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  • Question 1 - Sophie, a 27-year-old female, is brought to the Emergency Department by ambulance after...

    Incorrect

    • Sophie, a 27-year-old female, is brought to the Emergency Department by ambulance after being involved in a car accident. Upon examination, it is discovered that she has a surgical neck fracture of the humerus on X-ray.

      What is the structure that is most commonly at risk of damage with a surgical neck fracture of the humerus?

      Your Answer: Axillary artery

      Correct Answer: Axillary nerve

      Explanation:

      The most frequently occurring nerve injury in a surgical neck fracture of the humerus is damage to the axillary nerve. The radial nerve is at risk of injury in a mid shaft fracture of the humerus, as it passes through the radial groove. A supracondylar fracture of the humerus increases the likelihood of injury to the brachial artery, which can lead to volkmaan’s ischemic contractures.

      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.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      45.2
      Seconds
  • Question 2 - A 25-year-old man gets into a brawl and receives a cut on the...

    Incorrect

    • A 25-year-old man gets into a brawl and receives a cut on the back of his right arm, about 2 cm above the olecranon process. Upon examination at the ER, he is unable to straighten his elbow. Which tendon is the most probable one to have been severed?

      Your Answer: Pronator teres

      Correct Answer: Triceps

      Explanation:

      The elbow joint is extended by the triceps muscle, while the remaining muscles listed are responsible for flexion of the elbow joint.

      Anatomy of the Triceps Muscle

      The triceps muscle is a large muscle located on the back of the upper arm. It is composed of three heads: the long head, lateral head, and medial head. The long head originates from the infraglenoid tubercle of the scapula, while the lateral head originates from the dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve. The medial head originates from the posterior surface of the humerus on the inferomedial side of the radial groove and both of the intermuscular septae.

      All three heads of the triceps muscle insert into the olecranon process of the ulna, with some fibers inserting into the deep fascia of the forearm and the posterior capsule of the elbow. The triceps muscle is innervated by the radial nerve and supplied with blood by the profunda brachii artery.

      The primary action of the triceps muscle is elbow extension. The long head can also adduct the humerus and extend it from a flexed position. The radial nerve and profunda brachii vessels lie between the lateral and medial heads of the triceps muscle. Understanding the anatomy of the triceps muscle is important for proper diagnosis and treatment of injuries or conditions affecting this muscle.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      24.7
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  • Question 3 - A 25-year-old male arrives at the emergency department with a deep cut on...

    Correct

    • A 25-year-old male arrives at the emergency department with a deep cut on his left forearm following a knife assault. Upon examination, a deep laceration is observed on his anterior forearm, exposing muscle and subcutaneous tissue. He is unable to flex his left metacarpophalangeal and proximal interphalangeal joints, but his distal interphalangeal joint flexion remains intact. Which structure is the most likely to have been affected?

      Your Answer: Flexor digitorum superficialis

      Explanation:

      The forearm flexor muscles include the flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, and flexor digitorum profundus. These muscles originate from the common flexor origin and surrounding fascia, and are innervated by the median and ulnar nerves. Their actions include flexion and abduction of the carpus, wrist flexion, adduction of the carpus, and flexion of the metacarpophalangeal and interphalangeal joints.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      42.5
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  • Question 4 - A 67-year-old man with peripheral vascular disease is scheduled for a below knee...

    Incorrect

    • A 67-year-old man with peripheral vascular disease is scheduled for a below knee amputation. Can you identify the compartment in the lower leg where peroneus brevis is located?

      Your Answer: None of the above

      Correct Answer: Lateral compartment

      Explanation:

      The deep transverse fascia divides the leg into anterior and posterior compartments, while the interosseous membrane separates them. The lateral compartment includes the peroneus brevis muscle.

      Fascial Compartments of the Leg

      The leg is divided into compartments by fascial septae, which are thin layers of connective tissue. In the thigh, there are three compartments: the anterior, medial, and posterior compartments. The anterior compartment contains the femoral nerve and artery, as well as the quadriceps femoris muscle group. The medial compartment contains the obturator nerve and artery, as well as the adductor muscles and gracilis muscle. The posterior compartment contains the sciatic nerve and branches of the profunda femoris artery, as well as the hamstrings muscle group.

      In the lower leg, there are four compartments: the anterior, posterior (divided into deep and superficial compartments), lateral, and deep posterior compartments. The anterior compartment contains the deep peroneal nerve and anterior tibial artery, as well as the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius muscles. The posterior compartment contains the tibial nerve and posterior tibial artery, as well as the deep and superficial muscles. The lateral compartment contains the superficial peroneal nerve and peroneal artery, as well as the peroneus longus and brevis muscles. The deep posterior compartment contains the tibial nerve and posterior tibial artery, as well as the flexor hallucis longus, flexor digitorum longus, tibialis posterior, and popliteus muscles.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      19.5
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  • Question 5 - Which one of the following relationship descriptions regarding the scalene muscles is incorrect?...

    Incorrect

    • Which one of the following relationship descriptions regarding the scalene muscles is incorrect?

