Clinical correlates

Question 1

What is Torticollis?

Answer 1

when head is flexed and rotated away from affected side. Caused by persistent contraction or shortening of sternocleidomastoid m.

Question 2

Lesion in CN XI

Answer 2

weakening of sternocleidomastoid m. and trapezius m.

Question 3

Paralysis in suprascapular nerve causes?

Answer 3

individual cannot initiate abduction of arm.

Question 4

What do the rotator cuff muscles do?

Answer 4

They are the main source of stability of the glenohumeral joint and maintain the head of the humerus in place

Question 5

What would cause a dimpling of the skin in the breast?

Answer 5

traction on the suspensory ligaments of the breast (AKA cooper’s ligaments) by a tumer will cause this.

Question 6

What does it mean if the breast skin becomes thickened, resembling an orange peel?

Answer 6

Lymphatic drainage is blocked in the breast area (75% of lymphatic drainage is to the axillary nodes)

Question 7

What is “Tennis elbow”?

Answer 7

Tendonitis of the common extensor tendon at the lateral epicondyle

Question 8

What is “Student’s elbow”?

Answer 8

Bursitis of the superficial olecranon bursa from rubbing of the elbows on a desk top

Question 9

What is “Pulled elbow”?

Answer 9

In young children, it is a tear in the annular ligament of the radius, a result from a sudden jerk/pull on a pronated forearm that allows par tof the head of the radius to slip out of place.

Question 10

Erb-Duchenne Palsy (AKA Erb’s palsy):

How does this usually happen?

Nickname?

Qualitative result?

Roots lesioned?

Nerves affected?

Muscles paralyzed?

Answer 10

Happens when neck and shoulder are violently separated.

Nickname: Waiter’s Tip

Qual. result: arm hangs limply by side in medial rotation and pronated so that plam faces posteriorly

Roots lesioned: C5&6

Nerves affected: Suprascapular, musculocutaneous, axillary (Remember: SAM the WAITER wants a TIP)

Muscles paralyzed: all rotator cuff except subscapularis, biceps brachii, brachialis, coracobrachialis, and deltoid

Question 11

Klumpke’s Palsy

Qualitative result?

Roots lesioned?

Nerves affected?

Muscles paralyzed?

Answer 11

Qualitative result: clawed hand

Roots lesioned: C8 & T1

Nerves affected: Ulnar and Median

Muscles paralyzed: all intrinsic muscles of hand

Question 12

What nerve can be damaged by a fracture of the:

1. surgical neck of the humerus?
2. distal humerus?
3. shaft of humerus at radial groove?

Answer 12

1. Axillary n.
2. median n.
3. Radial n.

Question 13

Which bone of the wrist is the most commonly fractured bone?

Which bone is easily dislocated during hyperextension?

Answer 13

scaphoid bone;

lunate bone

Question 14

What is carpal tunnel syndrome?

Answer 14

compression of structures deep to the flexor retinaculum and impairment of the median n., the thumb is the most affected.

Question 15

A shortening of the fibers of the palmar aponeurosis is called ___. What is the result?

Answer 15

Dupuytren’s contracture; the fingers curl into flexion (especially the 4th finger)

Question 16

What are the 3 pathological curvatures of the vertebral column?

Answer 16

1. Kyphosis: (humpback) exaggerated posterior curvature
2. Lordosis: exaggerated anterior curvature
3. Scoliosis: Lateral curvature

Question 17

Paraplegia results from:

Answer 17

Spinal cord transection b/w cervical and lumbosacral enlargments

Question 18

Quadriplegia results from:

Answer 18

Spinal cord transection superior to C3

Question 19

Where is a lumbar puncture performed?

Answer 19

B/w spinous processes of L3/L4 or L4/L5

Question 20

Where is spinal anesthesia injected for a spinal block?

What about an epidural block?

Answer 20

CSF of the lumbar cistern;

Epidural space, inserting needle b/w L3/L4, L4/L5 or into the sacral hiatus. Note this takes a longer time to take effect and more anesthetic is needed.

