This document discusses MRI findings of various knee pathologies. It presents 7 case studies of patients who underwent MRI scans of their knees to evaluate pain and other symptoms. The MRI scans revealed conditions such as plica syndrome, meniscal tears, ligament injuries, bone tumors, and infectious arthritis. The conclusion is that MRI is a useful tool for diagnosing various knee conditions in a non-invasive manner, allowing for early diagnosis and treatment planning.
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Case 3 : KNEE PAIN.
A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?
Assessing Musculoskeletal Pain: Knee
Patient Initials: MA Age: 15 years Gender: Male
SUBJECTIVE DATA:
Chief Complaint (CC):
“My knees hurt, panful and with clicking sound. I experience catching sensation under the patella. ” The additional history will be assessed by asking questions related to the onset of the pain in terms of acute or gradual, duration of the pain and its associated symptoms and previous treatment for the pain.
History of Present Illness (HPI):
MA is a high school sophomore who came to the doctor complaining of knee pain. He is an active basketball player for his school team. He started experiencing knee pain in the last week. He claims to be suffering clicking sounds from both knees.
Location:
bilateral knees.
Onset:
Eight days while playing basketball.
Character:
Dull intermittent pain.
Associated signs and symptoms:
A catching sensation under kneecaps.
Timing:
For the past 8 dyas.
Exacerbating/ relieving factors:
gets worst while patient treks to school. The pain subsides with mediciation rest and ice pack.
Severity:
7 on a pain scale of 1-10 after pain medication Ibuprofen 200mg 2 tabs orally was taken and 10/10 worst pain level after a trek to school.
Medication:
Ibuprofen.
Allergies:
No allergy to medication but allergic to shellfish.
Past Medical History (PMH):
The patient sprained his left knee four months ago, and history of Rheumatic fever during his early childhood.
Past Surgical History (PSH):
No history of medical surgery.
Sexual/Reproductive History:
None. The patient is not sexually active.
Personal/Social History:
Denies smoking, drinking alcohol, or using any other drugs.
Immunization History:
All immunizations are up to date as per the parents. Received flu vaccine 10/5/19.
Significant Family History:
MA lives with his parents. Both grandfathers have diabetes, his mother is obese. His two other siblings are healthy. The family has a history of obesity.
Review of Systems
: MA has presented a complaint of dull knee pain that he experiences in both knees. The pain is clicking and accompanied with a catching sensation under the patella. The pain mostly persists during physical activity.
OBJECTIVE DATA:
General
: MA is a healthy 15 years old who has maintained a healthy body. MA is alert and oriented and very active in school when it comes to basketball an.
I need a respond to this assignmentthree referenceszero plag.docxflorriezhamphrey3065
I need a respond to this assignment
three references
zero plagiarism
Case 3 : KNEE PAIN.
A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?
Assessing Musculoskeletal Pain: Knee
Patient Initials: MA Age: 15 years Gender: Male
SUBJECTIVE DATA:
Chief Complaint (CC):
“My knees hurt, panful and with clicking sound. I experience catching sensation under the patella. ” The additional history will be assessed by asking questions related to the onset of the pain in terms of acute or gradual, duration of the pain and its associated symptoms and previous treatment for the pain.
History of Present Illness (HPI):
MA is a high school sophomore who came to the doctor complaining of knee pain. He is an active basketball player for his school team. He started experiencing knee pain in the last week. He claims to be suffering clicking sounds from both knees.
Location:
bilateral knees.
Onset:
Eight days while playing basketball.
Character:
Dull intermittent pain.
Associated signs and symptoms:
A catching sensation under kneecaps.
Timing:
For the past 8 dyas.
Exacerbating/ relieving factors:
gets worst while patient treks to school. The pain subsides with mediciation rest and ice pack.
Severity:
7 on a pain scale of 1-10 after pain medication Ibuprofen 200mg 2 tabs orally was taken and 10/10 worst pain level after a trek to school.
Medication:
Ibuprofen.
Allergies:
No allergy to medication but allergic to shellfish.
Past Medical History (PMH):
The patient sprained his left knee four months ago, and history of Rheumatic fever during his early childhood.
