Thursday, September 30, 2010

T6, Wk4, Day 352 - My Friend Died ...

My friend and my neighbor died - same person. He died this past Saturday and I just found out tonight. They were watching my dog when I went to the Ozarks to study. When I got back late Sunday night, his wife had left me a note on the kitchen table letting me know something unexpected had suddenly come up and they had to leave. She left me a couple phone numbers to call her at and did underline the word "please" in the note, with reference to calling. It was about 1:30 a.m. when I got home and figured it was too late to call. They hadn't been home all week and I had a feeling someone in their family had probably died. I just didn't think it was Scott. He's my age, a few months older. We don't know what he died from and I heard an autopsy is being performed to determine the cause of death.

Scott had been trying to sell his truck and was going to buy a computer with the proceeds. Then we'd be able to IM each other when we wanted to "take a break" and meet outside to have a smoke or something. His daughter, Dianne, turned 10 this year and just started the 6th grade. Up until this grade, Scott always walked his daughter to school and always went to the school to walk home with her. She was just starting to walk home alone this grade.

I'd auscultated Scott's back to check on his lung condition, kind of wondered if i missed something or if there was something I could have found. I know I couldn't tell where the lungs ended because I wasn't able to detect a sound difference down past where the diaphragm should have been.

It's kind of a numb surreal night. I must have talked with the guy almost every night for as long as I've lived here. I'd show him all the new books I'd get for school each semester and he would always share his latest finds from various flea markets. One of his last discoveries was a set of Navy Uniforms from World War II. We were supposed to get his set up on ebay after he got his computer. I was sure he would be able to pick up my wireless internet so all he needed was the computer.

He also recently found an old movie projector with reels from the 1930's.

I just don't get it. I don't understand.

One thing that really kind of made me sad was ....for as long as he lived here and for all the pictures I take. I never got a picture of us together. I never thought of it so I don't have a picture to post. I'm guessing he might be in some random shot I took - I'm not sure.
You just never know.

Just had an old classmate die last month. She was a year younger, a runner, vegetarian and a wife with two kids - died of cancer.

I have a phys dx II exam tomorrow. I should probably call Nancy.

Wednesday, September 29, 2010

T6, Wk4, Days 350, 351 - Tue & Wed

Today (Wed) was pretty simple and strightforward. Two hours of Phys Dx II, then two hours of Dx Imag II, a two hour lunch break then two hours of Phys Dx II Lab.

For tomorrow, we have two hours of Neurology, two hours of EENT, two hour Lunch, then three hours of Clinical Reasoning. We need to be able to get through a lumbar regional exam in 20 minutes. For Phys Dx lab we need to get through our Lung check up in 7 minutes and probably the same for the breast exam.

Our first test of the semester is this Friday in Phys Dx II and we have our first practical next Wednesday in Phys Dx II Lab. Things are starting to roll in.

I was talking to a Tri-9 today who keeps telling me things just get harder and harder. She mentioned she has a week coming up with 50 hours of NBS review for Part IV National Boards, 24 hours of work at a nearby clinic and 21 hours of classes. She said NBS is 10 hours on Saturday and Sundays then an additional 5 hours each night.

I also looked into a post graduate degree program, I'm eligible to sign up for to get certified as an internal health specialist. I think it's a 120 hour program and, as a student, the price is quite reasonable.

No pics because I just want to go to bed ...I've really been feeling physically obliterated lately.

Monday, September 27, 2010

T6, Wk4, Day 349 - Monday. Radiology Rotation

These are pictures from the Radiology Conference Room at Logan. The picture to the right is where one of the DACBRs would sit to read digital x-rays. There's a microphone so others in the room can hear what's being diagnosed.


The picture to the left shows viewing screens for other students and doctors to view and learn from while the main doctor is going over various diagnostic imaging files. I was going to say x-ray but we also got to look at several MRIs and Ultra sounds in addition to digital x-rays.





This last picture is from an opposing side of the room and shows where that old fashioned type of x-ray film is looked at, by shining light through the developed film.

What I found very interesting was the only thing that differentiates digital x-ray from conventional x-ray is the film and the processing machine. Any current x-ray machine can produce digital x-rays with the correct type of film and processor. Digital film is good for about 10,000 exposures.





T6, Wk3, Days 346, 347, 348 - Wed, Thur, Fri

I'm having a heck of a time staying caught up with my blog. Ironically enough, I still seem to have enough time to produce level 56 Sake on my Facebook Farmville game (as well as level 800 something in Mafia Wars) ....

oh well, I don't really drink or do much of anything else so I sometimes refer to those games as my "drug of choice" when it comes to escaping reality for a bit.

Last week kind of rocked w/ the radiology rotation. I took a picture of the conference room w/ my cell phone and will post that as my picture in my next blog - just getting the days caught up here.

