D2 Medical Information Flashcards

Question

Low Vision Mobility Challenges

Answer 1

Light Management… Glare, Light Adaption, Low Light Terrain Changes Judging speed/distance Fluctuating

Answer 2

GENERAL: Repetitive, involuntary movement: up and down, circular, side to side Idiopathic but often symptom of another eye problem (e.g. albinism, neurological problem, refractive error, etc) ISSUES: Blurry, shaky VA (but will not appear so to congenital) Depth perception (stereo vision degraded) Balance and dizziness Vertigo STRATEGIES Null point Large Print Magnification Increased lighting

Answer 3

GENERAL: not completely understood but something to do with eye muscles and nerves. Associated with stroke, trauma, infections, Strabismus – lazy, turned, crossed eye (can lead to amblyopia). Problem with eye muscle control, brain receives 2 different images and may learn to suppress image from weaker eye. Esotropia – inward turning Exotropia – outward turning Hypertropia – upward turning Hypotropia – downward turning Amblyopia – failure of one or both eyes to achieve VA despite normal structural health of eye. Brain begins to ignore a weaker eye (can cause strabismus). ISSUES: Depth perception Double vision Visual Acuity Fatigue Headaches Clumsiness, poor hand-eye coordination STRATEGIES… Strabismus usually fixed when found and treated early Alignment and focus test Prescription glasses/contact lenses help eyes focus on objects with less effort and improve ability to remain aligned Patching stronger eye and Eye Exercises for weaker eye classic treatment to build up weaker eye Medications botox weaken overactive eye muscle Surgery for severe cases manipulate length and position of muscles in and round eyes.

Answer 4

GENERAL Nearsighted / shortsighted, cornea or lens has too much curvature for length of eyeball, light focuses in front retina, treated with concave lens. The eyeball is elongated and a little bit squished down Increasing rapidly throughout the developed world, suggesting environmental factors are involved ISSUES VA far object blurry Headaches Sitting close to TV, screen Excessive blinking / eye rubbing Unaware distant objects STRATEGIES Prescription glasses, contact lenses, refractive surgery

Answer 5

GENERAL Farsightedness / long sighted, cornea or lens has too little curvature for length of eyeball, light focuses behind retina, treated with convex lens Hyperopia … life long condition, requires you to focus more strongly when you need to see up close Presbyopia …kicks in later and makes focusing itself more difficult due to loss of elasticity of the lenses (natural part of ageing), ISSUES holding books and newspapers at arm's length to be able to read them STRATEGIES Prescription glasses, contact lenses, refractive surgery bifocals if near and farsightedness combine

Answer 6

GENERAL Cornea forms cone shape due to collagen protein fibres thinning, symptoms develop 10-25 year and continue developing to 40 years (young person’s disease) Keratoconus is a condition caused by your cornea protruding into a cone-like shape, while astigmatism is caused by an imperfection in the cornea or lens of your eyes. Both conditions can result in blurry vision ISSUES VA (short sighted - cornea accounts for approximately ⅔ of eye’s total optical power Headaches / tiredness Photophobia Double vision STRATEGIES no cure Corneal topographer detect early keratoconus Corneal ultrasound measures corneal thickness Early on glasses or soft contact lenses Middle hard contact lenses (to help stablise shape) Advanced laser surgery makes tiny inserts into cornea to correct shape or full transplant

Answer 7

GENERAL Clouding of lens… Most common type of eye disease Age related… normal part of ageing but higher risk with family history, diabetes, eye injury, steroid treatment, UV exposure, smoking, alcohol. Congenital … pre-maturity, diabetes, inflammation, infection, metabolic problem Pupil maybe white due to cataract showing through the hole, ISSUES Blurred vision Double vision Glare sensitivity because light scatters Halos around lights again because light diffraction Feeling looking through veil or curtain Colours faded Trouble seeing at night Trouble reading or doing everyday activities For congenital cataracts … nystagmus, strabismus, amblyopia risk STRATEGIES Examine with dilate pupil and slit lamp AND sometimes imaging procedure such as computed tomography (CT) scan OR magnetic resonance imaging (MRI) screen OR ultrasound Age related Early: Increased lighting Anti-glare sunglasses Magnifying lenses Prescription glasses Age related Late: Surgery when gets in way of everyday activities like reading, driving, watching TV. Cloudy lens replaced with artificial lens Congenital: Surgery and prescription lens but opinions vary as to when due to growing eye in baby Protective … wear sunglasses and hat with brim to block sun, quit smoking, eat healthy, get dilated eye exam every 2 year if you’re 60+ he eye lens isn't clear, which causes the incoming light to scatter. Clouding of the lens can result in the diffraction of light entering the eye, resulting in halos around light sources

