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Spinal cord model | Medical Videos

Spinal cord model | Medical Videos

Remember about Synovial joints

Quick view of all joints and ligaments ( UAMS )

Joints and Ligaments of the Back Region - Listed Alphabetically
Joint or ligament	Description	Notes
anterior longitudinal ligament	a ligament that courses from superior to inferior along the anterior surfacesa of all vertebral bodies	it lies directly posterior to the thoracic and abdominal viscera
interspinous ligament	a ligament that connects the spinous processes of two adjacent vertebra	a syndesmosis
intervertebral disc	a fibrocartilaginous disk between adjacent vertebral bodies	a symphysis; it is composed of two parts: an outer anulus fibrosus and an inner nucleus pulposus; the nucleus pulposus is the remnant of the notochord; the intervertebral disks are important shock absorbers between vertebrae
ligamenta flava	a ligament formed predominantly by elastic fibers which joins the laminae of adjacent vertebrae	a syndesmosis; paired; the ligamentum flavum is penetrated by the needle during spinal tap; the word flavum is derived from the Latin word flavus, which means "yellow" - a reference to the predominance of yellow elastic fibers which gives this ligament its grossly visible color
nuchal ligament	a midline ligament that extends posteriorly from the spinous processes of cervical vertebrae and extends from the base of the skull to the 7th cervical vertebra	a syndesmosis; it provides muscle attachments to the cervical spinous processes without the necessity of long spinous processes that would hinder extension of the neck
posterior longitudinal ligament	a ligament that courses from superior to inferior along the posterior surfaces of all vertebral bodies	it is broader at the intervertebral disks and narrow at the vertebral bodies which gives it a scalloped edge; it is located in the vertebral canal; it is NOT penetrated by the needle during spinal tap
supraspinous ligament	a ligament that connects the tips of the spinous processes of thoracic and lumbar vertebrae	a syndesmosis; the supraspinous ligament begins at the C7 vertebra and ends at the mid-sacral segmental level; it serves as a muscle attachment site
zygapophyseal joint	a small joint between the articular processes of adjacent vertebrae	a synovial plane joint

Joints and Ligaments of the Upper Limb - Listed Alphabetically
Joint or ligament	Description	Notes
acromioclavicular joint	the joint between the distal end of the clavicle and the acromion of the scapula	a plane synovial joint; the shape of the articulation encourages the acromion to slide inferior to the clavicle during dislocation (shoulder separation) a condition that occurs when the coracoclavicular ligament is torn; a small articular disk occurs within this joint capsule
annular ligament	the ligament that encircles the head of the radius	it forms 4/5 of a circle - the radial notch of the ulna forms the other 1/5; it attaches to the margins of the radial notch; it holds the head of the radius against the ulna and cups in distal to the head to provide restraint against distal dislocation of the radius
carpometacarpal joint, finger	the articulation between the distal carpal bones and the proximal ends of the metacarpal bones of the hand	a synovial plane joint; limited motion is permitted at the carpometacarpal joint; the carpometacarpal joint is reinforced by dorsal and palmar ligaments
carpometacarpal joint, thumb	the articulation between the trapezium and the proximal end of the metacarpal bone of the thumb	a synovial saddle (sellar) joint; this articulation permits two planes of motion: flexion/extension and abduction/adduction which may be combined to produce circumduction
coracoacromial ligament	the ligament that connects the coracoid process to the acromion of the scapula	it passes superior to both the head of the humerus and the supraspinatus tendon; it provides support for the head of the humerus that prevents superior dislocation
coracoclavicular joint	the joint between the coracoid process of the scapula and the inferior surface of the lateral portion of the clavicle	a syndesmosis; this joint provides stability to the acromioclavicular joint
coracoclavicular ligament	the ligament that connects the upper surface of the coracoid process to the under surface of the clavicle	it has two parts: conoid ligament (posteromedial part) and trapezoid ligament; tearing of the coracoclavicular ligament permits the acromion to move inferior to the distal end of the clavicle (shoulder separation), a condition which could result from a fall on the point of the shoulder
costoclavicular ligament	a ligament that attaches the clavicle to the first rib	it resists superior displacement of the proximal end of the clavicle; the combined effect of this ligament, the sternoclavicular ligament and the interclavicular ligament is to produce a very strong sternoclavicular joint that seldom dislocates
elbow joint	the joint between the distal humerus and the proximal radius and ulna	a synovial hinge joint; the elbow joint is a complex joint consisting of humeroradial, humeroulnar and proximal radioulnar articulations all within a common articular capsule; it is strengthened by the ulnar and radial collateral ligaments
glenohumeral ligament, inferior	a ligament reinforcing the anterior wall of the capsule of the glenohumeral joint	it connects the humerus to the scapula; a thickening of the anteroinferior shoulder joint capsule
glenohumeral ligament, middle	a ligament reinforcing the anterior wall of the capsule of the glenohumeral joint	it connects the humerus to the scapula; a thickening of the anterior shoulder joint capsule
glenohumeral ligament, superior	a ligament reinforcing the anterior wall of the capsule of the glenohumeral joint	it connects the humerus to the scapula; a thickening of the anterosuperior shoulder joint capsule
intercarpal ligaments, dorsal	a series of short ligaments that connect adjacent carpal bones on their dorsal aspects	intercarpal ligaments reinforce the articular capsule of the intercarpal joints; they prevent excessive movement of these synovial plane joints
intercarpal ligaments, palmar	a series of short ligaments that connect adjacent carpal bones on their ventral aspects	intercarpal ligaments reinforce the articular capsule of the intercarpal joints; they prevent excessive movement of these synovial plane joints
interclavicular ligament	a ligament that reinforces the capsule of the sternoclavicular joint	it spans the superior surface of the sternoclavicular joint and manubrium of the sternum; the combined effect of this ligament, the sternoclavicular ligament and the costoclavicular ligament is to produce a very strong sternoclavicular joint that seldom dislocates
intermetacarpal joint	the articulation between the adjacent sides of the proximal ends of metacarpal bones 2-5	a synovial plane joint; limited motion is possible between at the carpometacarpal joints or between adjacent metacarpal bones
interosseous membrane, forearm	a fibrous membrane that connects the interosseous borders located on the shafts of the radius and the ulna	a syndesmosis; its fibers are oriented obliquely downward from the radius toward the ulna; the interosseous membrane is the classic example of a syndesmosis; proximally directed forces from the hand pass through the radius and are transferred to the ulna through the interosseous membrane; marked proximally by the oblique cord
interphalangeal joints	the articulations between the proximal and middle phalanges (proximal interphalangeal joint, abbreviated PIP) or the middle and distal phalanges (distal interphalangeal joint, abbreviated DIP)	a synovial hinge joint; these joints are strengthened by medial and lateral collateral ligaments
metacarpophalangeal joint	the articulation between the head of a metacarpal and the base of a proximal phalanx	a synovial condyloid (or ellipsoid) joint; it is strengthened by medial and lateral collateral ligaments; the joint has two planes of motion: flexion/extension and abduction/adduction which may be combined to yield circumduction
midcarpal joint	the joint which connects the proximal and distal rows of carpal bones	a series of synovial plane joints; small ranges of motion are permitted between carpal bones which take on an additive effect because there are several articulations in a proximodistal row (wrist, midcarpal and carpometacarpal joints); the midcarpal and intercarpal joints are reinforced by numerous ligaments
oblique cord	a thickening of connective tissue fibers at the proximal end of the interosseous membrane	it connects the proximal end of the shaft of the radius to the proximal end of the shaft of the ulna
radial collateral ligament, elbow	a ligament spanning the lateral side of the elbow joint	it connects the lateral epicondyle of the humerus with the radius and the annular ligament; it reinforces the lateral side of the elbow articular capsule; it is smaller and less distinct than the ulnar collateral ligament
radial collateral ligament, wrist	it connects the styloid process of the radius with the scaphoid and trapezium	it reinforces the articular capsule on the lateral side of the wrist
radiocarpal (wrist) joint	synovial, ellipsoidal	characterized by an intracapsular articular disk; radius articulates with the proximal row of carpals
radioulnar joint, distal	the articulation between the head of the ulna and the ulnar notch of the radius	a synovial pivot joint; this joint has a fibrocartilaginous articular disk that attaches to the styloid process of the ulna and the medial side of the distal radius
radioulnar joint, intermediate	the articulation formed by the interosseous membrane	a syndesmosis; it connects the interosseous border of the ulna to the interosseous border of the radius; proximally directed forces from the hand pass through the radius and are transferred to the ulna through the interosseous membrane
radioulnar joint, proximal	the proximal articulation between the radius and ulna that is contained within the capsule of the elbow joint	a synovial pivot joint; it is the articulation between the head of the radius and the radial notch of the ulna which is completed by the annular ligament
shoulder joint	the articulation between the head of the humerus and the glenoid fossa of the scapula	a synovial ball and socket joint; the glenoid labrum deepens the socket; glenohumeral ligaments reinforce the joint capsule anteriorly; the tendon of the long head of the biceps brachii m. passes through the shoulder joint cavity; the shoulder joint is supported by the muscles of the rotator cuff group (supraspinatus, infraspinatus, teres minor and subscapularis); also known as the glenohumeral joint; it is frequently dislocated
sternoclavicular joint	the joint what connects the clavicle with the sternum	a synovial joint; its joint capsule is subdivided by a fibrous articular disc; it is strengthened by the sternoclavicular, interclavicular and costoclavicular ligaments; the sternoclavicular joint has the range of movement, but not the form, of a ball and socket joint
sternoclavicular ligament	a ligament that reinforces the capsule of the sternoclavicular joint	the sternoclavicular ligament has two parts: anterior and posterior; it is a very strong ligament; the combined effect of this ligament, the costoclavicular ligament and the interclavicular ligament is to produce a very strong sternoclavicular joint that seldom dislocates
transverse humeral ligament	the ligament that spans the intertubercular sulcus of the humerus	it connects the greater tubercle of the humerus to the lesser tubercle of the humerus and acts to retain the tendon of the long head of the biceps brachii m. in the intertubercular sulcus
transverse metacarpal ligament, deep	a ligament that connects the metacarpophalangeal joints 2-5 on their palmar surface	limited motion is permitted between the distal ends of adjacent metacarpal bones due to the presence of the deep transverse metacarpal ligaments; the metacarpal bones are bound together to form a solid foundation for finger movements
transverse scapular ligament, superior	a ligament that spans the suprascapular notch of the scapula	it converts the suprascapular notch into a foramen; the suprascapular a. passes superior to the ligament and the suprascapular n. passes inferior to the ligament (Army over the bridge, Navy under the bridge)
ulnar collateral ligament, elbow	a strong ligament spanning the medial side of the elbow joint	it connects the medial epicondyle of the humerus with the ulna; it reinforces the medial side of the elbow articular capsule
ulnar collateral ligament, wrist	it connects the styloid process of the ulna to the pisiform and triquetrum	it reinforces the articular capsule on the medial side of the wrist
wrist joint	the articulation between the distal end of the radius and the proximal row of carpal bones	a synovial ellipsoid joint; two primary degrees of motion are permitted: abduction/adduction and flexion/extension - these motions are combined to produce circumduction; the radius actually articulates with the articular disk which in turn articulates with the proximal row of carpal bones (scaphoid, lunate and triquetrum)

