the saphenous nerve, and the nerve to vastus medialis.

      In summary, the sartorius muscle is a unique muscle in the anterior compartment of the thigh that plays an important role in hip and knee flexion, thigh abduction, and lateral rotation. Its location and relationship to the adductor canal make it an important landmark for surgical procedures in the thigh region.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 2 - A one-year-old is brought to the paediatric team for assessment. The parents report...

    Correct

    • A one-year-old is brought to the paediatric team for assessment. The parents report that the child's right arm hangs loosely and does not move in coordination with the other limbs.

      Upon examination, an adducted, internally rotated right upper limb with an extended elbow is observed. However, movement of the right wrist appears normal.

      Based on these findings, where is the most likely location of the lesion?

      Your Answer: C5 and C6

      Explanation:

      The infant’s arm is observed to be hanging loosely after a difficult forceps delivery, with adduction and internal rotation and extension of the elbow, indicating an injury to the upper trunk of the brachial plexus involving nerve roots C5 and C6. This is known as Erb’s palsy, which is commonly associated with difficult forceps deliveries and requires specialized management. Lower brachial plexus injuries affecting nerve roots C7 and C8 are less frequent and would cause wrist and forearm pathology rather than shoulder and elbow weakness. Isolated damage to the C6 nerve root is unlikely, as it is typically affected alongside the C5 nerve root.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 3 - A 78-year-old man is receiving community physiotherapy after a prolonged period of immobility...

    Incorrect

    • A 78-year-old man is receiving community physiotherapy after a prolonged period of immobility caused by depression. He is experiencing difficulty with hip abduction. Which muscle is primarily responsible for this movement?

      Your Answer: Gluteus maximus

      Correct Answer: Gluteus medius

      Explanation:

      The correct muscle for hip abduction is the gluteus medius, which has anterior and posterior parts. The anterior part contributes to hip flexion and internal rotation, while the posterior part contributes to hip extension and external rotation. When both parts work together, they abduct the hip. The gluteus maximus primarily functions for hip extension and external rotation, while the hamstrings coordinate flexion and extension of the hip and knee joints but do not contribute to abduction. The iliopsoas primarily functions for hip extension.

      Anatomy of the Hip Joint

      The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

      There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

      The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 4 - A 50-year-old woman visits the rheumatology clinic due to worsening joint pain caused...

    Correct

    • A 50-year-old woman visits the rheumatology clinic due to worsening joint pain caused by her longstanding rheumatoid arthritis. Her symptoms have progressed to the point where she can no longer perform her daily activities. She is interested in trying infliximab after hearing about it from a friend and reading about it online. She wants to know how the drug works and how it can potentially alleviate her symptoms.

      What is the mechanism of action of infliximab?

      Your Answer: Anti-TNF

      Explanation:

      Infliximab targets TNF through its monoclonal antibody action, while rituximab targets CD20, cetuximab acts as an antagonist to epidermal growth factor receptor, alemtuzumab targets CD52, and OKT3 targets CD3.

      Understanding Tumour Necrosis Factor and its Inhibitors

      Tumour necrosis factor (TNF) is a cytokine that plays a crucial role in the immune system. It is mainly secreted by macrophages and has various effects on the immune system, such as activating macrophages and neutrophils, acting as a costimulator for T cell activation, and mediating the body’s response to Gram-negative septicaemia. TNF also has anti-tumour effects and binds to both the p55 and p75 receptor, inducing apoptosis and activating NFkB.

      TNF has endothelial effects, including increased expression of selectins and production of platelet activating factor, IL-1, and prostaglandins. It also promotes the proliferation of fibroblasts and their production of protease and collagenase. TNF inhibitors are used to treat inflammatory conditions such as rheumatoid arthritis and Crohn’s disease. Examples of TNF inhibitors include infliximab, etanercept, adalimumab, and golimumab.

      Infliximab is also used to treat active Crohn’s disease unresponsive to steroids. However, TNF blockers can have adverse effects such as reactivation of latent tuberculosis and demyelination. Understanding TNF and its inhibitors is crucial in the treatment of various inflammatory conditions.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 5 - A young adult is started on a novel medication for managing their Crohn's...

    Correct

    • A young adult is started on a novel medication for managing their Crohn's disease. They are advised that the medication is to be taken once a week and may elevate their susceptibility to infections. Additionally, folic acid is prescribed alongside the new medication to mitigate other potential adverse effects.

      What is the mode of action of this drug?

      Your Answer: Inhibits dihydrofolate reductase

      Explanation:

      Methotrexate inhibits dihydrofolate reductase to suppress the immune system and manage Crohn’s disease. This medication is taken once weekly and prescribed with folic acid. Methotrexate blocks the production of nucleotides, which impairs cell replication, particularly in rapidly replicating immune cells, leading to a reduced autoimmune response. Binding to steroid receptors, inhibiting dihydropteroate synthetase, and mimicking the shape of purines are incorrect answers. These mechanisms of action belong to other medications used to manage different conditions.

      Methotrexate is an antimetabolite that hinders the activity of dihydrofolate reductase, an enzyme that is crucial for the synthesis of purines and pyrimidines. It is a significant drug that can effectively control diseases, but its side-effects can be life-threatening. Therefore, careful prescribing and close monitoring are essential. Methotrexate is commonly used to treat inflammatory arthritis, especially rheumatoid arthritis, psoriasis, and acute lymphoblastic leukaemia. However, it can cause adverse effects such as mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, and liver fibrosis.

