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D Flashcards 2 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

The hip joint

A

ASIS - anterior superior iliac spine

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2
Q

Knee bones

A
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3
Q

Ankle bones

A
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4
Q

Inguinal ring borders

A
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5
Q

Saphenofemoral junction

A

2.5cm below and lateral to the pubic tubercle

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6
Q

Quadricep Muscles

A

Rectus femoris

vastus lateralis

vastes medialis

vastus intermedius

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7
Q

hamstrings

A

biceps femoris

semitendinosus

semimembrinosus

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8
Q

shoudler joint

A
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9
Q

Calf

A

Gastrocnemius - lateral epicondyle

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10
Q

subclavian steal

A

narrow proximal subclavian artery (proximal to where vertebral artery leaves)

decreased pressure distally

:. subclavian artery takes blood from contralateral vertebral artery (via circle of willis and back down the vertebral artery)

can steal from internal mammary - CABG

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11
Q

lehriche

A

aortoiliac occlusion

absent femorals

buttock claudication

erectile dysfunction

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12
Q

gunstock deformity

A

malunion of a spuracondylar fracture

wedge osteotomy of lateral humerus

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13
Q

mitral regurgitation

A

jet width 0.6cm+

regurgitant volume more than 60 ml

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14
Q

aortic stenosis

A

pressure gradiant >40

valve area <1cm^2

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15
Q

6 Ps

A

acute limb ischaemia

pulseless

painful

Pallor

perishingly cold

paraesthesia

paralysis

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16
Q

Still’s

A

juvenila idiopathic arthritis

salmon coloured rash comes and goes

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17
Q

mig infuinal point scar

A

Navy

nerve

artery

vein

y fronts - lateral to medial

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18
Q

Posterior cruciate ligament anatomy

A

lateral edge of medial femoral condyle

tibial plateau

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19
Q

anterior cruciate ligament

A

posterior to anterior

lateral to medial

superior to inferior

attachments -

  • notch of distal femur (lateral femoral condyle)
  • tibial plateau
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20
Q

Acromegaly management

A

ocreotide - somatostatin analogue

pegvisomant - GH antagonist

examine

hands

face

visual fields - bitemporal hemianopia

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21
Q

Graves

A

carbimazole

propilthyouracil

radioiodine

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22
Q

Dercum’s

A

adiposis dolorosa

multiple painful benign lipomas

in obese

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23
Q

ICD

A

implanatable cardioverter defribrillator

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24
Q

Shoulders

A
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25
Q

Diabetic Retinopathy

A

Background

  • Venodilation
  • Microaneurysms (red dots)
  • Hard exudates

Pre-proliferative

  • Soft exudates (cotton wool spots)

Proliferative

  • New vessels
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26
Q

Hypertensive Retinopathy

A

Grade 1

Arteriolar narrowing + silver wiring

Grade 2

AV nipping

Grade 3

Flame shaped haemorrhages + cotton wool spots

Grade 4

Papilloedema

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27
Q

Carpal Tunnel Syndrome

A

numbness, tingling, burning thumb and fingers (esp index and middle fingers and radial half of ring finger)

thenar eminence wasting

Goal of surgery - divide transverse carpal ligament and distal aspect of volar ante brachial fascia

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28
Q

Optic Atrophy

A

0.3+ cup to disc ratio of optic nerve

Local

  • Optic Neuritis
  • Advanced Glaucoma
  • Ischaemia-Retinal artery occlusion (GCA)
  • SOL

Systemic

  • B12/Folate
  • Alcohol
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29
Q

Horner’s Syndrome Causes

A

lesion of sympathetic - hypothalamus, preganglionic tract, post ganglionic tract

CNS - MS, stroke, SOL - syrinx

Pancoast’s Tumour

Carotid artery aneurysm

Trauma - Carotid endarterectomy, central line

Migraine

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30
Q

Ptosis differentials

A

Horner’s

CN3 palsy

Guillain Barre

MG, Lambert Eaton

Myotonic Dystrophy

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31
Q

Blue sclera

A

Ehler’s Danlos

Osteogenesis Imperfecta (poor bone formation due to lack of type I collagen)

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32
Q

CEAP Classification

A
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33
Q

Femoral head blood supply

A

Deep femoral nerve

circumflex arteries

retinacular vessels

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34
Q

Median Nerve Injury

A

inability to abduct and oppose thumb - paralysis of the thenar muscles ape-hand deformity

Sensory loss - thumb, index finger, long finger, radial aspect ring finger

Weakness in forearm pronation and wrist and finger flexion

Activities of daily living such as brushing teeth, tying shoes, making phone calls, turning door knobs and writing, may become difficult with a median nerve injury.

