Block 12 Flashcards

Question

What are the 7 characteristics of rheumatoid arthritis? How do they differ from osteoarthritis?

Answer 1

May begin at any time (40-70yrs) Rapid disease progression (weeks-months) Joints are painful, swollen and stiff Begins in the small joints and progresses to the larger ones. Hips and spine normally spared Usually symmetrical Morning stiffness that last longer than 1h. Frequent feelings of fatigue and being ill. Usually begins later in life Slow progression over years Joints ache and may be tender but have little or no swelling Usually in the large joints (hips, knees, spine). The joints that have greatest strain. Usually asymmetrical Morning stiffness that lasts <1h and returns later in the day. Systemic symptoms are not present

Answer 2

* Scars, swellings, muscle wasting, deformity * Skin for thinning or bruising * Nails for pitting, onycholysis, vasculitis * Symmetrical or asymmetrical * What joints do the changes involve

Answer 3

* Peripheral pulses * Bulk of thenar and hypo-thenar eminences for tendon thickening * Median nerve sensation = thenar eminence * Ulnar nerve sensation = hypo-thenar eminence * Radial nerve sensation = 1st-2nd finger web space * Skin temperature * Tenderness in MCP joints by squeezing across the joints * Bimanually palpate any abnormal MCP joints * Bimanually palpate the wrists

Answer 4

* Straighten fingers fully against gravity (extensor damage) * Make a fist (tendon or small joint damage) * Wrist flexion and extension active and passive * Phalen’s test (forced wrist flexion for 60s) to reproduce symptoms * Abduction of the thumb (median nerve) * Finger spreading (ulnar nerve) * Pick a small object out of hand (pincer grip function)

Answer 5

Inserts into MP of each digit. Tested by isolating MPC joint and active flexion of PIP joints.

Answer 6

Inserts into DP of each digit. Tested by isolating PIP and active flexion of DIP joints.

Answer 7

1˚ flexor of the thumb. Tested by isolating MCP joint and active flexion of IP joint.

Answer 8

FCU, FCR, PL | Should be able to feel the tendons under the skin during wrist flexion.

Answer 9

1˚ extensor of thumb. Test extension of thumb IP joint by isolating MCP joint.

Answer 10

ECR, ECU | Function tested by extension of the wrist.

Answer 11

Median = All forearm extensors (-FCU and medial FDP) and elbow joint Anterior interosseous = deep flexor muscles of forearm (-medial FDP) Palmar cutaneous nerve = Skin of the hand

Answer 12

thin, thick on tip of fingers, hairless, defined stratum lucidum, high density of nerve endings and sweat glands, no sebaceous glands The proximal crease line of the hand-forearm (there are 2) marks the proximal end of the flexor synovial sheaths.

Answer 13

Superficial palmar branches of radial and ulnar arteries. Thenar and hypo-thenar respectively.

Answer 14

Radial nerve = posterior thumb and 2-3 digits Median nerve = Anterior thumb, 2-3 digits and ½ 4th digit Ulnar nerve = Anterior and posterior 4-5 digits

Answer 15

All from palmar aponeurosis 1) skin attachments just before the fingers 2) = Pass into the fingers where continuous with Cleland’s ligaments 3) = wrap around the extensor tendon and insert into metacarpal.

Answer 16

Natatory ligament (superficial transverse metacarpal) Deep transverse metacarpal (x3) Transverse fivers of palmar aponeurosis

Answer 17

Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate

Answer 18

Head of ulnar and ulnar notch of radius Pivot type synovial joint (same with proximal R-U joint) Articular disk Interosseous innervation and arterial supply

Answer 19

Pronation: Pronator teres, pronator quadratus Supination: Supinator, biceps

Answer 20

Synovial biaxial and ellipsoid joit Radius with: lunate and scaphoid + triquetrum (T only in contact in full adduction) Interosseous nerves and arteries Extrinsic ligaments = carpals --> radius/ulnar Intrinsic ligaments = carpals --> carpals

Answer 21

Flexion: FCR, FCU, FDS, FDP, PL, FPL Extension: ECRL, ECRB, ECU, ED, EDM, EI, EPL Adduction: FCU, ECU Abduction: ECRL, ECRB, FCR, APL, EPB

Answer 22

``` Synovial saddle joint 1st metacarpal base and trapezium Lateral, posterior, anterior ligaments Radial artery Post interosseous nerve ```

Answer 23

Flexion: FPB and FPL (flexion entails medial rotation) Extension: APL, EPL, EPB Abduction: APB, APL, Adduction: Adductor pollicis

Answer 24

``` Synovial ellipsoid joints Strong palmar and dorsal ligaments Interosseous ligaments Post carpal branches of radial and ulnar arteries Innervation = Ulnar, IO, radial, median ```

Answer 25

Synovial ellipsoid joints Each has 1 palmar and 2 collateral ligaments Deep transverse metacarpal ligaments Vascular = dorsal and palmar metacarpal arteries Innervation = Median, ulnar, IO nerves

Answer 26

Flexion: FDS, FDP, L, IO, FDM, FPL, FPB Extension: ED, EI, EDM, EPL, EPB Adduction: IO, AP Abduction: IO, ED, ADM, APB,

