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Lumbar puncture (tap) & epidural anesthesia correct answers → lumbar puncture: needle into subarachnoid space to extract CSF or to inject anesthetic to epidural space Needle inserted between L3/L4 (or L4/L5) level of horizontal line through upper points of iliac crests Spinal cord ends in: ...

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  • October 18, 2024
  • 38
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • lumbar puncture tap epidural anesthesia

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  • Anatomy NBME 100 concepts
  • Anatomy NBME 100 concepts

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Anatomy NBME 100 concepts || with Error-free Solutions.
Lumbar puncture (tap) & epidural anesthesia correct answers → lumbar puncture: needle into
subarachnoid space to extract CSF or to inject anesthetic to epidural space

Needle inserted between L3/L4 (or L4/L5) level of horizontal line through upper points of iliac
crests

Spinal cord ends in:
Adults: L2
Children: L3

Dural sac extends caudally to level S2

Herniated IV disc correct answers • Individuals younger than age 50 @ L4/L5 or L5/S1 OR
C5/C6 or C6/C7

• Back pain radiating down to lower limb - pain beginning after heavy lifting

• Herniated disc compressed nerve root one number below ("traversing root" -- ex. Herniation
L4/L5 compressed L5 nerve root)

→ lower limb reflexes are decreased on affected side:
• Patellar tendon reflex - herniation of L2/L3 or L3/L4
• Achilles tendon reflex - herniation of L5/S1

Abnormal curvatures of the spine correct answers • Kyphosis: thoracic curvature exaggeration,
elderly persons as result of osteoporosis (multiple compression fracture of vertebral bodies) or
disk degeneration

• Lordosis: lumbar curvature exaggeration, temporarily occurs during pregnancy,
spondylolisthesis or potbelly

• Scoliosis: lateral deviation/torsion that is caused by poliomyelitis, a leg-length discrepancy, or
hip disease

Upper limb fractures correct answers *Humerus fractures*
→ sites of potential injury to major nerves:
• Axillary nerve & posterior humeral circumflex artery @ surgical neck
• Radial nerve & profunda brachii artery at midshaft (midshaft fracture affects origin of
brachialis muscle)
• Median nerve & brachial artery @ supracondylar region
• Ulnar nerve @ medial epicondyle

*Distal radius fractures*

,Transverse fracture within the distal 2 cm of the radius. Most common fracture of forearm (after
50)
→ smith's fracture: results from fall or blow to dorsal aspect of the flexed wrist - produces
ventral angulation of wrist. Distal fragment of the radius is anteriorly displaced
→ colles' fracture: results from forced extension of the hand (by trying to ease a fall) - distal
fragment displaced dorsally ("dinner fork deformity")
• Often the ulnar styloid process is avulsed (broken off)

*Scaphoid fracture*
• Results from fall onto the palm when hand is abducted
• Pain: lateral side of wrist during wrist extension & abduction, deep tenderness present in
anatomical snuffbox → fracture may not show on X ray for 2-3 weeks
• Proximal fragment may undergo avascular necrosis due to blood supply being interruption

*Boxer's fracture*
• Necks of metacarpal bones are frequently fractured during fistfights
• Professional boxers: fractures of 2nd and 3rd metacarpals
• Unskilled fighters: fractures of 5th and sometimes 4th metacarpals

*Mallet or Baseball finger*
• DIP joint suddenly forced into extreme flexion (hyperflexion) when baseball is caught or
finger is jammed into base pad
• Extensor digitorum tendon is avulsed from the base of the distal phalanx. DIP joint cannot be
extended.

Rotator cuff muscles - SITS correct answers • Support shoulder joint by forming
musculotendinous rotator cuff around it
• Reinforces joint on all sides (except inferiorly) where dislocation is most likely
→ rotator cuff muscles:
• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis

Abduction of the upper limb correct answers • (0-15 deg) abduction of upper extremity initiated
by *supraspinatus muscle (suprascapular nerve)*
• (15-110 deg) abduction to horizontal position is function of *deltoid muscle (axillary nerve)*
• (110-180 deg) above horizontal requires scapular rotation by *trapezius (accessory nerve
CNXI) & serratus anterior (long thoracic nerve)*
Subacromial bursitis & tearing of supraspinatus tendon
• Subacromial bursitis (inflammation of the subacromial bursa) often due to calcific
supraspinatus tendinitis causing painful arc of abduction
• Same symptoms will be in the case of inflammation or trauma of supraspinatus tendon (MRI
→ torn tendon)

Elbows correct answers *Student's elbow (subcutaneous olecranon bursitis)*

, • Triceps tendon attaches distally to the olecranon (can be palpated easily). Separated from skin
by the olecranon bursa which allows mobility of overlying skin. Repeated excessive pressure &
friction causes bursa to inflame producing a subcutaneous olecranon bursitis

*Tennis elbow (lateral epicondylitis)*
• Lateral epicondylitis: repeated forceful flexion & extension of wrist resulting strain attachment
of common extensor tendon and inflammation of periosteum of lateral epicondyle.
- Pain: felt over lateral epicondyle & radiates down posterior aspect of forearm
- Opening door or lifting a glass

> Origins of following muscles may be affected:
- Extensor carpi radialis longus & brevis
- Extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris

*Golfer's elbow (medial epicondylitis)*
Inflammation of the common flexor tendon of the wrist where it originates on the medial
epicondyle of the humerus

> Origins of the following muscles affected:
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor carpi ulnaris

Arterial anastomoses around the scapula correct answers Blockage of the subclavian or axillary
artery can be bypasses by anastomoses between branches of the thyrocervical and subscapular
arteries:
- Transverse cervical
- Suprascapular
- Subscapular
- Circumflex scapular

Cubital fossa correct answers Contents from lateral to medial
1. Biceps brachii tendon
2. Brachial artery
3. Median nerve

Subcutaneous structures from lateral to medial
1. Cephalic vein
2. Median cubital vein:
joins cephalic and basilic
veins
3. Basilic vein

, Sites venipuncture is usually median cubital vein because
- Overlies bicipital
aponeurosis, therefore deep
structures protected
- Not accompanied by nerves

Carpal Tunnel Syndrome correct answers Results from a lesion that reduces the size of the carpal
tunnel (fluid retention, infection, dislocation of lunate bone)

Median nerve - most affected, most sensitive in the carpal tunnel

Clinical correlations:
- Pins & needles or anesthesia
of lateral 3.5 digits
- Palm sensation is not
affected because superficial
palmar cutaneous branch
passes superficially to carpal
tunnel
- Apehand deformity - absent
of opposition

Test of proximal and distal interphalangeal joints correct answers PIP - FDS

DID - FDP

Lesion of UL nerves correct answers *Upper Brachial Palsy (Erb-Duchenne palsy)*

- Injury of upper roots & trunk

- Results from excessive increase in angle between the neck & shoulder stretching & tearing of
the superior parts of brachial plexus (C5 & C6 roots of superior trunk)

- May occur as birth injury (forceful pulling of head during delivery)

- Paralysis of muscles of shoulder & arm supplied by C5 & C6 spinal nerves (roots) of upper
trunk

- Combination lesions of axillary, suprascapular, musculocutaneous nerves w loss of shoulder
movement and anterior arm

- Patient has "waiter's tip" hand:
- Adducted shoulder
- Medially rotated arm
- Extended elbow
- Loss of sensation in

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