Past Surgical History (PSH):
No history of medical surgery.
Sexual/Reproductive History:
None. The patient is not sexually active.
Personal/Social History:
Denies smoking, drinking alcohol, or using any other drugs.
Immunization History:
All immunizations are up to date as per the parents. Received flu vaccine 10/5/19.
Significant Family History:
MA lives with his parents. Both grandfathers have diabetes, his mother is obese. His two other siblings are healthy. The family has a history of obesity.
Review of Systems
: MA has presented a complaint of dull knee pain that he experiences in both knees. The pain is clicking and accompanied with a catching sensation under the patella. The pain mostly persists during physical activity.
OBJECTIVE DATA:
General
: MA is a healthy 15 years old who has maintained a healthy body. MA is alert and oriented and very active in school when it comes to basketball an.
APA format 3 peer references needs to review case study and documentGrazynaBroyles24
APA format 3 peer references needs to review case study and document on differential diagnosis as to agreeing or disagreeing Due October 20.2018 at 5pm
Episodic/Focused SOAP Note Template
Patient Information:
A.S., 46 F, Caucasain
S.
CC
“ankle pain in both ankles; worse in right ankle, after hearing ‘pop’ while playing soccer.”
HPI
: A.S. is a 46 year old Caucasian female who presents with bilateral ankle pain which she describes as chronic for the last 3 months. She acutely injured her right ankle 3 days ago while playing soccer. The pain is described as aching with intermittent sharp characteristics. Associated symptoms include limited ROM. The pain is worse with weight bearing and OTC pain medications have included alternating doses of Tylenol and Motrin with moderate relief.
Current Medications
:
Motrin 200 mg by mouth every 4-6 hours as needed for pain
Hydrochlorothiazide 12.5mg by mouth daily for 6 months for HTN
Allergies: PCN- rash, no known food/environmental allergies
PMHx
: HTN; immunizations are up to date- last tetanus 12/2017; flu shot 10/2018 cholecystectomy 2015
Soc Hx
: A.S. is employed as a Registered Nurse and remains active by playing soccer three times a week. She is married with two teenage daughters. She denies tobacco and alcohol use.
Fam Hx
: Maternal grandmother deceased at age 56 from MI. Maternal father deceased at age 75 from complications of COPD. Paternal grandparents unknown. Father history is unknown. Mother is alive with type 2 diabetes that is well controlled with oral agents. Sibling age 43 alive and well. Children are alive and well with no medical hx.
ROS
:.
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema,
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.
GENITOURINARY: No burning on urination.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: pain and swelling to right ankle, limited weight bearing and ROM in b/l ankles, worse in the right ankle. No muscle cramping. No back pain.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
GENERAL: AAOx 3, limping gait, no distress. No fever. Skin is warm, dry, and intact. Skin of the lower extremities is warm and pink in color.
CARDIOVASCULAR: chest is ...
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SUBJECTIVE DATA
:
CC: “Complains of dull pain in both of his knees”
HPI: The 15-year-old Caucasian male complains of dull pain in bilateral knees. Complains of catching under unilateral or both knees. Onset gradual but increasing over time, especially in last two weeks. Dull knee pain and catching sensation behind the right knee cap. Rarely, notices the clicking in the left knee but continues to have less pain. Pain is worse with exercise and activity. Pain eases with rest, elevation and ice. Patient rates the right knee at 8/10 and left knee 6/10
PMI: Tonsillectomy at 5-year-old, Flu vaccination 2019 season, HPV immunization completed 2019, Tetanus 2019, hospitalizations
CURRENT MEDICATIONS: None
SH: RR is a middle school student at Austin Middle School. He plays football and basketball with the school. He is a nonsmoker and his household members are nonsmoking. He does not use alcohol and his father drinks 1-2 drinks/monthly and his mother does not drink. He lives in the house with both his parents. He makes good grades.
ROS
GENERAL: no weight loss, no chills, no fever, no fatigue.
CV: Negative for palpitations or flutters, negative for hypertension. No edema noted to bilateral upper extremities. No edema to lower extremities.
GI: No nausea/ vomiting no diarrhea, no stomach pain.
