Great Mix Flashcards
Hickman Line
This is a an example of a long term central venous line which is inserted in a similar way to a central line (usually subclavian).
The remnant of the line is tunnelled subcutaneously, which decreases the incidence of line infection.
These are indicated for long-term parenteral nutrition, long-term intravenous antibiotic therapy and chemotherapy.
What is Mannitol?
Mannitol is an osmotic diuretic which can be used to lower raised intracranial pressure or drive the urine output in a patient with obstructive jaundice to prevent hepato renal syndrome.
IM Femoral Nail
This is an intramedullary femoral nail which is used to internally fix femoral shaft fractures.
Interlocking screws are used to fix the nail. They are usually removed after 12 / 18 months.
Monopolar Diathermy Handle
Monopolar diathermy is used for coagulation and dissection of tissue during open or laparoscopic surgery.
Swan Ganz catheter
This is a Swan Ganz catheter which is used to measure the pressures in the heart, the pulmonary artery wedge pressure and can also be used to measure the cardiac output.
These are used in the intensive care setting and are typically inserted into a central vein.
Ryles NG Tool
This is a Ryles nasogastric tube which is primarily used for decompression (drip and suck) in bowel obstruction, but can also be used to insert drugs or contrast into the GI tract.
After explaining what you are about to do to the patient, you will require a NG tube which has been in the fridge as it is stiffer, some lubricant, a bladder syringe, a drainage bag and pH dipstick.
The correct position of the tube is checked by aspirating gastric contents and checking for acidity on pH dipstick, if this is unavailable then air can be inserted to the tube and the epigastrium auscultated for bubbling. Finally, an x-ray can be taken to identify the tube.
Once the tube is in the correct position a bag is attached and it is taped to the patients face.
Surgical vs anatomical neck of the humerus?
The surgical neck is much more frequently fractured than the anatomical neck of the humerus. This type of fracture takes place when the humerus is forced in one direction while the joint capsule and the rotator cuff muscles remain intact.
It is a clinically important anatomical feature of the humerus as it is the most frequently fractured site of the proximal humerus, putting the axillary nerve and posterior circumflex humeral branch of the axillary artery at risk.
General principles of fracture management?
Reduce (open or closed)
Hold (metal or no-metal)
Rehabilitate (move, physiotherapy, use)
What hold options are there for fractures?
Closed = plaster, traction
Fixation
Internal fixation?
Intramedullary - nails, pins
Extramudllary - plates, pins
External fixation?
Monoplanar, multiplanar
Causes of patellar effusion:
Damaged structure in the knee.
Synovoitis, OA, torn menisucus, torn ACL, chondral injury
Movements to test median nerve?
thumbs up don’t let me push it down
Movements to test radial nerve?
o Fingers straight don’t let me push them down
Movements to test ulnar nerve?
spread fingers – don’t let push it in
o Looks like a U when they spread
Heberden’s nodes?
Bony bumps on the DIPs are called Heberden’s nodes.
More OA?
Bouchard’s nodes?
Bony bumps on the PIPs
Mora RA?
Empty can test assesses what?
Supra-spinatus weakness
Scarf test assess what?
Rotator cuff pathology
Joints involved in RA?
Multiple joints affected: usually small joints of hands and feet such as the proximal interphalangeal (PIP) joint, metacarpophalangeal (MCP) joint, wrist, knee, ankle, metatarsophalangeal (MTP) joint, and cervical spine
Hawkin’s kenedy test - robot arm push down assess what?
Subacromial impingement
The most common etiology of a winged scapula?
damage or impaired innervation to the serratus anterior muscle.
External rotation against resistance
This clinical test assesses the function of the infraspinatus muscle and teres minor.
Arthroscopy
Can be used to visualise the meniscus within the joint and is the gold-standard investigation for diagnosing a meniscal tear. Arthroscopy can also be used to repair or remove damaged sections of the meniscus.
immediate management of a suspected ACL tear
RICE (Rest, Ice, Compression and Elevation)
ACL treatment:
Conservative treatment involves rehabilitation, which utilises strength training of the quadriceps to stabilise the knee
In the emergency setting, inpatient admission is rarely required; the patient can often partially weight bear and a cricket pad knee splint can be applied for comfort.