Answer 27

``` Synovial uniaxial hinge joints • Palmar ligament (volar plate) • Collateral ligaments (x2) Vascular = palmar digital arteries Innervation = palmar digital branches of median nerve ```

Answer 28

Flexion: FDS, FDP, FPL Extension: ED, EDM, EPL, APL, EPB

Answer 29

Medial attachment = pisiform + hook of hamate Lateral attachment = scaphoid and trapezium. Forms the carpal tunnel with the carpal arch underneath • Flexor digitorum superficialis and profundus • Median nerve • Flexor pollicis longus • Flexor carpi radialis Crossed superficially by ulnar vessels and nerves. But another band crosses this neurovascular bundle forming Guyon’s canal that can be a site of ulnar nerve entrapment.

Answer 30

* Tubercle of trapezium and flexor retinaculum * Proximal phalanx of thumb * Lateral terminal branch of median nerve * Sup palmar branch of radial artery * Flexes thumb at metacarpophalangeal joint

Answer 31

* Flexor retinaculum * Radial side of proximal phalanx of thumb * Lateral terminal branch of median nerve * Sup palmar branch of radial artery * Abducts the thumb

Answer 32

* Tubercle of trapezium and flexor retinaculum * Lateral margin of metacarpal of thumb * Lateral terminal branch of median nerve * Sup palmar branch of radial artery * Flexes metacarpal of thumb

Answer 33

* Oblique head (capitate, base of 1+2) and transverse head (metacarpal 3) * Base of proximal phalanx and extensor hood of thumb * Deep branch of ulnar nerve * 1st palmar metacarpal artery * Adduction of the thumb

Answer 34

* Hook of hamate, flexor retinaculum * Base of proximal phalanx of 5 * Deep branch of ulnar nerve * Deep palmar branch of ulnar artery * Flexion of little finger

Answer 35

* Hook of hamate, flexor retinaculum * Ulnar margin of 5th * Deep branch of ulnar nerve * Deep palmar branch of ulnar artery * Flexes 5th = forward and lateral rotation

Answer 36

* Pisiform and tendon of FCU * Proximal phalanx of 5th * Deep branch of ulnar nerve * Deep palmar branch of ulnar artery * Abducts little finger

Answer 37

* x3 for 2nd, 4th and 5th * Whole length of metacarpal * Middle finger facing side of corresponding proximal phlange. * Deep branch of ulnar nerve * Deep palmar arch and perforating arteries * Adduct the fingers

Answer 38

* Four bipennate muscles (2 for the middle finger) * Arise from metacarpal and adjoining metacarpal * Insert into proximal phalanx above the muscle * Deep branch of ulnar nerve * Dorsal metacarpal arteries, palmar metacarpal arteries * Abduct the fingers

Answer 39

* Flexor retinaculum * Dermis on ulnar border of hand * Superficial branch of ulnar nerve * Ulnar end of superficial palmar arch * Hollows the palm, wrinkles skin and secures palmar grip

Answer 40

* x4 * From the tendons of the flexor digitorum profundus (first 2 are unipennate. 3rd and 4th are bipennate from opposite sides of adjacent tendons) * Radial side of corresponding finger * 1+2 = median nerve, 3+4 = deep branch of ulnar nerve * Corresponding palmar digital arteries * Both flexion and extension of the fingers

Answer 41

* 1st = minor contusion with bleeding | minimal pain | minimal impairment * 2nd = moderate contusion and structural tearing. Overall structure intact | bruising, pain, spasm | joint stable but painful, may be some loss of power * 3rd = totally torn, considerable loss of function and strength, Require surgical repair.

Answer 42

PRICE Protection, rest, ice, compression, elevation

Answer 43

* Heavily contaminated * Nerve damage (suspected?) * Vascular damage (suspected?) * Loss of tendon function * Communicates with joint cavity – high possibility for infection * When there is underlying fracture

Answer 44

``` Simple/closed = skin intact Open/compound = breach in skin and soft tissue Undisplaced = <2mm fracture with no movement Displaced = large movement of bone shards Oblique = diagonal fracture Comminuted/fragmentary = lots of shards Spiral = twisting force to form spiral damage ```

Answer 45

degenerative (osteoporosis), congenital, tumor, cysts

Answer 46

Avulsion = occur at point of tendon/ligament attachment = failure of bone in tension = abnormal bone Stress = repeated abnormal stress to bone. Could be normal stress in abnormal bone of extensive stress on normal bone.

Answer 47

* Heals in a good position * Joints to have full range of movement * Limb regains normal strength and function (as quickly as possible) * Person able to take up pervious role in society

Answer 48

* 1˚ survey = ABCDEE (disability & exposure/environment) * Resuscitation = O2, ventilation, fluids, vitals * 2˚ survey = complete evaluation (top to toe) and diagnostic tests * Definitive care = final treatment If something changes to the patient and they start to get worse, start again from the beginning. Their airway may have occluded while you are working on them.

Answer 49

* Local tenderness * Crepitus = ends of fracture running over each other * Deformity (may be ±) * Swelling * Loss of function and movement

Answer 50

* Reduction * External fixation * Casts * Internal fixation * Physiotherapy * Look at psychological impact (PTSD etc.)

Answer 51

• Nociceptive pain (acute tissue damage). Somatic = localized and easily described. Visceral pain = poorly localized and associated w/ autonomic changes. Responds well to conventional analgesics. • Neuropathic pain (structural neural damage). Peripheral or central. Usually associated with altered sensation. Burning, shooting, lancinating. Responds POORLY to conventional analgesics.

Answer 52

Nociceptor and touch fibers both synapse onto the same inter-neuron. A-delta fiber stimuli can inhibit the 2˚ central nociceptor by activating the inhibitory inter-neuron.

Answer 53

Both are increased sensitisation to pain. Hyperalgesia = increased sensitivity to NOXIOUS stimuli. Mainly due to cell damage and released chemicals. Allodynia = intense hyperalgesia to something that does not normally produce pain.

Answer 54

* Fear avoidance * Somatization = manifestation of mental health issues as physical pain * Catastrophising = excess worry associated with development of pain (pain→no job→no mortgage→no house→no wife→no children→ etc…)

Answer 55

* Positive = sympathy, support, attention * Negative = loss of income, altered family role, discomfort * (Depending on the person these will be different and individual +ve could be –ve etc.)

Answer 56

* Bio = physiological dysfunction or neurological pain * Psycho = illness behavior, beliefs, coping, emotions, distress * Social = culture, social interactions, sick role

Answer 57

* Physical therapy: exercise, hydrotherapy, TENS, yoga, accupuncture * Psychological approach: education, coping, CBT, management programmes * Non-drug interventions * Drugs * Self help programms

Answer 58

* Most common joint disorder * Not symmetrical * DIP, PIP, large weight bearing joints * Less inflammation * Symptoms increase with activity * Short <1h morning stiffness. * Increases with age * Women more likely * Some genetic component * Obesity = increased stress on joints (also manual labor etc.)

