Diagnosis and Symptomatology
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| What is the most common connective tissue disease? | What of disease is Systemic Lupus Erythematosus? |
| Organ failure, or overwhelming sepsis cause premature death. As well as cardiovascular disease to which chronic steroid therapy makes a major contribution. | What causes premature death in Systemic Lupus Erythematosus? |
| 5 Years | What is the mortality time for Systemic Lupus Erythematosus? |
| Vasculitis and organ damage are part of active (what disease)? | Immune complex formation is thought to be an important mechanism of tissue damage in active SLE, leading to widespread (2 answers)? |
| General symptoms: fever, weight loss and mild lymphadenopathy. Also has a raised, sore and itchy rash (often "butterfly" facial rash. | Clinical Features of Systemic Lupus Erythematosus |
| What is "Raynaud's phenomenon"? | ___________ is a condition resulting in discoloration of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events. |
| Is swelling, that is raised and painful or itchy | What is erythematous? |
| - Subacute cutaneous lupus erythematosus (SCLE) rashes are migratory, non-scarring and either annular or psoriaform. - Discoid lupus lesions are characterized by hyperkeratosis (dermal thickening) and follicular plugging, and may cause scarring alopecia (spotty balding). | What is the difference between Subacute cutaneous lupus erythematosus (SCLE) and Discoid lupus? |
| Systemic Sclerosis | (_____________) is a generalised disorder of connective tissue affecting the skin, internal organs and vasculature. |
| 4th and 5th life decades. Women. | What are the main decades of life that see the highest peak in Systemic Sclerosis? Which gender is most effected" |
| Thinning of the lips and radial furrowing (vertical lines around the mouth), discolouration of the ends of fingers, and shiny, taught skin over fingers with restricted ROM. | What are the symptoms of Systemic Sclerosis found in the face and hands? |
| - Arthralgia, morning stiffness. Restricted hand function is due to skin disease. | What are the musculoskeletal features of Systematic Sclerosis? |
| Comes from the Greek arthro-, joint + -algos, pain) literally means joint pain. | What does "Arthralgia" mean? |
| ________ is usually classified on the basis of the size of vessel involved (Sm/M/L) | Vasculitis is usually classified on the basis of _____________ involved |
| local tissue ischaemia (due to vessel inflammation and narrowing) and the systemic effects of widespread inflammation. These are the clinical features of what group of diseases? | Pathophysiology : The clinical features of vasculitis result from _____________ (2)? |
| ________ is a restriction in blood supply to tissues, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). | What does "ischaemia" mean? |
| Giant Cell Arteritis AND polymyalgia rheumatica (head and neck area with muscle pain), Takayasu’s arteritis (heart), | Name 1 large-vessle vasculitis. |
| Kawasaki's Disease (heart), Classical polyarteritis nodosa (multisystem disease) | Name 1 medium-vessle vasculitis. |
| Nasal (and sinus cavities), respiratory, skin, renal | In Vasculitises, what body parts are often concerned? |
| Behçet’s syndrome is what? | What is the Vasculitis with unknown etiology (size), that targets venules? |
| The study of the (medical) causes of an illness. | Define Aetiology/Etiology |
| Sjögren's Syndrome is an auto-immine disorder | Sjögren's Syndrome is a cancer, auto-immune disorder, disease or congenital disorder? |
| Lymphocytic infiltration of salivary and lachrymalglands (tear ducts) , leading to glandular fibrosis (scarring) and exocrine failure (horomones and glands). | What is the pathology of Sjögren's Syndrome? |
| EYE: keratoconjunctivitis sicca (dry eyes; tear duct failure), conjunctivitis (sore eyeballs), Blepharitis (swollen eye lids) MOUTH: Dry mouth/Xerostomia OTHER: Non-Erosive Artheritis (lack of lubrication???) | What are the clinical symptoms of Sjögren's Syndrome? |
| Inflamation of skeletal muscles. | What is Polymyositis? |
| It is Polymyositis with skin involvement. Causes skin lesions. | What is Dermatomyositis? |
| Proximal Muscle Weakness. Eyelids: Scaley rash and violet discolouration | What are the clinical features of Polymyositis? |
