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Final OSCES > Abdominal examination > Flashcards

Abdominal examination Flashcards

1
Q

Clubbing aetiology 1

A

Idiopathic

Familial - autodominant

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2
Q

Clubbing aetiology lung

A

Chronic suppurative diseases ie CF/bronchiectasis/chronic lung abscess
Pulmonary fibrosis
Lung carcinoma

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3
Q

Clubbing aetiology heart

A

congenital cyanotic cardiac disease
Subacute bacterial endocarditis
Infected PTFE grafts of the aorta causes clubbing in the feet

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4
Q

Clubbing aetiology GI

A 
Chronic bowel inflammatory disease
Coeliac disease
Hyperthyroidism
AV fistula - on the side of the fistula
Cirrhosis
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5
Q

Leuconychia

A 
Hypo-albuminaemia
Idiopathic
Familial
Sulphonamide Abx
Arsenic/heavy metal poisoning
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6
Q

Kolionychia

A 
Chronic iron def
idiopathic
Familial
Neonates
occupational
poor peripheral circulation or altitude
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7
Q

Gynaecomastia

A 
idiopathic- puberty/senile 
chronic liver disease
chronic renal disease
Drugs ie sprinolactone/digoxin
thyrotoxicosis
secretory malignancies of hCG ie testicular tumours
klinefelters
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8
Q

Spider naevi

= excess estrogen

A 
Normal in childhood
pregnancy
OCP
Chronic liver disease
Thyrotoxicosis
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9
Q

Acanthas nigricans

A 
Insulin resistant Type 2 DM
Paraneoplastic
Acromegaly
Hypo/hyperthyroidism
Cushings
Obesity
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10
Q

CRUSADE score

A

bleeding risk in post-MI- usually NSTEMI

incl baseline haemocrit, creatinine clearance, HR, Sex, CHF signs at PC, Prior vascular disease (PAD/Stroke), DM and systolic BP

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11
Q

GRACE Score

A

mortality within 6 months MI

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12
Q

Post MI bloods

A

FBC, U and E, RBGlucose, Lipids, Troponin, ECG and CXR

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13
Q

3 common causes of cirrhosis

A

alcoholic liver disease
chronic hepatitis
NASH
PBC

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14
Q

Investigations in cirrhosis

A 
USS
Baseline FBC, UE, LFT, glucose
Hep B and C serology
Autoantibodies and immunoglobulins
Ferritin
Caeruloplasmin
Alpha1-antitrypsin
AFP
INR/PT
albumin
liver biopsy ( percutaenous if failure then transjuglar liver biopsy)
Potentially ERCP to exclude PSC
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15
Q

ABCD2 score

A

stroke risk after a TIA

Age
->60 = 1
-<60
BP
->140 OR  >90 = 1
Clinical features
-Unilateral weakness = 2
-speech disturbances = 1
Duration
->60 min = 2
-10-59min = 1
-<10min
Diabetes
- Pc at assessment = 1

> 4 is high risk
aspirin and refer to TIA clinic to be seen < 24 hours

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16
Q

Mx of BP after acute stroke

A

> 185/110 then treat aiming for between 160/90 and 185/110

IV labetolol 2-10mg over 1 min and repeat every 5 min until in target range

If CI then use IV GTN infusion. CI include bronchospasm, acute LVF, allergy, HR <60, Type 2 AV heart block.

start thrombolysis once in range for bP

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17
Q

Stroke MX quick summary

A

ABC- O2, BP, Temp and ECG
Acute CT to exclude haemorrhage
Anti-plt
Bloods- FBC, lipids, glucose, ESR, UE, clotting
CXR to exclude co-morbidities
Reduction of BP then thrombolysis with tPA
secondary prevention- lipid lowering and anti-HTN and nicotine replacement

secondary inv- doppler of carotids>carotid angiogram > endarectomy

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18
Q

ROSIER

A

To help DDx from a stroke and a stroke mimic

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19
Q

Breast lump DDX

A 
Fibroadenoma
Breast cancer
Fibrocystic disease
Duct ectasia
Fat necrosis
Breast abscess
Breast cyst
Galactocele
Lipoma
Sebaceous cyst
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20
Q 
RFs
SCC bladder
Gastric
Ovarian
Cervical
HCC
A 
Schistosomiasis
Pernicious anaemia
HRT
HPV
T2D
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21
Q

