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Year 6 Cross Section > PACES > Flashcards

PACES Flashcards

1
Q

Valve replacement normal signs

A

midline sternotomy
abnormal S1 = mitral
abnormal S2 = aortic

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2
Q

advanced signs to look out for in valve replacement

A
  • assess for valve function (regurg/stenosis)
  • any cardiac decompensation/ HF
  • any IE
  • complications of over-anticoagulation
  • assess for haemolysis
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3
Q

signs of HF

A
  • tachypnoea/tachycardia
  • cool peripheries
  • raised JVP
  • displaced apex
  • S3 (ventricular gallop)
  • bi basal fine creps
  • peripheral oedema
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4
Q

signs of VSD

A

pansystolic murmur (loudest at LL sternal edge)
associated thrill
RV heave
loud P2
any signs of complications = RHF

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5
Q

signs of cor pulmonale

A

plethoric face
central cyanosis
raised JVP
giant V waves + pansystolic murmur if TR
R ventricular heave
loud S2
pedal oedema

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6
Q

what else to look for in cor pulmonale

A

signs of cause:
- end inspiratory creps (pulmonary fibrosis)
- clubbing (idiopathic PF)
- signs of COPD

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7
Q

HOCM signs

A
  • pacemaker
  • jerky pulse
  • double apex beat
  • ESM (LL sternal edge)
  • S4
  • signs of complications (HF)
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8
Q

JVP vs carotid pulse

A

JVP has double waveform
JVP not palpable
JVP changes with position
Abdominal pressure inc JVP

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9
Q

DDx for crescendo-decrescendo systolic murmur

A

aortic stenosis
aortic sclerosis
HOCM

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10
Q

AS mummur

A

ejection systolic
upper right sternal edge
loudest on expiration
radiates to carotids and apex

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11
Q

symptoms and signs of AS

A

Sx: exertional dyspnoea, syncope, angina
Signs: slow rising pulse, narrow PP, heaving apex beat, softy/absent S2, signs of LVF

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12
Q

aortic sclerosis murmur

A

ejection systolic
upper right sternal edge
does not radiate

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13
Q

sx and signs of aortic sclerosis

A

no symptoms
no abnormal signs
differentiate from AS by normal pulse, apex and S2

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14
Q

mitral regurg murmur

A

pansystolic
apex, loudest on expiration
radiates to axilla

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15
Q

symptoms of MR

A

dyspnoea
orthopnoea
PND
fatigue
palpitations

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16
Q

signs of MR

A

AF
displaced thrusting apex (volume-loaded)
soft S1
signs of pulmonary HTN (RV heave, loud P2)
may be signs of LVF (S3, pulmonary oedema)

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17
Q

causes ofMR

A

papillary muscle dysfunction (post-MI)
dilated cardiomyopathy
IE
congenital
connective tissue

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18
Q

mitral valve prolapse murmur

A

mid systolic click +/- late systolic murmur
apex, loudest on expiration
radiates to left axilla and back

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19
Q

TR murmur

A

pansystolic
differentiate from MR by:
- louder on inspiration (on right)
- giant JVP
- non-displaced apex

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20
Q

symptoms and signs of TR

A

sx: fatigue, ascites, peripheral oedema
signs: giant V waves in JVP, backflow signs (oedema, ascites, heptomegaly), signs of pulmonary HTN

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21
Q

causes of TR

A
  • RV dilation in pulmonary HTN
  • rheumatic heart disease
  • IE
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22
Q

assess severity of AS

A
  • pulse volume (slow-rising)
  • pulse pressure narrows
  • S2 intensity reduces
  • louder murmur
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23
Q

general indications of valve replacement

A
  • Left sided valve dysfunction (LVF, symptomatic)
  • infective endocarditis + HF/uncontrolled infection/high embolic risk
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24
Q

risks and complications of valve replacement

A
  • perioperative: arrhythmias, stroke/TIA, VTE, bleeding
  • valve complications: leakage, obstruction, haemolytic anaemia, IE
  • warfarin side effects: bleeding
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25
Q

aortic regurg murmur

A

early diastolic
upper right sternal edge
loudest on expiration

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26
Q

symptoms and signs of AR

A

sx: fatigue, SOB, palpitations
signs:
- collapsing pulse
- wide PP
- displaced thrusting apex beat
- Corrigan’s, de Musset, Quincke’s
- austin flint murmur