Answer 59

* Patient education * Pain relief * Exercise and strengthening * Surgical options

Answer 60

* Most painful joint disorder * Acute onset * Big toe MTP joint commonly * 1-2% prevalence in UK * Most common inflammatory arthritis in men * Male:female 5:1 * Prevalence increases with age * Co-morbidities are common (renal impairment, CVD, metabolic syndrome, renal stones) * Non-modifiable: age, gender, race, genetics, * Modifiable: hyperuricaemia, high-purine diet, alcohol, obesity, diuretics * Almost linear relationship between gout levels and recurrence of gout attacks * Steak, seafood, alcohol (particularly beer+spirits) are very high in purines = increased gout risk * Obesity = risk increase with BMI Caused by crystallisation of uric acid in the joints Causes irritation + inflammatory reaction

Answer 61

* Sudden onset * Fever * Sweats * Rigors * Temperature * Steroids, immunosuppression, antibiotic treatment? * Trauma * Recent infection/septicemia * IV drug user Joint is: swollen, red, hot, fixed, only one. Treatment/Dx: aspiration, FBC, LFT, renal function, blood culture, imaging S. aureus is most common organism

Answer 62

Multiaxial ball and socket joint It has high stability at the expense of movement Flexion, extension, abduction, adduction, lateral rotation and medial rotation Head of femur with lunate surface of acetabulum High levels of joint congruity with bony surfaces and acetabular labrum

Answer 63

Transverse acetabular ligament = bridges the lower part of teh acetabular notch and convertes it into a fossa Ligament of head of femur = fovea of femur to acetabulum. Carries a branch of the obturator artery which is important during bone development Iliofemoral ligament = inverse Y, ilium and intertrochanteric notch of femur Pubofemoral ligament = Anterioinferior to hip joint iliopubic emenence to inferior surface of iliofemoral ligament Ischiofemoral ligament = posterior to hip, ischium to greater trochanter. Deep to other ligaments

Answer 64

Obturator canal Greater sciatic foramen Lesser sciatic foramen Gap between inguinal ligament and pelvic bones

Answer 65

The obturator nerve and vessles

Answer 66

Divided into 2 by the piriformis muscle. Superior = sup. gluteal nerves and vessels Inferior = sciatic nerve, inferior gluteal nerve and vessels, pudendal nerve (out), nerve to obturator internus, nerve to quadratus femoris

Answer 67

Sacrospinous ligament Sacrotuberous ligament Tendon of obturator internus Internal pudendal nerve and vessels (in) to enter below levator ani muscles

Answer 68

Psoas major and minor, iliacus | Femoral nerve and vessels

Answer 69

Fascia lata A stocking like covering of the thigh, just below the superficial fat and fascia. Continuous with the deep (Scarpa's) fasica of the abdomen Thickened laterally into the iliotibial tract which is a major point of attachment for muscles Has a saphenous opening for the superficial saphenous vein.

Answer 70

Depression between the muscles of the upper thigh Base = inguinal ligament Medial = adductor longus Lateral = sartorius Floor = pectineus, adductor longus, iliopsoas Apex = contiunues into the adductor canal which lies deep to the sartorius Carries the femoral vein --> artery --> nerve (medial to lateral)

Answer 71

``` Obturator membrane Inguinal ligament Iliolumbar ligament Anterior sacroiliac ligament Posterior sacroiliac ligament Sacrotuberous ligament Sacrospinouis ligament ```

Answer 72

Anterior surface of sacrum (L1-L4) Greater trochanter of femur L5-S2 Superior gluteal artery (from post int iliac) Laterally rotates and extends hip. Adductor of flexed hip

Answer 73

``` Internal surface of obturator foramen Greater trochanter of femur Nerve to obturator internus Obturator artery Laterally rotates thigh. Abducts flexed thigh ```

Answer 74

``` External surface of obturator foramen Intertrochanteric fossa of femur Posterior branch of obturator nerve Obturator and circumflex femoral arteries Laterally rotates thigh. Abducts flexed ```

Answer 75

``` Upper ischial tuberosity Greater trochanter Nerve to quadratus femoris Medial circumflex femoral artery Lateral rotator of thigh ```

Answer 76

``` Dorsal ischial spine Greater trochanter Nerve to obturator internus Internal pudendal artery Laterally rotates thigh ```

Answer 77

Upper ischial tuberosity Quadrate tuberosity in the intertrochanteric fossa of femur Nerve to quadratus femoris Inferior gluteal and circumflex femoral arteries Laterally rotates thigh

Answer 78

Anterior 5cm of iliac crest Iliotibial tract of fascia latae Superior gluteal nerve Superior gluteal and circumflex femoral arteries Extends knee with lateral rotation. Mainly a postural muscle

Answer 79

Posterior gluteal line of ilium, iliac crest and sacrum Gluteal tuberosity and iliotibial tract Inferior gluteal nerve Inferior gluteal artery Extension of flexed thigh. Raising trunk after stooping

Answer 80

``` Just below external iliac crest Greater trochater of femur Superior gluteal nerve Superior gluteal artery Abducts thigh and raises contralateral pelvis during swing phase of walking. Prevents hip drop = Trendelenburg's sign ```

Answer 81

A hip drop when walking. Suggests damage/paralysis of the gluteus medius and minimus of the contralateral side.

Answer 82

Outer ilium between anterior and inferior gluteal lines Greater trochanter Superior gluteal nerve Superior gluteal artery Abducts thigh and raises contralateral pelvis during swing phase of walking. Prevents hip drop = Trendelenburg's sign

Answer 83

Anteriolateral surfaces of all 5 lumbar vertebrae Lesser trochanter of femur L1-L3 Iliolumbar artery Acts with iliacus (as iliopsoas) to flex the thigh and raise the trunk when the pelvis is fixed (sit-up)

Answer 84

``` Anteriolateral surfaces of T12-L1 Superior pubic ramus L1 Lumbar arteries Weak flexion of the trunk ``` Only present in 60% of the population

Answer 85

``` Superior interior 2/3 of iliac fossa Lesser trochanter of femur Femoral nerve Iliolumbar arteries Acts with psoas major (as iliopsoas) to flex the thigh and raise the trunk when the pelvis is fixed (sit-up) ```

Answer 86

``` ASIS Medial, proximal tibia Femoral nerve Femoral and profunda femoris arteries Flexion of leg and thigh. Slight abduction and lateral rotation of thigh ```

Answer 87

``` ASIS, supracetabular groove and hip capsule Posteior border of patella Femoral nerve Profunda femoris artery Extension of leg and flexion of thigh. ```

Answer 88

``` Intertrochanteric line of femur Medial border of patella Femoral nerve Profunda femoris artery Extension of leg and flexion of thigh. ```

Answer 89

``` Intertrchanteric line of femur Lateral border and base of patella Femoral nerve Profunda femoris artery Extension of leg and flexion of thigh. ```

Answer 90

``` Anteriolateral upper 2/3 of femur Laterla border of patella Femoral nerve Profunda femoris artery Extension of leg and flexion of thigh. ```

Answer 91

Medial margin of lower 1/2 of body of pubis Superior medial tibia Obturator nerve Profunda femoris artery Adduction of the thigh with flexion and slight medial rotation of the leg

Answer 92

``` Front of body of pubis Linea aspera in middle of femur Obturator nerve Profunda femoris artery Adduction of the thigh with flexion and slight medial rotation of the leg ```

Answer 93

Front of body of pubis, posterior to adductor longus Medial border of linea aspera. Above longus Obturator nerve Profunda femoris artery Adduction of the thigh with flexion and slight medial rotation of the leg

Answer 94

``` Ischiopubic ramus and ischial tuberosity Linea aspera on mid femur Obturator nerve Profunda femoris artery Adduction of the thigh with flexion and slight medial rotation of the leg ```

Answer 95

``` Superior pubic ramus Superiomedial humerus Femoral nerve Medial circumflex femoral artery Adducts thigh and flexes it on pelvis ```

Answer 96

Inferiomedial, posterior ischial tuberosity Upper surface of tibia Sciatic nerve Medial circumflex femoral artery Flexes leg + extends thigh with slight medial rotation.

