NCMB316 Final Term Explained Reviewer

1. Parkinson’s Disease

Degenerative Disease • Movement disorder

Main Concept

Parkinson’s Disease is a degenerative disorder of the basal ganglia caused by loss of dopamine-producing neurons in the substantia nigra, leading to abnormal voluntary movement.

Degenerative disorder

Paunti-unting nasisira or humihina yung affected part over time. Progressive siya, kaya maaaring lumala habang tumatagal.

Basal ganglia

Part ng brain na tumutulong mag-coordinate ng movement para smooth, controlled, and organized ang galaw.

Dopamine-producing neurons

Nerve cells na gumagawa ng dopamine. Dopamine ang chemical messenger na tumutulong sa maayos na movement.

Substantia nigra

Part ng brain kung saan ginagawa ang dopamine. Sa Parkinson’s, dito nasisira ang cells kaya bumababa ang dopamine.

Voluntary movement

Mga galaw na sinasadya mo, tulad ng paglakad, pagsusulat, pagbangon, pagkain, at pag-abot ng gamit.

Simple Explanation

Sa Parkinson’s, kulang ang dopamine dahil nasisira ang dopamine-producing cells. Kapag kulang ang dopamine, hindi smooth ang galaw ng katawan. Kaya nagkakaroon ng tremor, rigidity, bradykinesia, and shuffling gait.

Signs and Symptoms

Pill-rolling tremor: parang may iniikot sa daliri; usually resting tremor.
Rigidity: paninigas ng muscles; common ang cogwheel rigidity.
Bradykinesia: mabagal kumilos.
Shuffling gait: maliliit at dragging steps.
Mask-like face: kaunti ang facial expression.
Micrographia: maliit at cramped handwriting.
Drooling, constipation, depression, monotone speech, fatigue.

Management and Nursing Care

Levodopa: increases dopamine; helps tremor, rigidity, bradykinesia.
Carbidopa: prevents peripheral dopamine breakdown.
Amantadine: for mild/early cases.
Benztropine/Procyclidine: anticholinergics for tremor and rigidity.
Remove scatter rugs, install handrails, assist ambulation.
Give bite-sized food and allow enough time for meals.
If freezing occurs, tell the client to imagine stepping over something.

Exam Cue

Pill-rolling tremor + shuffling gait + mask-like face = Parkinson’s Disease.

2. Multiple Sclerosis

Degenerative Disease • CNS demyelinating disease

Main Concept

Multiple Sclerosis is an immune-mediated progressive demyelinating disease of the central nervous system, causing impaired nerve impulse transmission.

Immune-mediated

Sariling immune system ang umaatake. Imbes na protektahan ang body, inaatake nito ang nervous system.

Progressive

Paunti-unting lumalala over time, lalo na kapag may repeated attacks or worsening disease course.

Demyelinating disease

Nasisira ang myelin sheath, kaya humihina or bumabagal ang nerve signals.

Myelin sheath

Protective covering ng nerve, parang insulation ng wire. Kapag sira, sabog or delayed ang signal.

Central nervous system

Brain and spinal cord.

Nerve impulse transmission

Pagpapadala ng signal ng nerves. Halimbawa, brain signal papunta sa muscles para gumalaw.

Simple Explanation

Sa MS, inaatake ng immune system ang myelin sheath sa brain and spinal cord. Dahil damaged ang myelin, hindi maayos ang nerve signals. Kaya may visual problems, numbness, weakness, spasticity, and balance problems.

Signs and Symptoms

First symptom often visual: blurred vision, scotomas, diplopia.
Numbness, tingling, impaired pain/temp/position sense.
Weakness, paralysis, spasticity.
Ataxic gait, nystagmus, dysarthria, intention tremor.
Scanning speech, mood swings, bladder issues, constipation.

Diagnostics and Nursing Care

MRI: shows demyelination.
CSF: increased protein and IgG.
Corticosteroids: acute exacerbation.
Baclofen/Dantrolene/Diazepam: spasticity.
Test bath water with thermometer; avoid heating pads.
Use assistive devices and promote mobility.

Exam Cue

Young adult female + visual problems + numbness/weakness + remission and exacerbation = Multiple Sclerosis.

3. Myasthenia Gravis

Degenerative Disease • Neuromuscular junction disorder

Main Concept

Myasthenia Gravis is a chronic autoimmune neuromuscular disorder where antibodies destroy acetylcholine receptor sites at the neuromuscular junction, causing muscle weakness that worsens with activity and improves with rest.

Chronic

Long-term condition. Hindi siya panandalian lang.

Autoimmune

Sariling immune system ang umatake sa katawan.

Neuromuscular disorder

Problema sa connection ng nerves and muscles.

Acetylcholine

Chemical messenger na ginagamit ng nerve para utusan ang muscle na gumalaw.

Acetylcholine receptor sites

Receiving area ng muscle. Kapag nasira, hindi matanggap nang maayos ang signal.

Neuromuscular junction

Lugar kung saan nagtatagpo ang nerve and muscle para maipasa ang movement signal.

Simple Explanation

Sa MG, sinisira ng immune system ang acetylcholine receptors. Kahit nagpapadala ng signal ang nerve, hindi ito natatanggap nang maayos ng muscle. Kaya humihina ang muscle lalo na kapag ginagamit nang matagal, pero gumagaan kapag nagpahinga.

Signs and Symptoms

Ptosis: drooping eyelid.
Diplopia: double vision.
Dysphagia: difficulty swallowing.
Slurred speech, weak voice, hoarseness.
Weakness worsens with activity and improves with rest.