| Presents with synovitis, oedema/swelling of the hands, Raynaud's Phenominon and muscle weakness. | Mixed Connective Tissue Disease presents with what? |
| Forearm, hip, spine | In osteoporosis, where are some of the most common areas to fracture? |
| Heavy alchohol use and ANY smoking. Calcium and excersize during growth and adolescence also reduces the risks. | What can be done to reduce the likelihood and/or severity of osteoporosis? |
| Fractures. | Complete the sentence in regards to Osteoporosis: "The aim of treatment is to reduce the risk of _______". |
| Vitamine D is the most important, before Calcium. Vitamine D promotes calcium absorption. | Someone with osteoparosis should have a high intake of what (non-prescription)? |
| Rickets effects children, osteomalacia is developed only in adults. | Which ones effects children: Rickets or Osteomalacia? |
| The classic presentation is with bone pain, deformity, deafness and pathological fractures. Often asymptomatic. | Paget's Disease's clinical features (can be judged by patient). |
| If iand issue is in the the CNS, is the ______ ______, _________, _________ or ______ ________ responsible? | Cerebral cortex, basal ganglia, brainstem, cerebellum, or spinal cord |
| Symptoms that worsen after exposure to heat or exercise may indicate _______ _______ in demyelinated axons, as occurs in multiple sclerosis. | Conduction block |
| A patient with recurrent symptoms associated with exercise or fatigue may have a disorder of _______ ________ such as myasthenia gravis. | Neuromuscular transmission; is a process that permits the central nervous system to control the movement of muscles in the body. |
| During history taking, what are some vital pieces of information you need to learn from the patient, especially when it comes to trying to understand the origin/potential of an illness? (4, but one is a bonus, as it is often forgotten) | Family history, Medical illnesses and Drug use and abuse and toxin exposure are essential aspects to cover. |
| True or False: During the interview, you should look for difficulties with communication and determine whether the patient has recall, and insight into recent and past events. | True. This will help you determine how accureate the information your patients give is, as well as their mental faculties. |
| There are 6 things to do when doing a full neurological examination of a patient. What are they? | Mental State, Cranial Nerves, Motor, Sensory, Coordination, Gate |
| _____________ is a temporary period of symptoms similar to those of a stroke. It usually lasts only a few minutes and doesn't cause permanent damage. | Transient ischaemic attack (TIA) |
| What is fibrinogin and how is having too much of it increase your likelihood for strokes? | Fibrinogin is a protein used by the liver that helps control blood clots. Having a high amount of it increases blood clotting, including bloodclots in your brain, which causes strokes. |
| True or false: Social deprivation decreases your liklighood for cerebrovascular diseases. | False: Social Deprivation is the reduction or prevention of culturally normal interaction between an individual and the rest of society, which INCREASES your likelihood for cerebrovascular disease. |
| ________ _________usually results from rupture of a blood vessel within the brain parenchyma. | Intracerebral haemorrhage |
| What is parenchyma? | It refers to the cells that perform the biological function of the organ – such as lung cells that perform gas exchange, liver cells that clean blood, or brain cells that perform the functions of the brain |
| What is a haematoma? | A hematoma, also spelled haematoma, is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. Simple answer: bruises. |
| Can a haematoma be reabsorbed by the body? | Yes; for example, this is what happens when bruises heal (the body reabsorbs the subderma bleed that caused the discolouration). |
| True or false: Extremely low fibrinogen levels prevents intracerebral haemorrhage | False: Impaired blood clotting (Anticoagulant therapy, Blood dyscrasia, Thrombolytic therapy) increases your likelihood of Intracerebral haemorrhage. |
| What is the typical eitiology of Parkinson's Disease? | Trick question. The eitiology of Parkinson's Diseases is currently unknown, and there is not yet any identified genetic components. |