Answer 97

Superomedial posterior ischial tuberosity Upper surface of tibia Sciatic nerve Perforating femoral arteries Flexes leg + extends thigh with slight medial rotation.

Answer 98

Long head = inferiomedial posteior ischial tuberosity Short head = lateral line aspera of femur Head of fibula Sciatic nerve Medial circumflex femoral artery Flexes leg + extends thigh with slight medial rotation.

Answer 99

--(Phospholipase A2) --> Arachidonic acid --(COX)--> Cyclic endoperoxides --(lots of enzymes)--> Prostaglandins Arachidonic acid --(5-lipoxygenase)--> leukotrienes

Answer 100

Classic prostaglandins (PGE2, PGD2, PGF2) Thromboxane A2 Prostacycline

Answer 101

Vasodilation Vasopermeability Inflammatory reaction Nociceptive sensitisation

Answer 102

Platelet aggregation and vasoconstriction

Answer 103

Inhibition of platelet aggregation and vasoconstriction

Answer 104

Increase vascular permeability Promote leukocyte chemotaxis Contraction of bronchial smooth muscle

Answer 105

COX-1 = GI protective, platelet aggregation, systemic COX-2 = Induced at sites of inflammation and promotes production of prostanoids and leukotrienes

Answer 106

30% of over 65s have a fall every year 10% of falls result in serious injury 1-2% of falls result in hip fracture Around 2 billion is spent every year on falls and their consequences.

Answer 107

Because of age and other diseases. 20% die within 1 year 50% no longer live independently

Answer 108

* Hip protectors don't work and people don't wear them. No benefit and some possibility of harm. DONT USE THEM * Bisphosphonates = reduces hip fractures by around 30% * Calcium and vitamin D = together has reduction of around 10-15% (vitamin D alone has no effect) * HRT reduces hip fractures by around 20-30% lots of side effects for opposed oestrogens but can take unopposed oestrogens with hysterectomy.

Answer 109

* Bone mineral density (important but other factors outweigh it) * Age = every 5yrs doubles your risk * Women (menopause and living longer) * Family history * Lower body weight (fat tissue producing oestrogens and physical padding) * Prior history * Smoking * Ethnicity (quite high risk is Caucasian) * Corticosteroid use

Answer 110

* Muscle weakness * History of falling * Eyesight problems * Balance defects * Gait defects * Medical conditions (arthritis, depression, cognitive impairment, neuropathy) * Age * Drugs (psychotropic, anti-arrhythmics, diuretics, polypharma)

Answer 111

* Reducing medication * Occupational therapist assessing home environment * Podiatry = footwear, ankle supports, exercises * Strength and balance training * Education and information

Answer 112

* Risk factors * Coping strategies * Psychological consequences * Osteoporotic risk * Rehabilitation (overcome fear of falling and depression)

Answer 113

* Difficult to make decisions for themselves * Vulnerable to abuse and exploitation * Patients can be stigmatised, disempowered, ‘stripped of personhood’ * Happier if can make decisions for themselves * Respecting autonomy * Positive and stronger patient-doctor interaction * Professional and legal requirement.

Answer 114

* A person is assumed to have capacity unless presumed otherwise. * Patients are not treated as unable to make a decision unless all steps to help understanding have been taken 1. Different forms of communication (pictures, signs etc.) 2. Initially treating condition which may affect capacity 3. Attempts to improve capacity * A patient is not treated as incompetent merely because he makes unwise decision * An act done on behalf of a patient that lacks capacity must be done ‘in his best interest’ * Before an act is done, a decision must be made as to whether the purpose can be achieved in a less damaging and restrictive way.

Answer 115

* Understand relevant information * Retain information * Use information to weigh decision making process * Communicate their decision by some means

Answer 116

Advance directives are legally binding and are made when a patient has capacity as to what they wish to happen in the case of lacking capacity (e.g. DNR). Only give the patient the power to REFUSE a treatment, not to request. Requests can be part of advance wish statements but these are not legally binding.

Answer 117

* Flexion of hip (L2-L3) * Extension of hip (L4-L5) * Flexion of knee (L3-L4) * Extension of knee (L5-S1) Similar to the arm. Each action is supplied by two nerve roots. The opposite action is supplied 2 segments lower down. Going down 1 joint moves the nerve roots down 1 segment.

Answer 118

``` Cortisone (0.8) Hydrocortisone (1) Prednisolone (4) Dexamethasone (30) Betamethasone (30) ```

Answer 119

Articular surfaces of the femur (medial and lateral epicondyles ) and the tibia (medial and lateral condyles) Articulation between the femur and patella 2x collateral ligaments Anterior and lateral cruciate ligaments Ligament of the popliteus muscle entering the capsule 2x meniscus within the joint

Answer 120

Lateral = attached to popliteus but not lateral collateral ligament Medial = attached to the medial collateral ligament. Both are connected anteriorly by transverse meniscal ligament Function: • Increase joint congruity • Increase stability • Increase distribution (without a meniscus, loading is 3x greater) • Decrease loading stress • Increase synovial fluid distribution to the entirety of the joint

Answer 121

Lateral meniscus, femoral condyle, and posterior capsule. This means it pulls the meniscus and capsule out of the way when it laterally rotates the femur.

Answer 122

Large lateral femoral condyle | Medial attachment of the vastus mediais to the patella.

Answer 123

Anterior cruciate ligament

Answer 124

* Sup = biceps femoris and semimembranosus/semitendinosus * Inf = heads of the gastrocnemius * Roof = fascia lata * Floor = knee joint * Superficial to deep = nerve → vein → artery

Answer 125

Valgus = lateral (outward) deformity e.g. knock knees Varus = medial (inward) deformity

Answer 126

Pes anseuresis = formed from the medial muscles of the popliteal fossa Sartorius Gracilis Semitendinosus

Answer 127

Subcutaneous patella = superficial to patella ligament Deep infra patella = deep to patella ligament Prepatella = superficial to patella

Answer 128

Stabilisation of rotation of the hinge joint. Prevent lateral and medial movement. Lateral collateral ligament is a thin cylinder that is not attached to any joint structures Medial collateral ligament is a thick, flat band that attaches to the meniscus within the joint

Answer 129

Anterior = prevents anterior displacement of tibia on a fixed femur. Posterior = prevents posterior displacement of tibia on a fixed femur.

Answer 130

When the knee is fully extended, there is a slight medial rotation of the femur to move the two broad, flat articulating surfaces into contact. This tightens all of the ligaments to hold the knee in that position. The knee is back slightly to place the centre of gravity in front of the knee to prevent unlocking. The popliteus is a lateral rotator of the knee joint and functions to unlock it.

Answer 131

