NBME Anatomy Exam with precise |! |! |! |! |!
detailed solutions |!
at what vertebral level(s) should you perform a lumbar puncture ? - Correct answer
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✔L3/L4 or L4/L5; level of the iliac crests
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when doing a lumbar puncture, what does your needle pierce through - Correct answer
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✔skin --> fascia --> supraspinous ligament --> interspinous ligament --> ligamentum flavum
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--> epidural space --> dura mater --> subarachnoid space
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What is a herniated disc? - Correct answer ✔nucleus pulposus through anulus fibrosus
|! |! |! |! |! |! |! |! |! |! |! |! |!
(nucleus pulposus is remnant of notochord)
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-usually herniates postero-laterally
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-compresses spinal nerve root |! |! |!
most common levels of herniated disc - Correct answer ✔Lumbar Levels= L4/L5 or L5/S1
|! |! |! |! |! |! |! |! |! |! |! |! |!
cervical regions= C5/C6 or C6/C7
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herniated disk presentation - Correct answer ✔-individuals <50
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-history of back pain that may radiate down to the lower limb
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-pain begins soon after patient lifted something heavy
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-herniated lumbar disc compresses the nerve root one number below (L4/L5 will compress
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the L5 root)
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-lower limb reflexes are decreased on the affected side
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-patellar --> L2/L3 or L3/L4 herniation
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,-achilles --> L5/S1 herniation
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what is kyphosis ?
|! |! |!
who is it seen in? - Correct answer ✔-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
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what is lordosis?
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who is it seen in? - Correct answer ✔-exaggeration of the lumbar curvature that may be
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
temporary
-occurs during pregnancy, spondylolisthesis, or potbelly
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what is scoliosis?
|! |!
causes? - Correct answer ✔-lateral deviation/torsion of the spine
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-caused by poliomyelitis, leg length discrepancy, or hip disease
|! |! |! |! |! |! |! |!
what is the pars interarticularis - Correct answer ✔connects the superior facet and
|! |! |! |! |! |! |! |! |! |! |! |! |!
inferior facet |!
what is spondylolysis?
|! |!
presentation? - Correct answer ✔-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 answer ✔-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 answer ✔spinal
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
canal stenosis
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positional pain, relieved with rest and analgesics, lumbar or cervical spine - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔osteoarthritis/degenerative
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low back pain with paravertebral spasm after history of lifting a heavy object - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔lumbosacral strain
|! |!
low back pain in elderly which is exacerbated on minor exertion or touch - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔vertebral body fracture-- due to osteoporosis
|! |! |! |! |! |!
low back pain with paravertebral spasm and fever - Correct answer ✔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 answer ✔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
|! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔cauda equina syndrome, surgical emergency
|! |! |! |! |!
, low back pain in adolescent with slip off or step off in spine examination - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔spondylolisthesis
|!
back pain in pregnancy - Correct answer ✔lumbar lordosis
|! |! |! |! |! |! |! |!
low back pain with loss of DTR's, loss of sensation in dermatome, + straight leg - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔disc herniation
|! |!
low back pain in IV drug user/immunocompromised, tenderness on palpation of spinous
|! |! |! |! |! |! |! |! |! |! |! |!
process, fever - Correct answer ✔vertebral osteomyelitis
|! |! |! |! |! |!
low back pain, hip/butt/thigh claudication, impotence and atrophy of lower extremities,
|! |! |! |! |! |! |! |! |! |! |!
weak femoral pulses, bruit heard over femoral area - Correct answer ✔lehriche syndrome,
|! |! |! |! |! |! |! |! |! |! |! |!
aorticoiliac PAD
|! |!
low back pain, male, 25-35 yo, morning stiffness and improves with activity, may have
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
diarrhea or uveitis - Correct answer ✔ankylosing spondylitis, HLA B27
|! |! |! |! |! |! |! |! |!
omohyoid innervation? |!
insertion/origin? - Correct answer ✔-Scapula to the hyoid bone |! |! |! |! |! |! |! |!
-Innervated by ansa cervicalis C1-C3 |! |! |! |!
what is injured at the surgical neck of the humerus? - Correct answer ✔-axillary nerve
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
and posterior humeral circumflex artery
|! |! |! |!
what is injured in a midshaft humerus fracture? - Correct answer ✔-radial nerve and
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
profunda brachii artery (deep brachial)
|! |! |! |!
