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Phase 3b > 06/03/2021 [hand/foot bones, vagina disease, radiology, stomach anatomy, SVT] > Flashcards

06/03/2021 [hand/foot bones, vagina disease, radiology, stomach anatomy, SVT] Flashcards

1
Q

Three bone types in the hand

A

Carpal bones [x8]
Metacarpals [x5]
Phalanges [x14]

= 27

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2
Q

Name the carpals in the hand

A

Some Lovers Try Positions They Can’t Handle:

[Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate]. Split into distal 4, and proximal 4.

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3
Q

What do the carpal bones form?

A

Collectively, they form the coronal plane

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4
Q

What covers the carpal bone?

A

The flexor retinaculum [carpal tunnel]

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5
Q

What forms the wrist joint?

A

The proximal carpals [scaphoid and lunate] articulating with the wrist joint.

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6
Q

Typical cause and clinical features of a scaphoid fracture

A

Cause: falling on an outstretch hand [FOOSH]
Feature: pain and tenderness in the anatomical snuffbox.

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7
Q

Particular risk of a scaphoid fracture? Why is this so?

A

Avascular necrosis; retrograde blood supply to scaphoid which enters distal end.
Pts with missed scaphoid fracture more likely to develop OA later in life.

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8
Q

What are the two common fractures of the metacarpals?

A

Boxer’s fracture: fracture of the 5th metacarpal neck; usually caused by clenched fist striking a hard object. Distal part of the fracture disaplced anteriorlty, producing shortening of the affected finger.

Bennett’s fracture: fracture of the 1st metacarpal base, caused by forced hyperabduction of the thumb.

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9
Q

Why are the metacarpals concave?

A

To allow the attachement of the interossei muscles.

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10
Q

How many phalanges in each finger/thiumb?

A

x3 fingers, x2 thumb

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11
Q

Three groups of bones in the foot?

A

Tarsals [x7]
Metatarsals [x5]
Phalanges [x14]

= 23 [though apparently 26?]

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12
Q

How are the the tarsal bones organised?

A
  • Proximal group or hind-foot [talus and calcaeneus]
  • interrmediate group [the navicular]
  • Distal or midfoot [cuboid and cuneiforms]
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13
Q

What are the articulation of the talus in the hindfoot?

A
  • Superiorly: ankle joint [talus and bones of the leg [tibia and fibula]
  • Inferiorly: subtalar joint [talus and calcaneus]
  • Anteriorly: talonavicular koint [talus and navocular]
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14
Q

Why is there a high risk of avascular necrosis to the talus?

A

Numerous ligaments attach tot he talus, no muscles originate or insert onto it. So high risk of AN as vascular supply dependent on fascial structures.

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15
Q

Articulations of the calcaneus. Also, what is it?

A

It is the largest tarsal bone lies underneat the talus where it constitutes the heel.
Articulations:
- superiorly: subtalar joint
- anteriorly: calcaneocuboid joint

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16
Q

Where does the Achilles tendon attach on the foot?

A

Posterior aspect at the calcaneus tuberosity.

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17
Q

Where does the tibialis posterior attach to the foot?

A

Plantar surface of the navicular, tuberosity for the attachment of the tendon.

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18
Q

Distal group bones in the foot

A

Cuboid, three cuneiforms [lateral, intermediate, medial].]

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19
Q

Which muscles attach to the distal tarsals?

A

Medial cuneiform - tibialis anterior [tibialis posterior and fibularis posterior and longus]
Lasteral cuneiform - flexor hallucis brevis

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20
Q

Commonest fracture types foot

A

Talus and calcaenues [as where forces transmitted to the ground]

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21
Q

When do talus fractures typically occur?

A

Neck fractures to the talus; high energy dorsiflexion of the foot.
Body fractures typically occur jumping from high height.

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22
Q

Danger of talus fractures

A

Avascular necrosis

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23
Q

When is the calcaneus typically fractured?

A

Axial loading, typically falling from a height.

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24
Q

In axial loading, what should patients also be assessed for?

A

Associated injuries siuch as fractures of the lumbar spine/lower limb.

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25
Q

Fracture name when bone breaks several pieces?

A

Comminuted fracture

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26
Q

Cx of calcaneal fracture

A

Sub-talar joint usually effected, so can become arthritis. Pain on inversion and eversion.

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27
Q

Shape of the metatarsals

A

Convex dorsally and consist of head, neck and shaft.

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28
Q

How many articulations in the metatarsals?

A 
Proximally = tarsometatarsal joints
Laterally = intermetatarsal joints
Distally = metatarsophalangeal joint
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29
Q

Common fracture of the metatarsals?

