Subjective Examination Cervical spine Amir
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This document provides information about conducting a subjective cervical spine examination. It discusses the anatomy of the cervical spine, possible causes of cervical pain, and components of the subjective examination. The subjective examination includes using a body chart to document the location, quality, and characteristics of pain. It also involves asking special questions about symptoms like dizziness and assessing factors like aggravating activities, easing techniques, and how symptoms impact daily living. The goal is to gather detailed self-reported information from the patient to guide the physical examination and evaluation of their cervical condition.
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Acute cerebellar ataxia is sudden inability to coordinate muscle movement due to disease or injury to the cerebellum. This is the area in the brain that controls muscle movement. Ataxia means loss of muscle coordination, especially of the hands and legs.
Causes
Acute cerebellar ataxia in children, particularly younger than age 3, may occur several days or weeks after an illness caused by a virus.
Viral infections that may cause this include chickenpox, Coxsackie disease, Epstein-Barr, echovirus, among others.
Other causes of acute cerebellar ataxia include:
Abscess of the cerebellum
Alcohol, medicines, insecticides, and illicit drugs
Bleeding into the cerebellum
Multiple sclerosis
Strokes of the cerebellum
Vaccination
Trauma to head and neck
Certain diseases associated with some cancers (paraneoplastic disorders)
Symptoms
Ataxia may affect movement of the middle part of the body from the neck to the hip area (the trunk) or the arms and legs (limbs).
When the person is sitting, the body may move side-to-side, back-to-front, or both. Then the body quickly moves back to a sitting upright position.
When a person with ataxia of the arms reaches for an object, the hand may sway back and forth.
Common symptoms of ataxia include:
Clumsy speech pattern (dysarthria)
Repetitive eye movements (nystagmus)
Uncoordinated eye movements
Walking problems (unsteady gait) that can lead to falls
Difficulty controlling arm movements
Exams and Tests
The health care provider will ask if the person has recently been sick and will try to rule out any other causes of the problem. Brain and nervous system examination will be done to identify the most affected areas of the nervous system.
The following tests may be ordered:
CT scan of the head
MRI scan of the head
Spinal tap
Blood tests to detect infections caused by viruses or bacteria
Treatment
Treatment depends on the cause:
If the acute cerebellar ataxia is due to bleeding, surgery may be needed.
For an ischemic stroke, medicine to thin the blood can be given. Removing a blood clot from within the blood vessels may also be needed.
Infections may need to be treated with antibiotics or antivirals.
Corticosteroids may be needed for swelling (inflammation) of the cerebellum (such as from multiple sclerosis).
Cerebellar ataxia caused by a recent viral infection may not need treatment.
Physical therapy may be needed to reduce risk of falling.Outlook (Prognosis)
People whose condition was caused by a recent viral infection should make a full recovery without treatment in a few months. Strokes, bleeding, or infections may cause permanent symptoms.
Possible Complications
Falls may result in injury.
In rare cases, movement or behavioral disorders may persist.
When to Contact a Medical Professional
Contact your provider if any symptoms of ataxia appear.
Alternative Names
Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA
References
Kuo SH, Lin CC, Ashizawa T.
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This document discusses degenerative spine diseases, including anatomy of the intervertebral disc, degenerative changes, symptoms, diagnosis, and management. The intervertebral disc has two main components - the annulus fibrosis and nucleus pulposus. Degenerative changes include decreases in water and proteoglycan content as well as tears in the annulus fibers. Common symptoms are back and leg pain, numbness, and weakness. Diagnosis involves physical exam, imaging like MRI, and ruling out other causes. Treatment options include conservative measures like medication and physical therapy as well as surgery for severe cases.
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Physiology of Special Chemical Sensation of Taste
Title: Sense of Taste
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)
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Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
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Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
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Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
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Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
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Physiology of Chemical Sensation of smell.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
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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.