      Women should avoid pregnancy for at least six months after stopping methotrexate treatment, and men using methotrexate should use effective contraception for at least six months after treatment. Prescribing methotrexate requires familiarity with guidelines relating to its use. It is taken weekly, and FBC, U&E, and LFTs need to be regularly monitored. Folic acid 5 mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose. The starting dose of methotrexate is 7.5 mg weekly, and only one strength of methotrexate tablet should be prescribed.

      It is important to avoid prescribing trimethoprim or co-trimoxazole concurrently as it increases the risk of marrow aplasia. High-dose aspirin also increases the risk of methotrexate toxicity due to reduced excretion. In case of methotrexate toxicity, the treatment of choice is folinic acid. Overall, methotrexate is a potent drug that requires careful prescribing and monitoring to ensure its effectiveness and safety.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 6 - A 76-year-old man is experiencing symptoms suggestive of intermittent claudication. You plan to...

    Incorrect

    • A 76-year-old man is experiencing symptoms suggestive of intermittent claudication. You plan to evaluate the extent of his condition by measuring his ankle brachial pressure index. In order to do so, you need to locate the dorsalis pedis artery. Which of the following statements regarding this artery is incorrect?

      Your Answer: It is crossed by the tendon of extensor hallucis brevis

      Correct Answer: It originates from the peroneal artery

      Explanation:

      The anterior tibial artery continues directly into the dorsalis pedis artery.

      The foot has two arches: the longitudinal arch and the transverse arch. The longitudinal arch is higher on the medial side and is supported by the posterior pillar of the calcaneum and the anterior pillar composed of the navicular bone, three cuneiforms, and the medial three metatarsal bones. The transverse arch is located on the anterior part of the tarsus and the posterior part of the metatarsus. The foot has several intertarsal joints, including the sub talar joint, talocalcaneonavicular joint, calcaneocuboid joint, transverse tarsal joint, cuneonavicular joint, intercuneiform joints, and cuneocuboid joint. The foot also has various ligaments, including those of the ankle joint and foot. The foot is innervated by the lateral plantar nerve and medial plantar nerve, and it receives blood supply from the plantar arteries and dorsalis pedis artery. The foot has several muscles, including the abductor hallucis, flexor digitorum brevis, abductor digit minimi, flexor hallucis brevis, adductor hallucis, and extensor digitorum brevis.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 7 - A young girl comes to the clinic complaining of severe menstrual cramps that...

    Incorrect

    • A young girl comes to the clinic complaining of severe menstrual cramps that occur every month. Her physician assures her that this is a common issue and prescribes mefenamic acid as a pain reliever. What is the mechanism of action of mefenamic acid?

      Your Answer: Directly decreasing prostaglandin production

      Correct Answer: Inhibiting COX, decreasing prostaglandin production

      Explanation:

      Mefenamic acid is classified as an NSAID because it works by inhibiting COX, which ultimately leads to a decrease in prostaglandin production. Any response indicating an increase or alteration in prostaglandin levels would be inaccurate. The idea of blocking dorsal horn sodium channels is more characteristic of a neuropathic medication rather than an NSAID.

      Understanding Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and COX-2 Selective NSAIDs

      Non-steroidal anti-inflammatory drugs (NSAIDs) are medications that work by inhibiting the activity of cyclooxygenase enzymes, which are responsible for producing key mediators involved in inflammation such as prostaglandins. By reducing the production of these mediators, NSAIDs can help alleviate pain and reduce inflammation. Examples of NSAIDs include ibuprofen, diclofenac, naproxen, and aspirin.

      However, NSAIDs can also have important and common side-effects, such as peptic ulceration and exacerbation of asthma. To address these concerns, COX-2 selective NSAIDs were developed. These medications were designed to reduce the incidence of side-effects seen with traditional NSAIDs, particularly peptic ulceration. Examples of COX-2 selective NSAIDs include celecoxib and etoricoxib.

      Despite their potential benefits, COX-2 selective NSAIDs are not widely used due to ongoing concerns about cardiovascular safety. This led to the withdrawal of rofecoxib (‘Vioxx’) in 2004. As with any medication, it is important to discuss the potential risks and benefits of NSAIDs and COX-2 selective NSAIDs with a healthcare provider before use.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 8 - A 35-year-old male presents with weakness in his wrist and his fingers. His...

    Incorrect

    • A 35-year-old male presents with weakness in his wrist and his fingers. His hand appears 'clawed' with wasting of the lumbrical muscles and hypothenar eminence noted. There is numbness over his ring and little finger. He reports having fractured his arm eight weeks ago when he fell from his skateboard but adhered to keeping it immobilised in a cast as advised.

      What injury is likely to have caused this patient's presentation?

      Your Answer: Lateral epicondyle fracture

      Correct Answer: Medial epicondyle fracture

      Explanation:

      Humeral shaft fractures can result in a radial nerve palsy, also known as ‘Saturday night palsy’. This condition is characterized by wrist drop, which is the loss of function in the wrist and hand extensor muscles, as well as the inability to form a strong grip and loss of sensation in the first dorsal interosseous muscle.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 9 - Which of the following muscles is not involved in shoulder adduction? ...

    Incorrect

    • Which of the following muscles is not involved in shoulder adduction?

      Your Answer: Pectoralis major

      Correct Answer: Supraspinatus

      Explanation:

      The shoulder abductor is the supraspinatus.

      The shoulder joint is a shallow synovial ball and socket joint that is inherently unstable but capable of a wide range of movement. Stability is provided by the muscles of the rotator cuff. The glenoid labrum is a fibrocartilaginous rim attached to the free edge of the glenoid cavity. The fibrous capsule attaches to the scapula, humerus, and tendons of various muscles. Movements of the shoulder joint are controlled by different muscles. The joint is closely related to important anatomical structures such as the brachial plexus, axillary artery and vein, and various nerves and vessels.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 10 - Which of the metastatic bone tumours mentioned below is most susceptible to pathological...

