Pathology Flashcards
Myasthinia Gravis (MG) vs Multiple Sclerosis (MS)
Early s/s + Prognosis
Exercsise implications
MG: eyelid drooping, eye tracking problems, blurred or doubled vision. Muscular weakness @ ocular, limb, respiratory, and bulbar mm, aka speaking, swallowing, chewing, and holding the jaw in place, * S/S are exercise induced.
Common early signs of multiple sclerosis (MS) include:
vision problems./ tingling and numbness./ mm pains and spasms./ weakness or fatigue./ balance problems/ dizziness./ bladder issues./ sexual dysfunction./ cognitive problems.
Both benefit from GENTLE strengthening; STOP BEFORE FATIGUE! Rest and provide cool environment for MS
3 Types of MS + different timelines
Relapsing-remitting MS: People with this type have attacks when their symptoms get worse, called relapses, followed by full, partial, or no recovery. These flares seem to change over several days to weeks. Recovery from an attack takes weeks, sometimes months, but symptoms don’t get worse during this time. Most people have this type when they’re first diagnosed with MS.
Secondary-progressive MS: People who get this type usually start with relapsing-remitting MS. Over time, symptoms stop coming and going and begin getting steadily worse. The change may happen shortly after MS symptoms appear, or it may take years or decades.
Primary-progressive MS: In this type, symptoms gradually get worse without any obvious relapses or remissions. About 15% of all people with MS have this form, but it’s the most common type for people diagnosed after age 40.
What causes MS relapses and what medication treats?
What is a psudorelapse? What can trigger?
TRUE MS relapse starts when nerves in the brain and spinal cord get inflamed (swollen or irritated). Demyelination occurs and plaque forms. corticosteroids can treat MS relapses by reducing inflammation.
Stress, fever, infection, overheating = pseudorelaopse. Symtoms get worse temporarily.
symptomatic Differences: OA v RA
Morning stiffness = RA
Evening stiffness/Stiffness after use = OA
Warm/Soft/Tender joints, unlar deviation/swan neck/boutonnieres deformities = RA
Hard and bony joints, Herberdens Nodes = OA
OA = Unilateral RA = Bilateral
What is Dyspraxia AKA? S/s?
AKA Developmental coordination disorder
Dyspraxia symptoms in adults: abnormal posture. balance and movement issues, or gait abnormalities. poor hand-eye coordination. fatigue. trouble learning new skills. organization and planning problems.
Differentiate Sh Impingement vs RTC tear
sub acromial impingement syndrome: swelling due to repetitive or traumatic compression of structures causes pain and shoulder dysfunction,
RTC tear = Traumatic, torn fibres of the muscle directly inhibit muscle function due to loss of structural integrity
3 types of claudication? Differences?
Intermittent/Venous/Neuro
PAD/PVD: Difference in ulcers + LE
WHERE are ulcers for ea
Prevention?
PAD LE: Shiny skin, loss of hair, pale/cyanotic, toes/dorsum ulcers; dry c/necrosis
PVD LE: Edematous; Thick, tough, brown-tinged skin; Wet ulcers c/macerated border @ ANKLE
Prevention = STOP SMOKING; manage diabetes, high blood pressure and high cholesterol
DVT versus Intermittent Claudication
DVT :
Swelling; pain in calf like cramping or soreness. Heat.
Red or discolored skin on the leg that is not helped with elevation.
IC:
Pain/burning/fatigue in the legs and buttocks when you walk.
Shiny, hairless, blotchy foot skin that may get sores.
The leg is pale when raised (elevated) and red when lowered.
Cold feet.
Leg pain at night in bed.
Screening for PAD/intermittent claudication = Ankle-brachial index (ABI). Rubor of dependency.
Wells Criteria for DVT; pain w DF
Wells’ Criteria for DVT - how to grade?
Active cancer (patient either receiving treatment for cancer within the previous 6 months or currently receiving palliative treatment) 1 point
Paralysis, paresis, or recent cast immobilization of the lower extremities 1point
Recently bedridden for ≥ 3 days, or major surgery within the previous 12 weeks requiring general or regional anesthesia 1point
Localized tenderness along the distribution of the deep venous system 1point
Entire leg swelling 1point
Calf swelling at least 3 cm larger than that on the asymptomatic side (measured 10 cm below tibial tuberosity) 1point
Pitting edema confined to the symptomatic leg 1point
Collateral superficial veins (non-varicose) 1point
Previously documented deep vein thrombosis 1point
Alternative diagnosis at least as likely as deep vein thrombosis -2
-2 to 0: low probability, 1 to 2 points: Moderate probability, 3 to 8 points: high probability
Huntingtons vs ALS
Huntington’s = cognitive as well as physical impairment, while in most cases ALS leaves the mind unaffected.
