Clinical Anatomy Problems Flashcards
(33 cards)
A sick college freshman comes to see you with headache, fever and vomiting. Upon physical examination you note stiffness in his neck. You decide to do a spinal tap to see if he has meningitis. When doing the procedure, how do you want to position the patient and why?
You will put the patient in the fetal position lying on one side. This is so you can open up the posterior space between the lumbar vertebrae and stretch out the ligamentum flavum so it is easier to get the needle into the lumbar cistern.
A 55 year old male comes to the ER complaining of onset of paralysis in his legs and incontinence. Personal history only indicates atherosclerosis and a previous heart attack. What is the most likely cause of paralysis?
Obstructive arterial disease can occlude segmental medullary arteries that supply blood to the spinal cord (specifically the great anterior medullary artery of Adamkeiwicz). Blockage of blood supply to nerves = paralysis.
A 16 year old female comes to see you after taking a fall during gymnastics. She complains of back pain that she cannot resolve with Ibuprofen. You order an X-ray and note spondylolysis. What bone has she broken?
The pars interarticularis of the vertebrae
You wake up after a party and see your buddy passed out with his arm hanging over a chair. He wakes up and tells you he cannot hold anything with that hand. He looks at you and says, it just needs to wake up. What do you tell him?
He compressed his radial nerve all night and nerve compressions are serious injuries that are sometimes not recoverable.
After a car crash, a 25 year old male has erectile dysfunction. You suspect it is due to a nerve injury. Trace the path of the nerve from the effector organ to where signal should initiate.
Moving up the axon from the synaptic cleft in the effector organ, you will soon hit the post-synaptic neuron cell body in ganglia that resides near the effector organ. Moving up that you hit the axon of the presynaptic neuron that came a long way from the sacrum.
You are performing an epidural anesthetic injection for a laboring pregnant woman. She jerks due to a contraction while you have the needle in her back but she is uninjured. Minutes later she experiences a horrible onset of headaches. Through what layer in the spinal cord did your needle go through when she jerked?
The arachnoid matter. Puncturing this layer allows CSF contained in the subarachnoid space to leak out and put pressure on the spinal cord, resulting in a dural headache.
You are performing a cordotomy on a patient with lots of pressure and pain in his legs. What landmark do you use to make sure you cut the right nerve and which nerve do you want to cut?
You use the denticulate ligament as a landmark for the dorsal and ventral roots. You want to cut the dorsal root because it is sensory.
A 22 year old football player comes to see you complaining of acute low back pain after competing in a dead lift competition. After telling him he has a “slipped disc”, he tells you he is premed and wants to know what actually happened. What do you say?
When he leans forward to perform the dead lift the flexion of the spine pushes the nucleus pulposis in his disc posteriorly and it creates pressure against the annulus fibrosus. When he lifts, the annulus fibrosus breaks, fluid from the nucleus pulposis is ejected into the vertebral canal and pressure on spinal nerves creates this acute pain.
A high school football player gets hit in the head and instantly cannot move anymore. What are likely mechanisms of paralysis from getting hit in the head?
Fractured dens, torn transverse ligament or torn alar ligament.
A patient gets into a car accident and claims they had sever whiplash and want to sue the person that hit them. What do you recommend before she goes on to sue?
Get an MRI to use as evidence that the anterior longitudinal ligament was torn due to whiplash.
A 23 year old medic was injured in an IED blast and you think he may have broken his lower back. What is the most likely vertebrae to be broken in a blast?
T12. It is the link between the stiff thoracic vertebrae and the flexible lumbar vertebrae.
A baby does not learn to walk until two years old. What effect might this have on the development of the child’s spine?
When babies are born the entire spine is kyphosis. Learning to lift their head develops cervical lordosis and walking develops lumbar lordosis. This child may have decreased lumbar lordosis.
A 65 year old woman complains of chronic low back pain. The radiograph indicates extensive osteoarthritis and you decide to perform a rhizotomy on the patient’s low back spinal nerves to relieve her pain. Which joints will be denervated by your treatment?
Zygopophyseal joints. These are the joints between the SAP and IAP of the vertebrae and often become arthritic and cause low back pain.
You diagnose a patient with HNP. What joint does this patient have a problem with?
Symphyseal joint. These “joints” are just your discs.
A patient experiencing low back pain requests that you give them a caudal epidural steroid injection. You agree that it could help and do the procedure. Where do you inject the steroid and where does it go?
You enter through the sacral hiatus, pierce the sacrococcygeal ligament and inject steroid in the space where the cauda equina resides.
What cervical joints are highly susceptible to development of osteophytes?
Uncovertebral joints on the vertebral body
Twin brothers both diagnosed with connective tissue disorders come to see you. One is having issues with hyperflexion of his AA joint and the other with hyperextension of his AA joint. Which tendons are experiencing problems in these brothers?
The anterior longitudinal ligament in the spine prevents hyperextension and the posterior longitudinal ligament prevents hyperflexion.
People often say, use your legs not your back when lifting heavy things. Exactly what muscles of the back are they telling you that your should not use?
Erector spinae (Iliocostalis, longissimus, semispinalis) because they put pressure on the ligaments in your back when flexed
Regardless of the level, what structure do you want to be inferior to when performing a spinal tap?
Conus medullaris in the lumbar cistern. This is the terminal end of the spinal cord.
A soldier is hit by an IED and nerves severed by shrapnel. What is the highest nerve level that could be severed where he could still self feed?
C6-C8. C4-C5 results in quadriplegia.
You see a patient who was bucked from a bull in a rodeo. His arm hangs to the side and the lateral part of his forearm has lost sensation. What muscles have been affected in this injury?
This is likely an upper brachial plexus injury (Erb-Duchenne Palsy). This happens as a result of trauma pulling or stretching the C5 and C6 portions of the plexus away from the spinal cord. This results in loss of function in the deltoid, biceps and brachialis muscles.
Your friend calls you while backpacking with a pack full of canned food. He tells you he started having muscle spasms in his arm after ten hours of hiking. What is likely being damaged by his heavy backpack?
This is due to chronic injury to superior portions of the brachial plexus that result in Backpacker’s Palsy. The weight of the backpack results in damage to the musculocutaneous and radial nerves.
A patient comes in the day after receiving a vaccination complaining of muscle weakness in her arm. It started as severe shoulder pain the night before. What do you think her condition is?
Acute brachial plexus neuritis.
You see a patient who spent the day painting the ceiling in his house. He complains of tingling down his arm and weak grip. You note that his arm is erythematous. Why did painting his ceiling cause these problems?
The cords of the brachial plexus were likely compressed between the coracoid process and pectoralis minor tendon.