Tuesday, September 21, 2010

T6, Wk3, Days 344, 345, Mon & Tue

just a couple of long days. 9 hours of class yesterday and another 9 hours of classes today.

tomorrow will be 7:20 until about 6 p.m. or whenever the radiology rotation is over.

rotations will be over tomorrow -

Let's see, We've got another extra activity due in about 5 weeks for our Patient Communication class. We don't have any details about the assignment, just something extra for our plates.

When I talk with Tri 8's and 9's they just kind of shake their head at all the extra stuff they have to do and I have to wonder how much all the extra activities help us learn about being good doctors as opposed to just get us used to jumping through hoops.

Today's picture is of Sarah Palin. She was at Logan this past Friday to give a talk for the Young President's Club.

Monday, September 20, 2010

T6, W2, Days 339, 340, 341, 342, 343, M-F

Other then when I tried pledging, I think this is the longest I've gone between blogs during any semester so far. To me, this semester is significantly more difficult than any I've encounter so far. Previously, it was like racing down highway 64 at 80 mph in a giant bumper car with every lane covered in oil ...you'd smash into walls to the right and left, as well as other cars but just had to keep moving forward regardless of the collisions. This semester is like that except the road is now at a 30 degree incline so even more effort is needed just to maintain pace.

I have been on top of things as far as all the extra assignments are concerned. Last weekend I knocked out the extra Neurology assignment we had and, as of this past Thursday found out that only a total of two people in the class had completed that assignment so kudos there (I'll take the kudos when I can get them) ;)

Also, this past week, I knocked out my Laboratory Rotation. We have to dress in clinic attire for that which is almost a bit ironic, if not funny, because I'm having to wear a shirt and tie to look at urine under a microscope! LOL

Most of the time, however, we looked at blood under the microscope and we spent a couple hours looking through the microscopes and counting the different types of white blood cells (WBCs) which, was pretty cool because we've spent so much time learning about those different WBCs like neutrophils, lymphocytes, monocytes, eosinophils and basophils. With neutrophils we looked for those called bands and stabs. For many cells, and WBC in particular, there are various stages of development of the cells that are of clinical importance. Bands & stabs may be analogous to a person who may be either an infant or adolescent.

Today (Sunday) ...well, actually, I guess that was yesterday since it's about 4 a.m. Monday now (9/20) but, yesterday I went to the local Humane Society at 1 p.m. to get training on being a volunteer and then stayed until about 4 o'clock playing with the animals and walking some dogs. This fulfills my community service requirement for my professional development class. We need a total of four hours and I've got 75% in now and will easily finish up my time by the end of next weekend.

This week, on Wednesday, I'll complete my Radiology Rotation. It's another dress up day and one I'm looking forward to. I think I'm signed up for a 3:50 p.m. rotation and should be done by 6 p.m. I've been wanting to sit in on some of the radiology meetings and this gives me the mandated opportunity to do that.

I've got a HUGE amount of respect for those DACBR's (board certified radiologist) as well as any doctor with a diplomat or advanced training in any specialty. That DACBR certification really puts you head and shoulders above the masses and it does so for any type of doctor, whether you're an MD, DC or DO. Still, the reality of it seems very far away and is still somewhat intimidating. However, after another year of radiology at the doctoral level it might not seem so daunting. Plus, let's not forget it's another three years of schooling just for an opportunity to be tested ....no guarantee you'll become board certified ...just an opportunity to test.

I think, however, the enormous scale and difficulty level of becoming a DACBR is somewhat appealing. One of the most appealing aspects of radiology study is how much it encompases so many other disciplines such as pathology, microbiology and anatomy, for instance.

Week 3, Day 1 is a massive day that runs from 7:20 a.m. to 4:35 p.m. We have;
Jurisprudence - (2 hours)
Physical Dx II - (1 hour)
Dx Imag II - (1 hour)
Clinical Reasoning - (1 hour)
SHC Practicum II - (4 hours)

geez ...that's 9 hours worth of classes alone, plus a one hour lunch and a couple hours commute for me ....makes for a hefty day. Wednesday will be similar but even longer with my Radiology rotation.

This is a challenge - a huge, enormous challenge ...

Sunday, September 12, 2010

T6, Wk1, Day 338, Friday - ProD & Neurology


Whew! It's 3:30 in the morning and I've got to be up in two hours to get ready for school! Not sure what happened but, after a lackluster Saturday and a relatively lax Sunday morning, I kind of went into overdrive and got a bunch of much needed stuff done Sunday evening ...well, and Monday morning.

Pro-D - we have to complete four hours of community service for that class as one of our requirements. I sent an email out to a local humane society to get info on volunteering but, the email just got kicked back to me. I might have to go there in person to get the scoop.

Neurology - One extra requirement for that class is to complete an online course dealing with Stroke & Manipulation. There's that fear out there by some (and perhaps mostly by people wanting to discredit chiropractic) that a cervical adjustment may lead to a stroke. So, it looks like the NCMIC, which is the main malpractice insurance provider to chiropractors (at least in the US), has sponsored an online course regarding stroke and cervical adjustments.