Surgical reconstruction of the ACL (Fig. 4) involves the use of a tendon or an artificial graft
This is not performed acutely but following a period of ‘prehabilitation’, whereby the patient will engage with a physiotherapist for a period of months prior to the surgery
6Ps
Pale, Pulseless, Paraesthesia, Paralysis, Pain, Perishingly cold
Vascular exam:
Ankle-brachial pressure index
<0.9 = intermittent claudication
<0.6 = rest pain
<0.3 = critical ischaemia
NB: ABPI may be falsely elevated in patients with calcified arteries.
Imaging
Duplex ultrasound (first line imaging)
MR or CT angiography (second line imaging, MR preferred but CT more widely available)
Catheter angiography (third line)
Bloods: lipid levels, fasting glucose, FBC (rule out anaemia), U&Es (to check renal function prior to contrast), coagulation screen
ECG: to look for AF as a cause of emboli
Homonymous hemianopia
Homonymous hemianopia refers to a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. Vascular causes such as cerebral infarction or cerebral haemorrhage are the most commonly identified causes. In children, this visual field defect is commonly the result of a tumour.
Right homonymous hemianopia is due to a lesion on the left side of the brain and vice versa.
Superior homonymous quadrantanopia
A visual field defect involving the two right or two left upper quadrants of the visual fields in both eyes. Classically due to a lesion involving the temporal lobe optic radiations. Causes may include stroke, tumour, or demyelination. Accompanying features may include aphasia, memory deficits complex seizures, and auditory and visual hallucinations (depending on the dominance of the lobe).
A left superior homonymous quadrantanopia is due to a lesion on the right side of the brain (e.g. right temporal lobe)
Inferior homonymous quadrantanopia
A visual field defect involving the two right or two left lower quadrants of the visual fields in both eyes. Classically due to a lesion involving the parietal lobe optic radiations. Causes may include stroke, tumour, or demyelination. Accompanying features may include finger agnosia (inability to identify specific fingers), acalculia (inability to perform simple cautions), and right-left disorientation, neglect and inattention (depending on the dominance of the lobe).
A left inferior homonymous quadrantanopia is due to a lesion on the right side of the brain (e.g. right parietal lobe)
Third nerve palsy causes?
Presumed microvascular (42 percent)
Trauma (12 percent)
Compression from neoplasm (11 percent)
Post-neurosurgery (10 percent)
Compression from aneurysm (6 percent)
Fourth nerve palsy causes?
Fourth nerve palsy may be caused by hypertension, diabetes, TIA (transient ischemic attack/mini stroke), stroke or as a result of head trauma. Other causes may require investigation such as a scan. Sometimes a cause may not be found despite extensive investigation.
Sixth nerve palsy causes?
The most common causes of sixth nerve palsy are high blood pressure, diabetes, TIA (transient ischemic attack/mini stroke) or stroke.
4th CN muscle
The fourth nerve supplies the superior oblique muscle, which moves an eye down and ‘also rotates the eye’. If the fourth nerve is not working (palsy), then the superior oblique muscle will become weak and not work properly.
6th CN muscle innervation?
The sixth nerve supplies the eye muscles which are attached on the outer aspect of the eye (lateral rectus). The left lateral rectus moves the eye to the left and the right moves it to the right. If the sixth nerve is not working (palsy) then the lateral rectus muscle will become weak and not work properly.
3rd CN muscle innervation?
Medial Rectus. The medial rectus is also a muscle of the eye’s orbit. …
Inferior Rectus. The inferior rectus is also a muscle of the orbit. …
Superior Rectus. …
Inferior Oblique.
What is a heave?
Right ventricular enlargement
Murmur + thrill = grade?
4
Principles of treating a fracture?
Reduce, restrict/hold, rehabilitate
Peripheral Neuropathy
Peripheral neuropathy refers to reduced sensory and motor function in the peripheral nerves, typically affecting the feet and hands (“stocking-glove” distribution). It is a characteristic feature of Charcot-Marie-Tooth.
Causes of peripheral neuropathy
Charcot-Marie Tooth syndrome:
Other causes of peripheral neuropathy can be remembered with the ABCDE mnemonic:
A – Alcohol
B – B12 deficiency
C – Cancer (e.g., myeloma) and Chronic kidney disease
D – Diabetes and Drugs (e.g., isoniazid, amiodarone, leflunomide and cisplatin)
E – Every vasculitis
example of mononeuropathy?