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27
Q

causes of aortic regurg

A

acute causes: IE, aortic dissection
chronic causes:
- aortic root dilatation (HTN, vasculitis)
- connective tissue disorders
- rheumatic heart disease

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28
Q

mitral stenosis murmur

A

low rumbling mid-diastolic
apex in left lateral position
loudest on expiration

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29
Q

symptoms of MS

A

dyspnoea
fatigue
haemoptysis
chest pain

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30
Q

signs of MS

A

malar flush
AF
tapping apex
loud S1
signs of pulmonary HTN

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31
Q

pulmonary fibrosis signs

A

oxygen therapy
dry cough
tachypnoea
reduced expansion
fine end inspiratory crackles

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32
Q

what else to look for in pulmonary fibrosis

A
  • signs of aetiology (hand deformity, clubbing, CREST sx, butterfly rash, radiation burns)
  • signs of complications: steroid use, pulmonary HTN
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33
Q

COPD signs

A

bedside inhalers/nebs
accessory muscle use
tar stained fingers
tachypnoea
lip pursing
reduced cricosternal distance (<3 fingers)
tracheal tub
indrawing of intercostals
hyper-resonance
quiet breath sounds
wheeze
prolonged expiratory phase

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34
Q

signs of pneumonectomy

A

unilateral chest flattening
thoracotomy scar
tracheal deviation (towards)
reduced expansion
dull percussion note
dec breath sounds
bronchial breathing in upper zone (due to deviated trachea_

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35
Q

what to look for if pneumonectomy?

A

signs of cancer

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36
Q

signs of lobectomy on examination

A

thoracotomy scar
may be no other signs due to compensatory hyperexpansion of remaining lobes
may be dec expansion, dullness to percussion, dec air entry

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37
Q

pleural effusion signs

A

reduced expansion
stony dull percussion note
dec breath sounds
dec tactile fremitus and vocal resonance

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38
Q

bronchiectasis signs

A

productive cough
inspiratory clicks
clubbing
coarse, late expiratory creps

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39
Q

what signs of aetiology can you see in bronchiectasis

A

young and thin (CF)
lymphadenopathy (malignancy)
dextrocardia (Kartagener’s)

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40
Q

lung cancer signs

A

cacheixa
clubbing
tar stained fingers
irregular, hard lymphadenopathy
radiation burns

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41
Q

causes of upper zone pulmonary fibrosis

A

coal
AS
radiation
TB
EAA

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42
Q

causes of lower zone pulmonary fibrosis

A

connective tissue disorders
asbestos
Idiopathic PF
drugs

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43
Q

transudative vs exudative pleural effusion

A

high protein content (>30g/L) = exudate
low protein content = transudate

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44
Q

Light’s criteria

A
  1. pleural fluid protein/serum protein = >0.5
  2. pleural fluid LDH/serum LDH = >0.6
  3. pleural fluid LDH = >2/3 upper limit of normal serum LDH
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45
Q

transudate causes

A

HF
hypoalbuminaemia (liver cirrhosis, nephrotic )

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46
Q

exudate causes

A

infection (e.g. empyema)
inflammation
infarction (PE)
malignancy

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47
Q

what does TLCO measure

A

total diffusing capacity of lung
(reduced in restrictive/obstructive due to reduction in total ventilation)

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48
Q

what does KCO measure

A

diffusing capacity of lung per unit volume (TLCO corrected for lung volume)
- in restrictive is normal: normal lung tissue and inc pulmonary capillary blood volume per alveolar volume

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49
Q

investigations and imaging to consider to investigate peripheral arterial disease

A
  • bedside: ABPI, BP
  • imaging: duplex USS, MR/CT angio, catheter angio
  • bloods: lipid levels, fasting glucose, FBC
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50
Q

management of PAD

A
  • lifestyle: exercise, foot care, smoking cessation, weight reduction
  • medical: anti-plt, lipid control, BP, diabetes control
  • surgical: angioplasty, surgical reconstruction, amputation
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51
Q

varicose veins associated skin changes

A

change in pigmentation
ulceration
venous eczema
lipodermatosclerosis
haemosiderin deposits

