Professional Documents
Culture Documents
2008 MBBS
TB IS CALLED AS WHITE PLAGUE OR
CAPTAIN OF ALL MEN OF DEATH
OCCURS BY FIBROSIS
GENERAL EXAMINATION
PHYSICAL EXAMINATION
SYSTEMIC ILLNESS : DM , HYPERTENSION
INVESTIGATIONS
RADIOLOGY :
X-RAY SPECIFY THE LEVEL
2 VIEWS AP & LATERAL
CHEST X-RAY
X-RAY ABDOMEN
KUB - IF PSOAS ABSCESS SUSPECTED
FINDINGS
1. REDUCTION OF DISC SPACE- EARLY SIGN
COMPARE WITH NORMAL
LATERAL X-RAY IS BETTER
IMPORTANCE : SECONDARIES TO
BONES USUALLY PRESERVE THE DISC
2. DESTRUCTION OF VERTEBRAL BODY
EROSIONS AND WEDGING
3. DEFORMITY : DEPEND ON THE NO.
OF VERTEBRA AFFECTED
BONE DESTRUCTION
DESTRUCTION
OF THE BONE
COLD ABSCESS
1. PARAVERTEBRAL ABSCESS : A SOFT TISSUE
SHADOW CORRESPONDING TO AFFECTED
VERTEBRA.
WIDENED MEDIASTINUM
RETROPHARYNGEAL ABSCESS
PSOAS ABSCESS
RETROPHARYNGEAL ABSCESS
MEDISTINAL WIDENING
OTHER FINDINGS
RAREFACTION : ABOVE AND BELOW AFFECTED
VERTEBRA
OBLIQUE X RAY MAY SHOW POSTERIOR
COMPLEX INVOLVEMENT
SIGNS OF HEALING : ADJACENT VERTEBRAE
UNDERGO FUSION
OTHERS
CT : ACCURATE CONFIRMATIONS
MRI : TO ASSES NEURAL STATUS
MYELOGRAPHY : SUSPECTED SPINAL TUMOR
SYNDROME
BIOPSY : CT GUIDED NEEDLE OR OPEN BIOPSY
RETROPHARYNGEAL
SWELLING
CAN PRESENT AS
DYSPHAGIA
PSOAS ABSCESS
PSOAS ABSCESS
GENERAL INVESTIGATIONS
ESR
MANTOUX
ELISA : ANTI TB ANTIBODY
CHEST X RAY : FOR PULMONARY TB
D/D S
BACK ACHE : 1. TRAUMATIC
2. SECONDARIES OR MYELOMA
3. PROLAPSED DISC
4.ANKYLOSING SPONDYLITIS
NEUROLOGICAL
SPINAL TUMOR
TRAUMATIC
SECONDARIES IN THE SPINE
TREATMENT
PT SHOULD BE GIVEN A HIGH PROTEIN DIET
& GOOD ATMOSPHERE
1. MULTIDRUG THERAPY OF TB
2. REST TO THE SPINE : CHILDREN BODY CAST ,
COLLAR IF CERVICAL
3. MOBILISATION : ADVISED TO AVOID SPORTS
FOR TWO YEARS
RX COLD ABSCESS
SMALLER ONES SUBSIDE WITH TB THERAPY
IN SUPERFICIAL ABSCESSES :
ASPIRATION : USING THICK NEEDLE
EVACUATION
PSOAS ABSCESS : EXTRAPERITONEALLY VIA KIDNEY
INCISCION
MRCB CONTROLLED TRIAL
BED REST NOT NECESSARY
STREPTOMYCIN NOT NECESSARY
POP JACKETS PROVIDE NO BENEFIT
DEBRIDEMENT IS NOT A GOOD OPERATION
COMPLICATIONS
COLD ABSCESS
NEUROLOGICAL COMPLICATIONS : PARAPLEGIA
20 % INCIDENCE
COMMON IN DORSAL SPINE TB
CAUSES :
INFLAMMATORY EDEMA
EXTRADURAL PUS & GRANULATION TISSUE
COMMOMN
SEQUESTRA
INTERNAL GIBBUS
INFARCTION OF SPINAL CORD
EXTRADURAL GRANULOMA
TYPES
EARLY ONSET
LATE ONSET
C/F :
EITHER A KNOWN TB OR NEUROLOGICAL
SYMPTOMS PRESENTING FOR THE 1ST TIME
GRADUAL ONSET
CLONUS ANKLE OR PATELLAR PROMINENT
PARALYSIS : STAGES
1. MUSCLE WEAKNESS : SPASTICITY AND
INCORDINATION
2. PARAPLEGIA IN EXTENSION
3. PARAPLEGIA IN FLEXION
COMPLETE FLACCID PARALYSIS
GRADES : GOEL (1967)
BASIS IS EXTENT OF MOTOR INVOLVEMENT
GRADE ONE : CLINICIAN DETECTS THE DEFECIT
GRADE TWO : SYMPTOMATIC BUT MANAGES TO WALK
GRADE THREE: UNABLE TO WALK
PARAPLEGIA IN EXTENSION
PARTIAL SENSORY LOSS
GRADE FOUR : UNABLE TO WALK
PARAPLEGIA IN EXTENSION
NEAR COMPLETE SENSORY LOSS
SPHINCTER DISTURBANCES
TREATMENT
INVESTIGATIONS : CT & MRI ( INVESTIGATION
OF CHOICE)
CONSERVATIVE : ANTI TB RX , REST TO SPINE ,
NEUROLOGICAL EXAMINATION TO ASSES Px
SURGICAL :
INDICATIONS : PARAPLEGIA IN CONSERVATIVE Rx
SUDDEN ONSET SEVERE PARAPLEGIA
SEVERE PARAPLEGIA : IN FLEXION, MOTOR / SENSORY
LOSS > 6 MONTHS OR COMPLETE MOTOR LOSS ONE
MONTH DESPITE CONSERVATIVE Rx
PARAPLEGIA WITH UNCONTROLLED SPASTICITY
RELATIVE INDICATIONS :
RECURRENT PARAPLEGIA
PARAPLEGIA IN OLD AGE
PAINFUL PARAPLEGIA
COMPLICATIONS : UTI / STONES
PROCEDURES
1. COSTO TRANSVERSECTOMY
2. ANTEROLATERAL DECOMPRESSION
4. LAMINECTOMY
PROGNOSIS
AGE : CHILDREN HAS BETTER Px
DURATION OF PARAPLEGIA : LONG STANDING
HAS BAD Px
SEVERITY : MOTOR ALONE HAS GOOD Px
ONSET OF PARAPLEGIA : A/C ONSET HAS BETTER
SUDDEN PROGRESS : BAD Px