Exam Pathologies Module 358 PDF

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

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