Anatomy Flashcards

Question

Diabetic Retinopathy

Answer 1

Background * Venodilation * Microaneurysms (red dots) * Hard exudates Pre-proliferative * Soft exudates (cotton wool spots) Proliferative * New vessels

Answer 2

Grade 1 Arteriolar narrowing + silver wiring Grade 2 AV nipping Grade 3 Flame shaped haemorrhages + cotton wool spots Grade 4 Papilloedema

Answer 3

numbness, tingling, burning thumb and fingers (esp index and middle fingers and radial half of ring finger) thenar eminence wasting Goal of surgery - divide transverse carpal ligament and distal aspect of volar ante brachial fascia

Answer 4

0.3+ cup to disc ratio of optic nerve Local * Optic Neuritis * Advanced Glaucoma * Ischaemia-Retinal artery occlusion (GCA) * SOL Systemic * B12/Folate * Alcohol

Answer 5

lesion of sympathetic - hypothalamus, preganglionic tract, post ganglionic tract ## Footnote CNS - MS, stroke, SOL - syrinx Pancoast's Tumour Carotid artery aneurysm Trauma - Carotid endarterectomy, central line Migraine

Answer 6

Horner's CN3 palsy Guillain Barre MG, Lambert Eaton Myotonic Dystrophy

Answer 7

Ehler's Danlos Osteogenesis Imperfecta (poor bone formation due to lack of type I collagen)

Answer 8

Deep femoral nerve circumflex arteries retinacular vessels

Answer 9

inability to abduct and oppose thumb - paralysis of the thenar muscles ape-hand deformity Sensory loss - thumb, index finger, long finger, radial aspect ring finger Weakness in forearm pronation and wrist and finger flexion Activities of daily living such as brushing teeth, tying shoes, making phone calls, turning door knobs and writing, may become difficult with a median nerve injury.

Answer 10

Chronic Glaucoma Retinitis Pigmentosa Cataracts Ocular Migraine

Answer 11

Patchy ischaemia Can see cholesterol emboli Bruits in arteries Need carotid endarterectomy Remove clot that is showering little bits of clot

Answer 12

shake hands - doughy consistency + XS sweating Spade like hands Carpal tunnel syndrome - thenar wasting high BP Bitemporal hemianopia check - each eye separately Face * Coarse facial features: large nose, big ears * Prominent supra-orbital ridges * Macroglossia * Widely spaced teeth: “show me your gums” * Prognathism: inspect from side Acanthosis nigricans Look up nose for scars Ask for old photographs Ring size, shoe size change

Answer 13

Ocreotide (somatastatin analogue) Pegvisomant (GH antagonist) transphenoidal resection of pituitary gland - pituitary macroadenoma

Answer 14

* Hyperelastic skin * Hypermobile joints * Cardiac: MVP, AR, MR and aneurysms * Fragile blood vessels → easy bruising, GI bleeds * Poor healing

Answer 15

long arms (arm span\> height) Arms - radioradio delay (coarctation), collapsing pulse * arachnodactyly * hyperextensible joints Face - high arched palate, lens dislocation (upwards) Chest - pectus excavatum * Aortic regurgitation * Mitral Valve Prolapse AD Chr 15 Fibrillin protein MEN2b Treat - beta block and ACEI to slow aortic root dilatation

Answer 16

Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia Pituitary (70%) Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration) Also adrenal and thyroid

Answer 17

Medullary thyroid cancer (70%) 2 P's Parathyroid (60%) Phaeochromocytoma

Answer 18

Medullary thyroid cancer 1 P Phaeochromocytoma Marfanoid body habitus Neuromas

Answer 19

Cafe au lait spots 6+ Neurofibromas 2+ Axillary Freckling Eyes - Lisch nodules - harmatomas of the eye Peripheral neuropathy Optic glioma - visual acuity NF1 - chr 17 Complications - epilepsy, learning difficulties DDx - Mccune Albright, Tuberous Sclerosis

Answer 20

 Facial adenoma sebaceum: perinasal angiofibromata  Periungual fibromas: hands and feet  Shagreen-patch: roughened leathery skin over sacrum  Ash-leaf macule: hypopigmented macule on trunk  Fluoresce c¯ UV/Wood’s lamp  Café-au-lait spots epilepsy renal enlargement - cysts chr 16

Answer 21

Hereditary Haemorrhagic Telangiectasia

Answer 22

Peutz Jehger's

Answer 23

ears - gouty tophi NSAIDs - Naproxen Colchicine Steroids Allopurinol

Answer 24

elbows - rheumatoid nodules anti-CCP ab (cyclic citrulinated peptide) Morning stiffness \>≥1h Arthritis in 3+ joint areas Arthritis of the hands Symmetrical Rheumatoid nodules +ve RF Radiographic changes

Answer 25

Calcinosis Raynaud's (gloves, nifidepine) Eosophagial dysmotility (PPIs) Sclerodactyly (emollients) Telangiectasia ^BP (renal) - aggressive BP control Microstomia Beaked nose Pulmonary Fibrosis Anti centromere Ab Limited cutaneous systemic sclerosis

Answer 26

Skin * malar (butterfly) rash: spares nasolabial folds * discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas. Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic * photosensitivity * Raynaud's phenomenon * livedo reticularis * non-scarring alopecia Musculoskeletal * arthralgia * non-erosive arthritis Cardiovascular * myocarditis Respiratory * pleurisy * fibrosing alveolitis Renal * proteinuria * glomerulonephritis (diffuse proliferative glomerulonephritis is the most common type) Neuropsychiatric * anxiety and depression * psychosis * seizures