The course was pretty interesting. This is something we needed to get done by midterms otherwise our final grade in the class would be reduced by a FULL letter grade and, if we don't do it at all well, ya don't pass the class.

OK - I JUST GOT TO THINKING - and the result of that thinking was a new post on Facebook - here's the post.

Just doing the math .... there are about 700,000 strokes annually in the US so with a population of 300 million that comes out to 1 in every 428 people. Then I look at 6 different studies which cite the rate of stroke associated with chiropractic manipulation at less than 1 in a million ... hmmmm Actually, averaging those 6 studies from '78 to '96 gives a rate of 1 in 3.375 million


bbbOK ~ there just isn't going to be any sleep tonight ...it's almost 5 a.m. now but I've still gotten a lot of things done and a lot of those things needed to be done.

Wow ...today we have Jurisprudence, Phys Dx II, Dx Imaging II, Clinical Reasoning and SHC Practicum II ...
I'm never quite clear w/ HCP but, it looks like we're going to have 3 hours of it tomorrow. I've got a fellow classmate as a patient and she'll be mine for the entire semester and visa versa.

Well, maybe a 15 minute nap then I need to get ready for school. :)

Today's picture is of a normal vertebral artery. There are actually little holes along side the vertebrae in your neck that the vertebral artery (VA) runs through. The artery does not slide through those holes, rather, it stretches when you do things like turn your head or nod up and down. The VA supplies about 1/3 of the blood for your brain. The internal carotid arteries supplies the other 2/3rds.

Thursday, September 9, 2010

T6 – Wk1, Day 337 – Ch10 Arthritic Disorders Outline

From Yochum and Rowe's Essentials of Skeletal Radiology, 3rd ed, Volume Two

Ch 10 – Arthritic Disorders
(broad outline)

  • INTRODUCTION TO RADIOLOGIC INTERPRETATION IN JOINT DISEASE
    • Perspectives in Interpretation of Joint Disease
    • Anatomic Considerations
    • Radiologic Considerations
    • Differential Diagnosis of Arthritis
  • DEGENERATIVE DISORDERS – pg 958
    • Degenerative Joint Disease
    • Erosive Osteoarthritis
    • Diffuse Idiopathic Skeletal Hyperostosis
    • Ossified Posterior Longitudinal Ligament Syndrome
    • Neurotrophic Arthropathy
    • Synoviochondrometaplasia
  • INFLAMMATORY DISORDERS – pg 1010
    • Rheumatoid Arthritis
    • Juvenile Rheumatoid Arthritis
    • Ankylosing Spondylitis
    • Enteropathic Arthritis
    • Psoriatic Arthritis
    • Reiter's Syndrome
    • Systemic Lupus Erythematosus
    • Jaccoud's Arthritis
    • Idiopathic Chondrolysis of the Hip
    • Scleroderma
    • Osteitis Condensans Ilii
    • Osteitis Pubis
    • Hypertrophic Osteoarthropathy
  • METABOLIC DISORDERS – pg 1084
    • Gout
    • Calcium Phyrophosphate Dihydrate Crystal Deposition Disease
    • Hydroxyapatite Deposition Disease
    • Ochronosis
    • Tumoral Calcinosis
    • Sarcoidosis
    • Pigmented Villonodular Synovitis

 

Ch 10 – Arthritic Disorders
(specific outline)