Carpal tunnel syndrome
Cerebellar signs?
Dysdiadochokinesia/ dysmetria.
Ataxia.
Nystagmus.
Intention tremor.
Speech - slurred or scanning.
Hypotonia.
Anterior horn cell disease?
poliomyelitis, SMA, ALS,
Parkinson’s diseae?
involuntary shaking of particular parts of the body (tremor)
slow movement
stiff and inflexible muscles
Causes of spinal cord pathology?
Spinal artery occlusion
Abscess
Viral infection
Syphillus
Trauma
B12, copper deficiency
Degenerative disc disease
Neoplastic - cancer
Muscle weakness in UMN?
Lower limb > flexors
Upper limb > extension
how to reinforce reflexes?
Pull hands apart – lower limb reflexes
Clench jaw – upper limb reflexes
Lower limb reflexes: which dermatomes?
Knee and ankle
Knee = L3/4
Ankle = L5/S1
Romberg test?
It is a sign of a disturbance of proprioception, either from neuropathy or posterior column disease. The patient does not know where their joint is in space and so uses their eyes. In the dark or with eyes closed they have problems.
Indications for midline sternotomy scar?
open valve surgery (most commonly aortic or mitral), coronary artery bypass grafting (CABG), cardiac transplant or operations performed for the correction of congenital cardiac defects
posterolateral thoracotomy
Mainly used for pulmonary resections (pneumonectomy or lobectomy), chest wall resection, or oesophageal surgery.
Anterolateral thoracotomy
variety of operations for cardiac, pulmonary, and oesophageal pathology.
Telengectasia, sclerodactyly, fine crackles and dull bases?
CREST syndrome
Crest/scleroderma ix?
Pulmonary function tests or breathing tests to measure how well the lungs are working.
CT chest scan may also be ordered to evaluate the extent of lung involvement.
Electrocardiogram (EKG or ECG) to see if there are changes in the heart muscle tissue due to scleroderma.
Causes of pulmonary fibrosis?
Idiopathic,
drugs such as amiodarone, nitrofunatoinm sulfasalazine, methotrexate, propanolol
Smoking
Fumes
Radiation therapy
silica dust
Bird and animal droppings
RA, viral lung infections, TB, pneumonia, SLE, pulmonary hypertension, sarcoidosis, fungal infection
Coal workers, ankylosing spondylitis
Indications for laproscopy?
Ectopic pregnancy
Fibroid surgery
Hysterectomy
Acute abdomen diagnostic
staging tumour/biopsy
Orchidopexy
Inguinal hernia repair
Cholecystecomy
Recurrent abdo pain
Types of stoma?
Colostomy, ileostomy and urostomy
Can be permanent or temporary
Temprorary = diverticulitis, obstruction, bowel leak, emergency bowel resection
Permanent = FAP, cancer, UC
Charcot Marie’s tooth sx?
Reduced fine touch sensation, high stepping gait, reduce power peripherally
Triple assessment breast cancer?
Triple assessment, as the name indicates, includes three modalities, physical examination, imaging (mammography and/or ultrasound), and biopsy (FNAC and core biopsy)
Causes of illiac fossa mass?
Diverticulitis, loaded colon, cancer, ovarian mass, fibroids, loaded colon, lymph node swelling, enlarged undescended testis, appendicular abscess (Right side)
achilles tendinopathy
unilateral knee swelling
Septic arthritis, reactive arthritis, meniscal tear, ACL injury, pseudogout
Midline laparotomy scar
(anterior resection, APER, open repair of AAA).
Causes of lung crackles?
Coarse crackles or crepitations are associated with bronchiectasis or resolving pneumonia, whereas fine crackles can be heard with either pulmonary oedema or interstitial fibrosis.
Ix for IE?
Blood cultures are essential before starting antibiotics. Three blood culture samples are recommended, usually separated by at least 6 hours and taken from different sites. The gap between repeated sets may have to be shorter if antibiotics are required more urgently (e.g., sepsis).
Echocardiography is the usual imaging investigation. Transoesophageal echocardiography (TOE) is more sensitive and specific than transthoracic echocardiography. Vegetations (an abnormal mass or collection) may be seen on the valves.
Urne dipstick,
