Clinical Lower Limb

Question 1

what is a kyphosis and where is it seen

Answer 1

thoracic and sacral curvature of the spine like in the foetus

Question 2

what is lordosis

Answer 2

cervical and lumber - develops later

Question 3

what is scoliosis

Answer 3

spinal is not straight in the coronal plane

Question 4

what makes c1 and c2 atypical

Answer 4

C1 atlas - is a ring, anterior / posterior arches with lateral masses
no body or spinous process

C2 axis - has dens which articulates with arch of C1 which is held in place by transverse ligament

Question 5

what can cause fractures of the dens

Answer 5

hyperextension or hyperflexion

Question 6

describe the structure of costo-vertabral joints

Answer 6

head of the rib articulates with the superior demi facet of the corresponding vertebra and the inferior demifacet of the vertebra above

Question 7

what does the tubercle of the rib articulate with

Answer 7

costal facet on the transverse processionals

Question 8

who are most susceptible to common wedge fractures

Answer 8

post-menopausal women

Question 9

describe the structure of the thoracic vertebrae

Answer 9

body is heart shaped with superior and inferior costal demi-facets
long spinous process - extends downwards
has transverse process for tubercle of rib
2 articular facets for other vertebrae

Question 10

what are the effects of ageing on the vertebrae

Answer 10

loss of bone density and concave vertebral bodies

development of osetphytes

Question 11

describe the structure of the lumber vertebrae

Answer 11

large vertebral body
superior facet face medially
inferior facet face laterally
spinous process short and sturdy

Question 12

what are the three typical fractures of the lumbar vertebrae

Answer 12

lumbar transverse or spinous

burst

Question 13

what is spondylolithesis

Answer 13

slipping of vertebra

Question 14

what are intervertebral discs composed of

Answer 14

annulus fibrosis - peripheral fibrocartiledge

nucleus pulposus - central gélatinés shock absorber

Question 15

what happens to vertebral discs with ageing

Answer 15

nucelus pulposus dries and prone to tearing

Question 16

what is a slipped disc, where does it normally occur

Answer 16

herniation of the disc normally in L4/5 or L5/s1

compress spinal nerve rotes and cause pain

Question 17

what can slipped discs cause

Answer 17

cauda equina syndrome (surgery required)

compression of the cord itself

Question 18

what are the three ligaments of the vertebrae

Answer 18

anterior longitudinal (resist hyperextension) 
posterior longitudinal 
ligamentum flavum (binds lamina)

Question 19

what is whiplash

Answer 19

flexion or extension injure

anterior longitudinal ligament torn

Question 20

what is lower limb ischameia most commonly associated with

Answer 20

atherosclerotic disease (chronic)

Question 21

what is acute ischaemia usually due to

Answer 21

occlusive thrombus or embolus in an artery

Question 22

describe chronic lower limb ischameia

Answer 22

gradual process - causes anerobic metabolism - intermittent claudication

Question 23

what can critical ischameia in the lower limb cause

Answer 23

ulceration and gangrene

Question 24

describe sudden acute ischaemia of the lower limb

Answer 24

usually caused by emboli in the heart or patient with AF
sudden reduction in tissue perfusion
6 p’s of symptoms - pain, pallor, paralysis, pulse deficit, parastheisa, poikilothermic

Question 25

where is atherosclerosis most commonly made

Answer 25

affects large and medium conduit arteries turbulence of blood flow at biurification coronal, carotid and lower limb arteries and aorta itself

Question 26

what are the 4 stages in the fontaine classification of limb ischameia

Answer 26

1 asymp 2 intermittent claudication 3 ischamic rest pain 4 ulceration / gangrene (critical ischameia)

Question 27

what is the difference between wet and dry gangrene in critical ischamea

Answer 27

wet - tissue necrosis and infection, black soft putrid dry - tissue necrosis without infection - common in chronic ischamia usually affects toes first

Question 28

why is the femoral artery clinically relevant

Answer 28

superficial in femoral triangle - vulnerable easy to access for blood gas in emergencies use in minimally invasive procedures such as coronary angiography

Question 29

what is the femoral vein used for in the clinical setting

Answer 29

emergency IV access temporary access during burns, trauma venipuncture in emergencies

Question 30

which the vein other than the femoral vein is used for emergency iv access in the lower limb

Answer 30

great saphenous vein next to medial malleolus

Question 31

what are varicose veins and where are they common

Answer 31

in the lower limb - large protrusive veins

Question 32

what are varicose veins caused by and what are the complications

Answer 32

increased pressure in the saphenous vein = obstruction causes stagnation of blood and ulceration complications - bleeding, superficial thrombophlebitis varicose ulcers

Question 33

what is a DVT and where are they common with what symps

Answer 33

thrombus in the deep veins of pelvis or legs - swollen limb, red warm and painful can cause PE 50% have long term complications