Answer 8

GENERAL Form of cone dystrophy either complete achromatopsia (all colour perception gone) or incomplete achromatopsia (only a specific colour respectively gone) aka ‘total congenital colour blindness’, ‘rod monochromacy’, ‘day blindness’ as affected individuals see better in subdued light Non-progressive and hereditary visual disorder ISSUES Photophobia Nystagmus… one of first signs, needs immediate check by pediatric ophthalmologist Colour discrimination Astigmatism STRATEGIES Family history and symptoms Colour vision tests (e.g. Ishihara pseudoisochromatic tests, H-R-R tests, Farnsworth panel D15 colour test and the City University tests) Additional testing such as optical coherence tomography (OCT), fundus autofluorescence, visual fields, as well as electroretinogram (ERG) to measure cone function are also important in making the diagnosis for this condition Red coloured or darkly tinted lenses help reduce light sensitivity OCT like ultra sound except it uses light waves instead of sound to make an image of the eye

Answer 9

GENERAL Retinitis pigmentosa (RP) is the collective name for a range of diseases that damage the light sensitive cells of the retina and cause vision to fade. Rod and cone cells damaged = vision fades. In most cases, RP is caused by any one of more than 100 defective genes. It is thought that these flawed genes cause the formation of a wrong type of protein in the retina, which results in the death of rods and cones I think RP goes this way too? ISSUES: Different people with RP may have totally different disease courses because of genetic and other differences. Even within the same family, there may be variability in the rate of progression of the disease between different members Rods Damage: Typically rod cells damaged first resulting in… Night blindness: Tunnel vision: loss of peripheral vision, Vision Loss/Blindness: late symptoms Cone Damage: In other cases of RP, the central area of the retina is affected first, which means the person may have trouble with: distinguishing colours reading recognising visual details. Cataracts: Development of cataracts is a common complication of RP. However, it does not necessarily have great visual significance, as in most cases the retinal disease is the most important reason for the poor vision. In such cases removing the cataract by surgery does not always result in a great improvement in vision Usher Syndrome: Usher syndrome is a genetic disorder that includes retinitis pigmentosa and a partial or total hearing loss from birth. Usher syndrome is categorised into three broad groups according to the type and severity of symptoms. Type 1 and Type 2 account for around 10 per cent of children who are born deaf STRATEGIES: NO cure. Eye tests, photographs and scans… Ophthalmoscope: allows you to look into the back of the eye to look at the health of the retina, optic nerve, vasculature and vitreous humor with 15x magnification. Looking if retina is covered in deposits of black pigment (which gives Pigmentosa name) Electro-retinogram: electro-physiological test records the electric activity of the retina in a similar way to an ECG test. Exposing the person to dark and light conditions and measuring the retinal electric activity via electrodes placed on the person’s head or eyes. The test is painless and is sometimes repeated to monitor the disease progression Other Tests include Visual field test, Colour vision testing and Fluorescein angiogram (a special type of photography of the retina that is done after injection of dye into the arm vein) and Genetic test. Exploring Treatments… gene therapy (introducing healthy gene into the retina), vitamins and fatty acids (controversial if helps), retinal prosthesis (bionic retina researched),

Answer 10

GENERAL Onset early childhood or adolescence, CRD leading to total blindness by age 40 with additional rod involvement. genetic condition where the light sensitive cones and rods at the back of the eye waste away same family of eye conditions as Lebel Congenital Amaurosis Progressive retinal degeneration, form of RP, hereditary, starts with rods then cones later ISSUES Nystagmus and photophobia Contrast sensitivity Depth perception Fluctuating vision Light adaption Night blindness Photophobia Visual field (PV initially), visual acuity (CV later) STRATEGIES Fundus photography Braille training Cane (long) training Flash light (at night) Long cane (at night) High contrast materials Magnification Glare Control (UV shield and hat) Scanning strategies

Answer 11

GENERAL Leber congenital amaurosis (LCA) is not a single entity but a group of disorders due to mutation of at least 16-27 different genes Changed/mutated gene impairs development of the retina due to a change or mistake in one or more genes. Most children with LCA and EOSRD are otherwise healthy. However some children have kidney, bone, muscular, ear or brain abnormalities as well EOSRD …. Early-Onset Severe Retinal Dystrophy same family of eye conditions as rod-cone dystrophy, ISSUES Photophobia Nystagmus STRATEGIES: no cure Genetic testing Electrophysical Testing: The inside and outside of the eye may look normal, so electrophysical tests may be necessary to identify if the retina is malfunctioning.Tests measure electrical activity that occurs in your eye when you look at something. Electroretinography (ERG) is used to assess visual function by measuring activity in the retina. Working on gene therapies to target LCA linked mutations