PULMONARY: Denies cough, shortness of breath or labored breath.
MUSCULOSKELETAL: Normal gait, ambulates without assistance or limb.
NEUROLOGICAL: No headaches, dizziness, syncope, paralysis, ataxia, and denies numbness and tingling in the extremities. Denies seizures. Denies trauma.
PSYCHIATRIC: No depression or anxiety
OBJECTIVE DATA
:
VITALS: BP 120/68, P 86, RR 18, O2% 95%, 5’8”, 140#, BMI 21.3
GENERAL: Patient is a well-nourished 15-year-old Caucasian male. He is pleasant and cooperative. Complains of dull pain to knees. Right>left knee has catching sensation
CV: Heart sounds auscultated S1 and S2, no S3, no murmurs, no gallops noted.
GI: Flat abdomen, Bowel sounds normoactive in all 4 quadrants. No masses palpated.
PULMONARY: Chest symmetrical, unlabored breathing, Clear lung sounds in all fields, Percussion tympanic in all fields.
MUSCULOSKELETAL: Abnormal gait with limp favoring the right. Ambulates without assistance. No neck or back pain. Full ROM. Symmetrical bilateral upper extremities, no joint edema of pain. Full ROM. Full strength bilateral 5/5. Bilateral hip flexion 90 without pain, good strength 5/5. Right knee appears to have +1 edema to lateral aspect of knee and no bruising. Right knee is tender with palpation at the popliteal and tibiofemoral joint. Right knee is negative for the McMurray test. Negative Thessaly test to right knee. Right knee is positive at the Q angle 15 with clicking. Negative leg strength 4/5. Negative Thessaly’s test. Pain is passive and controlled range of motion. The left knee has no edema noted. Left knee has full ROM with .
Tmj Ankylosis In Still’s Disease – A Case ReportQUESTJOURNAL
ABSTRACT: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint swelling, joint tenderness, and destruction of synovial joints, leading to severe disability and premature mortality. TMJ complaints are present in about more than 50% of patients of RA. TMJ is usually among the last joint to be involved and is associated with many clinical signs and symptoms of which pain is a major problem later leading to inflammation, limited movements, swelling (joint stiffness) and muscle spasm. If it occurs in early age it may result in mandibular growth disturbance, facial deformity, and ankylosis and in adult these can vary from mild joint stiffness to total joint disruption with occlusal-facial deformity. The diagnosis and management of TMJ involvement in RA is exclusionary based on history, physical findings, radiographic study, and lab testing. Hence a multidisciplinary approach is necessary. The present paper reports a case of RA with bilateral TMJ involvement with its classical radiographic findings.
Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) an...MusaDanazumi
Abstract- Background and aim: Lumbar disc herniation with radiculopathy has been one of the most difficult conditions to manage in orthopedic manual therapy. While there are many clinical studies concerning the standardization of surgical treatment, there is to date no standardized literatures for the most effective non-operative care for lumbar disc herniation with radiculopathy which suggest that extreme measures to ameliorate lumbar disc herniation with radiculopathy are urgently warranted. In this study, a 35 year old man who was diagnosed with lumbar disc herniation and was planned for lumbar surgery due to failure of medical interventions was successfully treated using non-operative management.
Method: The management of the patient included Progressive Inhibition of Neuromuscular Structures (PINS), Spinal Mobilization with Leg Movement (SMWLM) and Therapeutic exercises inform of lumbar stabilization and stretching exercises. The patient was seen three times in a week over the period of 6 weeks after which the patient was discharged home without having lumbar surgery. Patient was assessed before and after treatments and during one and two year follow-ups using; Visual Analogue Scale (VAS) in the back and leg, Sciatica Bothersome Index (SBI), Sciatica Frequency Index (SFI) and Rolland-Morris Disability Questionnaire (RMDQ) for sciatica.
Results: After six weeks of management the patient had decreased in functional limitation (from 19 to 6), back pain (from 8 to 0), leg pain (from 10 to 2), sciatica frequency (from 18 to 8) and sciatica bothersomeness (from 18 to 8). These outcomes were maintained after one and two year follow-ups.
