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NBME 23 Answers

nbme23/Block 1/Question#17 (52.4 difficulty score)
A 54-year-old woman comes to the physician ...
tags: anatomy 

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submitted by thomasalterman(161),
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hTe otms rimnptato nthsi ot eth tneiousq aer as s,oflowl thwi #2 bngei eht tsmo :cecfisip

)1 tiptane trsepro ainp iwth eaodevhr otnmoi dna eporsrt ecrrturen haeorvde mtoino ginurd krw.o eehravdO otnoim nca ameagd eht anrsaspitpsuu mueslc deu to mnngmieepti yb hte oc.ornmai

)2 inPa is wsotr itwh raeintnl rotnotai fo hte hsuleodr - hits si nnsottesic ihwt hte ndniifgs of eht nepca-ymt etst, ciwhh edtnaisci a appnuuaisrsst ujnr.iy

mousie  I was thinking along the lines of overhead motion - damage to the subacromial bursa which is between the acromion and the supraspinatus ... also its the most commonly injured rotator cuff m. so could have guessed this one right +1  
sympathetikey  Thanks for the explanation. I was scratching my head as to why this is correct, since supraspinatus only does 15 degrees of abduction, but you make a lot of sense. +1  
charcot_bouchard  IDK WTF i picked Trapezius +41  
ls3076  why would injury to supraspinatus cause weakness with internal rotation though? +7  
targetusmle  yeah coz of that i picked subscapularis +3  
maddy1994  ya the whole question pointed to supraspinatus ...but last line internal rotation made me pick subscapularis +3  
darthskywalker306  I went for Trapezius. That shoulder flexion thing was a big distraction. Silly me. +1  
lowyield  saw someone post this on one of the other questions about shoulder... and it works pretty good for this there's some videos in it, this specific one for the question is the neer test +  
psay1  FA2019 pg. 438 +1  

submitted by drzed(254),
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"ngriuD resgnhtt gstietn het tpinate ahs ipna dna ksenwsae wthi c,taodnuib tlypraicalru itwh useatiosmlnu hsoerudl lirnetan ortotani"

hTis si a edvsptcieir yaw fo rgcnbdiies ers'eN negetinipmm nsi,g hwihc is a flayr()i eipscfci riondcait of rluhesdo cuff tdneon gpemntmi;nie eth mots mmylnooc dimnpgei etdnno fo eth orratot ffuc iegbn issunrtuppasa of ecuro.s

submitted by thotcandy(88),
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What si treeh ttha elsur uot id?dleot vhderoea bdtaucnio is tg&51'; os 'hnuldots atht npiot oerm wsotrda iodt?eld

baja_blast  Deltoid only does abduction from 15 to 90 degrees. So not overhead. +  
donttrustmyanswers  With that logic, supraspinatus only does abduction form 0-15 +8  
rina  the positive empty can test is the biggest thing "pain and weakness with abduction, particularly with simultaneous shoulder internal rotation" - that tells you it has to be one of the SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis), not the deltoid. tenderness in the right deltoid region tells you it's the supraspinatus which is right underneath the deltoid muscle +1  

submitted by skonys(8),

"I do not know who I am. I do not know why I am here. All I know is rotator cuff anatomy" ~ The Writer of this Exam (probably)