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35
Q

Tunnel Vision

A

Chronic Glaucoma

Retinitis Pigmentosa

Cataracts

Ocular Migraine

36
Q

Amarosis fugax

A

Patchy ischaemia

Can see cholesterol emboli

Bruits in arteries

Need carotid endarterectomy

Remove clot that is showering little bits of clot

37
Q

Acromegaly

A

shake hands - doughy consistency + XS sweating

Spade like hands

Carpal tunnel syndrome - thenar wasting

high BP

Bitemporal hemianopia check - each eye separately

Face

  • Coarse facial features: large nose, big ears
  • Prominent supra-orbital ridges
  • Macroglossia
  • Widely spaced teeth: “show me your gums”
  • Prognathism: inspect from side

Acanthosis nigricans

Look up nose for scars

Ask for old photographs

Ring size, shoe size change

38
Q

Acromegaly Treatment

A

Ocreotide (somatastatin analogue)

Pegvisomant (GH antagonist)

transphenoidal resection of pituitary gland

  • pituitary macroadenoma
39
Q

Ehler’s Danlos

A
  • Hyperelastic skin
  • Hypermobile joints
  • Cardiac: MVP, AR, MR and aneurysms
  • Fragile blood vessels → easy bruising, GI bleeds
  • Poor healing
40
Q

Marfan’s Syndrome

A

long arms (arm span> height)

Arms - radioradio delay (coarctation), collapsing pulse

  • arachnodactyly
  • hyperextensible joints

Face - high arched palate, lens dislocation (upwards)

Chest - pectus excavatum

  • Aortic regurgitation
  • Mitral Valve Prolapse

AD Chr 15 Fibrillin protein

MEN2b

Treat - beta block and ACEI to slow aortic root dilatation

41
Q

MEN1

3Ps

A

Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia

Pituitary (70%)

Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)

Also adrenal and thyroid

42
Q

MEN2a

A

Medullary thyroid cancer (70%)

2 P’s

Parathyroid (60%)
Phaeochromocytoma

43
Q

MEN2b

A

Medullary thyroid cancer

1 P

Phaeochromocytoma

Marfanoid body habitus
Neuromas

44
Q

Neurofibromatosis

A

Cafe au lait spots 6+

Neurofibromas 2+

Axillary Freckling

Eyes - Lisch nodules - harmatomas of the eye

Peripheral neuropathy

Optic glioma - visual acuity

NF1 - chr 17

Complications - epilepsy, learning difficulties

DDx - Mccune Albright, Tuberous Sclerosis

45
Q

Tuberous Sclerosis

A

 Facial adenoma sebaceum: perinasal angiofibromata

 Periungual fibromas: hands and feet

 Shagreen-patch: roughened leathery skin over sacrum

 Ash-leaf macule: hypopigmented macule on trunk

 Fluoresce c¯ UV/Wood’s lamp

 Café-au-lait spots

epilepsy

renal enlargement - cysts

chr 16

46
Q

 Multiple telangiectasia on face, lips and buccal mucosa

 Cyanosis: large pulmonary AVMs

 No signs of CREST

A

Hereditary Haemorrhagic Telangiectasia

47
Q

Small pigmented macules on lips, oral mucosa, palms and soles

A

Peutz Jehger’s

48
Q

gout where else to look

A

ears - gouty tophi

NSAIDs - Naproxen

Colchicine

Steroids

Allopurinol

49
Q

Rheumatoid arthritis where else to look

A

elbows - rheumatoid nodules

anti-CCP ab (cyclic citrulinated peptide)

Morning stiffness >≥1h

Arthritis in 3+ joint areas

Arthritis of the hands

Symmetrical

Rheumatoid nodules

+ve RF

Radiographic changes

50
Q

Systemic Sclerosis

A

Calcinosis

Raynaud’s (gloves, nifidepine)