      Your Answer: The anterior scalene inserts into the first rib

      Correct Answer: The subclavian artery passes posterior to the middle scalene

      Explanation:

      The middle scalene is located posterior to the subclavian artery.

      The Scalene Muscles and Thoracic Outlet Syndrome

      The scalene muscles are a group of three paired muscles located in the neck that play a role in elevating the ribs and tilting the neck. The scalenus anterior and medius muscles elevate the first rib and laterally flex the neck to the same side, while the scalenus posterior muscle elevates the second rib and tilts the neck to the opposite side. These muscles are innervated by spinal nerves C4-6 and originate from the transverse processes of C2 to C7, inserting into the first and second ribs.

      The scalene muscles are important because the brachial plexus and subclavian artery pass between the anterior and middle scalenes through a space called the scalene hiatus or fissure. The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as it crosses over the first rib. However, the scalenes are at risk of adhering to the fascia surrounding the brachial plexus or shortening, which can cause compression of the brachial plexus when it passes between the clavicle and first rib. This condition is known as thoracic outlet syndrome.

      In summary, the scalene muscles play an important role in the neck and chest, but can also cause issues if they become adhered or shortened, leading to thoracic outlet syndrome. It is important to be aware of this condition and seek medical attention if experiencing symptoms such as pain, numbness, or tingling in the arm or hand.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      21.8
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  • Question 6 - Which structure divides the cephalic vein and the brachial artery in the antecubital...

    Incorrect

    • Which structure divides the cephalic vein and the brachial artery in the antecubital fossa?

      Your Answer: Brachioradialis muscle

      Correct Answer: Biceps muscle

      Explanation:

      The Antecubital Fossa: Anatomy and Clinical Significance

      The antecubital fossa is a depression located on the anterior aspect of the arm, between the arm and forearm. It is an important area for medical professionals as it is where venous blood samples are typically taken from. The borders of the antecubital fossa are the brachioradialis muscle laterally, the pronator teres medially, and a line between the medial and lateral epicondyles superiorly.

      There are both deep and superficial structures found in the antecubital fossa. Deep structures include the radial nerve, tendon of the biceps muscle, brachial artery, and medial nerve. Superficial structures consist of a network of veins, including the cephalic vein and basilic vein, which come together as the median cubital vein.

      The main clinical relevance of the antecubital fossa is its use for blood sampling and cannulation. However, it is also important to have a working knowledge of the anatomy as structures can become damaged. Excessive straining of the biceps tendon can cause it to rupture, leading to a ‘Popeye sign’. Damage to the medial nerve can also occur, resulting in muscle paralysis in the forearm and hand. Overall, understanding the anatomy and clinical significance of the antecubital fossa is crucial for medical professionals.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      29.8
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  • Question 7 - A 25-year-old female experiences repeated anterior dislocations of her left shoulder and a...

    Incorrect

    • A 25-year-old female experiences repeated anterior dislocations of her left shoulder and a CT scan shows a Bankart lesion. What is the name of the rotator cuff muscle tendon located at the front of the shoulder capsule?

      Your Answer: Supraspinatus tendon

      Correct Answer: Subscapularis tendon

      Explanation:

      The tendon of the subscapularis runs in front of the shoulder capsule, while the supraspinatus tendon runs above it. The tendons of the infraspinatus and teres minor run behind the shoulder capsule, with the infraspinatus tendon positioned above the teres minor tendon. It should be noted that the teres major muscle is not part of the rotator cuff. A Bankart lesion refers to a tear in the front part of the glenoid labrum and is commonly seen in cases of anterior shoulder dislocation.

      Understanding the Rotator Cuff Muscles

      The rotator cuff muscles are a group of four muscles that are responsible for the movement and stability of the shoulder joint. These muscles are known as the SItS muscles, which stands for Supraspinatus, Infraspinatus, teres minor, and Subscapularis. Each of these muscles has a specific function in the movement of the shoulder joint.

      The Supraspinatus muscle is responsible for abducting the arm before the deltoid muscle. It is the most commonly injured muscle in the rotator cuff. The Infraspinatus muscle rotates the arm laterally, while the teres minor muscle adducts and rotates the arm laterally. Lastly, the Subscapularis muscle adducts and rotates the arm medially.

      Understanding the functions of each of these muscles is important in diagnosing and treating rotator cuff injuries. By identifying which muscle is injured, healthcare professionals can develop a treatment plan that targets the specific muscle and promotes healing. Overall, the rotator cuff muscles play a crucial role in the movement and stability of the shoulder joint.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      36.5
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  • Question 8 - A 79-year-old man comes to your clinic with a protruding lump in his...

    Incorrect

    • A 79-year-old man comes to your clinic with a protruding lump in his upper arm that he noticed while gardening last week. He experienced a dull ache in the front of his shoulder at the time, but he is now pain-free and has full use of his arm. During the examination, you observe an asymmetry in the patient's arms, with a circular mass on the lower portion of his left arm. When you ask him to flex his biceps muscles, you notice that the affected arm displays the 'popeye sign.' Based on the patient's history and physical examination, it appears that he has a rupture of the long head of biceps brachii tendon. What is the origin of the long head of biceps brachii tendon?

