07/03/2021 [RBD, GBS, LBMP, hip joint, asthma, ] Flashcards
What is GBS?
Rapid-onset muscle weakness caused by the immune system damaging the peripheral NS
Sx of GBS
Muscle weakness beginning in the feet and hands, usually ascending upwards
The serious Cx and how common is it?
Weakness breathing muscles with about 15% developing weaknesses that require mechanical ventilation
Common trigger
Infection, or less commonly, by surgery. Rarely, by vaccination.
Dx of GBS
Usually Sx and Sx though exclusion by NCS and examination of CSF
Tx for GBS
Prompt Tx with IVIG or plasmapheresis
Recovery for GBS
Weeks to years
How common is permanent weakness?
1/3rd
How common is Cn involvement?
In about half of cases, leading to muscles of the face/eyes paralysis, swallowing difficulties
How long is the plateau phase commonly?
2d-6m potentially, but most commonly a week then gets better
How common is pain in GBS?
About half of cases, incl. back pain, painful tingling, muscle pain, pain head/neck relating to irritation lining of the brain
What do many people have prior to a GBS infx?
Sx and Sx of an infection 3-6w prior to onset neuro Sx; consist of URTI or diarrhoea
Which group can be mistaken often?
Children, as often initially mistaken [for up to 2w] for other causes of pains and difficulties walking, such as infx, or bone/joint problems.
Neuro examination in GBS?
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
What is the Miller Fisher variant of GBS?
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.
Resp failure how common?
25%
Other system affected in GBS?
2/3rds have HR and BP problems as autonomic NS is effected.
20% may experience severe BP fluctuations and irregularities of the hear.t
Epidemiology of GBS?
Children/young adults less likely, men more likely [1.78x].
Causes of GBS?
2/3rd have infection. Commonoyl gastroenteritis, or URTI.
30% caused by campylobacter jejuni bacteria which cause diarrhoea, 10% by cytomegalovrisu.
Death rate GBS
5%, even with good care.
Hip joint articulation
Head of femur, acetabulum
How is the acetabalum deepened?
By teh acetabular labrum
Ligaments intracapsular
Ligament of head of femur
What does the ligament head of femur encase?
Obturator artery [minor blood supply hip]
Extracapsular ligaments
Iliofemoral
Pubofemoral
Ischiofemoral
Function of each ligament extracapsular
Iliofemoral - prevents hyperextension of the joint
Pubofemoral - triangular and prevents abduction and extension
Ischiofemoral - piral orientation, prevents hyperextension and holds femoral head in
What is the arterial supply hip joint mainly by?
Circumflex femoral arteries [branches from deep femoral artery]
What can damage to the medial femoral artery cause?
Avascular necrosis femoral head
Innervation hip joint
Sciatic, femoral, obturator arteries
Why can pain be referred to the knee from the hip?
Use the same three nerves [and vice versa]
Stabillising factors joint
Acetabulum
Acetabular labrum
Spiral orientation
Muscles/ligaments reciprocal working
What is the spiral orientation?
Ligaments of the hip tighten when the joint is extended
Anteriorly how does the recipoacy stabilise the joint
Ligaments strongest, and medial flexors are fewer and joint
posteriorly how is joint stabilised?
Ligaments weaknest, medial rotators greater in number and stronger
Flexion hip muscles
iliopsoas, rectus femoris, sartorius, pectineus
Extension
gluteus maximus; semimembranosus, semitendinosus and biceps femoris (the hamstrings)
Abduction
gluteus medius, gluteus minimus, piriformis and tensor fascia latae
Adduction
adductors longus, brevis and magnus, pectineus and gracilis
Lateral rotation
biceps femoris, gluteus maximus, piriformis, assisted by the obturators, gemilli and quadratus femoris
Medial rotatoin
anterior fibres of gluteus medius and minimus, tensor fascia latae
What does the degree to which flexion at the hip can occur depend on?
Whether the knee is flexed [relaxes hamstring muscles]
Extnesion at the hip limmited by what?
