A&PII

A 36 year-old woman is evaluated for several months of tingling and numbness involving the right hand and fingers that has progressed to dull aching pain. The symptoms initially were intermittent but eventually became persistent, with pain worsening overnight. The patient Works as an office secretary and has had difficulty typing and holding the phone due to hand weakness. On examination, she has weakness of thumb opposition and atrophy of the thenar eminence. The patient has attempted treatment with conservative measures, but has had no significant improvement and is now referred for surgery. During surgery, incision of which of the following structures is most likely to improve this patient's symptoms?

transverse carpal ligament

A 19 year-old college student comes to the office due to several months of left elbow pain. The pain is worse with activity and is limiting her exercise. The patient has attempted treatment with over the counter ibuprofen and acetaminophen but has had only partial relief. Her past medical history is notable for seasonal allergies, and current medications include a fluticasone nasal spray. Further evaluation reveals that the patient´s condition is due to tendon injury. A long acting glucocorticoid injection is administered at the lateral epicondyle. Which of the following actions is most likely performed by the affected muscle?

wrist extension

The action potential causes current to flow deep within the skeletal muscle fiber by which of the following?

A. Transmission along T tubules

A 5-year-old boy is brought to the physician by his mother because of progressive clumsiness and fatigue during the past 6 months. He says that his legs are tired. He was delivered at term after an uncomplicated pregnancy. He has met all developmental milestones, although there was some delay compared with other children his age. He is alert. He has difficulty rising from the chair, he uses his arms to push himself into a standing position. He is unable to jump with both feet together. Physical examination shows hypertrophy of the calf muscles. This patient most likely has weak hip adduction as a result of dysfunction of the muscle inserting onto the femur from which of the following locations?

Ischiun

A 21 year-old man is brought to the emergency following an assault. He was attempting to escape and turned away just as his attacker lunged toward him from behind with a knife. The patient suffered a 4 cm wide penetrating injury with significant associated blood loss. Following initial stabilization, he is transferred to the operating room. Surgical exploration reveals injury to a muscle that assists in internal rotation of the arm and is innervated by the thoracodorsal nerve. Which of the following muscles would be affected

Lattissimus dorsi

31 year old man has a large, yellow soft mass deeply infiltrating the gluteus maximus. Microscopic examination show irregular vacuolated cells and clear cells with frequent mitosis. Which of the following is the most likely diagnosis?

Liposarcoma

A 42-year-old man has an autoimmune disorder resulting in proximal muscle weakness of the lower extremities. Arrows in the photomicrograph shown indicate membranes that contain high concentrations of channels that are targeted by this condition. Which of the following is the most likely diagnosis?

Myasthenic (Lambert-Eaton) syndrome

A 55-year-old woman comes to the physician because of a 3-day history of persistent right shoulder pain. She began a weight-training program 6 weeks ago She says that the pain intensified after she increased the amount of weight that she had been lifting above her head. She rates the pain as 8 on a 10-point scale. Examination of the right shoulder shows point tenderness just lateral to the acromion, over the humeral head. Passive motion of the shoulder is full. Pain is reproduced with resisted abduction of the shoulder when the shoulder is abducted 90 degrees and the arm is giving the "thumbs down" sign. Sensation is intact over the right upper extremity. Which of the following tendons is most likely injured in this patient?

Supraspinatus

A 52 year-old man comes to the office due to right shoulder pain. He is and avid golfer but has been unable to play for the past 3 months due to the pain. Lately, it has started to interfere with his daily activities, such as getting dressed. An MRI shows thickening and calcification of the supraspinatus tendon. Which of the following shoulder actions is most likely to provoke pain in this patient?

abduction

A 24 year-old mountain climber is brought to the emergency department due to right arm pain after a fall. The patient was climbing a rock face at a nearby national park when he lost his grip and fell approximately 3m (9.8 ft) onto the boulders below. He has, ¨i landed on my right arm and Heard something snap. ¨the patient did not strike his head or lose consciousness. He has no other medical problems and takes no medications. Vital signs are within normal limits. Physical examination shows extensive bruising over the lateral right arm and a total inability to extend the right wrist. X-ray reveals a midshaft fracture of the right humerus. Which of the following arteries is most likely to be injured in this patient?

deep brachial artery

A 19 year old woman comes to the physician because of a 2-day history of pain in her left index finger. she injured it during a softball game when catching a ball. physical examination shows erythema of the index finger. The patient is unable to flex the distal phalanx when the interphalangeal joint and metacarpophalangeal joints are restrained. Laboratory studies and x-rays of the left hand show no abnormalities. which of the following structures is most likely injured in this patient?

flexor digitorum profundus tendon

A 16 year-old high school quarterback comes to the office with left shoulder pain after an injury. During a game, he was tackled from behind by a player who made direct contact at high speed with the posterior aspect of his left shoulder. The patient immediately had severe pain and did not return to the game. Over the next week, he had persistent pain despite talking over the counter ibuprofen. He has been unable to resume playing posterior aspect of the left shoulder. Left shoulder abduction is normal, but external rotation against resistance is weak and painful. Which of the following muscles is most likely injured?