Care and Medications

Anticholinesterase drugs: neostigmine, pyridostigmine, edrophonium.
Give medication exactly on time.
Give meds 30 minutes before meals.
Check gag reflex and swallowing before feeding.
Keep suction and emergency airway nearby.
Monitor respiratory status frequently.

Myasthenic Crisis vs Cholinergic Crisis

Feature	Myasthenic Crisis	Cholinergic Crisis
Cause	Too little medication	Too much medication
Tensilon response	Improves	Worsens
Vitals	Hypertension, tachycardia	Hypotension, bradycardia
Drug	Neostigmine	Atropine sulfate

Exam Cue

Weakness worse with activity, better with rest + ptosis/diplopia/dysphagia = Myasthenia Gravis.

4. Guillain-Barré Syndrome

Degenerative Disease • Ascending paralysis risk

Main Concept

Guillain-Barré Syndrome is an immunologic reaction that causes segmental demyelination of nerves, leading to ascending symmetrical weakness and possible respiratory failure.

Immunologic reaction

Abnormal immune response. Usually after infection, immune system mistakenly attacks nerves.

Segmental demyelination

Parts or segments ng myelin sheath ng nerve ang nasisira.

Ascending weakness

Nagsisimula ang weakness sa paa/legs then paakyat sa katawan.

Symmetrical weakness

Parehong sides ng katawan ang affected, like both legs.

Respiratory failure

Kapag umabot ang paralysis sa respiratory muscles, hindi na sapat ang paghinga.

Simple Explanation

Sa GBS, pagkatapos ng infection, inaatake ng immune system ang peripheral nerves. Nagsisimula ang panghihina sa legs then umaakyat. Delikado kapag umabot sa muscles na ginagamit sa paghinga.

Signs and Symptoms

Tingling of hands and feet.
Clumsiness, difficulty rising from chair.
Ascending symmetrical weakness.
Areflexia or absent DTRs.
Dysphagia and respiratory difficulty.

Diagnostics and Care

CSF: increased protein.
EMG: slowed nerve conduction.
ICU care, mechanical ventilation if needed.
Plasmapheresis removes antibodies.
Continuous ECG monitoring for autonomic dysfunction.
Priority: respiratory status and gag reflex.

Priority Red Flag

Any breathing difficulty in GBS is urgent because paralysis can ascend to respiratory muscles.

Exam Cue

Ascending weakness + absent DTR + respiratory risk = Guillain-Barré Syndrome.

5. Amyotrophic Lateral Sclerosis

Degenerative Disease • Motor neuron disease

Main Concept

Amyotrophic Lateral Sclerosis, or ALS, is a progressive disease where there is loss of motor neurons in the spinal cord and lower brainstem, causing progressive muscle weakness, dysphagia, and respiratory insufficiency.

Amyotrophic

“A” means without, “myo” means muscle, “trophic” means nourishment. Muscles lose nourishment and waste away.

Lateral

Refers to side areas of spinal cord where affected nerve pathways are located.

Sclerosis

Hardening or scarring of tissue.

Motor neurons

Nerve cells responsible for controlling muscle movement.

Dysphagia

Difficulty swallowing.

Respiratory insufficiency

Hindi sapat ang breathing function para ma-meet ang oxygen needs ng katawan.

Simple Explanation

Sa ALS, namamatay ang motor neurons. Kapag wala nang maayos na signal mula nerve to muscle, humihina at lumiliit ang muscles. Apektado ang arms, legs, speech, swallowing, and breathing.

Signs and Symptoms

Progressive muscle weakness and atrophy.
Fasciculations: small involuntary muscle twitching.
Dysarthria: difficulty speaking clearly.
Dysphagia, spasticity, brisk DTRs.
Respiratory insufficiency.

Management and Care

Riluzole: slows motor neuron deterioration.
Baclofen/Diazepam for spasticity.
Quinine for muscle cramps.
Feeding support to prevent aspiration.
Mechanical ventilation if hypoventilation develops.
Promote independence and emotional support.

Exam Cue

Progressive weakness + fasciculations + dysphagia + respiratory failure = ALS.

6. Huntington’s Disease

Degenerative Disease • Hereditary chorea and dementia

Main Concept

Huntington’s Disease is a chronic progressive hereditary nervous system disease that causes choreiform movements and dementia. It is transmitted as an autosomal dominant disorder.

Chronic

Long-term condition.

Progressive

Lumalala habang tumatagal.

Hereditary

Namamana sa family.

Choreiform movements

Rapid, jerky, purposeless movements na hindi makontrol.

Dementia

Decline in memory, thinking, judgment, and ability to function.

Autosomal dominant

Isang affected parent lang, may chance na maipasa. Each child has 50% risk.

Simple Explanation

Sa Huntington’s, may genetic problem na sumisira sa brain cells involved in movement and thinking. Kaya may uncontrolled jerky movements and progressive mental decline.

Signs and Symptoms

Choreiform movements.
Memory problems and impaired judgment.
Anger outbursts, depression.
Hallucinations, delusions, paranoia.
Increasing dependence on others.

Diagnostics and Care

Family history and classic symptoms.
CT/MRI may show caudate nucleus atrophy.
Phenothiazines, reserpine, tetrabenazine may be used.
Prevent falls, choking, aspiration, and infection.
Support family and learn patient communication cues.

Exam Cue

Chorea + dementia + family history + 50% inheritance risk = Huntington’s Disease.

7. Musculoskeletal Diagnostic Tests

Bone X-ray, bone scan, biopsy, EMG, arthroscopy, arthrocentesis

Main Concept

Musculoskeletal diagnostic tests help assess bone integrity, joint condition, muscle function, infection, tumors, fractures, and inflammatory disorders.