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52
Q

management of varicose veins

A

conservative: weight loss, avoid prolonged standing, exercise, compression stocking (look at ABPI first)
surgical: endothermal ablation, foam sclerotherapy, vein ligation and stripping

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53
Q

chronic liver disease signs

A

clubbing
leukonychia
palmar erythema
dupuytren’s contracture
jaundice
spider naevi
gyanecomastia
loss of axillary hair
distended abdominal veins
hepatomegaly
splenomegaly (portal HTN)
ascites

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54
Q

what would be signs of decompensation of CLD

A

asterixis
encephalopathy (confusion)
jaundice
ascites

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55
Q

transplanted kidney signs

A

old AV fistula
rutherford morrison scar (usually RIF)
smooth mass underlying scar (transplanted kidney)

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56
Q

if hepatomegaly, what signs to look for?

A

signs of CLD
lymphaednopathy (malignancy/lymphoma)
peripheral oedema/rasied JVP (R ventricular failure)

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57
Q

if splenomegaly, what signs to look out for?

A

hand deformity (RA/Felty’s)
signs of CLD
pale conjunctiva (leukaemia/HA)
lymphadenopathy (lymphoma)

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58
Q

PCKD signs

A

AV fistula (if had dialysis)
HTN
pale conjunctiva (anaemia)
flank scar (if kidney has been removed)
bilateral ballotable flank massess
hepatomegaly (cysts)

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59
Q

signs of liver transplant

A
  • signs of CLD
  • Mercedes Benz modification scar
  • signs of cause
  • complications of immunosuppression: tremor, cushingoid/bruising, skin lesions/excisions
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60
Q

signs of combined kidney-pancreas transplant

A
  • LIF scar (renal graft)
  • RIF scar (pancreas graft)
  • smooth mass underlying LIF scar (transplanted kidney)
  • signs of diabetic complications
  • renal graft functionality
  • pancreas graft functionality
  • previous RRT
  • complications of immunosuppression
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61
Q

ways to prevent graft rejection after renal transplant

A
  • HLA matching
  • testing for donor specific antibodies
  • immunosuppression
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62
Q

important aspects of hernia exam

A
  • chaperone
  • exam while standing up
  • lumps and describe
  • cough impulse
  • check for reducibility (deep inguinal ring = midway between ASIS and pubic tubercle)
  • percuss and auscultate lump (may reveal bowel is present)
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63
Q

features of direct inguinal hernia

A
  • superior to pubic tubercle
  • come directly out of abdomen in straight line
  • emerges through superficial inguinal ring
  • cannot be contained by applying pressure over deep inguinal ring
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64
Q

features of indirect inguinal ring

A
  • herniated abdo contents run within inguinal canal
  • emerges through deep inguinal ring
  • if reduced, can be contained by applying pressure over deep inguinal ring
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65
Q

femoral hernia

A

inferior and lateral to pubic tubercle

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66
Q

signs in hands in renal exam

A
  • tremors
  • nails: leukonychia, koilonychia
  • finger tips: cap glucose marks
  • pulse: rate and volume
  • arms: AV fistula, bruising, BP, skin lesions
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67
Q

what to look for in head and neck in renal?

A
  • eyes: periorbital oedema, conjunctival pallor, corneal arcus/xanthelasma
  • mouth: hydration, gingival hypertrophy
  • neck: JVP, central line scar
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68
Q

important chest signs in renal exam

A
  • scars
  • cap refil
  • HS
  • auscultate lung base (?odema)
  • inspect back for skin lesions
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69
Q

what to auscultate for in renal exams?

A

renal bruits

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70
Q

most common causes of end stage kidney disease

A
  1. diabetes
  2. HTN
  3. Glomerulonephritis
  4. PCKD
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71
Q

indications for dialysis

A

Acute renal failure: AEIOU
Chronic: when GFR <15ml/minute and symptoms/complications of kidney disease

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72
Q

complications of CKD

A
  • renal bone disease (due to secondary hyperparathyroidism)
  • CVS disease
  • anaemia due to low EPO
  • arrhythmia related to hyperkalaemia
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73
Q

lower limb neuro exam - what to assess in gait

A
  • normal walking
  • heel to toe if stable (ataxia = cerebellar)
  • stand on heels and then toes (tests distal power)
  • Romberg’s test (reduced stability = sensory ataxia due to proprioceptive deficit)
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74
Q

what would increased tone look like in LL exam?

