Clinical Pathologies 2

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mnm2186
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30728
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Clinical Pathologies 2
Updated:
2010-08-22 16:24:15
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Pathologies
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Exam 2
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  1. Most common form of primary CNS tumor in adults?
    Intermediate filaments expressed by the tumor cells?
    Astrocytoma 80-90% of glial tumors

    Glial fibrillary acid protein (GFAP)
  2. What is the prognosis of astrocytoma? Why?
    8-10 months survival

    • - Become more anaplastic w/ time
    • - Non-capsulated (difficult to resect)
    • - Spread to other parts of CNS via CSF
    • (seldom metastasize outside the CNS)
  3. Multiple Sclerosis
    • Chronic demyelination of CNS
    • Characterized by remission / relapse
    • CNS plaques formed by astrocytes
    • Optic nerve often affected
  4. Gliosis
    • CNS regeneration very limited in adults
    • - Astrocytes form glial scar
    • - Inhibits axonal regeneration
    • - Oligodendroglia express protein that prevents axonal growth
  5. Guillan-Barre Syndrome
    • Acute inflammatory polyradiculoneuropathy
    • Affects PNS myelin only
    • Usually bilateral, symmetrical, motor weakness
    • Evidence of T-cells, plasma cells and macrophages around axons
    • Severe cases can lead to death
    • Most cases resolve in 2-4 weeks
  6. Peripheral nerve regeneration
    • Best when crushed (CT sheaths intact)
    • Schwann cells very critical:
    • - undergo mitosis
    • - become phagocytic
    • - Synth. growth factors / cytokines
  7. Phantom limb
    • Neuroma!
    • (Peripheral nerve fails to regen.)
  8. Treatment for parkinson's:
    Dopamine vs. L-dopa
    • Blood-brain barrier
    • - dopamine can't cross
  9. Klinefelter's syndrome
    • XXY or XXXY (male)
    • mild effects
    • (extra X converted to barr bodies)
  10. 1st Degree Burn
    • Damage to superficial epidermis
    • Stratum germinativum still viable
    • Regenerates epidermis
  11. 2nd Degree Burns
    • Epidermis completely destroyed
    • Remnants of glands/hair follicles in dermis
    • Regenerates the epidermis
  12. 3rd Degree Burns
    • Destroys epidermis & dermis
    • Skin grafts typically needed
    • Hypovolemia / Shock
    • - 15% body area (adults)
    • - 10% body area (children)
  13. Basal Cell Carcinoma
    • 70% of skin cancers
    • Arise only in regions w/ sebaceous glands
    • Age > 40, fair skin
    • Eyelids / bridge of nose
    • Seldom metastasize
  14. Squamous Cell Carcinoma
    • 20% of skin cancers
    • Epithelium replaced w/ pleomorphic cells
    • Cells can penetrate dermis (late stage)
    • 2-5% metastasize to regional LN
  15. Malignant Melanoma
    • 2% of skin cancers
    • Very metastatic
    • - neural crest origin (migratory cells)
    • - cells invade dermis (blood / lymph)
  16. Hyporeflexia / areflexia
    Indicates problem with spinal segment(s) being tested
  17. Hyperreflexia
    Indicates UMN problem
  18. Flexor withdrawal crossed extensor reflex
    • Polysynaptic reflex
    • - stimulus causes flexor withdrawal reflex
    • - controlateral extensor neurons are fired
    • Maintain balance / posture
  19. UMN injury
    • Injury of corticospinal system
    • Above decussation = contralateral paralysis of limbs
    • Below decussation = ipsilateral paralysis below lesion
  20. Sensory Loss
    • Injury to spinal cord
    • Contralateral loss of pain / temperature
    • Ipsilateral loss of fine touch / proprioception / vibration

    (Ipsilateral paralysis below lesion)
  21. T6 Hemisection
    • Corticospinal Tract
    • - ipsilateral paralysis
    • Dorsal Column
    • - ipsilateral loss fine touch / proprioception / vibration
    • Anterolateral Column
    • - Contralateral loss crude touch / temperature / pain

