Clinical 6 Flashcards
If you feel an abdominal mass:
Important not to miss:
Cancer, abscess, aneurysm, obstruction
Common:
Constipation
Bladder enlargement
Organomegaly
Other: Transplanted kidney Gastric mass Ovarian cyst Hernia Uterus causes
If you feel ascites:
Cirrhosis Veno oclusive disease (esp if oncology) Congestive heart failure Constrictive pericarditis Tuberculosis Pancreatic Nephrotic syndrome
Shunt procedures:
G: Glenn shunt
superior vena cava to right pulmonary artery
F: Fontan procedure
inferior vena cava or right atrium to right pulmonary artery
R: Rastelli procedure
right ventricle to main pulmonary artery
W: Waterston shunt
ascending aorta to right pulmonary artery
B: Blalock-Taussig shunt
subclavian artery to pulmonary artery
P: Pott shunt
descending thoracic aorta to left pulmonary artery
What is bulbar palsy?
Cranial nerve 9 and 10
Bulbar palsy results from bilateral impairment of function of the IXth, Xth and XIIth cranial nerves. This gives rise to dysarthria, dysphagia (often with choking episodes and nasal regurgitation of fluids), dysphonia and poor cough, and susceptibility to aspiration pneumonia. The lowermost part of VII may, infrequently, be involved.
The disturbance is of the motor nuclei rather than of the corticobulbar tracts. It is distinguished from pseudobulbar palsy by the presence of lower motor neurone signs. Autonomic features are uncommon.
What are the causes of loss of proprioception?
Peripheral neuropathy Vincristine side effects GBS Friederichs ataxia CMT Hereditary neuropathy
Deep tendon reflexes and nerve roots:
Triceps C7,8
Supination C5/6
Biceps C5/6
Knee L3/4
Ankle S1/2
Nystagmus causes and lesions:
Vestibular away from lesion
Cerebellar towards side of lesion (Fast phase)
Non-reactive pupil
Third nerve palsy Cataracts corneal opacitoes, vitreous and retinal haemorrhage or detachment Infection iris/ciliary muscles Trauma Optic nerve pathology
Pes cavus:
CMT Friedreich's ataxia Neurological Trauma Orthopaedic Neuromuscular Spina bifida Diastometamyelia
Pes planus:
Dyspraxia, ligamentous laxity, hypermobility (collagen disorder ehlers-danlos and marfan), CP
Denys-Drash syndrome:
Denys–Drash syndrome (DDS) or Drash syndrome is a rare disorder or syndrome characterized by gonadal dysgenesis, nephropathy, and Wilms’ tumor.
Lens dislocation associations
Marfans superior intellect so superior
Homocysteinuria inferior
Quality of apex beat associations:
Sustained – pressure overload in AS
Forceful – LVH
Thrusting – volume overload (MR/AR) or L→R shunt
Parasternal heave – RVH
Palpable S2 = pulmonary hypertension
