Clinical Lower Limb Flashcards
what is a kyphosis and where is it seen
thoracic and sacral curvature of the spine like in the foetus
what is lordosis
cervical and lumber - develops later
what is scoliosis
spinal is not straight in the coronal plane
what makes c1 and c2 atypical
C1 atlas - is a ring, anterior / posterior arches with lateral masses
no body or spinous process
C2 axis - has dens which articulates with arch of C1 which is held in place by transverse ligament
what can cause fractures of the dens
hyperextension or hyperflexion
describe the structure of costo-vertabral joints
head of the rib articulates with the superior demi facet of the corresponding vertebra and the inferior demifacet of the vertebra above
what does the tubercle of the rib articulate with
costal facet on the transverse processionals
who are most susceptible to common wedge fractures
post-menopausal women
describe the structure of the thoracic vertebrae
body is heart shaped with superior and inferior costal demi-facets
long spinous process - extends downwards
has transverse process for tubercle of rib
2 articular facets for other vertebrae
what are the effects of ageing on the vertebrae
loss of bone density and concave vertebral bodies
development of osetphytes
describe the structure of the lumber vertebrae
large vertebral body
superior facet face medially
inferior facet face laterally
spinous process short and sturdy
what are the three typical fractures of the lumbar vertebrae
lumbar transverse or spinous
burst
what is spondylolithesis
slipping of vertebra
what are intervertebral discs composed of
annulus fibrosis - peripheral fibrocartiledge
nucleus pulposus - central gélatinés shock absorber
what happens to vertebral discs with ageing
nucelus pulposus dries and prone to tearing
what is a slipped disc, where does it normally occur
herniation of the disc normally in L4/5 or L5/s1
compress spinal nerve rotes and cause pain
what can slipped discs cause
cauda equina syndrome (surgery required)
compression of the cord itself
what are the three ligaments of the vertebrae
anterior longitudinal (resist hyperextension) posterior longitudinal ligamentum flavum (binds lamina)
what is whiplash
flexion or extension injure
anterior longitudinal ligament torn
what is lower limb ischameia most commonly associated with
atherosclerotic disease (chronic)
what is acute ischaemia usually due to
occlusive thrombus or embolus in an artery
describe chronic lower limb ischameia
gradual process - causes anerobic metabolism - intermittent claudication
what can critical ischameia in the lower limb cause
ulceration and gangrene
describe sudden acute ischaemia of the lower limb
usually caused by emboli in the heart or patient with AF
sudden reduction in tissue perfusion
6 p’s of symptoms - pain, pallor, paralysis, pulse deficit, parastheisa, poikilothermic
where is atherosclerosis most commonly made
affects large and medium conduit arteries
turbulence of blood flow at biurification
coronal, carotid and lower limb arteries and aorta itself
what are the 4 stages in the fontaine classification of limb ischameia
1 asymp
2 intermittent claudication
3 ischamic rest pain
4 ulceration / gangrene (critical ischameia)
what is the difference between wet and dry gangrene in critical ischamea
wet - tissue necrosis and infection, black soft putrid
dry - tissue necrosis without infection - common in chronic ischamia
usually affects toes first
why is the femoral artery clinically relevant
superficial in femoral triangle - vulnerable
easy to access for blood gas in emergencies
use in minimally invasive procedures such as coronary angiography
what is the femoral vein used for in the clinical setting
emergency IV access
temporary access during burns, trauma
venipuncture in emergencies
which the vein other than the femoral vein is used for emergency iv access in the lower limb
great saphenous vein next to medial malleolus
what are varicose veins and where are they common
in the lower limb - large protrusive veins
what are varicose veins caused by and what are the complications
increased pressure in the saphenous vein = obstruction causes stagnation of blood and ulceration
complications - bleeding, superficial thrombophlebitis
varicose ulcers
what is a DVT and where are they common with what symps
thrombus in the deep veins of pelvis or legs - swollen limb, red warm and painful
can cause PE
50% have long term complications