Bone integrity

Tinitingnan kung buo, aligned, dense, or damaged ang bone.

Joint condition

Tinitingnan ang joint space, cartilage, synovium, fluid, swelling, or damage.

Muscle function

Tinitingnan kung maayos ang electrical activity or strength ng muscle.

Inflammatory disorders

Conditions where joints/bones/tissues are inflamed, like RA or gout.

Common Tests

Bone X-ray: checks bone density, alignment, swelling, and intactness.
Bone scan: detects damage, metastasis, infection, trauma; hot spots may suggest tumor, fracture, or infection.
Bone biopsy: differentiates cancerous and non-cancerous bone tumors.
EMG: measures electrical activity of skeletal muscle.
Arthroscopy: endoscopic joint exam and possible repair.
Arthrocentesis: joint aspiration for fluid analysis, infection, gout crystals.

Nursing Considerations

X-ray: remove jewelry, remain still, inform if pregnant.
Bone scan: increase fluids after to excrete tracer.
Bone biopsy: site covered/elevated 24 hrs, dry 48 hrs; monitor bleeding.
EMG: avoid creams/lotions; soreness may happen after.
Arthroscopy: NPO 8–12 hrs; after elevate, ice, elastic wrap.
Arthrocentesis: rest joint 8–24 hrs; report fever/swelling.

Exam Cue

Synovial fluid with urate crystals = gout; hot spots on bone scan = increased bone activity such as tumor, fracture, or infection.

8. Sprain

Musculoskeletal • Ligament injury

Main Concept

A sprain is an injury to the ligaments surrounding a joint caused by a twisting motion, leading to pain, edema, and painful movement.

Sprain

Injury sa ligament, not muscle. Usually nangyayari sa ankle or joints.

Ligaments

Strong bands of tissue na nagko-connect ng bone to bone and stabilize joints.

Twisting motion

Biglang pagkapilipit ng joint, causing ligament stretch or tear.

Edema

Swelling due to fluid buildup after injury.

Simple Explanation

Kapag napilipit ang joint, pwedeng ma-stretch or mapunit ang ligament. Kaya masakit, namamaga, at mahirap igalaw.

Signs

Tender joint.
Painful movement.
Swelling and bleeding.
Pain increases in first 2–3 hours.
X-ray may be needed to rule out fracture.

Management: RICE

Rest: prevents further injury.
Ice: 20–30 min during first 24–48 hrs.
Compression: reduces edema and supports tissues.
Elevation: controls swelling.
After 24–48 hrs, heat may relieve spasm and promote repair.

Exam Cue

Twisting injury + ligament pain/swelling = sprain. First 24–48 hours = ice, not heat.

9. Knee Injury

Musculoskeletal • Ligament, cartilage, or meniscus injury

Main Concept

Knee injury can involve ligaments, cartilage, meniscus, or other joint structures, causing pain, swelling, limited range of motion, and instability.

Ligaments

Stabilizers ng knee. Kapag injured, pwedeng feeling “loose” or unstable ang knee.

Cartilage

Smooth tissue covering bone ends. Helps joints move smoothly.

Meniscus

C-shaped cartilage acting like cushion/shock absorber sa knee.

Range of motion

Kakayahan ng joint na gumalaw fully, like bending and straightening.

Simple Explanation

Sa knee injury, pwedeng maapektuhan ang stabilizers or cushions ng knee. Kaya may pain, swelling, hirap yumuko or ituwid ang knee, and sometimes instability.

Assessment

Pain, swelling, limited ROM.
Check stability and ability to bear weight.
Assess neurovascular status: circulation, motion, sensation.
Watch for increasing pain or swelling.

Management

RICE for acute injury.
Immobilization or brace if ordered.
Prepare for arthroscopy if diagnosis/repair is needed.
After arthroscopy: elevate, ice, elastic wrap, limited activity.

Exam Cue

Knee trauma + swelling + limited ROM = assess ligament/meniscus injury and neurovascular status.

10. Fracture

Musculoskeletal • Break in bone continuity

Main Concept

A fracture is a break or disruption in the continuity of bone. Management focuses on the 4 R’s: recognition, reduction, retention, and rehabilitation.

Fracture

Break sa bone. Pwedeng partial, complete, closed, or open.

Continuity of bone

Pagiging buo at tuloy-tuloy ng bone structure. Kapag na-break, fracture na.

Reduction

Pagbabalik ng fractured bone sa proper alignment.

Retention

Pag-maintain ng alignment gamit cast, traction, fixation, splint, brace, or bandage.

Rehabilitation

Pagbabalik ng function, strength, and mobility after healing.

Simple Explanation

Kapag may fracture, hindi lang basta broken bone. Kailangan ma-recognize, ma-realign, ma-stabilize, at ma-rehabilitate para bumalik ang function.

Classifications and Signs

Complete: break across entire bone.
Incomplete: partial break.
Closed/simple: skin intact.
Open/compound: wound reaches bone.
Pain, loss of function, deformity, shortening, crepitus, swelling.

Healing and Complications

Hematoma forms within 48–72 hrs.
Fibrocartilage forms within 3 days–2 weeks.
Callus forms within 2–6 weeks.
Complications: shock, fat embolism, compartment syndrome, AVN, delayed union, nonunion, malunion.

Emergency Complications

Fat embolism: dyspnea, confusion, petechial rash 24–72 hrs after long bone fracture.
Compartment syndrome: pain out of proportion, pressure, paresthesia; late pulselessness.

