PACES Flashcards
(198 cards)
1
Q
Valve replacement normal signs
A
midline sternotomy
abnormal S1 = mitral
abnormal S2 = aortic
2
Q
advanced signs to look out for in valve replacement
A
- assess for valve function (regurg/stenosis)
- any cardiac decompensation/ HF
- any IE
- complications of over-anticoagulation
- assess for haemolysis
3
Q
signs of HF
A
- tachypnoea/tachycardia
- cool peripheries
- raised JVP
- displaced apex
- S3 (ventricular gallop)
- bi basal fine creps
- peripheral oedema
4
Q
signs of VSD
A
pansystolic murmur (loudest at LL sternal edge)
associated thrill
RV heave
loud P2
any signs of complications = RHF
5
Q
signs of cor pulmonale
A
plethoric face
central cyanosis
raised JVP
giant V waves + pansystolic murmur if TR
R ventricular heave
loud S2
pedal oedema
6
Q
what else to look for in cor pulmonale
A
signs of cause:
- end inspiratory creps (pulmonary fibrosis)
- clubbing (idiopathic PF)
- signs of COPD
7
Q
HOCM signs
A
- pacemaker
- jerky pulse
- double apex beat
- ESM (LL sternal edge)
- S4
- signs of complications (HF)
8
Q
JVP vs carotid pulse
A
JVP has double waveform
JVP not palpable
JVP changes with position
Abdominal pressure inc JVP
9
Q
DDx for crescendo-decrescendo systolic murmur
A
aortic stenosis
aortic sclerosis
HOCM
10
Q
AS mummur
A
ejection systolic
upper right sternal edge
loudest on expiration
radiates to carotids and apex
11
Q
symptoms and signs of AS
A
Sx: exertional dyspnoea, syncope, angina
Signs: slow rising pulse, narrow PP, heaving apex beat, softy/absent S2, signs of LVF
12
Q
aortic sclerosis murmur
A
ejection systolic
upper right sternal edge
does not radiate
13
Q
sx and signs of aortic sclerosis
A
no symptoms
no abnormal signs
differentiate from AS by normal pulse, apex and S2
14
Q
mitral regurg murmur
A
pansystolic
apex, loudest on expiration
radiates to axilla
15
Q
symptoms of MR
A
dyspnoea
orthopnoea
PND
fatigue
palpitations
16
Q
signs of MR
A
AF
displaced thrusting apex (volume-loaded)
soft S1
signs of pulmonary HTN (RV heave, loud P2)
may be signs of LVF (S3, pulmonary oedema)
17
Q
causes ofMR
A
papillary muscle dysfunction (post-MI)
dilated cardiomyopathy
IE
congenital
connective tissue
18
Q
mitral valve prolapse murmur
A
mid systolic click +/- late systolic murmur
apex, loudest on expiration
radiates to left axilla and back
19
Q
TR murmur
A
pansystolic
differentiate from MR by:
- louder on inspiration (on right)
- giant JVP
- non-displaced apex
20
Q
symptoms and signs of TR
A
sx: fatigue, ascites, peripheral oedema
signs: giant V waves in JVP, backflow signs (oedema, ascites, heptomegaly), signs of pulmonary HTN
21
Q
causes of TR
A
- RV dilation in pulmonary HTN
- rheumatic heart disease
- IE
22
Q
assess severity of AS
A
- pulse volume (slow-rising)
- pulse pressure narrows
- S2 intensity reduces
- louder murmur
23
Q
general indications of valve replacement
A
- Left sided valve dysfunction (LVF, symptomatic)
- infective endocarditis + HF/uncontrolled infection/high embolic risk
24
Q
risks and complications of valve replacement
A
- perioperative: arrhythmias, stroke/TIA, VTE, bleeding
- valve complications: leakage, obstruction, haemolytic anaemia, IE
- warfarin side effects: bleeding
25
aortic regurg murmur
early diastolic
upper right sternal edge
loudest on expiration
26
symptoms and signs of AR
sx: fatigue, SOB, palpitations
signs:
- collapsing pulse
- wide PP
- displaced thrusting apex beat
- Corrigan's, de Musset, Quincke's
- austin flint murmur
27
causes of aortic regurg
acute causes: IE, aortic dissection
chronic causes:
- aortic root dilatation (HTN, vasculitis)
- connective tissue disorders
- rheumatic heart disease
28
mitral stenosis murmur
low rumbling mid-diastolic
apex in left lateral position
loudest on expiration
29
symptoms of MS
dyspnoea
fatigue
haemoptysis
chest pain
30
signs of MS
malar flush
AF
tapping apex
loud S1
signs of pulmonary HTN
31
pulmonary fibrosis signs
oxygen therapy
dry cough
tachypnoea
reduced expansion
fine end inspiratory crackles
32
what else to look for in pulmonary fibrosis
- signs of aetiology (hand deformity, clubbing, CREST sx, butterfly rash, radiation burns)
- signs of complications: steroid use, pulmonary HTN
33
COPD signs
bedside inhalers/nebs
accessory muscle use
tar stained fingers
tachypnoea
lip pursing
reduced cricosternal distance (<3 fingers)
tracheal tub
indrawing of intercostals
hyper-resonance
quiet breath sounds
wheeze
prolonged expiratory phase
34
signs of pneumonectomy
unilateral chest flattening
thoracotomy scar
tracheal deviation (towards)
reduced expansion
dull percussion note
dec breath sounds
bronchial breathing in upper zone (due to deviated trachea_
35
what to look for if pneumonectomy?