Joints and Ligaments of the Head and Neck - Listed Alphabetically
Joint or ligament	Description	Notes
coronal suture	the articulation between the frontal bone and the two parietal bones	a suture
intermaxillary suture	the articulation between the palatine processes of the right and left maxillae	a suture; it is a midline feature of the hard palate and marks the line of fusion of the two palatine shelves (secondary palate) during development
lambdoidal suture	the articulation between the occipital bone and the parietal bone	a suture
metopic suture	the articulation between the two ossification centers of the frontal bone	a suture; a midline structure, it usually disappears during development but is occasionally present in adults
pterion	the articulation between four bones: the greater wing of the sphenoid bone, the frontal bone, the parietal bone, the squamous part of the temporal bone	a suture; this is a site of relatively thin bone that is frequently fractured in blows to the side of the head; the middle meningeal a. is located deep to this site and may be injured in skull fractures at this location, leading to epidural hematoma
sagittal suture	the articulation between the two parietal bones	a suture; it is a midline structure that lies superficial to the superior sagittal venous sinus
sphenomandibular ligament	the ligament that attaches to the spine of the sphenoid bone superiorly and the lingula of the mandible inferiorly	paired; it is a specialization of the pterygoid fascia and is a remnant of the mesenchymal core of the first pharyngeal arch (Meckel's cartilage)
squamosal suture	the articulation between the parietal bone and the squamous portion of the temporal bone	a suture; the greater wing of the sphenoid bone participates in the formation of the anterior end of the squamosal suture
stylohyoid ligament	the ligament that connects the styloid process with the lesser horn of the hyoid bone	a syndesmosis; paired; a remnant of the mesenchymal core of the second pharyngeal arch (Reichert's cartilage)
stylomandibular ligament	the ligament that connects the styloid process with the angle of the mandible	paired; a thickening of the parotid fascia
temporomandibular joint	the articulation between the head of the condylar process of the mandible and the mandibular fossa of the temporal bone	a synovial hinge joint; it is separated into two joint spaces by an intracapsular fibrous articular disc; gliding action occurs superior to the articular disc and hinge action occurs inferior to the disc

Joints and Ligaments of the Thorax - Listed Alphabetically
Joint or ligament	Description	Notes
costal cartilage	the cartilage that caps the medial end of the rib	costal cartilages of ribs 1-7 connect to the sternum; costal cartilages of ribs 8-10 connect to the costal cartilage of rib 7; costal cartilages of ribs 11 & 12 do not articulate anteriorly but end in the muscles of the abdominal wall
radiate sternocostal ligaments	ligaments that reinforce the sternocostal joint capsule	these ligaments connect the costal cartilages of ribs 1-7 with the sternum on both the anterior and posterior surfaces of the sternocostal articulation
sternal angle	the angle formed by the articulation between the manubrium and the body of the sternum	a synchondrosis; the cartilage within this joint usually does not become ossified until old age; the angle formed by this articulation is also called the angle of Louis; the sternal angle marks the level of the second costal cartilage from which all other ribs are counted
sternocostal joints	the articulations that connect the costal cartilages with the sternum	a synchondrosis (rib 1) or synovial joints (ribs 2-10); sternocostal synovial joints involving ribs 2-7 contain thin joint capsules; interchondral joints involving ribs 8-10 have simple gliding synovial articulations; radiate sternocostal ligaments reinforce the sternocostal articulations
xiphisternal joint	the articulation that connects the xiphoid process with the body of the sternum	a synchondrosis; the cartilage within this joint usually becomes ossified in old age; the xiphisternal joint marks the inferior extent of the thoracic cavity

Joints and Ligaments of the Abdomen - Listed Alphabetically
Joint or ligament	Description	Notes
inguinal ligament	the ligament that connects the anterior superior iliac spine with the pubic tubercle	the inguinal ligament is a specialization of the inferior border of the external abdominal oblique aponeurosis; it is the site of origin for a part of the internal abdominal oblique muscle and for a part of the transversus abdominis muscle; also known as: Poupart's ligament
lacunar ligament	an extension of the medial end of the inguinal ligament which connects the pubic tubercle with the pecten of the pubis	the lacunar ligament is a flattened portion of the aponeurosis of the external abdominal oblique m. that projects posteriorly from the pubic tubercle; it forms the medial border of the femoral ring and the floor of the inguinal canal at the superficial inguinal ring
pectineal ligament	a thickening of fascia on the pecten of the pubis	the pectineal ligament looks like an extension of the lacunar ligament along the surface of the pectineal line; also known as: Cooper's ligament (note: Cooper's ligaments are also found in the breast)

Joints and Ligaments of the Pelvis and Perineum - Listed Alphabetically
Joint or ligament	Description	Notes
iliolumbar ligament	a ligament that connects the transverse process of the L5 vertebra to the iliac crest	the iliolumbar ligament stabilizes the lumbosacral joint
lumbosacral joint	the articulation between the L5 vertebral body and the body of the first sacral segment	a symphysis; this articulation is characterized by all of the features of a typical intervertebral articulation which include: an intervertebral disk, anterior and posterior longitudinal ligaments, synovial joints between articular processes, ligamenta flava, interspinal and supraspinal ligaments; a strong iliolumbar ligament strengthens this joint
pubic symphysis	the midline joint uniting the superior rami of the two pubic bones	a symphysis; a fibrocartilage interpubic disk unites the bones; the subpubic angle in the female is greater than the subpubic angle in the male
sacroiliac joint	the articulation between the ala of the sacrum and the auricular surface of the ilium	a synovial joint; the fibrous articular capsule is thickened dorsally and ventrally to form the sacroiliac ligaments; because of the interlocking nature of the joint surfaces and the strong sacroiliac ligaments, only limited movement is permitted at the sacroiliac joint
sacrospinous ligament	the ligament that connects the ischial spine to the lateral surface of the sacrum and coccyx	together with the sacrotuberous ligament, it converts the greater and lesser sciatic notches into greater and lesser sciatic foramina
sacrotuberous ligament	the ligament that connects the ischial tuberosity to the lateral surface of the sacrum and coccyx	together with sacrospinous ligament, it converts the greater and lesser sciatic notches into greater and lesser sciatic foramina