| What kind of condition is trigeminal neuralgia, where does it effect, and how often does it occur? | Trigeminal neuralgia (TN), also called is a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head. This creates frequent, spontanious pain in the lips, gums, cheek, and/or chin. Pain can also be caused by gentile stimulation. |
| What is the main cause for trigeminal neuralgia? | Compression of the trigeminal nerve root by a blood vessel, most often the superior cerebellar artery or on occasion a tortuous vein, is the source of trigeminal neuralgia in a substantial proportion of patients. |
| What other conditions might be present in the differential diagnosis of trigeminal neuralgia? Name 2. | Migraine or cluster headache tends , temporal arteritis, multiple sclerosis (MS), secondary to mass lesions (such as aneurysms, neurofibromas or meningiomas). |
| What is "Bell's Palsy?" What might precede the paralysis? | It is the most common form of facial paralysis. Pain behind the ear of the afflicted side might precede the paralysis. |
| Is Bell's Palsy a perminant dysfunction? | No; 80% of patients recover within a few weeks to a few months, however, there MIGHT be some lasting axonal damage. |
| What kind of lesion causes Bell's Palsy? | A lower motor neuron lesion. |
| This person is not having a stroke NOR do they have shingles. What condition do they probably have? | Bell's Palsy. |
| This person is not having a stroke and they do not have Bell's Palsy, per se, but they *DO* have SHINGLES. | Ramsay Hunt Syndrome; it looks just like Bell's Palsy, but is caused when a shingles outbreak affects one of the nerves behind the ear. |
| What is a possible differential diagnosis for Bell's Palsy? | Sarcoidosis, Guillain-Barré syndrome, diabetes mellitus, connective tissue diseases (e.g. Sjögren's syndrome), amyloidosis, Acoustic neuromas, Infarcts, demyelinating lesions of multiple sclerosis, and tumors |
| How might an osteopath treat Bell's Palsy? | Through massage of the area, possibly combined with cranial osteopathy. |
| What are some causes for "Multiple Cranial Nerve Palsies?" Name 3; the list is huge. | Trauma, localized infections ( varicella zoster virus), infectious and noninfectious causes of meningitis, granulomatous diseases (such as Wegener's), Behçet's disease, vascular disorders (including those associated with diabetes, enlarging saccular aneurysms), or locally infiltrating tumors( nasopharyngeal cancers, lymphomas, neurofibromas, meningiomas). |
| What is Cervical spondylosis? | This is the term given to the occurrence of osteoarthritis in the cervical spine. |
| What are some physical signs of cervical spondylosis? | Muscle Weakness, or sensory loss basically anywhere from the shoulder to the tips of the fingers. Also may have reflex loss in any muscle in the upper arm. |
| Where are some physical signs of Lumbar spondylosis found? | Lumbar Spondylosis will show weakness, sensory loss weakness in certain areas below the knee, to the toes, depending on which nerve root is effected. |
| This is the term given to the occurrence of degenerative disc disease and osteoarthritic change in the lumbar spine. Pain in the distribution of the lumbar or sacral roots (‘sciatica’) is often due to disc protrusion | Lumbar Spondylosis is the term given to the occurence of ________ and _______ change in the lumbar spine. |
| The main kind of spinal cord compression happens in the disks (vertebrally). What are some causes for this? | Trauma, Intevertabral Disk Prolapse (herniated disk), metastic carcinoma, myeloma (aka, certain cancers; tumours), Tuberculosis |
| What common symptoms might a patient with spinal cord compression complain of? | - Pain (localized over said area of spine. Aggrivated by coughing/sneezing) - Sensory (parasthysia/prickling or burning sensation, numbness, stiffness, cold feel. This often radiates from trunk)." - Motor (Stiffness in muscles and joints, especially when in the legs, weakness, "heavy" feeling) - Occassionally urinairy retention or frequent, sudden urgency, and/or hesitency to urinate. |
| What is Multiple sclerosis (MS)? | ________ _______ is a potentially disabling disease of the brain and spinal cord (central nervous system). *In MS , the immune system attacks the protective MYELINE SHEATH that covers nerve fibers and causes communication problems between your brain and the rest of your body.* |