Answer 12

GENERAL damage to the retina caused by blood leaking or new blood vessel growing causing leakage and scaring Diabetic Retinopathy: top 5, elevated blood sugar levels for extended period of time damage tiny blood vessels in retina. Problem with the way blood vessels develop on the surface of the retina. 5 grades: 1 is mild and 5 is most severe. Retinopathy of Prematurity (ROP): High amounts of oxygen used for premature birth damages the retina. High risk of retinal detachment caused by retinal bleeding ARMD technically included under the umbrella term retinopathy but is often discussed as a separate entity Diabetic and Prematurity are two most common causes of retinopathy Retinopathy is often a secondary to other diseases (e.g. diabetes or hypter-tension) so controlling sugar levels or blood pressure can decrease incidence of retinopathy. Many other causes of retinopathy listed on wiki page Trauma: Some injuries cause blood vessels in the back of the eye to bleed, most common retinopathy in young people. Hypertension: notes… eye detached retina 2 years ago due to stress and fall backwards; ISSUES: Not painful and symptoms don’t appear until very late at which point irreversible damage occurred = testing important. Floaters (Vitreous haemorrhage = leakage of blood around vitreous humor) Blurred vision, reddish tint to vision Photopsia (flashes of light in peripheral vision) Curtain falling over eyes Contrast sensitivity Depth perception Fluctuating vision Light adaption Nystagmus Photophobia STRATEGIES: Examination looking through dilated pupil or stereoscopic fundus photography (gold standard) Glare Control High contrast materials Magnification Retinal precautions Scanning strategies Treating blood flow issues either blood vessel leaking or growing is one of the major advances in eye health care in recent years. Used to burn the eye to stop bleeding but now can use the VEGF injection.

Answer 13

GENERAL Age Related Macular Degeneration Progressive breakdown of central part of retina Dry most common… deposits extra cellular material on macular Wet … abnormal blood vessels leak blood into macula, quick progression Stargardt's … juvenile MD, genetic ISSUES: Contrast sensitivity Depth perception Fluctuating vision Light adaption Photophobia Scotoma (blind spot) Visual acuity (CV and colour), normal peripheral STRATEGIES: Amsler Grid monitoring for changes Fundus photography highlight drusen (small yellow or white spots on the retina) showing early stages ARMD) Dry … not much you can do apart from AREDS2 supplements. special dietary supplements called AREDS 2 can help slow down vision loss. Wet … anti VEGF injection Eccentric viewing (to see around scotoma) High contrast materials Magnification Glare Control (UV shield and hat) Illumination