H = Choreatic movement ( involuntary, irregular, unpredictable), mood disorders, mm rigidity/contracture (dystonia), Slow or abnormal eye movements. Impaired gait, posture and balance. Difficulty with speech or swallowing. reduced muscle strength by 50% on average.
ALS AKA Lou Gehrig’s
Muscle twitches in the arm, leg, shoulder, or tongue. (fasiculations - look like worms moving below the dermis.)
Muscle cramps.
Tight and stiff muscles (spasticity), hyper DTR
Muscle weakness affecting an arm, a leg, the neck, or diaphragm.
Speech/swallowing difficulty
Types of SLAP tear (4) - most common?
Causes (3) - most common?
Type 1: Labral fraying
Type 2: most common SLAP tear; labrum and bicep tendon are detached from glenoid
Type 3: Frayed labrum tissue is caught in the shoulder joint. (Bucket handle)
Type 4: In this type, the tear that started in your labrum tears your bicep tendon. Detached AND bucket handle
Chronic injury - repetitive overhead motion. most common
Acute injury. SLAP tears can happen if you try to block a fall with your outstretched arm or you use abrupt jerking movements to lift heavy objects.
Aging. SLAP tears can simply happen as your labrum wears out over time. This tear is usually seen in people age 40 and older. (Type 1: )
Differences btwen LMN/UMN
UMN lesion: spastic paralysis BELOW lesion; Flexors more effected, Trunk mm spared
LMN lesion: flacid paralysis AT THE LEVEL of lesion
UMN: Hyperreflexive DTR, no fasiculations - BABINKSI sign
LMN: Absent DTR, possible fasiculations
Spinal tracts implicated in decortiate vs decerberate posutre
Rubro/Reticulo/Vesibulo
Rubro-spinal tract regulates flexor tone in upper limb.
Reticulo- and vestibulo-spinal tracts regulate extensor tone
Decorticate posture: rubrospinal tract still working; supercedes reticulo- and vestibulospinal tracts = arm flexion at the elbows and lower extremity extension, so-called decorticate posturing.
- Decerebrate posture: rubrospinal tract not working; extension of the neck and all four limbs
S/s +
Exercise precautions,
Ex recommended
spina bifida
S/s:
LE weakness/paralysis
incontinence.
loss of skin sensation in the legs
Avoid contact sports such as football. For children with shunts, avoid activity such as rolling and jumping from heights.
moderate-intensity exercise for a minimum of 150 minutes a week, ideally spread throughout the week in at least 10 minute episodes, and perform strengthening exercises 2 or more days a week.
Distinguising factor between MS and Guillien Barre, and Chronic inflammatory demyelinating polyneuropathy (CDIP) - All are autoimmune
GB = Acute onset, starts a few days or weeks after cold/flu; Starts in LE and spreads UP; peripheral nervous system myelin degeneration only; UE/LE weakness, numbness; RECOVERABLE
MS = Insidious onset UNILATERAL s/s; Central NS myelin degeneration; bladder, vision, fatigue, pain (not numb), cognitive problems; PROGRESSIVE
CDIP = RARE; Gradual onset (2-6 mo) with pauses in progression, but to gradual recovery; PNS, Bilateral
Lymphedema Stages (which is reversible, which has Stemmer sign, which has hyperkeratosis) 0-3
Mild/Moderate/Severe circumfrence measurements
0 - Latent; Capacity of lymph affected w/o s/s
1- Reversible; pitting edema increases with heat, decreases with elevation/rest
2- Spontaneous, irreversible; non-pitting, no change with elevation/rest; fibrotic skin changes, infection risk increased, Stemmer sign (cannot pinch skin on dorsum)
3- encephalitis stage; pappillomas, stemmers, hyperkeratosis
Mild = <3 cm Mod = 3-5 cm Severe = >5 cm
Contraindications for decongestive lymphedema therapy (lymph massage)
Type of exercise? Compression garments on/off?