``` Tibial tuberosity Anterior border Interosseous border Medial maleolus Soleal line Groove for tibialis posterior ```

Answer 132

• Medial head = upper medial epicondyle of femur Lateral head = lateral surface of lateral epicondyle • Aponeurosis that forms calcaneal tendon and inserts into calcaneal tuberosity • Tibial nerve • Perforating sural arteries from popliteal artery • Action with soleus (plantarflexion of the foot and flexion of the knee)

Answer 133

* Lateral supracondylar line of humerus * Calcaneus, medial to calcaneal tendon * Branches of tibial nerve * Popliteal artery * Vestigial muscle, week plantarflexor of the foot

Answer 134

* Posterior surface of head and upper ¼ of shaft of femur (soleal line) * Joins with gastrocnemius to form calcaneal tendon and insert into calcaneal tuberosity * Tibial nerve * Superior = popliteal artery & inferior = fibular artery * Action with gastrocnemius (plantarflexion of the foot and flexion of the knee)

Answer 135

* Medial side of posterior tibia * Plantar surfaces of distal phalanges of 2nd to 5th metatarsals * Tibial nerve * Posterior tibial artery * Flexion of 2nd to 5th metatarsals

Answer 136

* Posterior surface of fibular and IO membrane * Plantar surface of distal phalanx of 1st metatarsal * Tibial nerve * Fibular artery * Flexion of great toe

Answer 137

* Posterior surface of IO membrane and adjacent tibia and fibula * Tuberosity of navicular and medial cuneiform * Tibial nerve * Posterior tibial artery * Inversion and plantarflexion of foot. Also supports the arch during walking

Answer 138

* Lateral femoral condyle * Posterior and medial surface of proximal tibia * Tibial nerve * Posterior tibial artery * Stabilisation of knee and lateral rotation of femur = unlocking

Answer 139

* Head and upper lateral surface of fibula * Plantar surface of medial cuneiform and base of metatarsal 1 * Superficial fibular nerve * Superficial tibial and fibular arteries * Eversion and plantarflexion of the foot. Also supports the arch during walking.

Answer 140

* Distal 2/3 of the fibular shaft * Lateral tubercle of metatarsal 5 * Superficial fibular nerve * Superficial tibial and fibular arteries * Eversion of the foot

Answer 141

* Lateral, anterior tibia and adjacent IO membrane * Medial cuneiform and metatarsal 1 * Deep fibular nerve * Anterior tibial artery * Dorsiflexion and the foot and ankle. Inversion of the foot and dynamic support of medial arch.

Answer 142

* Middle ½ of medial tibia and adjacent IO membrane * Dorsal surface of distal phalanx of great toe * Deep fibular nerve * Anterior tibial artery * Extension of great toe and dorsiflexion of foot

Answer 143

* Proximal 1/2 of medial tibia and fibula * Bases of distal and middle phalanges of 2nd to 5th metatarsals * Deep fibular nerve * Anterior tibial artery * Extension of lateral 4 toes and dorsiflexion of foot

Answer 144

* Distal, medial surface of fibula * Dorsomedial surface of metatarsal 5 * Deep fibular nerve * Anterior tibial artery * Dorsiflexion and eversion of foot

Answer 145

``` Talus Calcaneus Navicular Cuboid 3x cuneiforms (medial, intermediate, lateral) ```

Answer 146

Talocrural joint Articulation between the talus and the tibia/fibula Synovial joint Allows dorsiflexion and plantar flexion of the foot Roof = inferior surface of distal tibia Medial side = medial malleolus of tibia Lateral side = lateral malleolus of fibula Stabilised by: Deltoid ligament medially Lateral ligaments

Answer 147

Tibionavicular Tibiocalcaneal Posterior tibiotalar Anterior tibiotalar

Answer 148

Anterior talofibular Posterior talofibular Calcaneofubular

Answer 149

``` Subtalar joint Talocalcaneonavicular joint Calcaneocuboidal joint Calcaneonavicular joint Cuneiform/cuneiform/navicular joints ```

Answer 150

Synovial Allows gliding and rotational movement Inversion and eversion of the foot Stabilised by talocalcaneal ligaments

Answer 151

Synovial plane joints Allow limited sliding movement Greatest movement is between the medial cuneiform and 1st metatarsal

