Case scenario

Case 1
• A 40 year old male, who was drunk, slept in the living room on a wooden chair
with his right hand hanging from the backrest of the chair. Next day he noticed
that his wrist and fingers were dropping and he was not able to extend his
right wrist. He also noted no sensation along posterior side of little finger.
a) What is the condition called?
b) Which nerve is involved in this case?
c) Which muscles are affected in this case?
d) What is the reason for wrist drop?
e) What is the reason for finger drop?
f) Why there is no sensation along posterior side of little finger?
 Explanation 1
Questions Answers
What is the condition called? Saturday night palsy
Which nerve is involved in this Radial nerve
case?
Which muscles are affected in this Posterior compartment of forearm
case? Lateral head of triceps
What is the reason for wrist drop? ECRL, ECRB, ECU
What is the reason for finger drop? Extensors of thumb and fingers
Why there is no sensation along Lateral 2 ½ digits by radial nerve
posterior side of little finger?
 Case 2
• A 72 years old woman slipped on a wet floor of a mall. She was admitted to the
emergency with complaint of severe pain in her right lower limb and was unable
to do any movements. Radiological examination revealed the fracture neck of
femur.
a) Why fracture neck of femur is more common in elderly women?
b) What are the types of fracture neck of femur?
c) Why avascular necrosis of head of femur is common in fracture neck of femur?
d) Which is the principal artery supply to the head of femur up to 8 years of age?
e) What is the position of lower limb in fracture NOF
f) Which other bone of lower limb is susceptible to avascular necrosis
 Explanation 2
Questions Answers
Why #NOF is more common in elderly Postmenopausal osteoporosis
women?
What are the types of #NOF? Subcapital, Transcervical, basal, intertrochanteric, subtrochanteric
Why avascular necrosis of HoF is Vascular insufficiency
common in #NOF? Retinacular branches of medial circumflex humeral A
MC- subcapital, LC- basal
Which is the principal artery supply to Acetabular branch of obturator A through fovea capitis
the HoF up to 8 years of age?
What is the position of lower limb in # Short-d/t traction of distal fragment by rectus femoris, adductor and
NOF? hamstrings
Laterally rotated due to gluteus maximus and other small lateral rotators
of hip
Which other bone of lower limb is Talus
susceptible to avascular necrosis As blood supply is through neck
 Case 3
• A 55 old woman visited her doctor with complaint of feeling chest
pain tightness and heaviness in chest when he can run a day before.
He also complained of profuse sweating and chest pain radiating to
his left hand . All these symptoms disappear on rest.
a) What is myocardial infarction?
b) Why the pain radiate to precordium?
c) Why the pain radiate to left arm and forearm?
d) Which artery is called the artery of sudden death?
e) Why did the patient complained of vomiting?
 Explanation 3
Questions Answers
What is myocardial Sudden block to either coronary artery lead to ischemia f/b
infarction? necrosis
Why the pain radiate to Precordium (dermatome T3-5) is supplied by same spinal
precordium? segments to which (T1-5 left side) the pain fibers of heart convey
via sensory sympathetic nerve.
Why the pain radiate to Pain of medial side of arm(T2dermatome) and medial side of
left arm and forearm? forearm (T1dermatome) of same spinal segment.
Which artery is called Anterior interventricular artery
the artery of sudden
death?
Why did the patient MI involving diaphragmatic surface irritate epigastric region.
complained of vomiting? Septum transversum – fibrous pericardium, central tendon of
diaphragm and lesser omentum of stomach.
 Case 4
• A 55 year old man presented with difficulty in walking with left leg
extended and arms flexed. On neurological examination, no signs of
facial palsy, deviation of tongue to right side on protrusion, atrophy of
right side, loss of position and vibration sense on left side.
• What is the clinical condition of the man?
• Why left leg is extended and arms flexed here?
• Explain the atrophy of right side, loss of position and vibration sense on
left side.
• Write the anatomical basis of tongue deviation.
• Which artery is most likely to be involved in this condition?
 Explanation 4
Questions
What is the clinical condition of the
man?
Why left leg is extended and arms flexed
here?
Explain the atrophy of right side, loss of
position and vibration sense on left side.
Write the anatomical basis of tongue
deviation.
Which artery is most likely to be
involved in this condition?
Answers
Paramedian region at the level of medulla
Medial medullary syndrome
Antigravity muscle of upper limb
Right pyramid
Right Median lemniscus
Right hypoglossal nerve
Anterior spinal artery occlusion
 Gate

Feature Cerebellar lesion Frontal lobe Sensory tract

lesion lesion
Initiation of gate Normal Hesitate Normal

Steps Staggering Short shuffling High stepping

Speed Normal/slow Slow Normal/slow

Heel to shin Abnormal Normal Variable

Falls Uncommon Very common Yes

Trunk Leans forward Upright Stopped

 Case 5
• A 26 years old woman continuing 7 months of pregnancy visited the
doctor for a regular ANC. Ultrasound reveals the herniation of small
bowel loop into the amniotic cavity. The condition is called
omphalocele.
a) What is omphalocele?
b) What are the coverings of omphalocele?
c) What is congenital umbilical hernia?
d) What is gastroschisis?
 Explanation 5
Questions
What is omphalocele?
What are the coverings of
omphalocele?
What is congenital umbilical
hernia?
What is gastroschisis?
Answers
Failure of coil of small intestine to return
to abdominal cavity after 6-10 m IUL
Whartons jelly and transparent amniotic
membrane
Covered with peritoneum, subcutaneous
tissue, skin
Reduced on its own by 2-3 years
Lateral fold of embryo (m/c –Right side)
fail to fuse with each other
Not covered by amniotic membrane
 Case 3
• A 55 year old man presented with difficulty in walking with left leg
extended and arms flexed. On neurological examination, no signs of
facial palsy, deviation of tongue to right side on protrusion, atrophy of
right side, loss of position and vibration sense on left side.

• d/o- medial medullary syndrome

Explanation 3