Where do you palpate the posterior tibial artery?
behind the medial maleolus
Outline the loocation of the kidneys
Left is slightly higher.
4-5cm from posterior medial line with the hilum being at L1 (transpyloric plane) . ~3-4cm superior to the supracristal plane.
The kidney can be palpated in the renal angle, a region located between the lower border of rib 12 and the lateral border of the paravertebral muscels.
Outline the position of the horizontal fissure
From 4th CC @ the sternum to the 4th rib MAL and meets the oblique fissure near the posterior axillary line.
Name the contents of the Carpal Tunnel and what forms it:
Formed by the bony arch of the carpal bones and the flexor retinaculum
- Median Nerve
- Tendon of flexor pollicus longus
- 4 x tendons of flexor digitorum profundus
- 4 x tendons of flexor digitorum superficialis
Name the 9 abdominal regions
At which vertebral angle is the superior spin of the scapula ?
What are the full numbers in a typical permanent set of teeth?
Where should you palpate the apex beat?
Palpate with the palm and middle three fingers of the right hand, aligning the middle finger in the left 5th ICS and the other two fingers in ICSs above and below
The facial nerve supplies motor fibres to the facial muscles. How would you test them?
Ask patient to look at ceiling (look at frontalis), screw up their eyes (look at orbicularis oculi) or show their teeth (look for symmetry of elevation of corners of mouth)
Describe Klumpke's paralysis
a brachial plexus injury in which the eighth cervical (C8) and first thoracic (T1) nerves are injured either before or after they have joined to form the lower trunk. The subsequent paralysis affects, principally, the intrinsic muscles of the hand (notably the interossei, thenar and hypothenar muscles) and the flexors of the wrist and fingers (notably flexor carpi ulnaris and ulnar half of the flexor digitorum profundus) The classic presentation of Klumpke's palsy is the “claw hand” where the forearm is supinated and the wrist and fingers are flexed.
Where do you palpate the Superficial temporal artery pulse
Palpate in front of the tragus of the ear
Name some of the possible complications of insertion of central venous lines
- Arterial puncture leading to haematoma and potential airway obstruction
- Nerve damage
- Air embolism
In the forearm, which compartments do the following nerves supply?
- Radial Nerve
- Ulnar Nerve
- Median Nerve
Radial nerve supplies all posterior compartment muscles
Ulnar nerve supplies FCU and the Ulnar half of FDP
Median nerve supplies all of the remaining anterior compartment muscles.
Where you would feel gall bladder pain first and where it spreads to?-
epigastrium and then right lumbar
At which vertebral level is the xiphisternum and which CC joins here?
Xiphersternum T8/9 (xiphersternal joint at 6th CC)
Where does the internal jugular vein drain?
Describe the safe triangle for unserting a chest drain.
Anterior axillary fold.
Superior border = below the axilla
Inferior border at 4th ICS (level of male nipple)
Insert needle above border of the rib, upwards and medially.
Sternal Angle is at what vertebral level? and which costal cartilage attaches there?
At T4/5. 2nd costal cartilage.
Outline the pleural border
Apex - 2-3cm above the middle of the clavicle, pass the mid sternal line at the sternal angle level. Continue inferiorly to 6th costal cartilage on the midline (on the left @4th CC the lung and pleura move left 4cm to accommodate the heart). Then continue posteriolaterally MCL - 8th CC MAL - 10th rib Scapular line 12th rib with the lungs at mid-inspiration 2 ribs above the pleura.
Which nerves supply general sensation and taste to the anterior and posterior parts of the tongue?
Anterior 2/3 sensation Mandibular V, taste VII
Posterior 1/3 sensation and taste IX
At which spinal level is the subcostal plane?
What test is used to examine the integrity of the abductors of the hip joint ?
A positive test indicates a loss or weakness of motor function in gluteus medius and minimus.
Which nerves control the optic muscles ?
At what level does the arch of the aorta start and end?
At the level of the sternal angle
What are the main nerves of the forearm?
Where is the most common site of venipuncture in the upper limb?
Medial cubital vein which often connect the cephalic and basilic veins.
What points should be considered in an examination with an opthalmoscope?
- Perform in a darkened room.
- Dilate the pupil with mydriatic drops, eg tropicamide.
- Asses red reflex, absence may suggest catarats/ retinoblastoma
- Assses the optic disk for:
Describe the veins of the arm
What are the surface markings of the liver?
Left upper - 5th rib MCL
Right upper - 5th ICS - MCL
Right lower - 10th CC
Outline the position of the oblique fissures of the lungs
Curves around the thoracic wall from spinous process T3 posteriorly, follows the medial border of abducted scapula to the 6th CC anteriorly at the MCL
describe where you would auscultate the lungs
Label the followinng diagram of the tympanic membrane
What are the 2 Main sites of access for central venous lines
Internal jugular vein or Subclavian vein
Which cranial nerves are involved in the cough and sneeze reflex
Cough - X
Sneeze - V
What are the surface marking s of the gall bladder?
Where rectus abdominus crosses the costal margin.