infraspinatus

A 17 year-old boy is brought to the emergency department due to a lower extremity injury. The patient was playing football with his Friends when he was tackled roughly and ¨felt something snap¨in his right leg. He avoids bearing weight on the right foot. Examination shows a large contusion with point tenderness at the proximal lateral right leg.. Which of the following would most likely be found on physical examination?

loss of sensation at the dorsum of the foot

A 65 year-old man comes to the physician because of right lower abdominal and groin pain and difficulty walking for the past week. Climbing stairs has been particularly difficult for him, and he has fallen several times due to ¨knee buckling¨ his past medical history is significant for diabetes mellitus, hypertension, and atrial fibrillation. He takes warfarin for chronic anticoagulation. On physical examination, the right patellar reflex is decreased compared to the left. Which of the following additional findings would you most expect on physical examination?

loss of sensation on the anterior aspect of the right thigh

A 30 year-old man is evaluated for 6 months of persistent pain in his right buttock and posterior thigh. He is a construction worker and has difficulty lifting heavy objects or climbing stairs. He has no history of back injury and no associated back pain. Past medical history is unremarkable. The patient does not use tobacco and drinks only moderate quantities of alcohol. On examination, the patient develops pain with forced adduction of the flexed thigh and internal rotation of the extended thigh against resistance. Further reveals possible entrapment of the sciatic nerve in the greater sciatic foramen. Which of the following structures passes through the foramen an occupies most of its volume?

piriformis muscle

A 34 year old man is evaluated in the emergency department due to difficulty walking. He was installing new singles on his roof when he fell to the ground and sustained a puncture injury to his right leg. On physical examination, the right foot is dorsiflexed and everted. The patent is unable to stand on his tiptoes. Muscular strength at the knee and hip appear intact. Pedal and tibial pulses are +2 and symmetric. X-rays of his right leg are negative for fracture. This patient is most likely to have sensory loss over which of the following areas?

plantar foot

A 46 year-old gardener comes to the office due to knee pain. It began abruptly 3 days earlier and improved only minimally with acetaminophen. The patient spends hours on his knees several times a week while working. Past medical history is notable for hypertension and seasonal allergies. His current medications include lisinopril, loratadine, and fluticasone nasal spray. Examination of the lower extremity shows no visible erythema or abrasions, but there is Sharp, localized pain non palpation which of the following bursae is most likely affected in this patient?

prepatellar

A 26 year old man comes to the emergency department with fever, right flank pain, and difficulty walking for the past 3 days. One week ago, he was treated with cephalexin for furunculosis. He was diagnose with type 1 diabetes mellitus 10 years ago and takes subcutaneous insulin. His temperature is 38.9 c (102F). the patient lies supine with his right knee flexed and externally rotated. He resists simultaneous extension of the leg and thigh, particularly at the hip. The pathological process occurring in this patient most likely involves which of the following muscles?

psoas major

A 34 year-old woman comes to the physician complaining of easy fatigability. She lives alone and Works as an accountant. Her menstrual cycles are regular and her last menstrual period was 2 weeks ago. She does not smoke or consume alcohol. Her blood pressure is 150/90 mm Hg and pulse is 82/min. During her physical examination, she sits up from the supine position without using her hands. Which of the following muscles contributes most to the described movement?

psoas major

A 15 year-old boy comes to the office due to right arm numbness. He is a member of his high school baseball team and has been intensively practicing his pitching for an upcoming game. For the past several weeks, the patient has had fluctuating and numbness involving the right shoulder, arm and hand. He also has recently developed dull pain in the right Little finger and hand. The symptoms worsen with overhead activities and when throwing a baseball. The boy has no medical problems other than being told that he has an extra rib. On examination, there is decreased sensation over the medial 2 fingers and hypothenar eminence of the right hand. Which of the following structures is most likely contributing to this patient´s condition?

scalene muscles

A 43 year-old man comes to the physician due to difficulty walking. He was seen at an out patient clinic 2 days ago and received a Deep intramuscular injection. He had no trouble walking at the time of the appointment but started having problems later that day. He denies any history of trauma or pain at the injection site. Physical examination is negative for local erythema and swelling. When the patient is asked to walk across the room, his right hip drops every time he rises his right foot off the ground. At which of the following locations did this patient most likely receive his injection?

superomedial quadrant of the left buttock

A 53 year old man comes to the office with a dull ache in his right shoulder. The pain is worse with movement and often interferes with his sleep. The patient cannot recall any traumatic events prior to the start of the pain but did experience increased discomfort after helping his daughter move into her college dorm room a week ago. His past medical history includes dyslipidemia and hypertension, for which he takes the appropriate medications. Physical examination reveals localized tenderness just below the acromion. The physician asks the patient to abduct his arms 90 degrees to the side and flex them 30 degrees forward with his thumbs pointing to the floor. She then applies downward force to his arms. This maneuver elicits pain in the patient´s right shoulder and reveals right-sided weakness as compared to the left side. A tendon of which of the following muscles is most likely injured in this patient?

supraspinatus