      Your Answer: Greater tubercle of the humerus

      Correct Answer: Supraglenoid tubercle of the scapula

      Explanation:

      The long head of biceps tendon runs from the supraglenoid tubercle of the scapula. A ruptured tendon of the long head of biceps brachii is more common in older individuals and may present with the ‘Popeye’ sign. Management is dependent on the patient, with surgical repair for younger patients or those with co-existing rotator cuff tears, and a conservative approach for most patients.

      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
      42.9
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  • Question 9 - A 30-year-old construction worker presents to the GP with a complaint of right...

    Incorrect

    • A 30-year-old construction worker presents to the GP with a complaint of right forearm pain that started 2 days ago. He reports that the pain began suddenly after lifting heavy equipment and has been progressively worsening. Upon examination, there is noticeable swelling in the forearm, and the pain intensifies with flexion of the elbow. The GP suspects a possible injury to the brachioradialis muscle.

      Which nerve could have been impacted by this injury?

      Your Answer:

      Correct Answer: Radial nerve

      Explanation:

      The correct nerve that supplies innervation to the brachioradialis muscle is the radial nerve.

      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 10 - A teenage boy comes to the clinic with a winged scapula on his...

    Incorrect

    • 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:

      Correct 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
      0
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  • Question 11 - 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:

      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 12 - A 75-year-old woman presents with a five-day history of difficulty initiating abduction of...

    Incorrect

    • A 75-year-old woman presents with a five-day history of difficulty initiating abduction of her right arm. She denies any pain or previous shoulder issues and has not experienced any trauma. During examination, her passive range of motion is normal, but she is unable to begin abduction from a neutral position. However, if she uses her left arm to lift her right arm to approximately 15 degrees, she is then able to continue abduction without difficulty. Which muscle is responsible for initiating shoulder abduction?

      Your Answer:

      Correct Answer: Supraspinatus

      Explanation:

      The Supraspinatus muscle is responsible for starting the process of lifting the arm away from the body, up to a point of about 15 degrees. After this point, the Deltoid muscle takes over as the primary muscle responsible for continuing the arm’s upward movement. When the arm is lifted beyond 90 degrees, the Trapezius muscle comes into play, elevating the shoulder and rotating the scapula. Finally, the Infraspinatus muscle is responsible for producing lateral rotation of the arm at the shoulder.

      Understanding the Rotator Cuff Muscles

      The rotator cuff muscles are a group of four muscles that are responsible for the movement and stability of the shoulder joint. These muscles are known as the SItS muscles, which stands for Supraspinatus, Infraspinatus, teres minor, and Subscapularis. Each of these muscles has a specific function in the movement of the shoulder joint.

      The Supraspinatus muscle is responsible for abducting the arm before the deltoid muscle. It is the most commonly injured muscle in the rotator cuff. The Infraspinatus muscle rotates the arm laterally, while the teres minor muscle adducts and rotates the arm laterally. Lastly, the Subscapularis muscle adducts and rotates the arm medially.

      Understanding the functions of each of these muscles is important in diagnosing and treating rotator cuff injuries. By identifying which muscle is injured, healthcare professionals can develop a treatment plan that targets the specific muscle and promotes healing. Overall, the rotator cuff muscles play a crucial role in the movement and stability of the shoulder joint.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 13 - A 21-year-old male comes to you with sudden onset back pain following weightlifting...

    Incorrect

    • A 21-year-old male comes to you with sudden onset back pain following weightlifting at the gym. He reports a sharp pain that travels from his lower back down his legs. During the physical examination, you observe that the pain is replicated when he is lying on his back and you lift his leg. Additionally, he has decreased sensation on the top of his foot. Based on these findings, you suspect that he may have a herniated intervertebral disc.

      Which level is the most probable location of the herniated disc?

      Your Answer:

      Correct Answer: L5-S1

      Explanation:

      When a disc herniates at the L5-S1 level, it can impact the L5 spinal nerve and result in a loss of sensation on the top of the foot. Additionally, it can affect the function of the sciatic nerve, leading to pain that travels down the leg from the lower back. This pain can be detected through the sciatic nerve stretch test.

      If the disc herniation occurs at the L3-L4 level, it can cause a loss of sensation in the front of the thigh and knee. The femoral nerve stretch test would be positive in this case.

      Finally, if the disc herniation is at the S1-S2 level, it can cause a loss of sensation on the back and side of the leg, as well as the outer edge of the foot.

      Understanding Prolapsed Disc and its Features

      A prolapsed disc in the lumbar region can cause leg pain and neurological deficits. The pain is usually more severe in the leg than in the back and worsens when sitting. The features of the prolapsed disc depend on the site of compression. For instance, compression of the L3 nerve root can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, compression of the L4 nerve root can cause sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

      Similarly, compression of the L5 nerve root can cause sensory loss in the dorsum of the foot, weakness in foot and big toe dorsiflexion, intact reflexes, and a positive sciatic nerve stretch test. Lastly, compression of the S1 nerve root can cause sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and a positive sciatic nerve stretch test.

