experience any significant technical issues

• The take home assessment must be submitted as a PDF or word document via Canvas Assignments by 09:30am on Sunday 15th Nov. You are provided with 24 hours, commencing 09:30am 14^th November to complete this task.
• You are required to answer all SIX (6) questions in the space provided in this electronic document.
• This assessment contains a total of 90 marks. The written work required by you is equivalent of a 120min exam
• Your submission will be submitted through Turnitin to assess plagiarism. Any questions that you have copied-and-pasted information from an online source, textbook or from another student will result in a mark of 0 for the question.
• If you experience any significant technical issues during the completion of the final assessment task, you must inform your Unit Convenor within the 24 hour window and are able to apply for special consideration. In this case you must provide evidence such as a screen shot or a photo from your phone, clearly showing the date and time, and then apply using the normal process for Special Consideration. There is no need for a Registered Practitioner Statement in this scenario. You can apply for special consideration at: https://www.swinburne.edu.au/student-administration/forms/online-applications/SPC-info.php

How to submit:

1. You may wish to print this document, transcribe your answers, and scan your pages for submission. Only ONE file should be submitted, so you are required to combine all scanned pages; OR
2. You may answer all answers in the space provided for each question in the word or PDF version.

Formatting: Arial or Times New Roman; minimum 10pt font; single space. Do not adjust margins or page breaks.

Instructions regarding drawings:

You are required to produce drawings/illustrations in response to some questions. These must be an original production (e.g. not traced or copied from an online source). You may draw this using the ‘drawing tools’ or ‘line art’ in the Microsoft Suite. Alternatively you may draw on blank paper and scan/take a photo of your diagram to include in the relevant space. Diagrams must be inserted in the correct section and fit the proportions of the allocated space.

CANDIDATE DETAILS

Surname: _Abbasi_________________ Given: Samira_________________ ID: 101892680____________________

CANDIDATE DECLARATION

• I am the person stated above
• I agree to obey the assessment instructions for proper conduct of the exam and understand that late submissions and/or plagiarism detection by Turnitin software will result in penalties as determined by the University
• I understand that plagiarism constitutes copying or reproducing work that is not my own (from online source, textbooks or from another student)
• I understand that it is my responsibility to ensure that I have been correctly enrolled for the above subject and I am fully liability for any outstanding fees and charges

STUDENT SIGNATURE: __________________________

BIO10008

30%

Musculoskeletal Anatomy

Examiners’ use only

1: /19

2: /22

3: /9

4: /21

5: /10

6: /9

TOTAL MARK: /90

You are provided with SIX (6) short answer questions, composed of a clinical stem/description and multiple parts. Write your answers directly in the spaces provided, in this paper. Do not move the page breaks. You are provided with two additional blank pages at the end of this document should you require more space.

QUESTION 1

16-year-old female gymnast Payson has slipped from the uneven bars and suffers a traumatic spinal cord injury. Access the footage provided at this OneDrive link. Use the footage and motor/sensory examination results provided to answer the following questions:

Motor Examination: Myotome testing demonstrates a grade of 0 (total paralysis) of ankle plantarflexion, knee extension, hip flexion and abduction. She is unable to flex, abduct or adduct her fingers. Elbow extension and forearm pronation is graded a 2, demonstrating weakness. Normal active movement is recorded for shoulder abduction, forearm supination, elbow and wrist flexion. No wasting of the serratus anterior muscle, nor winging of the scapula.

Sensory Examination: Pin prick test demonstrates no responsiveness to pain or light touch at the following sites:

 skin over the fold of axilla (armpit)  medial to the nipple and lateral to the umbilicus (belly button)

 skin over the medial epicondyle of humerus  tip of the 5^th digit of the hand  skin over femoral triangle

 medial malleolus of ankle  back of popliteal fossa

You are provided with a sensory map of the patient, illustrating the skin areas unresponsive to stimuli in green. Normal pain response was noted at the skin over the lateral epicondyle of humerus and the acromioclavicular joint.