A

roll leg side to side
if foot remains in line with knee

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75
Q

how would spasticity appear?

A

place hand under pt knee and briskly lift it up
if spasticity - foot kicks out involuntarily

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76
Q

hip flexion nerve roots

A

L2/L3

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77
Q

hip extension nerve roots

A

L4/L5

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78
Q

knee extension nerve roots

A

L3/L4

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79
Q

knee flexion nerve roots

A

L5/S1

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80
Q

ankle dorsiflexion nerve roots

A

L4/L5

81
Q

ankle plantar flexion nerve roots

A

S1/S2

82
Q

big toe extension

A

L5

83
Q

MRC power grades

A

5: full power
4: some resistance
3: GRAVITY
2: gravity eliminated
1: flicker of muscle contraction
0: nothing

84
Q

how to test sensation

A
  • if suspect glove and stocking: test from distal to proximal in 2-3 straight lines
  • if suspect nerve/root pathology: test dermatomes
85
Q

dorsal column modalities

A

light touch
proprioception
vibration

86
Q

spinothalamic modalities

A

temp
pain

87
Q

3 causes of bilateral upper motor neurone lesion

A

MS
MND (normal sensation)
Myelopathy (cord compression, trauma, syringomyelia)
Brain stem stroke
Cerebral palsy

88
Q

sensorimotor polyneuropathy differentials

A

Alcohol
B12/thiamine def
Charcot-Marie Tooth
Diabetes, Drugs
Every vasculitis and some infections (HIV, syphilis)

89
Q

causes of unilateral UMN lesion and pattern of loss

A
  • intracranial: stroke, SOL (hemisensory loss)
  • brainstem: stroke, SOL (may be crossed signs)
  • spinal cord: MS, infarct, SOL, disc prolapse (sensory level)
90
Q

features of Brown-Sequard

A
  • loss of power and proprioception on ipsilateral side
  • loss of pain and temp on contralateral side (as spinothalamic decussates in spine)
91
Q

hemiplegic

A

unilateral UMN

92
Q

spastic

A

bilateral UMN

93
Q

foot drop

A

LMN

94
Q

ataxic

A

cerebellar

95
Q

waddling

A

myopathic

96
Q

festinating

A

parkinsonian

97
Q

abnormalities in pronator drift

A
  • pronator drift and distal flexion = pyramidal weakness
  • upward drift = cerebellar pathology (accentuated by rebound)
98
Q

shoulder abduction nerve root

A

C5

99
Q

elbow flexion nerve root

A

C6

100
Q

elbow extension nerve root

A

C7

101
Q

wrist extension nerve root

A

C7

102
Q

finger extension nerve root

A

C7

103
Q

finger flexion nerve root

A

C8

104
Q

finger abduction nerve root

A

T1

105
Q

thumb abduction nerve root

A

T1

106
Q

DDx for bilateral proximal weakness

A

DENIM
- Dystrophies: Beker’s/Duchenne
- Endocrinological: Cushing, thyroid, diabetic amyotrophy
- NM: MG, LEMS
- Inflammatory: dermato/polymyositis, viral myositis
- Metabolic/congenital

107
Q

median nerve palsy causes

A

carpal tunnel
mononeuritis multiplex
pronator teres syndrome

108
Q

radial nerve palsy causes

A
  • trauma/compression at axilla (e.g. Saturday night palsy)
  • humeral shaft fracture
  • elbow trauma
109
Q

which are the bulbar CN

A
  1. 10, 12
110
Q

where is the lesion is there is visual inattention to one side?

A

contralateral parietal lesion

111
Q

what should you offer to test in vision?

A

colour vision
blind spots (central scotoma, papilloedema)
opthalmoscopy to visualise optic disc

112
Q

CN4 lesion

A

if eye cannot move down when facing medially

113
Q

what to say if there are dramatically abnormal eye movements which do not fit with single nerve lesion?

