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Phase 3b > 07/03/2021 [RBD, GBS, LBMP, hip joint, asthma, ] > Flashcards

07/03/2021 [RBD, GBS, LBMP, hip joint, asthma, ] Flashcards

1
Q

What is GBS?

A

Rapid-onset muscle weakness caused by the immune system damaging the peripheral NS

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2
Q

Sx of GBS

A

Muscle weakness beginning in the feet and hands, usually ascending upwards

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3
Q

The serious Cx and how common is it?

A

Weakness breathing muscles with about 15% developing weaknesses that require mechanical ventilation

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4
Q

Common trigger

A

Infection, or less commonly, by surgery. Rarely, by vaccination.

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5
Q

Dx of GBS

A

Usually Sx and Sx though exclusion by NCS and examination of CSF

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6
Q

Tx for GBS

A

Prompt Tx with IVIG or plasmapheresis

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7
Q

Recovery for GBS

A

Weeks to years

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8
Q

How common is permanent weakness?

A

1/3rd

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9
Q

How common is Cn involvement?

A

In about half of cases, leading to muscles of the face/eyes paralysis, swallowing difficulties

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10
Q

How long is the plateau phase commonly?

A

2d-6m potentially, but most commonly a week then gets better

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11
Q

How common is pain in GBS?

A

About half of cases, incl. back pain, painful tingling, muscle pain, pain head/neck relating to irritation lining of the brain

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12
Q

What do many people have prior to a GBS infx?

A

Sx and Sx of an infection 3-6w prior to onset neuro Sx; consist of URTI or diarrhoea

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13
Q

Which group can be mistaken often?

A

Children, as often initially mistaken [for up to 2w] for other causes of pains and difficulties walking, such as infx, or bone/joint problems.

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14
Q

Neuro examination in GBS?

A

On neurological examination, characteristic features are the reduced strength of muscles and reduced or absent tendon reflexes (hypo- or areflexia, respectively).However, a small proportion have normal reflexes in affected limbs before developing areflexia, and some may have exaggerated reflexes

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15
Q

What is the Miller Fisher variant of GBS?

A

In the Miller Fisher variant of Guillain–Barré syndrome (see below), a triad of weakness of the eye muscles, abnormalities in coordination, as well as absent reflexes can be found.

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16
Q

Resp failure how common?

A

25%

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17
Q

Other system affected in GBS?

A

2/3rds have HR and BP problems as autonomic NS is effected.

20% may experience severe BP fluctuations and irregularities of the hear.t

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18
Q

Epidemiology of GBS?

A

Children/young adults less likely, men more likely [1.78x].

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19
Q

Causes of GBS?

A

2/3rd have infection. Commonoyl gastroenteritis, or URTI.

30% caused by campylobacter jejuni bacteria which cause diarrhoea, 10% by cytomegalovrisu.

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20
Q

Death rate GBS

A

5%, even with good care.

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21
Q

Hip joint articulation

A

Head of femur, acetabulum

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22
Q

How is the acetabalum deepened?

A

By teh acetabular labrum

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23
Q

Ligaments intracapsular

A

Ligament of head of femur

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24
Q

What does the ligament head of femur encase?

A

Obturator artery [minor blood supply hip]

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25
Q

Extracapsular ligaments

A

Iliofemoral
Pubofemoral
Ischiofemoral

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26
Q

Function of each ligament extracapsular

A

Iliofemoral - prevents hyperextension of the joint
Pubofemoral - triangular and prevents abduction and extension
Ischiofemoral - piral orientation, prevents hyperextension and holds femoral head in

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27
Q

What is the arterial supply hip joint mainly by?

A

Circumflex femoral arteries [branches from deep femoral artery]

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28
Q

What can damage to the medial femoral artery cause?

A

Avascular necrosis femoral head

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29
Q

Innervation hip joint

A

Sciatic, femoral, obturator arteries

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30
Q

Why can pain be referred to the knee from the hip?

A

Use the same three nerves [and vice versa]

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31
Q

Stabillising factors joint

A

Acetabulum
Acetabular labrum
Spiral orientation
Muscles/ligaments reciprocal working

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32
Q

What is the spiral orientation?

A

Ligaments of the hip tighten when the joint is extended

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33
Q

Anteriorly how does the recipoacy stabilise the joint

A

Ligaments strongest, and medial flexors are fewer and joint

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34
Q

posteriorly how is joint stabilised?

A

Ligaments weaknest, medial rotators greater in number and stronger

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35
Q

Flexion hip muscles

A

iliopsoas, rectus femoris, sartorius, pectineus

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36
Q

Extension

A

gluteus maximus; semimembranosus, semitendinosus and biceps femoris (the hamstrings)

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37
Q

Abduction

A

gluteus medius, gluteus minimus, piriformis and tensor fascia latae

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38
Q

Adduction

A

adductors longus, brevis and magnus, pectineus and gracilis

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39
Q

Lateral rotation

A

biceps femoris, gluteus maximus, piriformis, assisted by the obturators, gemilli and quadratus femoris

40
Q

Medial rotatoin

A

anterior fibres of gluteus medius and minimus, tensor fascia latae

41
Q

What does the degree to which flexion at the hip can occur depend on?

A

Whether the knee is flexed [relaxes hamstring muscles]

42
Q

Extnesion at the hip limmited by what?