PART A:Based on the information provided, hypothesis at which vertebral level the injury has occurred (2 marks)

PART B: Justify your answer to part A, by providing FIVE points of explanation that support the hypothesis: (5 marks)

PART C: In the space below, provide an original representation (drawing or sketch) of the brachial plexus from roots to the peripheral branches, including important collateral branches covered in this unit. Highlight which spinal nerve root level/s have been injured in this patient. (5 marks)

PART D: The rhomboid major and minor muscles demonstrate active and full range and strength of movement in this patient. Which of the following spinal nerve roots innervate these muscles? (1 mark)

1. C5
2. C6 
3. C7 
4. C8 
5. T1 

PART E: With reference to your brachial plexus drawing, provide two examples of peripheral nerves most likely to be affected in the patient and provide two muscles for each nerve that are likely non-functioning in this case, based on the motor examination results provided on the previous page (4 marks)

Peripheral nerve	Impaired muscles	Justification

PART F: Payson’s mother reports that her daughter had been suffering ongoing back pain for the past 6 months, which increases in intensity upon hyperextension. A lateral lumbar-spine radiograph (x-ray) is provided below, revealing spondylolithesis. The orthopaedic surgeon reports that this condition is 17% more common in female artistic gymnasts, particularly if they have not reached skeletal maturity.

Describe which specific structure and vertebra has been affected on the lateral scan (1 mark)

PART G: Consistent with hyperextension manoeuvres in floor and beam routines, Payson’s MRI also demonstrates tears between 2-5mm in a stabilizing ligament of the back.

Which ligament is most likely affected? (1 mark)

Total for Q1: 19 marks

QUESTION 2

You are provided with a photo of 17-year-old Anna McNuity cheerleader and contortionist.

PART A: In the space, below list the movements, planes of motion, axes of rotation and normal range of motion of the lumbar spine and right hip.

(3 marks)

PART B: List one ligament that acts to resist the movement of the lumbar spine, one ligament that limits the range of motion at the right hip, and one ligament that stabilizes the pelvic girdle (3 marks)

PART C: Which muscle group is primarily responsible for the action of the lumbar spine? List the individual muscle contributions and comment on whether these muscles are contracting unilaterally or bilaterally (3 marks)

Muscle Group:

Individual Muscles:

Contraction:

PART D: List examples of four muscles responsible for the concentric action at the right hip (2 marks)

PART E: This question is worth 10 marks and is your opportunity to demonstrate your level of understanding. You may choose to draw a representation of the lumbosacral plexus and/or Dr. Pohls rules to support your explanation.

In Olympic gymnasts, Rossi et al (1978) reported spondylolisthesis (bilateral pars interarticularis fractures) in 8.9% of individuals, similar to a study by Jackson et al (1976) that reported an incidence of 11% in regional level gymnasts.

An athlete is found to have a bilateral pars interarticularis defect of the lumbar vertebrae, compressing the right L5 spinal nerve segment only. Detail the functional consequences, using your knowledge of myotomes, dermatomes and peripheral nerves. You should include areas of radicular pain, muscle weakness or loss, and decreased range of motion in your response. (10 marks)

PART F: Reflex testing of the Achilles (or calcaneal) tendon, tests which nerve and myotome? (1 mark)

Total for Q2: 22 marks

QUESTION 3

A 59-year-old male is a victim of an assault, presenting with extensive swelling and lacerations to the left side of the face and head. You are provided with a 3D reconstruction of the patient’s cranium.

Clinical Examination: The victim cannot open/close his jaw and a pinprick sensory examination demonstrates numbness of the infra-orbital region, temporal region and cheek. He demonstrates weakness when asked purse his lips, elevate the upper lip or raise his brow, and cannot produce tears on the left side of his face.

PART A: This fracture evident can be referred to as a ‘tripod’ fracture. List the three fracture components, structures or bones associated with this injury: (1 mark)

PART B: The fracture extends into the inferior sinus denoted by the yellow star. Name the specific sinus affected (0.5 mark)

PART C: List at least SIX bones that contribute to the formation of the orbital cavity (1.5 marks)

PART D: With reference to the clinical examination and the 3D reconstruction, list three muscles of the face that are likely damaged and list their primary actions (3 marks)

Muscle	Primary action

PART E: The victim is unable to open or close his mouth and protrude/retract his jaw upon examination. In the table below, list the muscles responsible for each of the actions of the temporomandibular joint (2 marks)

Action	Muscles (list at least two examples)
Elevation of mandible (close mouth)
Depression of mandible (open mouth)
Protrusion (protrude chin)
Retrusion (retrude or retract chin)

PART F: Which artery supplies the muscles listed in Part D? (1 mark)

Total for Q3: 9 marks

QUESTION 4

The adjacent image shows a person attempting to open a door by
turning the door handle with their right hand.