Answer 14

GENERAL High Intraocular pressure in the eye causes optic nerve damage (caused by aqueous fluid not draining properly), The eye is constantly producing a clear liquid called aqueous humor which it secretes into itself to nourish and hold the eye shape. Aqueous humor should drain out of the eye through an area called the anterior chamber angle or drainage angle. If this area is damaged then the aqueous humor can’t drain quickly enough and IOP rises. Open (wide) angle: most common where drainage for fluid remains open, for a long time there is no obvious problem, but the fluid pressure builds up the optic nerve gradually deteriorates and blind spots develop in your visual field. Tiny bits of pigment from your iris, the coloured part of your eye, get into the fluid inside your eye and clog the drainage canals. Activities such as jogging sometimes stir up the pigment granules, Closed (narrow) angle: sudden presentation connected with pain, blurred vision, redness of the eye, nausea. Drainage space between your iris and cornea becomes too narrow and the fluid stops circulating causing a sudden build-up of pressure in your eye and sudden pain in the eye and loss of vision. iris bulges forward to narrow or block the drainage angle formed by the cornea and iris. Congenital or Childhood Glaucoma: children born with congenital glaucoma have a defect in the angle of their eye, which slows or prevents normal fluid drainage. The optic nerve damage may be caused by drainage blockages or an underlying medical condition. Congenital glaucoma usually presents with symptoms, such as cloudy eyes, excessive tearing, or sensitivity to light. Congenital glaucoma can run in families. rare, genetic. It may be present from birth or develop in the first few years of life Secondary Glaucoma: This is when another condition, like cataracts or diabetes, causes added pressure in your eye. Secondary glaucoma is often a side effect of injury or another eye condition, such as cataracts or eye tumors. Medicines, such as corticosteroids, may also cause this type of glaucoma. Rarely, eye surgery can cause secondary glaucoma. Less-common causes of glaucoma include a blunt or chemical injury to your eye, severe eye infection, blocked blood vessels inside your eye, and inflammatory conditions ISSUES: Open Angle: Most people with open-angle glaucoma don’t have symptoms. If symptoms do develop, it’s usually late in the disease. That’s why glaucoma is often called the "sneak thief of vision." The main sign is usually a loss of side, or peripheral, vision gradual loss of peripheral vision, usually in both eyes tunnel vision Closed Angle: sudden symptoms, Symptoms of angle-closure glaucoma usually come on faster and are more obvious. Damage can happen quickly. If you have any of these symptoms, get medical care right away Eye pain, usually severe Blurred vision Nausea and possibly vomiting Seeing halo like glows around lights Redness in eyes Sudden, unexpected vision problems STRATEGIES: primary glaucoma, there is no identifiable cause. If they have secondary glaucoma there is an underlying cause, such as a tumour, diabetes, hypothyroidism, an advanced cataract, or inflammation. Possible to slow or stop progression of disease with medication, laser treatment or surgery. Once damaged optic nerve, vision loss is permanent. Risk Factors: increasing age, high pressure in the eye, family history, steroid medication Glaucoma Australia recommends all Australians 50 years or older visit an optometrist every 2 years for a comprehensive eye exam, and if you have a family history of glaucoma or are of Asian or African descent we recommend you get your eyes checked every 2 years from the age of 40. Ophthalmoscopy: Measure Intraocular pressure by putting eye drops in to widen pupil and then examine the inside of the eye using a special light and magnifying glass. Part of routine eye test. They may take photographs so they can spot changes at your next visit Perimetry: carry out a visual field test, look straight ahead while doctor presents a light spot in different palces around the edge of vision. Maps what a person can see. Tonometry: eye drops numb the eye, the doctor measures pressure in the eye with a device that either touches the cornea (applanation) or uses a puff of air Gonioscopy: eye drops to number the eye, then place a type of contact lens on the eye. The lens has mirror that can show if the angle between the iris and the cornea is normal, too wide (open) or too narrow (closed) Pachymetry: doctor places a probe on the front of the eye to measure the thickness of the cornea. The doctor will take this into account when they assess all the results, as corneal thickness can affect eye pressure readings. Treatment: the sooner you start treatment the better. Open-angle glaucoma is most often treated with combinations of eye drops, laser trabeculoplasty, and microsurgery. Doctors tend to start with medications, but early laser surgery or microsurgery could work better for some people. Acute angle-closure glaucoma is usually treated with a laser procedure. Eye Drops: most common treatment to reduce IOP. These either lower the creation of fluid in your eye or increase its flow out, lowering eye pressure: reduce the amount of aqueous fluid secreted into the eye Help increase the outflow of aqueous fluid from the drainage angle Approximately 50% of people don’t take glaucoma mediation as prescribed because open angle glaucoma has no symptoms, people may be tempted to stop taking, or may forget to take their medication/eye drops Oral Medication: rapidly reduces the amount of aqueous humour the eye secretes into itself. Used for acute angle glaucoma (medical emergency) usually used in emergency high eye pressure situations where eye drops are incapable of adequately lowering the eye pressure Often used as a short term measure for controlling very high intraocular pressure prior to more definitive treatment such as laser treatment or glaucoma surgery Laser Treatment: this procedure can slightly raise the flow of fluid from your eye if you have open-angle glaucoma. It can stop fluid blockage if you have angle-closure glaucoma. Procedures include: Trabeculoplasty: This opens the drainage area. Iridotomy: This makes a tiny hole in your iris to let fluid flow more freely Cyclophotocoagulation: This treats areas of the middle layer of your eye to lower fluid production MIGS (Minimally Invasive Glaucoma Surgery): MIGS procedures work by bypassing this blockage and help the fluid inside the eye drain out via different routes. tiny incisions to place microscopic devices inside the eye: Conventional Surgery: for more aggressive/advanced glaucoma where disease cannot be controlled using medications or laser or if above options not suitable.

Answer 15

Damage to blood vessels in the retina due to diabetes, blood leak into posterior section of eye, maybe abnormal new blood vessel and fibrous tissue in the retina ISSUES: Depth perception Fluctuating vision Light adaption Photophobia Scotoma Visual acuity (CV) STRATEGIES: Cane (long) training Glare Control Scanning Torch (at night)

Answer 16

GENERAL Optic nerve underdeveloped Visual signals not transmitted properly must rely on to in order move and interact in her daily environment. Underdeveloped optic nerve, congenital / non-progressive, sometimes surrounded with a halo. Maybe other issues like CP or nystagmus ISSUES Contrast sensitivity Light perception only Alternative sensory information Photophobia Visual field (PV) and visual acuity (CV) STRATEGIES Tune into other senses Braille training Cane (long) training High contrast materials Magnification Glare Control (UV shield and hat)