A

complex opthalmoplegia
e.g. Graves/MG/brainstem lesion

114
Q

medical vs surgical third nerve palsy

A
  • medical: spares pupil (only outermost part of nerve affected)
  • surgical: pupillary dilatation (affects whole nerve), painful
115
Q

causes of medical nerve palsy

A

microvascular ischaemia (diabetes)
Migraine
MS/AI disease

116
Q

causes of surgical nerve palsy

A

Posterior Communicating artery aneurysm
Cavernous sinus lesions
Cancer (SOL)

117
Q

unilateral UMN and bilateral UMN sign

A

pyramidal weakness

118
Q

patterns of unilateral LMN lesions and loss

A
  • radiculopathy (dermatomal sensory loss)
  • plexopathy (vast dermatomal sensory loss): brachial, lumbosacral
  • peripheral nerve palsy (peripheral nerve sensory loss)
  • mononeuritis multiplex
119
Q

causes of radiculopathy

A

disc hernation
degenerative disc disease
OA

120
Q

cause of distal motor neuropathy

A

chronic inflammatory demyelinating polyneuropathy
myotonic dystrophy
progressive muscular atrophy
prophyria

121
Q

causes of acute flaccid paralysis

A
  • GBS
  • rare infections (rabies, polio)
  • CES
  • spinal cord shoxk
122
Q

causes of mononeuritis multiplex

A
  • vasculitis
  • AI (RA, SLE)
  • infectious (Lyme disease, HIV, leprosy)
  • others (DM, amyloidosis, sarcoidosis)
123
Q

UMN + LMN

A
  • MND (no sensory deficit)
  • Dual pathology (e.g. cervical myelopathy + polyneuropathy)
  • myeloradiculopathy
  • Subacute combined degeneration of cord
124
Q

causes of cerebellar disease

A

MAVIS:
MS
Alcohol
Vascular - thomboembolic, haemorrhagic
Inherited - Friedreich’s ataxia, spinocerebellar ataxia
SOL

125
Q

causes of a sixth nerve palsy

A

raised intracranial pressure
microvascular ischaemia
SOL
trauma

126
Q

causes of bulbar palsy (LMN)

A
  • MND
  • brainstem infarct/SOL
  • GBS
  • Polio
  • Syringobulbia
127
Q

causes of pseudobulbar palsy (UMN)

A
  • MND
  • MS
  • bilateral internal capsule infarcts
  • TBI
128
Q

multiple cranial nerve palsies - no pattern

A
  • mononeuritis multiplex
  • meningitis
  • SOLs
  • trauma
129
Q

if CN 3-6 are involved, what are the causes?

A

cavernous sinus lesion
Miller-Fisher syndrome

130
Q

if CN5-8 and cerebellar signs, where is lesion?

A

cerebellopontine lesion
e.g. vestibular schwannoma, meningioma, brain mets

131
Q

if CN 9,10,11 involved

A

jugular foramen syndrome, mostly tumour

132
Q

if CN 9-12

A

pseudobulbar palsy (MS, MND, head injury)
bulbar palsy (MND, GBS, syringobulbia)

133
Q

CN 9-10, Horner’s syndrome + cerebellar + sensory disturbance (ipsilateral face, contralateral body)

A

lateral medullary (Wallenburg) syndrome

134
Q

what is pyramidal weakness?

A

weakness that preferentially spares antigravity muscles
mostly causes weakness of upper limb extensors and lower limb flexors
= upper limb fixed flexion and lower limb extension

135
Q

different causes of bitemporal hemianopia

A

pituitary tumours
craniopharyngioma
pregnancy

136
Q

which hand muscles does the median nerve supply?

A

all thumb muscles except adductor pollicis - “LOAF”
Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor Pollicis brevis

137
Q

which hand muscles does the ulnar nerve supply?

A

all intrinsic hand muscles except most of thumb:
- adductor pollicis
- lumbricals
- palmar interossei
- dorsal interossei

138
Q

which hand muscles does the radial nerve supply?

A

extensors

139
Q

how would bulbar palsy affect speech?

