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What is a subdural hematoma?
- Rupture of the bridging veins in the brain caused by a sudden change in velocity of the brain w/ respect to crainal vault (a blow to the head)
- There is a much slower spread of blood due to the decreased pressure in veins as compared to arteries
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When do the major symptoms of a subdural hematoma begin?
24-48 hours
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What causes "poisoning" of the tissue after a subdural hematoma?
Leakage of blood into the gray matter of brain -> multiple hematomas can lead to decreased brain maturity (pt may come across as silly or childish)
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Subdural hematomas predispose the pt to _____________.
Subarachnoid hemmorhagic stroke
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What are the signs of a subdural hematoma?
- Similar to the epidural hematoma:
- Swelling
- Compression
- Non-communicating hydrocephalus
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What is a brain parenchymal injury?
Trauma to the brain tissue
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A concussion is characterized by what?
- Sudden & transient neurological deficit secondary to mechanical forces
- Loss of conciousness
- Retrograde amnesia
- Fxnal impairement of the reticular formation of the brain (causes the amnesia)
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A loss of consciousness due to a concussion has a direct correlation b/w ____________ & ____________.
duration of loss of conciousness & severity of neurological injury
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What is retrograde amnesia?
Loss of memory about events just prior to & immediately after the injury
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What is a contusion?
- Hemorrhage into the superficial brain parenchyma due to a blunt trauma -> leads to real anatomical changes in the brain
- Traumatic subarachnoid hemorrhage may result from contusion
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What are the 2 types of contusions?
Coup & contra coup
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What is a coup?
Happens when the person's head is not moving & is hit by a moving object -> damage is on the side/site of contact
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What is a contra-coup?
Happens when the person's head is not moving & is hit by a moving object-> damage occurs in the brain on the opposite side of contact
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What is diffuse axonal injury?
Elongation or tears of axons in the white matter due to and acceleration/deceleration injury (whiplash)
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Diffuse axonal injury affects what part of the brain?
Corpus callosum & ventricular areas
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What are axonal spheroids?
- Little vessicles filled w/ amyloid precusor protein (APP)
- They indicate the degeneration of damage axons
- Common cause of future dimentia
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What is a laceration?
- Rupture or tear of the brain tissue causing irreversible changes
- The most serious
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What are the complications of a basilar skull fracture?
- Opening of the cranial fossa to the outside may result in infection (meningitis)
- If there is a shift of the basal skull, breakage of the vessels & nerves may occur
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Fracture of the orbital plate results in what?
- Periorbital subcutaneous hemmorrhage
- Rhinnorhea
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What is rhinorrhea?
Leakage of CSF thru the nose due to fracture of the orbital plate
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What is periorbital subcutaneous hemorrhage?
- Bilateral bruising around the eyes due to fracture of the orbital plate
- Raccoon or panda bear sign
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Fracture of the occipital or temporal bone may result in what?
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What is otorrhea?
Leakage of CSF thru the ears due to fracture of the occipital or temporal bone
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What is battle sign?
post auricular bruising/hematoma due to fracture of the occipital or temporal bone
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What is RA?
- Systemic, chronic inflammatory disease that affects principally the jts & sometimes many organs/tissue throughout the body
- Autoimmune
- M:F 1:4
- 1% of population
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RA has a predilection for which part of the spine?
C spine
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What is the leading cause of death in RA?
Vasculitis
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What MUST be present in an RA diagnosis?
Joint swelling & inflammation
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RA is characterized by what?
- Non-suppurative proliferative synovitis (not caused by infection)
- In time leads to the destruction of articular cartilage & progressively disabling arthritis
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What is the etiology of RA?
- Unknown
- There is a genetic predisposition associated w/ genetic markers HLAB-DR4 & DR1
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What is rheumatoid factor?
- Formation of IgG & IgM antibodies against Fc part of the IgG immunoglobin.
- IgG attacks itself
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What is pannus?
- Hyperplasia of the synovial cells that looks like granulation tissue
- Results in the destruction of the cartilage & underlying bone tissues
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What joints are MC affected by RA?
- Small joints of the hands (2-5 MCP) and foot
- Usually symmetrical
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The inflammatory pattern of pain in RA includes what?
- Pain & joint stiffness in the morning
- Minimal pain in the evening as the day progresses
- Pain relieved by exercise
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Advanced RA leads to what?
- Severe deformity of the hands w/ destruction of jts
- Local osteopenia
- Peri-articular osteopenia
- Luxation
- Destruction &/or fusion of the carpal bones
- Swan neck deformity
- Boutinniere deformity
- Foot involvement
- Knee involvement
- Hip involvement
- Rheumatoid nodules
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Severe deformity of the hands due to RA is characterized by what?
- Ulnar deviation of the hands w/ destruction of jts
- Atrophy of the lubricales & interossei muscles
- Wrist arthritis
- Ganglionic cyst aka tenosynovitis or tendonitis- due to inflammation of the tendon
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What is swan neck deformity?
- Hyperextension of the PIP
- Hyperflexion of the DIP
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What is boutinniere deformity?
- Hyperflexion of the PIP
- Hyperextension of the DIP
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Foot involvement due to advanced RA is characterized by what?
- Destruction of bones in the foot joints (MTP's except 1st) causing sharp fragments
- Calluses at the MTP's & PIPS
- Hammer (cock) toes
- Hallux valgus
- Flat foot
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What is hammer (cock) toes?
Hyperflexion of the PIP's
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What is hallux valgus?
- Increased laxity of ligaments b/w the heads of the metatarsals
- Heads of the metatarsals separate-> deformity
- Could be caused by RA or wearing heels
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Knee involvement in advanced RA is characterized by what?
- Symmetrical
- Accumulation of exudates within the joint
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What is the normal amount of fluid in the knee?
5ml
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Should exercise be recommended to someone with advanced RA in the knee? Why?
- NEVER!
- While exercise is recommended to remove fluid from jts, its not recommended for the the knee b/c the jt is unstable- movement should be passive, not against resistance
- Treatment is puncture to remove the fluid
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Hip involvement in advanced RA is characterized by what?
Accumulation of fluid in the joint -> compression of ligaments of the femur head -> compression of the vessels & blood supply -> aseptic osteonecrosis of the femur head -> not curable
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What are Rheumatoid nodules?
- Fibronoid necrosis
- Means that the disease has dramatically progressed
- Vasculitis
- Nodules may be hard or soft, small or large, moveable or immoveable
- MC location is just distal to the olecranon (less commonly on the sole of foot, on top of head, eyes, or lungs)
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What is Caplan's syndrome?
RA lung nodules w/ interstitial fibrosis in pneumoconiosis
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What is Felty's syndrome?
RA of adults including neutropenia (leukocytopenia) & hepatosplenomegaly
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