-affect origin of brachialis muscle
|! |! |! |!
detailed solutions |!
at what vertebral level(s) should you perform a lumbar puncture ? - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
✔L3/L4 or L4/L5; level of the iliac crests
|! |! |! |! |! |! |!
when doing a lumbar puncture, what does your needle pierce through - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
✔skin --> fascia --> supraspinous ligament --> interspinous ligament --> ligamentum flavum
|! |! |! |! |! |! |! |! |! |! |!
--> epidural space --> dura mater --> subarachnoid space
|! |! |! |! |! |! |! |! |!
What is a herniated disc? - Correct answer ✔nucleus pulposus through anulus fibrosus
|! |! |! |! |! |! |! |! |! |! |! |! |!
(nucleus pulposus is remnant of notochord)
|! |! |! |! |!
-usually herniates postero-laterally
|! |! |!
-compresses spinal nerve root |! |! |!
most common levels of herniated disc - Correct answer ✔Lumbar Levels= L4/L5 or L5/S1
|! |! |! |! |! |! |! |! |! |! |! |! |!
cervical regions= C5/C6 or C6/C7
|! |! |! |!
herniated disk presentation - Correct answer ✔-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 answer ✔-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 answer ✔-exaggeration of the lumbar curvature that may be
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
temporary
-occurs during pregnancy, spondylolisthesis, or potbelly
|! |! |! |! |!
what is scoliosis?
|! |!
causes? - Correct answer ✔-lateral deviation/torsion of the spine
|! |! |! |! |! |! |! |!
-caused by poliomyelitis, leg length discrepancy, or hip disease
|! |! |! |! |! |! |! |!
what is the pars interarticularis - Correct answer ✔connects the superior facet and
|! |! |! |! |! |! |! |! |! |! |! |! |!
inferior facet |!
what is spondylolysis?
|! |!
presentation? - Correct answer ✔-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 answer ✔-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 answer ✔spinal
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
canal stenosis
|!
positional pain, relieved with rest and analgesics, lumbar or cervical spine - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔osteoarthritis/degenerative
|!
low back pain with paravertebral spasm after history of lifting a heavy object - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔lumbosacral strain
|! |!
low back pain in elderly which is exacerbated on minor exertion or touch - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔vertebral body fracture-- due to osteoporosis
|! |! |! |! |! |!
low back pain with paravertebral spasm and fever - Correct answer ✔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 answer ✔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
|! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔cauda equina syndrome, surgical emergency
|! |! |! |! |!
, low back pain in adolescent with slip off or step off in spine examination - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔spondylolisthesis
|!
back pain in pregnancy - Correct answer ✔lumbar lordosis
|! |! |! |! |! |! |! |!
low back pain with loss of DTR's, loss of sensation in dermatome, + straight leg - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔disc herniation
|! |!
low back pain in IV drug user/immunocompromised, tenderness on palpation of spinous
|! |! |! |! |! |! |! |! |! |! |! |!
process, fever - Correct answer ✔vertebral osteomyelitis
|! |! |! |! |! |!
low back pain, hip/butt/thigh claudication, impotence and atrophy of lower extremities,
|! |! |! |! |! |! |! |! |! |! |!
weak femoral pulses, bruit heard over femoral area - Correct answer ✔lehriche syndrome,
|! |! |! |! |! |! |! |! |! |! |! |!
aorticoiliac PAD
|! |!
low back pain, male, 25-35 yo, morning stiffness and improves with activity, may have
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
diarrhea or uveitis - Correct answer ✔ankylosing spondylitis, HLA B27
|! |! |! |! |! |! |! |! |!
omohyoid innervation? |!
insertion/origin? - Correct answer ✔-Scapula to the hyoid bone |! |! |! |! |! |! |! |!
-Innervated by ansa cervicalis C1-C3 |! |! |! |!
what is injured at the surgical neck of the humerus? - Correct answer ✔-axillary nerve
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
and posterior humeral circumflex artery
|! |! |! |!
what is injured in a midshaft humerus fracture? - Correct answer ✔-radial nerve and
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
profunda brachii artery (deep brachial)
|! |! |! |!
-affect origin of brachialis muscle
|! |! |! |!