Exam Cue

Pain out of proportion after fracture/cast = compartment syndrome. Dyspnea + confusion + petechiae after femur fracture = fat embolism.

11. Rheumatoid Arthritis

Musculoskeletal • Autoimmune inflammatory arthritis

Main Concept

Rheumatoid Arthritis is a chronic autoimmune inflammatory joint disease affecting the synovium, causing pannus formation, cartilage destruction, bone erosion, and deformity.

Autoimmune inflammatory

Immune system attacks joint tissues, causing chronic inflammation.

Synovium

Joint lining that produces lubricating fluid. In RA, it becomes inflamed.

Pannus formation

Abnormal thickened inflamed synovial tissue that invades cartilage and bone.

Bone erosion

Gradual destruction of bone near the joint due to inflammation.

Simple Explanation

Sa RA, inaatake ng immune system ang joint lining. Dahil chronic ang inflammation, nasisira ang cartilage and bone, kaya nagkakaroon ng pain, stiffness, swelling, and deformities.

Signs and Symptoms

Bilateral and symmetric joint pain.
Small joints first: hands, wrists, feet.
Morning stiffness longer than 30 minutes.
Swelling, warmth, erythema, boggy joints.
Systemic: fever, weight loss, fatigue, anemia.
Late: ulnar deviation, swan-neck, boutonniere deformity.

Management

NSAIDs / COX-2 inhibitors.
DMARDs such as methotrexate.
Corticosteroids for inflammation.
PT/OT, rest and exercise balance.
Surgery if severe: synovectomy, arthrodesis, arthroplasty.

Exam Cue

Symmetric small-joint inflammation + morning stiffness more than 30 minutes = Rheumatoid Arthritis.

12. Gouty Arthritis

Musculoskeletal • Uric acid crystal arthritis

Main Concept

Gouty Arthritis is caused by defective uric acid metabolism, leading to deposition of monosodium urate crystals in joints, causing sudden severe pain and inflammation.

Uric acid metabolism

Process ng body sa pag-breakdown ng purines into uric acid and pag-excrete nito sa kidneys.

Purines

Chemical compounds found in some foods. Kapag na-breakdown, nagiging uric acid.

Monosodium urate crystals

Needle-like uric acid crystals na naiipon sa joints and cause intense inflammation.

Podagra

Severe gout pain sa big toe, common first manifestation.

Simple Explanation

Kapag mataas ang uric acid or hindi ma-excrete nang maayos, nagiging crystals ito sa joints. These crystals irritate the joint, kaya sobrang sakit, red, warm, and swollen.

Signs and Diagnosis

Sudden severe pain and swelling.
Big toe involvement: podagra.
Tophi in chronic gout.
Definitive: monosodium urate crystals in synovial fluid.
Elevated uric acid may be present.

Management and Diet

Acute: colchicine + NSAIDs.
Chronic: probenecid or allopurinol.
Avoid aspirin if contraindicated with gout meds.
Limit organ meats, beef, pork, lamb, seafood, yeast/beer, alcohol.
Low-fat milk/yogurt may lower risk.

Exam Cue

Big toe pain after beer/organ meats = Gouty Arthritis.

13. Osteoarthritis

Musculoskeletal • Degenerative joint disorder

Main Concept

Osteoarthritis is the most common degenerative joint disorder, involving cartilage degradation, bone stiffening, and reactive synovial inflammation.

Degenerative joint disorder

Joint wear-and-tear na lumalala over time, often due to age or overuse.

Cartilage degradation

Nasusuot or nasisira ang cartilage na cushion sa joint.

Bone stiffening

Bone under cartilage becomes denser or less flexible.

Reactive inflammation

Inflammation na response sa joint damage, but not as destructive/systemic as RA.

Simple Explanation

Sa OA, nauupos ang cartilage cushion ng joint. Kapag manipis na ang cushion, nagkakaroon ng pain with movement, stiffness, and limited function.

Signs

Pain with movement.
Morning stiffness less than 30 minutes.
Stiffness improves with movement.
Common in weight-bearing joints: hips, knees, spine.
Heberden’s nodes and Bouchard’s nodes.

Management

Weight reduction and avoid overuse.
Heat, joint rest, braces/splints.
Isometric, postural, and aerobic exercises.
Acetaminophen first-line, COX-2 inhibitors, topicals.
Arthroplasty, osteotomy, or viscosupplementation if needed.

Exam Cue

Weight-bearing joint pain + stiffness less than 30 minutes = Osteoarthritis.

14. Systemic Lupus Erythematosus

Musculoskeletal/Autoimmune • Multisystem disease

Main Concept

Systemic Lupus Erythematosus is an autoimmune multisystem disease caused by immune complex deposition and tissue damage, often involving the skin, joints, kidneys, heart, and CNS.

Autoimmune

Immune system attacks the body’s own tissues.

Multisystem disease

Maraming body systems ang pwedeng maapektuhan, not just joints.

Immune complex deposition

Antibody-antigen complexes naiipon sa tissues and organs, causing inflammation and damage.

Renal involvement

Kidney involvement. Important dahil leading cause of serious complications/death sa SLE.

Simple Explanation

Sa SLE, immune system attacks different body tissues. Kaya pwedeng may butterfly rash, joint pain, kidney problems, pericarditis, and neuropsychiatric symptoms.

Signs

Butterfly rash, photosensitivity, oral ulcers.
Joint pain and arthritis/synovitis.
Pericarditis.
Renal involvement: proteinuria, abnormal urinalysis, creatinine changes.
CNS: depression, psychosis, cognitive changes.

