Exam Pathologies PDF Module 358

Exam Pathologies Module 358  Definition: A bone break in the proximal femur, specifically in the region Neck of Femur Fracture (NOF) just below the femoral head. Common clinical features:...

Exam Pathologies Module 358  Definition: A bone break in the proximal femur, specifically in the region Neck of Femur Fracture (NOF) just below the femoral head. Common clinical features: Risk Factors: Age >65 years. Severe pain in the hip or groin following a trauma (e.g., fall) Female sex (postmenopausal osteoporosis). Inability to weight bear (although if the fracture is incomplete Osteoporosis or osteopenia. or non-displaced, some patients may retain limited mobility Falls (e.g., due to poor balance, vision impairment, or muscle but will experience significant pain. weakness). Shortened and externally rotated leg, due to muscle spasms Smoking and alcohol consumption. and pull of surrounding muscles. Use of corticosteroids or other medications affecting bone health Increased swelling and bruising around the groin and hip. Clinical Features: Causes: Pain in the groin or hip, often radiating to the Low-Energy Trauma: knee. Common in elderly individuals with Inability to weight-bear on the affected leg. osteoporosis (e.g., fall from standing Shortened and externally rotated leg (common height). in displaced fractures). High-Energy Trauma: Tenderness over the hip joint. Common in younger individuals (e.g., Complications motor vehicle accidents, sports injuries). Avascular Necrosis (AVN): Disruption of Classification: blood supply to the femoral head, especially Anatomical Location: in displaced intracapsular fractures. Intracapsular: Within the joint capsule. Non-Union: Poor healing due to insufficient Includes sub-capital and transcervical stability or blood supply. fractures. Deep Vein Thrombosis (DVT): Due to Extracapsular: Outside the capsule. immobilization post-injury or surgery. Includes intertrochanteric and Post-Traumatic Arthritis: Following joint subtrochanteric fractures. damage. Knee Osteoarthritis Definition: A degenerative joint disease of the knee, it is typically the result of wear and tear and progressive loss of articular cartilage. Because of its progressive nature, it is more prevalent in the elderly. Common Symptoms: Risk Factors: Joint swelling/effusion Age: Limited functional capacity (Stair climbing) Increased prevalence in the elderly. Reduced Range of motion on testing Obesity: Crepitus and joint deformity Extra weight increases stress on the knee joint, accelerating Pain and stiffness cartilage breakdown. Antalgic gait (Compensation patterns can add to joint Previous Injury: stress and functional limitations) A history of trauma, ligament tears, or meniscal injuries increases the risk of OA. Pathophysiological Changes: Weak Quadriceps: 1.Cartilage Breakdown/Joint Space Narrowing: Muscle weakness contributes to joint instability, worsening wear Loss of cartilage reduces joint space and impairs its ability to cushion and protect and tear on the knee. the joint. 2. Bone Wearing: As cartilage deteriorates, bones may rub against each other, causing pain, inflammation, and the formation of osteophytes (bone spurs). 3.Synovial Inflammation: The synovial membrane becomes inflamed and thickened, leading to pain and swelling by reducing joint lubrication. Clinical Management Goals: 1.Reduce pain and inflammation (e.g., medications, physical therapy). 2.Improve joint function and mobility (strengthening exercises, weight management). 3.Enhance quality of life through ADL adaptations and assistive devices if needed.  Ankle Sprain Definition: A ligament injury around the ankle joint, most commonly involving the lateral ligaments due to excessive inversion. Lateral Ligaments (most commonly Clinical Features injured): Pain and tenderness over the affected ligaments. Anterior Talofibular Ligament Swelling and bruising around the ankle. (ATFL): Most frequently sprained. Reduced range of motion (ROM). Calcaneofibular Ligament (CFL). Difficulty or inability to weight-bear (depending on severity). Posterior Talofibular Ligament (PTFL). Management: Medial Ligaments: 1. Acute Phase (First 48–72 Hours) Deltoid ligament (less commonly RICE Protocol: sprained due to its strength). Rest: Avoid weight-bearing. Ice: 15–20 minutes every 2–3 hours to reduce swelling. Mechanism of Injury: Compression: Elastic bandage or brace. Lateral Ankle Sprain: Excessive inversion Elevation: Above heart level to reduce swelling. and plantarflexion (e.g., landing Analgesia: NSAIDs or paracetamol for pain relief. awkwardly). 