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Klinische Vraagstukken Cluster B
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Cluster BInhoudsopgave
B1 - Motoriek............................................................................................................................................ 4
Lokaliseren .......................................................................................................................................................... 4
Perifere aandoeningen ....................................................................................................................................... 7
Voorhoornaandoeningen............................................................................................................................... 7
Aandoeningen van de neuromusculaire overgang ...................................................................................... 10
Spierziekten ................................................................................................................................................. 11
Bewegingsstoornissen ...................................................................................................................................... 14
Pyramidebaansyndroom.............................................................................................................................. 14
Cerebellaire ataxie ....................................................................................................................................... 14
Basale ganglia .............................................................................................................................................. 15
Parkinsonisme................................................................................................................................................... 17
B2 - Ogen en visus................................................................................................................................... 20
Anatomie en fysiologie ..................................................................................................................................... 20
Het visuele systeem .......................................................................................................................................... 26
Onderzoek......................................................................................................................................................... 27
Anamnese .................................................................................................................................................... 27
Algemeen oogheelkundig onderzoek .......................................................................................................... 28
Refractieafwijkingen ......................................................................................................................................... 30
Emmetropie en ametropie .......................................................................................................................... 30
Visus en gezichtsvelden .................................................................................................................................... 31
Oogtrauma ....................................................................................................................................................... 32
Rood oog........................................................................................................................................................... 32
Infecties ............................................................................................................................................................ 33
Cataract (staar) ................................................................................................................................................ 33
Glaucoom.......................................................................................................................................................... 35
Netvliesaandoeningen en macula..................................................................................................................... 36
Netvliesloslating........................................................................................................................................... 36
Diabetische retinopathie ............................................................................................................................. 37
Leeftijdsgebonden maculadegeneratie (LMD) ............................................................................................ 37
Oogleden .......................................................................................................................................................... 38
De orbita ........................................................................................................................................................... 39
B3 - Oren en gehoor ................................................................................................................................ 42
Anatomie .......................................................................................................................................................... 42
De schedel.................................................................................................................................................... 42
De keel ......................................................................................................................................................... 43
Trigeminus en facialis .................................................................................................................................. 44
Rotsbeen ...................................................................................................................................................... 45
1
, Gehoorverlies .................................................................................................................................................... 47
Conductief gehoorverlies ............................................................................................................................. 47
Perceptief gehoorverlies .............................................................................................................................. 48
Behandelingen / revalidatie ......................................................................................................................... 49
Oorpijn .............................................................................................................................................................. 51
Uitwendige oor ............................................................................................................................................ 51
Middenoor ................................................................................................................................................... 51
Binnenoor .................................................................................................................................................... 53
Referred pain ............................................................................................................................................... 53
Vertigo .............................................................................................................................................................. 53
Anatomie ..................................................................................................................................................... 53
Centrale vertigo ........................................................................................................................................... 55
Perifere vertigo ............................................................................................................................................ 55
Niet-vestibulaire duizeligheid ...................................................................................................................... 56
Vestibulaire aandoeningen .......................................................................................................................... 57
Nervus Facialisparese ....................................................................................................................................... 60
Anatomie ..................................................................................................................................................... 60
Diagnostiek .................................................................................................................................................. 60
Etiologie ....................................................................................................................................................... 60
B4 - Sensibiliteit ...................................................................................................................................... 62
Mononeuropathie ............................................................................................................................................. 62
..................................................................................................................................................................... 63
Radiculopathie .................................................................................................................................................. 63
Guillain Barré ............................................................................................................................................... 67
..................................................................................................................................................................... 67
Polyneuropathie ............................................................................................................................................... 69
Multipele Sclerose............................................................................................................................................. 71
Dwarslaesie ...................................................................................................................................................... 75
B5 - Bewegingsapparaat ..................................................................................................................... 79
Reumatologie ................................................................................................................................................... 79
Onderscheid maken ..................................................................................................................................... 79
Bloedbeeld ................................................................................................................................................... 80
Beeldvormend onderzoek............................................................................................................................ 81
Reumatische aandoeningen ............................................................................................................................. 82
Systemische auto-immuunaandoeningen ................................................................................................... 82
Behandelingsprincipes systemische reumatische aandoeningen................................................................ 88
Infectieuze artritis ........................................................................................................................................ 91
Metabole gewrichtsaandoeningen .............................................................................................................. 92
Wekedelenreuma ........................................................................................................................................ 94
Artrose ......................................................................................................................................................... 95
Orthopedie ........................................................................................................................................................ 96
Schouder ...................................................................................................................................................... 96
Cuffruptuur .................................................................................................................................................. 98
Subacromiaal impingement ......................................................................................................................... 99
De elleboog ................................................................................................................................................ 100
De onderarm .............................................................................................................................................. 102
De heup...................................................................................................................................................... 105
De knie ....................................................................................................................................................... 108
2
,3
, B1 - Motoriek
Lokaliseren
Lokaliseren = zo precies mogelijk nagaan waar in het zenuwstelsel een stoornis aanwezig is,
is een belangrijke vaardigheid in de aanpak van een klacht vaneen patiënt die komt met een
vermoedelijk neurologische aandoening.
Stap 1: waar zit het probleem?
Stap 2: wat is de oorzaak?
Belangrijk hierbij is na te gaan of het uberhaupt een neurologisch probleem is, zo ja, bevindt
het zich dan in het pzs of czs?
Centraal zenuwstelsel:
- Cortex
- Basale ganglia
- Witte stof
- Hersenstam
- Cerebellum
- Ruggenmerg
Perifeer zenuwstelsel:
- Motore voorhoorncel
- Wortel
- Perifere zenuw
- Neuromusculaire overgang
- Spier
4
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