In the Grand Scheme of Things

C-Spine

100

Which ligament is responsible for retaining dens in contact with anterior arch of atlas?

Transverse portion of the cruciform ligament

200

DOUBLE POINTS:

What levels of the C-Spine are the uncovertebral joints found?

What two surfaces make them up?

1. C3-C7

2. They are formed between:

• The uncinate process (raised lip) on the superolateral edge of the vertebral body below, and

• The inferolateral aspect of the vertebral body above

300

T2 and T1 MRI differ in that fluids and intervertebral discs will be hyperintense on __

T2: fluids/blood, CSF, discs are hyperintense

(T1: fat, bone marrow are hyperintense)

400

In the flexion portion of nodding, describe the roll/glide of the AO joint

In flexion convex occiput rolls anterior and glides posterior

500

The tectorial membrane is an extension of which ligament ?

Posterior Longitudinal Ligament

Foot/Ankle

100

Which nerve innervates the lateral compartment of the lower leg?

Superficial Peroneal

200

This ligament is most commonly injured in lateral ankle sprains involving slight plantarflexion

Anterior Talofibular Ligament (ATFL)

300

Explain the procedure to test gastrocnemius muscle length

1. Measure DF ROM in knee extended, then knee flexed

2. If DF is much higher in flexion than extension (>10-15 degree difference), suspect gastroc tightness

400

Need both for points:

In the foot posture index score (FPI), a positive score is indicative of relative (supination OR pronation) 

T/F: The average person has a slightly negative score

Pronation

False: the average score is +4 which is relative pronation

500

Please provide the four components of closed-chain supination (note: one of them involves rotation of the tib/fib)

• Calcaneal inversion

• Talar abduction

• Talar dorsiflexion

• Tib/fib external rotation

Knee

100

T/F: In OKC knee extension, patellofemoral contact stress is maximized at roughly 90 degrees of flexion

False: maximized closer to terminal knee extension (30-35 degrees)

200

DOUBLE POINTS:

1. The odd facet is located on the (medial OR lateral) aspect of the posterior surface of the patella

2. At roughly what degree of knee flexion does the odd facet articulate with the femur?

Medial

Deep knee flexion (>135 degrees)

300

Need all of them:

Open and closed pack position of the tibiofemoral joint? Capsular pattern?

OPP: 30 degrees of flexion

CPP: Full extension

Capsular pattern: flexion> extension

400

What are the two popliteal ligaments that are part of the posterolateral corner?

Arcuate, Oblique 

500

During the dial test, an increased external tibial rotation at 30° but not 90° of knee flexion indicates injury to this structure.

PLC

The Dial Test results are interpreted based on the degree of external rotation of the tibia at 30° and 90° of knee flexion. A positive test is indicated by an increase in external rotation, typically more than 10°, suggesting a PLC or combined injury. The test is particularly useful for differentiating between isolated PLC injuries and those involving the Posterior Cruciate Ligament (PCL).

• Isolated PLC Injury: Greater than 10° of external rotation in the injured knee at 30° of flexion, but not at 90° of flexion.

• Combined Injury (PCL & PLC): Greater than 10° of external rotation in the injured knee at both 30° and 90° of flexion.

• Isolated PCL Injury: Greater than 10° of external rotation in the injured knee at 90° of flexion, but not at 30° of flexion.

Meniscus

100

T/F: due to its attachments to numerous structures, the medial meniscus is less mobile than the lateral meniscus and thus less prone to injury

F: More prone to injury

"These attachments limit its mobility, so when the femur moves on the tibia (especially with rotation), the medial meniscus is more likely to be trapped and torn."

200

Isolated meniscal tears tend to have (more OR less) effusion than an ACL tear

Less

300

Provide the meniscal cluster

1. Pain at end flexion,

2. pain at end extension

3. McMurrays

4. Joint Line tenderness

5. Reports of clicking/locking/popping

400

According to the UPMC protocol following meniscal repair, will open-chain or closed-chain exercises be more emphasized in the early stages of rehab?

OKC, we want to avoid impact stresses associated with CKC early on

500

There are 3 characteristics of meniscal tears that would designate the tear as "complex" and have a worse prognosis. Name 2 of the 3

1. Greater 3cm length

2. Located in less vascularized regions

3. Radial or root tears (longitudinal is simpler)

Vestibular

100

This canal is most commonly involved in BPPV, and this repositioning maneuver is classically used to treat it.

Posterior SCC, Modified Epley Maneuver

200

In right posterior canal BPPV, this is the expected direction of nystagmus during the Dix–Hallpike test.

Torsional (right) upbeating nystagmus

300

This structure is a dilated region at the end of each semicircular canal that contains the cupula and hair cells

Ampulla

400

Match the following:

• Geotropic nystagmus, Apogeotropic nystagmus

• cupulolithiasis, canalithiasis
  
  

• Geotropic (toward ground) → canalithiasis

• Apogeotropic (away from ground) → cupulolithiasis

500

Name which sensory structures are innervated by the superior and inferior vestibular nerve

Superior Vestibular Nerve

• Anterior (superior) semicircular canal

• Horizontal (lateral) semicircular canal

• Utricle

Inferior Vestibular Nerve

• Posterior semicircular canal

• Saccule