| What is Guillain–Barré syndrome? What causes the acute ________? | - What is a syndrome of acute paralysis (more proximally than distally) develops, in 70% of patients, 1–4 weeks after respiratory infection or diarrhea (particularly Campylobacter)? -This causes acute inflamation, the resulting cytokins block nerve conduction and is followed by a complement-mediated destruction of the myelin sheath and the associated axon. This often causes acute pain. |
| What suppliments might be suggested for someone with neuropathic conditions? | Vitamin B12, Thiamin, Pyridoxine, Folic acid and Vitamin E |
| The autonomic nervous system regulates what? | The nervous system that regulates blood pressure (BP), heart rate, sleep, and bladder and bowel function |
| When the autonomic nervous system does not work as it should it is called...? | Dysautonomia is when this nervous system has a disfunction. |
| Finish the sentence: Disorders of the Autonomic Nervous System may result from pathology of either the __________ or the ___________ | Disorders of the _________ may result from pathology of either the central nervous system or the peripheral nervous system. |
| Name 2 subacute neuropathic conditions | 1. Subacute autoimmune autonomic ganglionopathy (AAG) • a. Subacute paraneoplastic autonomic neuropathy • b. Guillain-Barré syndrome • c. Botulism • d. Porphyria • e. Drug induced autonomic neuropathies: stimulants, drug withdrawal, vasoconstrictor, vasodilators, beta-receptor antagonists, beta-agonists. •Toxic autonomic neuropathies |
| Name 2 Symptoms of Autonomic Dysfunction | Impotence (sexual dysfunction in men), bladder dysfunction (mainly in women, often with CNS involvement), Cold Feet (possible peripheral vasomotor dysfuntion). Gastrointestinal autonomic dysfunction typically presents as severe constipation or Diarrhea (diabetes). Orthostatic or (postural) hypotension is perhaps the most disabling feature of autonomic dysfunction. |
| What is Myasthenia Gravis? What is the biomechanical cause of the symptoms? | This condition is characterised by progressive fatigable weakness, particularly of the ocular, neck, facial and bulbar muscles (swallowing/speaking/chewing). Eventually effects other body parts, like the limbs. CAUSE: reduced acetylcholine receptors via inflamation response to antibodies e which reduces the number of acetylcholine receptors and damages the end plate (oversimplified; inhibited ACH reception). |
| _______ ________ - a group of inherited disorders characterized by progressive degeneration of groups of muscles, with cardiomyopathy, | Muscular Dystrophies |
| __________a disorder characterized by persistent and unexplained fatigue resulting in severe impairment in daily functioning. Name two of the additional symptoms of this syndrome | Chronic Fatigue Syndrome (CFS), Additional Symptoms: pain, cognitive dysfunction, unrefreshing sleep, headache, sore throat, tender lymph nodes, muscle aches, joint aches, feverishness, difficulty sleeping, psychiatric problems, allergies, and abdominal cramps. Impaired memory |
| Alzheimer’s disease | The key clinical feature is impairment of the ability to remember information acquired in the past. (Later on: Gradual impairment of memory, short-term (more obvious) and long-term memory are both affected, as well as apraxia, visuo-spatial impairment and aphasia. It is common for patients to deny that there is anything wrong (anosognosia).) |
| Chronic fatigue syndrome requires the existence of 4 from a list of criteria. Name 4. | Severe persistent and unexplained fatigue lasting >6 months (required), impaired memory, lymph node tenderness, muscle pain, joint pain, headache, non-refreshing sleep, malaise after exertion |
| What can cause chronic fatigue syndrome? | Somatic events (pregnancy, infection, illness) Psychosocial stress/life events (military experience, family death, job loss) NOT the result of organic disease. |
| What is on of the most effective treatment for chronic fatigue syndrome? | Cognitive behavioral therapy (CBT) Graded exercise therapy (GET) |
| What is dementia? What are some symptoms? | Dementia is a term for a GROUP of symptoms. This group of symptoms show problems with: memory, thinking, problem solving, language and perception. Over all cognitive ability. |