Question 21

When there is a problem at or near the root of a nerve, and the pain is localized to the body surface along the dermatomal distribution of that n. this is called:

Answer 21

Radiculopathy

Question 22

What is sciatica (aka sciatic radiculopathy)?

Answer 22

Pain resulting from irritation of the sciatic n.

Question 23

What is phantom pain and referred pain?

Answer 23

Phantom pain: irritation of the cut stumps of amputated n.’s

Referred pain: stimulation of pain fibers in one region, but the brain localizes the pain to a region innervated by a different n. (eg heart attack is pain felt in left arm)

Question 24

What is “Flail chest” and what are the 2 ways you can get it?

Answer 24

The corresponding part of the chest (to that which is broken) will move outwards during expiration, and inwards during inspiration (aka paradoxical mvmnt);

Results when ribs are broken in 2+ places, or if sternum is broken from ribs on BOTH sides

Question 25

What is a slipping rib?

Answer 25

When a false rib separates from the costal margin and overrides the superior costal cartilages

Question 26

How would one relieve pain from a pneuothorax or hemothorax?

Answer 26

By anesthetizing the corresponding intercostal n.

Question 27

What is thoracic outlet syndrome?

Answer 27

When a cervical rib (usually 7th rib) compress the brachial plexus and subclavian a. causing coldness, numbness, and tingling in the upper extremity Way to remember: Think you "unplugged" the brachial plexus/subclavian a. from the thoracic "outlet"

Question 28

Which ribs are the most commonly fractured?

Answer 28

Middle ribs

Question 29

What is thoracocentesis and where should it be performed?

Answer 29

Introduction of a needle into the thorax, should be performed above the superior border of the rib so as not to jeopordize the intercostal nerve bundle

Question 30

Which nodes are often enlarged in bronchogenic carcinoma?

Answer 30

The supraclavicular nodes (AKA sentinal nodes)

Question 31

What is pericarditis? What does it feel like to the pt? How is it aggravated?

Answer 31

inflammation of the pericardial sac, sounds like a friction rub during auscultation; It is sharp, knifelike, severe and persistent; Aggravated by breathing and coughing

Question 32

Which heart valve is most susceptible to disease?

Answer 32

Mitral valve

Question 33

Defects in Ventricular Septum is present in \_\_% of all congenital heart defects.

Answer 33

50%

Question 34

Which a.'s are frequent sites of arteriosclerosis and atherosclerosis?

Answer 34

Coronary a.'s (-sclerosis is hardening)

Question 35

What is a myocardial infarction? What % of people w/ a MI experience angina pectoralis (pain in chest and left arm resulting from ischemia to the heart)?

Answer 35

Death of a region of heart muscle; 30%

Question 36

What is a coronary bypass?

Answer 36

A surgical procedure in which one uses a vessel (a. OR v.) from another region of the body to 'bypass' the blockage and improve coronary circulation

Question 37

What are specfic symptoms you should be aware of during a cardiac physical exam?

Answer 37

Chest pain, shortness of breath, syncope (fainting feeling), edema, and paroxysmal nocturnal dyspnea

Question 38

Paplation allows you to feel any thrills and heaves. What are they and what pathologies are they associated w/?

Answer 38

Thrills: large areas of sustained outward motion, associated w/ loud, harsh/rumbling murmurs such as aortic stenosis or mitral stenosis; Heaves: vibration, indicate right ventricular hypertrophy

Question 39

What is dysphagia lusoria?

Answer 39

Difficulty in swallowing due to a "retroespophageal right subclavian a."

Question 40

What is aortic atresia?

Answer 40

When the ascending aorta is reduced in size, and the ductus arteriosis (normally closing during birth) is patent, and there is usually a ventricular septal defect

Question 41

Mitral stenosis can lead to which 2 things?

Answer 41

It can lead to enlargement of LA, which can cause esophageal dysphagia

Question 42

What is reflex espohagitis?

Answer 42

Inflammation of the esophageal mucosa by reflux of gastric acid.

Question 43

What is diffuse esophageal spasm?

Answer 43

Motor dysfunction of the esophageal m., causes mild to severe squeezing which may radiate to jaw, back, and arm. Swallowing of food/cold liquid can aggravate symptoms.