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Pathophysiology > Class 9 chapter 38 > Flashcards

Class 9 chapter 38 Flashcards

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1
Q

Conjunctivitis

A

Inflammation of the conjunctiva
Causes of bilateral
- Infection (bacterial/fungal/viral), allergens, radiant energy
Causes of unilateral
- Foreign body, chemical irritation/damage

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2
Q

Conjunctivitis manifestations

A

Sensation of a foreign body
Scratching/burning/itching
Pain (usually mild)
Photophobia (sensitive to light)
Tearing
Hyperemia of peripheral conjunctiva (too much blood in area)
Bacterial/fungal infection = mucopurulent discharge
Viral infection, allergy, foreign body = discharge

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3
Q

Conjunctivitis types

A
  1. Bacterial
    - Acute
    - Chronic
    - Hyperacute
  2. Chlamydial
  3. Viral
  4. Allergic
    - Hay fever
    - Airborne allergen
    - Itching, tearing, redness
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4
Q

Acute & Chronic Bacterial Conjunctivitis

A

Streptococcus pneumonia, Staphylococcus aureus, H. influenza
1. Acute - manifestations
- + yellow green exudate = sticky eyelids
- Excoriation possible (scratch the surface)
2. Chronic (often unilateral)
Causes
- Obstruction of nasolacrimal duct
- Chronic infection of lacrimal sac

Manifestations
- Burning, itching, mornign crusting, eyelash loss, redness

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5
Q

Hyperacute Bacterial Conjunctivitis

A

Neisseria gonorrhoeae (common), Neisseria meningitidis

Manifestations (progressive)

  • Chemosis (edema) of conjunctiva, with redness
  • Lid swelling, tenderness
  • Swollen preauricular lymph nodes (just infront of ear)

Treatment

  • Systemic and topical antimicrobial
  • Based on C&S swab as penicillin resistant N. gonorrhoeae common
  • If untreated, corneal ulceration, perforation, vision loss
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6
Q

Chlamydial Conjunctivitis

A 
Chlamydia trachomatis (also causes STIs)
Leading cause of preventative blindness in the world

Transmission

  • Direct contact
  • Fomites, flies
  • Mom to newborns
  • Unchlorinated pools

Self-limiting/mild

More serious (stronger strain)
- Ulceration, scarring, blindness
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7
Q

Viral Epidemic Keratoconjunctivitis

A

Adenoviruses

  • Inadequately chlorinated swimming pools
  • Highly contagious (no specific treatment)

Manifestations of mild form
- Generalized hyperemia
- + tearing with little discharge
Pharyngitis, fever, malaise

Manifestations of “epidemic” keratoconjunctivitis

  • Visual disturbances
  • Self-limiting but lasts for weeks
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8
Q

Corneal Trauma

A

Minor if epithelial layer damaged as can regenerate with no scarring

Damage to endothelia

  • Edema (dull/hazy cornea)
  • Slow healing, scarring

Manifestations

  • Pain
  • Decreased visual acuity
  • Iridescent vision
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9
Q

Keratitis (inflammation of cornea)

A

Bacteria, viruses
Herpes simplex virus, acanthamoeba (rare)

Causes

  • Infections, tearing defects
  • Contact lenses
  • Hypersensitivity reaction
  • Ischemia, trauma
  • Local anaesthesia

Non-Ulcerative
- All layers of epithelium but leaves it intact

Ulcerative

  • Epithelium, stroma (outer layer of iris) or both
  • Results in scarring, impaired vision, blindness
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10
Q

Disorders of Refraction

A
  1. Hyperopia (far sightedness)
    Anterior-posterior distance of eye too short
    Image is focused behind retina
    Correct with convex lens
  2. Myopia (near sightedness)
    Anterior-posterior distance of eye is too long
    Image is focused front of retina
    Correct with concave lens
  3. Astigmatism
    Asymmetric bowing/defect of cornea or lens
    - Congenital
    - Scarring
    Non-uniform refraction of light onto retina = blurred vision

Contact Lens or Surgery (to remove epithelial section)

