Question 1

In a 63-year-old man, a magnetic resonance imaging scan of the lower thoracic region of the vertebral column reveals the presence of a tumor pressing on the lumbar segments of the spinal cord. He has a loss of sensation in the skin over the anterior surface of the left thigh and is unable to extend his left knee joint. Examination reveals that the muscles of the front of the left thigh have atrophied and have no tone and that the left knee jerk is absent.
-The following statements concerning this patient are correct except which?

Accepted Answer

The patellar tendon reflex (knee jerk) involves L2, 3, and 4 segments of the spinal cord.

Question 2

A woman recently took up employment in a factory. She is a machinist, and for 6 hours a day she has to move a lever repeatedly, which requires that she extend and flex her right wrist joint. At the end of the second week of her employment, she began to experience pain over the posterior surface of her wrist and noticed a swelling in the area.
-The following statements concerning this patient are correct except which?

Accepted Answer

The wrist joint is not diseased. This patient has traumatic tenosynovitis of the long tendons of the extensor digitorum muscle.

Question 3

A 43-year-old woman was seen in the emergency department with a large abscess in the middle of the right posterior triangle of the neck. The abscess was red, hot, and fluctuant. The abscess showed evidence that it was pointing and about to rupture. The physician decided to incise the abscess and insert a drain. The patient returned to the department for the dressings to be changed 5 days later. She stated that she felt much better and that her neck was no longer painful. However, there was one thing that she could not understand. She could no longer raise her right hand above her head to brush her hair.
-The following statements explain the signs and symptoms in this case, suggesting that the spinal part of the accessory nerve had been incised, except which?

Accepted Answer

The spinal part of the accessory nerve, which supplies the sternocleidomastoid and the trapezius muscles, lies superficial to the levator

Question 4

A 46-year-old man was seen in the emergency department after being knocked down in a street brawl. He had received a blow on the head with an empty bottle. On examination, the patient was conscious and had a large gaping wound on the top of the head.
-Why did the wound in this patient gape wide open when he was hit with a blunt object and not a knife?

Accepted Answer

A blunt object forcibly striking the head often splits the epicranial aponeurosis against the underlying skull, causing the skin wound to gape open as if incised by a knife.

Question 5

A 75-year-old woman was dusting the top of a high closet while balanced on a chair. She lost her balance and fell to the floor, catching her right lumbar region on the edge of the chair.
-The following statements about this patient are correct except which?

Accepted Answer

A lumbar puncture (spinal tap) is not required in cases of simple trauma to the back.

Question 6

A resident obtained a sample of pleural fluid from a patient's right pleural cavity. He inserted the needle close to the upper border of the sixth rib in the anterior axillary line.
-Name the muscles that the needle pierced in order to enter the pleural cavity.

Accepted Answer

On the anterior axillary line (a line extending vertically downward from the lower border of the pectoralis major muscle) at the level of the upper border of the sixth rib, the needle would pierce the skin, fascia, the serratus anterior muscle, the external intercostal muscle, the internal intercostal muscle, the innermost intercostal muscle, and the parietal pleura (see text Fig. 3-4).

Question 7

A 75-year-old man with chronic bronchitis noticed that a bulge was developing in his left groin. On examination, an elongated swelling was seen above the medial end of the left inguinal ligament. When the patient coughed, the swelling enlarged but did not descend into the scrotum. The patient had weak abdominal muscles.
-The symptoms and signs displayed by this patient can be explained by the following statements except which?

Accepted Answer

The conjoint tendon, formed by the fusion of the tendons of the internal oblique and transversus abdominis muscles, greatly strengthens the posterior wall of the inguinal canal. A weakness of the conjoint tendon and the lower abdominal musculature was responsible for the bulge, which constitutes a direct inguinal hernia.

Question 8

A 40-year-old woman noticed a painful swelling in her right groin after helping her husband move some heavy furniture. On examination, a small tender swelling was noted in the right groin.
-The symptoms and signs displayed by this patient can be explained by the following statements except which?

Accepted Answer

The neck of the femoral hernial sac is situated below and lateral to the pubic tubercle (see CD Fig. 13-10).

Question 9

Following a sudden severe blow on the anterior abdominal wall from the hind leg of a horse, a patient complained of pain and swelling below the umbilicus. On examination, extensive bruising of the skin was observed over the lower part of the right rectus muscle. On gentle palpation, a deep swelling confined to the right rectus sheath was felt. Given that the deep swelling was due to a collection of blood (hematoma), which blood vessels were likely to have been ruptured?

Accepted Answer

The answer of Following a sudden severe blow on the...

Question 10

In a patient with a history of tuberculosis, an angular kyphosis of the lumbar vertebral column suddenly developed. On examination, a swelling was found in the groin, just below the right inguinal ligament. On deep palpation of the anterior abdominal wall above the right inguinal ligament, a further swelling could be felt. Digital pressure on the first swelling caused expansion of the second swelling and vice versa. What is the diagnosis? Explain the swelling in anatomical terms.

Accepted Answer

The answer of In a patient with a history of...

Question 11

A multiparous 57-year-old woman visited her gynecologist complaining of a "bearing-down" feeling in the pelvis and of low backache, both of which were worse when she was tired. On vaginal examination, the external os of the cervix was found to be located just within the vaginal orifice. A diagnosis of uterine prolapse was made. What are the main supports of the uterus?

