Musk/Neuro/Endocrine Flashcards
- Pathophysiology
o Cervical sprain- nonradiating pain in neck associated with loss of neck motion and stiffness
o When abnormal forward posture of the head occurs consistently- looking at computer, faulty sitting position, stress
Cervical sprain
radicular pain reproduced when examiner exerts downward pressure on vertex while tilting the head toward symptomatic side- usually negative
Spurling’s sign- cervical neck pain
- Pathophysiology
o Can compress spinal nerves as they exit the foramina, leading to cervical radiculopathy- mostly C6 and C7- pain/parethesias in lower lateral arm, thumb, and middle finger
o Degeneration may cause narrowing of spinal canal- can cause myelopathy- can cause shoulder or arm pain and numbness/tingling (pins and needles)- not as common (less than 5%)- usually a result of soft-disc herniation
Cervical spondylosis
- Management
o Cervical traction if radiculopathy is present
o PT
o NSAIDs
o Oral steroids if nothing else works
o Steroid epidural injection for radiculopathy
o Surgery for myelopathy, intractable pain, severe disability
Cervical spondylosis
Hallmark for _______ is recurrent pain that radiates to one or both buttocks- exacerbated by bending, stooping, twisting- there may be intermittent sciatica
• May be relieved with lying down or sleeping but may also keep the paitent awake at night
Chronic lower back pain
- Management
o Usually mild and self-limited- most resolve in 1-6 weeks
Symptom control
o Nonpharm
Exercise, motor control exercise, CBT, tai chi, yoga, progressive relaxation, heat, massage, acupuncture, spinal manipulation, rehab
o Pharm
Tylenol, NSAIDs, and skeletal muscle relaxants
• NSAIDs- increase risk of GI bleed/ulcers, renal problems, fluid retention, edema
• Muscle relaxants- short-term- can be addicting and cause drowsiness/dizziness, avoid alcohol (CNS depressant)
o Activity
Rest does not help- so weight loss, PA, exercise is important
chronic low back pain
- Most common cause of radicular pain to lower extremities- can cause pain, numbness, or weakness in one or both extremities- from compression of nerve root and chemical irritation of nerve root by substances in nucleus pulposus
Herniated lumbar disc
Which lumbar level for radicular pain: produces symptoms extending to the dorsum of the foot with weakened dorsiflexion of large toe and weakened heel walking
L5
Which lumbar level for radicular pain:lateral and posterior calf, gastrocnemius weakness, impaired toe walking, reduces or absent ankle reflex
L5 and S1 together
What kind of low back pain:• Pain worse with sitting, walking, standing, coughing, sneezing- hard to find a comfortable position
o Helps when lying in fetal position or on back with pillow under knees
Herniated disc
What sign for herniated disc: when sitting, patient may have pain and spinal extension (leaning back) when leg is raised
Flip sign
two tests for low back pain to assess for radicular pain
straight-leg-raise and crossed straight-leg-raise
Better for visualizing conditions of soft-tissue structure
MRI
pain with abduction from 45-120 degrees- supraspinatus tendonitis and subacromial bursitits
Early rotator cuff injuries
- Idiopathic loss of both active and passive ROM with no clear predisposition
Adhesive capsulitis- frozen shoulder
tests to diagnose meniscal tears (2)
McMurray and Apley
Test that helps diagnose ACL injury
Lachman test
Test to identify patella dislocation
Fairbank test (Apprehension test)
test for ACL- positive can diagnose, negative may be false…
Anterior drawer test
test to diagnose posterior cruciate ligament injury
Posterior drawer test
inflammation of tendon- usually at point of insertion into bone or at muscular origin
Tendinitis
inflammation involving synovial sheaths surrounding the tendon in addition to the tendons
Tenosynovitis
Diagnostic imaging for tendinitis/tenosynovitis
MRI