      The management of prolapsed disc is similar to that of other musculoskeletal lower back pain, which includes analgesia, physiotherapy, and exercises. However, if the symptoms persist even after 4-6 weeks, referral for an MRI is appropriate. Understanding the features of prolapsed disc can help in early diagnosis and prompt management.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 14 - A 50-year-old woman presents with two months of lower back pain. The pain...

    Incorrect

    • A 50-year-old woman presents with two months of lower back pain. The pain worsens during prolonged periods of sitting and shoots down her left leg. She is still able to perform all of her usual activities but has noticed that she has been catching her left foot on stairs when walking.

      On examination, power is normal in all myotomes of the right leg. In the left leg, dorsiflexion is slightly weak. The sensation is intact to touch and pin-prick on the right leg but there is a subjective loss of sensation along the sole of the left foot. Reflexes are normal. Hip abduction is assessed, which shows reduced power on the left compared to the right.

      An MRI is organised to assess for pathology.

      What spinal level corresponds to the symptoms?

      Your Answer:

      Correct Answer: Fifth lumbar vertebrae (L5)

      Explanation:

      Understanding Prolapsed Disc and its Features

      A prolapsed disc in the lumbar region can cause leg pain and neurological deficits. The pain is usually more severe in the leg than in the back and worsens when sitting. The features of the prolapsed disc depend on the site of compression. For instance, compression of the L3 nerve root can cause sensory loss over the anterior thigh, weak quadriceps, reduced knee reflex, and a positive femoral stretch test. On the other hand, compression of the L4 nerve root can cause sensory loss in the anterior aspect of the knee, weak quadriceps, reduced knee reflex, and a positive femoral stretch test.

      Similarly, compression of the L5 nerve root can cause sensory loss in the dorsum of the foot, weakness in foot and big toe dorsiflexion, intact reflexes, and a positive sciatic nerve stretch test. Lastly, compression of the S1 nerve root can cause sensory loss in the posterolateral aspect of the leg and lateral aspect of the foot, weakness in plantar flexion of the foot, reduced ankle reflex, and a positive sciatic nerve stretch test.

      The management of prolapsed disc is similar to that of other musculoskeletal lower back pain, which includes analgesia, physiotherapy, and exercises. However, if the symptoms persist even after 4-6 weeks, referral for an MRI is appropriate. Understanding the features of prolapsed disc can help in early diagnosis and prompt management.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 15 - Which muscle is responsible for causing flexion of the interphalangeal joint of the...

    Incorrect

    • Which muscle is responsible for causing flexion of the interphalangeal joint of the index finger?

      Your Answer:

      Correct Answer: Flexor pollicis longus

      Explanation:

      There are a total of 8 muscles that are involved in the movement of the thumb. These include two flexors, namely flexor pollicis brevis and flexor pollicis longus, two extensors, namely extensor pollicis brevis and longus, two abductors, namely abductor pollicis brevis and longus, one adductor, namely adductor pollicis, and one muscle that opposes the thumb by rotating the CMC joint, known as opponens pollicis. The flexor and extensor longus muscles are responsible for moving both the MCP and IP joints and insert on the distal phalanx.

      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.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
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  • Question 16 - A 17-year-old boy is out on a movie date with his girlfriend. During...

    Incorrect

    • A 17-year-old boy is out on a movie date with his girlfriend. During the film, he keeps his arm over her seat. However, when the movie ends, he realizes that he has limited wrist movement. Upon examination, he is unable to extend his wrist and has reduced sensation in his anatomical snuff box. Which nerve did he damage while at the cinema?

      Your Answer:

      Correct Answer: Radial

      Explanation:

      Saturday night syndrome is a condition where the brachial plexus is compressed due to sleeping with the arm over the back of a chair. This can result in a radial nerve palsy, commonly known as wrist drop, where the patient is unable to extend their wrist and it hangs flaccidly.

      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 17 - At what level does the inferior thyroid artery penetrate the thyroid gland? ...

    Incorrect

    • At what level does the inferior thyroid artery penetrate the thyroid gland?

      Your Answer:

      Correct Answer: C6

      Explanation:

      Surface Anatomy of the Neck: Identifying Structures and Corresponding Levels

      The neck is a complex region of the body that contains numerous structures and landmarks. By understanding the surface anatomy of the neck, healthcare professionals can accurately identify and locate important structures during physical examinations and medical procedures.

      In the midline of the neck, several structures can be felt from top to bottom. These include the hyoid at the level of C3, the notch of the thyroid cartilage at C4, and the cricoid cartilage at C6. The lower border of the cricoid cartilage is particularly significant as it corresponds to several important structures, including the junction of the larynx and trachea, the junction of the pharynx and esophagus, and the level at which the inferior thyroid artery enters the thyroid gland. Additionally, the vertebral artery enters the transverse foramen in the 6th cervical vertebrae at this level, and the superior belly of the omohyoid muscle crosses the carotid sheath. The middle cervical sympathetic ganglion is also located at this level, as well as the carotid tubercle, which can be used to compress the carotid artery.

