Pathology Flashcards
Muscular Dystrophy
Weakness progression: proximal LE and pelvis, shoulders and neck, UE, respiratory mm
Inherited
Central Cord Syndrome
Distal > proximal, UE > LE (usually hands most affected)
Incomplete SCI, often resulting from cervical hyperextension
Sensory involvment possible bur more rare
ALS
Starts unilateral
Distal to proximal
Progressive - death within 5 years
UMN & LMN
Guillan-Barre Syndrome
Progressive LMN disorder - sensory and motor impairment
Symmetrical, distal to proximal, starts in LE’s and moves superiorly - may have respiratory paralysis
Autoimmune response to previous respiratory infection, influenza, immunization, or surgery
Majority has full recovery, 20% have remaining neuro deficits, and 3-5% of pts die from respiratory complications.
Myasthenia gravis pattern of weakness
Proximal > distal
Anterior Interosseous Syndrome
Entrapment of AIN (branch of median n.)
No sensory fibers => no sensory sx
Weakness in FPL, pronator quadratus, FDP in 1st and 2nd digits
General cerebellar disorders
Generalized weakness
Hypotonia (especially in acute lesions)
Difficulty with posturalcontrol of axial muscles
Motor learning impairments: Decreased anticipatory control, feedback and learning delays.
Deficits in inormation procession, attention deficits.
Emotional dysregulation
Dysmetria, nystagmus, dysdiadochokinesia
Bell’s Palsy
Compression of CN VII
Muscles of facial expression on one side weak/paralyzed
Loss of control of salivation/lacrimation
Acute onset, max severity in hours/days
Commonly preceded by 1-2 days of pain behind ear
Most recover in weeks/months
Normal sensation
ACA Stroke
Contralateral sensory loss & hemiparesis (leg>arm)
Polyneuropathy
Bilateral symmetrical involvement of peripheral nerves
Usually legs>arms
Distal segments earlier and more involved
Autonomic Dysreflexia
Noxious stimulus produces pathological autonomic reflex:
- Paroxysmal HTN
- Bradycardia
- H/ache
- Diaphoresis (sweating)
- Flushing
- Diplopia
- Convulsions
Lesions at or above T6
What to do during episode of Autonomic Dysreflexia
Elevate head
Check for irritating stimuli
Check/empty catheter
Neocerebellar lesion sx
Ataxic limb movements
Intension tremor: Irregular, oscillatory voluntary movements
Dysdiadochokinesia
Dysmetria
Dyssynergia: Abnormal timing, movement decomposition of agonist/antagonist interactions. Impairments of multi-joint coordination, movement sequences, complex motor tasks.
Errors in timing related to perceptual tasks
PCA stroke
Occlusions Produce:
Contralateral homonymous hemianopsia
Contralateral sensory loss
Thalmic syndrome
Involuntary movements (choreoathetosis, interntion tremor, hemiballismus)
Transient contralateral hemiparesis
Weber’s syndrome: Occulomotor nerve palsy with contralateral hemiplegia
Visual symptoms (paralysis of vertical eye movements, miosis, ptosis, decreased light reaction).
Anterior cord syndrome
Loss of motor function, pain and temp
Preservation of light touch, proprio, position sense
Relapsing/remitting MS
Abrupt onset of neurological dysfunction occurring over several hours or days. This is followed by recovery, which may be complete, more commonly is partial so that there is a residual disability
Secondary progressive MS
Secondary progressive MS starts as relapsing/remitting disease. After a period of time, the secondary progressive phase begins. This is characterized by slow worsening of baseline symptoms. Attacks may, or may not continue during the progressive phase. Secondary progressive MS differs from relapsing/remitting MS in that the baseline slowly worsens between attacks
Primary progressive MS
Slowly worsens from the onset. By definition, patients do not have attacks. Progression may be steady or may have periods of faster or slower progression. There may even be periods of slight improvement. It is the complete absence of attacks that identifies this subtype.
Progressive/relapsing MS
Begins like primary progressive, but relapses then develop later in the disease course. Following these relapses, there may be recovery or no recovery.