Accepted Answer

The answer of A multiparous 57-year-old woman visited her gynecologist...

Question 12

A 50-year-old woman complaining of severe "pins and needles" in her right hand and lateral fingers visited her physician. She said that she had experienced difficulty in buttoning up her clothes when dressing. On physical examination the patient pointed to her thumb and index, middle, and ring fingers as the areas where she felt discomfort. No objective impairment of sensation was found in these areas. The muscles of the thenar eminence appeared to be functioning normally, although there was some loss of power compared with the activity of the muscles of the left thenar eminence.
-The following statements concerning this patient are correct except which?

Accepted Answer

The median nerve occupies a small restricted space in the carpal (see CD Fig. 13-6).

Question 13

Following a radical mastectomy operation a woman noticed that her right shoulder blade projected backwards. Can you explain this deformity?

Accepted Answer

The answer of Following a radical mastectomy operation a woman...

Question 14

A 40-year-old man visited his physician complaining of pain of 3 weeks' duration in his right shoulder. On examination, the patient could actively abduct his right shoulder to $50^{\circ}$; thereafter, he experienced severe pain that prevented further movement. If the arm was then passively raised above a right angle, it could be held actively without pain in that position. If the patient attempted to lower the arm, he again experienced severe pain in the middle range of abduction. What is your diagnosis?

Accepted Answer

The answer of A 40-year-old man visited his physician complaining...

Question 15

A 64-year-old man consulted his physician because he had noticed during the past 6 months a thickening of the skin at the base of his left ring finger. As he described it: "There appears to be a band of tissue that is pulling my ring finger into the palm." On examination of the palms of both hands, a localized thickening of subcutaneous tissue could be felt at the base of the left ring and little fingers. The metacarpophalangeal joint of the ring finger could not be fully extended, either actively or passively.
-The following statements concerning this patient are correct except which?

Accepted Answer

The distal end of the palmar aponeurosis gives rise to four slips, which pass to the four medial fingers (see CD Fig. 13-9).

Question 16

A 54-year-old man was told by his physician to reduce his weight. He was prescribed a diet and was advised to exercise more. One morning while jogging, he heard a sharp snap and felt a sudden pain in his right lower calf. On examination in the emergency department, the physician noted that the upper part of the right calf was swollen and a gap was apparent between the swelling and the heel. A diagnosis of rupture of the right Achilles tendon was made.
-The following statements concerning this patient are correct except which?

Accepted Answer

The Achilles tendon is inserted into the posterior surface of the calcaneum (see text Fig. 13-55).

Question 17

A 25-year-old man was admitted to the emergency department after an automobile accident. Apart from other superficial injuries, he was found to have a fracture of the middle third of the right femur.
-The following statements concerning this patient are possible except which?

Accepted Answer

The gastrocnemius muscle is responsible for the backward rotation of the distal fragment of the fractured femur.

Question 18

A 42-year-old woman was seen in the emergency department after slipping on some ice on the way to work. She complained of pain on movement of her right ankle joint. The physician asked the patient to evert her right foot. Which of the following muscles everts the foot?

Accepted Answer

The peroneus longus everts the foot.

Question 19

A 61-year-old woman was being examined for osteoarthritis of the left hip joint by an orthopedic surgeon. He flexed the left hip joint with the knee flexed. What structure normally limits the flexion of this joint with the knee flexed?

Accepted Answer

Flexion of the hip joint (with the knee flexed) is limited by the thigh coming in contact with the anterior abdominal wall.

Question 20

A physician's assistant asked a patient to walk up and down the examining room so that she might study his gait. Which of the following muscles plays an important role in lifting the left foot off the ground while walking?

Accepted Answer

The right gluteus medius and the right gluteus minimus tilt the pelvis so that the left lower limb is raised, thus permitting the left foot to be advanced forward clear of the ground. Read the following case histories/questions and give the best answer for each.

Quiz 13: Skeletal Muscles

A 75-year-old woman was dusting the top of a high closet while balanced on a chair. She lost her balance and fell to the floor, catching her right lumbar region on the edge of the chair. -The following statements about this patient are correct except which?

A resident obtained a sample of pleural fluid from a patient's right pleural cavity. He inserted the needle close to the upper border of the sixth rib in the anterior axillary line. -Name the muscles that the needle pierced in order to enter the pleural cavity.

A 40-year-old woman noticed a painful swelling in her right groin after helping her husband move some heavy furniture. On examination, a small tender swelling was noted in the right groin. -The symptoms and signs displayed by this patient can be explained by the following statements except which?

Following a radical mastectomy operation a woman noticed that her right shoulder blade projected backwards. Can you explain this deformity?

A 25-year-old man was admitted to the emergency department after an automobile accident. Apart from other superficial injuries, he was found to have a fracture of the middle third of the right femur. -The following statements concerning this patient are possible except which?

A 42-year-old woman was seen in the emergency department after slipping on some ice on the way to work. She complained of pain on movement of her right ankle joint. The physician asked the patient to evert her right foot. Which of the following muscles everts the foot?

A 61-year-old woman was being examined for osteoarthritis of the left hip joint by an orthopedic surgeon. He flexed the left hip joint with the knee flexed. What structure normally limits the flexion of this joint with the knee flexed?

A physician's assistant asked a patient to walk up and down the examining room so that she might study his gait. Which of the following muscles plays an important role in lifting the left foot off the ground while walking?