Joints and Ligaments of the Lower Limb - Listed Alphabetically
Joint or ligament	Description	Notes
acetabular labrum	a fibrocartilage rim around the acetabulum	the acetabular labrum deepens the acetabulum; it cups around the head of the femur and holds it firmly in the acetabulum
ankle joint	the articulation between the distal tibia, the medial malleolus of the tibia, the lateral malleolus of the fibula and the talus	a synovial hinge joint; the ankle is reinforced by the deltoid ligament (anterior tibiotalar, tibionavicular, tibiocalcaneal, posterior tibiotalar parts), the anterior talofibular lig., the calcaneofibular lig. and the posterior talofibular lig.; because of the shape of the talus, the ankle is most stable when the foot is dorsiflexed; the ankle is often injured when the foot is plantar flexed
anterior cruciate ligament	a ligament connecting the anterior aspect of the intercondylar eminence of the tibia with the medial surface of the lateral femoral condyle	an intracapsular ligament located within the fibrous joint capsule of the knee but external to the synovial cavity of the knee; the anterior cruciate ligament limits the anterior movement of the tibia relative to the femur in all positions of joint movement; clipping-type injuries tear the anterior cruciate ligament because the leg is forced anteriorly relative to the femur which places great stress on the anterior cruciate ligament
anterior talofibular ligament	a ligament that connects the lateral malleolus of the fibula with the anterolateral surface of the talus	it is a ligament that reinforces the ankle joint
anterior tibiofibular ligament	the ligament that connects the distal ends of the tibia and the fibula anteriorly	this ligament reinforces the tibiofibular syndesmosis (at the distal ends of these bones)
anterior tibiotalar ligament	part of the deltoid ligament connecting the medial malleolus of the tibia with the talus	it is a ligament that reinforces the ankle joint
calcaneofibular ligament	a ligament that connects the lateral malleolus of the fibula with the calcaneus	it is a ligament that reinforces the ankle joint
deltoid ligament	the ligament that connects the medial malleolus of the tibia with the talus, navicular and calcaneus	the deltoid ligament reinforces the ankle joint; it has the shape of the Greek letter delta, hence its name; it has four parts (from anterior to posterior): anterior tibiotalar lig., tibionavicular lig., tibiocalcaneal lig., posterior tibiotalar lig.
fibular collateral ligament	the collateral ligament of the knee that connects the lateral epicondyle of the femur with the head of the fibula	an extracapsular ligament, not part of the fibrous capsule of the knee; the fibular collateral ligament passes superficial to the tendon of origin of the popliteus m.
hip joint	the articulation between the os coxae and the head of the femur	a synovial ball and socket joint; it is reinforced by capsular ligaments (iliofemoral, pubofemoral, ischiofemoral, zona orbicularis); the fibers of the articular capsule become taut on hip extension and lax on hip flexion; dislocation injuries of the hip are most common when the hip is flexed (sitting in a car seat during an impact that causes the knees to strike the dash board, for example)
iliofemoral ligament	the ligament reinforcing the anterior surface of the articular capsule of the hip joint	the iliofemoral ligament is shaped like an inverted "Y"; it connects the anterior inferior iliac spine to the anterior surface of the intertrochanteric line of the femur; also known as: ligament of Bigelow
infrapatellar bursa, deep	the bursa lying between the patellar ligament and the tibia	synovial membrane, the deep infrapatellar bursa reduces friction between the patellar ligament and the tibia
infrapatellar bursa, superficial	a subcutaneous bursa overlying the patellar ligament	synovial membrane
interosseous ligaments of the foot	ligaments that reinforce intertarsal (gliding) synovial joints	they connect adjacent tarsal bones; they are named for the two bones that they connect and whether they are located on the dorsal or plantar surface of those bones
interosseous membrane of the leg	the membrane that connects the interosseous borders of the shafts of the tibia and fibula	a syndesmosis
interphalangeal joints	the articulations between the proximal and middle phalanges (proximal interphalangeal joint, abbreviated PIP) or the middle and distal phalanges (distal interphalangeal joint, abbreviated DIP)	a synovial hinge joint; these joints are strengthened by medial and lateral collateral ligaments
ischiofemoral ligament	the ligament reinforcing the posterior surface of the articular capsule of the hip joint	the ischiofemoral ligament connects the body of the ischium to the posterior portion of the femoral neck
knee joint	the articulation between the femoral condyles and the tibial condyles	a synovial hinge joint; it is reinforced by intracapsular ligaments (anterior & posterior cruciate ligaments) and two types of collateral ligaments (capsular - tibial collateral ligament, and extracapsular - fibular collateral ligament); the medial and lateral menisci are contained within the joint capsule
lateral meniscus	an intra-articular disc within the knee joint located between the lateral femoral condyle and the lateral tibial condyle	fibrocartilage; it is attached to the coronary ligament and the intercondylar eminence of the tibia
ligament of the head of the femur	an intracapsular ligament that attaches to the fovea of the head of the femur and to the acetabular fossa	the ligament of the head of the femur contains a small artery (the a. of the ligament of the head of the femur) which supplies the femoral head; in fractures of the neck of the femur the retinacular aa. that course along the neck may be damaged, so that the artery to the head may be the only blood supply to the head and proximal neck
long plantar ligament	a ligament that connects the plantar surface of the calcaneus, cuboid and the bases of the lateral 3 metatarsal bones	a ligament that reinforces a complex set of intertarsal (gliding) synovial joints; the long plantar ligament supports the longitudinal arch of the foot
longitudinal arch of the foot	the arch that passes from the calcaneus to the talus to the navicular to the cuneiforms to the metatarsal	a series of plane synovial joints; the longitudinal arch of the foot is formed by the shapes of the metatarsal bones and is supported by the plantar calcaneonavicular (spring) ligament and many other small interosseous ligaments; the tendons of the tibialis anterior and tibialis posterior mm. also play a supporting role in maintaining the longitudinal arch of the foot
medial meniscus	an intra-articular disc within the knee joint located between the medial femoral condyle and the medial tibial condyle	fibrocartilage; it is attached to the tibial collateral ligament, coronary ligament and intercondylar eminence of the tibia; its attachment fo the tibial collateral ligament results in injury to the medial meniscus whenever the medial collateral ligament is injured
metatarsophalangeal joint	the articulation between the head of a metatarsal and the base of a proximal phalanx	a synovial condyloid (or ellipsoid) joint; it is strengthened by medial and lateral collateral ligaments; the joint has two planes of motion: flexion/extension and abduction/adduction which may be combined to yield circumduction
patellar ligament	the tendon of insertion of the quadriceps femoris muscle	the quadriceps femoris tendon connects the quadriceps femoris muscle group to the patella and the patellar ligament connects the patella to the tibial tuberosity; the patella is a sesamoid bone within the quadriceps femoris tendon
plantar calcaneocuboid ligament	a ligament that connects the calcaneus with the cuboid on their plantar surfaces	a ligament that reinforces a complex set of intertarsal (gliding) synovial joints; it supports the longitudinal arch of the foot; also known as: short plantar ligament
plantar calcaneonavicular ligament	a ligament that connects the sustentaculum tali with the plantar surface of the navicular bone	a ligament that reinforces a complex set of intertarsal (gliding) synovial joints; it supports the longitudinal arch of the foot; also known as: spring ligament
posterior cruciate ligament	a ligament connecting the posterior aspect of the intercondylar eminence with the lateral surface of the medial femoral condyle	an intracapsular ligament located within the fibrous joint capsule of the knee but external to the synovial cavity of the knee; the posterior cruciate ligament limits the posterior movement of the tibia relative to the femur in all positions of joint movement
posterior meniscofemoral ligament	an intracapsular ligament that connects the posterior part of the lateral meniscus with the lateral surface of the medial femoral condyle	may be absent
posterior talofibular ligament	a ligament that connects the lateral malleolus of the fibula with the posterolateral surface of the talus	it is a ligament that reinforces the ankle joint
posterior tibiofibular ligament	the ligament that connects the distal ends of the tibia and the fibula posteriorly	this ligament reinforces the tibiofibular syndesmosis (at the distal ends of these bones)
posterior tibiotalar ligament	part of the deltoid ligament connecting the medial malleolus of the tibia with the talus posteriorly	it is a ligament that reinforces the ankle joint
prepatellar bursa	a subcutaneous bursa overlying the patella	synovial membrane; inflammation of this bursa leads to the condition known as "housemaid's knee" (prepatellar bursitis), so named because housemaids at one time traumatized this bursa while scrubbing floors on their hands and knees
pubofemoral ligament	the ligament reinforcing the medial surface of the articular capsule of the hip joint	the pubofemoral ligament connects the pubic portion of the rim of the bony acetabulum to the medial surface of the femoral neck
suprapatellar bursa	the superior extension of the synovial membrane of the knee joint	it passes deep to the quadriceps femoris tendon; the suprapatellar bursa reduces friction between the quadriceps femoris tendon and the femur
tarsometatarsal joints	the articulations between the distal row of tarsal bones and the proximal ends of the metatarsal bones	gliding synovial joints; they are reinforced by dorsal and plantar ligaments which limit the motion between adjacent bones
tibial collateral ligament	the collateral ligament of the knee joint connecting the medial epicondyle of the femur with the medial surface of the medial condyle of the tibia	the tibial collateral ligament reinforces the medial surface of the articular capsule of the knee; it is attached to the medial meniscus which has clinical relevance - when the tibial collateral ligament tears in a clipping-type injury (knee abduction), the medial meniscus also tears
tibiocalcaneal ligament	part of the deltoid ligament connecting the medial malleolus of the tibia with the sustentaculum tali	it is a ligament that reinforces the ankle joint
tibionavicular ligament	part of the deltoid ligament connecting the medial malleolus of the tibia with the navicular	it is a ligament that reinforces the ankle joint
transverse acetabular ligament	the ligament that spans the acetabular notch near the rim of the acetabulum	the acetabular branch of the obturator artery enters the hip joint by passing beneath the transverse acetabular ligament; the artery of the ligament of the head of the femur is a branch of the acetabular a.
transverse arch of the foot	the arch that passes through the distal row of tarsal bones	a series of plane synovial joints; the transverse arch of the foot is supported by the shape of the tarsal bones, many small interosseous ligaments and the tendons of the fibularis longus m., tibialis anterior m. and tibialis posterior m.
zona orbicularis	circularly oriented ligamentous fibers that reinforce the capsule of the hip joint	the zona orbicularis fibers tend to constrict the fibrous joint capsule around the neck of the femur, helping to hold the head of the femur in the acetabulum