Management and Nursing

No single lab test confirms SLE.
NSAIDs for minor symptoms.
Corticosteroids for inflammation.
Hydroxychloroquine for skin/musculoskeletal symptoms.
Immunosuppressants for severe disease.
Monitor renal and cardiovascular involvement; avoid sunlight/UV triggers.

Exam Cue

Butterfly rash + joint pain + photosensitivity + renal involvement = SLE.

15. Osteomalacia

Musculoskeletal • Soft bones due to vitamin D problem

Main Concept

Osteomalacia is softening of bones caused by lack of vitamin D or impaired vitamin D metabolism, resulting in poor bone mineralization.

Osteomalacia

Soft bones in adults. Different from osteoporosis, which is porous/brittle bones.

Vitamin D

Needed for calcium absorption in the intestines.

Bone mineralization

Process of depositing calcium and minerals into bone to make it hard and strong.

Simple Explanation

Kapag kulang ang vitamin D, hindi naa-absorb nang maayos ang calcium. Dahil dito, lumalambot ang bones at nagkakaroon ng bone pain and weakness.

Signs

Bone pain.
Muscle weakness.
Soft bones.
Fracture risk.
Difficulty walking may occur.

Management

Vitamin D supplementation.
Calcium supplementation.
Phosphorus depending on cause.
Higher doses if malabsorption is present.

Exam Cue

Vitamin D deficiency + soft bones = Osteomalacia.

16. Osteomyelitis

Musculoskeletal • Bone infection

Main Concept

Osteomyelitis is an infection of the bone that may occur through hematogenous spread, soft tissue extension, or direct contamination.

Osteomyelitis

Bone infection. Serious because infection can destroy bone tissue.

Hematogenous spread

Infection travels through the blood to the bone.

Sequestrum

Dead bone fragment caused by infection and poor blood supply.

Involucrum

New bone that forms around the infected dead bone.

Simple Explanation

Sa osteomyelitis, may infection sa bone. Pwedeng galing sa dugo, nearby tissue infection, or direct wound. Kapag lumala, pwedeng magkaroon ng dead bone and chronic drainage.

Risk Factors and Signs

Diabetes, elderly, poor nutrition, obesity.
Immunosuppression and long-term steroids.
Swollen, warm, painful, tender area.
Chills, fever, malaise.
Constant pulsating pain worse with movement.
Chronic draining sinus may occur.

Nursing Care

Relieve pain.
Control infection.
Promote mobility.
Teach self-care and monitor wound/drainage.

Exam Cue

Bone infection + fever + constant pulsating bone pain = Osteomyelitis.

17. Pott’s Disease

Musculoskeletal • Spinal tuberculosis

Main Concept

Pott’s Disease is tuberculosis of the spine, usually affecting the lower thoracic and upper lumbar vertebrae, and may lead to kyphosis, spinal cord compression, and paraplegia.

Tuberculosis of the spine

TB infection that affects vertebrae instead of only lungs.

Thoracic/lumbar vertebrae

Upper/mid back and lower back bones of the spine.

Kyphosis

Hunchback deformity caused by vertebral collapse.

Paraplegia

Paralysis of the lower body due to spinal cord involvement.

Simple Explanation

Sa Pott’s disease, TB infects the spine. Dahil nasisira ang vertebrae, pwedeng mag-collapse ang spine and ma-compress ang spinal cord.

Signs

Gradual onset of back pain.
Fever, night sweats, anorexia, weight loss.
Spinal mass.
Numbness, tingling, muscle weakness in legs.
Late: kyphosis, spinal cord compression, paraplegia.

Diagnostics and Treatment

Elevated ESR.
Tuberculin skin test.
Spine X-ray, bone scan, CT/MRI.
Bone biopsy.
Antituberculous drugs, analgesics, immobilization.
Surgery if abscess or instability occurs.

Exam Cue

Spinal TB + back pain + night sweats + kyphosis/paraplegia risk = Pott’s Disease.

18. Paget’s Disease

Musculoskeletal • Abnormal bone remodeling

Main Concept

Paget’s Disease is a disorder of abnormal bone remodeling, causing enlarged, weak, and deformed bones, commonly affecting the skull, spine, pelvis, and legs.

Abnormal bone remodeling

Bone breakdown and rebuilding process becomes disorganized and excessive.

Enlarged bones

Because rebuilding is abnormal, bone may become bigger but not stronger.

Weak/deformed bones

Bone looks bigger or denser but is structurally weak and prone to deformity/fracture.

Neural deafness

Hearing loss from nerve compression, often if skull bones are affected.

Simple Explanation

Sa Paget’s, mabilis at magulo ang bone remodeling. Kaya lumalaki ang bones pero mahina and deformed. Kapag skull affected, pwedeng magkaroon ng headache or hearing loss.

Signs: PANICS

Pain in bone.
Arthralgia.
Neural deafness/nerve compression.
Increased bone density.
Cardiac failure.
Skull or sclerotic vertebra.

Management

Bisphosphonates: alendronate/risedronate.
Calcitonin.
NSAIDs/analgesics.
Surgery for deformity/fracture.
Monitor alkaline phosphatase and X-rays.
Calcium, vitamin D, gentle weight-bearing exercise.

Exam Cue

Older adult + bone pain + enlarged skull/bowed legs + hearing loss = Paget’s Disease.

19. Anatomy of the Eyes

Special Senses • Eye structures and vision pathway

Main Concept

The eye converts light into electrical nerve impulses. Light passes through the cornea, pupil, lens, and vitreous humor to the retina, then signals travel through the optic nerve to the brain.