A

Most common direct flow from heavy object.
Also, stress fracture common in athletes 2/3rd mets.
Finally, excessive inversion of the foot.

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30
Q

Foot violently inverted what can happen?

A

Fibularis brevis muscle can avulse [‘tear off’] and the base of the fifth metatarsal.

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31
Q

How many bones in the phalanges?

A

bones of the foot. All have three apart from great two which has 2.

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32
Q

Commonest cause to miscarry in the first trimester?

A

Chromosomal abnormality [50-60%]; autosomal trisomy

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33
Q

Commonest cause to miscarry in the second trimester?

A

Incompetent cervix [RF previous cervical surgery]

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34
Q

Other potnetial causes for a miscarry?

A

fetal mlaformations, uterine structure abnormalities, chronic maternal health factors, active infections, iatrogenic causes, social factors like smoking, exposure to envirnomental toxins, advanced paternal age

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35
Q

How are miscarraiges classfied?

A

According to stage

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36
Q

How many types of miscarriage are there? Name the,m.

A

5:

  • threatened miscarriage
  • inevitable miscarriage
  • oncomplete miscarriage
  • complete miscarriage
  • other [missed, blighted ovum, setpic miscarriage, recurrent miscarruage]
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37
Q

Threatened miscarriage what is it?

A

Fetus is threatened and miscarriage may happen. Some vaginal bleeding, but cervical os is closed and USS viable intrauterine pregnancy.

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38
Q

How many threatened miscarriages go to term?

A

90%

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39
Q

Inevitable miscarriage?

A

Bound to happen miscarriage e.g. vaginal bleeding +/- cramping abdominla pain AND cervical os is open but produts of conception not passed

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40
Q

Incomplete miscarriage?

A

Currently happening, heavy and increased vaginal bleeding, intense lower abdominal pain and passage of some products of conception. Cervical os is OPEN and there arer PRODUCTS OF CONCEPTION present in the canal.

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41
Q

Complete miscarriage

A

PoC have passed, cervical os is CLOSED.

USS shows a EMPTY uterus.

42
Q

Missed miscarriage

A

Miscarriage was missed i.e. NONVIABLE IU pregnancy reminaed inside uteris.
Patient is amenorrhoiec but has not had any vaginal bleedingor abdmoinal pain.
On examination, cervical is is CLOSED. USS confirms a non-viable IU pregnancy.

43
Q

BLighted ovum

A

missed miscarriage which embryonic dev elopment stopped before embryoinc pole was visible. Gestartional sac may continue to grow

44
Q

Septic miscarriage

A

Miscarriage+sepsis [Sx of fever/significant abdo tenderness]

45
Q

Recurrent miscarriage

A

occurence of 3+ miscarriages

46
Q

Sx of miscarriage

A

Amenorrhoea, vaginal bleeding, cramping in abdominal region, passage fetal ittuse, fever [usually associated with setpic miscarriage].

47
Q

Ix for miscarriage?

A

COmplete blood count with differential
b-hCG
Transvaginal USS

48
Q

5 points of check on transvaginal USS are wjhat?

A

dating, location, multiple pregnancy, molar pregnancy, nonviable pregnancy, retained PoC,

49
Q

Sx of molar pregnancy on scan?

A

Snowstorm appearance

50
Q

nonviable pregnancy is what on an ISS?

A

Gestation sac over 25mm diameter with no yolk sac or embryo

No cardiac activity: fetal heart rate is typically detected at 5.5 to 6w

51
Q

Gravidity and parity?

A

g is the total number of pregnancies regardless of outcome.

p is th etotal number of pregnancies over 24w.

52
Q

What is antiphospholipid syndrome?

A

Immune system to attack body increasing the risk of blood clots. Pregnant women increased risk miscareriage.

53
Q

Who’s affected mostly by it?

A

3/5 more likely women, all ages.

54
Q

Which condition is it similar to?

A

MS

55
Q

Tx for APS

A

Anticoag like warfarin or an antiplatelet like low dose aspirin.

56
Q

Tx for retained products of conception?

A

Misoprostol

57
Q

What are the four namin anatomical dvision of the stomach?

A

Cardia, fundus, body, pyolrus

58
Q

Whihc level is the stomach at?

A

T11 is the cardia, L1 is the pylorus

59
Q

Describe the greater curvature of the stomach

A

orms the long, convex, lateral border of the stomach. Arising at the cardiac notch, it arches backwards and passes inferiorly to the left. It curves to the right as it continues medially to reach the pyloric antrum. The short gastric arteries and the right and left gastro-omental arteries supply branches to the greater curvature

60
Q

Describe the lesser curve

A

forms the shorter, concave, medial surface of the stomach. The most inferior part of the lesser curvature, the angular notch, indicates the junction of the body and pyloric region

61
Q

Which ligament attaches to the lesser curvature?