A

Joint capsule and iliofemoral ligament

43
Q

CF of DDH

A

Limited abduction at hip
LLD in affected limb
Asymmetric skin/thigh folds

44
Q

Tx of DDH

A

Pavlik harness

45
Q

How common acquired dislocation?

A

Not very, can happen trauma/Cx surgery

46
Q

Two types of disolocation

A

posterior [90%]

anterior [10%] due to traumatic extnesion/abduction/lateral rotation

47
Q

Type of cartilage is the acetablar labrum?

A

Fibrocartilaginous collar

48
Q

Cause of asthma

A

Combination genetic and einvoinrment

49
Q

Triggers

A

Air pollution and allergens, medication like beta blockers/aspirin

50
Q

two big types of asthma

A

Atopic and non-atopic [atopic T1 hypersensitivty reaction]

51
Q

What is salbuatmol

A

Beta-2 agonist

52
Q

Sx asthma

A

wheezing, SOB, chest tightness, coughin, sputum possibly

53
Q

What may sputum look like in an attack?

A

Pus-like due to high levels white blood cells eosinophils

54
Q

When Sx worse asthma?

A

Worse at night, and in early morning, or response to exercise/cold air

55
Q

health disorders that commonly occur more freq ni asthma

A

GERD, rhinosinusitis, obstructive sleep apnoea

56
Q

Where is the inflammation in asthma?

A

Chronic inflammation conducting zone airways [bronchi and bronchioles mainly], causing contracility smooth muscles = wheezing

57
Q

Changing of the airways in asthma

A

Increase in eosinophils and thickening of the lamina reticularis

58
Q

Dx asthma

A

No precise test. If suspected due to Sx, spirometry can be used to confirm Dx.

59
Q

Who is it hard to diagnose and why?

A

Children under 6 as can;t do spirometry

60
Q

Spirometry Dx

A

FEV1 measured and if this improves by more than 12% and increases by at least 200 millilitres following administration of a bronchodilator such as salbutamol, supportive of Dx. [may however be normal in those with history of asthma acting up. Other test incl methacholine challenge and PEF possibly]

61
Q

Classification of asthma

A

Intermittent [<2 pw, >80%]
Mild persistent [>2 pw, >80%]
Moderate persistent [daily, 60-80%
Severe persistent [continuously, under 60%]

BY Sx, FEV1, PEF

62
Q

DDx in children

A

Allergic rhinitis and sinusitis [aspiration, LN neck, laryngomalacia]

63
Q

DDX adults

A

COPD, CHF, airway masses, medciation

64
Q

Which drug can induce asthma Sx?

A

ACE inhibitors

65
Q

After age 65, what will most people with obstructivee airway disease have?

A

COPD and asthma

66
Q

How can COPD be differentiated?

A

increased airway neutrophils, abnormally increased wall thickness, increased smooth muscle bronchi

67
Q

Why not important to differentiate COPD/asthma old people?

A

Tx the same []COC/LABA/smoking cessation

68
Q

Prevention

A

weak evidence, lower RF like no smokinh, air pollution, lower LRT

69
Q

Mx of asthma short-term

A

identifying triggers best way of prevneting

Bronchodilators short term relief.

70
Q

Mill dpersistent disease asthma

A

More than two attacks a week, then low dose COC/leukotriene agonist

71
Q

Daily attacks asthma

A

inhaled corticosteroids

72
Q

Name for LBP

A

Lumbago

73
Q

How long to be chronic back pain?

A

more than 12w

74
Q

Way to test for intervertebral disc damage

A

Straight leg rise

75
Q

Which type of spinal disease needs surgery

A

Spinal stenosis

76
Q

She lumbago typically develops

A

20-40 y/o

77
Q

What is pain radiating down the leg called?

A

Sciatica

78
Q

What may women have with lower back pain?

A

Female reproductive: endometriosis, ovarian cyst, ovarian Ca, uterine fibroids

79
Q

Why are the 4 broad categories of lower back pain?

A
  1. MSK
  2. Inflammatory [HLA-B27 associated]
  3. Malignancy [bone mets]
  4. Infections [OM, abscess]
80
Q

What is the lumbar spine made up of?

A

5 vertebrae: L1-5

81
Q

Prevention of MLBP

A

Exercise, medium-firm [but not firm] mattresses

82
Q

What’s REM sleep disorder known as?

A

Parasomnia

83
Q

When does most dreaming occur?

A

REM

84
Q

What is RBD a predictor of?

A

Synucleinopathy

85
Q

Common Tx for RBD?

A

Melatonin

86
Q

How does RBS present?

A

Laughing, crying, chocking, screaming

87
Q

Which particular diseases is it predictive of?

A

Almost half with PD, 88% multiple system atrophy, 80% LBD

88
Q

What’s an astigmatism?

A

Refractive error in which eye does not focus eye evenly on the retina

89
Q

Eye vision problems

A

Distorted or blurred vision at any distance

90
Q

If it occurs in early life, what can it result in?

A

Amblyopia

91
Q

Why is amblyopia?

A

Also called lazy eye, means one eye isn’t used and is focused on the other

92
Q

Diagnostic method for astigmatism

A

Eye exam

93
Q

How common is an astigmatism ?

A

30-60%

94
Q

Tx for astigmatism?

A

Glasses most commonly, but also surgery

95
Q

What is strabismus?

A

Eye does not align when looking at an object

Phase 3b (10 decks)

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