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Year 2 > Case 17 > Flashcards

Case 17 Flashcards

1
Q

What are the boundaries of the femoral triangle?

A

Superior: inguinal ligament (base)
Medial: adductor longus
Lateral: sartorius
(apex is where adductor longus and sartorius cross)

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2
Q

What’s inside the femoral triangle?

A

Femoral vein, artery, nerve (VAN - medial to lateral)

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3
Q

Which fascial extension surrounds the femoral vessels?

A

Femoral sheath (fascial extension of abdomen)

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4
Q

What is screening?

A

Finding apparently healthy people who may be at increase risk of a disease/ condition
Can then be offered info, further tests, treatment to reduce risks/ complications of disease

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5
Q

What does sensitivity detect?

A

Correctly identifies those with the condition

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6
Q

What does specificity detect?

A

Correctly identifies those without the condition

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7
Q 
Use these phrases to create formulae for sensitivity and specificity;
true positive 
false positive
false negative 
true negative
A

Sensitivity = true positives/ (true + false positives)

Specificity = false negatives/ (false + true negatives)

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8
Q

What does positive predictive value mean?

A

Probability that someone with a positive screen result has the condition

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9
Q

What does negative predictive value mean?

A

Probability that someone with a negative screen result does not has the condition

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10
Q

What have studies shown people with less power, status and money to blame their illnesses on?

A

External factors

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11
Q

What are health differences between genders or ethnic groups mostly due to?

A

Social structures

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12
Q

What is the largest ethnic minority group?

A

South Asian ethnic origin

Indian, Pakistani, Bangladeshi descent

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13
Q

What is ethnicity?

A

Refers to a person’s identification with a social group – on the basis of shared values, beliefs, customs, traditions, language, and lifestyles

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14
Q

Does UK mortality data include information on ethnic group?

A

No only country of origin recorded on death certificate

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15
Q

What is the principle within in NHS in regards to self reported identity?

A

Person should self-assign their ethnic group

Individual’s own identity takes priority

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16
Q

What are the 7 explanations for the ethnic patterning of health & disease? (Davey Smith et al)

A 
Artefact 
Biological 
Socio-economic 
Culture beliefs and behaviour 
Effects of migration 
Racism (social stress/ institutional racism)
Health service and access use
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17
Q

What does an artefact explanation draw attention to?

A

The processes involved in data collection and measurement

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18
Q

What does research suggest are the reasons why south asians have high rates of CHD?
How is this racialization of culture?

A

Cultural practice of cooking with ghee (butter made from the milk of a buffalo/ cow), not exercising or not making best use of medical facilities
Victim blaming
Assumes all south asians are culturally similar in diet and lifestyle
Ignored socio-economic impacts

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19
Q

What’s the largest ethnic minority group in the UK?

A

South Asian Indian

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20
Q

What has research found about ageing and ethnicity?

A

Ethnic inequalities in health are most pronounced at older ages

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21
Q

What is social cohesion?

A

Implies feeling part of a society/ social group

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22
Q

What’s inside the femoral canal?

A

Loose connective tissue
Fat
Lymphatic vessels
Sometimes a deep inguinal lymph node - cloquet node

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23
Q

What are the compartments of the femoral sheath and what to they contain?

A

Lateral compartment - femoral artery
Intermediate compartment - femoral vein
Medial compartment - femoral canal

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24
Q

How can direct inguinal and femoral hernias be told apart?

A

Direct inguinal hernia - medial and superior to pubic tubercle, rare to compress femoral vein

Femoral hernia - lateral and inferior to pubic tubercle, can compress femoral vein, firmer than inguinal hernia, more prone to strangulation (narrow neck of femoral ring)

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25
Q

Which nerve is affected in meralgia paraesthetica?

A

Lateral cutaneous nerve of thigh

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26
Q

What is meralgia paraesthetica?

A

Trapping or compression of lateral cutaneous nerve of thigh beneath the inguinal ligament
Causing altered sensation/ sensory symtoms in upper outer thigh (L2)

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27
Q

Which cutaneous nerve supplies the inner lower leg including the medial malleolus?

A

L4

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28
Q

Which cutaneous nerve supplies the outer lower leg?

A

L5

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29
Q

Which cutaneous nerve supplies the lateral side of foot and lateral malleolus?

A

S1

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30
Q

What’s the cutaneous innervation of the medial lower leg?

A

Saphenous nerve

31
Q

What’s the cutaneous innervation of the lateral lower leg?

A

Lateral sural cutaneous nerve

32
Q

What’s the cutaneous innervation of most of the dorsal surface of the foot?

A

Superficial fibular nerve becoming dorsal digital nerves

33
Q

What’s the cutaneous innervation between the big toe and 2nd toe?

A

Deep fibular nerve

34
Q

What’s the cutaneous innervation of the dorsal side of the lateral foot?

A

Lateral dorsal cutaneous nerve of foot

35
Q

What’s the cutaneous innervation of most of the anterior thigh?

A

Anterior cutaneous branches of femoral nerve

36
Q

What’s the cutaneous innervation of the upper, outer thigh?

A

Lateral cutaneous nerve of thigh

37
Q

What’s the cutaneous innervation of the upper, inner thigh?