Answer 17

GENERAL Electric Impulse: Retina, Optic nerve, Optic chiasm, Optic tract, Lateral geniculate body, Optic radiation, Visual cortex Lesion before Optic chiasm = total right eye visual loss Lesion at centre X Optic chiasm = nasal information gone from each eye (field loss on outside OR bitemporal (heteronymous) hemianopia) Lesion on side Optic chiasm = temporal information gone from L eye = L nasal hemianopia Lesson on optic tract = homonymous hemianopia Lesion at Optic radiation = superior or inerior quadrantanopia (if on line line cut) or homonymous hemianopia with macular sparing (if all lines cut near the visual cortex) L eye (Nasal Hemifield) and R eye (Temporal Hemifield) travels down RHS but represents left side of image Right-sided homonymous hemianopia, which results after left-sided surgeries, can have a severe impact on learning to read in children who read languages that are written and read from left to right. skilled readers take in words from a small area around the eyes’ fixation point – about four letters to the left and 15 letters to the right. The more letters you can see on the right, the faster your reading speed because you know which word to focus your eyes on next. Adult readers with left-sided brain injury resulting in right-sided hemianopia describe severe frustration when reading because they are attempting to read into nothingness. ISSUES Unaware of field loss, don’t see visual field loss. The child lacks vision in the lost visual field in the same way that you lack vision behind you. You do not see black behind you, but instead see nothing bump into pedestrians or obstacles that they simply cannot see because the object or person is in the lost field of vision trouble with activities which require good vision, like team sport activities, playground games, or choosing food in a cafeteria line Scanning slow search patterns do not allow them to fully understand the environment around them fast enough to avoid an obstacle, so children with homonymous hemianopia often avoid new environments altogether socio-emotional well-being. For example, the child may not be chosen for team sports during recess. Because the eyes look normal, other children and teachers may not understand how the visual field loss affects the child. They may think “they are not trying hard enough”. Homonymous hemianopia may be hidden to all. walking in crowded areas such as sidewalks, shopping malls and supermarkets, classroom hallways and playgrounds, seeing playmates or teammates, identifying and finding objects, crossing the street, reading and learning, and other activities of daily living such as cooking, pouring beverages, and especially driving. leaving out of important parts of a scene and, consequently, to poor comprehension and social misunderstanding. Because homonymous hemianopia causes a loss of half the central field of vision, the child only sees part of the word when looking at it. This makes word identification very difficult. The child must scan to see the entire word before reading it, adding an additional step to the process of reading the word. Longer words are never seen as a whole word resulting in various reading accuracy errors. This can include misidentifying a word, omitting letters, syllables, skipping over short words unintentionally, or guessing errors. Guessing errors can be frequent because the child does not see the entire word. The child may identify the prefix only and then fill in the rest of the word based on prior experience Children may have problems finding the next line of text or may skip the next line altogether STRATEGIES Teach scanning search the lost visual field by turning their head Children with homonymous hemianopia often require a lot of effort to recognize that there are moving objects, people, or obstacles in their missing visual field.

Answer 18

GENERAL Disturbance of visual cortex or posterior visual pathway from lack of oxygen, head injury, infections of central nervous system, developmental brain anomalies Effects very depending on the location, extent, onset 3 requirements: Ocular exam normal History of acquired brain injury, congenital injury, neurological disorder Unique visual characteristics and behaviours ISSUES: Ventral stream dysfunction usually happens in conjunction with dorsal stream dysfunction—even though dorsal stream dysfunction can happen on its own Dorsal Stream Damage: common Difficulty with visuospatial attention, which is how we focus and filter the visual information world around us Lack of or loss of being able to process simultaneous visual information Difficulty shifting attention from one element of a scene to another because of difficulty processing too many pieces of visual information at once Impaired visual search; difficulty figuring out what to, and what not to, look at when there is competing visual stimuli Difficulty with sustained attention Difficulty with selective attention—in other words, taking in important stimuli but filtering out the rest Difficulty with spatial awareness and spatial relationships Temporal Stream Damage: Visual object agnosia, or the inability to recognize common objects Prosopagnosia, or the inability to recognize faces. This happens when the right temporal lobe is damaged Topographic agnosia, which affects your child’s ability to orient themselves in space or follow a route. This also happens with right temporal lobe damage Fluctuating vision / level of attention Self-stimulation … eye pressing, flicking of fingers in front of light source, gazing at light source STRATEGIES: Perform better with… Reduce visual clutter and complexity Familiar Shiny & reflective Colour preference Moving targets Visual latency allowance (up to 20 seconds) Touch exploration over visual exploration High contrast material Consistent visual clues, Task analysis Simplify instruction High illumination Children with CVI have unique visual behaviours and require CVI-specific assessments to evaluate their functional vision and access to the environment

