Anatomy NBME-Clinical Correlates |! |! |!
Exam with precise answers |! |! |! |!
Where does the spinal cord end? - Correct answer ✔L2- Adults
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L3-Kids
Where is a needle inserted for a lumbar puncture? - Correct answer ✔L3/L4
|! |! |! |! |! |! |! |! |! |! |! |! |!
or L4/L5 at the level of the horizontal line through upper points of iliac crests
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(supracristal plane LV4)
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As you are doing a lumbar puncture, what is the needle passing through from
|! |! |! |! |! |! |! |! |! |! |! |! |!
superficial to deep? - Correct answer ✔Skin--> Fat--> Supraspinous
|! |! |! |! |! |! |! |! |! |!
Ligament--> Interspinous Ligament--> Ligamentum Flava--> Epidural Fat +
|! |! |! |! |! |! |! |!
Veins--> Dura--> Subarachnoid space
|! |! |!
Where does the dural sac end caudally? - Correct answer ✔S2
|! |! |! |! |! |! |! |! |! |!
Where does herniation of the disc typically occur? - Correct answer
|! |! |! |! |! |! |! |! |! |! |!
✔Lumbar: L4/L5 or L5/S1 |! |! |!
Cervical: C5/C6 or C6/C7 (ppl under 50)
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Symptoms of a herniated intervertebral disc? - Correct answer ✔Back pain
|! |! |! |! |! |! |! |! |! |! |!
that radiates down to lower limb
|! |! |! |! |!
,Pain begins after lifting something heavy
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T or F: Herniated lumbar disc compresses the nerve root one number ABOVE
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- Correct answer ✔FALSE: A herniated lumbar disc compresses the nerve
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root BELOW |!
Ex: Herniation of L4/L5 compresses the L5 nerve root
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T or F: Lower limb reflexes are decreased on the side of a herniated disc -
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Correct answer ✔TRUE |! |!
ex: |!
Patellar reflex will be affected with herniation of IV discs L2/L3 or L3/L4
|! |! |! |! |! |! |! |! |! |! |! |!
Achilles reflex affected by herniation of L5/S1
|! |! |! |! |! |!
What is Kyphosis? - Correct answer ✔Exaggerated thoracic curvature
|! |! |! |! |! |! |! |! |!
(concave anterior) |!
Ex: Hunchback of Notre Dame!
|! |! |! |!
Kyphosis can cause what dx? - Correct answer ✔Osteoporosis in the elderly
|! |! |! |! |! |! |! |! |! |! |!
-multiple compression fracture of vertebral bodies) |! |! |! |! |!
,Can also cause disk degeneration
|! |! |! |!
What is Lordosis? - Correct answer ✔Exaggerated lumbar curvature (concave
|! |! |! |! |! |! |! |! |! |!
posterior)
May be temporary (think of pregnant women)
|! |! |! |! |! |!
What are some causes of Lordosis? - Correct answer ✔Pregnancy,
|! |! |! |! |! |! |! |! |! |!
spondyloisthesis or potbelly |! |!
What is Scoliosis? - Correct answer ✔Lateral deviation, or torsion, that is
|! |! |! |! |! |! |! |! |! |! |! |!
caused by poliomyelitis, leg length discrepancy, or hip dx
|! |! |! |! |! |! |! |!
What are 4 humerus fractures and what is injured? - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |!
✔Surgical neck of humerus |! |! |!
- Axillary N + Posterior Humeral Circumflex A
|! |! |! |! |! |! |!
Midshaft
-Radial N + Profunda Brachii A.
|! |! |! |! |!
-Affect the origin of brachialis muscle
|! |! |! |! |!
Supracondylar region |!
- Median N + Brachial A
|! |! |! |! |!
Medial Epicondyle|!
, -Ulnar N |!
What is the most common fracture of the forearm? - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |!
✔Transverse fracture within the distal 2cm of the radius |! |! |! |! |! |! |! |!
Most common after age 50
|! |! |! |!
What is Smith's Fracture? - Correct answer ✔Results from a fall or blow on
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
the dorsal aspect of the flexed wrist
|! |! |! |! |! |!
Produces ventral angulation of the wrist |! |! |! |! |!
Distal fragment of the radius is ANTERIORLY displaced
|! |! |! |! |! |! |!
What is Colle's Fracture? - Correct answer ✔Results from forced extension of
|! |! |! |! |! |! |! |! |! |! |! |!
the hand, usually as a result of trying to ease a fall by outstretching the upper
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
limb
|!
Dorsally- "dinner fork deformity" The ulnar styloid process is broken off
|! |! |! |! |! |! |! |! |! |!
OUCH!
What is a scaphoid fracture? - Correct answer ✔Results from a fall onto palm
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
when hand is abducted
|! |! |!
Pain on lateral side of wrist, especially during wrist extension and abduction
|! |! |! |! |! |! |! |! |! |! |!
Fracture may not show on X-Ray for 2-3 weeks
|! |! |! |! |! |! |! |!
Exam with precise answers |! |! |! |!
Where does the spinal cord end? - Correct answer ✔L2- Adults
|! |! |! |! |! |! |! |! |! |!