      Overall, understanding the surface anatomy of the neck is crucial for healthcare professionals to accurately identify and locate important structures during physical examinations and medical procedures.

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  • Question 18 - A man in his early 50s complains of experiencing numbness and pain in...

    Incorrect

    • A man in his early 50s complains of experiencing numbness and pain in his right hand's thumb, index finger, and middle finger. Which nerve roots are most likely to be impacted?

      Your Answer:

      Correct Answer: C5-T1

      Explanation:

      Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

      There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

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  • Question 19 - A 22-year-old man presents to his GP complaining of ankle pain. He has...

    Incorrect

    • A 22-year-old man presents to his GP complaining of ankle pain. He has been training for a marathon and running up to 60 miles per week. During the examination, he experiences difficulty flexing his four lateral toes. The GP suspects tenosynovitis affecting his flexor digitorium longus.

      Which other muscles are part of the affected leg compartment?

      Your Answer:

      Correct Answer: Tibialis posterior, flexor hallucis longus, and popliteus

      Explanation:

      The muscles located in the deep posterior compartment include the Tibialis posterior, Flexor hallucis longus, Flexor digitorum longus, and Popliteus. The Flexor digitorum longus muscle is specifically affected in this compartment.

      Muscular Compartments of the Lower Limb

      The lower limb is composed of different muscular compartments that perform various actions. The anterior compartment includes the tibialis anterior, extensor digitorum longus, peroneus tertius, and extensor hallucis longus muscles. These muscles are innervated by the deep peroneal nerve and are responsible for dorsiflexing the ankle joint, inverting and evert the foot, and extending the toes.

      The peroneal compartment, on the other hand, consists of the peroneus longus and peroneus brevis muscles, which are innervated by the superficial peroneal nerve. These muscles are responsible for eversion of the foot and plantar flexion of the ankle joint.

      The superficial posterior compartment includes the gastrocnemius and soleus muscles, which are innervated by the tibial nerve. These muscles are responsible for plantar flexion of the foot and may also flex the knee.

      Lastly, the deep posterior compartment includes the flexor digitorum longus, flexor hallucis longus, and tibialis posterior muscles, which are innervated by the tibial nerve. These muscles are responsible for flexing the toes, flexing the great toe, and plantar flexion and inversion of the foot, respectively.

      Understanding the muscular compartments of the lower limb is important in diagnosing and treating injuries and conditions that affect these muscles. Proper identification and management of these conditions can help improve mobility and function of the lower limb.

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  • Question 20 - A 20-year-old man visits his GP with a complaint of right arm weakness...

    Incorrect

    • A 20-year-old man visits his GP with a complaint of right arm weakness that he noticed upon waking up after a night out. He is concerned that he may be experiencing a stroke, as his uncle had died from one.

      During the examination, the doctor observes that the patient's right arm is drooping to the side. There is a decrease in power for elbow and wrist extension, but elbow and wrist flexion remain intact.

      Which anatomical structure is most likely damaged, resulting in this patient's symptoms?

      Your Answer:

      Correct Answer: Radial nerve

      Explanation:

      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.

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  • Question 21 - A 25-year-old male patient visits his physician complaining of a rash that has...

    Incorrect

    • A 25-year-old male patient visits his physician complaining of a rash that has been present for two weeks. Upon examination, the doctor observes multiple oval-shaped lesions with a fine-scale on the outer aspects of the lesions. The rash has spread across the patient's trunk and back, resembling a fir tree. The patient reports feeling generally well. The doctor suspects pityriasis rosea and wonders which organism has been linked to its development.

      Your Answer:

      Correct Answer: Herpes hominis virus 7 (HHV-7)

      Explanation:

      Herpes hominis virus 7 (HHV-7) is believed to be involved in the development of pityriasis rosea, while the other choices are not linked to this condition. Slapped cheek syndrome is associated with Parvovirus B-19, while Coxsackie B virus is an enterovirus that is associated with aseptic meningitis, Bornholm disease, pericarditis, and myocarditis.

      Understanding Pityriasis Rosea

      Pityriasis rosea is a rash that typically affects young adults and is characterized by an acute, self-limiting nature. While the exact cause is not fully understood, it is believed that herpes hominis virus 7 (HHV-7) may play a role. Most patients do not experience any warning signs, but some may report a recent viral infection. The rash begins with a herald patch on the trunk, followed by oval, scaly patches that follow a distinct pattern with the longitudinal diameters running parallel to the line of Langer, creating a fir-tree appearance.

      The condition is self-limiting and usually disappears within 6-12 weeks. There is no specific treatment for pityriasis rosea, but topical agents used for psoriasis may be helpful. UVB phototherapy may also be an option. It is important to differentiate pityriasis rosea from guttate psoriasis, which is characterized by tear-drop shaped, scaly papules on the trunk and limbs. Guttate psoriasis is often preceded by a streptococcal sore throat, while pityriasis rosea may be associated with recent respiratory tract infections. Both conditions typically resolve spontaneously within a few months.

