September 2005
MT Newsletter
SMT Faculty
Jessie Jacob
Manu Prakash
Rema Valsala 		Thought for the month: If A is success in life, then A equals x plus y plus z. Work is x; y is play; and z is keeping your mouth shut.
            ...Albert Einstein
Answers to the previous issue

FAQs

Standards

Questionnaire

     The word used to describe a person who can use both hands equally well is ambidextrous.

     All roads lead to Rome -- People can arrive at the same conclusion by different means..

     Palpation of the area did not elicit pain.

     If you have further questions about the medical procedure, please call.

     The pupils were dilated on examination. 



   Affect:     As a verb, affect (pronounced af-féct) means to influence or change.


                  She suffers from a neuropathy affecting her upper extremities.


                  The warm encouragement of the patient’s wife positively affected his outcome.


                 As a noun, affect (pronounced áf-fect) means an expressed or observed emotion or feeling.


                   The patient displayed a flat affect.


                   Her affect did not change throughout the course of the interview.


   Effect:     As a verb, effect means to bring about or cause to happen.


                    We plan to effect a decrease in the size of the tumor using adjunctive therapy.


                   The medication effected relief.


                  As a noun, effect means result.


                   The effect of the treatment was easily noticeable.


                   A mass effect was seen on x-ray.


   Allude:    Make a more or less disguised reference to... 


                   She alluded to her mother's history.


   Elude:      1. Avoid or try to avoid, as of duties, questions and issues.


                   He eluded the question by a counter question.


                   2. Be incomprehensible to 


                   The diagnosis eludes us.

                                       
   Pale:        1. Turn pale, as if in fear (verb)


                   2. Lacking in vitality or interest or effectiveness (adjective)


                   3. Very light colored; highly diluted with white (adjective)


                   4. Abnormally deficient in color as suggesting physical or emotional distress (adjective)


                   5. A wooden strip forming part of a fence (noun)


   Pail:          A bucket.




FAQs

Q. What is meant by 'orthostatics'?

An individual's pulse and BP are measured while lying supine first and then repeated while he/she is sitting with legs dangling or in the standing position..

If the second measurements show that the pulse has increased by 20 bpm (beats per minute) or the systolic BP has decreased by 20 mmHg, the orthostatics are considered positive. Positive result indicates that fluid loss has occurred.

This test is indicated in patient situations with suspected blood loss, fluid loss, or dehydration.

This is a more sensitive indicator for slow fluid loss. Example: Gastrointestinal bleeding

If the patient is unable to stand, orthostatics may be taken while the patient is sitting with the feet dangling. If positive orthostatic changes occur while sitting, do not continue to the standing position.



Q. What are gait abnormalities?

Gait:

The manner or style of walking.

Many different types of gait abnormalities are produced unconsciously. Most, but not all, are due to some physical malfunction.

In general, abnormal gait may occur in:

· Trauma

· Fracture

· Foot problems (such as a callus, corn, ingrown toenail, wart, pain, skin ulcer, swelling, spasms)

· Chondromalacia patellae (a softening of the articular cartilage of the patella, associated with pain)

· Legs that are different lengths

· Myositis

· Tight or uncomfortable shoes

· Shin splints

· Infections

· Tendinitis

· Conversion disorder (a mental disorder in which an unconscious emotional conflict is expressed as an alteration or
                                 loss of physical functioning, usually controlled by the voluntary nervous system).

Abnormal gait may be caused by disease in different areas of the body.

· Central nervous system disorders of the brain resulting in gait disturbance
      due to muscular problems (multiple sclerosis and cerebral palsy).

· Spinal cord abnormalities (disease, trauma, degeneration)

· Peripheral nerve diseases (nerves from the spinal cord to the muscles may be damaged
      by disease or trauma and result in gait abnormalities)

· Degenerative muscle diseases (muscular dystrophy, myotonic dystrophy, myositis)

· Neurodegenerative illnesses (Parkinson's disease)

· Vestibular disorders (damage to the inner ear results in vertigo)

· Skeletal abnormalities and disease

· Arthritis

· Conditions affecting the feet (plantar warts, bunions, ingrown toenails, pressure ulcers)

· Toxicity (alcohol, drugs, allergens)

Types of abnormal gait

Ataxic or cerebellar gait:

Wide-based gait with lateral veering, unsteadiness, and irregularity of steps; often with a tendency to fall to one or other side, forward or backward.