(tranpyloric plane, meets right mid clavicular line)
Dorsalis pedis artery
(Palpate dorsum of the foot, lateral to extensor hallucis longus tendon)
Which muscles are supplied by the axillary nerve ?
Arises from posterior cord of brachilal plexus and supplies deltoid and teres minor. also sensory innervation to the "regimental patch" of skin on upper arm
What is the contents of the femoral triangle?
What does the accessory nerve innervate
supplies the sternocleidomastoid and trapezius muscles
WHICH IS THE ONLY MOTOR NERVE OF THE TONGUE
The hypoglossal nerve
Which tendon is not present in the forearms of some people
What demarcates the borders of the popliteal fossa?
Medial head of gastrocnemius
Lateral head of gastrocnemius
Identify the structures:
Which muscles control the movement of the eye?
Describe the arteries of the leg:
Where would you perform a cricothyroidotomy?
Via the cricothyroid membrane, which lies in the space between the thyroid cartilage (laryngeal prominence, Adam’s apple) and the cricoid cartilage, on the anterior aspect of the neck.
On the optic disk what might be deduced from:
Of the optic disk?
Colour - Pallor is observed in neuritis/ischaemia
Contour - a poorly defined border may indicate papilloedema
Cupping - increased cup to disc ration is observed in glaucoma
Which spinal nerves supply the Knee jerk and ankle jerk reflex ?
Knee jerk L3
Ankle jerk S1
Where do you palpate the femoral artery?
in the mid-inguinal point
What are the numbers of teeth in each quadrant ?
- Incisors- 2
- Premolars- 2
Veins of the leg
What is the difference between the midinguinal point and the midpoint of the inguinal ligament?
- The midinguinal point is situated halfawy between the ASIS and the (midline) pubic symphisis = +/-1.5cm FEMORAL PULSE
Midpoint of the inguinal ligament = midway between the ASIS and the pubic tubercle. Often intersected by the midclavicular line,
At which spinal level is the trnstubercular plane
What are the margins of the posterior traingle of the neck ?
- anterior margin of trapezius
- posterior margin of sternocleidomastoid
- and the middle third of the clavicle
Why is it so easy to feel masseter and so difficult to feel temporalis?
Masseter is superficial and large whereas temporalis is fan-shaped, thin and covered by the temporal fascia
What is McBurney's point?
Imprecise approximation of the location of the apendix. 1/3 of the way up a line drawn from the ASIS to the umilicus
What demarcates the borders of the femoral triangle?
Superiorly - Inguinal ligament
Medially - adductor longus
Laterally - sartorius
Describe the arteries of the arm
Relative Afferent Pupillary Defect - What is it and how do you tet for it?
Loss on consensual pupillary light reflex during the swinging flashlight test. Light shone in the affected eye will produce less pupillary constriction than light in the unaffected eye. Indicates an afferent defect, ususally at the level of the retina or optic nerve.
Where would you auscultate the heart valves?
- Aortic- right 2nd intercostal space near sternum
- Pulmonary left 2nd (or 3rd) intercostal space near sternum
- Tricuspid- left 5th intercostal space near sternum
- Mitral- left 5th intercostal space at mid-clavicular line (= apex beat)
Cardiac surface projection of the heart
How would you test these function of the trigeminal nerve?
Pin-prick test to determine sensation in three divisions and ask patient to clench teeth to test motor component
What common signs might be observed in the examination of the retinal vasculature?
Retinal vasculature :
Diabetes - Cotton wool spots/neovascularisation
Hypertension - flame haemorrhage
Retinal artery Occlusion - retinal pallor /cherry red spots
What is Horner's syndrome and how does it manifest itself?
Horner syndrome is due to a deficiency of sympathetic activity
- partial ptosis - Eyelid lag
- upside-down ptosis (slight elevation of the lower lid)
- pseudoenophthalmos (the impression that the eye is sunken, caused by a narrow palpebral aperture)
- pupillary dilation lag
loss of ciliospinal reflex
bloodshot conjunctiva, depending on the site of lesion.
Which valves create the lub and which the dub sound?
Lub (S1 ) = AV
Dub (S2) = P and A
What spinal level does the angle of the mandibule denote?
At which spinal level is the transpyloric plane?
Which are the 4 muscles of the rotator cuff?
Subscapularis, Supraspinatus, Infaspinatus, Teres minor
Describe where you would ausculatet the lungs posteriorly
Outline the placement of ECG leads
V1- right 4th intercostal space next to the sternum
V2- left 4th intercostal space next to the sternum
V3- left 5th intercostal space between V2 and V4
V4- left 5th intercostal space at mid-clavicular line
V5- left 5th intercostal space at anterior axillary line
V6- left 5th intercostal space at mid-axillary line
From which cord do the following nerve branches arise?
Musculocutaneous - Lateral
Axillary - Posterior
Radial - Posterior
Ulnar - Median
Outline the visible differences between a CT and an MRI image
CT - Fat almost black, bone white
MRI - Fat White, cortical bone black