PPT on anatomy of joints

http://www.scribd.com/doc/34930281/Joints

NMC Viva questions

1. Growth and development:

a. What happens in IUGR the ratio of OFC and Chest  circumference?
 -OFC is 3 cm more than chest circumference.

b. When is the peak growth velocity in adolescent girl?
 -Just before commencement of menarche

c. What is the probable age of child who climbs with alternate steps but can not say his name and sex?
-30 months.

d. What is the probable age of a child who hold head at 90 degree?
 -12 weeks.

e. A baby has unilateral moro with positive palmar grasp reflex where is the site of lesion?
-C5-C6

f. A child can walk down stairs with alternate steps holding on to the rail. What is the probable age?
 -4 year.

g. At what age the moro reflex disappears?
 -Approximately 12 weeks.

h. Earliest hormonal change to occur in puberty?
 -Sleep augmented pulsatile secretion of pituitary
  gonadotrophin and growth hormone.

i. What is short stature?
 -Below third percentile of less than 2 SD.

j. what is the characteristic of hypothyroid short stature?
 -Asymmetrical dwarfism with delayed bone age.

k. What is the characteristic of genetic short stature?
 -Gain in height is more than 4cm/yr. Bone age and body
  proportions are normal.

l. What is psychosocial short stature?
 -Emotional deprivation. Symmetrical . Bone age normal
  or delayed.

m. what are the causes of short stature?
 -Genetic short stature; chromosomal (down
  syndrome/turner syndrome);
  endocrinal (pituitary / hypothyroidism), nutritional
  (rickets/malnutrition);
  Chronic disease (chronic renal failure/congenital heart
    disease).

n. At one year how many carpal bones are seen radiologically?
 -Two carpal bones

2. Nutritional

a. Fatty liver, patchy depigmentation of hair and oedema is diagnosis of:
 -Kwashiorkor

b. A child with alopecia, eczematous lesion over mouth and genitalia and hypogonadism is likely to have suffered from:
 -Zn deficiency.

c. The characteristic three radiological feature of rickets is:
 -Cupping, fraying and widening of epiphysis.

d. what is the calorie requirement for a severely malnourished child?
 -200 cal/kg/day and 10% of total calories should come from proteins of higher biological values.

e. What are the percentage of calorie from diet in balance diet?
 -15% from protein; 50% from carbohydrate and 35% from fat.

f. How breast feeding offers lower risk of infection?
 -Because of presence of secretary IgA; lysozyme; lactoferin;
  low pH, bifidous factor and viable phagocytic macrophages.

g. What are iron dependent enzymes?
 -Catalase and cytochrome C.

h. Which vitamins are synthesized in the intestine?
 -vit K; Pantothenic acid; biotin.

i. What is the chief protein of milk?
 -It is casein.

i. Human milk contains which nutrients in greater amount than cow’s milk?
 -Linoleic acid; oleic acid; more sugar (lactose)

j. What are the characteristics of the stool of an exclusive breast bed baby?
 -Low pH; golden colour and acidic reaction.

j. What is the characteristics of colostrums?
 -Deep yellow with alkaline reaction, 10-40 ml/day, high
  protein/VitA/Na and Cl, contains antibodies (IgA/IgG/IgM).

k. what are the advantages of breast feeding in later life of the child?
 -Protection against obesity, demyelinating disease,
  atherosclerosis, and diabetes mellitus.

l. What is marasmus?
 -Deficient of energy; body weight less than 60% of expected
  weight.

m. What is the dose of vitamin A for measles?
 -2 lakh unit orally each day for 2 days.

n. what are the important signs of hypervitaminosis A?
 -pseudotumour cerebri ( papilloedema, raised fontanel, and
  cranial nerve palsy); hyperostosis and hypercalcaemia.

o. What are the C/F of thiamine deficiency?
 -Dry beri beri (nervous system affected) wet beri beri
  (cardiovascular system affected) and infantile beri beri
  (infantile tremor).


p. What are C/F of riboflavin deficiency?
 -Glossitis/ cheliosis/scaly dermatitis/keratitis.

q. What are C/F of Niacin deficiency?
 -Diarrhoea/ dermatitis/dementia/red swollen tongue.

r. What are C/F of pyridoxine deficiency?
 -Hyperirritability/ hyperacusis/ hypochromic anemia/
  convulsion in infancy.


s. What are C/F of vitamin C deficiency?
-Pseudoparalysis/ subperiosteal he/ gingival hyperplasia/
 scorbutic rosary/ follicular hyperkeratosis.

t. What are C/F of vitamin D deficiency?
 -Craniotabes/ frontal bossing/ ricketic rosary/ Harrison groove/
  delayed eruption of tooth/ pot belly/ widening of epiphysis of
  long bone.

u. What percentage of children under 5 are stunted in Nepal?
 -It is more than 50% (54% based on 1998
  Nepal Micronutrient Status Survey)

v. At what age there is greatest risk of PEM?
 -  6-18 months.

w. How will you classify a child whose weight is 60-80% and oedema present?
 -Kwashiorkor.

x. How will you classify a child whose weight is less than 60 and oedema present?
 -Marasmic Kwashiorkor.

y. Tell three indication for admission of a malnourished child.
Weight deficit of less than 70% of weight for height or <60% for weight/
 -Hb < 5gms/ hypothermia/persistent
  diarrhoea/dehydration/sepsis.

z. Tell three causes of death in malnutrition.
 -Hypothermia/hypoglycemia/dehydration and
  dyselectrolytemia.

a. which fluid will you use to treat dehydration in malnutrition?
 -Resomal which contains low sodium and added zinc

3. Hematological disorders

a. A child aged two years presents with anemia. Peripheral
smear shows target cells and hypochromic/microcytic picture with Hb of 6gm. There is a positive family history. The next investigation of choice is:
 -Hb electrophoresis.

b. Feature of Fetal RBC is:
 -Alkali denaturation resistance.

c. As per WHO for infants less than 6 months, the Hb cut off level for anemia is:
 -11.5gm/L

d. What percentage of children between 6-23 months suffer from anemia in Nepal?
 -20%

e. What is the commonest cause of anemia in Nepal?
 -Nutritional anemia

f. What is the dose of oral iron to treat iron deficiency?
 -6mg/kg of elemental iron.

g. What are the three causes of hypochromic microcytic anemia?
 -Iron deficiency/ thalassaemia/ lead poisoning.

h. What are three causes of normochromic anemia with low reticulocyte count?
 -Leukemia/chronic infection/pure RBC anemia.

i. What further two test you will do for a child having normochromic anemia with high reticulocyte count?
 -Coombs test and hemoglobin electrophoresis.

j. What is the most likely diagnosis of a child whose total count  is 2,500/cmm, platelet 60,000/cmm, RBC:200,000/cmm and no lymphadenopathy and hepatosplenomegaly?
 - Aplastic anemia.

k. What is the most likely diagnosis for a child with anemia, uremia, thrombocytopenia and raised FDP?
 -Hemolytic uremic syndrome.

l. What two investigations is done for bleeding disorders?
 -Bleeding time and clotting time.

m. What three tests are performed for vascular and platelet defects?
 -Platelet count/ Hess test/ bleeding time.

n. What three tests are assessed for diagnosing coagulation defect?
 -APTT/PT/Thrombin time.

o. Tell three clinical signs that differentiates platelet or vascular defects from coagulation defects?
 -Superficial and deep hemorrhages/ superficial bleeding
  arrested by pressure/ spontaneous bleeding are small and
  multiple.


p. Tell five causes of purpura?
 -ITP/leukemia/HSP/aplastic anemia/drugs/SLE/sepsis.

q. What is the desired rise of a coagulation factor required for the control of bleeding in a hemophilic child with single hemarthrosis?
 -30%.

r. Tell three complications of transfusion reaction?
 -Febrile reaction/allergic reaction/circulatory over load/
  Hemolysis.