INTRODUCTION TO RADIOLOGIC INTERPRETATION IN JOINT DISEASE

  • Perspectives in Interpretation of Joint Disease – over 100 rheumatic conditions have been identified and classified. By understanding joint anatomy, pertinent clinical features, pathophysiology and important roentgen signs, a single dx or sort list of diff dx can usually be made.
    • Incidence of Individual Arthrities
      • weekly –
        • DJD (osteoarthritis)
      • Montly –
        • ankylosing spondylitis,
        • CPPD,
        • DISH,
        • Osteitis condesans ilii,
        • Psoriatic arthritis,
        • rheumatoid arthritis
        • synoviochondrometaplasia
      • Yearly
        • Gout
        • Infection
        • SLE
        • Reiter's syndrome
        • Scleroderma
    • Cinical Information – Table 10-2, General Age of Onset of Arthritis
      • 0-20 Years
        • Juvenile rheumatoid arthritis
      • 20-40 Years
        • Anklylosing spondylitis
        • Osteitis condensans ilii
        • SLE
        • Psoriatic arthritis
        • Reiter's syndrome
        • Scleroderma
        • Synoviochondrometaplasia
      • >= 40 Years
        • DJD
        • DISH
        • Gout
        • Hypertrophic osteoarthropathy
        • Pseudo-gout (CPPD)
    • Cinical Information – Table 10-3, Arthropathies Associated with Distinct Sex Predilection
      • Male
        • Ankylosing spondylitis
        • gout
        • hypertrophic osteoarthropathy
        • reiter's syndrome
        • secondary osteoarthritis
      • Female
        • Juvenile rheumatoid arthritis
        • SLE
        • Osteitis condensans ilii
        • Primary osteoarthritis
        • rheumatoid arthritis
        • scleroderma
  • Anatomic Considerations – pg 952. Essentially, three broad categories of articulations exist in the body and are classified according to the tissue type at the junctional region: fibrous, cartilaginous and synovial.
    • Fibrous Joints – example; cranial sutures; syndesmoses (tibia-fibula, radius-ulna)
    • Cartilaginous – ex. symphysis pubis; intervetebral discs, manubriosternal junction. regarding IVD's, the inner fibers are made up of fibrocartilage and the outer fibers of collagen. attachment to the annulus is by way of penetrating fibers and Sharpey's fibers.
    • Synovial – ex, fingers, toes, knees, hips; apophyseal joints, sacroiliac joints
      • Joint Capsule – essentially serves the function of a ligament and not normally visible radiographically.
      • Synovial Membrane –
      • Synovial Fluid – a direct dialysate of blood plasma to which is added a mucoid substance secreted by the synovium. – provides lubrication and nutrition for the joint
      • Articular Cartilage – hyaline is the most common. it is composed of chondrocytes embedded in a matrix of collagen fibrils and a ground substance made up of mucopylysacchardes, particularly chondroitin sulfate
      • Subchondral Bone Plate – bony tissue beneath the articular cartilage is composed of a thin cortex and underlying cancellous trabeculae.
  • Radiologic Considerations – pg 954    
    • Technologic Aspects – xray examination of a joint requires a minimum of two views perpendicular to each other with at least one view clearly demonstrating the opposing articular sufaces.
    • Anatomic-Radiologic Correlation – use the ABC's approach
      • A, Alignment
      • B, Bones
      • C, Cartilage
      • S, Soft tissue
    • Basic Terminology in Joint Disease – pg 955
      • enthesis – anatomic term for the transition zone btw bone and ligament or tendon
      • enthesopathy – inflammatory cellular infiltrate at the bone-ligament or bone-tendon junction. Seen in inflammatory arthritides, especially ankylosing spondylitis as cortical erosion and periostitis.
      • erosion – loss of bone owing to pressure atrophy or active breakdown of bone tissue.
      • hyperostosis – Exuberant ossification of a ligament or tendone, characteristically seen in diffuse idiopathic skeletal hyperostosis.
      • monoarticular – a single joint is involved in the dz process.
      • non-uniform loss of joint space – localized decrease in the joint cavity owing to isolated loss of cartilage usually at the most stressed site. This is a sign of degenerative arthritis.
      • osteophyte – degenerative bony outgrowth continuous with underlying cortex, covered with a cartilaginous cap, occurring at the insertion of a ligatent near a joint.
      • pauciarticular – two to four joints are involved in the dz process.
      • periostitis – elevation of the periosteum results in localized periosteal new bone and is seen in inflammatory arthritides.
      • polyarticular – more than four joints are involved in the dz process.
      • threumatoid variants – inflammatory arthropathies that may simulate theumatoid arthritis clinically but lack theumatoid factor and show different pathologic and radiographic features.
      • seronegative arthritis – inflammatory arthritis that lacks the presence of rheumatoid factor, including ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome and enteropathic arthritis.
      • spondyloarthropathy – inflammatory arthritis involving the spine.
      • spondylophyte – degenerative spinal osteophyte.
      • symmetric pattern of joint involvement – when comparing one side of the body with the other or one joint to another, the changes appear similar.
      • syndesmophyte – inflammatory ossification within a spinal ligament, especially ankylosing spondylitis (marginal type) and, less commonly, psoriasis or Reiter's syndrome (non-marginal type).
      • uniform loss of joint space – the entire joint cavity is decreased owing to complete loss of the cartilage independent of stressed areas: This is a sign of inflammatory arthritis.
  • Differential Diagnosis of Arthritis, pg 955 – A successful diff dx among arthritic disorders is based on the correlation of clinical, pathologic and radiographic findings.
    • Inflammatory - …these include rheumatoid arthritis, psoriasis, ankylosing spondylitis and Reiter's syndrome.
    • Degenerative – in contrast to inflammatory dz, here we exhibit a non-uniform loss of joint space, Osteophytes, subchondral sclerosis, subchondral cysts and a predilection for being distrinctly asymmetric.
    • Metabolic – joint spaces are generally preserved …

My head is going to explode! I need to switch now to a different topic ….