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11
Q

Disorders of Accommodation

A

Accommodation is the ability of the eye to adjust through contraction of ciliary muscles

  • Controlled by oculomotor nerve (CN III)
  • Adjusts the shape of the lens and size of pupil
  1. Cycloplegia
    Paralysis of ciliary muscle results in loss of accommodation
  2. Presbyopia
    Age related decreased accommodation (lens thickens and hardens)
    - Ability to see nearer objects improves (“second sight”)
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12
Q

Cataracts: Opacity of Lens

A

Most common cause of blindness
Most are bilateral
Fiber build-up causes layered sclerosis

Causes

  • Aging (most common)
  • Hereditary, congenital
  • Environmental (trauma, heat, ionizing radiation)
  • Metabolic
  • Drugs
  • Smoking

Manifestations

  • Blurred/distorted vision
  • Acquired myopia (second night)
  • Loss of far-vision
  • Glare
  • Loss of colour discrimination

Diagnosis
- Snellen vision test: degree of visual impairment

Treatment

  • Corrective lens
  • Surgical implants
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13
Q

Papilledema

A

Edema of optic papilla resulting in compression of blood vessels and nerves
- Tissue surrond optic nerve entrance to optic disc

Causes
Increased intracranial pressure!
- Tumours, subdural hematomas, hydrocephalus, malignant hypertension

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14
Q

Retinopathies

A 
Changes in retinal blood vessel structures
Results in:
1. Microaneurysms 
Leak plasla – edema causes haziness
2. Neovascularization
Fragile – leak proteins and blood
3. Hemorrhages
Result in schema
4. Retinal opacities
D/t all of the above
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15
Q

Diabetic Retinopathy (DR)

A 
A leading cause of blindness
Due to
- Hyperglycemia
- Hypertension
- Hypercholesterolemia
- Smoking

Non-proliferative: confined to retina

Proliferative: more severe d/t neovascularization

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16
Q

Non-proliferative DR

A

Retinal vein engorgement
Thickened capillary membranes
Capillary microaneurysms/hemorrhage
- Hemorrhage/microinfarcts causing leakage of exudate
- “Cotton wool spots” d/t damage to nerve fibers
- Symptoms of glare
- Macular edema d/t leakage at capillary level

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17
Q

Proliferative Diabetic Retinopathy

A

New vessels attach vitreous too tightly to retina and resulting tension causing detachment
Bleeding
Hemorrhages/microinfarcts

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18
Q

Hypertensive Retinopathy

A

Increased pressure results in:

  1. Initial vasospasm
    - Ischemia/necrosis
    - Hemorrhage
  2. Persistent/chronic
    - Compensatory arteriorlar wall thickening
    - Ischemia/necrosis
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19
Q

Retinal Detachment

A

Separation of retina from blood vessels behind it (epithelium)
Resulting painless ischemia and loss of vision in that area

Risk Factors

  • Age
  • Myopia (d/t stretch of retina)
  1. Exudative type
    - Hypertension, inflammation, neoplasm
  2. Traction type
    - Fibrotic tissue/scarring from injury, infection, surgery
  3. Rhegmatogenous (rhegma = hole) most common
    - Vitreous shrinks with age, separates from retina, causes tear
Symptoms
Slow painless changes in vision
Beginning in peripheral vision
- Flashing lights, sparks
- Floaters or spots in field of vision
- Shadow or dark curtain with progression

Treatment = early detection
Laser or cryotherapy to seal retinal tear
Scleral buckling
- Silicone is placed on sclera so it attaches to retina that is “loose”

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20
Q

Macular Degeneration

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A

Destructive changes to central fovea

Risks
Aging
Female
Caucasian
Smoker
Heredity

Results in loss of central vision

21
Q

Non-neovascular MD: Dry

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A

Degeneration/atrophy of retinal cells
Drusen spots enlarge over time

Manifestations
- Minimal vision changes but may worsen suddenly

22
Q

Vascular MD: Wet

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A

Age-related neovascularization of the choroid
Blood vessels leak
Fluid buildup pushes retina away from choroid, scarring