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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
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Subjective Examination Cervical spine Amir
- 1. . 1
- 2. CERVICAL SPINE SUBJECTIVE EXAMINATION Dr. Alam Zeb AmiR DPT(KMU), MSPT(KMU) alamzebamir92@gmail.com
- 4. 4
- 5. 5
- 6. CERVICAL SPINE Consist of seven vertebrae(C1-7) C1(atlas),C2(axis) C1,C2,C7 called atypical vertebrae C3-C7 called typical vertebrae All cervical vertebrae have unique transverse foramina. Functionally it is divided in two regions: Upper cervical Spine (C0-2) Lower cervical spine(C3-C7) 6
- 7. CERVICAL SPINE Seven vertebrae C 1-7 More flexible Supports the head Wide range of motion Rotation to left and right Flexion Up and down Peripheral nerves Arms Shoulder, Chest and diaphragm
- 9. OC1 motion: Flexion/extension, and limited side bending C1-C2 motion Rotation/ slight flex/ext, and side bending Half of the total cervical rotation occur at C1-C2 C3-C7 motion Flex/ext/rotation/side-bending 9
- 12. POSSIBLE CAUSES OF PAIN AND/OR LIMITATION OF MOVEMENT ● Trauma – Whiplash – Fracture of vertebral body, spinous or transverse process – Ligamentous sprain – Muscular strain ● Degenerative conditions – Spondylosis – degeneration of C2–C3 intervertebral disc – Arthrosis – degeneration of zygapophyseal joints 12
- 13. POSSIBLE CAUSES OF PAIN AND/OR LIMITATION OF MOVEMENT ● Inflammatory conditions – Rheumatoid arthritis – Ankylosing spondylitis ● Neoplasm ● Infection ● Headache – Migraine – Tension-type headache – Cluster headache • Cervical rib • Torticollis • Hypermobility syndrome 13
- 14. SUBJECTIVE EXAMINATION 14 Location Referred pain MOI Quality Depth Intensity Constant or Intermittent Aggravating Factors Easing Factors 24 -hour pattern
- 15. SUBJECTIVE EXAMINATION Body chart Area of current symptoms Areas relevant to the region being examined Quality of pain Intensity of pain Depth of pain Abnormal sensation Constant or intermittent symptoms Behaviour of symptoms Severity and irritability of symptoms Twenty-four hour behaviour of symptoms Function Stage of the condition 15
- 16. Special questions History of the present condition (HPC) Past medical history (PMH) Social and family history Plan of the physical examination 16
- 17. 17
- 18. BODY CHART 18
- 19. SPECIAL QUESTIONS FOR CERVICAL SPINE Signs of some Cervical Arterial Dysfunction, upper cervical instability, disease of inner ear 5 D’s Dizziness Drop attacks Dysphagia (swallowing problems) Dysarthria (speech problems) Diplopia ( Double vision)
- 20. Subjective Examination Body Chart Type & area of symptom Depth Quality Intensity Abnormal Sensation Relationship of Symptoms Behavior of Symptoms Aggravating factors Easing Factors Severity & Irritability 24 hrs behavior Daily Activity Stage of Condition Special Questions General Health Drugs Steroids Anticoagulant s Weight loss – recurrent unexpected Rheumatoid Arthritis Spinal Cord Cauda equina symptoms Dizziness X-ray (recent) History of Present Illness How it started? Past Medical History Relevant Medical History Previous Attacks Effects of previous treatments Social & Family History Age Gender Home of work situation Dependents Leisure Activities
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Editor's Notes
- The vertebral arteries arise from the subclavian arteries, one on each side of the body, then enter deep to the transverse process at the level of the 6th cervical vertebrae (C6),[1] or occasionally (in 7.5% of cases) at the level of C7. They then proceed superiorly, in the transverse foramen of each cervical vertebra.[1] Once they have passed through the transverse foramen of C1 (also known as the atlas), the vertebral arteries travel across the posterior arch of C1 and through the suboccipital triangle[citation needed] before entering the foramen magnum.[1]