Cornea

Clear front surface/window of the eye. First structure na dadaanan ng light.

Iris

Colored part of the eye; controls pupil size.

Pupil

Black opening that lets light enter.

Lens

Focuses light. Becomes cloudy in cataract.

Retina

Light-sensitive layer where light impulses become electrical signals.

Optic nerve

CN II; carries visual impulses from retina to brain.

Rods

Help with peripheral vision and dim-light vision.

Cones

Allow color vision, concentrated in the macula.

Simple Explanation

Hindi talaga “mata” ang nag-iinterpret ng vision; brain ang nag-iinterpret. The eyes receive light, convert it into nerve signals, then the brain forms the image.

Exam Cue

Rods = dim/peripheral vision. Cones = color/central vision. Optic nerve = CN II.

20. Eye Assessment

Special Senses • Inspection and PERRLA

Main Concept

Eye assessment evaluates symmetry, eyelids, sclera, cornea, pupils, eye movement, and visual function. A key finding is PERRLA.

Symmetry

Tinitingnan kung pantay ang eyes in size, position, and prominence.

Ptosis

Drooping eyelid.

Exophthalmos

Protruding eyes.

Enophthalmos

Sunken eyes.

Sclera

White part of the eye. Yellow sclera may suggest jaundice/systemic problem.

PERRLA

Pupils Equal, Round, Reactive to Light and Accommodation.

Assess For

Head tilting, squinting.
Equal distance from nose, same size, same prominence.
Eyelid redness, lesions, swelling.
Cornea: transparent, smooth, shiny, bright.
Pupillary response to light and accommodation.

Normal Pupil Concepts

Round and equal in size.
Normal diameter: around 3–5 mm.
Direct response: same eye constricts when light is shined.
Consensual response: opposite eye also constricts.

Exam Cue

PERRLA = Pupils Equal, Round, Reactive to Light and Accommodation.

21. Eye / Optic Medications

Special Senses • Local anesthetics, mydriatics, cycloplegics, glaucoma meds

Main Concept

Eye medications may decrease pain, dilate pupils, paralyze accommodation, reduce inflammation, or decrease intraocular pressure.

Local anesthetics

Decrease pain sensation in the eye for exams or procedures. Example: tetracaine, lidocaine.

Mydriatics

Dilate the pupil. Example: phenylephrine.

Cycloplegics

Dilate pupil and paralyze ciliary muscle. Example: atropine, scopolamine.

Intraocular pressure

Pressure inside the eye. High IOP is important in glaucoma.

Glaucoma Medication Examples

Miotics: pilocarpine; increases aqueous humor outflow.
Carbonic anhydrase inhibitors: acetazolamide; decreases aqueous humor production.
Beta blockers: timolol; lowers IOP.
Osmotic agents: mannitol IV for acute closed-angle glaucoma.

Nursing Points

Explain temporary blurred vision after dilation.
Use sunglasses if pupils are dilated.
Avoid driving if vision is affected.
For glaucoma, medication adherence is important to prevent vision loss.

Exam Cue

Mannitol IV may be used in acute closed-angle glaucoma to quickly lower IOP.

22. Error of Refraction

Special Senses • Myopia, hyperopia, astigmatism, presbyopia

Main Concept

Error of refraction occurs when the eye cannot focus light properly on the retina, causing blurred or distorted vision.

Refraction

Bending of light as it passes through cornea and lens.

Retina

Target area at the back of the eye where clear image should focus.

Myopia

Nearsightedness. Distant objects are blurry.

Hyperopia

Farsightedness. Near objects are blurry.

Astigmatism

Uneven corneal curvature causing distorted vision.

Presbyopia

Age-related difficulty focusing on near objects.

Simple Explanation

Kapag hindi eksakto ang focus ng light sa retina, nagiging blurred ang vision. Depende sa focus problem, pwedeng myopia, hyperopia, astigmatism, or presbyopia.

Exam Cue

Far blurry = myopia. Near blurry = hyperopia/presbyopia. Uneven curvature = astigmatism.

23. Cataract

Special Senses • Cloudy lens

Main Concept

A cataract is a cloudy or opaque area in the lens that causes painless, progressive visual blurring, glare, and faded colors.

Cataract

Pag-cloudy ng lens. Parang foggy glass kaya blurred ang vision.

Lens

Clear structure that focuses light. Kapag cloudy, hindi clear ang image.

Opaque

Hindi na transparent; hindi nakakadaan nang maayos ang light.

Glare

Over-sensitivity to bright light, common during night driving.

Signs and Risk Factors

Painless cloudy or foggy vision.
Needs more light to read.
Glare sensitivity.
Difficulty driving at night.
Double vision in one eye.
Faded or yellowish colors.
Risk: aging, diabetes, injury, radiation, steroids, sunlight.

Treatment and Nursing

Surgery when it interferes with daily activities.
Phacoemulsification: ultrasonic fragmentation and aspiration of lens.
IOL implantation.
Post-op: eye shield, HOB 30–45°, assist ambulation.
Avoid bending, straining, coughing, heavy lifting.

Exam Cue

Painless cloudy vision + glare + faded colors = Cataract.

24. Glaucoma

Special Senses • Optic nerve damage and IOP

Main Concept

Glaucoma is a group of eye disorders that damage the optic nerve, often related to increased intraocular pressure, and may lead to permanent vision loss.

Glaucoma

Eye disorder that can cause blindness if untreated.

Optic nerve

Nerve that sends visual signals from retina to brain.

Intraocular pressure

Pressure inside the eye. Too high pressure can damage optic nerve.