Manifestations
- Slow progression to irreversible loss of vision

23
Q

Glaucoma

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A

Chronic, degenerative optic neuropathy d/t increased intraocular pressure
Second leading cause of blindness in the world
Optic disk rim thins, increases “cupping”
- Damages optic nerve axons

Causes
Congental
Acquired (age related)

24
Q

Open-angle Glaucoma

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A

Most common
Trabecular meshwork decreases absorption of aqueous humor resulting in increased pressure
Iridocorneal angle remains open

Risk Factors
Primary: family history, age, severe myopia
Secondary: anything increasing intraocular pressure (Inflammation, trauma, tumour, htn, DM, hyperthyroidism, migraine, headache, corticosteroid - topical or inhaled)

Manifestations

  • Asymptomatic, chronic, slow damage optic nerve cupping
  • Loss of visual field unless treated
  • Light sensitivity
25
Closed Angel (Angel-Closure) Glaucoma
Iris occludes flow of aqueous humor to trabecular meshwork Causes Inherited defect of angle or structures - Results in age related iris thickening Conditions that cause prolonged dilation of pupil Atropine dilates pupils (mydriasis), displaces iris ``` Manifestations Pain Blurred vision Enlarged/fixed pupil Some relief with sleep ```
26
Visual Field Defects
Anopia = blindness one eye Hemianopia = half visual field is lost in one eye Quadrantanopia = quarter of visual field in one eye is lost Tunnel Vision = narrowed binocular field
27
Strabismus
Loss of binocular vision d/t abnormal coordination or alignment Often children Can result in partial loss of vision ``` Esotropia: medial deviation Exotropia: lateral deviation Hypertropia: upward deviation Hypotropia: downward deviation Cyclotropia: torsional deviation ```
28
Strabismus Types
1. Concomitant Equal deviation in all direction of gaze 2. Nonconcomitant Varies with direction of gaze 3. Intermittent/periodic Periods where eyes are parallel 4. Monocular Same eye always deviates and the other always fixates
29
Nonparalytic Strabismus (most common)
No obvious defect of muscles Possibly genetic Amount of deviation is relatively constant Both eyes can be different Secondary symptoms may result if persistent
30
Paralytic Strabismus
Paresis or plegia of one or more extraocular muscles Uncommon in children; possible from birth trauma Causes: stroke, myasthynia gravis, Graves disease, trauma, childhood nonparalytic strabismus
31
Amblyopia (lazy eye)
Abnormal visual development in infancy or early childhood Mostly reversible but can progress to partial or full loss of vision Causes - Visual deprivation: cataracts, ptosis (droopy eyelid) - Binocular problems: Strabismus, anisometropia (refractive indexes of 2 eyes are different)
32
Nystagmus
Spontaneous involuntary rhythmic & oscillatory eye movements occurring without head movement or visual stimuli Causes - Fatigue - Psychological factors - CNS damage (Multiple Sclerosis d/t demyelination, hyperosmolar hyperglycemic state)
33
The External Ear
Impacted Cerumen - Asymptomatic unless total occlusion or hardens onto the tympanic membrane - Pain, itchiness, sensation of fullness, hearing loss, tinnitus
34
Otitis Externa : Inflammation of external ear
``` Causes Infection (bacteria or fungi) - Frequent exposure to water Irritation (cleaning with other than your elbow, hearing aides) Allergies/skin reactions ``` Manifestations - Itching, redness, tenderness, edema, pain - Watery/purulent drainage - Intermittent hearing loss “Acute cellulitis” often d/t S. aureus More severe symptoms
35
Disorders of Eustachian Tube
Abnormal patency Does not close Does not close enough Obstruction 1. Functional Persistent collapse d/t lax tube or muscles - Often with infants as collagen hasn’t developed fully Cleft palate alters structure 2. Mechanical Allergic reaction or viral infection
36
Otitis Media (inflammation of middle ear)
