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Flashcards in Anatomy Deck (87):
1

The hip joint

ASIS - anterior superior iliac spine 

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2

Knee bones

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3

Ankle bones

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4

Inguinal ring borders

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5

Saphenofemoral junction 

2.5cm below and lateral to the pubic tubercle

 

 

6

Quadricep Muscles 

Rectus femoris 

vastus lateralis 

vastes medialis 

vastus intermedius 

7

hamstrings

biceps femoris 

semitendinosus 

semimembrinosus 

8

shoudler joint 

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9

Calf 

Gastrocnemius - lateral epicondyle

 

10

subclavian steal

narrow proximal subclavian artery (proximal to where vertebral artery leaves)

 

decreased pressure distally 

:. subclavian artery takes blood from contralateral vertebral artery (via circle of willis and back down the vertebral artery) 

 

can steal from internal mammary - CABG

11

lehriche 

aortoiliac occlusion

 

absent femorals

buttock claudication 

erectile dysfunction

12

gunstock deformity

malunion of a spuracondylar fracture

 

wedge osteotomy of lateral humerus

13

mitral regurgitation 

jet width 0.6cm+

regurgitant volume more than 60 ml

 

14

aortic stenosis 

pressure gradiant >40

valve area <1cm^2

 

15

6 Ps

acute limb ischaemia 

 

pulseless

painful

Pallor

perishingly cold 

paraesthesia 

 

paralysis

16

Still's 

juvenila idiopathic arthritis 

salmon coloured rash comes and goes 

17

mig infuinal point scar 

Navy

nerve 

artery 

vein 

y fronts - lateral to medial

18

Posterior cruciate ligament anatomy

 lateral edge of medial femoral condyle 

tibial plateau 

19

anterior cruciate ligament 

posterior to anterior

lateral to medial 

superior to inferior 

 

attachments - 

- notch of distal femur (lateral femoral condyle)

- tibial plateau 

20

Acromegaly management

ocreotide - somatostatin analogue 

pegvisomant - GH antagonist 

 

 

examine 

hands

face

visual fields - bitemporal hemianopia 

21

Graves 

carbimazole

propilthyouracil 

radioiodine 

22

Dercum's

adiposis dolorosa

multiple painful benign lipomas

in obese

23

ICD

implanatable cardioverter defribrillator

24

Shoulders

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25

Diabetic Retinopathy 

Background

  • Venodilation
  • Microaneurysms (red dots)
  • Hard exudates

Pre-proliferative

  • Soft exudates (cotton wool spots)

Proliferative

  • New vessels

26

Hypertensive Retinopathy 

Grade 1

Arteriolar narrowing + silver wiring

Grade 2

AV nipping

Grade 3

Flame shaped haemorrhages + cotton wool spots

Grade 4

Papilloedema

27

Carpal Tunnel Syndrome 

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 

 

 

28

Optic Atrophy

0.3+ cup to disc ratio of optic nerve

 

Local

  • Optic Neuritis
  • Advanced Glaucoma
  • Ischaemia-Retinal artery occlusion (GCA)
  • SOL

Systemic

  • B12/Folate
  • Alcohol

29

Horner's Syndrome Causes

lesion of sympathetic - hypothalamus, preganglionic tract, post ganglionic tract

CNS - MS, stroke, SOL - syrinx

Pancoast's Tumour

Carotid artery aneurysm

Trauma - Carotid endarterectomy, central line 

Migraine 

30

Ptosis differentials

Horner's

CN3 palsy

Guillain Barre

MG, Lambert Eaton

Myotonic Dystrophy

31

Blue sclera

Ehler's Danlos

Osteogenesis Imperfecta (poor bone formation due to lack of type I collagen)

 

32

CEAP Classification

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33

Femoral head blood supply

Deep femoral nerve 

circumflex arteries 

retinacular vessels 

34

Median Nerve Injury

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.

