OSCE

 CASE REPORT- 

 https://shaardul124.blogspot.com/2023/12/prefinals-case.html

LEARNING POINTS- 

1 Difference between rheumatoid arthritis and osteoarthritis

2 Different etiologies and presentations of vertigo 

3 Romberg test demonstrating sensory ataxia v cerebellar ataxia- 

“For sensory ataxia and cerebellar ataxia, their Romberg’s signs are both positive, but there are some differences. The patient can keep standing steady during the eye-opening phase, and standing unsteadily, wobbling, or even falling in the closed eye phase (), as shown in Figure 1. The cerebellar ataxia patients were unstable in the stage of closing eyes and opening eyes, and tend to tilt toward the diseased side of cerebellum”
“The maintenance of human balance mainly depends on the coordination of vestibular system, visual system and proprioceptive system (). In an upright position, a normal person can stand steadily when the eyes open and close; but when two or more systems are damaged, the human body will not be able to maintain balance. For example, when a patient is suffering from Sensory Ataxia, the visual system can provide compensation information when the eyes are open, so the patient can remain upright and stable; Visual compensation would disappear when the eyes are closed, patients will not be able to maintain upright stability. This is the theoretical basis of Romberg’s sign“

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046926/

4 Proprioception evaluation 

5 Vertebrobasillar insufficiency caused by fluorosis/spondyloarthopathy leading to intermittent vertigo (similar to angina) 

VERTEBROBASILAR INSUFFICIENCY- 

"Vertebrobasilar insufficiency (VBI) is defined by inadequate blood flow through the posterior circulation of the brain, supplied by the 2 vertebral arteries that merge to form the basilar artery. The vertebrobasilar arteries supply the cerebellum, medulla, midbrain, and occipital cortex. When the blood supply to these areas is compromised, it can lead to severe disability and/or death.
Symptoms include:
  • Vertigo (the most common symptom)
  • Dizziness/syncope: Sixty percent of patients with VBI have at least 1 episode of dizziness. 
  • "Drop attacks:" Patient feels suddenly weak in the knees and fall
  • Diplopia/Loss of vision
  • Paresthesia
  • Confusion
  • Dysphagia/dysarthria
  • Headache
  • Altered consciousness
  • Ataxia
  • contralateral motor weakness
  • Loss of temperature and pain
  • Incontinence"

FLUOROSIS- 

Our patient is from a fluorosis endemic area. 

"Endemic skeletal fluorosis is a chronic metabolic bone and joint disease caused by ingesting large amounts of fluoride either through water or rarely from foods of endemic areas. Fluoride is a cumulative toxin which can alter accretion and resorption of bone tissue. It also affects the homeostasis of bone mineral metabolism. The total quantity of ingested fluoride is the single most important factor which determines the clinical course of the disease which is characterized by immobilization of joints of the axial skeleton and of the major joints of the extremities. A combination of osteosclerosis, osteomalacia and osteoporosis of varying degrees as well as exostosis formation characterizes the bone lesions."

https://pubmed.ncbi.nlm.nih.gov/3295994/

CERVICAL SPONDYLOSIS- 

"Cervical spondylosis is a term that encompasses a wide range of progressive degenerative changes that affect all the components of the cervical spine (i.e., intervertebral discs, facet joints, joints of Luschka, ligamenta flava, and laminae). It is a natural process of aging and presents in the majority of people after the fifth decade of life. Symptoms of cervical spondylosis manifest as neck pain and neck stiffness and can be accompanied by radicular symptoms when there is compression of neural structures"

https://pubmed.ncbi.nlm.nih.gov/31855384/

OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT-  

"Patients with myelopathy often give a history of changes in balance and fine motor skills (worsening handwriting, difficulty buttoning buttons). As myelopathy progresses, patients may require ambulatory aids or a wheelchair. During the physical examination, the clinician should assess both the Rhomberg and tandem gait tests to identify early signs of gait or balance dysfunction. Brisk reflexes as well as clonus may be present in the upper and lower extremities"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771496/

OSSIFICATION OF POSTERIOR LONGITUDINAL LIGAMENT AND ASSOCIATION WITH FLUOROSIS- 

"Fluorosis is associated with a higher incidence of OPLL."

https://pubmed.ncbi.nlm.nih.gov/30233012/#:~:text=The%20continuous%20variant%20of%20OPLL,a%20higher%20incidence%20of%20OPLL.

CASE REPORTS OF FLUOROSIS CAUSING CERVICAL MYELOPATHY- 

 https://www.jocn-journal.com/article/S0967-5868(08)00501-8/fulltext

https://nimhans.ac.in/wp-content/uploads/2020/10/25.-Fluorosis-of-the-Cervical-Spine-_151-157.pdf

CERVIVAL SPONDYLOSIS CAUSING VERTEBROBASILAR INSUFFICIENCY- 

"Although the most common aetiology of transient vertebrobasilar insufficiency is atherosclerosis, a similar syndrome may occasionally be produced by cervical osteophytes. The possibility of such a remedial lesion makes further investigation mandatory in such patients—especially if symptoms are associated with sudden movements of the head or neck"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC493808/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC493808/pdf/jnnpsyc00214-0020.pdf

FLUOROSIS MIMICKING CERVICAL SPONDYLOSIS- 

Skeletal fluorosis can mimic various arthritis such as rheumatoid arthritis, osteoarthritis or spondyloarthropathy. The early stages of the disease may be asymptomatic or present as vague pain in the neck or back with rigidity, arthralgia and paraesthesia in the limbs, achilles tendinitis, and early morning stiffness

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9450208/





Comments

Post a Comment

Popular posts from this blog

65 F postural dizziness and vomiting

Image
   This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio.   OSCE/discussion-  https://shaardul124.blogspot.com/2023/12/osce.html 63 year old housewife from Nalgonda  Chief complaints- Vomiting 5 episodes 3 days ago History of present illness-  Patient was apparently alright 1 year back then developed vomiting associated with giddiness and pain. she came to our hospital and vomiting subsided with treatment. She was asked to take Vertin 24 (betahistine) at discharge. she took the medication for 3 months and then stopped after consulting with her physician. She had mild episodes of
Read more

General Medicine Assignment 2

  Question 1: Competency tested for Peer to peer review and assessment :    Please go through one student's entire answer paper from this link, the one who is closest to your own roll number :   http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1   and share your peer review of each answer with your qualitative insights into what was good or bad about the answer.   Answer 1: Link chosen- https://seemalaanjali123.blogspot.com/?m=1  Peer review: ·        Answer 1: Answer has not been clearly labelled. Patient history has been taken into account for provisional diagnosis. Proper justification of diagnosis is given. Diagrams have been inserted where necessary. In Patient care has been recorded. Drugs used have been written. Drug function and mechanism of action have not been written. ·        Answer 2: Not attempted ·        Answer 3: The disease has been identified and defined. Pathology of the disease has also been ex
Read more