Open-angle glaucoma

Gradual drainage blockage; often no early symptoms; peripheral vision lost first.

Closed-angle glaucoma

Iris blocks drainage; acute attack is emergency.

Acute Closed-Angle Signs

Severe eye pain.
Halos around lights.
Nausea and vomiting.
Headache.
Vision loss.

Diagnostics and Treatment

Tonometry measures IOP.
Gonioscopy checks drainage angle.
Visual field testing checks peripheral loss.
Miotics, beta blockers, acetazolamide.
Mannitol IV for acute closed-angle glaucoma.
Laser trabeculoplasty may be used.

Emergency Cue

Severe eye pain + halos + nausea/vomiting + headache = acute closed-angle glaucoma.

25. Retinal Detachment

Special Senses • Retina separates from underlying tissue

Main Concept

Retinal detachment occurs when the retina separates from its underlying tissue, often causing flashes, floaters, and a curtain-like loss of vision.

Retina

Light-sensitive layer at the back of the eye. Important for vision.

Detachment

Paghiwalay ng retina from its base. Delikado because retina needs contact for nourishment and function.

Flashes

Light flashes due to retinal traction or pulling.

Floaters

Small spots or shadows floating in vision.

Curtain-like loss

Parang may tabing or kurtina na bumababa/natatakpan ang visual field.

Risk Factors and Signs

Trauma, aging, severe myopia.
Post-cataract extraction.
Severe diabetic retinopathy.
Flashes of light, floaters.
Increasing blurred vision.
Loss of part of visual field.

Care and Treatment

Bed rest.
Cover both eyes to reduce eye movement.
Avoid jerky head movements.
Scleral buckle, cryopexy, or laser photocoagulation.
Post-op: head elevated; avoid bending, straining, lifting, vigorous exercise.

Exam Cue

Flashes + floaters + curtain-like vision loss = Retinal Detachment.

26. Hearing Assessment

Special Senses • Whisper, Weber, Rinne, Audiometry, Tympanometry, BAER, ENG

Main Concept

Hearing assessment evaluates hearing acuity, middle ear function, auditory pathways, and vestibular function using tests like Weber, Rinne, audiometry, tympanometry, BAER, and ENG.

Hearing acuity

Kakayahan makarinig ng sound at different frequencies/intensities.

Weber test

Tuning fork sa middle of head; checks lateralization.

Rinne test

Compares air conduction and bone conduction.

Audiometry

Formal hearing test using audiometer.

Tympanometry

Checks middle ear and eardrum mobility.

ENG

Records eye movements/nystagmus to evaluate vestibular causes of vertigo.

Test	Key Point
Whisper Test	Stand 1–2 feet behind; prevents lip reading.
Weber	Conductive loss: sound to poor ear. Sensorineural loss: sound to good ear.
Rinne	Normal: AC > BC. Conductive loss: BC ≥ AC.
Audiometry	Measures hearing acuity; pure tones below 25 dB not heard = some hearing loss.
Tympanometry	Do not talk, move, swallow, or startle.
BAER	Evaluates auditory brainstem pathways.
ENG	Evaluates vestibular function and nystagmus.

Exam Cue

Weber: poor ear = conductive; good ear = sensorineural. Rinne normal = AC greater than BC.

27. Otitis Externa

Special Senses • Swimmer’s ear

Main Concept

Otitis externa, or swimmer’s ear, is infection of the skin lining the external ear canal, often causing itching, pain, discharge, and pain when the outer ear is moved.

Otitis externa

Infection sa external ear canal, not middle ear.

Swimmer’s ear

Called this because moisture can promote infection.

External ear canal

Tube from outer ear opening to eardrum.

Wick

Small material placed in swollen canal to help ear drops reach deeper.

Signs

Itching.
Ear canal pain.
Clear discharge.
Possible fever and hearing loss.
Pain increases when touching or moving outer ear.
Ear canal red and swollen.

Treatment and Care

Clean drainage from canal.
Antibiotic and corticosteroid ear drops.
Wick if canal is very swollen.
Analgesics and warm compress.
Keep ears clean and dry; avoid swimming.

Exam Cue

Pain when pulling/moving outer ear = Otitis Externa.

28. Otitis Media

Special Senses • Middle ear infection

Main Concept

Otitis media is inflammation or infection of the middle ear, common in children because their eustachian tubes are shorter and more horizontal.

Middle ear

Space behind the eardrum where tiny hearing bones are located.

Eustachian tube

Tube that connects middle ear to throat and helps drain fluid/equalize pressure.

Acute otitis media

Sudden onset, usually 3 weeks or less.

Chronic otitis media

Repeated or long-lasting middle ear infection, higher risk for hearing loss.

Signs

Earache and fever.
Trouble sleeping.
Infants: irritability, inconsolable crying.
Red, dull, bulging or retracted eardrum.
Fluid behind eardrum; may be purulent or bloody.

Treatment and Care

Antibiotics, analgesics, antipyretics.
Complete full antibiotic course.
Avoid chewing during acute period.
Lie with affected ear down.
Myringotomy if fluid persists despite antibiotics.
Hearing screening if recurrent/chronic.

Exam Cue

Child + earache + fever + bulging red tympanic membrane = Otitis Media.

29. Mastoiditis

Special Senses • Complication of otitis media

Main Concept

Mastoiditis is infection or inflammation of the mastoid bone behind the ear, often occurring as a complication of untreated or persistent otitis media.

Mastoid bone

Bone behind the ear with air cells connected to the middle ear.

Complication

Mas serious problem that develops from another condition, like otitis media.