Answer 19

Malignant intraocular tumour in retinal cells, hereditary, may see small white mass on exterior of the fundus, strabismus,

Answer 20

GENERAL cornea or lens is curved more steeply in one direction than in another (egg shape rather ball shape) Present at birth or develop with aging, hereditary component detected and measured with corneal topography, keratometry, vision testing and refraction ISSUES VA (poor focus at all distances) Headaches / tiredness Night Vision Lazy eye in children STRATEGIES Prescription glasses, contact lenses, refractive surgery

Answer 21

GENERAL Inflammation of any part of uveal tract (iris, ciliary body or choroid) Anterio Uveitis (aka iritis) Intermediate Uveitis (middle layer) - inflammation involving vitreous gel Posterior uveitis - inflammation of the choroid ISSUES Red, watery eye, pain Light sensitivity Blurred vision Floaters STRATEGIES Dilated eye exam Early treatment before bigger problems: dark glasses, eye drops to dilate pupil and reduce pain, steroid eye drops to reduce inflammation

Answer 22

GENERAL Reduces pigmentation of iris which is essential for normal vision ISSUES VA Depth / Stereoscopic vision Nystagmus Strabismus Photophobia STRATEGIES

Answer 23

CHALLENGES High Light / Glare Light Adaption Low Light / Night Vision Terrain Changes Judging speed/distance Fluctuating Low Contrast Fine Detail STRATEGIES Regular eye checks Braille training O&M training Flash light (at night) Long cane (at night) High contrast materials Magnifiers & CCTV Glare Control (UV shield and hat) Scanning strategies

Answer 24

VA Snellen Chart (SS, FS) and what for chn? and Amsler Grid (AMD), VF Static Perimetry look at centre and dots flash up on screen, does 30 degrees nasal / temporal, about half the field (Humphrey) VF Kinetic Perimetry isopter of different size coming in from sides, 90 degrees nasal / temporal (Goldmann field). Also confrontation 4 sides only. Imaging... Optical Coherence Tomography Electro retinography Pressure... Applanation tonometers Visual Acuity: Snellen Chart … at 6m or 3m with a mirror, record smallest line read accurately (can be less 1 letter) 6/30 -1. If 6/60 can’t be read go 1m closer until can be read, if still not read then go less accurate measurement of count fingers (CF), hand movement (HM), Light perception (LP) - seeing a light switch on and off. Amsler: grid where person focuses on black dot in middle. If parts of grid appear distorted, blurry, dark or blank it indicates a visual field deficit. Often test for macular degeneration. Peripheral Vision: Tested using perimetry: all tests must maintain constant gaze toward fixed location for several minutes, each eye tested separately while opposite eye covers with patch. Static perimetry: most common, look at centre of illuminate white screen, machine presents flashing lights of different sizes and brightness. Gradually increase size or brightness, press button each time you see light. Very important for monitoring glaucoma. Usually 4-7 min each eye only does central 30 degrees as full field is more time consuming. Print out shows dots black and grey where vision going for each eye. Most popular machines are Humphrey, Octopus, Medmont. Kinetic perimetry: points of light moved inwards slowly until you see them, location of points , brightness and size of light can be changed, not automated so accuracy depends on person operating it. End up with a series of dot to dot connecting line showing visual field. Normally map neurological field defects rather than monitor glaucoma. Goldmann field. Confrontation perimetry: simple method for gross field defects. Simply cover one eye, asking patient to look straight ahead while using peripheral vision to identify an object or number of fingers shown by examiner. Field is only tested at four locations usually. Topographic map showing island of vision Each healthy eye gives horizontal field of 160 degrees and vertical field of 135 degrees: 100 degrees temporally (toward your ear), 60 nasally (towards nose) 60 degrees superiorly (up) 75 degrees inferiorly (down) Combined healthy eyes horizontal field of 190 degrees, legal blindness is 20 degrees or less Macula accounts for about 12 degrees of visual field, fovea about 3 degrees of visual field Blind spot is ~15 degrees toward your ear (temporally) from centre Imaging Eye: Optical Coherence Tomography - scan eye like ultrasound, see individual cells in back of eye to identify and diagnose eye disease. Counts the cables, how many missing, how to fix. Print out with cross section of cells, lots of pictures, numbers etc. Electro retinography Eye Pressure: Handheld device Slit lamp - Gold standard. General: Legal blind = 6/60 or <20 degrees field of vision 6/12 is legal driving limit

Answer 25

OU (oculus uterque) means both eyes AU (uterque)means both ears

Answer 26

Oculus dexter means right eye AD dexter ( right ear) OD … The words "dexterity" and "dextrous" derive from "dexter" since the right hand is usually more skillful than the left