4. Neonate:
a. Full term small for date babies are at risk of:
 -Hypoglycemia.

b. What are the three features seen in cold injury in neonate?
 -i. Bradycardia
 ii. Metabolic acidosis
iii. Sclerema

c. when you should not use bag and mask resuscitation?
 -i. Thick meconium aspiration
 ii. Diaphragmatic hernia.

d. What are the three characteristics of post term neonate?
-Looks thin and old; vernix caseosa absent; nail protrudes
 beyond nail beds.

e. What is perinatal period?
 -28 weeks of gestation to 7 days after birth.

f. what is the normal anthropometric measurement of newborn?
 -Weight: 2.5 Kg; OFC: 35 cms; length: 50 cms.

g. What are the five observations made in APGAR scoring?
 -i. respiratory effort; ii: heart reate; iii: colour of the body, iv:
  muscle tone, v: reflex stimulation.


h. Energy requirement for new born: 55 kcal/kag/day; at the end of first week:
 -110kcl/kag/day.

i. A newborn has flaccid paralysis of right upper limb, pronated hand in the waiters position. Where is the lesion?
 -Erbs palsy at 5th and 6th cervical roots.

j. A newborn has absent palmar grasp in the left hand , left pupil is small/irregular. Where is the lesion?
 -Klumpke’s paralysis 8th cervical/1st thoracic and sympathetic
  plexus left side.


k. What is the first step of neonatal resuscitation?
  -Dry and cover with towels/give oxygen by face mask and
   gentle oropharyngeal suction and peripheral stimulation.


l. What will you do if there is no cry, but occasional gasp and heart rate is<100/min?
 -Insert oropharyngeal air way/ extend neck/ bag mask
  resuscitation.

m. What laboratory tests will you order if the neonate has the jaundice within 24 hours of birth?
  -Coombs test/ blood group and Rh of mother and baby and
   serum bilirubin.

n. What is the most likely diagnosis of jaundice in a neonate noticed after 24 hours, direct reacting bilirubin is not raised and haematocrit is high?
 -Polycythaemia.

o. Tell three investigation you will perform in a neonate whose mother noticed jaundice on 20th day of life otherwise well?
 -Thyroid function/urine for reducing substances/SGOT.

p. A newborn develops respiratory distress and is more tachypnoeic after positive pressure ventilation and has scaphoid abdomen, what is the most
likely diagnosis?
 -Diaphragmatic hernia.

q. A newborn is cyanosed and does not improve with 100 % oxygen, what is the most likely diagnosis?
 -Congenital cyanotic heart disease.

r. What are two indications to stop exchange transfusion?
 -After calculated amount is exchanged and if signs of
  impending cardiac failure is seen.


s. What are three complications of artificial ventilation in a neonate?
 -Tension pneumothorax/interstitial emphysema/intraventricular
  hemorrhage.

t. Tell three characteristics of jitteriness that differentiates from convulsion?
 -Stimulus evoked/rapid oscillatory movement/movement ceases
  when limb held/conscious/no eye deviation.


u. A new born develops melena on 96 hours of life. His platelet is normal but PT and PTT is prolonged. What is the most likely diagnosis?
 -Haemorrhagic disease of new born.

v. Tell three problems that may be encountered in preterm?
 -Hyaline membrane disease/HIE/PDA/ anaemia/hypothermia.

w. What are the causes of neonatal hypoglycemia?
 -Small for date/ prematurity/ infant of diabetic mother/ inborn
  errors of metabolism/endocrine deficiencies/ intrapartum
  asphyxia.


x. What is the X-ray findings in necrotizing enterocolitis?
 -Intramural gas shadow in intestine.

y. Tell three conditions for large for gestational age?
 -Diabetic mothers/beckwith syndrome/ transposition of great
  vessels/constitutional.

5. Gastrointestinal disorders:

a. A child presented with white patches in the tongue and buccal mucosa which is not removable by spatula, what could be the cause?
 -Oral thrush.

b. An infant presented with fever, difficulty in swallowing with drooling of
saliva and is active and is irritable. Examination reveals two ulcers over
the palatofaucial junction. what is the most likely cause?
 -Herpangina or herpetic gingivostomatitis.

c. A five year old child presents with recurrent history of vomiting since
birth. His birth weight is 3 kg and present weight is 5 kg. He is cheerful.
What is the most likely diagnosis?
 -Gastrooesophageal reflux.

d. A ten year old child presents with acute onset of vomiting of blood. He
has marked spleenomegaly. What is the most likely diagnosis?
 -Portal hypertnension.

e. A three weeks old male child presents with the history of recurrent
projectile vomiting for two weeks with increasing severity. A mass, firm
and round is palpable in epigastrium. What is the most likely diagnosis?
 -Congenital pyloric stenosis.

f. What is the commonest cause of gastritis?
 -Helicobacter pylori.

g. Tell three causative agent to produce acute diarrhoea in a child of 18
months?
 -Rota virus; enterotoxigenic e. coli; sheigella.

h. What should be the osmolality of home fluid for rehydration?
 -Less than 300 mOsmol/l.

i. Which fluids should not be given in diarrhoea?
 -Sweetened fruit drinks.

j. Which fluid is preferred in severe dehydration?
 -Ringer lactate.

k. Why Rringer lactate is preferred for severe dehydration? It contains
 -Na/K/Cl and lactate.

l. What happens to lactate of Ringer lactate after IV and why it is preferred?
 -Lactate is metabolized to bicarbonate, for the correction of base deficit
acidosis.

m. What are the four parameter on which dehydration is assessed?
 -General condition of the patient; sunken eyes; eager to drink and loss of
skin turgor.

n. What is the amount of ORS you advise to give to a mother whose 20
months kid has diarrhoea without dehydration after each loose stool?
 - 50-100ml.

o. What is the amount of ORS you advise for a child weighing 10 kg.?
 -750 ml.

p. Which fluid you will use and why in a child with malnutrition having
diarrhoea?
 -RESOMAL as it contains low sodium and extra nutrients like zinc.

q. How much Ringer lactate you want to give IV to a 8 months child in the
first hour?
 -30 ml/kg.

r. What are the three complications of dehydration?
 -Convulsion, paralytic ileus, hypoglycemia.

s. Tell three aetiological agents to cause dysentery?                                                                                      

 -Sheigella, salmonella, camphylobacter, enteroinvasive e.coli, entamoeba
   histolytica.


t. What are the four key components in the treatment of dysentery?
 -Antimicrobials; fluids; feeding and follow-up.

u. What are five risk factors for persistent diarrhoea?
 -Malnutrition, recent introduction of animal mild or formula, young age,
  immunological impairment, recent diarrhoea.

v. What are to dreadful complications during rehydration therapy?
 -Pulmonary oedema and renal failure.

w. A child with diarrhoea has serum sodium of 155 mmol/L. Which fluid
will you use?
 -Preferably 5% dextrose with 25 meq/L of sodium as a combination of
  bicarbonate and chloride. If this is not available then half strength normal
  saline.

x. A 18 months old child on formula feeding has persistent diarhroea. His
stool pH is less than 5.5 what will you do?
 -Stop the lactose in the diet.

y. What is the autosomal recessive disorder that causes persistent
steatorrhoea, retinitis pigmentosa, and areflexia?
 - A-B-lipoproteinaemia.

z. Tell four medical causes that may mimic acute abdominal emergencies?
 -Ascaris obstruction; basal pneumonia; acute mesenteric adenitis; preicteric
  hepatitis, acute bacillary dysentery, HSP, severe constipatioin, urticaria,
  acute intermittent prophyria.

aa. What are four extraintestinal causes of abdominal enlargement?
 -Hepatospelenomegaly, divarication of recti, hypotonia, wilms tumour,
  hydronephrosis, distended bladder, pancreatic cyst and choledochal cyst.

bb. What are the types of abdominal tuberculosis?
 -Ascitic, visceral, mesenteric and intestinal.

cc. A 6 year old female child is suffering from nephritic syndrome complains
of acute onset of abdominal pain. She has high fever and is delirius. What
is the appropriate treatment?
 -Parenteral penicillin.

dd. What are the two diseases of intestine where radiological studies are
nearly diagnostic?
 -Chronic ulcerative colitis (lead pipe), cobblestone (regional ieitis),
  Hirschprung (rat tail).


Respiratory disease:

a. What is the ARI episodes per child per year in Nepal?
 - 4-6 episodes.

b. In which age group ARI causes highest mortality?
 -Less than one year.

c. Tell four risk factors for ARI in children.
 -LBW; Domestic smoke pollution, malnutrition, no immunization, passive
  smoking,

d. What is the best way to diagnose pneumonia in child with cough or difficulty
in breathing?
 -Respiratory rate.

e. What is the clinical bed side sign that differentiates obstructive airway disease
from restrictive lung disease?
 -Presence of wheeze.

f. In which disease the infant breathe more easily in the prone position?
 -Micrognathia, Pierre-Robin syndrome.

g. What is the best treatment for acute nasopharyngitis?
 -Paracetamol and home care (cleaning the nose and safe home medicines
  for cough).

h. What are the three upper respiratory common causes of recurrent cough in
children?
 -Post nasal drip/ hypertrophied adenoids/allergic rhinitis.

i. For how long you will treat acute tonsillitis with antibiotics?
 -Full ten days.

j. What two acute emergency condition can be diagnosed with lateral cervical xray?
 -Acute epiglottitis and retropharyngeal abscess.

k. What are four causes that can present with cervical lymphadenitis?
 -Superficical infection of drainage area/ tuberculosis/Hodgkin’s disease/
  infectious mononucleosis/ leukemia.

l. What is glue ear?
 -It is the secretary otitis media due to the blockage of Eustachian tube
  causing vacuum in the middle ear cavity.

m. What are the two long term complications of streptococcal pharyngitis?
 -Rheumatic fever and glomerulonephritis.

n. A three year old child presents in ER with acute respiratory distress. Stridor is
audible. What two investigations are done urgently?
 -Lateral cervical x-ray and total/differential count.

o. A three year old child presents with acute onset of croup. The child is active
feeding well but the croup worsens during exertion. What is the most likely
diagnosis?
 -Acute spasmodic laryngitis.

p. What are the three causes of croup?
 -Epiglottitis/ laryngotracheobronchitis/ foreign body.

q. How does the IMCI classifies a child with cough or difficulty breathing?
 -Severe pneumonia or very severe disease/ pneumonia/ no pneumonia or cough
  and cold.

r. Which three organisms cause persistent pneumonia?
 -Chlamydia; pneumocystis; tuberculosis.