L3-Kids
Where is a needle inserted for a lumbar puncture? - Correct answer ✔L3/L4
|! |! |! |! |! |! |! |! |! |! |! |! |!
or L4/L5 at the level of the horizontal line through upper points of iliac crests
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
(supracristal plane LV4)
|! |! |!
As you are doing a lumbar puncture, what is the needle passing through from
|! |! |! |! |! |! |! |! |! |! |! |! |!
superficial to deep? - Correct answer ✔Skin--> Fat--> Supraspinous
|! |! |! |! |! |! |! |! |! |!
Ligament--> Interspinous Ligament--> Ligamentum Flava--> Epidural Fat +
|! |! |! |! |! |! |! |!
Veins--> Dura--> Subarachnoid space
|! |! |!
Where does the dural sac end caudally? - Correct answer ✔S2
|! |! |! |! |! |! |! |! |! |!
Where does herniation of the disc typically occur? - Correct answer
|! |! |! |! |! |! |! |! |! |! |!
✔Lumbar: L4/L5 or L5/S1 |! |! |!
Cervical: C5/C6 or C6/C7 (ppl under 50)
|! |! |! |! |! |!
Symptoms of a herniated intervertebral disc? - Correct answer ✔Back pain
|! |! |! |! |! |! |! |! |! |! |!
that radiates down to lower limb
|! |! |! |! |!
,Pain begins after lifting something heavy
|! |! |! |! |!
T or F: Herniated lumbar disc compresses the nerve root one number ABOVE
|! |! |! |! |! |! |! |! |! |! |! |!
- Correct answer ✔FALSE: A herniated lumbar disc compresses the nerve
|! |! |! |! |! |! |! |! |! |! |! |!
root BELOW |!
Ex: Herniation of L4/L5 compresses the L5 nerve root
|! |! |! |! |! |! |! |!
T or F: Lower limb reflexes are decreased on the side of a herniated disc -
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
Correct answer ✔TRUE |! |!
ex: |!
Patellar reflex will be affected with herniation of IV discs L2/L3 or L3/L4
|! |! |! |! |! |! |! |! |! |! |! |!
Achilles reflex affected by herniation of L5/S1
|! |! |! |! |! |!
What is Kyphosis? - Correct answer ✔Exaggerated thoracic curvature
|! |! |! |! |! |! |! |! |!
(concave anterior) |!
Ex: Hunchback of Notre Dame!
|! |! |! |!
Kyphosis can cause what dx? - Correct answer ✔Osteoporosis in the elderly
|! |! |! |! |! |! |! |! |! |! |!
-multiple compression fracture of vertebral bodies) |! |! |! |! |!
,Can also cause disk degeneration
|! |! |! |!
What is Lordosis? - Correct answer ✔Exaggerated lumbar curvature (concave
|! |! |! |! |! |! |! |! |! |!
posterior)
May be temporary (think of pregnant women)
|! |! |! |! |! |!
What are some causes of Lordosis? - Correct answer ✔Pregnancy,
|! |! |! |! |! |! |! |! |! |!
spondyloisthesis or potbelly |! |!
What is Scoliosis? - Correct answer ✔Lateral deviation, or torsion, that is
|! |! |! |! |! |! |! |! |! |! |! |!
caused by poliomyelitis, leg length discrepancy, or hip dx
|! |! |! |! |! |! |! |!
What are 4 humerus fractures and what is injured? - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |!
✔Surgical neck of humerus |! |! |!
- Axillary N + Posterior Humeral Circumflex A
|! |! |! |! |! |! |!
Midshaft
-Radial N + Profunda Brachii A.
|! |! |! |! |!
-Affect the origin of brachialis muscle
|! |! |! |! |!
Supracondylar region |!
- Median N + Brachial A
|! |! |! |! |!
Medial Epicondyle|!
, -Ulnar N |!
What is the most common fracture of the forearm? - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |!
✔Transverse fracture within the distal 2cm of the radius |! |! |! |! |! |! |! |!
Most common after age 50
|! |! |! |!
What is Smith's Fracture? - Correct answer ✔Results from a fall or blow on
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
the dorsal aspect of the flexed wrist
|! |! |! |! |! |!
Produces ventral angulation of the wrist |! |! |! |! |!
Distal fragment of the radius is ANTERIORLY displaced
|! |! |! |! |! |! |!
What is Colle's Fracture? - Correct answer ✔Results from forced extension of
|! |! |! |! |! |! |! |! |! |! |! |!
the hand, usually as a result of trying to ease a fall by outstretching the upper
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
limb
|!
Dorsally- "dinner fork deformity" The ulnar styloid process is broken off
|! |! |! |! |! |! |! |! |! |!
OUCH!
What is a scaphoid fracture? - Correct answer ✔Results from a fall onto palm
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
when hand is abducted
|! |! |!
Pain on lateral side of wrist, especially during wrist extension and abduction
|! |! |! |! |! |! |! |! |! |! |!
Fracture may not show on X-Ray for 2-3 weeks
|! |! |! |! |! |! |! |!