signs of cancer
36
signs of lobectomy on examination
thoracotomy scar
may be no other signs due to compensatory hyperexpansion of remaining lobes
may be dec expansion, dullness to percussion, dec air entry
37
pleural effusion signs
reduced expansion
stony dull percussion note
dec breath sounds
dec tactile fremitus and vocal resonance
38
bronchiectasis signs
productive cough
inspiratory clicks
clubbing
coarse, late expiratory creps
39
what signs of aetiology can you see in bronchiectasis
young and thin (CF)
lymphadenopathy (malignancy)
dextrocardia (Kartagener's)
40
lung cancer signs
cacheixa
clubbing
tar stained fingers
irregular, hard lymphadenopathy
radiation burns
41
causes of upper zone pulmonary fibrosis
coal
AS
radiation
TB
EAA
42
causes of lower zone pulmonary fibrosis
connective tissue disorders
asbestos
Idiopathic PF
drugs
43
transudative vs exudative pleural effusion
high protein content (>30g/L) = exudate
low protein content = transudate
44
Light's criteria
1. pleural fluid protein/serum protein = >0.5
2. pleural fluid LDH/serum LDH = >0.6
3. pleural fluid LDH = >2/3 upper limit of normal serum LDH
45
transudate causes
HF
hypoalbuminaemia (liver cirrhosis, nephrotic )
46
exudate causes
infection (e.g. empyema)
inflammation
infarction (PE)
malignancy
47
what does TLCO measure
total diffusing capacity of lung
(reduced in restrictive/obstructive due to reduction in total ventilation)
48
what does KCO measure
diffusing capacity of lung per unit volume (TLCO corrected for lung volume)
- in restrictive is normal: normal lung tissue and inc pulmonary capillary blood volume per alveolar volume
49
investigations and imaging to consider to investigate peripheral arterial disease
- bedside: ABPI, BP
- imaging: duplex USS, MR/CT angio, catheter angio
- bloods: lipid levels, fasting glucose, FBC
50
management of PAD
- lifestyle: exercise, foot care, smoking cessation, weight reduction
- medical: anti-plt, lipid control, BP, diabetes control
- surgical: angioplasty, surgical reconstruction, amputation
51
varicose veins associated skin changes
change in pigmentation
ulceration
venous eczema
lipodermatosclerosis
haemosiderin deposits
52
management of varicose veins
conservative: weight loss, avoid prolonged standing, exercise, compression stocking (look at ABPI first)
surgical: endothermal ablation, foam sclerotherapy, vein ligation and stripping
53
chronic liver disease signs
clubbing
leukonychia
palmar erythema
dupuytren's contracture
jaundice
spider naevi
gyanecomastia
loss of axillary hair
distended abdominal veins
hepatomegaly
splenomegaly (portal HTN)
ascites
54
what would be signs of decompensation of CLD
asterixis
encephalopathy (confusion)
jaundice
ascites
55
transplanted kidney signs
old AV fistula
rutherford morrison scar (usually RIF)
smooth mass underlying scar (transplanted kidney)
56
if hepatomegaly, what signs to look for?