Conclusion: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement are effective in the management of patients diagnosed with lumbar disc herniation with radiculopathy.
Implication: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement may be considered as useful therapeutic non-operative measures for patients diagnosed with lumbar disc herniation with radiculopathy.
Index Terms- Progressive Inhibition of Neuromuscular Structures; Spinal Mobilization with Leg Movement; Lumbar Disc Herniation with Radiculopathy.
APA format 3 peer references needs to review case study and documentGrazynaBroyles24
APA format 3 peer references needs to review case study and document on differential diagnosis as to agreeing or disagreeing Due October 20.2018 at 5pm
Episodic/Focused SOAP Note Template
Patient Information:
A.S., 46 F, Caucasain
S.
CC
“ankle pain in both ankles; worse in right ankle, after hearing ‘pop’ while playing soccer.”
HPI
: A.S. is a 46 year old Caucasian female who presents with bilateral ankle pain which she describes as chronic for the last 3 months. She acutely injured her right ankle 3 days ago while playing soccer. The pain is described as aching with intermittent sharp characteristics. Associated symptoms include limited ROM. The pain is worse with weight bearing and OTC pain medications have included alternating doses of Tylenol and Motrin with moderate relief.
Current Medications
:
Motrin 200 mg by mouth every 4-6 hours as needed for pain
Hydrochlorothiazide 12.5mg by mouth daily for 6 months for HTN
Allergies: PCN- rash, no known food/environmental allergies
PMHx
: HTN; immunizations are up to date- last tetanus 12/2017; flu shot 10/2018 cholecystectomy 2015
Soc Hx
: A.S. is employed as a Registered Nurse and remains active by playing soccer three times a week. She is married with two teenage daughters. She denies tobacco and alcohol use.
Fam Hx
: Maternal grandmother deceased at age 56 from MI. Maternal father deceased at age 75 from complications of COPD. Paternal grandparents unknown. Father history is unknown. Mother is alive with type 2 diabetes that is well controlled with oral agents. Sibling age 43 alive and well. Children are alive and well with no medical hx.
ROS
:.
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema,
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.
GENITOURINARY: No burning on urination.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: pain and swelling to right ankle, limited weight bearing and ROM in b/l ankles, worse in the right ankle. No muscle cramping. No back pain.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
GENERAL: AAOx 3, limping gait, no distress. No fever. Skin is warm, dry, and intact. Skin of the lower extremities is warm and pink in color.
CARDIOVASCULAR: chest is ...
I need a response to this assignmentthree referenceszero pla.docxflorriezhamphrey3065
I need a response to this assignment
three references
zero plagiarism
SUBJECTIVE DATA
:
CC: “Complains of dull pain in both of his knees”
HPI: The 15-year-old Caucasian male complains of dull pain in bilateral knees. Complains of catching under unilateral or both knees. Onset gradual but increasing over time, especially in last two weeks. Dull knee pain and catching sensation behind the right knee cap. Rarely, notices the clicking in the left knee but continues to have less pain. Pain is worse with exercise and activity. Pain eases with rest, elevation and ice. Patient rates the right knee at 8/10 and left knee 6/10
PMI: Tonsillectomy at 5-year-old, Flu vaccination 2019 season, HPV immunization completed 2019, Tetanus 2019, hospitalizations
CURRENT MEDICATIONS: None
SH: RR is a middle school student at Austin Middle School. He plays football and basketball with the school. He is a nonsmoker and his household members are nonsmoking. He does not use alcohol and his father drinks 1-2 drinks/monthly and his mother does not drink. He lives in the house with both his parents. He makes good grades.
ROS
GENERAL: no weight loss, no chills, no fever, no fatigue.
CV: Negative for palpitations or flutters, negative for hypertension. No edema noted to bilateral upper extremities. No edema to lower extremities.
GI: No nausea/ vomiting no diarrhea, no stomach pain.
PULMONARY: Denies cough, shortness of breath or labored breath.
MUSCULOSKELETAL: Normal gait, ambulates without assistance or limb.
NEUROLOGICAL: No headaches, dizziness, syncope, paralysis, ataxia, and denies numbness and tingling in the extremities. Denies seizures. Denies trauma.