Erb’s Palsy
Upper brachial plexus injury or palsy resulting from difficult birth – C5-C6 affected, sometimes C7 as well
Motor and possibly sensory sx
S&S of anemia
Heart palpitations, SOB
S&S of HTN
Dizziness, HA, blurred vision
Typical and atypical brachial plexus lesions during delivery
C4 and C7 rare
C5 and C6 common
Typical methods of brachial plexus lesions during delivery
Traction or rotation of the head or shoulder
Clavicle or humerus fracture
Short scalene muscles -> nn. compression
Types of peripheral n. injury
Neurotmesis - Complete rupture
Axontomesis - Disruption of axons, Intact neural sheath
Neuropraxia- Temporary nerve conduction block, Intact axons
Arm positioning resulting from Erb’s Palsy
Humeral internal rotation, extension and ADDuction
Elbow extension
Forearm pronation
Wrist and finger flexion (“Waiter’s tip” position)
If C7 involvement
Erb-Klumpke Palsy
Injury to C5-T1
Arm positioning resulting from Erb-Klumpke ‘s Palsy
Flaccid arm due to total paralysis of UE
Often recedes to become Erb’s palsy
Klumpke’s Palsy
Injury to C7-T1
Arm positioning resulting from Klumpke ‘s Palsy
Forearm supination
Weak or flaccid hand and wrist
Legg-Calve Perthes Disease
Ischemia, AVN of femoral head
Tends to occur most often in boys 5-7 y/o, very active and skeletally immature
Slipped Capital Femoral
Epiphysis (SCFE)
Displacement of femoral head on femoral
neck; head inferior and posterior in relationship
to femoral neck
Tend to be obese, skeletally immature males, around time of puberty (11-14)
With flexion, hip moves into ER
↓ hip flex, abd, int rot
Metatarsus Adductus
Pediatric
►Forefoot adducted at tarsometatarsal joints
►Normal alignment of hindfoot and midfoot
►Full dorsiflexion
May resolve without tx if mild; otherwise serial casting, surgery
Calcaneovalgus
Hindfoot valgus
Excessive dorsiflexion
Corrects spontaneously
Can be positional or rigid (rocker-bottom foot)
Clubfoot - Talipes Equinovarus
Forefoot curved medially Small calcaneus, hindfoot varus Ankle plantarflexion Calf atrophy, often absent or small anterior tibial artery and dorsalis pedis Tx: casting, taping, splinting, surgery
Addison’s Disease
Hypofunction of the adrenal glands
Hypotension, fatigue, weight loss
General sx following basal ganglia injury
Athetosis, rigidity, bradykinesia, hemiballismus
MS
Demyelination of Myelin sheaths that surround nerves w/in brain and spinal cord resulting in plaque development, decreased nerve conduction velocity and failure of impulse transmission.
Systemic Lupus Erythematosus
Connective tissue disorder caused by an autoimmune reaction in the body
Females higher risk 15-40 yrs of age
Red Butterfly rash across the cheeks and nose, red rash over light exposed areas, arthralgias, alopecia, pleurisy, kidney involvement, seizures and depression
Reflex Sympathetic Dystrophy
Vasoconstriction of blood vessels by incease in sympathetic activity causing a release in norepinephrine
Affects all ages, found in 35-60 yrs mostly in females
Intense burning and chronic pain in affected extremity , spreads proximal
Reflex Sympathetic Dystrophy
Vasoconstriction of blood vessels by incease in sympathetic activity causing a release in norepinephrine
Affects all ages, found in 35-60 yrs mostly in females
Intense burning and chronic pain in affected extremity , spreads proximal
Reflex Sympathetic Dystrophy
Vasoconstriction of blood vessels by incease in sympathetic activity causing a release in norepinephrine
Affects all ages, found in 35-60 yrs mostly in females
Intense burning and chronic pain in affected extremity , spreads proximal
Emphysema
History of chronic broncitis, recurrent alveolar inflammation or genetic predisposition of congenital alpha 1-antitrypsin def
Barrel Chest appearance, increased subcostal angle, rounded shoulders sec. to tight pectorals and rosing skin coloring
Symtoms worsen with progression, persistant cough, wheexing, difficulty breathing esp. w/ expiration and increased respiration rate.
Fibromyalgia
Nonarticular rheumatic condition, pain caused by tender points w/in muscles, tendons and ligaments
Greater in females 75% affecting any age
History of pain in all quantrants, above and below waist, axial pain present, 11 of 18 tender points present
Carpal Tunnel Syndrome
Higher in Females 35-55 yrs . Musle atrophy in the abductor pollicis brevis muscle and thenar muscles. Electromyography, Tinel’s sign, Phalen’s test
Severe clubbing of the nails is an abnormality associated with what pathologies?
Lung cancer and chronic hypoxia
The nails of patients with renal failure may appear to have what?
Short transverse lines across the nail (Mees lines) or a brownish distal one-third end of the nail (half-and-half nails)
Liver dysfunction may result in nails with what?
Transverse depressions (Beau lines) or a nail bed that is white and extends two-thirds of the length of the nail (Terry nails).
Cellulitis signs/symptoms
Pain, redness, tenderness, edema, and at times, fever, chills, tachycardia, headache, and hypotension
Dermatitis signs/symptoms
Presence of papules, vesicles, blisters, or ulcerations
Folliculitis signs/symptoms
Bacterial infection of hair follicles that produces individual pustules, each pierced by a hair
Keratitis
Corneal inflammation
Metabolic syndrom
Characterized by abdominal obesity (waist size > 40 in (101.6 cm), high triglycerides levels, high low-density lipids and low high-density lipids cholesterol values, and elevated blood pressure (> 130/85 mm Hg).