signs of CLD
lymphaednopathy (malignancy/lymphoma)
peripheral oedema/rasied JVP (R ventricular failure)
57
if splenomegaly, what signs to look out for?
hand deformity (RA/Felty's)
signs of CLD
pale conjunctiva (leukaemia/HA)
lymphadenopathy (lymphoma)
58
PCKD signs
AV fistula (if had dialysis)
HTN
pale conjunctiva (anaemia)
flank scar (if kidney has been removed)
bilateral ballotable flank massess
hepatomegaly (cysts)
59
signs of liver transplant
- signs of CLD
- Mercedes Benz modification scar
- signs of cause
- complications of immunosuppression: tremor, cushingoid/bruising, skin lesions/excisions
60
signs of combined kidney-pancreas transplant
- LIF scar (renal graft)
- RIF scar (pancreas graft)
- smooth mass underlying LIF scar (transplanted kidney)
- signs of diabetic complications
- renal graft functionality
- pancreas graft functionality
- previous RRT
- complications of immunosuppression
61
ways to prevent graft rejection after renal transplant
- HLA matching
- testing for donor specific antibodies
- immunosuppression
62
important aspects of hernia exam
- chaperone
- exam while standing up
- lumps and describe
- cough impulse
- check for reducibility (deep inguinal ring = midway between ASIS and pubic tubercle)
- percuss and auscultate lump (may reveal bowel is present)
63
features of direct inguinal hernia
- superior to pubic tubercle
- come directly out of abdomen in straight line
- emerges through superficial inguinal ring
- cannot be contained by applying pressure over deep inguinal ring
64
features of indirect inguinal ring
- herniated abdo contents run within inguinal canal
- emerges through deep inguinal ring
- if reduced, can be contained by applying pressure over deep inguinal ring
65
femoral hernia
inferior and lateral to pubic tubercle
66
signs in hands in renal exam
- tremors
- nails: leukonychia, koilonychia
- finger tips: cap glucose marks
- pulse: rate and volume
- arms: AV fistula, bruising, BP, skin lesions
67
what to look for in head and neck in renal?
- eyes: periorbital oedema, conjunctival pallor, corneal arcus/xanthelasma
- mouth: hydration, gingival hypertrophy
- neck: JVP, central line scar
68
important chest signs in renal exam
- scars
- cap refil
- HS
- auscultate lung base (?odema)
- inspect back for skin lesions
69
what to auscultate for in renal exams?
renal bruits
70
most common causes of end stage kidney disease
1. diabetes
2. HTN
3. Glomerulonephritis
4. PCKD
71
indications for dialysis
Acute renal failure: AEIOU
Chronic: when GFR <15ml/minute and symptoms/complications of kidney disease
72
complications of CKD
- renal bone disease (due to secondary hyperparathyroidism)
- CVS disease
- anaemia due to low EPO
- arrhythmia related to hyperkalaemia
73
lower limb neuro exam - what to assess in gait
- normal walking
- heel to toe if stable (ataxia = cerebellar)
- stand on heels and then toes (tests distal power)
- Romberg's test (reduced stability = sensory ataxia due to proprioceptive deficit)
74
what would increased tone look like in LL exam?
roll leg side to side
if foot remains in line with knee
75
how would spasticity appear?