    Incorrect

    • Which of the metastatic bone tumours mentioned below is most susceptible to pathological fracture?

      Your Answer: Peritrochanteric lesion from a prostate cancer

      Correct Answer: Peritrochanteric lesion from a carcinoma of the breast

      Explanation:

      Fracture risks are highest in peritrochanteric lesions due to loading. Lytic lesions from breast cancer are at greater risk of fracture compared to the sclerotic lesions from prostate cancer.

      Understanding the Risk of Fracture in Metastatic Bone Disease

      Metastatic bone disease is a condition where cancer cells spread to the bones from other parts of the body. The risk of fracture in this condition varies depending on the type of metastatic bone tumour. Osteoblastic metastatic disease has the lowest risk of spontaneous fracture compared to osteolytic lesions of a similar size. However, lesions affecting the peritrochanteric region are more prone to spontaneous fracture due to loading forces at that site. To stratify the risk of spontaneous fracture for bone metastasis of varying types, the Mirel Scoring system is used. This system takes into account the site of the lesion, radiographic appearance, width of bone involved, and pain. Depending on the score, the treatment plan may involve prophylactic fixation, consideration of fixation, or non-operative management. Understanding the risk of fracture in metastatic bone disease is crucial in determining the appropriate treatment plan for patients.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 11 - A 43-year-old woman visits her GP with a complaint of pain in her...

    Correct

    • A 43-year-old woman visits her GP with a complaint of pain in her left hand. She reports experiencing occasional pins and needles in her left thumb and index fingers on the palm of her hand for the past two months. The pain is more severe at night and sometimes prevents her from sleeping.

      Which nerve is responsible for her symptoms?

      Your Answer: Median nerve

      Explanation:

      The patient is experiencing paraesthesia (pins and needles) and pain in the thumb and index finger, which worsens at night. This is likely due to nerve compression, specifically the median nerve, which supplies sensation to the palmar aspect of the lateral 3½ fingers.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 12 - A 65-year-old man with critical limb ischaemia is having a femoro-distal bypass graft....

    Incorrect

    • A 65-year-old man with critical limb ischaemia is having a femoro-distal bypass graft. When mobilizing the proximal part of the posterior tibial artery, what is the most vulnerable structure to injury?

      Your Answer: Saphenous nerve

      Correct Answer: Tibial nerve

      Explanation:

      The posterior tibial artery and tibial nerve are in close proximity to each other. The nerve passes behind the vessel about 2.5cm below where it begins. Initially, the nerve is positioned on the medial side of the artery, but it shifts to the lateral side after crossing it.

      Anatomy of the Posterior Tibial Artery

      The posterior tibial artery is a major branch of the popliteal artery that terminates by dividing into the medial and lateral plantar arteries. It is accompanied by two veins throughout its length and its position corresponds to a line drawn from the lower angle of the popliteal fossa to a point midway between the medial malleolus and the most prominent part of the heel.

      The artery is located anteriorly to the tibialis posterior and flexor digitorum longus muscles, and posteriorly to the surface of the tibia and ankle joint. The posterior tibial nerve is located 2.5 cm distal to its origin. The proximal part of the artery is covered by the gastrocnemius and soleus muscles, while the distal part is covered by skin and fascia. The artery is also covered by the fascia overlying the deep muscular layer.

      Understanding the anatomy of the posterior tibial artery is important for medical professionals, as it plays a crucial role in the blood supply to the foot and ankle. Any damage or blockage to this artery can lead to serious complications, such as peripheral artery disease or even amputation.

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      • Musculoskeletal System And Skin
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  • Question 13 - Emma, a 26-year-old with ulcerative colitis attends for a routine clinic appointment. Her...

    Incorrect

    • Emma, a 26-year-old with ulcerative colitis attends for a routine clinic appointment. Her symptoms are now well-controlled on her current treatment. Her medication includes: azathioprine, citalopram, loperamide hydrochloride, paracetamol, salbutamol and a beclometasone dipropionate inhaler.

      You check her most recent blood tests and find the following results:

      Hb 98 g/l
      MCV 90 fl
      Platelets 124 x 109/l
      WBC 2.8 x 109/l
      CRP <5 mg/l

      Which medication is most likely to have contributed to these blood results?

      Your Answer: Paracetamol

      Correct Answer: Azathioprine

      Explanation:

      Regular monitoring of a patient’s full blood count is important when taking Azathioprine, as it is an immunosuppressant drug that may cause myelosuppression. Patients should also be educated on signs of infection to watch out for. However, Citalopram, paracetamol, and salbutamol are not known to cause myelosuppression. Although beclometasone dipropionate is a steroid, the small and localized dose in an inhaler makes it highly unlikely to have contributed to the patient’s myelosuppression.

      Azathioprine is a medication that is converted into mercaptopurine, which is an active compound that inhibits the production of purine. To determine if someone is at risk for azathioprine toxicity, a test for thiopurine methyltransferase (TPMT) may be necessary. Adverse effects of this medication include bone marrow depression, nausea and vomiting, pancreatitis, and an increased risk of non-melanoma skin cancer. If infection or bleeding occurs, a full blood count should be considered. It is important to note that there may be a significant interaction between azathioprine and allopurinol, so lower doses of azathioprine should be used. However, azathioprine is generally considered safe to use during pregnancy.

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      • Musculoskeletal System And Skin
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  • Question 14 - An elderly retired manual labourer in his late 60s presents to his GP...

