LEARNING TASK LECTURE 1

20 Feb 17

Axial Skeleton
Case 1
A 65-year-old man and a14-year-old boy were involved in severe automobile
accident. In both patients the thorax had been badly crushed. X-ray examination
revealed that the man had five fractured ribs but the boy had no fractures.

Learning task
1. What is the most likely explanation for this difference in medical findings?
a. Factor internal:
i. Bone density antara orang tua dan anak-anak (>30 th akan
menurun)
ii. Chest walls lebih lentur pada anak-anak
b. Faktor eksternal:
i. Posisi duduk
ii. Penggunaan safety belt
iii. Posisi saat tabrakan

2. Explain why the last two ribs are prone to fracture?

Karena dia floating ribs → hanya punya satu penyangga (rusuk lain punya
2 penyangga)

3. Describe the type of the ribs and how they joint with other bones.
a. Rusuk sejati/ true ribs/ vertebrosternal ribs (T1-T7) → artikulasi
dengan sternum dan spine.
i. Yang paling pendek: T1
ii. Yang paling panjang: T7
iii. Makin ke bawah makin panjang
iv. Radius lengkungan makin ke bawah makin besar
b. Rusuk palsu/ false ribs/ vertebrochondral ribs (T8-T10) →
artikulasi dengan true ribs dan spine.
c. Rusuk melayang/ floating ribs/ vertebral ribs (T11-T12) →
artikulasi dengan spine

Case 2
A medical student offered to move a grand piano for his landlady. He just finished
his final examinations in Anatomy and was in poor physical shape. He struggled
with the antique monstrosity and suddenly experienced an acute pain in the back,
which extended down the back and outer side of his left leg. On examination in
the emergency department, he was found to have a slight scoliosis with the
convexity on the right side. The deep muscles of the back in the left lumbar region

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felt firmly than normal. No evidence of muscle weakness was present, but the left
ankle jerk was diminished. The symptoms and signs of the patient strongly
suggested a diagnosis of prolapsed intervertebral disc.

Learning task
1. Why the doctor concluded that the patient suffered from prolapsed
intervertebral disc?

2. What is the normal position of lumbar vertebrae in erect position?

Melengkung ke depan(?)

3. Compare the lumbar vertebrae with other vertebrae.

4. Describe all muscles that construct the back

a. Superficial back muscles:
i. M. trapezius
ii. M. levator scapulae
iii. M. latissimus dorsi
iv. M. rhomboid major
v. M. rhomboid minor
b. Intermediate back muscles:
i. M. serratus posterior
ii. M. serratus inferior
c. Deep back muscles:
i. M. spinalis
ii. M. longissimus
iii. M. illiocostalis

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Case 3
A 45-year-old man was seen in the emergency department after being knock down
in a street brawl. He had received a blow on the right head with an empty bottle.
On examination the patient was conscious with swelling on his upper right head
and right face. The head skin is intact and he could not move his lower jaw.

Learning task
1. What layer of SCALP the hematoma occupied?
a. SCALP:
i. S: Skin
ii. C: Connective tissue
iii. A: Aponeurosis (galea aponeurotica)
iv. L: Loose areloar tissue
v. P: Pericranium
b. Bleeding: Connective tissue, karena di sana terdapat pembuluh
darah.

2. If the lateral side of cranium was injured, what muscles and bones are
suffered?
a. Muscle:

b. Bones:
i. Frontal Bone
ii. Parietal Bones
iii. Temporal Bones
iv. Occipital Bone
v. Sphenoid Bone
vi. Ethmoid Bone

3. What probably occurred to him so he could not move his lower jaw?
a. Trauma di temporomandibular joint
b. kerusakan N.V (trigeminal)

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 4. What structures involve in temporomandibular joint movement?

The Appendicular Skeleton

Upper Limb
Case 1
A15-year-old girl, while demonstrating to her friends her proficiency at standing
on her hands, suddenly went off balance and put all her body weight on her left
outstretched hand. A distinctive cracking noise was heard, and he felt a sudden
pain in her left shoulder region. On examination in the emergency department, the
smooth contour of her left shoulder was absent. The clavicle was obviously
fractured, and the edge of the bony fragments could be palpated.

Learning task
1. Which part of clavicle that the fracture commonly occurs. Why?
2/3 dari medial, 1/3 dari lateral

2. What is the position of lateral and medial fragments according to muscles

traction?
a. Lateral fragments: lebih stabil karena diikat oleh M. subscpularis
b. Medial fragments: tertarik ke atas.

3. Describe all bones that joint the clavicle.

a. Sternal (medial) end attaches to the sternum
b. Acromial (lateral) end articulates with the scapula

4. What is the function of clavicle?

a. Rigid support from which the scapula and free limb suspended.

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 b. Menjaga jarak bahu dengan dada
c. Covering the cervicoaxillary canal, it protects the neurovascular
bundle that supplies the upper limb (plexus brachialis).

Case 2
A 63-year-old man fell down a flight of stairs and sustained a fracture of the lower
end of the left radius. On examination the distal end of the radius was displaced
posteriorly. This patient has sustained a Colles’ fracture → sangat khas
deformasinya. Berbentuk seperti senapan.

Learning task
1. Why the distal end of the radius was displaced posteriorly?
Karena kemungkinan jatuhnya menopang badan ke depan, sehingga beban
tubuh ditumpu semua di radius (mengingat radius adalah sambungan ke
telapak tangan).

2. Describe all bones that joint the radius

a. Proximal:
i. Os. ulna
ii. Os. humerus
b. Distal:
i. Os. ulna
ii. Os. carpal

3. Describe all muscles attached to the radius

a. M. brachioradialis
b. M. pronator kuadratus
c. M. pronator teres
d. M. flexor digitorum superficialis
e. M. bisep brachii
f. M. supinator

Lower Limb
Case 1
After recovery from long hospitalization, a 65-year-old woman try to walk alone.
But suddenly she fell down. The doctor noted that the woman had a spontaneous
fracture of the neck of the femur . The neck fractures are common and are of two
types, subcapital and trochanteric. Subcapital femoral neck fractures are
particularly common in women after menopause.

Learning task
1. Why the fractures have gender predisposition?
Karena saat menopause, estrogen mengalami penurunan, sehingga bone
strength akan menurun juga.

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 2. In the neck fractures the leg become shortened and pointed laterally. Why?
(Think about the muscles pull action).
Karena psoas major menarik femur.

3. Describe all muscles attached to the neck and shaft of the femur
a. Neck:
i. M. obturator externus
b. Shaft:
i. M. abductor brevis
ii. M. abductor longus
iii. M. abductor magnus
iv. M. gracilis

Case 2
A motorcyclist try his new motorcycle in town main road in high speed. But he
did not know the truck in front of him suddenly turn to the right. The accident
could not be avoided. After striking hard the truck the man was thrown 10 meters
and landed first on his right leg. On examination in the emergency department the
doctor noted fractures of the right tibia with minimal displacement.

Learning task
1. Why the displacement was minimal?
Karena ada interosessous joint.

2. Why the fracture of the shaft of the tibia are more frequent compare to
fibula?
a. Karena menopang berat tubuh
b. Karena tibia lebih ke depan
c. Karena terletak pada kaki (cruris)

3. What muscles are attached to tibia?

a. M. tibialis anterior
b. M. extensor digitorum
c. M. soleus
d. M. flexor digitorum