Colorectal cancer

A

M:F ratio 1:1
RF- high fat diet, UC, adematous polyps and FMHX
Right sided PC: wt loss and anaemia
Left sided PC: abdo pain, altered bowel habit and rectal bleeding/ bowel obstruction/ perforation
Liver mets most common then lungs, adrenal, kidneys and bones
Duke staging

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22
Q

Malignant melanoma

A

common 20-40
f>m
derives from a mole/naevus
>6mm diameter, irregular, assymmetry, colour variation and evolving are RFs
Breslow thickness= depth
Clarkes= anatomical level of skin invaded
mets to LN, remote skin sites, brain, SI, lung, Liver, adrenals and the heart

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23
Q

Lung cancer mets

A 
Bone
Liver
Adrenal
Brain
LN
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24
Q

Breast carcinoma

Fibroadenoma

cyst

A

solid, firm, irregular outline, painless

20-35y.o mobile, firm, overgrowth of terminal duct lobules, no assc or risk with breast cancer

post-menopausal women often but common aged 35-50, fluctuant and mobile

abscesses

  • lactational - peripherally, in those breast feeding
  • non lactational - in smokers, edge of nipple and hence assc with nipple inversion
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25
Q

Types of leg ulcers

A 
Traumatic
Venous
Arterial
Neuropathic
IV drug users/ SCA / Buergers / vasculitis
Malignant ulcers
pyoderma gangrenosum
26
Q

Describing ulcers

A

Base
Assc. features- venous disease, pulses, sensation
Site, size, shape
Edges

27
Q

Venous ulcers Mx

A

IV Abx and wound care ie desloughing
ABPI
Analgesia and compression bandaging

28
Q

Special tests for varicose veins

A

sapheno-femoral junction

29
Q

Chronic liver disease signs

A

General- cachexic in malignancy, jaundiced/icterus, excoriations and bruising
Hand- palmar erythema, dupuytrens contractures, clubbing
Face- xanthelasma, parotid swelling, and fetor hepaticus
Chest - spider naevi, caput medusae, reduced body hair, gynaecomastia and testicular atrophy

30
Q

Hepatomegaly signs

A 
Moves on respiration
Cannot get above
Dull on percussion
Smooth or craggy
Pulsatile if TR in CCF
Bruit if HCC
31
Q

Clues to aetiology in liver disease

A

Tattoo and needle marks in infectious

Xanthelasma in PBC

Slate grey in HH

Cachexic in malignancy

Midline sternotomy scar in CCF

32
Q

Decompensated liver disease

A

Ascites
Encephalopathy
Asterixis

33
Q

Causes of hepatomegaly

A

3 Big Cs and small Is

Cirrhosis
Carcinoma
CCF
Infectious (Hep B/C)
Immune (PBC, PSC, AIH)
Infiltrative (myeloproliferative and amyloidosis)
34
Q

Investigations in chronic liver disease

A

Bloods general
FBC, UE, LFT, Clotting, glucose

Inv general : USS and tap ascites

Inv cirrhotic
Hepatitis serology
Autoantibodies and immunoglobulins- ANA, AMA, anti-LKM1, anti-SM
Ferritin
caeruloplasmin
a1 antitrypsin
AFP
Liver synthetic function: Albumin and PT
Liver biopsy
ERCP if PSC
Inv malignancy
Bone profile
CXR
CT abdo and chest to stage
Colonoscopy/gastroscopy
Biopsy
35
Q