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  • Question 22 - A histopathologist receives multiple muscle tissue specimens and wants to identify the muscle...

    Incorrect

    • A histopathologist receives multiple muscle tissue specimens and wants to identify the muscle type based on the presence of nuclei. Which muscle type has a single nucleus located centrally along the muscle fiber?

      Your Answer:

      Correct Answer: Cardiac and smooth muscle

      Explanation:

      There are three categories of muscle: skeletal, cardiac, and smooth.

      The Process of Muscle Contraction

      Muscle contraction is a complex process that involves several steps. It begins with an action potential reaching the neuromuscular junction, which causes a calcium ion influx through voltage-gated calcium channels. This influx leads to the release of acetylcholine into the extracellular space, which activates nicotinic acetylcholine receptors, triggering an action potential. The action potential then spreads through the T-tubules, activating L-type voltage-dependent calcium channels in the T-tubule membrane, which are close to calcium-release channels in the adjacent sarcoplasmic reticulum. This causes the sarcoplasmic reticulum to release calcium, which binds to troponin C, causing a conformational change that allows tropomyosin to move, unblocking the binding sites. Myosin then binds to the newly released binding site, releasing ADP and pulling the Z bands towards each other. ATP binds to myosin, releasing actin.

      The components involved in muscle contraction include the sarcomere, which is the basic unit of muscles that gives skeletal and cardiac muscles their striated appearance. The I-band is the zone of thin filaments that is not superimposed by thick filaments, while the A-band contains the entire length of a single thick filament. The H-zone is the zone of the thick filaments that is not superimposed by the thin filaments, and the M-line is in the middle of the sarcomere, cross-linking myosin. The sarcoplasmic reticulum releases calcium ion in response to depolarization, while actin is the thin filaments that transmit the forces generated by myosin to the ends of the muscle. Myosin is the thick filaments that bind to the thin filament, while titin connects the Z-line to the thick filament, altering the structure of tropomyosin. Tropomyosin covers the myosin-binding sites on actin, while troponin-C binds with calcium ions. The T-tubule is an invagination of the sarcoplasmic reticulum that helps co-ordinate muscular contraction.

      There are two types of skeletal muscle fibres: type I and type II. Type I fibres have a slow contraction time, are red in colour due to the presence of myoglobin, and are used for sustained force. They have a high mitochondrial density and use triglycerides as

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  • Question 23 - Which one of the following structures is not closely related to the adductor...

    Incorrect

    • Which one of the following structures is not closely related to the adductor longus muscle? Also, can you provide information on the relationship between the adductor longus muscle and nearby structures for a 12-year-old student?

      Your Answer:

      Correct Answer: Tendon of iliacus

      Explanation:

      The femoral triangle is bordered by the Adductor longus medially, Inguinal ligament superiorly, and Sartorius muscle laterally. The Adductor longus muscle is located along the medial border of the femoral triangle and is closely associated with the long saphenous vein and the profunda branch of the femoral artery. The femoral nerve is located inferiorly to the Adductor longus muscle. However, the tendon of iliacus inserts proximally and does not come into contact with the Adductor longus muscle.

      Adductor Longus Muscle

      The adductor longus muscle originates from the anterior body of the pubis and inserts into the middle third of the linea aspera. Its main function is to adduct and flex the thigh, as well as medially rotate the hip. This muscle is innervated by the anterior division of the obturator nerve, which originates from the spinal nerves L2, L3, and L4. The adductor longus is one of the adductor muscles, which are a group of muscles located in the thigh that work together to bring the legs towards the midline of the body. The schematic image below illustrates the relationship of the adductor muscles.

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  • Question 24 - A 50-year-old male presents to the emergency department after sustaining a high-impact golf...

    Incorrect

    • A 50-year-old male presents to the emergency department after sustaining a high-impact golf ball injury to his foot while playing golf. Upon examination, there is bruising around the lateral malleolus and loss of sensation to the lateral foot. Palpation reveals tenderness in the lateral malleolus. An X-ray confirms a posteriorly displaced fracture of the lateral malleolus. What structure is likely to have been affected by this displacement?

      Your Answer:

      Correct Answer: Sural nerve

      Explanation:

      The sural nerve is situated behind the lateral malleolus, which is commonly fractured due to direct trauma. In this patient, the lateral malleolus fracture is displaced posteriorly, posing a risk of direct compression and potential injury to the sural nerve. Other structures located behind the lateral malleolus include the short saphenous vein, peroneus longus tendon, and peroneus brevis tendon. The anterior talofibular ligament is a flat band that extends from the front edge of the lateral malleolus to the neck of the talus, just ahead of the fibular facet. The remaining options are incorrect.

