THE USMLE TIMES - #85
Highlights for the week of July 22, 2024
Welcome to issue #85 of The USMLE Times… We’ve now posted our USMLE TIMES newsletter eighty-five weeks in a row! Welcome to the 79 new members of the community 👋
Here’s what’s on tap for issue #85 of the USMLE Times:
Question of the Week (MSK)
This week’s video training (The NBME Trifecta)
Links to recent training
Question deep-dive & breakdown
Let’s dive in!
A 62-year-old man presents to his primary care physician with complaints of progressive difficulty in fully extending the ring and little fingers of his right hand over the past six months. He has a history of heavy alcohol consumption and smoking. On examination, the physician notes thickened, nodular bands of tissue in the palmar fascia of his right hand. Which of the following anatomical structures is most directly involved in the pathogenesis of this condition?
A. Flexor digitorum superficialis tendons
B. Flexor digitorum profundus tendons
C. Transverse carpal ligament
D. Extensor digitorum tendons
E. Ulnar collateral ligament
F. Palmar aponeurosis
G. Radial collateral ligament
The answer & question breakdown is at the bottom of the post.
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USMLE Times Issue #84 - READ HERE
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USMLE Step 1 Question (Pulmonary) - TRY IT HERE
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ANSWER + QUESTION BREAKDOWN
The Mental Model for this week’s question:
Step 1. Identify the question’s goal (ID the involved structure).
Step 2. Diagnose the problem.
Step 3. Ask yourself which structure is involved.
Step 4. Look for your hypothesized answer in the answer choices.
GENERAL ANALYSIS
The question involves a 62-year-old man presenting with progressive difficulty in fully extending the ring and little fingers of his right hand, with thickened, nodular bands of tissue in the palmar fascia.
ANSWER CHOICES:
ANSWER CHOICE A: Flexor digitorum superficialis tendons
These tendons are responsible for flexing the proximal interphalangeal joints of the fingers.
ANSWER CHOICE B: Flexor digitorum profundus tendons
These tendons flex the distal interphalangeal joints of the fingers.
ANSWER CHOICE C: Transverse carpal ligament
This ligament forms the roof of the carpal tunnel.
ANSWER CHOICE D: Extensor digitorum tendons
These tendons are responsible for extending the fingers.
ANSWER CHOICE E: Ulnar collateral ligament
This ligament is located at the medial side of the elbow joint.
ANSWER CHOICE F: Palmar aponeurosis
This is a thick layer of connective tissue that lies beneath the skin and above the tendons, nerves, and blood vessels in the palm.
ANSWER CHOICE G: Radial collateral ligament
This ligament is located at the lateral side of the elbow joint.
FINAL VERDICT…
The patient’s condition is characteristic of dupuytren's contracture… This is a fibrosing disorder that results in the progressive thickening and shortening of the palmar fascia, specifically the palmar aponeurosis. This condition leads to the formation of nodules and cords in the palm, which can pull the fingers into a flexed position, making it difficult to fully extend them. The ring and little fingers are most commonly affected, as seen in this patient.
The palmar aponeurosis is the anatomical structure most directly involved in the pathogenesis of Dupuytren's contracture. It lies beneath the skin and above the tendons, nerves, and blood vessels in the palm. In Dupuytren's contracture, the fascia becomes abnormally thickened and contracted, forming cords that tether the fingers into a bent position.
In summary, the patient's symptoms and physical findings are characteristic of Dupuytren's contracture, and the palmar aponeurosis is the structure most directly involved in this condition.
FINAL ANSWER: F: Palmar aponeurosis
That’s it for issue #85 of The USMLE Times!
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