Antalgic gait:

A characteristic gait resulting from pain on weightbearing in which the stance phase of gait is shortened on the affected side (seen in hip injuries).

Calcaneal gait:

A gait disturbance, characterized by walking on heel, due to paralysis of the calf muscles, seen following poliomyelitis and in some other neurologic diseases.

Charcot gait:

The peculiar gait seen in Friedreich ataxia. Ataxia: An inability to coordinate muscle activity during voluntary movement; most often due to disorders of the cerebellum or the posterior columns of the spinal cord; may involve the limbs, head, or trunk. Friedreich ataxia: A neurologic disorder with sclerosis of the posterior and lateral columns of the spinal cord, autosomal recessive inheritance, characterized by ataxia, dysarthria, scoliosis, high-arched foot or pes cavus and paralysis of the muscles, especially of the lower extremities with onset usually in childhood or youth.

Circumduction gait or hemiplegic or spastic gait:

Gait in which the leg is stiff, without flexion at knee and ankle, and with each step is rotated away from the body, then towards it, forming a semicircle.

Double step gait:

A gait in which the length and/or timing of alternate steps is noticeably different.

Drag-to gait:

A gait in which the feet are dragged (rather than lifted) toward the crutches.

Equine gait or high-steppage gait:

A gait in which the foot is raised high to avoid catching a drooping foot and brought down suddenly in a flapping manner; often seen in peroneal nerve palsy (i.e., foot-drop) and tabes.

Festinating gait or propulsive gait:

Gait in which the trunk is flexed, legs are flexed at the knees and hips, but stiff, while the steps are short and progressively more rapid; characteristically seen with Parkinsonism and other neurologic diseases.

Four-point gait:

A gait in forward motion: first one crutch and then the opposite leg, followed by the other crutch and then the other leg, and so on.

Gluteus maximus gait:

Compensatory backward propulsion of trunk to maintain center of gravity over the supporting lower extremity.

Gluteus medius gait or Trendelenburg gait:

Compensatory lift of body (or throw of trunk) to the weak gluteal side, to place the center of gravity over the supporting lower extremity.
The gluteus maximus and gluteus medius are two large muscles in the buttocks that contribute greatly to forward and upward propulsion, and also to lateral or sideways motion.

Helicopod gait:

A gait, seen in some conversion reactions or hysterical disorders, in which the feet describe half circles.

Hysterical gait:

A variety of bizarre gaits seen with hysteria-conversion reaction; usually the foot is dragged or pushed ahead, instead of lifted, while walking; frequently the foot is held dorsiflexed and inverted.

Myopathic gait or dystrophic gait:

Exaggerated alternation of lateral trunk movements with an exaggerated elevation of the hip, suggesting the gait of a duck or penguin; characteristic of muscle diseases such as progressive muscular dystrophy, spinal muscular atrophy, and sometimes acute febrile polyneuropathy.

Paraplegic spastic gait:

A gait in which the legs are held together and move in a stiff manner, the toes seeming to drag and catch; caused by lesions of the central nervous system.

Quadriceps gait:

A gait seen when the quadriceps muscle is paralyzed or absent; with each step of the affected leg, the knee goes into hyperextension and the trunk tends to lurch forward.

Scissor gait:

Gait in which each leg swings medially as well as forward on walking; usually due to bilateral lower extremity spasticity, the result of cerebral palsy.

Staggering gait:

A reeling, tottering, and tipping gait in which the individual appears as if he may fall backward or lose his balance; associated with alcohol or barbiturate intoxication.

Steppage gait:

A gait in which the advancing foot is lifted higher than usual so that it can clear the ground, because it cannot be dorsiflexed. Seen with peroneal neuropathies and other disorders causing foot dorsiflexion weakness.

Swing-through gait:

A gait in which the crutches are advanced and then the legs are swung past them.

Swing-to gait:

A gait in which the crutches are advanced and the legs are swung to the same point.

Tabetic gait:

An ataxic gait that accompanies tabes dorsalis.

