Capscule cases 3

Question 1

What is :

Dysphagia

Dysphasia

Dysarthria ?

Answer 1

0 Dysphagia- difficulty swallowing - disorder

0 Dysphasia - language disorder - difficulty with verbal communication because of damage to area in the brain responsible for speech and language.

0 Dysarthria - difficulty speaking - motor speech disorder

damage to brain / nervous system ——- > causes damage to muscle supplied by these —–> muscle weakenes or paralysed ——-> Cannot control tounge , layrnx , vocal cords , surrounding muscles

• SYMPTOMS
• difficulty speaking -slurred , quiet or quiet ,
  strained /horse voice (due to vocal cord paralysis )
• difficulty swallowing leading to dysphagia - can cause constant drooling (salavia collects in mouth as unabe to swallow ).

Question 2

What is Dysphasia ?

• types

Answer 2

Difficulty with language and speech.

Inability to comprehend or formulate language because of damage to specific parts of the brain.

0 Receptive / fluent - damage to Wernicke’s area - cannot understand words or recognise auditory , visual or tactile (touch ) symbols.

Wernicke’s area - temporal lobe

HOW IT PRESENTS -

• speak words fluently but sentence etc. often meaningless - don’t make sense - patient unware of this
• reading and writing severely impaired.

0 Expressive / non -fluent -

impaired speech production - difficulty producing words

(comprehension and ability to conceptualize usually preserved)

Broca’s area - frontal lobe - inferior frontal gyrus - in most people in the left cerebral hemisphere

0 Involved in Language production.

HOW IT PRESENTS - patient finds it hard to speech get words out - can still understand

writing is impaired

0 Global / mixed

• difficult speaking but also speech comprehension - do not read and write above elementary level.

0 Anomic / Nominal -

• retrieval word failures - cant find the specific word for what they are trying to say - particular verbs and nouns.
  Speech is often fluent and can understand and read well. difficulty finding words evident in writing.

Subset of expressive dysphasia .

Transcortical (T -for my notes ) asphasia -

3 types

0 T Motor Aphasia

• damage to area surrounding broca’s area - but spares Broca’s area -

Impairment of spontaneous speech (cant say their own setences ), but can repeat sentences.

0 T Sensory Aphasia -

• Damage to area surrounding Wernicke’s area but sparing Wernicke’s area.
• Inability to understand , but can repeat sentences.

0 Mixed T aphasia -

• damage to area surrounding Broca’s and Wernicke’s area but not damaging the B or W area itself.
• Inability to speak or understand but can repeat.

Question 3

What is Bulbar Palsy ?

Answer 3

Lower motor neurone conditions - diseases effecting cranial nerve 9, 10, 11, 12

A speech deficit often occurs due to paralysis or weakness of muscles supplied by these nerves.

bulbar nerves innervate muscles involved in speech , swallowing and facial muscles.

Question 4

What is Pseudobulbar palsy ?

Answer 4

Upper neurone condition -

effects cranial nerve - 5, 7, 9, 10 , 12

CAUSES

Bilateral upper motor neurone brainstem lesions.

Question 5

how to distinguish between Bulbar and Pseudobulbar Palsy ?

Answer 5

Both cause Dysarthria and Dysphagia

but Pseudobulbar causes :

0 Hyperactive gag refex

0 emotional lability - rapid , exaggerated changes in mood - strong feelings e.g :

• uncontrollable crying / laughing
• heightened irritability / temper.

While Bulbar causes :

• decreased gag reflex (contraction of the back of the throat when something touches the roof of mouth)
• absence of emotional liability .

Question 6

Whay is Melithesoma ?

Answer 6

Malignant cancer linked to asbestos poisoning / exposure .

Usually affects lung but can affect ( tummy )peritoneum , testes or heart

Symptoms typically dont appear until years after exposure

Question 7

What is Dyskaryosis ?

Answer 7

Abnormal cell changes in cells in the epithelium of cervix

• abnormal nucleus

Grades
CIN 1 -Mild
CIN 2- Moderate
CIN 3 -Severe

Smear test / cervical screening used to detect this

Question 8

What is cervical intra-epithelial neoplasia (CIN )

Answer 8

CIN/ CGIN

CGIN - Cervical glandular intra - epithelial neoplasia

Abnormal cell changes found when colonscopy is done .

Grades

CIN 1- mild changes not likely to become cancer, may not need treatment, can go away on its own
Will be invited back for after 12 months

CIN 2 - moderate chance they will become cancerous, removal is usually recommended

CIN 3 - highly likely to become cancer and treatment to remove them recommended.

Question 9

Treatment if abnormal cells are found in colonscopy ?

Answer 9

LLETZ

The most common treatment islarge loop excision of the transformation zone (LLETZ). It:

involves removing the abnormal cells using athin wire loop that’s heated with an electric current

can be carried out at the same time as a colposcopy

is usually done while you’re awake–local anaestheticis injected intoyour cervihx to numb it during the treatment

does not usuallyneed an overnight stay in hospital

LLETZ is also calledloop diathermy, loop cone, loop biopsy or loop excision.

Cone biopsy

A cone biopsy isdone less often than LLETZ. It:

is a minor operation to cut out a cone-shaped piece of tissue containing the abnormal cells

only tends to be used ifa large area of tissue needs to be removed

cannot be done at the same time as a colposcopy

is usually done undergeneral anaesthetic(where you’re asleep)

may require an overnight stay in hospital

Other treatments

Hysterectomy

Cryotherapy- abnormal cells frozen off

Laser treatment

Cold coagulation ‘ heat source applied to burn away abnormal cells

Question 10

what routine investigations are done for someone presenting with confusion ?

Answer 10

Blood test - (need to check for reversible cause )

       - FBC - full blood count 
       - Glucose
       - Calcium 
       - TFT
       - Iron
       - transferrin
        - ferretin
        - Vitamin D
        - folate 
        - Vitamin B12
       - CRP - C reactive protein - produced by liver due to inflammation
       - LFT - Liver function test 
       - U & E 

Infection common cause of confusion so :

        - Chest radiograph
        - midstream urine for culture and sensitivity. 

If repeated falls - arrthymia needs to be exluded - ECG

Question 11

What is encephalomalacia ?

Answer 11

Encephalomalacia is the softening or loss of brain tissue after cerebral infarction, cerebral ischemia, infection, craniocerebral trauma, or other injury.

Question 12

treatment if subdural hematoma ?

Answer 12

craniotomy – a section of the skull is temporarily removed so the surgeon can access and remove the haematoma

burr holes – a small hole is drilled into the skull and a tube is inserted through the hole to help drain the haematoma