Eosophagial dysmotility (PPIs)

Sclerodactyly (emollients)

Telangiectasia

^BP (renal) - aggressive BP control

Microstomia

Beaked nose

Pulmonary Fibrosis

Anti centromere Ab

Limited cutaneous systemic sclerosis

51
Q

SLE

A

Skin

  • malar (butterfly) rash: spares nasolabial folds
  • discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas. Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic
  • photosensitivity
  • Raynaud’s phenomenon
  • livedo reticularis
  • non-scarring alopecia

Musculoskeletal

  • arthralgia
  • non-erosive arthritis

Cardiovascular

  • myocarditis

Respiratory

  • pleurisy
  • fibrosing alveolitis

Renal

  • proteinuria
  • glomerulonephritis (diffuse proliferative glomerulonephritis is the most common type)

Neuropsychiatric

  • anxiety and depression
  • psychosis
  • seizures
52
Q

SLE treatment

A

Mild disease: cutaneous and joints only

  • Topical corticosteroids
  • Sun cream
  • Hydroxychloroquine

Moderate disease: + organ involvement

  • Prednisolone
  • Azathioprine

Severe Disease

AIHA, nephritis, pericarditis, CNS disease

  • High-dose methylprednisolone
  • Cyclophosphamide
53
Q

Ankylosing Spondylitis

A

Schober’s test <5cm

XR

sacroilitis: subchondral erosions, sclerosis

squaring of lumbar vertebrae

‘bamboo spine’ (late & uncommon)

syndesmophytes: due to ossification of outer fibers of annulus fibrosus

chest x-ray: apical fibrosis

54
Q

tophacous gout XR findings

A

punched out periarticular erosions

55
Q

Dermatomyositis

A

Skin features

  • photosensitive
  • macular rash over back and shoulder
  • heliotrope rash in the periorbital region
  • Gottron’s papules - roughened red papules over extensor surfaces of fingers
  • nail fold capillary dilatation

Other features

  • proximal muscle weakness +/- tenderness
  • Raynaud’s
  • respiratory muscle weakness
  • interstitial lung disease: e.g. Fibrosing alveolitis or organising pneumonia
  • dysphagia, dysphonia

muscle biopsy

Prednisolone

56
Q

Yellow nail syndrome

A

Primary lymphedema with yellow nails and pleural effusion

also bronchiectasis

57
Q

Behcet’s

A

classically: 1) oral ulcers 2) genital ulcers 3) anterior uveitis

thrombophlebitis

arthritis

neurological involvement (e.g. aseptic meningitis)

GI: abdo pain, diarrhoea, colitis

erythema nodosum, DVT

58
Q

Jone’s Criteria

A

Rheumatoid Arthritis

Carditis

Arthritis

Sydenam’s Chorea

Erythema Marginatum

Subcutaneous nodules

Minor criteria

arthralgia

fever

elevated inflammatory markers

first degree heart block

59
Q

Duke Criteria

A

Infective endocarditis

Major criteria

Positive blood cultures

  • two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group, or
  • persistent bacteraemia from two blood cultures taken > 12 hours apart or three or more positive blood cultures where the pathogen is less specific such as Staph aureus and Staph epidermidis, or
  • positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci, or
  • positive molecular assays for specific gene targets

Evidence of endocardial involvement

  • positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or
  • new valvular regurgitation

Minor criteria

  • predisposing heart condition or IVDU
  • microbiological evidence does not meet major criteria
  • fever > 38ºC
  • vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
  • immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots
60
Q

Visual Fields Diagram

A
61
Q

Bulbar vs Pseudobulbar

A

CN 9 10 11

bulbar LMN

pseudobulbar UMN

62
Q

Blood Vessels of leg

A
63
Q

RAPD / Marcus Gunn Pupil

A

Features

 Minor constriction to direct light

 Dilatation on moving light from normal to abnormal eye.

