Archive | August 2010

Polymyositis

Polymyositis means ‘many muscle inflammation’.

A type of chronic inflammatory myopathy related to dermatomyositis and inclusion body myositis, a rheumatic disease that causes weakness and inflammation of muscles.

Manifestations:

  • weakness of limb and neck muscles
  • muscle pain and swelling
  •  progression and severity vary among individuals
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Werner Syndrome (Adult progeria)

Etiology:

A very rare, autosomal recessive disorder.

Resulting from a mutation in the WRN gene, which encodes a helicase protein on chromosome 8p.

Presents as accelerated aging that typically has an adult onset.

Manifestations:

  1. sclerodermalike skin changes
  2. bilateral juvenile cataracts
  3. progeria
  4. hypogonadism
  5. diabetes mellitus

Angelman Syndrome (Happy puppet Syndrome)

Etiology:

A neuro-genetic disorder.

Occurs in 1 in 15,000 live births

Manifestations:

 The disorder is characterized by:

  1. intellectual and developmental delay
  2. sleep disturbance
  3. seizures
  4. jerky movements, especially hand-flapping
  5. frequent laughter or smiling, and usually a happy demeanor
  6. microcephaly
  7. hypotonia
  8. hyperactivity

Abnormalities of Gait

 

Spastic Hemiparesis

  • associated with unilateral upper motor neuron disease

 

Manifestations:

  • one arm is flexed, close to the side and immobile
  • the leg is circled stiffly outward and forward, circumducted
  • often the toe is dragged when walking

 

Scissors gait:

  • associated with bilateral spastic paresis of the legs

 

Manifestations:

  • Each leg is advanced slowly
  • Thighs tend to cross forward on each other at each step
  • The steps are short
  • The patient looks as if he were walking through water.

 

Stepping Gait:

  • Associated with foot drop, usually secondary to lower motor neuron disease

 

Manifestations

  • The feet are lifted high, with knees flexed and then brought down with a slap on the floor.
  • The patient looks as if he were walking upstairs.

 

Sensory Ataxia

  • Associated with loss of position sense in the legs

 

Manifestations:

  • The gait is unsteady and wide-based, the feet are far apart.
  • The feet are lifted high and brought down with a slap
  • The patient watches the ground to guide his steps
  • He cannot stand steadily with feet together when his eyes are closed, Romberg test is positive.

 

Cerebellar Ataxia

  • Associated with disease of the cerebellum or associated tracts

 

Manifestations

  • The gait is staggering, unsteady and wide-based with exaggerated difficulty on the turns
  • The patient cannot stand steadily with feet together, whether eyes closed or open.

 

Parkinsonian Gait

  • Associated with the basal ganglia defects of Parkinson’s disease

 

Manifestations:

  • The posture is stooped
  • The hips and knees are slightly flexed
  • Steps are short and often shuffling
  • Arm swings are decreased and the patient turns around stiffly – “all in one piece”.

Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.

Nystagmus

 

 

A rhythmic oscillation of the eyes.

It can be compared to tremors in other regions of the body.

It is a disorder of ocular posture.

Etiology:

  1. Early life visual impairment
  2. labyrinth disorders
  3. cerebellar disorders
  4. Drug toxicity

 

Manifestations:

Occurs when the individual watches a rapidly moving object (passing car).

Nystagmus is usually quicker in one direction than the other.

It is defined by its quick phase.

If the eyes jerk quickly to the left and drift back slowly towards the right this is defined as a left nystagmus.

Rarely nystagmus consists of coarse oscillations without quick and slow components, this is defined as a pendular nystagmus.

Nystagmus movements may occur in one or more planes (horizontal, vertical or rotatory).

Nystagmus may be present in all fields of gaze.

It may appear or become accentuated on deviation of the eyes, to the side or upward.

On extreme lateral gaze the normal person may show a few beats that resemble nystagmus.

  • Avoid extreme movements and observe for nystagmus only within the field of full binocular vision.

Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.

Ketamine

Use:

A general anesthetic given intravenously or intramuscularly and used especially for minor surgical procedures in which muscle relaxation is not required.

Class:

  • general anesthetic and tranquilizer.
  • NMDA receptor antagonists,  a class of anesthetics that work to antagonize, or inhibit the action of, the N-methyl d-aspartate receptor (NMDAR).

Applications:

Ketamine, like other NMDA receptor antagonists induces a state called dissociative anesthesia, marked by catalepsy (a trancelike state with loss of voluntary motion and failure to react to stimuli), amnesia, and analgesia.

 Ketamine and other NMDA receptor antagonists are most frequently used in conjunction with diazepam (a sedative and anti-anxiety medication) as anesthesia in some surgeries such as, cosmetic or reconstructive plastic surgery It is also used in the treatment of burn victims.

Ketamine is a favored anesthetic for emergency patients with unknown medical history because it depresses breathing and circulation less than other anesthetics.

Jendrassik maneuver

a medical maneuver wherein the patient flexes both sets of fingers into a hook-like form and interlocks those sets of fingers together. The tendon below the patient’s knee is then hit with a reflex hammer to elicit the patellar reflex.

The elicited response is compared with the reflex result of the same action when the maneuver is not in use.

Often a larger reflex response will be observed when the patient is occupied with the maneuver, as the maneuver may prevent the patient from consciously inhibiting or influencing his or her response to the hammer.

This effect was first observed in the late 19th century by Hungarian physician Erno Jendrassik, whom it was named after.