place hand under pt knee and briskly lift it up
if spasticity - foot kicks out involuntarily
76
hip flexion nerve roots
L2/L3
77
hip extension nerve roots
L4/L5
78
knee extension nerve roots
L3/L4
79
knee flexion nerve roots
L5/S1
80
ankle dorsiflexion nerve roots
L4/L5
81
ankle plantar flexion nerve roots
S1/S2
82
big toe extension
L5
83
MRC power grades
5: full power
4: some resistance
3: GRAVITY
2: gravity eliminated
1: flicker of muscle contraction
0: nothing
84
how to test sensation
- if suspect glove and stocking: test from distal to proximal in 2-3 straight lines
- if suspect nerve/root pathology: test dermatomes
85
dorsal column modalities
light touch
proprioception
vibration
86
spinothalamic modalities
temp
pain
87
3 causes of bilateral upper motor neurone lesion
MS
MND (normal sensation)
Myelopathy (cord compression, trauma, syringomyelia)
Brain stem stroke
Cerebral palsy
88
sensorimotor polyneuropathy differentials
Alcohol
B12/thiamine def
Charcot-Marie Tooth
Diabetes, Drugs
Every vasculitis and some infections (HIV, syphilis)
89
causes of unilateral UMN lesion and pattern of loss
- intracranial: stroke, SOL (hemisensory loss)
- brainstem: stroke, SOL (may be crossed signs)
- spinal cord: MS, infarct, SOL, disc prolapse (sensory level)
90
features of Brown-Sequard
- loss of power and proprioception on ipsilateral side
- loss of pain and temp on contralateral side (as spinothalamic decussates in spine)
91
hemiplegic
unilateral UMN
92
spastic
bilateral UMN
93
foot drop
LMN
94
ataxic
cerebellar
95
waddling
myopathic
96
festinating
parkinsonian
97
abnormalities in pronator drift
- pronator drift and distal flexion = pyramidal weakness
- upward drift = cerebellar pathology (accentuated by rebound)
98
shoulder abduction nerve root
C5
99
elbow flexion nerve root
C6
100
elbow extension nerve root
C7
101
wrist extension nerve root
C7
102
finger extension nerve root
C7
103
finger flexion nerve root
C8
104
finger abduction nerve root
T1
105
thumb abduction nerve root
T1
106
DDx for bilateral proximal weakness
DENIM
- Dystrophies: Beker's/Duchenne
- Endocrinological: Cushing, thyroid, diabetic amyotrophy
- NM: MG, LEMS
- Inflammatory: dermato/polymyositis, viral myositis
- Metabolic/congenital
107
median nerve palsy causes
carpal tunnel
mononeuritis multiplex
pronator teres syndrome
108
radial nerve palsy causes
- trauma/compression at axilla (e.g. Saturday night palsy)
- humeral shaft fracture
- elbow trauma
109
which are the bulbar CN
9. 10, 12
110
where is the lesion is there is visual inattention to one side?
contralateral parietal lesion
111
what should you offer to test in vision?
colour vision
blind spots (central scotoma, papilloedema)
opthalmoscopy to visualise optic disc
112
CN4 lesion
if eye cannot move down when facing medially
113
what to say if there are dramatically abnormal eye movements which do not fit with single nerve lesion?
complex opthalmoplegia
e.g. Graves/MG/brainstem lesion
114
medical vs surgical third nerve palsy
- medical: spares pupil (only outermost part of nerve affected)
- surgical: pupillary dilatation (affects whole nerve), painful
115
causes of medical nerve palsy
microvascular ischaemia (diabetes)
Migraine
MS/AI disease
116
causes of surgical nerve palsy
Posterior Communicating artery aneurysm
Cavernous sinus lesions
Cancer (SOL)
117
unilateral UMN and bilateral UMN sign
pyramidal weakness
118
patterns of unilateral LMN lesions and loss
- radiculopathy (dermatomal sensory loss)
- plexopathy (vast dermatomal sensory loss): brachial, lumbosacral
- peripheral nerve palsy (peripheral nerve sensory loss)
- mononeuritis multiplex
119
causes of radiculopathy
disc hernation
degenerative disc disease
OA
120
cause of distal motor neuropathy
chronic inflammatory demyelinating polyneuropathy
myotonic dystrophy
progressive muscular atrophy
prophyria
121
causes of acute flaccid paralysis
- GBS
- rare infections (rabies, polio)
- CES
- spinal cord shoxk
122
causes of mononeuritis multiplex
- vasculitis
- AI (RA, SLE)
- infectious (Lyme disease, HIV, leprosy)
- others (DM, amyloidosis, sarcoidosis)
123
UMN + LMN
- MND (no sensory deficit)
- Dual pathology (e.g. cervical myelopathy + polyneuropathy)
- myeloradiculopathy
- Subacute combined degeneration of cord
124
causes of cerebellar disease
MAVIS:
MS
Alcohol
Vascular - thomboembolic, haemorrhagic
Inherited - Friedreich's ataxia, spinocerebellar ataxia
SOL
125
causes of a sixth nerve palsy
raised intracranial pressure
microvascular ischaemia
SOL
trauma
126
causes of bulbar palsy (LMN)
- MND
- brainstem infarct/SOL
- GBS
- Polio
- Syringobulbia
127
causes of pseudobulbar palsy (UMN)
- MND
- MS
- bilateral internal capsule infarcts
- TBI
128
multiple cranial nerve palsies - no pattern
- mononeuritis multiplex
- meningitis
- SOLs
- trauma
129
if CN 3-6 are involved, what are the causes?