A

Cutaneous branch of obturator nerve

38
Q

What’s the cutaneous innervation of the heel?

A

Medial calcaneal branches of tibial nerve

39
Q

What’s the cutaneous innervation of plantar surface of the lateral foot?

A

Lateral plantar nerve

40
Q

What’s the cutaneous innervation of the majority of the plantar surface of the foot?

A

Medial plantar nerve

41
Q

What’s the cutaneous innervation of the middle of the posterior lower leg including the lateral malleolus?

A

Sural nerve

42
Q

What’s the cutaneous innervation of the majority of the posterior thigh?

A

Inferior clunial nerve of thigh

43
Q

What’s the cutaneous innervation just inferior to posterior knee?

A

Posterior cutaneous nerve of thigh

44
Q

What’s the blood and nerve supply of the anterior compartment of the lower leg?

A

Blood: Anterior tibial artery
Nerve: Deep fibular nerve

45
Q

What’s the blood and nerve supply of the lateral compartment of the lower leg?

A

Blood: Branches of fibula artery
Nerve: Superficial fibular nerve

46
Q

What’s the blood and nerve supply of the posterior (deep and superficial) compartment of the lower leg?

A

Blood: Posterior tibial artery
Nerve: Tibial nerve

47
Q

What is compartment syndrome and how can it be treated?

A

Haemorrhage, inflammation of muscles or oedema in the compartment leads to an increase in intracompartmental pressure
Compression
Structures distal to compression become ischaemic
Fasciotomy (incision of fascia/ septum) performed to relieve pressure

48
Q

What clinical signs may confirm compartment syndrome?

A

Arterial compression - loss of distal leg pulses, lower temperature distal to compression

49
Q

What are the 3 muscles of the superficial posterior compartment of lower leg?

A

Gastrocnemius
Soleus
Plantaris

50
Q

What are the 4 muscles of the deep posterior compartment of lower leg?

A

Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior

51
Q

What structures pass posterior to the medial malleolus on their way to the foot?

A

Flexor hallucis longus, Flexor digitorum longus, Tibialis posterior tendons (from deep posterior compartment of leg)
Posterior tibial artery
Tibial nerve

52
Q

In which order do the tendons pass through the osteofascial tunnel posterior to the medial malleolus?

A 
Tom, Dick and Harry (anterior to posterior)
Tibialis posterior (anterior - closest to malleolus)
flexor Digitorum longus 
flexor Hallucis longus (posterior - furthest from malleolus)
53
Q

The structures passing posterior to the medial malleolus on their way to the foot, run beneath what?

A

Flexor retinaculum

54
Q

What do the tibial nerve and posterior tibial artery divide into before entering the foot?

A

Medial and lateral plantar arteries/ nerves

55
Q

What happens to the valves in varicose veins?

A

Valves dilate/ rotate/ do not function

Blood flows inferiorly

56
Q

Which vessel is commonly become varicose?

A

Small saphenous vein

57
Q

What does the great saphenous vein drain into?

A

Femoral vein

58
Q

What does the small saphenous vein drain into?

A

Popliteal vein

59
Q

Which vessels drain the foot?

A

Dorsal venous arch

Plantar arch

60
Q

Which vessels are likely to be damaged from intracapsular femur fracture?

A

Retinacular arteries from mainly medial circumflex artery

61
Q

Do extracapsular femur fractures usually compromise blood supply to the femoral head?

A

No

62
Q

In an intracapsular femur fracture damaging the medial circumflex artery, what may be the only remaining blood supply to the head of the femur?

A

Artery to the head of femur (branch of obturator artery) - traverses ligament of the head

63
Q

What would point tenderness at proximal attachment of plantar aponeurosis to medial tubercle of calcaneus suggest?

A

Plantar fascitis (straining and inflammation)

64
Q

What gives rise to the dorsalis pedis artery?

A

Popliteal artery becomes anterior tibial artery becomes dorsalis pedis artery

65
Q

Which 2 muscles make the lateral compartment of the lower leg?

A

Fibularis longus

Fibularis brevis

66
Q

Which artery at the ankle is used for the ankle-brachial pressure index (ABI)?

A

Posterior tibial artery

67
Q

What is the ankle-brachial pressure index (ABI)?

A

Ratio of systolic blood pressure at ankle compared to brachial artery
Used to determine competency of arterial vessels in the lower limb and to diagnose probable peripheral artery disease

68
Q

What is normal ABI?

A

Ankle pressure greater than elbow (normal)

1 - 1.4

69
Q

What ABI is suggestive of peripheral artery disease?

A

Less than 0.9
Less than 0.8 - moderate PAD
Less than 0.5 - severe PAD
(moderate to severe refer to vascular specialist)

70
Q

Where can the femoral pulse be found?

A

Just inferior to mid-inguinal point

71
Q

Where can the popliteal pulse be found?

A

Midline of popliteal fossa - easier if knee is flexed as it relaxes the popliteal fascia

72
Q

Where can the posterior tibial artery be found?

A

Behind medial malleolus

Between flexor hallucis and digitorum longus

73
Q

Where can the dorsalis pedis pulse be found?

A

Lateral to extensor hallucis longus tendon

Year 2 (13 decks)

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