DEGENERATIVE DISORDERS – pg 958

  • Degenerative Joint Disease
  • Erosive Osteoarthritis
  • Diffuse Idiopathic Skeletal Hyperostosis
  • Ossified Posterior Longitudinal Ligament Syndrome
  • Neurotrophic Arthropathy
  • Synoviochondrometaplasia

INFLAMMATORY DISORDERS – pg 1010

  • Rheumatoid Arthritis
  • Juvenile Rheumatoid Arthritis
  • Ankylosing Spondylitis
  • Enteropathic Arthritis
  • Psoriatic Arthritis
  • Reiter's Syndrome
  • Systemic Lupus Erythematosus
  • Jaccoud's Arthritis
  • Idiopathic Chondrolysis of the Hip
  • Scleroderma
  • Osteitis Condensans Ilii
  • Osteitis Pubis
  • Hypertrophic Osteoarthropathy

METABOLIC DISORDERS – pg 1084

  • Gout
  • Calcium Phyrophosphate Dihydrate Crystal Deposition Disease
  • Hydroxyapatite Deposition Disease
  • Ochronosis
  • Tumoral Calcinosis
  • Sarcoidosis
  • Pigmented Villonodular Synovitis

T6 - Wk1, Day336 - Wednesday

First day of class - didn't get my blog in yesterday but sure thought about it. I'm getting distracted here - I just downloaded a pdf file of P450 inducers and inhibitors ...medically inclined, to be sure but, not exactly having anything to do with any of my current classes.

I did get a new book today! Cecil Medicine, 23rd edition. It's a recommended book for our Neurology class as well as a required book next tri for endocrinology. This new edition just came out last year and I found a 1990 Cecil book in the library that was 21st edition so I'm figuring this 23rd edition should serve me well for a while. The darn thing is over 3,000 pages long! :)

I'm posting a separate blog for today because I think I'm going to outline Chapter 10 in Essentials of Skeletal Radiology for my Thursday (Day 337) blog. Kind of killing two birds with one stone by using word to directly blog a document that I actually need and can use for class as well as share information to whoever cares to read about this stuff :)

I'm kind of starting to get amazed at the amount of stuff i'm recognizing and familiar with. There was a commercial on television the other day talking about menstrual cycles and I'm thinking to myself it sounds like amenorrhoea and I'll be darned if that wasn't the next word that popped up on the screen! :)

Then today, I'm listening to the radio and a local med school is looking for patients with meniere's disease and I suddenly think of meniere's triad ..thinking vertigo, vomiting and tinnitus ...I'm not sure if that's the exact triad of symptoms but I did hear the radio go on to mention the vertigo and ringing in the ears so, it was definitely the same thing :)

I read a bit of neurology in the Cecil Medicine book today. Oh, and Oxford University released a study today about how B vitamins slow brain atrophy in people with memory problems.

Anyway, I need to get focused. Chapter 10 is 170 pages long so I've got my work cut out for me tonight. Look for the outline in tomorrow's post. :)

oh, today's pic is of my Cecil Medicine book :)