A

flaccid

140
Q

how would pseudobulbar palsy affect speech?

A

spastic

141
Q

how would cerebellar lesion affect speech?

A

slurred, staccato (jerky), scanning (variability in pitch/volume)

142
Q

how would myasthenia affect speech?

A

weak, quiet, fatiguable

143
Q

Expressive (Broca’s) dysphasia

A
  • pt knows what they want to say but can’t say it
    = non-fluent speech
  • they still understand speech, have awareness of their speech difficulty
144
Q

Receptive (Wernicke’s) dysphagia

A

fluent, effortless speech that is disorganized and lacks meaning ( talks Rubbish)
cannot understand language
they lack awareness of their speech difficulty

145
Q

how you can test these?

A
  • commands (unable to follow = receptive)
  • naming objects (difficulty saying name = expressive, incorrect names = receptive)
146
Q

tremor in Parkinson

A

asymmetrical resting pill-rolling
begins distally
reduced with finger to nose testing
worsened by distraction

147
Q

gait in Parkinson’s

A

shuffling
hesitant (difficulty initiating and turning)
festinating (walk faster and faster)
lack of arm swing
unsteadiness

148
Q

how can you accentuate the tone in Parkinson’s

A

by distraction
ask pt to move contralateral arm up and down

149
Q

how to test bradykinesia

A

open and close thumb and index finger like clicking as fast as possible

150
Q

to complete exam in Parkinsons…

A
  • exclude Parkinson Plus syndromes by examining eye movements
  • look for cerebellar signs (MSA)
  • check postural BP (MSA)
  • MMSE (LBD)
  • review drug charts (Parkinsonism drugs)
151
Q

4 key symptoms of Parkinsons

A

tremor
rigidity
bradykinesia
postural instability

152
Q

different functions of cerebellum

A
  • maintain balance and posture
  • coordinate movement
  • motor learning (fine tuning of movements)
153
Q

differentiating sensory ataxia from cerebellar ataxia

A

Romberg’s test (tests proprioception caused by sensory disorder)
If cerebellar ataxia, patient ataxic prior to test

154
Q

what to look for in shoulder exam?

A
  • alignment and posture
  • arm position (abducted, externally rotated = ant dislocation, adducted, internally rotated = post dislocation)
  • bony prominences: Sternoclavicular joint, clavicle, AC joint
  • skin
  • muscle wasting
  • axilla
155
Q

what to feel for in shoulder exam?

A
  • skin
  • bony landmarks
  • muscle bulk
  • tendons (biceps tendon, suprapinatus attachment)
156
Q

what movements in shoulder exam?

A
  • flexion
  • extension
  • abduction
  • adduction
  • external rotation
  • internal rotation (touch scapula behind back)
157
Q

special test for serratus anterior

A

press hands on wall and lean forwards
?scapula winging

158
Q

testing deltoid

A

abduct shoulder against resistance at 90

159
Q

testing supraspinatus muscle

A

Empty can test
“empty a can of coke”
ask them to push their wrist up against resistance

160
Q

testing infraspinatus/teres minor

A

resisted external rotation

161
Q

testing supscapularis

A

place dorsum of hand over their lumbar spine
move hand away posteriorly

162
Q

testing impingement

A

stabilise scapula
internally rotate
passively flex it
pain = +ve

163
Q

scarf test

A

pt hand over opposite shoulder
push elbow posteriorly
pain = acromioclavicular joint pathology

164
Q

other tests to offer

A

Hawkins, apprehension

165
Q

common shoulder pathology

A
  • supraspinatus tendonitis (impingement) = painful arc
  • rotator cuff tears = weakness of abduction initiation, supraspinatus wasting
  • adhesive capsulitis
  • OA
166
Q

Boutonniere deformity

A

PIP joint flexion
DIP joint hyperextension

167
Q

common hand pathologies

A
  • RA
  • OA
  • Carpel tunnel syndrome
  • Trigger finger
168
Q

cause of trigger finger

A

thickening of flexor tendon sheath
causes entrapment at A1 pulley

169
Q

RA exam findings

A
  • swelling of MCP and PCP
  • positive MCP squeeze
  • Rh nodules
  • ulnar deviation
  • Z-thumb
  • Swan neck deformity (hyperextended PIP, flexed DIP)
170
Q

extra-articular manifestations of RA

A
  • episcleritis and scleritis
  • Atlanto-axial subluxation
  • carpal tunnel syndrome
  • pulmonary fibrosis
  • pericarditis
  • anaemia of CD
  • splenomegaly
171
Q

what conditions is trigger finger associated with?