A

hepatogastric ligament

62
Q

Blood supply greater curve

A

gastro-omental arteries

63
Q

Bloood supply lesser curve

A

Left gastric artery and right gastric branch of the hepatic artery

64
Q

Superior to the stomach

A

Oesophagus and diaphragm

65
Q

Anterior to stomach

A

greater omentum, diaphragm, left lobe liver, gall bladder

66
Q

Posterior to the stomach

A

Lesser sac, pancreas, left kidney, left adrenal gland, spleen, splenic artery, transverse mesocolon

67
Q

Sphincters of the stomach

A

inferior oesophageal sphincter

pyloric sphincter

68
Q

What is chyme?

A

Food and gastric acid mixture formt eh stomach

69
Q

What part does the stomach attach to?

A

Duodenum

70
Q

Muscle type of each sphincter

A

Anatomical sphincter pylorus with smoothj muscle

71
Q

When does emptying of the stomach occur?

A

When intragastric pressure overcomes resistance of the pylorus.

72
Q

What is the peritoneum?

A

Doubl elayered mambrane that supports msot of teh abdominal viscera and assists with their attachment to the abdominal wall

73
Q

What is the omentum?

A

Split into greater and lesser, with peritoneum folded over itself.

74
Q

Where does the omentum attach

A

the stomach [greater omentum greater curve stomach]

75
Q

What does the greater omentum contain lots of?

A

LN and may adhere to inflamed areas, therefore playing key role in GI immmunity

76
Q

Whhere does th elesser omentum arise/atach?

A

Continuous with peritoneal layers of the stomach and duodenum, arises from the lesser curvature and ascend to attach to the liver

77
Q

What do the omenta divide the abdominal cavity into?

A

greater andf lesser sacs

78
Q

Where does the stomach lie in relation to the omenta?

A

immediately anterior to the lesser sdac

79
Q

How do the sacs communicate?

A

Epiploic formane, a hole in the lesser omentum

80
Q

Arterial supply to the stomach comes from where?

A

Coeliac trunk and its branches.

81
Q

Innervation o fthe stomach?

A

Autonomic NS:

  • parasympathetic nerve supply: anterioer and posterio vagal trunks, derived from teh vagus nerve.
  • sympathetic nerve supply arises form the T6-T9 spinal cord segments and passes tot he coeliac plexus via the greater splanchic nerve. Also contains some pain tranistting fibres.
82
Q

Lymphatics stomach

A

gastric lymphatic vessels travel with the arteries along the greater and lesser curves stomach.

83
Q

Where does lymph fluid drai into

A

Gastric and gastro-omental LN found on the curves

84
Q

What do the efferent lymphatic vessels form these nodes connect to?

A

Coelaic LN, located posterior abdominal wall

85
Q

3 maion causes for GORD?

A

dysfinction of the LES
delayed gastric emptying
hiatal hernia

86
Q

How common is GORD?

A

5-7% population

87
Q

Sx of GORD

A

dyspepsia, dysphagia, inupleasant taste mouth.

88
Q

Whatv is a hital hernia?

A

Part of the stomach protrudes into teh chest through the oesophageal hiatus int eh diaphragm.

89
Q

Two mian types of HH?

A

Sliding HH: LES slides superiorly, reflux common Cx as diaphragm no longer reinforcing sphincgter

90
Q

Rolling HH

A

LES reamins in pllace, but a part of the stomach herniates into the chest next to it. This type is more likely to require surgery.

91
Q

What effect does stimulation vagus nerve have?

A

Relxation of pyloric sphincter

92
Q

What is SVT?

A

ocndiiton where heart beats suddenly much faster than normal [above 100bpm]

93
Q

Can SVT happen during exercise?

A

Yes, jsut means it suddenly goes up

94
Q

Sx of SVT?

A

heart beats faster usually for few minutes [can be several hours though]
can happen several times a day or once a year
- chest pain, feel weak, feel tired, feel sick can be associated Sx

95
Q

Can be triggered by what SVT?

A

caffeine, tiredness, alcohol, drugs, often no obvious

96
Q

Tx for SVT?

A

Medicine to control
Cardioversion
Catheter ablation

97
Q

What are the 4 main types of SVT?

A

Atril fibrillation, paroxysmal supraventricilar tachycardia, atrial flutter, WpW syndrome

98
Q

Where does SVT stasrt from?

A

Either atria or AVN

99
Q

Generally, cause of SVT?

A

Re-entry or increased automaticity.

100
Q

Are they life threatening?

A

mostly unpleasant not life threatening. Risky if have IHD.

Phase 3b (10 decks)

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