    Incorrect

    • An elderly retired manual labourer in his late 60s presents to his GP with a complaint of gradual loss of extension in his 4th and 5th finger. During the examination, the doctor observes the presence of nodules between the affected fingers.

      What is the probable diagnosis for this patient?

      Your Answer: A trigger finger

      Correct Answer: Dupuytren's contracture

      Explanation:

      Dupuytren’s contracture commonly affects the ring finger and little finger, particularly in older males. This condition causes nodules and cord development in the palmar fascia, resulting in flexion at the metacarpophalangeal and proximal interphalangeal joints.

      Trigger finger causes stiffness, pain, and a locking sensation when flexing, making it difficult to extend the finger.

      Ganglion cysts, also known as bible cysts, are typically soft and found in the dorsal and volar aspect of the wrist. Many cysts will disappear on their own.

      Flexor tendon rupture is usually caused by trauma to the flexor tendon, such as a sports injury. This condition is typically acute and results in a sudden loss of flexion in the affected finger, often requiring surgery.

      Understanding Dupuytren’s Contracture

      Dupuytren’s contracture is a condition that affects about 5% of the population. It is more common in older men and those with a family history of the condition. The causes of Dupuytren’s contracture include manual labor, phenytoin treatment, alcoholic liver disease, diabetes mellitus, and trauma to the hand.

      The condition typically affects the ring finger and little finger, causing them to become bent and difficult to straighten. In severe cases, the hand may not be able to be placed flat on a table.

      Surgical treatment may be necessary when the metacarpophalangeal joints cannot be straightened.

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      • Musculoskeletal System And Skin
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  • Question 15 - A 50-year-old woman presents to the clinic with complaints of muscle aches that...

    Correct

    • A 50-year-old woman presents to the clinic with complaints of muscle aches that have been ongoing for more than a year. She reports that her chest and back are more affected than her limbs. She also mentions experiencing shortness of breath every 3 months. The patient leads a healthy lifestyle and does not drink or smoke.

      During the physical examination, the doctor observes a flat erythematous rash on the patient's torso and purple discoloration around her eyelids, which she has had for a long time. What is the antibody associated with this patient's condition?

      Your Answer: Anti-Jo-1

      Explanation:

      Dermatomyositis is characterized by muscle weakness, muscle pain, and a skin rash, and is often associated with the anti-Jo-1 antibody. The weakness typically affects proximal muscles and can even impact breathing, while systemic symptoms may include dysphagia, arrhythmias, and joint calcifications. One key feature to look out for is the heliotrope rash, which is a purple discoloration often seen in dermatomyositis cases.

      There are several other antibodies that can be associated with dermatomyositis, such as ANA, anti M2, and anti-Jo1. However, anti-Jo-1 is more commonly found in polymyositis, although it can also be present in dermatomyositis cases.

      Other antibodies that are associated with different autoimmune conditions include anti-smooth muscle antibody (autoimmune hepatitis), anti-histone (drug-induced lupus), and anti Scl-70 (scleroderma).

      Understanding Dermatomyositis

      Dermatomyositis is a condition that causes inflammation and weakness in the muscles, as well as distinct skin lesions. It can occur on its own or be associated with other connective tissue disorders or underlying malignancies. Patients with dermatomyositis may experience symmetrical, proximal muscle weakness, and photosensitive skin rashes. The skin lesions may include a macular rash over the back and shoulders, a heliotrope rash in the periorbital region, Gottron’s papules, and mechanic’s hands. Other symptoms may include Raynaud’s, respiratory muscle weakness, interstitial lung disease, dysphagia, and dysphonia.

      To diagnose dermatomyositis, doctors may perform various tests, including screening for underlying malignancies. The majority of patients with dermatomyositis are ANA positive, and around 30% have antibodies to aminoacyl-tRNA synthetases, such as anti-synthetase antibodies, antibodies against histidine-tRNA ligase (Jo-1), antibodies to signal recognition particle (SRP), and anti-Mi-2 antibodies.

      In summary, dermatomyositis is a condition that affects both the muscles and skin. It can be associated with other disorders or malignancies, and patients may experience a range of symptoms. Proper diagnosis and management are essential for improving outcomes and quality of life for those with dermatomyositis.

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      • Musculoskeletal System And Skin
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  • Question 16 - A 19-year-old male presents with a severe spreading sepsis in his hand. During...

    Incorrect

    • A 19-year-old male presents with a severe spreading sepsis in his hand. During surgical exploration of the palm, the flexor digiti minimi brevis muscle is mobilized to aid in drainage of the infection. Which of the following structures is not in close proximity to this muscle?

      Your Answer: Digital nerves arising from the ulnar nerve

      Correct Answer: Median nerve

      Explanation:

      The flexor digiti minimi brevis originates from the Hamate and is located beneath the ulnar contribution to the superficial palmar arterial arch and digital nerves. The median nerve is positioned over the flexor tendons.

      Anatomy of the Hand: Fascia, Compartments, and Tendons

      The hand is composed of bones, muscles, and tendons that work together to perform various functions. The bones of the hand include eight carpal bones, five metacarpals, and 14 phalanges. The intrinsic muscles of the hand include the interossei, which are supplied by the ulnar nerve, and the lumbricals, which flex the metacarpophalangeal joints and extend the interphalangeal joint. The thenar eminence contains the abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis, while the hypothenar eminence contains the opponens digiti minimi, flexor digiti minimi brevis, and abductor digiti minimi.