meniere's triad

Saturday, September 4, 2010

Outline - Ch 39 Degenerative Dzs of the Nervous System

From Adams and Victor's Principles of Neurology, Ninth Edition

Part 4: Major Categories of Neurologic Disease, pg 589

Ch 39: Degenerative Diseases of the Nervous System, pg 1011-1080

General Clinical characteristics of Degenerative Diseases

General Pathologic and Pathogenic Features

  • Clinical Classification
    • Syndrome of progressive dementia, other neurologic signs being absent or inconspicuous
      • Diffuse cerebral atrophy
        • Alzheimer dz
      • Circumscribed cerebral atrophies including primary progressive aphasias and progressive visuospatial disorders
        • pick dz (lobar sclerosis)
        • frontotemporal dementias including primary progressive aphasias
    • Syndrome of progressive dementia in combination with other neurologic abnormalities
      • Huntington dz (chorea)
      • Lewy-body dz
      • some cases of Parkinson dz
      • corticobasal ganglionic degeneration
      • cortical-striatal-spinal degeneration (Jakob dz)
      • Demential-Parkinson-anyotrophic lateral sclerosis complex
      • cerebrocerebellar degeneration
      • Familial dementia w/ spastic paraparesis, amyotrophy or myoclonus
      • Polyglucosan body dz
      • Frontotemporal dementia with parkinsonism or ALS
    • Syndrome of disordered posture and movement
      • Parkinson dz
      • multiple system atrophy (striatonigral degeneration and Shy-Drager syndrome
      • Progressive spuranuclear palsy
      • Dystonia musculorum deformans
      • Huntington dz (chorea)
      • Acanthocytosis with chora
      • Corticobasal ganglionic degeneration
      • Lew-body dz
      • Restricted dystonias, including spasmodic torticollis and Meige syndrome
      • Essential tremor
    • Syndrome of progressive ataxia
      • Spinocerebellar ataxias (early onset)
      • Cerebellar cortical ataxias
      • Complicated hereditary and sporadic cerebellar ataxias
        • Olivopontocerebellar degenerations (OPCA)
        • w/ extrapyramidal and autonomic degeneration
        • (Menzel type)
      • Dentatorubral degeneration
      • Dentatorubropallidoluysian adtrophy (DRPLA)
      • Machado-Joseph (Azorean) dz
      • Other complicated late onset …
    • Syndrome of slowly developing muscular weakness & atrophy
      • Motor disorders w/ amyotrophy
        • ALS, et. al.
      • Spastic paraplegia without amyotrophy
        • primary lateral sclerosis
        • hereditary spastic paraplegia (Strumpell-Lorrain)
    • Sensory and sensorimotor disorders (neuropathies; see ch46)
    • Syndrome of progressive blindness or ophthalmoplegia with or without other neurologic disorders (see ch 13)
    • Syndromes characterized by degenerative neurosensory deafness (see ch15)
  • Diseases Characterized Mainly By Progressive Dementia
    • Alzheimer Disease – most common and important degenerative disease of the brain …
      • Epidemiology – majority of pts are in their 60s or older.
      • Clinical Features (see also ch21) – The gradual development of forgetfulness is the major symptom.
        • echolalia – a rather dramatic repetition of every spoken phrase
        • acalculia or dysalculia – when a pt can no longer carry out the simplest calculations
        • ideational and ideomotor apraxia – advanced forms of motor incapacity
      • Minimal Cognitive Impairment (MCI)
        • 1. Korsakoff amnesic state – a disproportionate failure of retentive memory w/ integrity of other cognitive abilities – immediate memory is essentially a measure of attention – short term and long-term (retentive) memory fails
        • 2. Dysnomia – the forgetting of words, especially proper names. Later the difficulty involves common nouns & progresses to the point where fluency of speech is seriously inpaired. Every sentence is broken by a pause and search for the wanted workd; if this is not found, a circumlocution is substituted or the sentence is left unfinished.
        • 3. Visuospatial disorientation – Parietooccipital functions are sometimes deranged in the course of Alzheimer dz and may fail while other functions are relatively preserved.
        • 4. Paranoia and other personality and mood changes – frequently, at some point in the development of Alzheimer dementia, paranoia or bizarre behavior occasionally assum prominence.
      • For research purposes, etc – exclusive criteria for the dx of Alzheimer dz two groups have adopted 5 criteria. The two groups are National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer's Dz and Related Dz's Association (ADRDA). The 5 criteria are
        • 1. dementia defined by clinical examination (the Mini-Mental Scale, see Table 21-6)
        • 2. pt older than 40
        • 3. deficits in two or more areas of cognition and progressive worsening of memory and other cognitive functions such as language, perception and motor skills (praxis)
        • 4. absence of disturbed consciousness
        • 5. exclusion of other brain dz
      • using these criteria, correct diagnosis is achieved in more than 85 percent of patients.
    • Pathology – in advanced stages the brain presents a diffusely strophied appearance and it's weight is usually reduced by 20 percent or more. Cerebral convolutions are narrowed and sulci are widened (I saw an example of this in Neuro lab w/ Dr. Clifford)
      • Three microscopic changes give this dz its distinctive character
        • 1. presence within the nerve cel cytoplasm of thick, fiber-like strands of silvers-staining material, also in the forms of loops, coils or tangled masses ("tangles")
        • 2. spherical deposits of amorphous material scattered throughout the cerebral cortex and easily seen w/ periodic acid-schiff (PAS) and silver-staining methods – the core of the aggregates is the protein amyloid surrounded by degenerating nerve terminals (neuritic plaques)
        • 3. Granulovacuolar degeneration of neurons, most evident in the pyramidal layer of the hippocampus – probably, this last change is reactive and least important in diagnosis
    • Pathogenesis –
      • Tau, when talking about a protein in this context is not the Greek letter but rather an acronym for "tubulin associated unit"
      • APP – amyloid-protein precursor
      • The gene coding for APP is located on chromosome 21, one of the regions linked to one type of familial Alzheimer dz and the duplicated chromosome in Down syndrome – possible overproduction of amylid and all its ABeta residues as being causative factors in the dz. other mechanistic theories exist
    • Diagnostic Studies – CT scanning and MRI are useful, but not definitive, ancillary test.
      • In advanced stages, the lateral and third ventricles are enlarged to about twice normal size and cerebral sulci are widened.
      • SPECT, single-photon emission for study of cerebral blood flow
      • PET, positron emission tomography, for metabolism study
      • Newer PET ligand agents that bind to amyloid, such as the "Pittsburgh compound" are more sensitive in identifying and plotting the course of Alzheimer disease.
    • Differential Diagnosis (see also Table 21-3) – Alzheimer dz is a form of dementia – The potentially treatable forms of dementia are those caused by normal-pressure hydrocephalus; chronic subdural hematoma; the dementia of AIDS; paraneoplastic limbic encephalitis; nutritional definciencies (thiamine – Wernicke-Korsakoff syndrome, Marchiafava-Bignami dz, pellagra, vitamin B12 deficiency); chronic drug intoxication (e.g., alcohol, sedatives); multiple cerebral infarctions; certain endocrine and metabolic disorders (myxedema, Hashimoto encephalopathy, neurosyphilis and other chronic meningitides, Cushing dz, chronic hepatic encephalopathy); frontal and temporal lobe tumors; cerebral vasculitis; sarcoidosis; Whipple dz; multiple sclerosis; and perhaps above all, the pseudodementia of depression. Exclusion of most of these diseases is readily accomplished by sequential outpatient evaluations or by a brief admission to a hospital were examinations of blood CSF, EEG, CT, MRI and neuropsychologic testing can be undertaken.