Answer 152

``` Ellipsoid synovial joints Mainly extension and flexion (limited sideways movement) Medial and lateral collateral ligaments Plantar ligaments Deep transverse metatarsal ligaments ```

Answer 153

Synovial hinge joints Allow flexion and extension Medial and lateral collateral ligaments

Answer 154

A fibrous covering between the medial malleolus and the medial talus/calcaneus It is the roof of the tarsal tunnel ``` FDL tendon TP tendon Tibial artery and vein Tibial nerve FHL tendon (medial --> lateral) ```

Answer 155

Two ligaments: Sup. = anterior tibia and fibular Inf. = 'Y' calcaneus and medial malleolus and plantar aponeurosis ``` TA tendon EHL tendon Dorsalis pedis artery FT tendon EDL tendon (medial --> lateral) ```

Answer 156

Two ligaments: Sup. = lateral calcaneus and lateral malleolus Inf. = lateral calcaneus and inf. extensor retinaculum FL tendon FB tendon

Answer 157

Extensor digitorm brevis • Superiolateral surface of calcaneus • Base of proximal phalanx of great toe Lateral sides of tendons from EDL toes 2-5 • Deep fibular nerve • • Extension of MTP and IP joints of all toes.

Answer 158

Happens when a relationship between an exposure and an outcome is distorted by their shared relationship with something else.

Answer 159

* No intervention by investigator * ‘Looking in through the window’ * An analysis of spontaneously occurring events * Group assignments are not random * Often used to explore aetiology * Cohort study = start with exposure and look for outcome * Case-control study = start with outcome and look for exposure

Answer 160

Exposure → confounder → outcome | Exposure → outcome

Answer 161

* Restriction * Matching * Stratification * Multiple variable regression

Answer 162

exclusion, limitation of groups, less data, difficult when >1 confounder.

Answer 163

case-control, create comparison group ‘matched’ on possible confounders, actively create balanced groups. Used for ‘strong confounders’ (sex and age). Has to be used with analytical approaches.

Answer 164

analytical approach; analyze exposure:outcome association in different sub-groups of the confounder. Take the confounders out of both groups and compare their association with the group without the confounding factor. Final step is adjusting to create a weighted average. Doesn’t work with multiple confounding factors as for 4 factors 32 strata are needed. Run out of data!

Answer 165

COMPLEX :(

Answer 166

Purely special sensory - vision

Answer 167

Common tendinous ring --> optic canal --> optic chiasma --> optic tract --> 1, 2, 3 ``` 1 = internal capsule --> visual cortex 2 = pre-tectal nucleus = pupil reflexes 3 = superior colliculus = body reflexes ```

Answer 168

Purely special sensory - smell

Answer 169

cribiform plate --> olfactory bulb --> olfactory tract --> brainstem and hypothalamic nuclei

Answer 170

Somatic motor = sup, inf, mid rectus and inf oblique and levator palpebrea superior Autonomic motor = ciliary muscles

Answer 171

midbrain --> cavernous sinus --> sup. orbital fissure --> sup + inf divisions sup = common tendinous ring --> S. rectus and LPS Inf = common tendinous ring --> M. rectus, I. rectus, I. oblique, ciliary muscles

Answer 172

Purely somatic motor to the superior oblique eye muscle

Answer 173

dorsal aspect of midbrain --> around cerebellar peduncles --> cavernous sinus --> Sup. orbital fissure --> common tendinous ring --> S. oblique

Answer 174

Saccule Utricle Both contain endolymph and are surrounded by perilymph.

Answer 175

Semicircular canals Saccule Utricle

Answer 176

Macula In the saccule positioned vertically for position when lying down In the utricle positioned horizontally for position when standing up.

Answer 177

Lots of microfillaments (stereocilia) and one larger cilia (Kinocilum). The stereocilia are oriented towards the kinocilum and attached by filamentous attachments. Bending of the micro cilia towards the kinocilum opens ion channels in the hair cell causing depolarisation and increased nervous impulses. Away = closing of the channels and reduced firing. Lots of hair cells in each macula, al oriented in different directions = some are activated in every axis of movement for full proprioception.

Answer 178

STRATOCONIA. Contains lots of calcium carbonate crystals and has a very high specific gravity so it pulls the cilia in the direction of strongest gravitational pull

Answer 179

The canals are used to measure an acceleration of change in acceleration of the head within space. The saccule and utricle are useful for positioning within space when the head is still but with movement - the stratoconia falls onto the cilia which the body falsely interprets as a backwards falling motion.

Answer 180

Ampulla at the end of each canal. Contains endolymph and a CUPULA. Cupula is very similar to that of the macula with hair cells (and micro cilia) however, all face in the same direction so only measure movement in one axis. (Reason for 3 canals) Fluid movement pushes the cupula and causes firing of the hair cells. Allows for measurement of change in movement and rate of change.

Answer 181

Scala vestubuli Scala media Scala tympani

Answer 182

looks like a wave. Top = tectorial membrane Inner hair cells Outer hair cells Resting on the basilar membrane Rods of corti attach the membrane to the organ. Cochlear nerve (mainly attached to the inner hair cells) Basilar fibres attached to the bony modiolus of the cochelar.

Answer 183

Ascending nervous pathway for: pain, temperature, crude touch, sexual sensations, itch. 1st order neurone: periphery, decussation in spinal cord after rising 1-2 levels. Synapse in the dorsal grey horns 2nd order neurone: Travels contralaterally to the thalamus (some synapses in the medulla) 3rd order neurone: From the thalamus to the post-central gyrus (3,2) via the internal capsule ``` Paleospinothalamic = slow pain (C type with substance P) Neospinothalamic = fast pain (a delta with glutamate) ```

Answer 184

Ascending sensory pathway for: fine touch, proprioception, vibration and fine pressure 1st order neurones: periphery to the medulla. Travels ipsilaterally in the cuneate and gracile fasiculae. Cuneate and gracile nuclei in the medulla. 2nd order neurone: Decussates in the medulla and travels ipsilaterally to the thalamus in the medial lemniscus pathway. 3rd order neurone: From the thalamus to the somatosensory cortex (post-central gyrus 3+2) via the internal capsule.

Answer 185

Part of the dorsolateral system of motor neurones. Controls fine movement of the periphery. 1st order neurone: Form the pre-frontal gyrus (1), down the internal capsule and into the medulla. 90% decussation in the medulla (lateral corticospinal tract) 10% dont decussate and do in the spinal cord (anterior corticospinal tract) 2nd order neurone: From the spinal cord to the periphery. With damage to this tract, a pianist could walk to a piano but couldn't play.

Answer 186

Corticospinal | Rubrospinal

Answer 187

Pontine reticulospinal Tectospinal Vestibulospinal Control gross movements of the trunk and major limb movements. Also balance and movement against gravity.

Answer 188

Dysarthria = a physical disorder of speech caused by a failure of the muscles of articulation and speech. Dysphagia = a disorder of language and/or the understanding of language. Caused by upper motor neurone lesions within the CNS. Either expressive = Broca's area where the individual not fluent in language and can't form proper words or sentences but can understand. Or receptive = Wernike's area where the individual can speak fluently but has meaningless articulation and no comprehension (FOREIGN LANGUAGE)

Answer 189

Primary = advertising, eat healthy, exercise, education Secondary = minimising the progression of risk factors = high BP, diabetes, AF, smoking, obesity. Tertiary = medication, stent, thrombolytics, etc...

Answer 190

A painless, transient, monocular loss of vision. Described as a 'curtain of darkness'. Caused by some form of blockage of the opthalmic artery, a large division of the internal carotid as it enters the skull.

Answer 191

Haemorrhage Mass (tumor, object) A failure of the CSF (increased production, flow blockage or decreased drainage)

Answer 192

``` Depends on the area of the brain that is compressed. Major problems are of herniation: - Subfalcine - Transtentorial - Tonsillar (coning) ``` Tonsillar herniation is the worst form as it compresses the brainstem and can cause fatal respiratory depression.

