Interval 8 Flashcards
How to do Allen’s test?
It is used to test patency of radial & ulnar arteries.
Both arteries are first compressed at the wrist and then have patient open and close hand until it blanches; then release one of the vessels and observe normal pink color of hand return if that vessel is patent.
Can be used to assess patency of radial artery prior to arterial puncture, prior to creation of wrist A-V fistula for hemodialysis access, or to assess patency of that vessel to use as a conduit in coronary artery bypass grafting.
The anatomic landmarks for subclavian vein catheter insertion?
The clavicle & suprasternal notch.
In supine patient, place index finger in suprasternal notch & thumb on mid-clavicle. Insert needle 1 cm inferior & 1cm lateral to junction of middle and medial 1/3 of clavicle. Direct needle medially towards index finger, ~15 degrees above horizontal plane, along inferior border of clavicle.
What “nursemaid’s elbow” ( subluxation of the radial head ) is?
Occurs when swinging child by the arms during play with sudden pull on extended pronated arm tears the annular ligament.
Usually in children 1-3 yrs. of age; child holds arm flexed & pronated and will not use it. Cannot supinate. Treated with closed reduction.
The utility of the biceps reflex?
It tests the integrity of the musculocutaneous nerve (rarely injured). More importantly, it checks the C5-C6 spinal cord segments.
What a compartment syndrome is?
A limb-threatening condition where there is insufficient blood flow to supply muscles & nerves with oxygen because of raised pressure in a tight compartment such as those encased by the crural fascia of the leg (can also occur in the arm).
Caused by bleeding, crush injuries, emboli, reperfusion injury, burns and tight casts. May require urgent fasciotomies, often to decompress all 4 leg compartments.
What is a normal calcaneal (Achilles) reflex?
Normal response is plantar flexion of ankle joint.
Tests S1-S2 spinal cord segments.
What lower extremity pulses should be routinely palpated in a good physical exam?
- Femoral
- popliteal
- posterior tibial
- dorsalis pedis.
Cannot feel the fibular ( peroneal ) pulse since vessel terminates above the ankle.
What “tennis elbow” is?
Also called lateral epicondylitis, it is inflammation of the origins of the extensor muscles of the forearm ( common extensor tendon ).
It is a painful overuse injury that occurs with backhand tennis shots or using screwdrivers for example.
Get tears where tendon attaches to periosteum of lateral epicondyle of humerus.
Why the “ superficial” femoral vein is a misnomer?
It is actually part of the deep system and, therefore, a clot here can lead to pulmonary emboli &/or chronic leg swelling ( post-phlebitic syndrome).
Clots usually start in the crural veins and propagate cephalad into the popliteal & femoral veins.
Diagnose with ultrasound, then treat with anticoagulation, thrombolysis, or possibly IVC filter.
The anatomy involved in Osgood-Schlatter disease?
Also called epiphysitis of the tibial tubercle.
It is an irritation of the patellar ligament at tibial tuberosity insertion, generally in ages 9-16, often due to excess weight or exercise during periods of bone growth.