Joint capsule and iliofemoral ligament
CF of DDH
Limited abduction at hip
LLD in affected limb
Asymmetric skin/thigh folds
Tx of DDH
Pavlik harness
How common acquired dislocation?
Not very, can happen trauma/Cx surgery
Two types of disolocation
posterior [90%]
anterior [10%] due to traumatic extnesion/abduction/lateral rotation
Type of cartilage is the acetablar labrum?
Fibrocartilaginous collar
Cause of asthma
Combination genetic and einvoinrment
Triggers
Air pollution and allergens, medication like beta blockers/aspirin
two big types of asthma
Atopic and non-atopic [atopic T1 hypersensitivty reaction]
What is salbuatmol
Beta-2 agonist
Sx asthma
wheezing, SOB, chest tightness, coughin, sputum possibly
What may sputum look like in an attack?
Pus-like due to high levels white blood cells eosinophils
When Sx worse asthma?
Worse at night, and in early morning, or response to exercise/cold air
health disorders that commonly occur more freq ni asthma
GERD, rhinosinusitis, obstructive sleep apnoea
Where is the inflammation in asthma?
Chronic inflammation conducting zone airways [bronchi and bronchioles mainly], causing contracility smooth muscles = wheezing
Changing of the airways in asthma
Increase in eosinophils and thickening of the lamina reticularis
Dx asthma
No precise test. If suspected due to Sx, spirometry can be used to confirm Dx.
Who is it hard to diagnose and why?
Children under 6 as can;t do spirometry
Spirometry Dx
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]
Classification of asthma
Intermittent [<2 pw, >80%]
Mild persistent [>2 pw, >80%]
Moderate persistent [daily, 60-80%
Severe persistent [continuously, under 60%]
BY Sx, FEV1, PEF
DDx in children
Allergic rhinitis and sinusitis [aspiration, LN neck, laryngomalacia]
DDX adults
COPD, CHF, airway masses, medciation
Which drug can induce asthma Sx?
ACE inhibitors
After age 65, what will most people with obstructivee airway disease have?
COPD and asthma
How can COPD be differentiated?
increased airway neutrophils, abnormally increased wall thickness, increased smooth muscle bronchi
Why not important to differentiate COPD/asthma old people?
Tx the same []COC/LABA/smoking cessation
Prevention
weak evidence, lower RF like no smokinh, air pollution, lower LRT
Mx of asthma short-term
identifying triggers best way of prevneting
Bronchodilators short term relief.
Mill dpersistent disease asthma
More than two attacks a week, then low dose COC/leukotriene agonist
Daily attacks asthma
inhaled corticosteroids
Name for LBP
Lumbago
How long to be chronic back pain?
more than 12w
Way to test for intervertebral disc damage
Straight leg rise
Which type of spinal disease needs surgery
Spinal stenosis
She lumbago typically develops
20-40 y/o
What is pain radiating down the leg called?
Sciatica
What may women have with lower back pain?
Female reproductive: endometriosis, ovarian cyst, ovarian Ca, uterine fibroids
Why are the 4 broad categories of lower back pain?
- MSK
- Inflammatory [HLA-B27 associated]
- Malignancy [bone mets]
- Infections [OM, abscess]
What is the lumbar spine made up of?
5 vertebrae: L1-5
Prevention of MLBP
Exercise, medium-firm [but not firm] mattresses
What’s REM sleep disorder known as?
Parasomnia
When does most dreaming occur?
REM
What is RBD a predictor of?
Synucleinopathy
Common Tx for RBD?
Melatonin
How does RBS present?
Laughing, crying, chocking, screaming
Which particular diseases is it predictive of?
Almost half with PD, 88% multiple system atrophy, 80% LBD
What’s an astigmatism?
Refractive error in which eye does not focus eye evenly on the retina
Eye vision problems
Distorted or blurred vision at any distance
If it occurs in early life, what can it result in?
Amblyopia
Why is amblyopia?
Also called lazy eye, means one eye isn’t used and is focused on the other
Diagnostic method for astigmatism
Eye exam
How common is an astigmatism ?
30-60%
Tx for astigmatism?
Glasses most commonly, but also surgery
What is strabismus?
Eye does not align when looking at an object