      The fascia of the palm is thin over the thenar and hypothenar eminences but relatively thick elsewhere. The palmar aponeurosis covers the soft tissues and overlies the flexor tendons. The palmar fascia is continuous with the antebrachial fascia and the fascia of the dorsum of the hand. The hand is divided into compartments by fibrous septa, with the thenar compartment lying lateral to the lateral septum, the hypothenar compartment lying medial to the medial septum, and the central compartment containing the flexor tendons and their sheaths, the lumbricals, the superficial palmar arterial arch, and the digital vessels and nerves. The deepest muscular plane is the adductor compartment, which contains adductor pollicis.

      The tendons of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) enter the common flexor sheath deep to the flexor retinaculum. The tendons enter the central compartment of the hand and fan out to their respective digital synovial sheaths. The fibrous digital sheaths contain the flexor tendons and their synovial sheaths, extending from the heads of the metacarpals to the base of the distal phalanges.

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      • Musculoskeletal System And Skin
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  • Question 17 - A 50-year-old woman comes to the emergency department complaining of crushing chest pain....

    Incorrect

    • A 50-year-old woman comes to the emergency department complaining of crushing chest pain. Her ECG shows no abnormalities. She has a medical history of rheumatoid arthritis managed with methotrexate, hypertension, and type II diabetes. Her BMI is 34 kg/m². As a healthcare provider, you initiate aspirin therapy.

      What is the most significant risk this patient is facing?

      Your Answer: Polymyositis

      Correct Answer: Bone marrow toxicity

      Explanation:

      Taking aspirin while on methotrexate treatment can be dangerous as it reduces the excretion of methotrexate, leading to an increased risk of toxicity and bone marrow problems. However, some studies suggest that methotrexate may be helpful in treating severe osteoarthritis and polymyositis. All other options are incorrect.

      Methotrexate is an antimetabolite that hinders the activity of dihydrofolate reductase, an enzyme that is crucial for the synthesis of purines and pyrimidines. It is a significant drug that can effectively control diseases, but its side-effects can be life-threatening. Therefore, careful prescribing and close monitoring are essential. Methotrexate is commonly used to treat inflammatory arthritis, especially rheumatoid arthritis, psoriasis, and acute lymphoblastic leukaemia. However, it can cause adverse effects such as mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, and liver fibrosis.

      Women should avoid pregnancy for at least six months after stopping methotrexate treatment, and men using methotrexate should use effective contraception for at least six months after treatment. Prescribing methotrexate requires familiarity with guidelines relating to its use. It is taken weekly, and FBC, U&E, and LFTs need to be regularly monitored. Folic acid 5 mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose. The starting dose of methotrexate is 7.5 mg weekly, and only one strength of methotrexate tablet should be prescribed.

      It is important to avoid prescribing trimethoprim or co-trimoxazole concurrently as it increases the risk of marrow aplasia. High-dose aspirin also increases the risk of methotrexate toxicity due to reduced excretion. In case of methotrexate toxicity, the treatment of choice is folinic acid. Overall, methotrexate is a potent drug that requires careful prescribing and monitoring to ensure its effectiveness and safety.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 18 - A teenage boy comes to the clinic with a winged scapula on his...

    Correct

    • A teenage boy comes to the clinic with a winged scapula on his right side after sustaining an injury while playing rugby. The physician informs him that a nerve has been affected. Which specific nerve is responsible for this?

      Your Answer: Long thoracic nerve

      Explanation:

      A mastectomy patient experiences winged scapula due to paralysis of the serratus anterior muscle, which is innervated by the long thoracic nerve. This nerve is often affected by rib injuries. The other nerves mentioned do not play a role in this disorder as they do not innervate this muscle. Damage to the musculocutaneous nerve would affect arm flexion, while damage to the axillary nerve would affect arm abduction. Damage to the thoracodorsal nerve would affect raising the trunk with the upper limb, and damage to the accessory nerve would affect neck movement.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 19 - A 9-year-old boy came to the clinic with a smooth, painless swelling on...

    Incorrect

    • A 9-year-old boy came to the clinic with a smooth, painless swelling on the superotemporal aspect of his orbit. There were no visual disturbances observed during examination. Upon excision, the lesion was found to be lined by squamous epithelium and hair follicles. Which of the following conditions is most similar to these findings?

      Your Answer: Schwannoma

      Correct Answer: Dermoid cyst

      Explanation:

      Dermoid cysts are remnants from embryonic development and can be lined with hair and squamous epithelium, similar to teratomas. They are typically found in the midline and may be connected to deeper structures, resulting in a dumbbell-shaped lesion. Complete removal is necessary as they have a tendency to recur locally if not completely excised.

      On the other hand, desmoid tumors are distinct from dermoid cysts. They usually develop in ligaments and tendons and are also known as aggressive fibromatosis. These tumors consist of dense fibroblasts, resembling scar tissue. Treatment for desmoid tumors should be similar to that of soft tissue sarcomas.

      Skin Diseases

      Skin diseases can be classified into malignant and non-malignant conditions. Malignant skin diseases include basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and Kaposi sarcoma. Basal cell carcinoma is the most common form of skin cancer and typically occurs on sun-exposed areas. Squamous cell carcinoma may arise from pre-existing solar keratoses and can metastasize if left untreated. Malignant melanoma is characterized by changes in size, shape, and color and requires excision biopsy for diagnosis. Kaposi sarcoma is a tumor of vascular and lymphatic endothelium and is associated with immunosuppression.

      Non-malignant skin diseases include dermatitis herpetiformis, dermatofibroma, pyogenic granuloma, and acanthosis nigricans. Dermatitis herpetiformis is a chronic itchy condition linked to underlying gluten enteropathy. Dermatofibroma is a benign lesion usually caused by trauma and consists of histiocytes, blood vessels, and fibrotic changes. Pyogenic granuloma is an overgrowth of blood vessels that may mimic amelanotic melanoma. Acanthosis nigricans is characterized by brown to black hyperpigmentation of the skin and is commonly caused by insulin resistance. In the context of a malignant disease, it is referred to as acanthosis nigricans maligna.