Answer 27

Oculus sinister means left eye AS sinister ( left ear) OS … The word sinister, suggestive of darkness or evil, comes from a Latin word meaning “on the left side.” The association of “left” with “evil” is likely because of the dominance of right-handed people within a population

Answer 28

Graph representing relationship of vibration frequency and minimum sound intensity required for hearing Hertz / frequency on horizontal axis Decibel dB / hearing level on vertical axis Bone conduction: bypasses outer ear and sraight to inner ear via bone to test cochlea. Bone conduction vibrator placed on skull. “>” left ear pure tone bone conduction threshold “<” right ear pure tone bone conduction threshold Air conduction: tests all peripheral structures at once using sound travelling through the air (headphones or ear inserts) “O” = right ear air conduction “X” = left ear air conduction

Answer 29

GENERAL: Dysfunction within inner ear or nerve pathways from inner ear to brain, generally cochlear is the cause Audiogram results show same or less than 10dB difference between bone and air Most common type of permanent hearing loss. Surgery / medicine can’t fix, hearing aids may help. Caused through illness, ageing, head injury, loud noises, misformed inner ear, drugs that affect hearing. ISSUES: HIGH frequency loss, Echolocation Soft / distorted sound Noisy environments Talk louder to hear themselves STRATEGY: Hearing aids Speak distinctly Gestures, Position face to face or best hearing side Interpreter Move out of noisy environments for speaking

Answer 30

GENERAL: Audiogram shows bone conduction normal or at least 15dB better than air conduction. Caused by fluid in middle ear from colds/allergies, ear infection, tumours, earwax, object stuck in outer ear, misformed outer/middle ear. Sound cannot get through outer and middle ear. ISSUES: LOW frequency loss sound localisation (need hearing in both ears) reduced sound intensity STRATEGY: Surgery increase volume

Answer 31

both air and bone conduction show significant loss. Conductive hearing loss happens at the same time as SNHL hearing loss. E.g. you work around loud noises and you have fluid in your middle ear Manual communication skills may be required Interpreter may be used

Answer 32

Measure the intensity /loudness between -10 to 110 dB (0dB does not mean “no sound” – it is just extremely soft) Normal hearing: 0 to 15 Mild hearing loss: 20 – 40 dB = no soft sounds, difficulty with conversation in noisy environment, difficulty hearing faint speech or speech from a distance Moderate hearing loss: 40-70 dB = difficulty with normal conversation in a quiet room. Can understand speech in close proximity 1 -1.5 m. Difficulty in group discussion. Lip read or use amplifier to understand most words Severe hearing loss: 70-90 dB = cannot hear conversation unless spoken loudly near ear within 30 cm, may be able to identify environmental sounds Profound hearing loss: 91 dB + = cannot understand speech. Can only hear very loud sounds if at all. Cannot rely on sounds consistently for primary communication Conversational voice level is around 65 decibels Jet taking off if you are standing 25 metres 120dB

Answer 33

Rate of particle vibration, Perceived as pitch Measured in Hertz High frequency have short wavelengths / phase cycle Low frequency have long wavelengths / phase cycle

Answer 34

Outer Ear: collects and conducts soundwaves to the ear drum using pinna, ear canal, concha Middle Ear: converts sounds to mechanical vibrations (transformer) using ear drum or tympanic membrane (two muscles protect inner ear from excessively loud noises) Inner Ear: 2 systems one for hearing and one for balance. Hearing part turns mechanical energy into electrochemical energy for frequency analysis of incoming signal using the cochlea

Answer 35

Discuss and Observe Functional Impacts Maximise safety and efficiency with alternative sensory info (vibrations, smells, air, ) and supports (hearing aid, support cane) Note balance is difficult if the vestibular system impaired. Functional Assessment Hearing with observation and self reporting. Preferred learning styles (e.g. sequential memorisation). Focus on alternative senses… Vibrations. Smells. Air Movement. Allow longer sessions. Best ear for traffic = Hearing aid may interfere with traffic detection as tailored for protection from intense sound and comport BUT another says may help with sound localisation.

Answer 36

ASSOCIATED EYE DISEASE: Diabetic retinopathy. Glaucoma. Cataracts. ISSUES: (in the eye) diabetes affects the small blood vessels, blood vessels is basically the plumbing that takes oxygen and other things to and from organs. Damage pipes = narrowing = blockages = decrease oxygen = ischaemia (blood flow (and thus oxygen) is restricted or reduced in a part of the body) = more oxygen required to areas and signal Vascular endothelial growth factor (VEGF) = stimulates growth of more new blood vessels. But they’re abnormal and bleed into vitreous humor. fluctuating vision; neuropathy (nerve damage leads to pain, weakness, numbness or tingling in one or more parts of your body) flareup STRATEGY: Observant of change in gait, watch temperature extreme, plan indoor session. Hyper (high blood sugar): thirsty, tired, blurred vision, hot, dry skin, smell acetone on breath. Help administering medication if required, drink water, Hypo (low blood sugar): weakness, shaking, sweating, headache, dizzy, crying, hunger, numb around lips and fingers, leading to slurred speech, confusion, loss of consciousness, seizures. Treat help to comfortable position, give sugar (jellybeans) every 15min until patient recovers. Follow with carbohydrates (snadwich) Shorter walking routes. Carry diabetic info and sugar.