cavernous sinus lesion
Miller-Fisher syndrome
130
if CN5-8 and cerebellar signs, where is lesion?
cerebellopontine lesion
e.g. vestibular schwannoma, meningioma, brain mets
131
if CN 9,10,11 involved
jugular foramen syndrome, mostly tumour
132
if CN 9-12
pseudobulbar palsy (MS, MND, head injury)
bulbar palsy (MND, GBS, syringobulbia)
133
CN 9-10, Horner's syndrome + cerebellar + sensory disturbance (ipsilateral face, contralateral body)
lateral medullary (Wallenburg) syndrome
134
what is pyramidal weakness?
weakness that preferentially spares antigravity muscles
mostly causes weakness of upper limb extensors and lower limb flexors
= upper limb fixed flexion and lower limb extension
135
different causes of bitemporal hemianopia
pituitary tumours
craniopharyngioma
pregnancy
136
which hand muscles does the median nerve supply?
all thumb muscles except adductor pollicis - "LOAF"
Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor Pollicis brevis
137
which hand muscles does the ulnar nerve supply?
all intrinsic hand muscles except most of thumb:
- adductor pollicis
- lumbricals
- palmar interossei
- dorsal interossei
138
which hand muscles does the radial nerve supply?
extensors
139
how would bulbar palsy affect speech?
flaccid
140
how would pseudobulbar palsy affect speech?
spastic
141
how would cerebellar lesion affect speech?
slurred, staccato (jerky), scanning (variability in pitch/volume)
142
how would myasthenia affect speech?
weak, quiet, fatiguable
143
Expressive (Broca's) dysphasia
- pt knows what they want to say but can't say it
= non-fluent speech
- they still understand speech, have awareness of their speech difficulty
144
Receptive (Wernicke's) dysphagia
fluent, effortless speech that is disorganized and lacks meaning ( talks Rubbish)
cannot understand language
they lack awareness of their speech difficulty
145
how you can test these?
- commands (unable to follow = receptive)
- naming objects (difficulty saying name = expressive, incorrect names = receptive)
146
tremor in Parkinson
asymmetrical resting pill-rolling
begins distally
reduced with finger to nose testing
worsened by distraction
147
gait in Parkinson's
shuffling
hesitant (difficulty initiating and turning)
festinating (walk faster and faster)
lack of arm swing
unsteadiness
148
how can you accentuate the tone in Parkinson's
by distraction
ask pt to move contralateral arm up and down
149
how to test bradykinesia
open and close thumb and index finger like clicking as fast as possible
150
to complete exam in Parkinsons...
- exclude Parkinson Plus syndromes by examining eye movements
- look for cerebellar signs (MSA)
- check postural BP (MSA)
- MMSE (LBD)
- review drug charts (Parkinsonism drugs)
151
4 key symptoms of Parkinsons
tremor
rigidity
bradykinesia
postural instability
152
different functions of cerebellum
- maintain balance and posture
- coordinate movement
- motor learning (fine tuning of movements)
153
differentiating sensory ataxia from cerebellar ataxia
Romberg's test (tests proprioception caused by sensory disorder)
If cerebellar ataxia, patient ataxic prior to test
154
what to look for in shoulder exam?
- alignment and posture
- arm position (abducted, externally rotated = ant dislocation, adducted, internally rotated = post dislocation)
- bony prominences: Sternoclavicular joint, clavicle, AC joint
- skin
- muscle wasting
- axilla
155
what to feel for in shoulder exam?
- skin
- bony landmarks
- muscle bulk
- tendons (biceps tendon, suprapinatus attachment)
156
what movements in shoulder exam?