2. Rehabilitation Phase Medial Ankle Sprain: Excessive eversion Phase 1 (1–2 weeks): (less common). Gentle ROM exercises (e.g., ankle circles). Weight-bearing as tolerated with support (e.g., crutches or Risk Factors for Ankle Sprain: Classification: brace). Grade I (Mild): Microtears, mild swelling, Phase 2 (2–6 weeks): Previous ankle sprain. and tenderness. Strengthening exercises (e.g., resistance bands). Weak muscles or poor balance. Grade II (Moderate): Partial ligament tear, Balance and proprioception training (e.g., single-leg stands, High-risk sports (e.g., basketball, moderate swelling, bruising, and difficulty wobble board). football). weight-bearing. Phase 3 (6–12 weeks): Return to full activity with sport-specific training. Inappropriate footwear or uneven Grade III (Severe): Complete ligament surfaces. rupture, significant swelling, instability, and Gradual weaning off braces. inability to weight-bear. 3. Severe or Recurrent Sprains Obesity or poor fitness. Referral to physiotherapy for specialized rehab. Surgical repair in rare cases (e.g., chronic instability). Shoulder Dislocation Definition: Displacement of the humeral head from the glenoid cavity, most commonly anterior. Types: Anterior Dislocation (most common ~95%): Caused by abduction, external rotation, and extension. Associated with Bankart lesions and Hill-Sachs deformities. Complications: Posterior Dislocation (~2–4%): Axillary nerve injury (loss of Caused by seizures, electric shocks, or trauma. sensation over deltoid). Presents with internal rotation and adduction. Recurrent dislocations (common in Inferior Dislocation (rare): younger patients). Caused by hyperabduction. Labral tears (e.g., Bankart lesion). Rotator cuff injuries (more Clinical Features: common in older patients). Severe shoulder pain. Visible deformity (flattened deltoid). Management: Limited range of motion (ROM). 1. Acute Phase: Supporting arm in a guarded position. Immediate reduction under sedation or analgesia. Numbness/tingling (may indicate axillary nerve Post-reduction imaging to confirm placement. injury). Sling immobilization (1–3 weeks). 2. Rehabilitation Phase: Diagnosis: Gradual physiotherapy focusing on: Clinical Exam: Inspection, palpation, and ROM testing. Pain control and early ROM exercises. Imaging: Strengthening rotator cuff and scapular stabilizers. X-ray (AP, lateral, or axillary views): Confirm Proprioception and functional training. dislocation, assess fractures. 3. Surgical Intervention (if needed): MRI (if soft tissue injury suspected). Indicated for recurrent dislocations, large fractures, or ligament damage.  Axial Spondylitis (AxSpA) Definition: A chronic inflammatory condition primarily affecting t axial skeleton (spine and sacroiliac joints), leading to pain, Types: Management: stiffness, and progressive fusion of vertebrae in severe cases. Non-Radiographic AxSpA: 1. Pharmacological: Early stage with no visible changes on X-ray NSAIDs: First-line for pain and inflammation. but detectable inflammation (e.g., via MRI). Biologics (e.g., TNF inhibitors, IL-17 inhibitors): For refractory or severe cases. Ankylosing Spondylitis (AS): Advanced stage with visible changes on X- DMARDs (e.g., sulfasalazine): Limited use, mainly for peripheral joint rays (e.g., sacroiliitis, syndesmophytes). involvement. 2. Non-Pharmacological: Clinical Presentation: Regular exercise (focus on posture, flexibility, and strength). Chronic back pain (insidious onset, >3 Physiotherapy for tailored movement programs. months). Morning stiffness, improving with activity. Smoking cessation (reduces disease progression). Pain often worse at night or early morning. 