Three-point gait:

A gait in which both crutches and the affected leg are advanced together and then the normal leg is moved forward.

Toppling gait:

A gait in which the steps are uncertain and hesitant, and the patient totters and sometimes falls; probably due to a balance disorder; may be seen in elderly patients after a stroke.

Waddling gait:

Rolling gait in which the weight-bearing hip is not stabilized; it bulges outward with each step, while the opposite side of the pelvis drops, resulting in alternating lateral trunk movements; due to gluteus medius muscle weakness, and seen with muscular dystrophies, among other disorders.

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Standards

When to use LITTLE, A LITTLE, and The LITTLE:

LITTLE: Not much. (i.e. hardly any). Thus the adjective, ‘little’ has a negative meaning.

Examples:

There is little hope of his recovery. i.e. he is not likely to recover.

He showed little concern for his nephew.

He has little appreciation of good poetry.

A LITTLE: Some, though not much. ‘A little’ has a positive meaning.

Examples:

There is a little hope of his recovery. i.e., he may possibly recover.

A little tact would have saved the situation.

A little knowledge is a dangerous thing.

THE LITTLE: Not much, but all there is.

The little knowledge that he had was sufficient to get our job done.

He gave me the little money he had.

The little knowledge of carpentry that he possessed, he used to the best advantage.

The above sentence means: The knowledge of carpentry he possessed was not much, but all that knowledge was used to the best advantage.



When to use FEW, A FEW, and THE FEW:

FEW: Not many; hardly any. (Compare with ‘little’). ‘Few’ has a negative meaning.

Examples:

Few people can keep a secret.

Few towns in India have public libraries.

Due to his unpleasant nature, few approach him for help.

A FEW: some. ‘A few’ has a positive meaning, and is opposed to ‘none’.

Examples:

A few patients responded to the new drug immediately.

A few days of rest is all that is needed.

In a few words, he expressed his gratitude to his friends.

THE FEW: Not many, but all there are.

Examples:

The few months that he spent in the hospital did him a lot of good.

The few public libraries that we have are not well equipped.

The few clothes they had were all tattered and torn.



When to use an APOSTROPHE:

The apostrophe is used to show possession.

Examples:

The patient's condition is better now.

His doctor's opinion was to try out the new drug.

Do not use an apostrophe with a possessive pronoun.

Examples:

Its measurements are irregular.

The dog wagged its tail.

The apostrophe is used to form contractions.

Examples:

He’s having none of the symptoms we suspected. (He is)

We'll have a meeting tomorrow. (We will)

It’s my opinion that he should be discharged. (It is)

Do not use an apostrophe to form the plural of an all-capital abbreviation or of numerals, including years.

Examples:

High numbers of WBCs may indicate many disease states.

In general the number of D&Cs being performed has declined over the years.

His temperature is in the 90s.

She was born in the 1930s.

This is a patient in his 50s with complaint of fever and chills.

When a word or letter could be misread, the apostrophe is sometimes used for clarity.

Examples:

She received all A’s in her final exam.

The T’s were left uncrossed.

Record the patient’s I’s and O’s (intake and output).

The apostrophe is used with units of time and money used as possessive adjectives.

Examples:

A weeks’ work; a dollar’s worth; in a month’s time etc.(all show singular possessive)

Seven days work, six months gestation, four weeks rest etc.(all show plural possessive).






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Questionnaire

Q. The word used to describe someone having a shrill sound is _________.
a. stridulous
b. credulous
c. punctilious

Q. Select the meaning of the proverb -- The best fish swim near the bottom.
a. The finest things are hard to get.
b. Everything that is attractive on the outside may not be really valuable inside.
c. If one arrives early, one gets a better choice.
d. One should not assume success prior to actually achieving it.

Q. Fill in the blanks with the suitable word given in brackets:
1. The patient went to the hospital for an asthma _______. (flair, flare)
2. He had erythema with multiple ______ that were discolored yellow.(vesicles, vesicals)
3. The patient ______ easily and appropriately with her eyes. (tracks, tracts)


Q. Find the meaning of these homonyms:

   scleroma and scleroderma

   prostatic and prosthetic

   ostial and osteal


See the answers in the next month's issue....
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