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NBME 24 Answers

nbme24/Block 3/Question#39 (37.9 difficulty score)
A 34-year-old woman is brought to the ...
tags: MSK 

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submitted by neonem(570),
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agFilnl on hctttodeseru a:nhd psidhcoa si ostm mcoonm oen to be tda,frceur uatenl si smot ommocn ot be eLntua iocontsliad cna scaue utcae alcpra teunnl derosyn.m

kihnT of teh nconiemm htarSti"g ienL To Pni,yk eerH sCemo heT Tumb"h for hte ebnso fo eth ap,lm gairndw a ltoalfob heasp insgttar wbole eth btmhu CMP ontij ecnaadjt to teh uridas, enth mvongi ot yuro medlia ir,stw nad enth back ot het mb.uht

hda,cioSp tnaeu,l eutu,rmqtir oimrf,spi mah,ate tet,aicap orpiatdze, zpm.utreia heT tneaul oslko keil 'sti ryrtoieslpo dotdsliaec

sympathetikey  Yep. I didn't even look at the X-ray. +11  
dr.xx  loonies love lunate +2  
wes79  she landed on her "right hand", but the X-ray is showing a left hand?? +1  
wes79  i legit have no idea whats going on in that xray lol +9  
nbme4unme  X-ray confused the hell out of me, I was going to put lunate based on Q stem but ended up putting Pisiform because it looks like that's what's messed up in the photo? Should have ignored the picture haha. +1  
nwinkelmann  for @dr.xx, love your mnemonic. I added to it, or at least found an explanation on why it works. "loonies love lunate" and "loonies" are "dislocated" from reality. +3  
niboonsh  Some Lovers Try Positions That They Cant Handle +10  
vsn001  ngl if scaphoid was an option - would've sprung at that real quick -> thanks for teaching me the importance of knowing to look for dislocation vs fracture :D +  
regularstudent  Ahh, the classic "left hand" x-ray but actual fracture of "right hand" NBME tactic +  
sars  I think the x-ray is showing the lunate protruding out of the palmar side. Imagine the situation where you are falling and using your hand to stop the fall. Your lunate will dislocate forward as the rest of the carpal bones recoil back, hence why it protrudes through the palmar side. Thats why it causes an acute carpal tunnel syndrome. +  
makingstrides  Another mnemonic, Some Lovers Tried Positions, That They Can't Handle +  

submitted by jucapami(11),
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bodtasdpecrho/ra-rgcnaetrellpati/osi:iap./as/rohtw tkgian a oklo

submitted by pingra(3),

Check out UWORLD question 16595 - The X-ray is showing the "spilled T cup" sign

pingra  which is specific for a lunate dislocation* +