Answer 193

Primary = initial damage occurring at the moment of impact. Secondary = delayed, non-mechanical damage = Diffuse axonal injury and brain swelling Secondary damage due to ischaemia (ischaemic cascade) increased anaerobic respiration and cerebral oedema. Failure of the membrane ion pumps and increased depolarisation with Ca2+ influx. Calcium leads to membrane damage and cellular death.

Answer 194

Superior rectus = Moves eye upwards - (elevation with internal rotation) Inferior rectus = Moves eye downwards - (depression with internal rotation) Lateral rectus = Moves eye outwards - (abduction) Medial rectus = Moves eye inward - (adduction) Superior oblique = Rotates eye towards nose and moves it downwards Inferior oblique = Rotates eye away from nose and moves it upwards

Answer 195

Nociceptive = acute tissue damage. Visceral and somatic pain. Responds well to conventional analgesics. Neuropathic = Structural neural damage. Usually associated with altered sensation. Responds poorly to conventional analgesics.

Answer 196

Nociceptors and sensory fibres both synapse onto the same interneurone and by activating the sensory fibres, pain can be controlled.

Answer 197

Fear avoidance Somatization = manifestation of mental health issues as physical pain Catastrophising = excess and unnecessary worry associated with the development of pain. pain --> no job --> no mortgage --> no house --> no family

Answer 198

Between 7 and 8 percent.

Answer 199

Loose abduction to 90 degrees and loose the majority of external rotation.

Answer 200

Wrist drop as damage to the forearm extensors | Loose power grip as it requires extension of the forearm.

Answer 201

Loss of forearm flexion (at the elbow) and strong supination (biceps brachii)

Answer 202

Loss of flexion of the wrist and ulnar deviation (flexor carpi ulnaris is supplied by the ulner nerve)

Answer 203

Claw hand. Only nerve damage when a proximal lesion is better than a distal one. This is because with a distal lesion, 1/2 of FDP can act on the fingers to cause a worse claw hand.

Answer 204

Supplies the serratus anterior and causes a 'winged scapula' and loss of abduction of the shoulder greater than 90 degrees.

Answer 205

A stroke is an episode of focal cerebral function lasting longer than 24h. Usually a TIA last less than 90 minutes.

Answer 206

Non-modifiable: Age, male gender, race, FHx Modifiable: CHADS2 Congestive heart failure, hypertension, (age), diabetes, prior stroke Atrial fibrillation, smoking, hyperlipidemia, obesity

Answer 207

RITA ``` R = rheumatic heart disease I = ischaemic heart disease T = thyrotoxicosis A = Alcohol ```

Answer 208

Occulomotor nerve - has a very long and tortuous path through the skull and is easily compressed. The first things to go are the outer sympathetic nerves which supply the pupil.

Answer 209

Extradural = meningeal arteries = arterial bleed externally to dura so smooth oval edges. Subdural = dural sinuses and veins = venous bleed within the dura os slow expansion with irregular edges.

Answer 210

``` Nausea and vomiting Post-traumatic amnesia Pain Dizziness Alteration of consciousness ```

Answer 211

The components within the cranium (arterial blood, venous blood, CSF, brain) are able to compensate for an increase in one of the components through movement into another compartment. However, this only compensates for an increase in ICP up to a point.

Answer 212

Precentral gyrus = primary motor cortex so ataxia of contralateral movements Brocas area = motor coordination of speech so expressive aphasia Prefrontal areas = personality, initiative and drive damage. Bladder and bowel controls. = neurogenic bladder

Answer 213

Post-central gyrus = primary somatosensory cortex so contralateral abnormal sensation Wernike's area = understanding of speech so receptive aphasia Visual pathways Handeling of: numbers, calculation, body image, awareness of environment.

Answer 214

Auditory cortex Learning and memory Visual pathways

Answer 215

Occlusion 50% Haemorrhage = 20% Embolisation = 25% Other (demyelination, tumour) = 5%

Answer 216

``` Alzheimers Vascular Frontotemporal dementia Dementia with Lewy bodies Parkinsonian dementia ``` (Parkinsonian dementia is very similar to dementia with lewy bodies, however, in DLB the parkinsonian symptoms appear after the dementia rather than before)

Answer 217

All of the damage is caused by beta amyloid plaque deposits within the brain. Amyloid precursor proteins is broken down by: alpha, beta and gamma secretase enzymes. In alzheimers disease, the alpha secretase enzyme doesn't work and the B, G enzymes form an insoluble beta amyloid protein that lodges within the brain.

Answer 218

Loss of orientation in: person, place and time Memory loss (not all forms but most) Loss of personality Loss of functional ability Difficulty with language Possible psychiatric features (dementia, etc.)

Answer 219

Varies with age. 4% under 65yrs 20% over 85rys

Answer 220

``` Age Genetics and family history Repeated head trauma High cholesterol (risk factors for atheroma) AF (risk factors for arterial embolus) ```

Answer 221

``` Optic canal Superior orbital fissure Inferior orbital fissure Cribiform plate Foramen rotundum Foramen ovale Foramen spinosum Foramen lacerum Internal acoustic meatus Jugular foramen Hypoglossal canal Foramen magnum ```

Answer 222

50-70/100,000 | The chance of an individual having some form of seizure in their lifetime is 1/10

Answer 223

Focal (confined to one specific area of the brain) | Generalised (beginning in one area but spreading to the rest of the brain - total involvement)

Answer 224

``` Fatigue (mental and physical) Sleep deprivation Flashing lights Missed doses of anti-epileptic drugs Concurrent infection ```

Answer 225

An imbalance in the levels of inhibitory GABA and excitatory glutamate within the brain. Leading to generalised neuronal hyperactivity

Answer 226

A medical emergency. Occurs when a seizure goes on longer than 30mins. Patients can die of exhaustion. Treated by rectal diazepam to halt the seizure.

Answer 227

``` Tonic-clonic Absence Tonic Myoclonic Atonic ```

Answer 228

With involvement of consciousness - affecting the temporal lobe - Smacking lips and picking at clothes Without involvement of consciousness -Motor or sensory impairment

Answer 229

Generalised absence = childhood, brief, can occur 20-30pd, no warning, no post-ictal state Focal = later in life, last longer, post-ictal state, possible preceding aura.