      In summary, skin diseases can range from benign to malignant conditions. It is important to seek medical attention for any suspicious skin lesions or changes in the skin’s appearance. Early diagnosis and treatment can improve outcomes and prevent complications.

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      • Musculoskeletal System And Skin
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  • Question 20 - Sophie, a 35-year-old female, is brought to the Emergency Department by ambulance after...

    Incorrect

    • Sophie, a 35-year-old female, is brought to the Emergency Department by ambulance after being involved in a car accident.

      Upon conducting several tests, an X-ray reveals that she has sustained a mid shaft humeral fracture.

      What is the structure that is typically most vulnerable to injury in cases of mid shaft humeral fractures?

      Your Answer: Axillary nerve

      Correct Answer: Radial nerve

      Explanation:

      The humerus is a long bone that runs from the shoulder blade to the elbow joint. It is mostly covered by muscle but can be felt throughout its length. The head of the humerus is a smooth, rounded surface that connects to the body of the bone through the anatomical neck. The surgical neck, located below the head and tubercles, is the most common site of fracture. The greater and lesser tubercles are prominences on the upper end of the bone, with the supraspinatus and infraspinatus tendons inserted into the greater tubercle. The intertubercular groove runs between the two tubercles and holds the biceps tendon. The posterior surface of the body has a spiral groove for the radial nerve and brachial vessels. The lower end of the humerus is wide and flattened, with the trochlea, coronoid fossa, and olecranon fossa located on the distal edge. The medial epicondyle is prominent and has a sulcus for the ulnar nerve and collateral vessels.

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      • Musculoskeletal System And Skin
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  • Question 21 - Which one of the following structures connects periosteum to bone? ...

    Incorrect

    • Which one of the following structures connects periosteum to bone?

      Your Answer: Fibrolamellar bundles

      Correct Answer: Sharpeys fibres

      Explanation:

      Sharpey’s fibers, which are strong collagenous fibers, attach the periosteum to the bone and extend to the outer circumferential and interstitial lamellae. Additionally, the periosteum serves as a point of attachment for muscles and tendons.

      Understanding Periosteum: The Membrane Covering Bones

      Periosteum is a membrane that envelops the outer surface of all bones, except at the joints of long bones. It is made up of dense irregular connective tissue and is divided into two layers: the outer fibrous layer and the inner cambium layer. The fibrous layer contains fibroblasts, while the cambium layer contains progenitor cells that develop into osteoblasts. These osteoblasts are responsible for increasing the width of a long bone and the overall size of other bone types.

      Periosteum is very sensitive to manipulation as it has nociceptive nerve endings. It also provides nourishment by supplying blood to the bone. The membrane is attached to the bone by strong collagenous fibers called Sharpey’s fibers, which extend to the outer circumferential and interstitial lamellae. Additionally, periosteum provides an attachment for muscles and tendons.

      After a bone fracture, the progenitor cells develop into osteoblasts and chondroblasts, which are essential to the healing process. Periosteum that covers the outer surface of the bones of the skull is known as pericranium, except when referring to the layers of the scalp. Understanding periosteum is crucial in comprehending bone structure and the healing process after a bone fracture.

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      • Musculoskeletal System And Skin
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  • Question 22 - A 26-year-old patient with a past medical history of Crohn's disease is initiated...

    Incorrect

    • A 26-year-old patient with a past medical history of Crohn's disease is initiated on azathioprine. What is the mode of action of azathioprine?

      Your Answer: Causes cross-linking in DNA

      Correct Answer: Inhibits purine synthesis

      Explanation:

      The active compound mercaptopurine, which inhibits purine synthesis, is produced through the metabolism of azathioprine, a purine analogue.

      Azathioprine is a medication that is converted into mercaptopurine, which is an active compound that inhibits the production of purine. To determine if someone is at risk for azathioprine toxicity, a test for thiopurine methyltransferase (TPMT) may be necessary. Adverse effects of this medication include bone marrow depression, nausea and vomiting, pancreatitis, and an increased risk of non-melanoma skin cancer. If infection or bleeding occurs, a full blood count should be considered. It is important to note that there may be a significant interaction between azathioprine and allopurinol, so lower doses of azathioprine should be used. However, azathioprine is generally considered safe to use during pregnancy.

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      • Musculoskeletal System And Skin
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  • Question 23 - A 42 year old woman comes to your general practice with a complaint...

    Incorrect

    • A 42 year old woman comes to your general practice with a complaint of right wrist pain that has been bothering her for a year. The pain worsens with flexion and she rates it as a 7 on the pain scale. She has tried pain medication but with little success. Upon examination, there is no indication of synovitis, but a small effusion is present in the right wrist. Onycholysis is also observed. Purple plaques are present on the extensor surfaces of the elbows bilaterally. What is the clinical diagnosis?

      Your Answer: Rheumatoid arthritis

      Correct Answer: Psoriatic arthritis

      Explanation:

      Psoriatic arthritis is strongly linked to psoriasis, with skin and nail bed changes serving as indicators of this related pathological process. Diagnosis is made through clinical evaluation. For comprehensive information on these conditions, Arthritis Research UK is a valuable resource.