Answer 37

ASSOCIATED EYE DISEASE: Cytomegalovirus (CMV) lesions on retina hemorhage, swelling optic nerve, Kaposi’s sarcoma - tumour Keratosis - skin sores, lesions Uveitis - infection of uval tract Toxoplasmosis - retinal inflammation Cryptococcal meningitis - damage optic nerve Central Nervous System Infections (CNS) - HIV retinopathy - ISSUES: Susceptible to infections / illness Uveitis - inflection of uval tract, Keratosis - skin sores, lesions STRATEGY: Good hygiene (fluids or blood) Reschedule if unwell Shorter session, confirm session

Answer 38

ISSUES: Limit strobe light effects and reflective geometric patters, know side effects of medication and duration of spike/low. Insist on medical-alert bracelet STRATEGY: Avoid triggers Clear environment Loosen clothing Protect person Stay close Document seizure time, injury, first aid Call for assistance if longer than a few minutes

Answer 39

Reassure the person Call for assistance Check for injury Provide first aid treatment as indicated Assess vital signs and neurological observations Notify family/friend Complete incident report Ensure post fall assessment and interventions carried out, update management plan

Answer 40

ISSUES: Balance Trips Joint pain STRATEGY: Reduce cane weight Make grip bigger Rest periods Relieve join discomfort via creams or wrapping/strapping joints Adapt lesson length, weather (cold/hot)

Answer 41

ISSUES: Stress Dizziness Short Breath STRATEGY: Observe / assess client and adjust session as required Minimise stress Keep list of medications Diuretics may cause need for toilet breaks

Answer 42

GENERAL The letters in CHARGE stand for: Coloboma of the eye, Heart defects, Atresia of the choanae, restriction of growth and development, and Ear abnormalities and deafness. Those features are no longer used in making a diagnosis of CHARGE syndrome, but we’re not changing the name. Vision loss increases reliance on auditory information Hearing loss increases reliance on visual information Deafblindness distorts and fragments compensatory sense ISSUES disorder that affects many areas of the body. CHARGE is an abbreviation for several of the features common in the disorder: coloboma, heart defects, atresia choanae (also known as choanal atresia), growth retardation, genital abnormalities, and ear abnormalities. STRATEGY Imitate - so person can see or hear you, tactile perception of touch, movement. Tactile signing.

Answer 43

GENERAL one of the most common additional disabilities found in children with visual impairments affect a person’s ability to move and maintain balance and posture Caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles. ISSUES Deafblind label name can be confusing or disturbing for some families special equipment to be able to walk, or might not be able to walk at all and might need lifelong care problems with movement and posture Many also have related conditions such as intellectual disability; seizures; problems with vision, hearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures). STRATEGY There is no cure for Cerebral plasy but treatment can improve the lives medicines; surgery; braces; and physical, occupational, and speech therapy.

Answer 44

Usher Syndrome: Usher syndrome is a genetic disorder that includes retinitis pigmentosa and a partial or total hearing loss from birth. Usher syndrome is categorised into three broad groups according to the type and severity of symptoms. Type 1 and Type 2 account for around 10 per cent of children who are born deaf.

Answer 45

Anaphylaxis trigger event swelling life threatening Avoid allergy prone areas or times of the year, request epi-pen from family Call 000 Use epipen Lay person on back Keep the person calm Loosen clothing Put on side if vomiting or bleeding Observe patient closely, CPR if required Ensure management plan is current, report incident, complete risk assessment

Answer 46

Review behaviour expectations prior to lesson Develop behaviour contract and reward system Use students communication system Use praise, focus on positive behaviours Allow time before and after lesson for students who have difficulty transitioning Take structured break Teach in preferred environments Implement choice making Remain calm, avoid expressing anger or shock Stay focused on what is happening, try to distract if possible Show compassion and express empathy and concern Manage your own personal safety If required respond to immediate risk by seeking emergency help Notify family Complete incident report: what happened before the incident (something they said or did, an emotional state, the environment eg hot. what was the actual behaviour, note this Ensure risk assessment completed and intervention carried out, update management plan and reassess program and lesson plans to avoid triggers

D2 Medical Information Flashcards

(70 cards)