Answer 230

Warning (aura) Tonic phase (stiffness, falling, tongue biting, incontinence) Clonic phase (irregular jerking of muscles, frothing at the mouth) Recovery (post-ictal state)

Answer 231

Always occurs in childhood (juvenile absence epilepsy). Is a short, loss of consciousness with no preceding factors or sequelae. 20-30pd May be mistaken for day-dreaming.

Answer 232

Brief jerking movements of the limbs Mainly the arms Mostly occurring in the morning and provoked by fatigue / lack of sleep

Answer 233

Increase in muscle tone (+- loss of consciousness) Usually seen as part of a epileptic syndrome and not on its own.

Answer 234

Brief loss of muscle tone accompanied by heavy falls. | +- loss of consciousness

Answer 235

``` Optic canal Superior orbital fissure Inferior orbital fissure Foramen rotundum Foramen ovale Foramen lacerum Foramen spinosum Internal auditory meatus Jugular foramen Hypoglossal canal Foramen magnum ```

Answer 236

Two large venous plexuses that lie within the body of the sphenoid bone, on either side of the sella turcica. 4 cranial nerves pass through the cavernous sinus in their course through the skull. + the jugular artery ``` Occulomotor nerve (II) Trochlear nerve (III) Trigeminal nerve (IV) Abducent nerve (V) ``` A lesion within the cavernous sinus can, therefore, damage these nerves with the corresponding signs: 3, 4, 6 = nystagmus, ptosis, mydriasis, 5 = loss of sensation, anhidrosis, reduced power to muscles of mastication.

Answer 237

An area - from the corners of the mouth to the bridge of the nose that (due to the blood supply) when infected, the infection can spread retrograde into the brain/meninges and cause encephalitis and meningitis. Mainly due to the vein from the superior sagital sinus passing through the skull and into the frontal compartment of the cranium. Through the foramen cecum (anterior to the cribiform plate).

Answer 238

In the anterior cranial fossa. The 3rd most anterior skull foramen, posterior to the foramen cecum and the cribiform plate. Carries the optic nerve to the retina and the opthalmic artery.

Answer 239

Just posterior to the optic canal, in the lesser wing of the sphenoid bone. Carries cranial nerves: 3, 4, 5(1) Superior and inferior devisions of the opthalmic veins.

Answer 240

A foramen in the inferior wall of the orbit. Transmits the infraorbital vessels and zygomatic branch of the maxillary nerve.

Answer 241

Posterior to the superior orbital fissure, in the middle cranial fossa. Transmits the maxillary branch of the trigeminal nerve. (5(2)).

Answer 242

A large foramen in the posterior - middle cranial fossa. Middle of the group of 3 foramina. Transmits the mandibular division of the trigeminal nerve (5(3)).

Answer 243

In the posterior - middle cranial fossa. Lateral of the group of 3 foramina. Transmits the middle meningeal artery

Answer 244

In the posterior - middle cranial fossa. Medial of the 3 foramina. Largely filled with fibrocartilage at the base but the carotid artery passes through it laterally after entering the skull via the carotid canal

Answer 245

Spinal cord, meninges, spinal accessory nerve entering the skull, vertebral arteries, brainstem.

Answer 246

Located in the anterior - posterior cranial fossa. Transmits the facial nerve, vestibulocochlear nerve and the labyrinthine artery.

Answer 247

A large foramen in the posterior cranial fossa. Transmits the Jugular vein, glossopharyngeal nerve, vagus nerve and spinal accessory nerve

Answer 248

A very small foramen in the circumference of the foramen magnum. Transmits the hypoglossal nerve.

Answer 249

Cranial nerve 7. Arises from the pons (between the pons and medulla). The most anterior of the cranial nerves arising from the side of the brainstem between the pons and medulla. 7, 8, 9 and 10. Enters the internal acoustic meatus (with the vestibulocochlear nerve). Innervates the stapedius and chorda tympani before exiting the skull through the stylomastoid foramen. Wraps round the outside of the mastoid process to innervate the muscles of facial expression.

Answer 250

Superior branch = innervates sup. rectus and LPS | Inferior branch = innervates: MR, IF, IO

Answer 251

``` Diplopia Dilated pupil Ptosis "down and out eye" action of LR and SO Loss of pupil reflexes (only on the side of the lesion) ```

Answer 252

Down and in

Answer 253

Up and out

Answer 254

``` V1 = opthalmic = sensory from upper face and cornea V2 = maxillary = sensory from cheeks and upper teeth V3 = mandibular = sensory from lower face and anterior 2/3 of tongue, motor to the muscles of mastication ```

Answer 255

motor to the muscles of the face and the scalp, parasympathetic innervation to the sublingual and submandibular glands. Sensory = sense of taste

Answer 256

Bells palsy = peripheral nerve inflammation = ipsilateral face drop = non-permenant Central nerve palsy = contralateral face drop with forehead sparing.

Answer 257

Loss of hearing Spinning and dizziness Rotatory nystagmus

Answer 258

Motor to the stylopharyngus Sensory to the pharynx, posterior 1/3 of tongue and external ear Impaired swallowing, loss of taste, uvula deviates towards healthy side

Answer 259

Motor for larynx and upper oesophagus voluntary Involuntary (parasympathetic) innervation to most of the chest and abdominal viscera. Impaired swallowing, hoarse voice. Loss of ability to swallow LIQUID is indicative of nervous damage. Solid swallowing impairment is muscular damage.

Answer 260

Motor innervation to the tongue muscles (-palatoglossus, innervated by the glossopharyngeal). Fasiculation and deviation of the tongue towards the damaged side.

Answer 261

Non-modifiable: age, male, previous MI, FHx Modifiable: hypertension, diabetes, hyperlipidemia, smoking, AF (AF is a MAJOR risk factor)

Answer 262

Aspirin Warfarin Clopidogrel (g2b3a inhibitor) Dipyrimadole (ADP inhibitor)

Answer 263

``` Risk factors for development of AF Congestive heart failure = 1 point Hypertension = 1 point Atrial fibrillation = 1 point D = Diabetes = 1 point S = stroke or TIA history = 2 points. ```

Answer 264

Contralateral hemiplegia/hemisensory disturbance. Hemianopia Decreased GCS (only major stroke) Receptive or expressive aphasia (or global) Severe dysarthria If haemorrhage, also symptoms of raised ICP = headache, N+V, decreased GCS, pupillary changes, 3rd and 6th nerve palsy, ptosis (superior branch of occulomotor)

Block 12 Flashcards

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