PART A: Assuming the right hand always starts in the position shown in the adjacent figure, complete the following table listing two (2) muscles primarily responsible for rotating the forearm in a clockwise direction and two (2) muscles primarily responsible for rotating the forearm in an anticlockwise direction. Also list the nerve supply to these muscles. (4 marks)

FOREARM MOVEMENT	Muscle	Nerve Supply
Clockwise
Anticlockwise

PART B: The person finds the door handle stiff and they need to grip it tighter. Complete the table below. Name the joints indicated by the letters A-D, the muscles responsible for the action of these joints, the compartments each are located and nerves supplying these muscles. (8 marks)

LETTER	Name of Joint	Muscle flexing this joint	Compartment	Nerve Supply to Muscle
A
B
C
D

PART C: Describe the structural classification of the joint indicated by letter A in the diagram. (1 mark)

1. Pivot 
2. Saddle 
3. Plane 
4. Ball-and-socket 
5. Hinge  

PART D:List muscles located in the superficial layer of the anterior forearm and state their general actions. (3 marks)

PART E: Name the muscle bulge at the base of the thumb indicated by the yellow star? Specify which three muscles form this muscle group. (2 marks)

PART F: ‘Ape Hand’ refers to a deformity causing an inability to oppose or abduct the thumb, due to atrophy of the muscles indicated in Part D. Damage to which nerve causes this presentation and where is it damaged? (1 mark)

PART G:On the diagram below (PALMAR surface of the hand), colour in the sensory supply for the ulnar nerve (1 mark)

PART H: A mid-shaft humeral fracture may result in the clinical presentation of ‘wrist drop’. Which peripheral nerve has most likely been damaged? (1 mark)

1. Ulnar
2. Median
3. Radial
4. Axillary
5. Musculocutaneous

Total for Q4: 21 marks

QUESTION 5

A 23 year old football player received a blow to the posterolateral side of the knee and is stretchered from the field. Upon examination, his knee was swollen, he was unable to move the knee across any anatomical plane of motion and the tibia was anteriorly displaced slightly. Pain is increased with torsion and sliding movements of the knee. Xrays demonstrate no fractures, however an MRI was requested to investigate soft tissue injury.

PART A: In the normal MRI scan of the knee label the following structures (A – H) directly on the scan. (4 marks)

1. cortical bone of the femur
2. anterior cruciate ligament
3. posterior cruciate ligament
4. tendon of quadriceps femoris
5. patellar ligament
6. synovial fluid
7. suprapatellar bursa
8. infrapatellar fat pad;

PART B: With reference to the patient’s MRI, which ligament has been torn? List its attachments and function. (2 marks)

LIGAMENT	ATTACHMENTS	FUNCTION

PART C: Which passive structure limits valgus of the tibia? (1 mark)

1. Patella ligament
2. Posterior cruciate ligament
3. Lateral collateral ligament
4. Annular ligament
5. Medical collateral ligament

PART D:The physician concludes an “unhappy triad” injury. List the structures included in this classification. (1 mark)

PART E: Follow up investigations show a fracture to the neck of the fibula, which has likely damaged a nerve. Explain how the doctor should investigate motor and sensory supply of this nerve. (2 marks)

Total for Q5: 10 marks

QUESTION 6

A state-level basketball player (with the ball) presented to his physician with acute swelling and severe pain associated with the lateral aspect of his LEFT ankle. The mechanism of injury is demonstrated on the right image, hyperinventing his ankle upon contact with an opponent. Refer to AP radiograph (left) and player collision photo (right) to answer the questions below.

PART A:Identify the joint indicated by the yellow star and describe the movements it permits, the respective plane and range of motion (3 marks)

PART B:List two muscle tendons likely strained or stretched, given the position of the player’s left foot(1 mark)

PART C: A fractured ankle was suspected and confirmed by the AP radiograph of the left ankle. In addition, his physician confirmed ligamentous tears associated with the ankle.

1. Describe the radiographic appearance of the fracture. (1 mark)

2. Which specific ligament of the ankle has he most likely torn? (1 mark)

PART D: A hyper-inversion injury caused by high-impact sports may result in an acute posterior tibial tendon dysfunction.

(i) Which longitudinal arch of the foot does this tendon support and list its bony contributions (2 marks)

(ii) Which artery supplies blood to the arch discussed in part (i) (1 mark)

Total for Q6: 9 marks

ADDITIONAL WRITING SPACE