      Psoriatic arthropathy is a type of inflammatory arthritis that is associated with psoriasis. It is classified as one of the seronegative spondyloarthropathies and is characterized by joint inflammation that often precedes the development of skin lesions. While it affects both males and females equally, only 10-20% of patients with psoriasis develop this condition. The presentation of psoriatic arthropathy can vary, with the most common types being symmetric polyarthritis and asymmetrical oligoarthritis. Other signs include psoriatic skin lesions, periarticular disease, and nail changes. X-rays may show erosive changes and new bone formation, as well as a pencil-in-cup appearance. Treatment is similar to that of rheumatoid arthritis, but mild cases may only require NSAIDs and newer monoclonal antibodies may be used. Overall, psoriatic arthropathy has a better prognosis than RA.

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      • Musculoskeletal System And Skin
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  • Question 24 - A 23-year-old individual arrives at the emergency department after experiencing a sharp pain...

    Correct

    • A 23-year-old individual arrives at the emergency department after experiencing a sharp pain on the right side of their chest while bench pressing 120kg at the gym. They heard a snapping noise and noticed swelling on the right side of their chest and bruising on their right arm. Upon examination, the right side of their chest appears asymmetrical with bunched up musculature, indicating a tear of the pectoralis major tendon. What is the typical insertion point for this tendon?

      Your Answer: Lateral lip of the intertubercular sulcus

      Explanation:

      The correct answer is the lateral lip of the intertubercular sulcus, which is the insertion site of the latissimus dorsi muscle.

      A ruptured pectoralis major tendon is a common injury in weight training, often occurring during the bench press exercise. The patient may experience a painful snap or hear a snapping noise, and the tension in the muscle is lost, causing the chest wall to lose its shape. Bruising may be visible on the chest or arm.

      Other anatomical features mentioned in the question include the lesser and greater tubercles of the humerus, which are insertion sites for various rotator cuff muscles, and the pectineal line on the femur, which is the insertion site for the pectineus muscle.

      Pectoralis Major Muscle: Origin, Insertion, Nerve Supply, and Actions

      The pectoralis major muscle is a large, fan-shaped muscle located in the chest region. It originates from the medial two thirds of the clavicle, manubrium, and sternocostal angle and inserts into the lateral edge of the bicipital groove of the humerus. The muscle is innervated by the lateral pectoral nerve and its main actions include adduction and medial rotation of the humerus.

      In simpler terms, the pectoralis major muscle is responsible for bringing the arm towards the body and rotating it inward. It is an important muscle for movements such as pushing, pulling, and lifting. The muscle is commonly targeted in strength training exercises such as bench press and push-ups. Understanding the origin, insertion, nerve supply, and actions of the pectoralis major muscle is important for proper exercise form and injury prevention.

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      • Musculoskeletal System And Skin
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  • Question 25 - A 28-year-old woman comes in with a pigmented lesion measuring 1.5cm on her...

    Incorrect

    • A 28-year-old woman comes in with a pigmented lesion measuring 1.5cm on her back. The surgeon suspects it may be a melanoma. What would be the best course of action?

      Your Answer: Wide excision of the lesion with 1 cm margins

      Correct Answer: Excisional biopsy of the lesion

      Explanation:

      It is not recommended to partially sample suspicious naevi as this can greatly compromise the accuracy of histological interpretation. Complete excision is necessary for lesions that meet diagnostic criteria. However, it may be acceptable to delay wide excision for margins until definitive histology results are available.

      When dealing with suspicious melanomas, it is important to excise them with complete margins. Radical excision is not typically performed for diagnostic purposes, so if subsequent histopathological analysis confirms the presence of melanoma, further excision of margins may be necessary. Incisional punch biopsies of potential melanomas can make histological interpretation challenging and should be avoided whenever possible.

      Malignant melanoma is a type of skin cancer that has four main subtypes: superficial spreading, nodular, lentigo maligna, and acral lentiginous. Nodular melanoma is the most aggressive, while the other forms spread more slowly. Superficial spreading melanoma typically affects young people on sun-exposed areas such as the arms, legs, back, and chest. Nodular melanoma appears as a red or black lump that bleeds or oozes and affects middle-aged people. Lentigo maligna affects chronically sun-exposed skin in older people, while acral lentiginous melanoma appears on nails, palms, or soles in people with darker skin pigmentation. Other rare forms of melanoma include desmoplastic melanoma, amelanotic melanoma, and melanoma arising in other parts of the body such as ocular melanoma.

      The main diagnostic features of melanoma are changes in size, shape, and color. Secondary features include a diameter of 7mm or more, inflammation, oozing or bleeding, and altered sensation. Suspicious lesions should undergo excision biopsy, and the lesion should be completely removed to facilitate subsequent histopathological assessment. Once the diagnosis is confirmed, the pathology report should be reviewed to determine whether further re-excision of margins is required. The margins of excision are related to Breslow thickness, with lesions 0-1mm thick requiring a margin of 1 cm, lesions 1-2mm thick requiring a margin of 1-2 cm (depending on site and pathological features), lesions 2-4mm thick requiring a margin of 2-3 cm (depending on site and pathological features), and lesions over 4mm thick requiring a margin of 3 cm. Further treatments such as sentinel lymph node mapping, isolated limb perfusion, and block dissection of regional lymph node groups should be selectively applied.

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      • Musculoskeletal System And Skin
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  • Question 26 - A 7-year-old girl is referred to a paediatrician by her dentist due to...

    Incorrect

    • A 7-year-old girl is referred to a paediatrician by her dentist due to dental imperfections. The child has a history of multiple fractures from minor injuries.

      During the examination, the paediatrician observes blue sclera in the child.

      The mother is informed of the diagnosis and the potential complications associated with it.

      What is a recognized complication of this condition?

      Your Answer: Fragile skin

      Correct Answer: Deafness

      Explanation:

      Patients with osteogenesis imperfecta typically develop the condition during childhood, with a medical history of multiple fractures from minor trauma and potential dental problems. Blue sclera is a common characteristic. Additionally, these patients may experience deafness due to otosclerosis.

