Pt Encounters Flashcards
Typical initial presentations of MS
Focal inflammatory demyelination gets event in the CNS
Typically acute or subacute with duration of at least 24 hours with or without recovery
Occurs in the absence of fever or infection
Can be unilateral optic neuritis, manifesting with painful monocular visual loss consisting of visual blurring or scotoma
Painless diplopia due to internuclear ophthalmologist (often bilateral) or less commonly 6th nerve palsy
Brainstem or cerebellum syndrome like diplopia described above, ataxia with gaze-evoked nystagmus, vertigo facial numbness or paroxysmal episode of dysarthria or vertigo.
Symptoms worsen in the presence of increased temperatures
The transition from relapsing remitting MS to secondary progressive MS
10-20 years after disease onset
Median 19 years in one and another was 12
Primary progressive MS is characterized by
What is the age of onset and what is the most common clinical presentation
Progressive accumulation of disability
With temporary mino improvements or acute relapses
Median age is around 40 years
The Most common presentation is a spinal cord syndrome that worsens over months or years with asymmetric spastic paraparesis and no clear sensory level
Less often develops as a ataxia
Rarely with cognitive symptoms
Worse prognosis than relapsing remitting MS
Imaging for MS
McDonald criteria and MRI (87 and 73 sensitivity and speicificity)
Dawson finger ovoid plaques
Additional testing of CSF is possible too
Typical MS presentation with one or more episodes of diplopia
Optic neuritis
DIS and DIT
On PE you can see relative afferent pupillary defect, color desaturation, UPN
What is DJD
This is osteoarthritis
A degenerative disorder with minimal articular inflammation
So systemic symptoms
Pain is relieved by rest
Morning stiffness is usually brief
On XR DJD
Narrowed joint space
Ostephytes
Increased density of subchondral bone
And bone cysts
Osteoarthritis typically develops in
Older women arthropathy is characterized by a degeneration of cartilage by hypertrophy of bone at the articular margins
Inflammation is usually minimal
Hereditary and mechanical factors can influence
What increases to risk of DJD (OA)
Obesity (hip and knee)
Running DOES NOT
Competitive contact sports does
Jobs requiring frequent bending and carrying increase the risk of knee OA
Two divisions of DJD
1 primary which most commonly affects some or all of the DIP and PIP the carpometacarpal joints of the thumb the hizo the knee and the metatarophalangeal joint (MTP) and the cervical lumbar spine
Secondary which may occur in any joint as a séquele to articular injury may be acute as in a fracture or chronic that’s is due to occupation
Bony enlargement of the DIP
HEBERDON
Bony enlargement of the PIP
Bouchard
What Is the onset of DID and the progression
Initially seldom lasts longer than 15 minutes and later develops into pain on motion of the affected joint and is made worse by activity or weight bearing and relieved by rest
Dx test for DJD
Can see a high ESR or other laboratory signs of inflammation but the synovial fluid is non inflammatory and radiographs revela narrowing of the joint space and osteophyte formation and lipping of marginal bone and thickened dense subcgondral bone
Bone cysts may be present
OA definitionq
Joint failure disease in which all structures of the joint have gone pathological change often in concert
The pathological sine qua non of the disease is hyaline articular cartilage loss present in a focal and initially non uniform manner
This is accompanied by increasing thickness and sclerosis of the subchondral bony plate by the outgrowth of ostephytes at the joint margin
Can also see mild synovial in affected joints
Weakness of muscles bridging the joint
In knees you see meniscle degeneration
Initial step is a failure or protective mechanisms
Joint protectors
CALM
Capsule
Ligaments
Muscle
Sensory afferent
And underlying bone