    • Treatment – there is no evidence that any of the previously proposed forms of therapy for Alzheimer dz – cerebral vasodilators, stimulants, L-dopa, massive doses of vitamins B, C and E, gingko biloba and many others has any salutary effect. Trials of oral physostigmine, choline and lecithin have yielded mostly negative or uninterpretable results and the evidence favoring the currently popular cholinergic precursors and agonists and acetylcholinesterase inhibitors, such as donepezil, is valid but only modest. With regard to the latter group of drugs, several large trials have demonstrated a slight prolongation of the pts ability to sustain an independent life, but such evidence generally requires that the medications be taken for 6 to 12 months. ….
      • NMDA – N-methyl-D-aspartate – here I'm assuming we're talking about NMDA receptors as mentioned in previous blogs pertaining to neuromusculoskelatal dx (NMS). The NMDA – N-methyl-D-aspartate glutaminergic antagonists, specifically memantine (20mg daily), have also been tried. - …there was no change in three main measures of cognitive performance but, because the side effects were ostensibly minor this drug was approved for use in late-stage Alzheimer dz and in conjunction with cholinergic drugs.
    • Associated Pathologic States – Amyloid plaques and tangle deposition are far more common in the brains of pts w/ Parkinson dz (20 to 30 percent) than in the brains of age-matched controls. These findings partly explain the high incidence of dementia in pts w/ Parkinson disease.
    • Lobar Atrophies (Pick Disease and Frontotemporal Dementia)
      • Clinical Features –
    • Frontotemporal Dementia –
    • Primary Progressive Aphasia
    • Posterior Cortical Atrophy
    • Lewy-body Dementia
      • Clinical Features
    • Other Degenerative Dementias
      • Diffuse Cerebral Atrophy of Non-Alzheimer Type
      • Argyrophilic Grain Disease
      • Thalamic Dementia
      • Neuroserpinopathy
    • Vascular (Multiinfarct) Dementia
    • Denentia Caused by Metabolic Diseases (see ch 37)
  • Dementing Diseases in Which Other Neurologic Abnormalities are Prominent
    • Huntington Disease (Huntington Chorea)
      • This disease is distinguished by the triad of dominant inheritance, choreoathetosis and dementia, commemorates the name of George Huntington, a medical of Pomeroy, Ohio. In 1872, his paper, read before the Meigs and Mason Academy of Medicine and published later that year in the Medical and Surgical Reporter of Philadelphia, gave a succinct and graphic account of the disease that was based on observations of patients that his father and grandfather had made in the course of their practice in East Hampton, Long Island.
      • A marker linked ot the Huntington gene and localized to the short arm of chromosome 4 was the first important achievement in respect to the biologic understanding of Huntington dz.
      • The mutation was an excessively long repeat of the trinucleotide CAG within the Huntington gene – the length of the repeating pattern not only determines the presence of the dz but also the age of onset – the longer the repeating length, the earlier appearance of signs.
      • A rare alternative mutation, termed HDL2 (Huntington dzlike-2) is associated with CATCG repeat expansion of the juntophilin-3 gene but it is so rare that few clinicians will encounter it …so, maybe we'll see this on the TV show, House, MD ;)
      • Clinical Features
      • Pathology and Pathogenesis
      • Diagnosis
      • Treatment
      • Acanthocytosis with Chorea
      • Corticostriatospinal Degenerations
      • Familia Dementia with Spastic Paraparesis
      • Adult Polyglucosan Body Disease
  • Disease Characterized by Abnormalities of Posture and Movement
    • Parkinson Disease
      • Genetic Aspects
      • Clinical Features
      • Diagnosis
      • Pathology and Pathogenesis
      • Treatment
        • L-Dopa & L-Dopa-Modifying Drugs
        • Dopamine Agonists
        • Adjunctive Medications
        • Neuroprotective Agents
        • Side Effects of L-Dopa Treatment and Their Management
      • Initiating Drug Treatment for Parkinson Disease
      • Surgical Measures
    • Multiple System Atrophy (Striatonigral Degeneration, Shy-Drager Syndrome, Olivopoontocerebellar Degeneration)
    • Progressive Supranuclear Palsy
      • Clinical Features
    • Corticobasal Degeneration
    • Dystonic Disorders
      • Dystonia Musculorum Deformans (Torsion Dystonia)
    • Hereditary Dystonia-Parkinsonism (Segawa Syndrome, Juvenile Dopa-Responsive Dystonia)
    • Torticollis and Other Restricted Dyskinesias and Dystonias (see ch6)
    • Other Forms of Hereditary Dystonia
  • Syndrome of Progressive Ataxia
    • Early Onset Spinocerebellar Ataxias (Predominantly Spinal)
      • Friedreich Ataxia
    • Predominantly Cerebellar (Cortical, Holmes Type) Hereditary and Sporadic Ataxia
    • Fragile X Tremor-Ataxic Premutation Syndrome
    • Familial and Sporadic Forms of Complicated Cerebellar Atrophy with Brainstem and Extrapyramidal Features
    • Cerebellar Atrophy with Prominent Basal Ganglionic Features
      • Machado-Joseph-Azorean Desease (SCA3)
      • Multiple System Atrophy with Predominant Ataxia
      • Dentatorubropallidoluysian Atrophy (DRPLA)
      • Dentatorubral Degeneration
      • Paroxysmal Ataxias (see ch5)
    • Genetics of the Heredodegenerative Ataxias (Table 39-5)
    • Differential Diagnosis of the Degenerative Ataxias (see Table 5-1)
    • Hereditary Polymyoclonus
  • Syndrome of Muscular Weakness and Wasting Without Sensory Changes
    • Motor System Disease
      • Amyotrophic Lateral Sclerosis – a common disease with an annal incidence rate of 0.4 to 1.76 per 100,000 population. Men are affected nearly twice as often as women. Most patients are older than 45 at the onset of symptoms and the incidence increases with each decade of life. The disease occurs in a randome pattern throughout the world except for a dramatic clustering of patients among inhabitants of the Kii peninsula in Japan and in Guam, where ALS is often combined with dementia and parkinsonism. In approximately 10 percent of the cases the disease is familial, being inherited as an autosomal dominant trait with age-dependent penetrance.
      • Progressive Muscular Atrophy – this purely lower motor neuron syndrome is more common in men than in women, reportedly in a 4:1 ratio.
      • Progressive Bulbar Palsy
      • Primary Lateral Sclerosis – PLS
      • Laboratory Features of Motor Neuron Disease
      • Pathology – The principal finding in ALS is a loss of nerve cells in the anterior horns of the spinal cord and motor nuclei of the lower brainstem. Large alpha motor neurons tend to be affected before small ones. In addition to neuronal loss, there is evidence of slight gliosis and proliferation of microglia cells. Many of the surviving nerve cells are small, shrunken and filled with lipofuscin.
      • Diagnosis of ALS
      • Pathogenesis – the pathogenesis of the sporadic form of motor system disease is not known. Some insight has been afforded by analyses of the 10 percent of ALS cases that are caused by gene mutations.
      • Treatment – With the exception of riluzole, there is no specific treatment for any of the motor neuron diseases. The antiglutamate agent riluzole was shown to slow the progression of ALS and improve survival in patients with disease of bulbar onset. However, it adds only 3 months of life at best.
    • Heredofamilial Forms of Progressive Muscular Atrophy
      • Spinal Muscular Atrophy (Werdnig-Hoffman Disease)
      • Kennedy Syndrome (X-Linked Bulbospinal Muscular Atrophy)
      • Progressive Bulbar Palsy of Childhood (Fazio-Londe Syndrome)
    • Hereditary Forms of Spastic Paraplegia
      • Hereditary Spastic Paraplegia (Strumpell-Lorrain Disease)
      • Variants of Familial Spastic Paraplegia
  • Symdrome of Progressive Blindness (see ch 13)
    • Hereditary Optic Atrophy of Leber
    • Retinitis Pigmentosa (see ch 13)
    • Stargardt Disease
  • Syndrome of Progressive Deafness (see ch 15)
    • Hereditary Hearing Loss with Retinal Diseases
    • Hereditary Hearing Loss with Diseases of the Nervous System