35

Tunnel Vision 

Chronic Glaucoma 

Retinitis Pigmentosa

Cataracts

Ocular Migraine 

36

Amarosis fugax

Patchy ischaemia

Can see cholesterol emboli

Bruits in arteries

Need carotid endarterectomy

Remove clot that is showering little bits of clot

37

Acromegaly

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

38

Acromegaly Treatment

Ocreotide (somatastatin analogue)

Pegvisomant (GH antagonist)

transphenoidal resection of pituitary gland 

- pituitary macroadenoma 

 

 

39

Ehler's Danlos

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

40

Marfan's Syndrome 

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 

 

41

MEN1 

 

3Ps

Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia

Pituitary (70%)

Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)

 

Also adrenal and thyroid

42

MEN2a

Medullary thyroid cancer (70%) 
 

2 P's

Parathyroid (60%)
Phaeochromocytoma

43

MEN2b

Medullary thyroid cancer
 

1 P

Phaeochromocytoma

Marfanoid body habitus
Neuromas

44

Neurofibromatosis 

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 

45

Tuberous Sclerosis 

 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

46

 Multiple telangiectasia on face, lips and buccal mucosa

 Cyanosis: large pulmonary AVMs

 No signs of CREST

Hereditary Haemorrhagic Telangiectasia 

47

Small pigmented macules on lips, oral mucosa, palms and soles

Peutz Jehger's

48

gout where else to look

ears - gouty tophi 

 

NSAIDs - Naproxen

Colchicine 

Steroids 

 

Allopurinol 

 

49

Rheumatoid arthritis where else to look

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

50

Systemic Sclerosis 

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 

51

SLE

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

52

SLE treatment 

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

53

Ankylosing Spondylitis

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

 

54

tophacous gout XR findings

punched out periarticular erosions

55

Dermatomyositis

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 

 

56

Yellow nail syndrome 

Primary lymphedema with yellow nails and pleural effusion

also bronchiectasis 

57

Behcet's

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

58

Jone's Criteria

Rheumatoid Arthritis

 

Carditis

Arthritis

Sydenam's Chorea

Erythema Marginatum

Subcutaneous nodules 

 

 

Minor criteria 

arthralgia

fever

elevated inflammatory markers

first degree heart block

59

Duke Criteria

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

60

Visual Fields Diagram

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61

Bulbar vs Pseudobulbar 

CN 9 10 11

bulbar LMN

pseudobulbar UMN

 

62

Blood Vessels of leg

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63

RAPD / Marcus Gunn Pupil

Features

 Minor constriction to direct light

 Dilatation on moving light from normal to abnormal eye.

64

Features of Optic Atrophy

 ↓ visual acuity

 ↓ colour vision: esp. red desaturation

 Central scotoma

 Pale optic disc

 RAPD

65

Argyl Robertson Pupil

Small Irregular pupils

accomodate but don't react to light

 

Neurosyphillis

DM

66

Holmes Adie Pupil

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

67

Pleural Effusion 

 

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

68

Safe triangle chest drain

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69

ECG rate

large squares between QRS complexes 

/4

70

Light's Criteria

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

71

Lateral Medullary Syndrome (lateral medulla oblongata)

Dysphagia

Ataxia

Nystagmus

Vertigo

Altered sensation/anaesthesia (reduced contralateral pain in body, reduced ipsilateral pain in face)

Horner’s

72

Hallux Valgus

  • 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 

 

73

Latissimus dorsi flap

scar on back

mobilise latissimus dorsi 

74

tram flap

transverse rectus abdominus flap

Pedicled 

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75

DIEP flap

deep inferior epigastric perforators

removes only skin and fat

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76

Volkmann's Ischaemic Contracture

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77

Long posterior flap of burgess

skin and gastrocnemius brought forward and cover shin bone 

 

 

 

(skewed flap - kingsley robinson - less common)

78

complications of amputation

stump breakdown - poor blood supply

phantom limb pain

79

aortoiliac stenosis surgery

axillofemoral bypass 

80

peripheral vascular disease management 

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

81

anaphylaxis 

1:10000

IM Adrenaline 0.5mg

Chlorphenamine 10mg IV

Hydrocortisone 200mg IV

82

CURB 65

Confusion

Urea >7

Resp Rate >30

Blood pressure systolic <90 diastolic <60

 

Age 65+

83

Status epilepticus

lorazepam IV 2-4mg 

within 2 minutes again if no response

 

Phenytoin 18mg/kg 

- put on ECG

84

Tunnel vision

advanced glaucoma

cataracts

ocular migraine 

retinitis pigmentosa 

 

85

Cataracts

Classification

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 

86

 

Cavernous sinus thrombosis
 

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

87