    BELOW T6!
  22. Most definitive index of meningitis
    PMN leukocytes in CSF
  23. Lumbar Puncture
    • L4 or below
    • Subarachnoid (thecal sac)
  24. Caudal Epidural
    • - Outside of thecal sac (below S2)
    • - Selective nerve block w/o affecting spinal cord
  25. Spinal Epidural
    • Anesthetic placed in subarachnoid
    • Loss of resistance passed ligamentum flavum
  26. Artery of Ademkiewicz
    • Spinal cord supply (horiz. comp.)
    • Arises on left @ T12 / L1 in 65% of people
    • Damage to this artery can cause paralysis
  27. Metastases via Batson's Plexus
    • - Epidural plexus that drains spinal cord
    • - Veins do NOT have valves
    • - Increased intra-abd. pressure can cause reflux of blood into plexus
  28. Horner's Syndrome
    • Injury to neurons / axons of superior cervical ganglia
    • Sympathetics knocked-out / parasympathetics unopposed
    • 1. Ptosis (drooping eyelid)
    • 2. Miosis (small pupil)
  29. Hirschsprung's Disease
    Congenital aganglionic megacolon

    Failure of neural crest cells to migrate to distal colon

    • 1:5000 births
    • Affects males more (4:1)
  30. Achalasia
    • Onset 25-60 y/o
    • Loss of myenteric neurons (Auerbach's plexus) in lower esophagus
    • Lower esophageal sphincter paralyzed in constriction
    • Esophagus dilated
  31. Referred Pain
    Visceral pain afferents enter spinal cord with somatic afferents

    All pain fibers run w/ sympathetic system and enter spinal cord at the same segment that gives rise to preganglionic efferents
  32. Radiculopathy
    • Caused by injury of nerve root / spinal nerve
    • Sensory Dysfunction:
    • - posterior (dorsal root) injury
    • - deficit pattern is dermatomal
    • - burning / tingling radiates in dermatome

    • Motor Dysfunction:
    • - anterior (ventral root) injury
    • - may cause paresis (weakness)
  33. Most common cause of radiculopathies
    Vertebral disc herniations
  34. Neuropathies
    • Caused by pathology affecting a peripheral nerve
    • Sensory Dysfunction:
    • - burning / tingling radiates in nerve distribution
    • - involve adjacent dermatomes

    • Motor Dysfunction:
    • - cause paralysis
  35. Both radiculopathies & neuropathies can cause _________
    • - sensory loss (patterns are different)
    • - atrophy
    • - fasciculations
  36. 40 y/o M feels sharp pain in left side of neck / weakness in LUE. ER exam shows loss of sensation over lateral aspect of left shoulder / weakness on abduction of LUE / elbow flexion. Cannot retract left scapula. LUE adduction against resistance is normal.
    Where is injury? Likely cause? Diagnosis?
    • - C5 spinal nerve
    • - C4/5 IV disc herniation
    • - C5 radiculopathy
  37. 20 y/o M stabbed / knife blade penetrated the man’s right coracobrachialis. ER exam showed complete inability to flex right elbow or supinate right hand. He had a complete loss of sensation over lateral aspect of forearm.
    Where is injury? Likely cause? Diagnosis?
    • - musculocutaneous nerve
    • - transection of n. as it passes thru coracobrachialis m.
    • - traumatic musculocutaneous neuropathy
  38. Breast Cancer Metastases
    • > 75% lymph drainage via axillary nodes
    • enlargement of axillary node indicates early metastases
  39. Risks of axillary LN excision?
    (metastatic breast cancer)
    • - damage LTN
    • - damage Thoracodorsal n.
    • - can result in lymphedema of UE
  40. Winged Scapula
    • - Protrusion / retraction of scapula
    • - Inability to protract / rotate scapula
    • - Inability to abduct UE > 90o
    • Caused by injury to LTN (innervates serratus anterior)
    • LTN & lat. thoracic a. both run superficial to serratus anterior
  41. Loss of lateral & medial pectoral nerves
    • Total denervation of pectoralis major m.
    • (action: adduct / med. rotate UE)