Answer 27

Mild disease: cutaneous and joints only * Topical corticosteroids * Sun cream * Hydroxychloroquine Moderate disease: + organ involvement * Prednisolone * Azathioprine Severe Disease AIHA, nephritis, pericarditis, CNS disease * High-dose methylprednisolone * Cyclophosphamide

Answer 28

Schober's test \<5cm XR sacroilitis: subchondral erosions, sclerosis squaring of lumbar vertebrae 'bamboo spine' (late & uncommon) syndesmophytes: due to ossification of outer fibers of annulus fibrosus chest x-ray: apical fibrosis

Answer 29

punched out periarticular erosions

Answer 30

Skin features * photosensitive * macular rash over back and shoulder * heliotrope rash in the periorbital region * Gottron's papules - roughened red papules over extensor surfaces of fingers * nail fold capillary dilatation Other features * proximal muscle weakness +/- tenderness * Raynaud's * respiratory muscle weakness * interstitial lung disease: e.g. Fibrosing alveolitis or organising pneumonia * dysphagia, dysphonia muscle biopsy Prednisolone

Answer 31

Primary lymphedema with yellow nails and pleural effusion also bronchiectasis

Answer 32

classically: 1) oral ulcers 2) genital ulcers 3) anterior uveitis thrombophlebitis arthritis neurological involvement (e.g. aseptic meningitis) GI: abdo pain, diarrhoea, colitis erythema nodosum, DVT

Answer 33

Rheumatoid Arthritis Carditis Arthritis Sydenam's Chorea Erythema Marginatum Subcutaneous nodules Minor criteria arthralgia fever elevated inflammatory markers first degree heart block

Answer 34

Infective endocarditis Major criteria Positive blood cultures * two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group, or * persistent bacteraemia from two blood cultures taken \> 12 hours apart or three or more positive blood cultures where the pathogen is less specific such as Staph aureus and Staph epidermidis, or * positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci, or * positive molecular assays for specific gene targets Evidence of endocardial involvement * positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or * new valvular regurgitation Minor criteria * predisposing heart condition or IVDU * microbiological evidence does not meet major criteria * fever \> 38ºC * vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura * immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots

Answer 35

CN 9 10 11 bulbar LMN pseudobulbar UMN

Answer 36

Features  Minor constriction to direct light  Dilatation on moving light from normal to abnormal eye.

Answer 37

 ↓ visual acuity  ↓ colour vision: esp. red desaturation  Central scotoma  Pale optic disc  RAPD

Answer 38

Small Irregular pupils accomodate but don't react to light Neurosyphillis DM

Answer 39

Dilated pupil that has no response to light and sluggish response to accommodation. ↓ or absent ankle and knee jerks Benign condition, more common in young females

Answer 40

Transudate (\< 30g/L protein) * heart failure (most common transudate cause) * hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption) * hypothyroidism * Meigs' syndrome Exudate (\> 30g/L protein) * infection: pneumonia (most common exudate cause), TB, subphrenic abscess * connective tissue disease: RA, SLE * neoplasia: lung cancer, mesothelioma, metastases * pancreatitis * pulmonary embolism * Dressler's syndrome * yellow nail syndrome

Answer 41

large squares between QRS complexes /4

Answer 42

if the protein level is between 25-35 g/L, Light's criteria should be applied. An exudate is likely if at least one of the following criteria are met: pleural fluid protein divided by serum protein \>0.5 pleural fluid LDH divided by serum LDH \>0.6 pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Answer 43

Dysphagia Ataxia Nystagmus Vertigo Altered sensation/anaesthesia (reduced contralateral pain in body, reduced ipsilateral pain in face) Horner’s

Answer 44

* Irritated skin * Pain on walking * Joint redness * Pain * Shift of big toe towards other toes * Blisters around site of bunion Pain relief Good shoe support Splinting between first and second toe Bunionectomy First Metatarsal realignment osteotomy

Answer 45

scar on back mobilise latissimus dorsi

Answer 46

transverse rectus abdominus flap Pedicled

Answer 47

deep inferior epigastric perforators removes only skin and fat

Answer 48

skin and gastrocnemius brought forward and cover shin bone (skewed flap - kingsley robinson - less common)

Answer 49

stump breakdown - poor blood supply phantom limb pain

Answer 50

axillofemoral bypass

Answer 51

Conservative: diet, exercise program, smoking, diabetic specialist nurse, podiatrist for foot care Medical: * Aspirin 75 mg * ACD treatment hypertension * Statins * Optimise insulin/oral hypoglycemics Surgical: * Endovascular: stents/grafts * Endarterectomy * Reconstructive surgery: anatomical or extra-anatomical bypasses * Amputation

Answer 52

1:10000 IM Adrenaline 0.5mg Chlorphenamine 10mg IV Hydrocortisone 200mg IV

Answer 53

Confusion Urea \>7 Resp Rate \>30 Blood pressure systolic \<90 diastolic \<60 Age 65+

Answer 54

lorazepam IV 2-4mg within 2 minutes again if no response Phenytoin 18mg/kg - put on ECG

Answer 55

advanced glaucoma cataracts ocular migraine retinitis pigmentosa

Answer 56

Classification ## Footnote Nuclear: change lens refractive index, common in old age Polar: localized, commonly inherited, lie in the visual axis Subcapsular: due to steroid use, just deep to the lens capsule, in the visual axis Dot opacities: common in normal lenses, also seen in diabetes and myotonic dystrophy RF - diabetes - trauma - steroid use

Answer 57

other causes of cavernous sinus syndrome: local infection (e.g. sinusitis), neoplasia, trauma periorbital oedema ophthalmoplegia: 6th nerve damage typically occurs before 3rd & 4th trigeminal nerve involvement may lead to hyperaesthesia of upper face and eye pain central retinal vein thrombosis

Anatomy Flashcards

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