Complications of liver cirrhosis

A

variceal haemorrhage
encephalopathy
spontaneous bacterial peritonitis

36
Q

Child-pugh score

A

Based on bilirubin, albumin, INR, ascites and encephalopathy

C has a 45% 1 year survival rate vs 100% in score A

37
Q

Ascites aetiology

A

Cirrhosis
Carcinomatosis
CCF

38
Q

Palmar erythema

A 
Pregnancy
Chronic liver disease
hyperthyroidism
RA
Polycythaemia
39
Q

Nipple location

A

4th ICS

40
Q

Breast

A

2-6th rib

41
Q

T4/5 sternal angle

A 
carina
SVC enters RA
Pulmonary bifurcation
Start of aortic arch
2nd ICS
42
Q

Breast blood supply

A

Internal thoracic, intercostals and axillary vessels

43
Q

Diagphramatic openings

A

T8- aortic hiatus
T10- esophagus
T12- IVC

44
Q

Posterior mediastinum components

A 
Descending aorta
Azygos
Thoracic duct
Esophagus
SNS trunk
45
Q

RLN

A

All intrinsic laryngeal muscles for motor except cricothyroid (superior laryngeal intrinsic branch)
Lower laryngeal sensation

Trauma= partial paralysis= adducted= if bilateral= no breathing

Resection=complete paralysis= ab/aducted= no speaking or coughing

46
Q

Inguinal region

A

Deep ring = mid point of inguinal ligament (ASIS and pubic tubercle)/ 1.5cm above femoral pulse

Superficial ring= superiomedial to pubic tubercle

47
Q

Inguinal canal

A

Roof - internal oblique and transversus abdominus
Floor - inguinal ligament
Medial - pubic tubercle
lateral - deep ring
Front - external oblique aponeurosis
Back - conjoint tendon of internal oblique and transversus abdominus and transversalis fascia

Males- ilioinguinal nerve and spermatic cord
Females- ilioinguinal nerve, genital branch of genitofemoral nerve and round ligament of uterus

48
Q

Spermatic cord

A

3 layers

  • external spermatic- EO
  • cresmateric -IO
  • internal spermatic - TA

3 arteries

  • cresmateric -mesenteric
  • artery to vas
  • testicular - aorta

3 veins

  • cresmateric
  • pampiniform plexus
  • vein to vas

3 others

  • LN
  • vas deferns
  • obliterated processus vaginalis

2 nerves

  • cresmateric
  • SNS
49
Q

Direct hernia

A

Hesselbach triangle

M - rectus abdominis
L - inferior epigastric
I - inguinal

50
Q

Femoral canal

A

Front - inguinal
Back - pectineal
lateral - femoral vein
Medial - lacunar

Contains fat and cloquet nodes

51
Q

L1 transplyoric

A 
pyloric orifice
D1
Pancreatic neck
SMA
Coeliac
Renal hilar
DJ flexure
Gallbladder fundus
52
Q

L4- between iliac crest

A

Aorta bifurcation

53
Q

Umbilicus

A

L3/4

54
Q

Spleen

A

Rib 9-11

55
Q

Liver

A

5th ICS - 10th rib

56
Q

ANS abdo

A

SNS- thoracic and lumbar splanchnic

PNS- vagus and pelvic splanchnic

57
Q

Coeliac branches
SMA branches
IMA branches

A

coaelic- left gastric, splenic and common hepatic

SMA- ileocolic, middle colic, right colic, inf pancreaticoduodenal, jejunal and ileal branches

IMA- left colic, sigmoid branches and superior rectal

margincal artery of drummond between middle and left colic

58
Q

Ureterc narrowings

A

Pelviureteric
Pelvic brim
Vesicoureteric

59
Q

Urethra in males

A

Pre-prostatic
Prostatic
membranous
spongy

60
Q

Facial nerve route

A 
Arises between medulla and pons
internal auditory canal
Forms geniculate ganglion in middle ear
branch to styloid
chorda tympani to ant 2/3
greater superior petrosal to lacrimal
leaves temporal bone via stylomastoid foramen
parotid
branch to digastric post. belly and stylohyoid
divides into
-temporal
-zygomatic
-buccal
-mandibular
-cervical

Final OSCES (2 decks)

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