3. Surgical: Alternating buttock pain (sacroiliac joint Rare; indicated for severe spinal deformities or joint replacements in late involvement). stages. Fatigue Inflammation in peripheral joints Complications: Risk Factors: Ankylosis (fusion of vertebrae, Genetic: Strong "bamboo spine"). association with HLA-B27. Reduced chest expansion Male gender (more (costovertebral joint involvement). common in men). Fractures (weakened, rigid spine). Family history of AxSpA Cardiovascular complications (e.g., aortitis) Stroke (CVA) Definition: A stroke is a disruption of blood flow to the brain that causes a rapid disturbance of cerebral function lasting more than 24 hours. Clinical Features: Diagnosis: Types: FAST Acronym: Imaging: Ischemic Stroke (~85%): Face: Drooping or asymmetry. CT scan (to differentiate ischemic vs. Caused by obstruction (thrombus or embolus) Arms: Weakness or inability to lift one arm. hemorrhagic). in a cerebral artery. Speech: Slurred or difficulty speaking. MRI (better for small ischemic strokes). Subtypes: Time: Act quickly—call emergency services. Blood Tests: Thrombotic: Clot forms in the brain. Additional symptoms: Glucose, cholesterol, and clotting Embolic: Clot originates elsewhere (e.g., Sudden severe headache (hemorrhagic profile. heart, carotid arteries). stroke). Cardiac Assessment: Hemorrhagic Stroke (~15%): Vision changes (blurred or loss). ECG (for atrial fibrillation). Caused by rupture of a blood vessel. Balance issues or dizziness. Echocardiography (for embolic sources). Subtypes: Management: Intracerebral hemorrhage (within brain 1. Acute Phase: tissue). Ischemic Stroke: Subarachnoid hemorrhage (bleeding into Thrombolysis with tissue plasminogen activator (tPA) within the subarachnoid space). 4.5 hours. Transient Ischemic Attack (TIA): Thrombectomy (if large vessel occlusion). Temporary blockage causing stroke-like Hemorrhagic Stroke: symptoms resolving within 24 hours. Blood pressure control. Neurosurgical intervention (e.g., aneurysm clipping or coiling). Risk Factors: 2. Secondary Prevention: Hypertension (strongest Antiplatelets (e.g., aspirin, clopidogrel). modifiable risk factor). Anticoagulation (for AF-related strokes). Smoking. Control risk factors: Diabetes mellitus. BP, cholesterol, diabetes management, smoking cessation. Hyperlipidemia. 3. Rehabilitation: Atrial fibrillation (AF). Physiotherapy: Motor recovery and mobility. Obesity and sedentary lifestyle. Speech therapy: For communication difficulties. Advanced age. Occupational therapy: ADL training and home adaptations. Family history of stroke Parkinson’s Disease Definition: A progressive neurodegenerative disorder caused by the loss of dopamine-producing neurons in the substantia nigra, leading to motor and Clinical Features: non-motor symptoms. Motor Symptoms (TRAP mnemonic): Management: Tremor: Resting tremor ("pill-rolling"). 1. Pharmacological: Rigidity: Increased muscle tone (lead-pipe or Levodopa + Carbidopa: Gold standard for motor symptoms. cogwheel). Dopamine Agonists (e.g., pramipexole, ropinirole): Used in early Akinesia/Bradykinesia: Slowness of stages or adjunctively. movement or difficulty initiating movements. 2. Non-Pharmacological: Postural Instability: Impaired balance, Physiotherapy: Improve mobility, posture, and balance. increased fall risk. Occupational therapy: Optimize daily activities. Non-Motor Symptoms: Speech therapy: Address dysarthria or swallowing issues. Cognitive impairment (dementia in advanced 3. Surgical: stages). Deep Brain Stimulation (DBS): For refractory motor symptoms. Autonomic dysfunction (constipation, orthostatic hypotension). Mood disorders (depression, anxiety). Complications: Sleep disturbances (REM behaviour disorder, Motor fluctuations (e.g., "on-off" insomnia). phenomena with Levodopa). Diagnosis: Dyskinesia (involuntary Clinical diagnosis based on history and examination. movements from prolonged Supportive criteria: Asymmetric onset, response to Levodopa use). dopaminergic therapy. Increased fall risk and fractures. Imaging: DaTscan (dopamine transporter imaging) Dementia in advanced stages. may aid in diagnosis if uncertain. Chronic Obstructive Pulmonary Disorder (COPD) Definition: A progressive, irreversible lung disease characterised by chronic airflow limitation due to inflammation, airway narrowing, and alveolar destruction. Diagnosis: Clinical Features: Spirometry: FEV1/FVC ratio