s. What are the complications of pneumonia?
 -Lung abscess; effusion; SIADH; cardiac failure; metastasis infection;
  acidosis.

t. What are the four causes of persistent pneumonia?
 -Chlamydia; pneumocystitis; foreign body; asthma; tuberculosis; cardiac
  failure.

u. Which is the most effective way to monitor the improvement in asthma
during treatment?
 -Peak flow meter.

v. A nine year old child with history of asthma again presents in the ER with
respiratory distress. On auscultation there are no air entry both the lung fields.
What are the most important steps in the treatment?
 -Oxygen; IV fluid; hydrocortisone IV; aminophyline; ABG.

w. What are the four principles in the management of respiratory failure?
 -IV isoproterenol; mechanical ventilationi; neuromuscular blocakade;
  sedation morphine.

x. What is the typical findings in X-Ray of a child with bronchiectasis?
 -Honeycomb appearance.

y. What are the four causes of pleural effusion?
 -Tubercular; pyogenic; collagen disease; malignancy; cardiac failure;
  nephritic syndrome; visceral larva migrans.

z. A nine year old child diagnosed as a case of pneumonia suddenly presents
with the history of respiratory distress for few hours. His chest examination
reveals hyerresonance on the right side with reduced air entry. The chest x-ray
shows deviation of the mediastinum on the left side. What is the immediate
management?
 -A case of pneumothorax: water seal drainage.


Cardiovascular disease

a. What is the commonest acquired heart disease in developing country?
 -Rheumatic heart disease.

b. What are the three antenatal condition that predisposes to cardiac disease?
 -Maternal rubella; foetal alcohol syndrome; chromosomal anamolies.

c. Which physiological process closes the foramen ovale after birth?
 -Left atrial pressure rises as pulmonary venous return increases.

d. Which physiological process closes the ductus arteriosus?
 -The postnatal rise in arterial oxygen tension together with local changes
  in prostaglandin metabolism.

e. What are the four respiratory conditions that mimic congenital heart disease?
 -Meconium aspiration; respiratory distress syndrome; pneumothorax.

f. Which simple test differentiates the cyanosis from cardiac or pulmonary
disease?
 -Hypoxia test. Cyanosis due to pulmonary disease lessens with 100 percent
  oxygen where as in cardiac it remains the same.

g. What is the clinical sign that diagnoses the commonest congenital cardiac
defect?
 -Systolic murmur in the left fourth intercostals space close to the sternum.
  VSD.

h. What is the typical signs of VSD in ECG?
 -High voltage R waves in V5 and V6.

i. What is the typical three clinical sign of PDA?
 -Continuous murmur in the pulmonary area; collapsing pulse; chest
  indrawing; enlarged liver.

j. What are the two typical clinical signs of ASD?
 -Heaving cardiac impulse just left to the sternum and fixed splitting of the
  second heart sound.

k. What are the three typical findings in the ECG of ASD?
 -Right axis deviation and light bundle branch block pattern in V1 and V2.

l. Tell four cardiac condition that can present as cyanosis in infancy?
 -TOF; TGA; Tricuspid atresia; total anamolous pulmonary venous
  drainage and single ventricle.

m. What are the major and minor criteria to diagnose rheumatic heart disease?
 -Major are carditis; polyarthritis, chorea, erythema marginatum and
  subcutaneous nodule. Minor are fever; arthralgia, ECG changes and rise of
  acute phase reactants.

n. What are the four clinical signs that is present mostly in Bacterial
endocarditis?
 -Preexisting heart murmur; fever; pallor, palpable spleen.

o. What condition you suspect in a child who has grossly enlarged heart without
valvular disease?
 -Cardiomyopathy.

p. What are the four clinical signs present mostly in pericardial effusion?
 -Raised JVP; distant heart sound, hepatomegaly and pulsus paradoxus.

q. What are the four features of Tetralogy of Fallot?
 -VSD; Pulmonary stenosis; over riding of aorta and right ventricular
  hypertrophy.

r. What are the three groups of clinical symptoms of arrhythmia?
 -Symptoms due to decreased cerebral blood flow; symptoms due to
  congestive heart failure and perceptions of rhythm disturbances.

s. How will you treat sinus tachycardia?
 -Carotid sinus pressure.

t. What are three important clinical signs of Paroxysmal supraventricualar
tachycardia?
 -Heart rate more than 200;; breathlessness, change in colour.

u. Which two cardiac valvular disease where digoxin is contraindicated?
 -TOF and pulmonary stenosis.

v. Tell three complications of cardiac disease?
 -Cardiac failure, thromboembolism and cerebral abscess.

w. What are four common clinical signs of cardiac failure?
 -Respiratory distress; oedema; enlarged liver and basal crepitations.

x. What is the reason to have hemiplegia in a child with cyanotic heart disease?
 -Polycythemia with increased viscosity and dehydration.

y. What is the commonest cause of hypertension in children?
 -Glomerulonephritis

z. What are five causes of hypertension in children?
 -Coarctation of aorta; renal artery stenosis, pheochromocytoma, steroid
  use, polycystic kidney. Pyelonephritis, neuroblastoma, Cushing’s
  syndrome


Hepatobiliary disorders

a. What are the four common symptoms of hepatobiliary disease?
 -Jaundice; ascites; oedema; upper abdominal pain.

b. What are the condition in which there is unconjuated hyperbilirubinemia?
 -Hemolytic, jaundice of prematurity, Gibert’s diseae, Criggler-Najjar syndrome;
and pernicious anemia.

c. What are the condition in which there is unconjugated hyperbilirubinemia?
 -Dubin Johnson’s syndrome; biliary atresia; viral hepatitis; biliary obstruction;
  choledochal cyst.

c. What are five infective causes of hepatosplenomegaly?
 -Typhoid, infectious mononucleosis; malaria; kala-azar; tuberculosis.

d. What are the causes of only hepatomegaly?
 -Amoebic liver abscess; hydatid cyst; hemangioma; liver flukes, congestive
  cardiac failure; constrictive pericarditis.

e. What are the causes of only spleenomegaly?
 -Portal hypertension, Felty syndrome; SBE; hemangioma, cyst, splenic trauma.

f. What are the types of hepatits that is transmitted by faecal oral route?
 -Hepatitis A; E.

g. What are the diagnostic test for the hepatitis B?
 -HBs Ag; Hbe Ag; anti HBc.

h. What chromosomal anomalies may be associated with biliary atresia?
 -Down’ syndrome; trisomy 17 and 18.

i. What is your diagnosis in an s week young infant with jaundice noticed from 5th
day of life and has pale stools but dark urine?
 -Biliary atresia.

j. Which type of hepatitis is associated with raised serum alphafetoprotein?
 -Idiopathinc neonatal hepatitis.

k. An child has varicella infection one week back. At present he is irritable and has
hypoglycemia and raised serum ammonium. What is the most likely diagnosis?
 -Reye’s syndrome.

l. Name three storage disease that can cause cirrhosis?
 -Galactosaemia; Wilson’s disease; glycogen storage disease.

m. How will you treat a child who has hepatocellular failure and is bleeding?
 -Vit K 5-10 mg IM and blood transfusion.

n. What are the four management principal in the treatment of hepatic coma?
 -Restricted protein; laxatives; neomycin; fluid restriction.

o. What is the most possible diagnosis in a child with hepatomegaly, abdominal
pain, ascites and hepatic histology comprising sinusoidal distension?
 -Budd-Chiari syndrome.


Genitourinary disorders

a. How will you confirm the UTI?
 -Isolating the organism and colony count should be more than 100,000/ml in a
  midstream or clean catch urine.

b. What further three investigations are necessary in a child with repeated UTI?
 -USG of abdomen; voiding cystourethrography, and DMSA scan.

c. How will you treat a nine year old child who presents in the ER with very high
fever and rigor? The urine routine examination shows plenty of pus cells.
 -IV cefotaxime or ceftriaxone.

d. What is the commonest cause of hematuria in children?
 -Acute poststreptococcal glomerulonephritis.

e. What are the five important symptoms that identifies a child with glomerular
disease?
 -Puffiness of face; oliguria, dark coloured urine; headache; convulsion.

f. What are the indication for biopsy in glomerulonephritis?
 -Persistently low C3; oliguria for more than 3 weeks; persistent hypertension.

g. What are the four diagnostic criteria for Nephrotic syndrome?
 -Proteinuria (more than 40mg/m2/hour), hypoalbuminemia, oedema, and
  hyprcholesteremia.

h. What is the drug and its dose that is mostly used in nephritic syndrome?
 -Prednisolone; 60mg/m2/day.

i. How will you define relapse?
 -The recurrence of oedema with proteinuria.

j. What do you mean by frequent relapse?
 -More than 3 relapse in one year.

k. Eneumerate four important complications of Nephrotic syndrome.
 -Pneumococcal peritonitis; coagulation abnormalities, renal failure and
  hyperlipidemia.

l. How will you define acute renal failure?
 -Oliguria less than 300 ml/sq.m/day or urine output of less than 0.5ml/kg/hr for 12-
  24 hours.

m. Enumerate three causes of prenal acute renal failure?
 -Dehydration; haemorrhage, decreased cardiac output.

n. Enumerate three causes of post renal acute renal failure?
 -Obstructive uropathy; posterior urethral valve; renal vein thrombosis.

o. What is the commonest cause of nocturnal enuresis?
 -Inadequate bladder training.

p. Which investigation will confirm the diagnosis of posterior urethral valve?
 -Micturating cystourethrogram

q. What are the four important signs of polycystic disease of kidney?
 -Unilateral or bilateral flank mass; haematuria; hypertension and failure to thrive.

r. How will you prevent renal scarring in a child with ureteric reflux?
 -Prophylatic antibiotics and surgical implantation.

s. How long one should wait for undescended testis?
 -Up to the first year of life.

t. What is the treatment for hydrocele in a neonate?
 -Observation for few months (one year).

u. What is the common precipitating factor for vulvovaginits in children?
 -Thread worm infestation.