PSYCHIATRIC: No depression or anxiety
OBJECTIVE DATA
:
VITALS: BP 120/68, P 86, RR 18, O2% 95%, 5’8”, 140#, BMI 21.3
GENERAL: Patient is a well-nourished 15-year-old Caucasian male. He is pleasant and cooperative. Complains of dull pain to knees. Right>left knee has catching sensation
CV: Heart sounds auscultated S1 and S2, no S3, no murmurs, no gallops noted.
GI: Flat abdomen, Bowel sounds normoactive in all 4 quadrants. No masses palpated.
PULMONARY: Chest symmetrical, unlabored breathing, Clear lung sounds in all fields, Percussion tympanic in all fields.
MUSCULOSKELETAL: Abnormal gait with limp favoring the right. Ambulates without assistance. No neck or back pain. Full ROM. Symmetrical bilateral upper extremities, no joint edema of pain. Full ROM. Full strength bilateral 5/5. Bilateral hip flexion 90 without pain, good strength 5/5. Right knee appears to have +1 edema to lateral aspect of knee and no bruising. Right knee is tender with palpation at the popliteal and tibiofemoral joint. Right knee is negative for the McMurray test. Negative Thessaly test to right knee. Right knee is positive at the Q angle 15 with clicking. Negative leg strength 4/5. Negative Thessaly’s test. Pain is passive and controlled range of motion. The left knee has no edema noted. Left knee has full ROM with .
Tmj Ankylosis In Still’s Disease – A Case ReportQUESTJOURNAL
ABSTRACT: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint swelling, joint tenderness, and destruction of synovial joints, leading to severe disability and premature mortality. TMJ complaints are present in about more than 50% of patients of RA. TMJ is usually among the last joint to be involved and is associated with many clinical signs and symptoms of which pain is a major problem later leading to inflammation, limited movements, swelling (joint stiffness) and muscle spasm. If it occurs in early age it may result in mandibular growth disturbance, facial deformity, and ankylosis and in adult these can vary from mild joint stiffness to total joint disruption with occlusal-facial deformity. The diagnosis and management of TMJ involvement in RA is exclusionary based on history, physical findings, radiographic study, and lab testing. Hence a multidisciplinary approach is necessary. The present paper reports a case of RA with bilateral TMJ involvement with its classical radiographic findings.
Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) an...MusaDanazumi
Abstract- Background and aim: Lumbar disc herniation with radiculopathy has been one of the most difficult conditions to manage in orthopedic manual therapy. While there are many clinical studies concerning the standardization of surgical treatment, there is to date no standardized literatures for the most effective non-operative care for lumbar disc herniation with radiculopathy which suggest that extreme measures to ameliorate lumbar disc herniation with radiculopathy are urgently warranted. In this study, a 35 year old man who was diagnosed with lumbar disc herniation and was planned for lumbar surgery due to failure of medical interventions was successfully treated using non-operative management.
Method: The management of the patient included Progressive Inhibition of Neuromuscular Structures (PINS), Spinal Mobilization with Leg Movement (SMWLM) and Therapeutic exercises inform of lumbar stabilization and stretching exercises. The patient was seen three times in a week over the period of 6 weeks after which the patient was discharged home without having lumbar surgery. Patient was assessed before and after treatments and during one and two year follow-ups using; Visual Analogue Scale (VAS) in the back and leg, Sciatica Bothersome Index (SBI), Sciatica Frequency Index (SFI) and Rolland-Morris Disability Questionnaire (RMDQ) for sciatica.
Results: After six weeks of management the patient had decreased in functional limitation (from 19 to 6), back pain (from 8 to 0), leg pain (from 10 to 2), sciatica frequency (from 18 to 8) and sciatica bothersomeness (from 18 to 8). These outcomes were maintained after one and two year follow-ups.
Conclusion: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement are effective in the management of patients diagnosed with lumbar disc herniation with radiculopathy.
Implication: Progressive inhibition of neuromuscular structures and spinal mobilization with leg movement may be considered as useful therapeutic non-operative measures for patients diagnosed with lumbar disc herniation with radiculopathy.