      Ehlers-Danlos syndrome is characterized by hyperflexible joints, stretchy skin, and fragility.

      Wide spaced nipples are not typically associated with osteogenesis imperfecta, but rather with Turner syndrome.

      Understanding Osteogenesis Imperfecta

      Osteogenesis imperfecta, also known as brittle bone disease, is a group of disorders that affect collagen metabolism, leading to bone fragility and fractures. The most common type of osteogenesis imperfecta is type 1, which is inherited in an autosomal dominant manner and is caused by decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides.

      This condition typically presents in childhood, with individuals experiencing fractures following minor trauma. Other common features include blue sclera, deafness secondary to otosclerosis, and dental imperfections. Despite these symptoms, adjusted calcium, phosphate, parathyroid hormone, and ALP results are usually normal in individuals with osteogenesis imperfecta.

      Overall, understanding the symptoms and underlying causes of osteogenesis imperfecta is crucial for proper diagnosis and management of this condition.

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      • Musculoskeletal System And Skin
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  • Question 27 - A young woman presents with the inability to extend her wrist. Examination confirms...

    Incorrect

    • A young woman presents with the inability to extend her wrist. Examination confirms this and is consistent with a 'wrist drop'. Which nerve has most likely been affected?

      Your Answer: Ulnar nerve

      Correct Answer: Radial nerve

      Explanation:

      If the radial nerve is damaged, it can lead to wrist drop because it is responsible for innervating the extensor muscles that help extend the hand against gravity. This symptom is unique to radial nerve damage and is not seen with any of the other nerves listed.

      Damage to the axillary nerve would affect the deltoid muscle and cause problems with arm abduction.

      Impaired biceps brachii muscle function and arm flexion would result from damage to the musculocutaneous nerve.

      Damage to the ulnar nerve would cause weakness in the lateral two fingers, resulting in a claw-like appearance.

      Paralysis of the thenar muscles due to damage to the median nerve would lead to an inability to abduct and oppose the thumb.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 28 - A 60-year-old patient visits the GP with symptoms indicative of a rotator cuff...

    Incorrect

    • A 60-year-old patient visits the GP with symptoms indicative of a rotator cuff injury. The GP intends to assess the subscapularis muscle. What is the most suitable special test to examine the subscapularis muscle?

      Your Answer: Scarf test

      Correct Answer: Lift-off test

      Explanation:

      If a lift-off test shows abnormal results, it suggests that the subscapularis muscle may be involved.

      Rotator cuff injuries are a common cause of shoulder problems and can be classified into four types of disease: subacromial impingement, calcific tendonitis, rotator cuff tears, and rotator cuff arthropathy. The symptoms of a rotator cuff injury include shoulder pain that worsens during abduction. The signs of a rotator cuff injury include tenderness over the anterior acromion and a painful arc of abduction. The painful arc of abduction is typically between 60 and 120 degrees for subacromial impingement, while for rotator cuff tears, the pain may be in the first 60 degrees. Proper diagnosis and treatment are essential to prevent further damage and improve shoulder function.

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      • Musculoskeletal System And Skin
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  • Question 29 - A carpal tunnel release results in median nerve damage. Which muscles will be...

    Correct

    • A carpal tunnel release results in median nerve damage. Which muscles will be impacted by this in the patient?

      Your Answer: Abductor pollicis brevis

      Explanation:

      Only the abductor pollicis brevis is innervated by the median nerve, while the other muscles are innervated by different nerves. It is important to be careful not to confuse the terms adductor and abductor when discussing muscle innervation.

      Abductor Pollicis Brevis: Anatomy and Function

      The abductor pollicis brevis is a muscle located in the palm of the hand. It originates from the flexor retinaculum, scaphoid, and trapezium bones and inserts into the radial side of the proximal phalanx of the thumb via a short tendon. The muscle is innervated by the recurrent branch of the median nerve in the palm.

      The main function of the abductor pollicis brevis is to abduct the thumb at the carpometacarpal and metacarpophalangeal joints. This causes the thumb to move anteriorly at right angles to the plane of the palm and to rotate medially, which is useful for activities such as typing. When the thumb is fully abducted, there is an angulation of around 30 degrees between the proximal phalanx and the metacarpal.

      Abduction of the thumb involves medial rotation of the metacarpal, and the abductor pollicis brevis is used along with the opponens pollicis in the initial stages of thumb opposition. Overall, the abductor pollicis brevis plays an important role in the movement and function of the thumb.

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      • Musculoskeletal System And Skin
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  • Question 30 - A 28-year-old male presents to the emergency department with a complaint of right...

    Incorrect

    • A 28-year-old male presents to the emergency department with a complaint of right arm pain. He reports that the pain started abruptly while lifting weights at the gym and that his arm feels weaker than usual.

      Upon performing an ultrasound of the upper arm, a distal biceps tendon tear is identified.

      Which specific movement is expected to be impacted by this injury?

      Your Answer:

      Correct Answer: Supination and elbow flexion

      Explanation:

      The biceps brachii is mainly responsible for supination and elbow flexion. If the tendon associated with this muscle is torn, it can affect these movements.

      External rotation is primarily performed by the infraspinatus and teres minor muscles, not the biceps brachii.

      The teres major muscle, not the biceps brachii, is responsible for internal rotation.

      Pronation is performed by the pronator quadratus and pronator teres muscles, while elbow flexion is performed by the triceps muscle. Therefore, these actions are not associated with the biceps brachii.

      Shoulder abduction involves muscles such as the supraspinatus and deltoid, but it does not involve the biceps brachii.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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