    • Total denervation of pectoralis minor m.
    • (action: stabilize scapula)
  42. Loss of medial pectoral nerve
    • Partial denervation of pectoralis major m.
    • (action: adduct / med. rotate UE)

    • Total denervation of pectoralis minor m.
    • (action: stabilize scapula)
  43. Loss of lateral pectoral nerve
    • Partial denervation of pectoralis major m.
    • (action: adduct / med. rotate UE)

    • Pectoralis minor m. intact!!!
    • (action: stabilize scapula)
  44. Erb's Palsy
    • C5 (C6) brachial plexus injury
    • This causes the limb to be...:
    • - adducted
    • - medially rotated
    • - elbow extended (only if C6 is involved)
    • - forearm pronated (waiter's tip)
  45. Klumpke's Palsy
    • C7 / C8 (T1) brachial plexus injury
    • - chiefly affect muscles of forearm / hand
    • - Horner's Syndrome may accompany if T1 is involved
  46. Klumpke's Palsy w/ Horner's Syndrome
    • C7 - T1 brachial plexus injury
    • Horner's is only present if T1 is involved

    Ptosis / Miosis caused by damage of T1 White Communicating Ramus
  47. Wrist Drop
    • Radial N. Injury (@ radial groove)
    • - Triceps paresis (medial head)
    • - Extensor muscle paralysis (wrist drop)
  48. Significance of venous drainage in upper limb
    2 routes: deep (paired) / superficial (unpaired)

    • Unpaired (superficial) drainage begins in dorsum of hands (dorsal venous network)
    • Paired (deep) drainage begins in the palm of hand (deep veins)
  49. Common site of venipuncture? Careful not to go too far! Why?
    Median cubital vein (above biceps aponeurosis)

    (TAN) Biceps tendon, brachial a., median n.
  50. Pronator (Teres) Syndrome
    • Median N. Injury (entering forearm between heads of pronator teres)
    • - loss of DIP & PIP flexion (digits 1-3)
    • - "hand of benediction"

    Ulnar n. to lateral half of FDP still works!!!
  51. Claw Hand
    • Ulnar N. Injury - (commonly in cubital tunnel)
    • Patient can't flex DIP of 4th - 5th digits (FDP medial half)
    • Also, wrist adduction impaired (FCU); wrist abducts when trying to flex

    If trauma is in distal forearm, most intrinsic hand muscles will be denervated!
  52. Dupuytren's Contracture
    • Thickening of palmar fascia
    • Surgery needed to free the fingers
  53. Carpal Tunnel Syndrome
    Compression of Median N. w/in tunnel
  54. Compartment Syndrome
    • Bleeding in muscle compartment increases pressure.
    • Causes decreased tissue perfusion (venous & arterial) distal to injury

    • Surgical Emergency! (ischemia)
    • Fasciotomy
  55. Anatomical center of gravity
    Anterior to S2
  56. Significance of venous drainage in lower limb
    2 routes: Superficial vs. Deep

    Superficial veins in subcutaneous tissue (superficial fascia)

    Deep veins accompany arteries below the deep fascia (fascia lata & crural fascia)
  57. Osgood-Sclatter's Disease
    • Disruption of the epiphyseal plate at the tibial tuberosity in adolescence.
    • May cause inflammation of the tuberosity and chronic recurring pain, especially in young athletes
  58. Positive Trendelenburg Gait / Sign
    • Gluteus medius muscle weakness causes pelvis to drop to contralateral side
    • (superior gluteal n. injury)
  59. Riders Bones
    • Ossification of adductor tendons
    • chronic irritaion / inflamation
  60. Common Fibular N. Injury
    • "Foot Drop" - inability to dorsiflex / evert foot
    • Causes "toe drag" gait

    Most common nerve injury of the lower limb
  61. Varicose Veins
    Incompetent valves in LE veins

    Gravity takes over

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