Thursday, September 2, 2010

FlashMyBrain.com - Day 335 & Holding

I had a comment from a gentlemen named Roy who inquired about FlashMyBrain.com

I think it's a good investment with a good interface. I paid the $25 or so dollars for it and was able to download it to three different computers. I downloaded it to two computers then found out something went awry with the transaction so I've never been able to use the online features and therefore cannot comment on that aspect. There are games that can be played with the flashcards.

Overall, I'm happy with the program. Some shortcomings may be in the fact that if you have the same answer for two different flashcards, you might pick the correct answer but it might be a flashcard associated with a different question. There is no formatting such as bold or underline and things like that and when you use the "resize to fit" option the program doesn't realize certain words like spondylolisthesis is all one word and will put it on two lines - over all somewhat minor short comings and doesn't diminish too much from the overall value of the software.

Another flashcard type online program I've used is called flashcardexchange.com and I started using that circa 2008. It seems I got the ball rolling with that site and since I started using it we've now got 100 card sets for various classes at my school (keyword: Logan)

There is a one time fee that can be paid to the flashcardexchange of about $25 which I did and that allows some additional features such as being able to upload pictures to your flashcards.

I have thought about trying to reregister FlashMyBrain.com so I can see what other card sets may be available for specific classes at my school ....and, considering I just dropped another $1,200 on books, it makes the $25 fee seem pretty insignificant.

New T6 Books :)

- Holding at Day 335 -