      Anatomy of the Lateral Malleolus

      The lateral malleolus is a bony prominence on the outer side of the ankle joint. Posterior to the lateral malleolus and superficial to the superior peroneal retinaculum are the sural nerve and short saphenous vein. These structures are important for sensation and blood flow to the lower leg and foot.

      On the other hand, posterior to the lateral malleolus and deep to the superior peroneal retinaculum are the peroneus longus and peroneus brevis tendons. These tendons are responsible for ankle stability and movement.

      Additionally, the calcaneofibular ligament is attached at the lateral malleolus. This ligament is important for maintaining the stability of the ankle joint and preventing excessive lateral movement.

      Understanding the anatomy of the lateral malleolus is crucial for diagnosing and treating ankle injuries and conditions. Proper care and management of these structures can help prevent long-term complications and improve overall ankle function.

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  • Question 25 - A 40-year-old man with a diagnosis of chronic fatigue syndrome visits his GP...

    Incorrect

    • A 40-year-old man with a diagnosis of chronic fatigue syndrome visits his GP reporting a recent worsening of his symptoms following a strenuous workout. The GP decides to conduct routine blood tests.

      What are the most probable results that the GP will discover assuming that the patient's current condition is the cause of the exacerbation?

      Your Answer:

      Correct Answer: Normal ESR, normal haemoglobin

      Explanation:

      Graded exercise therapy is often recommended for chronic fatigue syndrome as symptoms can worsen after over-exercising. Routine blood tests are used to rule out other potential causes of the symptoms, such as anaemia or underlying inflammatory diseases, as chronic fatigue syndrome is a diagnosis of exclusion.

      Understanding Chronic Fatigue Syndrome

      Chronic fatigue syndrome is a condition that is diagnosed after at least four months of disabling fatigue that affects mental and physical function more than 50% of the time, in the absence of other diseases that may explain the symptoms. It is more common in females, and past psychiatric history has not been shown to be a risk factor. Fatigue is the central feature of this condition, and other recognized features include sleep problems, muscle and/or joint pains, headaches, painful lymph nodes without enlargement, sore throat, cognitive dysfunction, physical or mental exertion that makes symptoms worse, general malaise or ‘flu-like’ symptoms, dizziness, nausea, and palpitations.

      To diagnose chronic fatigue syndrome, a large number of screening blood tests are carried out to exclude other pathology, such as FBC, U&E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin*, coeliac screening, and urinalysis. The management of chronic fatigue syndrome includes cognitive behavior therapy, which is very effective, with a number needed to treat of 2. Graded exercise therapy is also recommended, which is a formal supervised program, not advice to go to the gym. ‘Pacing’ is another management technique, which involves organizing activities to avoid tiring. Low-dose amitriptyline may be useful for poor sleep, and referral to a pain management clinic is recommended if pain is a predominant feature. Children and young people have a better prognosis than adults.

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  • Question 26 - A 35-year-old woman presents to your clinic complaining of increased joint pain and...

    Incorrect

    • A 35-year-old woman presents to your clinic complaining of increased joint pain and fatigue. She reports no significant medical history but mentions that her sister was recently diagnosed with systemic lupus erythematosus (SLE). On examination, there are no notable findings. Laboratory tests reveal the following results:

      - Hemoglobin: 118 g/L (normal range for females: 115-160 g/L)
      - Platelets: 260 * 109/L (normal range: 150-400 * 109/L)
      - White blood cells: 7.5 * 109/L (normal range: 4.0-11.0 * 109/L)
      - ANA: Negative
      - ANCA: Negative
      - Anti-La antibody: Negative
      - Rheumatoid factor: Positive

      Which blood test result is the most reliable indicator that SLE is unlikely in this patient?

      Your Answer:

      Correct Answer: ANA (antinuclear antibodies)

      Explanation:

      Systemic lupus erythematosus (SLE) can be investigated through various tests, including antibody tests. ANA testing is highly sensitive and useful for ruling out SLE, but it has low specificity. About 99% of SLE patients are ANA positive. Rheumatoid factor testing is positive in 20% of SLE patients. Anti-dsDNA testing is highly specific (>99%) but less sensitive (70%). Anti-Smith testing is also highly specific (>99%) but has a lower sensitivity (30%). Other antibody tests that can be used include anti-U1 RNP, SS-A (anti-Ro), and SS-B (anti-La).

      Monitoring of SLE can be done through various markers, including inflammatory markers such as ESR. During active disease, CRP levels may be normal, and a raised CRP may indicate an underlying infection. Complement levels (C3, C4) are low during active disease due to the formation of complexes that lead to the consumption of complement. Anti-dsDNA titres can also be used for disease monitoring, but it is important to note that they are not present in all SLE patients. Overall, these investigations can help diagnose and monitor SLE, allowing for appropriate management and treatment.

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  • Question 27 - You are the physician attending to a 32-year-old expectant mother who is experiencing...

    Incorrect

    • You are the physician attending to a 32-year-old expectant mother who is experiencing discomfort in her thumb and index finger. She reports paraesthesia in the palmar region of her thumb and index finger, which worsens at night.

