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Final OSCES > Abdominal examination > Flashcards

Abdominal examination Flashcards

(60 cards)

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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
Types of leg ulcers
``` Traumatic Venous Arterial Neuropathic IV drug users/ SCA / Buergers / vasculitis Malignant ulcers pyoderma gangrenosum ```
26
Describing ulcers
Base Assc. features- venous disease, pulses, sensation Site, size, shape Edges
27
Venous ulcers Mx
IV Abx and wound care ie desloughing ABPI Analgesia and compression bandaging
28
Special tests for varicose veins
sapheno-femoral junction
29
Chronic liver disease signs
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
Hepatomegaly signs
``` Moves on respiration Cannot get above Dull on percussion Smooth or craggy Pulsatile if TR in CCF Bruit if HCC ```
31
Clues to aetiology in liver disease
Tattoo and needle marks in infectious Xanthelasma in PBC Slate grey in HH Cachexic in malignancy Midline sternotomy scar in CCF
32
Decompensated liver disease
Ascites Encephalopathy Asterixis
33
Causes of hepatomegaly
3 Big Cs and small Is ``` Cirrhosis Carcinoma CCF Infectious (Hep B/C) Immune (PBC, PSC, AIH) Infiltrative (myeloproliferative and amyloidosis) ```
34
Investigations in chronic liver disease
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
Complications of liver cirrhosis
variceal haemorrhage encephalopathy spontaneous bacterial peritonitis
36
Child-pugh score
Based on bilirubin, albumin, INR, ascites and encephalopathy C has a 45% 1 year survival rate vs 100% in score A
37
Ascites aetiology
Cirrhosis Carcinomatosis CCF
38
Palmar erythema
``` Pregnancy Chronic liver disease hyperthyroidism RA Polycythaemia ```
39
Nipple location
4th ICS
40
Breast
2-6th rib
41
T4/5 sternal angle
``` carina SVC enters RA Pulmonary bifurcation Start of aortic arch 2nd ICS ```
42
Breast blood supply
Internal thoracic, intercostals and axillary vessels
43
Diagphramatic openings
T8- aortic hiatus T10- esophagus T12- IVC
44
Posterior mediastinum components
``` Descending aorta Azygos Thoracic duct Esophagus SNS trunk ```
45
RLN
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
Inguinal region
Deep ring = mid point of inguinal ligament (ASIS and pubic tubercle)/ 1.5cm above femoral pulse Superficial ring= superiomedial to pubic tubercle
47
Inguinal canal
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
Spermatic cord
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
Direct hernia
Hesselbach triangle M - rectus abdominis L - inferior epigastric I - inguinal
50
Femoral canal
Front - inguinal Back - pectineal lateral - femoral vein Medial - lacunar Contains fat and cloquet nodes
51
L1 transplyoric
``` pyloric orifice D1 Pancreatic neck SMA Coeliac Renal hilar DJ flexure Gallbladder fundus ```
52
L4- between iliac crest
Aorta bifurcation
53
Umbilicus
L3/4
54
Spleen
Rib 9-11
55
Liver
5th ICS - 10th rib
56
ANS abdo
SNS- thoracic and lumbar splanchnic | PNS- vagus and pelvic splanchnic
57
Coeliac branches SMA branches IMA branches
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
Ureterc narrowings
Pelviureteric Pelvic brim Vesicoureteric
59
Urethra in males
Pre-prostatic Prostatic membranous spongy
60
Facial nerve route
``` 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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