Cardiac Edema Diabetes HTN Renal Failure Malignancy DVT Acute infection
Low impact, aerobic + compression garments DURING - monitor for signs of exacerbation
Exercise prescription for non-complicated pregnancy
50-60% max HR
30 mins per session
NWB preferred
3x wk
STOP when fatigued
Relative contraindications for pregnancy and exrcise
Severe anemia Cardiac dysrythmia Chronic bronchitis Morbid obesity Underweight BMI >12 Hx of extreme sedentary lifestyle IUGR in previous pregnancy Poor controlled HTN, epilepsy, diabetes type 1, hyperthyroidism Heavy Smoker
Signs of pre-eclampsia
HTN + proteinuria, edema, Decreased urine output. HA Changes in vision Upper Right Quadrant pain Nausea/vomiting.
Neruogenic bladder s/s
what disease increases risk?
loss of urge to urinate
inablity to empty bladder
leakage
UTI
Diabetes!
When to exercise for dyalisys?
1 Day after or right before treatment. During tx can take a walk, low grade cardio on bike, while monitored. BP low after tx, contraindicated.
Normal wound healing stages
Inflammatory - days 0-10
Proliferation - days 3-21
Maturation - days 7 up to 2 yrs
Types of necrotic (dead) tissue
Eschar - black , dehydrated, strongly attached to wound bed- debridement req
Slough - White/yellow, moist, loosely attached in clumps - remove debris and absorb drainage
Gangrene - interruption of blood flow or bacterial
Hyperkeratosis - Callus
Rule of 9s
head/neck - 9%
Anterior + Posterior trunk - 18% (9x2)
Ant + Posterior arm/forearmhand - 9% (18% whole arm)
Ant + Post leg/foot - 18% (36% whole leg) (9x4)
Ancticiapted deformities based on burn location
Neck Anterior chest/axilla Elbow Hand/wrist Hip Knee Ankle
Neck - Flexion/lateral flexion; cervical collar
chest/axilla - Sh Add, MR; airplaine splint/abd brace
Elbow - flexion + pronation; Gutter splint, 3 point splint, air splint
Hand/wrist - Flexed fingers, extended MCP, flexed + ADD thumb, flexed wrist; Dorsal/extension wrist splint
Hip - flex + ADD; Abd splint. Anterior hip spica
Knee - Flex = 3 point/air splint
Ankle - PF - Foot drop splint
arthralgia; alopecia; lung pleuritis; kidney involvement; seizures; depression; Red butterfly rash on cheeks/nose; Rash from light exposure;
What connective tissue disease?
Lupus Erythmatosis
Polydyspia, polyruria , blurred vision, delayed healing, freqquent infection, and dark discoloration of skin in armpits/behind knee (acanthosis nigricans)
early s/s of what disease?
Diabetes 2
Metabolic bone disorder where reabsorbtion outpaces production; LB pain, compression fx associated
what disease?
Osteoporosis
What modalities are contraindicated in acute stage of RA? What is okay to use instead?
what is contraindicated regardless of flare up?
Resistive ex, stretching, deep heat (US/diathermy) contraindicated
Use joint protection techniques, gentle massage, hydrotherapy, hot pack, parrafin, cold pack; gentle isometrics OK
Aggresive stretching ALWAYS contraindicated; gentle stretching and endurance activities focus of long term care
Increase in sympathetic activity, release of norepineprhine –> vasoconstriction of BV resulting in pain and increased sensitivity to peripheral stimulation; burning chronic pain spreads in proximal direction; occurs after traumatic injury, more commonly in males
what disease?
Complex regional pain syndrome
Noncontagious bacterial skin infection in dermal/subcutaneous layers; localized redness, edema progressively worsen; potentially fatal if not caught early (sepsis); pts with weakened immune systems most vulnerable or conditions that impede bloodflow
what disease?
Cellulitis
What syndrome can be caused by excessive use of steriods or the bodys abnormal production of cortisol?
Hallmark signs; purple strie, ruddy complexion, weight gain
Cushing’s syndrome
Unbilical or gastric pain that migrates to right lower quadrant
Appendicititts
Adrenal insufficiency disease; fluid/electrolyte imbalances, cardiovascular dysfunction, metabolic dysfunctions; ACTH (adrenocortiocotropic hormone) tested to validate
Addisons disease
Dx by uric acid crystals in joints; big toe, knee, ankle most affected; considered compled form of arthritis
Gout
What signs to look for in melanoma - change in appearance of mole that include…
asymmetry
irregular border
uneven coloration
increased diameter
S/s of metabolic acidosis
results from
Tachypnea, confusion, lethargy
overproduction/inadequate excretion of biocarbonate (HCO3-)…
severe diarrheia, kidney dysfunction