Mastoidectomy

Surgical removal of infected mastoid air cells if antibiotics fail.

Tympanoplasty

Surgery to repair or reconstruct the eardrum.

Signs

Ear pain/discomfort.
Pain behind ear.
Redness behind ear.
Fever, headache.
Ear drainage.

Treatment and Post-op Care

Long-term/repeated antibiotics.
IV then oral antibiotics.
Mastoidectomy if antibiotics fail.
Monitor dizziness and signs of meningitis.
Position flat with operative side up.
Assist ambulation.

Exam Cue

Otitis media + pain/redness behind ear + fever/drainage = Mastoiditis.

30. Meniere’s Disease

Special Senses • Inner ear balance and hearing disorder

Main Concept

Meniere’s Disease is an inner ear disorder involving abnormal endolymphatic pressure, causing episodic vertigo, tinnitus, fluctuating hearing loss, and ear fullness.

Inner ear

Part of ear involved in hearing and balance.

Endolymphatic pressure

Pressure of fluid inside inner ear structures. Too much pressure affects balance/hearing.

Vertigo

Feeling na umiikot ang paligid or ikaw mismo, kahit hindi naman gumagalaw.

Tinnitus

Ringing, buzzing, or noise in the ear.

Ear fullness

Feeling of pressure or fullness inside the ear.

Signs and Diagnostics

Episodic vertigo.
Tinnitus.
Fluctuating/progressive low-frequency hearing loss.
Nausea, vomiting, sweating.
Worsens with sudden movement.
Diagnostics: CN VIII assessment, CT/MRI, BAER, ENG, audiometry.

Treatment and Nursing

No known cure; control attacks and pressure.
Low-salt diet and diuretics.
Antihistamines, anticholinergics, antiemetics.
Diazepam/sedatives may be used.
Avoid sudden movements, bright lights, TV, reading during attacks.
Assist walking; avoid driving/heavy machinery until 1 week after symptoms disappear.

Exam Cue

Vertigo + tinnitus + hearing loss + ear fullness = Meniere’s Disease.

31. Hearing Impairment / Presbycusis

Special Senses • Hearing loss and communication

Main Concept

Hearing impairment is partial or complete loss of hearing. Presbycusis is age-related sensorineural hearing loss.

Hearing impairment

Hirap makarinig, pwedeng mild hanggang severe.

Presbycusis

Age-related hearing loss, usually gradual.

Sensorineural hearing loss

Problem sa inner ear or auditory nerve, not just blocked sound conduction.

Conductive hearing loss

Problem sa sound transmission through outer/middle ear, like wax or middle ear issue.

Causes and Signs

Degeneration of cochlear ganglion cells.
Loss of basilar membrane elasticity.
Decreased blood supply to inner ear.
May be related to B12/folate deficiency, atherosclerosis, HTN, diabetes, Meniere’s.
Difficulty hearing high-frequency sounds and hearing in noisy areas.

Care and Communication

Check for cerumen first.
Audiology evaluation.
Hearing aids may help.
Face the client while speaking.
Speak clearly, not too fast.
Reduce background noise and use written instructions when needed.

Exam Cue

Presbycusis = age-related sensorineural hearing loss.

32. Otic Medication Administration

Special Senses • Ear drop administration

Main Concept

Otic medication administration means safely instilling ear drops into the ear canal while preventing contamination and helping the medication reach the affected area.

Otic

Related to the ear.

Instilling drops

Paglalagay ng prescribed number of drops into the ear.

Contamination

Pagdumi ng dropper tip by touching ear, fingers, or surfaces.

Tragus pumping

Pag-press sa tragus para matulungan pumasok ang drops, especially with tubes.

Steps

Handwashing.
Warm and shake bottle if ordered/appropriate.
Client lies on side with infected ear up.
Instill 3–5 drops as ordered.
Do not touch dropper tip to ear, fingers, or surfaces.

Special Notes

Middle ear infection with tubes: press tragus 5 times in pumping motion.
Outer ear infection: pull outer ear upward and backward to help drops flow down canal.
Remain side-lying at least 60 seconds.

Exam Cue

Ear drops: infected ear up, avoid contamination, stay side-lying after drops.

Quick High-Yield Differentiation Table

Fast review bago exam

Condition	Best Clue
Parkinson’s	Pill-rolling tremor, shuffling gait, mask-like face
Multiple Sclerosis	Visual symptoms first, remissions/exacerbations
Myasthenia Gravis	Weakness worse with activity, better with rest
Guillain-Barré Syndrome	Ascending weakness, absent DTRs, respiratory risk
ALS	Progressive motor weakness, fasciculations, dysphagia
Huntington’s	Chorea, dementia, family history
RA	Symmetric small joints, morning stiffness > 30 min
OA	Weight-bearing joints, stiffness < 30 min
Gout	Big toe pain, urate crystals, high-purine foods
SLE	Butterfly rash, photosensitivity, renal involvement
Osteomalacia	Vitamin D deficiency, soft bones
Osteomyelitis	Bone infection, fever, pulsating bone pain
Pott’s Disease	Spinal TB, back pain, night sweats, kyphosis
Paget’s Disease	Bone pain, enlarged skull/bowed legs, hearing loss
Cataract	Painless cloudy vision, glare, faded colors
Glaucoma	Optic nerve damage, increased IOP
Retinal Detachment	Flashes, floaters, curtain vision loss
Otitis Externa	Pain when moving outer ear
Otitis Media	Child, earache, fever, bulging tympanic membrane
Meniere’s	Vertigo, tinnitus, hearing loss, ear fullness
Presbycusis	Age-related sensorineural hearing loss