Index Terms- Progressive Inhibition of Neuromuscular Structures; Spinal Mobilization with Leg Movement; Lumbar Disc Herniation with Radiculopathy.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. MRI FINDINGS OF VARIOUS
KNEE PATHOLOGIES
Interventional Radiology
CME & Live Workshop
Author: Dr. CHINTAN BANUGARIYA
Guide: Dr. Nalin G. Patel, Prof. & H.O.D
M.K. Shah Medical College & Research Centre
2. AIMS & OBJECTIVES
Performing MRI scan in patient’s
presenting with similar complaints – Knee
pain and difficulty in walking.
3. METHODS AND MATERIALS
Patients were evaluated in last 1 year on 1.5
Tesla MRI scanner – with MRI (plain &
contrast when required) protocol used in knee
joint.
4. LEARNING OBJECTIVE:
To demonstrate the application of high-
field (1.5T) MRI for the assessment of
knee pathologies.
To study specific signs on MRI in patents
with and without knee injuries. To
establish the role of MRI in their
management.
5. CASE:1
History –
H/O pain and effusion in the left knee
joint since 3 days. K/C/O sacro-iliatis. No
H/O trauma or fever or tuberculosis.
7. CASE:2
History –
C/O pain in left knee since few months. H/O frequent small
falls. No H/O of major trauma or fever.
8. Grade III extrusion of anterior horn
and body of medial meniscus on
T1W and T2W image
Mucoid degeneration of lower fibers of
anterior cruciate ligament
Subchondral edema in the anterior
aspect of medial tibial plateau on STIR
image
T1W T2W T2W
STIR
9. CASE:3
History -
H/O pain in the left knee joint, mainly on the medial
side of knee with increase in pain on climbing the
stairs, since 6 months. No H/O knee injury. Her
anterior drawer test is positive.
10. PD
T2W
T2W
DESS DESS
Complex meniscal tear in
the posterior horn of
medial meniscus on PD
and T2W.
Grade II changes
(moderate degree) of
chondromalacia patella
on T2W,and DESS
images.
11. CASE:4
History –
H/O pain in left knee while walking and
heaviness while walking since last 15
days. Past H/O trauma present before
10 year. O/E: Stress test negative.
12. Near complete tear of proximal fibers (Femoral
attachment) of anterior cruciate ligament.
Buckling of posterior cruciate ligament.
T2W
T2W
PD
15. CASE:6
History –
19 year old boy with H/O of joint
effusion since 2 months. H/O trauma 2
months back. H/O 3-4 episodes of fever
in last 2 months. ESR is raised.
16. PD STIR T1W
T1W+ Contrast
T1W+ Contrast
Synovial effusion.
Synovial Thickening
Changes of synovitis
Favor Possibility of
infective monoarthritis
(Possibly Tuberculous
in origin).
17. CASE:7
H/O pain in the right knee joint since 15
days. No H/O recent trauma. H/O
trauma 2 years back. H/O on and off
fever. O/E more pain in the anterio-
medial aspect of the knee joint.
History –
18. T1W PD T2W
PD FS T2W
Moderate synovial
effusion
Frond like thickening of
the of the synovium
suggestive of Lipoma
arborescens.
19. MRI “one-stop-shop” method of kneebecame
assessment before arthroscopic surgical
treatment. 1.5T MR-systems allow earliest
diagnosis of knee pathologies(1,2).
CONCLUSION
20. REFERENCES
1. Wilkinson ID, Paley MNJ. Magnetic resonance imaging:
basic principles. In: Grainger RC, Allison D, Adam,
Dixon AK, eds. Diagnostic Radiology: A Textbook of
Medical Imaging. 5th ed. New York, NY: Churchill
Livingstone; 2008:chap 5.
2. DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s
Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa:
Saunders Elsevier; 2009:chap 23.
3. Grainger RG, Thomsen HS, Morcos SK, Koh DM, Roditi
G. Intravascular contrast media for radiology, CT, and
MRI. In: Adam A, Dixon AK, eds. Grainger & Allison's
Diagnostic Radiology: A Textbook of Medical Imaging.
5th ed. New York, NY: Churchill Livingstone; 2008:chap
2.
Thank you…..