Infectious disease:

a. What is the infectivity period of chicken pox and measles?
 -Until 5 days after the onset of lesion and 14th day from the appearance of rash.

b. What is the infectivity period of whooping cough?
 -21 days.

c. Which diseases has the rash on the first day of fever?
 -Rubella; Chicken pox and meningococcal infection.

d. In which disease the rash appears on the second or third day?
 -Scarlet fever and exanthema subitum.

e. In which disease the rash appears and the fever subsides?
 -Exanthema subitum.

f. A child is brought in the summer months with conjunctivitis, pertussis like
syndrome and hematuria, what is the most likely diagnosis?
 -Adenoviral infection.

g. What is the disease which causes dysentery and tender hepatomegaly?
 -Amoebiasis.

h. Can a child who passes ova of ascariasis can have auto infection?
 -No, the ova must be in the soil for two weeks to become infective.

i. Which two drugs are antagonistic in ascaris infestations?
 -Pyrental pamoate and piperazine.

j. A child has diarrhoea and the stool report shows Balantidium coli, which drug
you will use?
 -Tetracycline is the drug of choice and metronidazole is the alternate drug.

k. Which two diseases can spread by milk which is not boiled?
 -Tuberculosis and Brucellosis.

l. Which bacteria is related to GB syndrome that causes dysentery? What is the drug
of choice?
 -Camphylobacter jejuni and erythromycin is the drug of choice.

m. Tell three causes that can cause muco-cutaneous candidiasis?
 -Prolonged use of antibiotics; immunodeficiency and endocrinologic disease.

m. A nine year old child presented with the recurrent history of fever, hoarseness,
productive cough and cervical lymphadenopathy. His total count is normal and
mantaux is negative. What is the most likely causative organism.
 -Mycoplasma pneumoniae infection

n. An eight weeks infant presented with the findings of pneumonia without fever.
Which is the most likely infective agent?
 -Chlamydia.

o. A ten year old child had been in a marriage party in Tarai. After 12 hours he
presented with the history suggestive of descending flaccid paralysis. What is the
most likely diagnosis?
 -Botulism.

p. A child is being treated with oral ampicillin for three weeks. He developed
dysentery with abdominal pain from 20th day of ampicillin. What is the most
likely diagnosis?
 -Clostridium fefficile.

q. An six months old infant of a HIV positive mother presented with the history of
watery diarrhoea for one month. He is not dehydrated but his weight is 4 kg.
What is the most likely aetiological agent for this diarrnoea?
 -Cryptosporidiosis.

r. What are the four important clinical findings of CMV infection in a neonate?
 -Microcephaly, hepatosplenomegaly, purpura, intracranial infections and
  chorioretinitis.

s. What are the two non polio enteroviral infections?
 -Coxackie and echoviruses.

t. Which E.coli can cause dysentery?
 -Enteroinvasive and enterohaemorrhagic.

u. What type of diarrhoea is produced by giardia lamblia?
 -Osmotic diarrhoea.

v. How will you treat gonococcal neonatal ophthalmia neonatorum?
 -IV ceftriaxone.

w. How can you prevent the invasive hemophilus influenzae infections?
 -Hib immunization.

x. What is the chance of hepatits B in a neonate who is born to a mother who is
HBeAg positive?
 -90% of infection.

y. What is the commonest type of hepatitis that is prevalent in Nepal?
  -Hepatitis E (non A non B).

z. A nine months old child presented with the history of acute onset of high fever,
excessive salivation, and irritability. He has ulcers involving the gum and mucous
membrane of mouth. What is the most likely diagnosis?
 -Herpes simplex.

aa. How does the HIV infection spreads?
 -Sexual contact; contaminated needles; vertical transmission and blood products.

bb. Mention four AIDS indicator diseases.
 -Persistent candidiasis; persistent parotitis; persistent diarrhoea; persistent
  generalized lymphadenopathy and hepatosplenomegaly.

cc. Mention one retroviral drug for children.
 -  3-azido-3-deoxythymidine.

dd. What can cause abdominal pain, positive occult blood and eosinophilia?
 -Hookworm infestation.

ee. What is the most possible diagnosis of a child who has fever, exudative
pharyngitis, lymphadenopathy, hepatosplenomegaly and atypical lymphocytosis?
 -Infectious mononucleosis.

ff. What is the most serious complication of Kawasaki disease?
 -Coronary artery aneurysm.

gg. Which drug is contraindicated in Kawasaki disease?
-Corticosteroids.

hh. What type of fever is present in Kala-azar?
 -Double peak fever.

ii. What are the four classification of Leprosy?
 -Tuberculoid; lepromatous; borderline; intermediate.

jj. In which type of Leprosy the cell mediated immunity is intact?
 -Tuberculoid.

kk. What are the four complications of P. falciparum?
 -Convulsion; renal failure; vascular collapse and black water fever.

ll. How will you treat cerebral malaria?
 -Inj. Quinine hydrochloride: 20 mg salt/kg loading dose in 10ml/kg of 5% dextrose
  over four hours IV followed by 10mg salt/kg every eight hours.

mm. Which is the commonest malarial parasite found in Nepal?
 -Plasmodium vivax.

nn. Mention five complications of measles.
 -Otitis media, diarrhoea, xerophthalmia; encephalitis; SSPE.

oo. When you will advise vaccination against measles?
 -Nine months and 15-18 months (MMR).

oo. A five year old child presented in the ER with history of high fever, headache,
convulsion and has purpuric spots. What is the most likely diagnosis?
 -Meningococcal meningitis.

pp. Which drug will you use for the chemoprophylaxis?
 -Rifampicin.

qq. What is the most common site for molluscum contagiosum in children?
 -Face.

rr. Mention the gram negative organism that causes otitis media in children.
 -Moraxella caterrhalis.

ss. What are the three complications of mumps?
 -Pancreatitis; orchitis and encephalitis.

tt. What is the common aetiological agent for pneumonia in children older than five
years?
 -Mycoplasma pneumoniae.

uu. Which group of drug will you use for this?
 -Macrolide.

vv. A ten year old child presented with haemoptysis, chronic cough and very high
eosiniphilia and the mantaux is negative?
 -Paragonimiasis.

ww. Which viral infection can cause “slapped cheek” appearance?
 -Erythem infectiosum

xx. Mention three vaccine preventable disease that can occur in a neonate?
 -Pertussis, tetanus and hepatitis B.

yy. Which is the drug of choice for Pneumococcal infection?
 -Penicillin G

zz. Mention one infection commonly seen in severely malnourished or
immunocompromised child which can be treated with cotrimoxazole.
 -Penumocystis carini

Aaa. Mention three causes of acute flaccid paraplegia.
 -Poliomyelitis; GB syndrome and transverse myelitis

Bbb. What is the cause of death in poliomyelitis?
 -Respiratory paralysis.

ccc. Which is national program that is supported by WHO for the eradication of
Polio?
 -Plus polio program.

Ddd. What is the incubation period of rabies?
 -One week to more than one year.

Eee. Which drug is used in bronchiolitis which has reduced the mortality?
 -Ribavirin by aerosol.

Fff. What is the commonest cause of winter diarrhoea in an infant?
 -Rota virus.

Ggg. Mention four ophthalmologic features of congenital rubella.
 -Cataract; microophthalmia; glaucoma; chorioretinitis.

Hhh. Mention three features of post natal rubella.
 -Erythematous maculopapular rash; generalized lymphadenopathy; fever on the
  same day of rash.

iii. Mention three diseases caused by salmonella.
 -Gastroenteritis; enteric fever; osteomyelitis, abscess, meningitis.

Jjj. Mention two drugs used for scabies.
 -Lindane; crominton, benzyl benzoate.

Kkk. What are the diagnostic criteria for toxic shock syndrome?
 -Fever of 38.9 degree C or higher; diffuse macular erythema; desquamation 1-2
  weeks after illness particularly palm and soles; hypotension and involvement of
  three or more systems.

Lll. Mention two diseases that occurs after 2 weeks of infection with group A beta
haemolytic infection.
 -Rheumatic fever and glomerulonephritis.

mmm. A child presented with sandpaper like rash, strawberry tongue, exudative
pharyngitis and tender anterior cervical lymphnodes. What is the most likely
diagnosis?
 -Scarlet fever.

Nnn. Mention three features of GAS toxic schock syndrome.
 -Hypotension, DIC, purpura and renal impairement.

Ooo. Which age group is vulnerable for GBS infection?
 -Neonate.

Ppp. Which parasitic disease causes high eosinophil count and migrating pruritic
erythematous tracks?
 -Strongyloidiasis.