Joint condition in which loss of articular cartilage and degeneration occur, leading to pain and deformity
Osteoarthritis
Cartilage matrix degradation predominates in
Osteoarthritis
- Clinical Presentation
o Subjective
Slowly developing, localized pain in joint- interferes with usual activities
• Subtle onset
• Early morning stiffness or after inactivity
• Later stages- pain is also at rest
o Objective
Minimal or no swelling of joints
Tenderness on direct palpation, crepitus
Reduced passive and active ROM
PE exam findings for specific joints on page 853…
most common symptom is joint pain
• Worse with activity after a period of rest (stiffness subsides within 30 minutes, RA is 45+ minutes)
Joint locking or instability
joints most commonly affected- hands, knees, hips and spine
Osteoarthritis
Generalized skeletal disorder characterized by normal bone mineralization but low bone mass (bone mineral density) and disruption of the bone architecture
Osteoporosis
Gold standard for osteoporosis diagnosis/measurement
Bone mineral density (dual-energy x ray- DXA)
Dose of calcium and vitamin D for women less than 50 years
calcium 1000mg QD, vitamin D 800IU QD
First line treatment for osteoporosis
Bisphosphonates- alendronate (Fosamax)
Test for lateral cruciate ligament (LCL)of the knee
Varus stress test
Test for medial cruciate ligament (MCL) of the knee
Valgus stress test
Acute transient disturbance in thought process
Delirium
More persistent or severe confusion with or without psychomotor hyperactivity characterized by a significant time span between symptom appearance and death
Dementia
Muscle contraction headache- mild to moderate bilateral, nonpulsating, tightening pain that is not aggravated by routine physical activity
Tension-type headache
Usually unilateral, moderate to severe intensity with pulsating quality, aggravated by physical activity
Migraine headache
Usually occurs at night and can last from 15-180 minutes
• Usually severe, unilateral orbital, supraorbital, and/or temporal pain accompanied on same side of face with sweating, lacrimation, nasal congestion, ptosis, rhinorrhea, eyelid edema, and/or conjunctival injection
Cluster headache
Most common type of headache
Tension-type
Thunderclap headache most common with _______
Subarachnoid hemorrhage
What type of brain hematoma is venous?
Subdural hematoma
Severe unilateral pain behind eye or temple lasting 30min to 1 hour
Pain constant, deep, piercing, can radiate to forehead, neck, or shoulder
Do not pulsate or cause nausea but do worsen with PA
Triggered by an abnormality in ipsilateral circadian pacemaker- located in ventral hypothalamus
• Pain is caused by hypersentisized ophthalmic nerve
• Autonomic symptoms are caused by concurrent excitation of parasympathetic fibers running with the ophthalmic nerve
Cluster headache
Seizure from an underlying focal lesion or abnormality in the brain
Focal
Most common type of generalized seizure- sudden stiffening of muscles followed by convulsions
Tonic-clonic
Type of seizure: sudden, brief, shock-like contractions that can be generalized or confined to face or trunk or other extremities
• Can occur predominantly during sleep and are associated with generalized epilepsy syndromes
Myoclonic
Type of seizure: sudden loss of muscle control
Atonic
Type of seizure: sudden muscle stiffening
Tonic
What disease as neuritic plaques and neurofibrillary tangles
Alzheimer’s Disease
3 drugs for treatment of AD
Cholinesterase inhibitors (donepezil- Aricept), NMDA receptor antagonist (memantine-Namenda), and atypical antipsychotics (risperidone, olanzapine, quetiapine)
Accumulation of Lewy bodies and degeneration of pigmented dopaminergic cells of the substantia nigra (located in the brainstem)
Parkinson’s Disease
PD- what does TRAP stand for
Tremor (resting), rigidity, akinesia (bradykinesia), and postural disturbances (postural instability is not part of diagnostic criteria)
