at what vertebral level(s) should you perform a lumbar puncture ? correct answers L3/L4 or L4/L5; level of the iliac crests
when doing a lumbar puncture, what does your needle pierce through correct answers skin --> fascia --> supraspinous ligament --> interspinous ligament --> ligam...
NBME Anatomy 100 concepts || QUESTIONS &
ANSWERS 100% CORRECT
at what vertebral level(s) should you perform a lumbar puncture ? correct answers L3/L4 or
L4/L5; level of the iliac crests
when doing a lumbar puncture, what does your needle pierce through correct answers skin --
> fascia --> supraspinous ligament --> interspinous ligament --> ligamentum flavum -->
epidural space --> dura mater --> subarachnoid space
What is a herniated disc? correct answers nucleus pulposus through anulus fibrosus (nucleus
pulposus is remnant of notochord)
most common levels of herniated disc correct answers Lumbar Levels= L4/L5 or L5/S1
cervical regions= C5/C6 or C6/C7
herniated disk presentation correct answers -individuals <50
-history of back pain that may radiate down to the lower limb
-pain begins soon after patient lifted something heavy
-herniated lumbar disc compresses the nerve root one number below (L4/L5 will compress
the L5 root)
-lower limb reflexes are decreased on the affected side
-patellar --> L2/L3 or L3/L4 herniation
-achilles --> L5/S1 herniation
what is kyphosis ?
who is it seen in? correct answers -exaggeration of the thoracic curvature
-may occur in the elderly as a result of osteoporosis or disk degeneration
-osteoporosis= multiple compression fractures of the vertebral bodies
what is lordosis?
who is it seen in? correct answers -exaggeration of the lumbar curvature that may be
temporary
-occurs during pregnancy, spondylolisthesis, or potbelly
what is scoliosis?
causes? correct answers -lateral deviation/torsion of the spine
-caused by poliomyelitis, leg length discrepancy, or hip disease
what is the pars interarticularis correct answers connects the superior facet and inferior facet
what is spondylolysis?
presentation? correct answers -defect/stress fracture in the pars interarticularis
-most common reason for lower back pain in adolescent athletes
,-usually at L5
what is spondylolisthesis?
presentation? correct answers -forward slippage of one vertebral body with respect to the one
beneath it
-most commonly occurs at lumbosacral junction with L5 slipping over S1
-low back pain aggravated by standing and walking
-rarely can cause cauda equina
-often results from spondylolysis
low back pain with extension or standing, relief with flexion correct answers spinal canal
stenosis
positional pain, relieved with rest and analgesics, lumbar or cervical spine correct answers
osteoarthritis/degenerative
low back pain with paravertebral spasm after history of lifting a heavy object correct answers
lumbosacral strain
low back pain in elderly which is exacerbated on minor exertion or touch correct answers
vertebral body fracture-- due to osteoporosis
low back pain with paravertebral spasm and fever correct answers epidural abscess
lower back pain in elderly, continuous pain that is worse at night, resistant to pain meds and
positional changes. fever, weight loss, night sweats correct answers cord compression due to
metastatic tumor
Prostate Breast Kidney Thyroid Lung (PB KTL)
radicular lower back pain, saddle anesthesia, loss of DTR's, bowel/bladder issues correct
answers cauda equina syndrome, surgical emergency
low back pain in adolescent with slip off or step off in spine examination correct answers
spondylolisthesis
back pain in pregnancy correct answers lumbar lordosis
low back pain with loss of DTR's, loss of sensation in dermatome, + straight leg correct
answers disc herniation
low back pain in IV drug user/immunocompromised, tenderness on palpation of spinous
process, fever correct answers vertebral osteomyelitis
low back pain, hip/butt/thigh claudication, impotence and atrophy of lower extremities, weak
femoral pulses, bruit heard over femoral area correct answers lehriche syndrome, aorticoiliac
PAD
low back pain, male, 25-35 yo, morning stiffness and improves with activity, may have
diarrhea or uveitis correct answers ankylosing spondylitis, HLA B27
, omohyoid innervation?
insertion/origin? correct answers -Scapula to the hyoid bone
-Innervated by ansa cervicalis C1-C3
what is injured at the surgical neck of the humerus? correct answers -axillary nerve and
posterior humeral circumflex artery
what is injured in a midshaft humerus fracture? correct answers -radial nerve and profunda
brachii artery (deep brachial)
-affect origin of brachialis muscle
what is affected in a supracondylar humeral fracture? correct answers -brachial artery and
median nerve
what is affected in a medial epicondyle fracture? correct answers ulnar nerve
what is the most common fracture of the forearm >50 yo correct answers transverse fracture
within the distal 2 cm of the radius
what is a smith's fracture? correct answers -results from a fall or a blow on the dorsal aspect
of the flexed wrist
-produces a ventral angulation of the wrist
-the distal fragment of the radius is anteriorly displaced
smiths fracture correct answers
smiths fracture correct answers
what is a colle's fracture? correct answers -results from forced extension of the hand
-usually as a result of trying to ease a fall by outstretching the upper limb
-the distal fragment is displaced dorsally
"dinner fork deformity"
-often the ulnar styloid process is avulced
colles fracture correct answers
colles fracture correct answers
colles fracture correct answers
how does a scaphoid fracture occur? correct answers -due to a fall onto the palm when the
hand is abducted
scaphoid fracture presentation? correct answers -pain occurs primarily on the lateral side of
the wrist-- especially during wrist extension and abduction
-may not show on x-ray films for 2-3 weeks but a deep tenderness will be present in the
anatomical snuffbox
-proximal segment may undergo avascular necrosis if the blood supply is interrupted
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