      What nerve is likely to be impacted?

      Your Answer:

      Correct Answer: Median

      Explanation:

      The patient is experiencing pins and needles and pain in the thumb and index finger, which worsens at night. These symptoms are indicative of carpal tunnel syndrome, which occurs when the median nerve is compressed due to increased pressure in the carpal tunnel. The distribution of the patient’s symptoms aligns with the area supplied by the median nerve.

      The inferior lateral cutaneous nerve does not innervate the thumb and index finger, so it cannot explain the patient’s symptoms. Damage to the musculocutaneous nerve would cause weakness in the upper arm flexors and impaired sensation in the lateral forearm, but not in the thumb and index finger.

      The radial nerve is responsible for wrist extension, and damage to it would result in wrist drop and altered sensation in the dorsum of the hand. The ulnar nerve causes clawing of the hand and paraesthesia in the medial two fingers when damaged, which is not consistent with the patient’s symptoms.

      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.

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  • Question 28 - A 55-year-old male visited his doctor complaining of pain and paresthesia in his...

    Incorrect

    • A 55-year-old male visited his doctor complaining of pain and paresthesia in his right hand, especially upon waking up. During the examination, the doctor observed weakness in the affected hand and a sensory disturbance in the front of his thumb and index finger. The patient was subsequently referred to an orthopaedic specialist who identified the ailment as carpal tunnel syndrome. What anatomical structure passes through the carpal tunnel?

      Your Answer:

      Correct Answer: Flexor pollicis longus

      Explanation:

      The median nerve innervates the abductor pollicis brevis and flexor pollicis brevis muscles. To remember other muscles innervated by the median nerve, use the acronym LOAF for lumbricals (first and second), opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis. De Quervain Syndrome affects the extensor pollicis brevis and abductor pollicis longus muscles. Structures within the carpal tunnel include the flexor digitorum profundus (four tendons), flexor digitorum superficialis (four tendons), flexor pollicis longus, and median nerve.

      Carpal tunnel syndrome is a condition that occurs when the median nerve in the carpal tunnel is compressed. This can cause pain and pins and needles sensations in the thumb, index, and middle fingers. In some cases, the symptoms may even travel up the arm. Patients may shake their hand to alleviate the discomfort, especially at night. During an examination, weakness in thumb abduction and wasting of the thenar eminence may be observed. Tapping on the affected area may also cause paraesthesia, and flexing the wrist can trigger symptoms.

      There are several potential causes of carpal tunnel syndrome, including idiopathic factors, pregnancy, oedema, lunate fractures, and rheumatoid arthritis. Electrophysiology tests may reveal prolongation of the action potential in both motor and sensory nerves. Treatment options may include a six-week trial of conservative measures such as wrist splints at night or corticosteroid injections. If symptoms persist or are severe, surgical decompression may be necessary, which involves dividing the flexor retinaculum.

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  • Question 29 - Liam, a 4-year-old boy, is brought to the emergency department by his parents....

    Incorrect

    • Liam, a 4-year-old boy, is brought to the emergency department by his parents. They report that Liam has been holding his left arm close to his body and not using it much since they were playing catch in the backyard.

      During examination, the doctor observes that Liam's left arm is slightly bent at the elbow and turned inward. The doctor diagnoses a pulled elbow and successfully reduces it.

      What is the anomaly associated with this condition?

      Your Answer:

      Correct Answer: Subluxation of radial head

      Explanation:

      In children, the annular ligament is weaker, which can result in subluxation of the radial head during a pulled elbow. It’s important to note that a subluxation is a partial dislocation, meaning there is still some joint continuity, whereas a dislocation is a complete disruption of the joint. Additionally, a fracture refers to a break in the bone itself. It’s worth noting that the ulnar is not implicated in a pulled elbow.

      Subluxation of the Radial Head in Children

      Subluxation of the radial head, also known as pulled elbow, is a common upper limb injury in children under the age of 6. This is because the annular ligament covering the radial head has a weaker distal attachment in children at this age group. The signs of this injury include elbow pain and limited supination and extension of the elbow. However, children may refuse examination on the affected elbow due to the pain.

      To manage this injury, analgesia is recommended to alleviate the pain. Additionally, passively supinating the elbow joint while the elbow is flexed to 90 degrees can help alleviate the subluxation. It is important to seek medical attention if the pain persists or worsens.

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  • Question 30 - Which muscle is responsible for causing flexion of the distal interphalangeal joint of...

    Incorrect

    • Which muscle is responsible for causing flexion of the distal interphalangeal joint of the middle finger?

      Your Answer:

      Correct Answer: Flexor digitorum profundus

      Explanation:

      The flexor digitorum superficialis and flexor digitorum profundus muscles are accountable for inducing flexion. The tendons of the superficialis muscle attach to the bases of the middle phalanges, while the tendons of the profundus muscle attach to the bases of the distal phalanges. Both tendons are responsible for flexing the wrist, MCP, and PIP joints, but only the tendons of the profundus muscle are responsible for flexing the DIP joints.

      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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