Qqq. Mention five signs of congenital syphilis.
 -Osteitis, hepatitis, lymphadenopathy, mucocutaneous lesion and anaemia.

Rrr. Which tape worm completes its life cycle in human and what is the drug of
choice.
 -Hymenolopis nana; praziquantel.

Sss. How will you treat tineasis?
 -Topical application of miconazole/clotrimazole/2.5% selenium sulphide/oral
   ketoconazole.

Ttt. A five year old child presents with perianal pruritus and there are no other
symptoms. What is the most likely diagnosis and how will you treat this.
 -Thread worm infestation and pyrental pamoate or albendazole.

Uuu. Which disease is spreads through cat/dog and causes high eosinophil count?
 -Toxicariasis.

Vvv. Mention five features of congenital toxoplasmosis.
 -Maculopapular rash, lymphadenopathy, hepatosplenomegaly, microcephaly,
  chorioretinitis, thrombocytopenia, convulsion.

www. What is the indication to use corticosteroids in tuberculosis?
 -tubercular meningitis and large pericardial or pleural effusions.

xxx. What is the indication to use acyclovir in chicken pox?
 -Older than 12 years, chronic cutaneous or pulmonary disorders, receiving
  steroids, salicylates and other immunosuppressive drugs.

Yyy. What is pseudoappendicitis syndrome?
 -Infection caused by yersinia enterocolitica with fever, pain in right iliac region
  and leucocytosis.


Neuromuscualar Disease.

a. In a floppy child if the reflexes are brisk and planter is up going where is the
lesioin?
 -Cortex.

b. In a floppy child there are no tendon reflexes but sensation is normal and is of
normal intelligence where is the lesion?
 -Anterior horn cell.

c. Mention five metabolic causes of hypotonia.
 -Hypokalemia, hypothyroidism, rickets, hypercalcemia, renal acidosis and
  glycogenosis, lipoidosis.

d. Mention three causes of convulsion associated with skin lesions.
 -Neurofibromatosis, tuberous sclerosis, cysticercosis, sturgeweber syndrome.

e. What is the typical finding on EEG in petit mal?
 -3HZ spike and wave paroxysm seen made worse by hyperventilation.

f. What are the important clinical signs of brain stem lesion?
 -Crossed hemiplegia, ataxia and cranial nerve palsy at the level of lesion and
  difficulty with eye movements.

g. What are the clinical signs of corticospinal lesions?
 -Hyperactive stretch reflexes, increased tone, weakness usually greater than
  atrophy.

h. Mention three important feature of febrile seizure.
 -Occurs between 6 months to 5 years, convulsion lasts for less than 15 minutes, no
  localizing neurological signs and LP is normal.

i. What is the cause of fixed and dilated pupil?
 -Third nerve lesion.

j. What decorticate posturing indicates?
 -It indicates bilateral hemisphere dysfunction with intact brainstem.

k. What decerebrate posturing indicates?
 -It indicates bilateral damage to structures at the upper brain stem or deep
   hemishphere level.

l. Mention three causes of coma with focal neurological signs but without raised
intracranial pressure.
 -Tuberculoma, cysticercosis, vascular cause.

m. Mention five signs of severely raised intracranial pressure.
 -Decerebrate posture, irregular respiration, tonic seizures, fixed dilated pupil,
  stridor and bounding pulse.

n. Mention two drugs that are used to reduce the intracranial pressure.
 -IV mannitol and dexamethasone.

o. When will you suspect a child having meningitis?
 -If the child has unexplained fever with convulsion and persisting headache.

p. What is the commonest cause of death in acute bacterial meningitis?
 -Raised intracranial pressure.

q. Mention five complications of meningitis.
 -Hydrocephalus, cranial nerve palsies, subdural effusion, SIADH, DIC, brain
  abscess.

r. What are the four features of spinal cord dysfunction?
 -Sensory level, a level of motor dysfunction, no facial involvement and urinary
  dysfunction..

s. Mention four causes of peripheral nerve disease.
 -Acute infective polyneuritis, diphtheria, botulism, peroneal muscualar atrophy,
  and Friedreich’ ataxia.

t. What is the finding of CSF of a patient with GBS if done on second week.
 -Normal or slight increase cells with raised protein.

u. What are the signs of myopathies?
 -Gradual weakness, absence of paresthesias, bowel and bladder not affected,
  positive Gower’s sign, no fasciculations.

v. Mention muscular dystrophies with autosomal dominant inheritance.
 -Myotonia congenital, central core disease, fascioscapulohumoral dystrophy.

w. Mention three causes of cherry red spots.
 -Tay-Sachs , Neimann-Pick and Gm1-gangliosiodoses.

x. What are the metabolic disease associated with peripheral neuropathy?
 -Metachromatic leukodystrophy, Krabbe’s disease and Neuroaxonal dystrophy.

y. Mention neuronal disease with visceral inlargement.
 -Gaucher, Neimann-Pick, Hurler and glycogen disease.

z. Mention the spinal centre for ankle and knee jerk.
 -S1 and L2,L3,L4 respectively.


Skeletal Disorders

a. A three year old child is brought in the OPD because of short stature. His mental
status is normal. His limbs are short but trunk is normal. His hand give the
appearance of trident. What is the most likely diagnosis?
 -Achondroplasia.

b. A newborn is presented with multiple fractures. What genetic disease you suspect
and mention is inheritance?
 -Osteogenesis imperfecta, autosomal dominant.

c. Mention two conditions associated with hemihypertrophy.
 -Mental retardation and neoplasia of kidney or adrenal.

d. A child presents with hypermobility of joints from birth. What is the most likely
diagnosis.
 -Ehlers-Danlos syndrome.

e. A newborn present with simple malformations with contractures and deformitites
of the joints, what is the most likely diagnosis?
 -Arthrogryposis multiplex congentia.

f. Mention two organism that commonly cause acute suppurative arthritis.
 -S.aureus and H.influenzae.

g. Which part of bone is commonly involved first in osteomyelitis?
 -Metaphysis.

h. Which investigation can confirm the osteomyelitis lesion in bone in 48 hours?
 -Triple phase technetium-99 diphosphate bone scan.

i. How long will you give antibiotics in osteomyelitis?
 -Two to three weeks.

j. Mention one clinical sign that differentiates TB hip joint from Perthe’s disease.
 -In TB hip joint child complains first of pain at night then he limps. In Perthe’s
  the child first limps and pain follows.

k. Mention two signs of TB spine.
 -Kyphosis and pressure symptoms on the chord.

l. A newborn presents with the symmetrical swelling of the arm, leg and elbow. He
is pyrexial and does not move limbs. What is the most likely diagnosis?
 -Congential syphilis.

m. A four year old child presents with acute onset of limp. He had mild fever, cough
and runny nose one week back. He complains of pain in groin that radiates to
knee. What is the most likely diagnosis?
 -Transient monoarticular synovitis.

n. How will you treat congential dislocation of hip?
 -Kepping the hip joint in the position of flexion and abduction for 1-2 months by
  applying double of triple diapers.

o. A two year old child is diagnosed as genu valgum without other problem. What
advice you will give to parent?
 -It is spontaneously corrected by five years.


Endocrinal disorders

a. A two month old infant is brought to you with history of prolonged jaundice,
hoarse cry and umbilical hernia, which investigation you suggest?
 -TSH.

b. What is the normal size of thyroid gland?
 -It should not be larger than the distal phlynx of the individual thumb.

c. A 12 year old male child has enlarged thyroid, which investigation you suggest?
 -T3/T4/TSH

d. A three day old male child presented with recurrent vomiting. His scrotum is
hyperpigmented and penis us unusually enlarged. What is the most likely
diagnosis?
 -Adrenogential syndrome.

e. A five year old child presents with polyuria and polydipsia. His urine examination
is normal except the specific gravitiy of 1001. Which investigation should be
done?
 -Water deprivation test.

f. Which disease is seen in basophil tumour of the anterior lobe of pituitary?
 -Cushing’s syndrome.

g. A ten year old child presented in the ER with drowsiness. There is no history of
diarrhoea or drug ingestion. On examination he is dehydrated and has Kussmaul
breathing. Mention two investigation that you will do urgently.
 -Blood sugar and ketone in urine.


Immunological disorders

a. Which eye complication is seen in juvenile rheumatoid arthritis?
 -Iridocyclitis.

b. How will you cofirm the diagnosis of SLE?
 -By finding the LE cells.

c. What happens to ESR/CRP/Hb and Leucocyte count in JRA?
 -All will be raised except Hb.

d. What is the most likely diagnosis of a child who is previously diagnosed as
pulmonary haemosiderosis present with hematuria?
 -Goodpasture’s syndrome.

e. What are the immunological reaction in Urticaria?
 -Interaction of mast cells or basophil bound IgE antibody with antigen,
  complement system and the plasma kinin-coagulation scheme.

f. What are the clinical signs of severe angiooedema?
 -Acute respiratory distress and collapse.

g. Which is the commonest non-infectious hyperactive inflammatory disease of the
skin in infancy?
 -Atopic dermatitis.

h. What is the commonest skin lesion in atopic dermatitis?
 -Erythematous exudative lesions on forehead and cheeks.

i. What is the treatment for atopic dermatitis?
 -Avoidance of soap/ detergens and application of topical steroids.