- flexion
- extension
- abduction
- adduction
- external rotation
- internal rotation (touch scapula behind back)
157
special test for serratus anterior
press hands on wall and lean forwards
?scapula winging
158
testing deltoid
abduct shoulder against resistance at 90
159
testing supraspinatus muscle
Empty can test
"empty a can of coke"
ask them to push their wrist up against resistance
160
testing infraspinatus/teres minor
resisted external rotation
161
testing supscapularis
place dorsum of hand over their lumbar spine
move hand away posteriorly
162
testing impingement
stabilise scapula
internally rotate
passively flex it
pain = +ve
163
scarf test
pt hand over opposite shoulder
push elbow posteriorly
pain = acromioclavicular joint pathology
164
other tests to offer
Hawkins, apprehension
165
common shoulder pathology
- supraspinatus tendonitis (impingement) = painful arc
- rotator cuff tears = weakness of abduction initiation, supraspinatus wasting
- adhesive capsulitis
- OA
166
Boutonniere deformity
PIP joint flexion
DIP joint hyperextension
167
common hand pathologies
- RA
- OA
- Carpel tunnel syndrome
- Trigger finger
168
cause of trigger finger
thickening of flexor tendon sheath
causes entrapment at A1 pulley
169
RA exam findings
- swelling of MCP and PCP
- positive MCP squeeze
- Rh nodules
- ulnar deviation
- Z-thumb
- Swan neck deformity (hyperextended PIP, flexed DIP)
170
extra-articular manifestations of RA
- episcleritis and scleritis
- Atlanto-axial subluxation
- carpal tunnel syndrome
- pulmonary fibrosis
- pericarditis
- anaemia of CD
- splenomegaly
171
what conditions is trigger finger associated with?
- diabetes
- RA
- hypothyroidism
- gout
172
abnormalities in gait in hip exam
- Trendelenburg waddling gait (abductor dysfunction)
- Antalgic gait (limp)
173
special tests in hip
Thomas's test
Trendelenburg's test
174
common hip pathologies
- Hip OA
- Trochanteric bursitis
- Childhood problems
175
signs of Hip OA on exam
- pain and reduced range of movement (internal rotation often lost first)
- Thomas and Trendelenburg test +ve in severe disease
176
how would you manage intracapsular hip fractures?
- displaced >60y: THR or hemiathroplasty
- <60 or undisplaced: try cannulated screws
177
how would you manage extracapsular hip fractures?
- intertrochanteric: dynamic hip screw
- subtrochanteric: intra-medullary nail
178
complications of hip fractures
infection
blood loss
fracture non-union
avascular necrosis
DVT
179
valgus vs varus
valgus = knock knees
varus = bowed legs
180
varus force vs valgus force
varus force = force on lateral side
valgus force = force on medical side
181
how to do Lachman's test
pt knee flexed to 30 degrees
one hand on top of thigh
other on back of tibia
pull tibia anteriorly
182
how to do McMurray's test?
externally rotate foot
apply varus force to knee
extend knee joint
positive = painful click
183
collateral ligament tears signs and tx
signs: varus laxity or valgus laxity
effusion
tenderness over affected ligaments
tx: rest, physio, hinged brace
184
signs of OA
pain
stiffness
reduced ROM
crepitus
185
signs of prepatellar bursitis
localised swelling over patella
caused by period of kneeling
signs: tenderness over patella, normal ROM
186
unhappy triad of knee injuries
rupture of medial collateral ligament
damage to medial meniscus
rupture of ACL
187
position for breast exam
initially sitting
then lying at 30 degrees
188
aspects in inspection
1. arms relaxed
2. hands rested on thighs
3. hands pressed into hips
4. hands behind head leaning forward
5. lift breast to look in submammary fold
189
what is DCIS?
abnormal cells in mammary ducts of breast
not invaded BM
pre-invasive Ca
190
what is LCIS?
abnormal cells inside lobules of breast
not cancerous
associated with small increased breast Ca risk
191
benign differentials for breast lump
fibroadenoma
fibrocystic disease
cyst
lipoma
fat necrosis
duct ectasia
duct papilloma
192
CP definition
non-progressive permanent neuro condition
caused by damage to developing brain
193
CP classified by limb involvement
- monoplegic: affects one limb
- hemiplegic: one side of body
- diplegic: symmetrical, lower limbs moer affected than upper
- quadriplegic: all 4 limbs severely affected
194
CP signs
mostly UMN lesion and signs
- hemiplegic (circumduction)/diplegic (scissoring) gait
- increased muscle tone and spasticity in legs
- brisk reflexes
- slightly reduced power
- tremors or jerky involuntary movements
195
CP management
MDT - physio, OT, SALT, dieticians, symptomatic relief (for spasticity, seizures, drooling etc)
196
CP complications and associated conditions
learning disability
epilepsy
kyphoscolisosis
muscle contractures
hearing/visual impairment
GORD
197
components of prosthetic knee
femoral component
plastic spacer
tibial component
198
compartments of knee
patellofemoral
medical
lateral