Most CVAs are
ischemic
From severe head injuries- usually along temporal wall and from tears in middle meningeal artery
• Increases ICP, reducing cerebral blood perfusion, causes contralateral hemiparesis
• Then increasing pressure affects diencephalon, causing lethargy and drowsiness
• Once midbrain becomes compressed, patient can have lateral oculomotor nerve palsy and enlarged pupils
• Can eventually cause herniations and compress the PCAs, pressing on brainstem and becoming fatal
Epidural hematomas
Usually from blunt trauma- knocking brain against the skull
• Venous injuries- veins that drain external cerebral veins
o Bleed expands more slowly
o Can be reabsorbed or can continue to enlarge
Subdural hematoma
Aka intraparenchymal hemorrhage
Bleeding within the brain parenchyma
Common cause is HTN- arteries rupture
• Other causes- trauma, amyloid angiopathy, tumors, clotting disorders, low platelet counts, anticoagulants, vasoconstrictors (and amphetamines or cocaine), eclampsia during pregnancy
Intracerebral hemorrhage
Tears in the arteries running along the space at surface of the brain
• Usually from ruptured arterial aneurysms
• Usually at branch points of large arteries- especially circle of Willis
CSF circulates in the subarachnoid space- so RBCs in LP is a diagnostic tool
Symptoms are sudden increase in ICP, HA, vomiting, drowsiness
Subarachnoid hemorrhage
Thyroxine
T4
Triiodothyronine
T3
Most common spontaneous cause hyperthyroidism
Autoimmune d/o- autoreactive, agonistic antibodies to TSH receptor
80-90% of all hyperthyroid cases
Graves
Glandular inflammation and follicular cell destruction
Viral etiology- following acute infection
40-50 years, more in women
Subacute thyroiditis
In parts of the world where dietary iodine deficiency is prevalent
Plummer disease- hyperthyroidism
Leads to thyroid hyperplasia (goiter)
Increases synthesis of T3
Correlates with DMI, pernicious anemia, myasthenia gravis, and adrenal insufficiency
Demonstrates excessive uptake of radioactive iodine on diagnostic tests
Graves
Normal free T4 with elevated TSH
Subclinical hypothyroidism
Low FT4 and elevated TSH
Primary hypothyroid
High FT4 and low TSH
Hyperthyroid
Initial dosing for hypothyroid
1.6mcg/kg/day (common dosage is 75-150
Target TSH levels for hypothyroid
0.3-2.4
Most common cause of thyroid CA
Papillary
Thyroid CA treatment of choice
Thyroidectomy
Standard treatment for DMI
Basal insulin plus prandial insulin
Suppresses excessive hepatic glucose production by increasing glucose utilization in peripheral tissues
o Reduces fasting and postprandial hyperglycemia and reduces hepatic gluconeogenesis
o Can also improve glucose levels by reducing intestinal glucose absorption
Metformin
Stimulate pancreatic insulin secretion
o Pancreatic beta cells must be still producing insulin
o Do not reduce insulin resistance
o Second gen- improved safety profile compared to 1st gen
But also carry higher risk of hypoglycemia and weight gain than other meds
Sulfonylureas- glipizide
Slow breakdown of complex carbs into monosaccharides
o Reduces postprandial blood glucose levels
Alpha-glucosidase inhibitors- acarbose or miglitol
Sensitize peripheral tissues to insulin by activating nuclear glitazone receptor
Thiazolidineodiones- pioglitazone and rosiglitazone
Prolongs and enhances activity of incretins, which suppress glucagon secretion and modestly reduces A1C
DPP4-I’s- sitagliptin (Januvia)
Enhances insulin secretion in glucose dependent manner in response to food intake
Improves insulin sensitivity, increases beta cell mass, and decreases glucagon secretion
Affect satiety and hunger by decreasing the hedonic value of food (appeal)
GLP-1 analogues-dulaglutide (Trulicity)
Block activity of SGLT proteins in renal proximal tubule, decreasing glucose reuptake and increasing secretion of glucose in the urine
SGLT-2 inhibitors