Usually d/t dysfunction eustachian tube allowing reflux ``` Risk Factors Infants: bottle vs breast fed, structure of ET Premature birth Children 5 years old* (children start to interact with other children outside household) Males Ethnicity Family history of same Siblings in household Genetic syndromes Low socioeconomic status ``` Usually post upper respiratory infection Rhinoviruses & respiratory syncytial virus (RSV) Manifestations Otalgia, irritability, poor eating and sleeping habits Fever, hearing loss Erythemic tympanic membrane Pain, increasing with perforation of tympanic membrane - Purulent drainage Rhinorrhea/vomiting Otitis Media with Effusion (OME) - Fluid in middle ear with out signs of infection
37
Complications of Otitis Media
``` Hearing loss Mastoiditis Cholesteatoma cysts of middle ear Erosion of ossicles Labyrinthitis Otogenic meningitis Brain abscess Sinus thrombophlebitis Facial nerve paralysis ```
38
Treatment of Otitis Media
Analgesia, heat Myringotomy (incision of TM) with immediate relief Antimicrobial needs careful consideration Surgery Typanostomy tubes Adenodiectomy
39
Tinnitus
Perception of abnormal ear/head noises - Ringing, buzzing, roaring - Constant, intermittent - Unilateral, bilateral Objective (rare) Detectable by others - Turbulent blood flow Subjective - No noise stimulation of cochlea
40
Causes of Subjective Tinnitis
``` Impacted cerumen Medications (ASA, nicotine, caffeine) Foods (MSG, red wine, cheese) Presbycusis (hearing loss d/t aging) Hypertension Atherosclerosis Head injury Cochlear or labyrinthine infection ```
41
Hearing Loss
Transient/permanent Unilateral/bilateral Prelingual/postlingual (before/after speaking) Conductive Hearing Loss - Transmission failure through outer/middle to inner ear Sensorineural Hearing Loss - Sound waves travel through outer/middle ear but are distorted by (Cochlear damage, Nerve damage, Damage to auditory pathway of brain)
42
Causes of Sensorineural Hearing Loss
``` Intrauterine infections (maternal rubella) Congenital malformation of inner ear Genetic mutation Trauma (physical noise) Tumor Hemorrhage, Thrombosis Infections (bacterial meningitis) Drugs (labelled ototoxic) ```
43
Damage to Vestibular System
``` Skull fracture (temporal bone) Infection of nearby structures Toxins carried in bloodstream Drugs (gentamycin) Alcohol ``` Irritation of vestibular organs or nerves results in balance issues and vertigo Adaptation occurs with time
44
Vertigo: illusion of motion
1. Objective vertigo Sensation that person is statiionary but environment moves 2. Subjective vertigo Sensation that person is in motion & environment is stationary Causes: motion sickness, moving objects Motion sickness: form of normal physiologic vertigo d/t repeated rhythmic stimulation of vestibular system
45
Benign Paroxysmal Positional Vertigo
Inflammation of vestibular nerve Causes Recent upper respiratory tract illness Herpes zoster Manifestations Change in position of head results in - Vertigo and rotary nystagmus Relief with motion ceases or with continued motion
46
Benign Paroxysmal Positional Vertigo
Most common cause of vertigo in 40+ year olds Cause Damage to calcium crystals (otoliths) than line labyrinth - Float in endolymph of posterior canal Manifestations Change in position of head results in - Vertigo and rotary nystagmus Relief when motion ceases, or with continued motion
47
Acute Vestibular Neuronitis
Inflammation of vestibular nerve Causes Recent upper respiratory tract illness Herpes zoster ``` Manifestations Vertigo, nausea, vomiting No auditory or neurological symptoms Lasts for days Repeated attacks without predictability ```
48
Meniere Disease
Due to distension of endolymphatic compartment of inner ear (d/t excess fluid) - Increased production of endolymph - Decreased absorption of endolymph - Decreased production of perilymph Causes: Trauma, infection, endocrine insufficiency, vascular disorders, autoimmune
49
Meniere Disease Manifestations
Hearing loss Vertigo – violent rotary Tinnitus – fluctuating Feelings of ear fullness ANS symptoms: pallor, sweating, nausea, vomiting Initially unilateral = imbalance Progression = bilateral healing loss, lessening vertigo

Pathophysiology (13 decks)

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