A
  • diabetes
  • RA
  • hypothyroidism
  • gout
172
Q

abnormalities in gait in hip exam

A
  • Trendelenburg waddling gait (abductor dysfunction)
  • Antalgic gait (limp)
173
Q

special tests in hip

A

Thomas’s test
Trendelenburg’s test

174
Q

common hip pathologies

A
  • Hip OA
  • Trochanteric bursitis
  • Childhood problems
175
Q

signs of Hip OA on exam

A
  • pain and reduced range of movement (internal rotation often lost first)
  • Thomas and Trendelenburg test +ve in severe disease
176
Q

how would you manage intracapsular hip fractures?

A
  • displaced >60y: THR or hemiathroplasty
  • <60 or undisplaced: try cannulated screws
177
Q

how would you manage extracapsular hip fractures?

A
  • intertrochanteric: dynamic hip screw
  • subtrochanteric: intra-medullary nail
178
Q

complications of hip fractures

A

infection
blood loss
fracture non-union
avascular necrosis
DVT

179
Q

valgus vs varus

A

valgus = knock knees
varus = bowed legs

180
Q

varus force vs valgus force

A

varus force = force on lateral side
valgus force = force on medical side

181
Q

how to do Lachman’s test

A

pt knee flexed to 30 degrees
one hand on top of thigh
other on back of tibia
pull tibia anteriorly

182
Q

how to do McMurray’s test?

A

externally rotate foot
apply varus force to knee
extend knee joint
positive = painful click

183
Q

collateral ligament tears signs and tx

A

signs: varus laxity or valgus laxity
effusion
tenderness over affected ligaments
tx: rest, physio, hinged brace

184
Q

signs of OA

A

pain
stiffness
reduced ROM
crepitus

185
Q

signs of prepatellar bursitis

A

localised swelling over patella
caused by period of kneeling
signs: tenderness over patella, normal ROM

186
Q

unhappy triad of knee injuries

A

rupture of medial collateral ligament
damage to medial meniscus
rupture of ACL

187
Q

position for breast exam

A

initially sitting
then lying at 30 degrees

188
Q

aspects in inspection

A
  1. arms relaxed
  2. hands rested on thighs
  3. hands pressed into hips
  4. hands behind head leaning forward
  5. lift breast to look in submammary fold
189
Q

what is DCIS?

A

abnormal cells in mammary ducts of breast
not invaded BM
pre-invasive Ca

190
Q

what is LCIS?

A

abnormal cells inside lobules of breast
not cancerous
associated with small increased breast Ca risk

191
Q

benign differentials for breast lump

A

fibroadenoma
fibrocystic disease
cyst
lipoma
fat necrosis
duct ectasia
duct papilloma

192
Q

CP definition

A

non-progressive permanent neuro condition
caused by damage to developing brain

193
Q

CP classified by limb involvement

A
  • monoplegic: affects one limb
  • hemiplegic: one side of body
  • diplegic: symmetrical, lower limbs moer affected than upper
  • quadriplegic: all 4 limbs severely affected
194
Q

CP signs

A

mostly UMN lesion and signs
- hemiplegic (circumduction)/diplegic (scissoring) gait
- increased muscle tone and spasticity in legs
- brisk reflexes
- slightly reduced power
- tremors or jerky involuntary movements

195
Q

CP management

A

MDT - physio, OT, SALT, dieticians, symptomatic relief (for spasticity, seizures, drooling etc)

196
Q

CP complications and associated conditions

A

learning disability
epilepsy
kyphoscolisosis
muscle contractures
hearing/visual impairment
GORD

197
Q

components of prosthetic knee

A

femoral component
plastic spacer
tibial component

198
Q

compartments of knee

A

patellofemoral
medical
lateral

Year 6 Cross Section (23 decks)

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