64
Q

Features of Optic Atrophy

A

 ↓ visual acuity

 ↓ colour vision: esp. red desaturation

 Central scotoma

 Pale optic disc

 RAPD

65
Q

Argyl Robertson Pupil

A

Small Irregular pupils

accomodate but don’t react to light

Neurosyphillis

DM

66
Q

Holmes Adie Pupil

A

Dilated pupil that has no response to light and sluggish response to accommodation.

↓ or absent ankle and knee jerks

Benign condition, more common in young females

67
Q

Pleural Effusion

A

Transudate (< 30g/L protein)

  • heart failure (most common transudate cause)
  • hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
  • hypothyroidism
  • Meigs’ syndrome

Exudate (> 30g/L protein)

  • infection: pneumonia (most common exudate cause), TB, subphrenic abscess
  • connective tissue disease: RA, SLE
  • neoplasia: lung cancer, mesothelioma, metastases
  • pancreatitis
  • pulmonary embolism
  • Dressler’s syndrome
  • yellow nail syndrome
68
Q

Safe triangle chest drain

A
69
Q

ECG rate

A

large squares between QRS complexes

/4

70
Q

Light’s Criteria

A

if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:

pleural fluid protein divided by serum protein >0.5

pleural fluid LDH divided by serum LDH >0.6

pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

71
Q

Lateral Medullary Syndrome (lateral medulla oblongata)

A

Dysphagia

Ataxia

Nystagmus

Vertigo

Altered sensation/anaesthesia (reduced contralateral pain in body, reduced ipsilateral pain in face)

Horner’s

72
Q

Hallux Valgus

A
  • Irritated skin
  • Pain on walking
  • Joint redness
  • Pain
  • Shift of big toe towards other toes
  • Blisters around site of bunion

Pain relief

Good shoe support

Splinting between first and second toe

Bunionectomy

First Metatarsal realignment osteotomy

73
Q

Latissimus dorsi flap

A

scar on back

mobilise latissimus dorsi

74
Q

tram flap

A

transverse rectus abdominus flap

Pedicled

75
Q

DIEP flap

A

deep inferior epigastric perforators

removes only skin and fat

76
Q

Volkmann’s Ischaemic Contracture

A
77
Q

Long posterior flap of burgess

A

skin and gastrocnemius brought forward and cover shin bone

(skewed flap - kingsley robinson - less common)

78
Q

complications of amputation

A

stump breakdown - poor blood supply

phantom limb pain

79
Q

aortoiliac stenosis surgery

A

axillofemoral bypass

80
Q

peripheral vascular disease management

A

Conservative: diet, exercise program, smoking, diabetic specialist nurse, podiatrist for foot care

Medical:

  • Aspirin 75 mg
  • ACD treatment hypertension
  • Statins
  • Optimise insulin/oral hypoglycemics

Surgical:

  • Endovascular: stents/grafts
  • Endarterectomy
  • Reconstructive surgery: anatomical or extra-anatomical bypasses
  • Amputation
81
Q

anaphylaxis

A

1:10000

IM Adrenaline 0.5mg

Chlorphenamine 10mg IV

Hydrocortisone 200mg IV

82
Q

CURB 65

A

Confusion

Urea >7

Resp Rate >30

Blood pressure systolic <90 diastolic <60

Age 65+

83
Q

Status epilepticus

A

lorazepam IV 2-4mg

within 2 minutes again if no response

Phenytoin 18mg/kg

  • put on ECG
84
Q

Tunnel vision

A

advanced glaucoma

cataracts

ocular migraine

retinitis pigmentosa

85
Q

Cataracts

A

Classification

Nuclear: change lens refractive index, common in old age

Polar: localized, commonly inherited, lie in the visual axis

Subcapsular: due to steroid use, just deep to the lens capsule, in the visual axis

Dot opacities: common in normal lenses, also seen in diabetes and myotonic dystrophy

RF

  • diabetes
  • trauma
  • steroid use
86
Q

Cavernous sinus thrombosis

A

other causes of cavernous sinus syndrome: local infection (e.g. sinusitis), neoplasia, trauma

periorbital oedema

ophthalmoplegia: 6th nerve damage typically occurs before 3rd & 4th

trigeminal nerve involvement may lead to hyperaesthesia of upper face and eye pain

central retinal vein thrombosis

87
Q
A

D Flashcards 2 (3 decks)

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