Nervous System
A 32-year old woman was in a car accident. She is complaining of a stiff neck and tilts her head to the right when she looks at you. You note that her left eye has difficulty moving inferiorly from a fully adducted horizontal position, such as when she looks down at her feet. You order a head CT because you suspect damage to which cranial nerve?
CN IV [Trochlear nerve]
-innervates superior oblique muscle of eye
LR6 SO4/3
-moves eye inferiorly and laterally
An exaggerated thoracic curvature of the spine.
Hyperkyphosis
This nerve has a motor component that control forearm and wrist extension
Radial nerve
Helen was sent to get x-rays of her lumbar spine, after having a constant pain in the area. After reading her x-rays, the doctor explained that she had a fracture in the pars interarticularis of her L4 vertebrae, which caused that vertebrae to "slip" or subluxate anteriorly, beyond the L5 vertebrae. This condition is classified as:
Spondylolisthesis
"slipping" of a vertebrae
-Spondylolysis is a defect of a vertebra in the pars interarticularis
- Degeneration or arthritis of the [facet joints in] vertebral column
A person arrives at the hospital in a neck collar and on a back board. The emergency responder states that they have fallen from a 3rd story balcony while drinking. You are asked by the attending to explain what level of the spinal cord you are testing during a patellar tendon reflex test. What is the best response to give to the attending?
L3, L4
L3 "over the knee"
A 72-year-old male presents due to significant back and hip pain that worsens throughout the day. On physical exam there are prominent bony enlargements of the distal interphalangeal joints bilaterally. What is the likely cause of his symptoms?
Osteoarthritis
A patient slipped on some ice and fell on an outstretched hand. She now has pain to touch within the anatomical snuffbox. Which bone do you suspect has been fractured?
Scaphoid
A 3 year-old child with a history of premature birth and cerebral palsy syndrome has difficulties in walking. Characteristically, when attempting to take a step, strong adduction occurs at the hip joint, resulting in scissoring of the lower limbs. Which nerve is involved in creating the hyperactive adduction?
Obturator nerve
This disease involves the loss of dopaminergic neurons from the substantia nigra and cogwheel rigidity during examination
What is Parkinson's disease
A 32-year-old male with a history of psoriasis presents for evaluation of new-onset joint pain. He reports feeling stiffness in his lower back in the morning and in the most distal joints in his left hand. On physical exam, he has papules and plaques along his hairline and scalp with overlying silver scales. His left middle finger has dactylitis and the distal interphalangeal joint is swollen. Laboratory evaluation shows that he is seronegative for rheumatoid factor. What is the most likely diagnosis?
Psoriatic arthritis
Which of the following muscles is most likely implicated if a patient is unable to abduct their arm between 15-90 degrees?
What is the deltoid.
Supraspinatus between 0-15 degrees
Trapezius above 90 degrees
Following an injury suffered during a hockey game, a 21-year old male is examined in a seated position in the orthopedic clinic. Holding the left tibia with both hands, the clinician can pull the tibia forward under the distal part of the femur. The right tibia cannot be displaced in this way. Which structure is MOST likely damaged in the left knee to specifically account for the findings on the physical exam?
Anterior cruciate ligament [ACL]
-prevents anterior sliding of the tibia on the femur
This is the most important excitatory neurotransmitter in the brain that is important in learning and memory and is implicated in a myriad of psychiatric disorders.
Glutamate
A 70-year-old male presents to the clinic with bilateral joint pain and morning stiffness. His shoulders and hips have the most prominent symptoms. The symptoms began abruptly three days ago. He denies any history of trauma. Physical examination reveals a decrease in range of motion but normal strength. Laboratory findings include an elevated erythrocyte sedimentation rate. What is the most likely diagnosis?
What is polymyalgia rheumatica?
It causes muscle pain and stiffness in muscles
Poly= many
Myalgia= muscle pain
A college baseball player has shoulder discomfort and you suspect a rotator cuff injury. The tendon of which muscle is mostly likely rubbing against the coracoacromial ligament leading to his pain?
Supraspinatus
-Attaches from supraspinous fossa of scapula to greater tubercle of humerus
-Sits right below the coracoacromial ligament
A 75-year-old male presents to the emergency department with severe right knee pain that began yesterday. Examination shows a large effusion in the knee, warmth, erythema, diffuse tenderness to palpation, and pain with range of motion. Laboratory tests show a normal white blood cell count, normal uric acid level, and erythrocyte sedimentation rate of 50 mm/hr. Synovial fluid analysis yields a white blood cell count of 50,000 cells per cubic millimeter and needle-shaped, negatively birefringent crystals. What is the most likely diagnosis?
Gout
Patient with episode of arm weakness and numbness that resolved spontaneously over two weeks. Physical examination shows impaired adduction of the right eye, and nystagmus on abduction of the left eye on left lateral gaze. A brain MRI shows 3 lesions compatible with demyelination. What is most likely the diagnosis?
Multiple sclerosis
A 35-year-old female presents to the office complaining that over the past several months her fingertips have been visibly getting pale and numb, especially in cold weather. After they are warmed, her affected fingers become bright red with painful numbness and tingling throughout. She also notes that the skin on both hands has become dry and feels tight, especially on the palmar surfaces. A blood test is positive for antinuclear antibodies and anticentromere antibodies. What is the most likely diagnosis?
Scleroderma
A patient is severely hemorrhaging and is in shock. You insert a cannula into a vein near medial malleolus for fluid administration. Which structures are you utilizing for the procedure?
Great saphenous vein
A 65-year-old woman presents to the clinic to discuss the results of a recent bone density (DEXA) scan. The results of the scan show a T-score of -3.0, indicating osteoporosis. The patient is started on a medication known to bind to hydroxyapatite binding sites, therefore inhibiting osteoclastic activity. What could be a potential serious side effect of this medication?
Esophagitis
These medications inhibit bone resorption by attaching to hydroxyapatite binding sites. When the osteoclast begins to resorb bone that has bisphosphonate attached to it, the osteoclast is impeded from developing the ruffled border.
The most severe side effects of bisphosphonates include esophagitis and osteonecrosis of the jaw