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Biomedicine II > 18. Sense Organs Pathologies > Flashcards

18. Sense Organs Pathologies Flashcards

1
Q

Otitis Externa (‘Swimmer’s Ear’)

A

Inflammation of the outer ear: 90% associated with a bacterial infection and the remaining fungal or allergic.
• 5x more common in swimmers. Also more prevalent in humid climates, diabetes mellitus, HIV and persons with a narrow auditory canal.
• Ear wax (cerumen) contains lysozymes and oil that create an acidic, lubricating coat. This inhibits bacterial and fungal growth so insufficient wax can predispose to infection.
• Other causes include excess wax (obstruction), water in the ear, frequent use of earplugs / headphones / hearing aids, acne, eczema, fungal infections following antibiotic use.

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2
Q

Otitis Externa (‘Swimmer’s Ear’): Signs and Symptoms

A
  • Pain (especially with movement of pinna).
  • Discharge (often purulent), swelling, itchy, red, swollen auditory canal.
  • Hearing deficit.
  • Can cause itching, fever, lymphadenopathy.
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3
Q

Otitis Externa (‘Swimmer’s Ear’): Treatment

A

Hygiene, avoid water in ears, syringe ears with saline solution (by GP), topical antibiotics.

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4
Q

Otitis Media

A

Inflammation of the middle ear.
• Most common cause of earache in children. The eustachian tube is more horizontal (common route of spread). 75% < 10 years. Many have food or inhaled allergies ( e.g. cow’s milk, wheat, egg).
• Fluid puts pressure on tympanic membrane.

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5
Q

Otitis Media: Cause

A

• Infectious organisms typically spread from nasopharynx (bacterial, viral). Or due to allergy.

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6
Q

Otits Media: Signs and Symptoms

A
  • Earache / pain.
  • Malaise, fever, mild hearing loss, nausea.
  • Can get bulging of tympanic membrane.
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7
Q

Otitis Media: Treatment

A
  • Rupture of the tympanic membrane — results in discharge from the ear canal and relief of pain.
  • Antibiotics (consider adverse effects).
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8
Q

Secretory Otitis Media

A

An effusion of the middle ear resulting from incomplete resolution of acute otitis media.
• Also known as ‘glue ear’.
• Gluey fluid dampens the tympanic membrane and ossicle vibrations, which leads to hearing impairment.

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9
Q

Secretory Otitis Media: Signs and Symptoms

A
  • Hearing loss (difficult to determine in young children -> listening to TV very loudly).
  • Pressure in ear and mild intermittent ear pain.
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10
Q

Secretory Otitis Media: Treatment

A

• Tympanostomy tube (‘grommet’):
- A tiny pipe inserted into eardrum under anaesthetic and fluid is drained, air circulates in middle ear and hearing improves. Typically fall out within 6–12 months.
- Hole usually heals when grommets fall out.
• Tonsils may be removed to improve eustachian drainage -> immune compromise!

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11
Q

Labyrinthitis (Otitis Interna)

A

balance disorder, associated with inflammation of the membranous labyrinth.

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12
Q

Labyrinthitis (Otitis Interna): Causes

A
  • Often following upper respiratory infection.

* Following head injury, an allergy or reaction to medication.

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13
Q

Labyrinthitis (Otitis Interna): Signs and Symptoms

A
  • Sudden and severe vertigo (not triggered by movement, unlike benign paroxysmal positional vertigo (BPPV).
  • Sudden unilateral hearing loss (not in BPPV).
  • Nausea and vomiting, tinnitus.
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14
Q

Labyrinthitis (Otitis Interna): Treatment

A

Anti-emetic drugs

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15
Q

Meniere’s Disease

A

A disorder of the inner ear, caused by a change in fluid volume in labyrinth, associated with progressive distention of the membranous labyrinth.

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16
Q

Meniere’s Disease: Causes

A
  • Unknown: Genetics, viral, autoimmune links (RA, SLE).

* Links with food allergies.

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17
Q

Meniere’s Disease: Signs and Symptoms

A
  • Vertigo, tinnitus and hearing loss.
  • Nausea and vomiting. Ear pressure.
  • Characterised by fluctuating patterns of symptoms (acute attacks typically last two–three hours every one–two months).
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18
Q

Meniere’s Disease: Treatment

A

•No cure — only symptom minimisation (managing acute attacks).

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19
Q

Tinnitus

A

The perception of sound originating from within the head rather than outside.

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20
Q

Tinnitus: Types

A

Objective

Subjective

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21
Q

Tinnitus: Objective

A

Pulsatile (carotid stenosis, valve disease), muscular (spasm of tympanic muscles).

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22
Q

Tinnitus: Subjective

A

No acoustic stimuli: Ear origin (Meniere’s, ear infection, wax), Neurological (head injury, MS, tumour), infections (meningitis), drug-related (NSAIDs, loop diuretics), TMJ (jaw) dysfunction.

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23
Q

Tinnitus: Treatment

A
  • Treat any underlying causes.
  • Very early stages: Ginkgo biloba.
  • Avoiding loud noise and earwax build-up.
  • Manual therapy to neck and jaw.
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24
Q

Hearing Impairment

A
  • Measured in the degree of loudness, in decibels (dB):
  • Mild hearing loss -> adults 25–40 dB.
  • Moderate hearing loss -> 41–70 dB.
  • Severe hearing loss -> 71–90 dB.
  • Profound hearing loss -> 90 dB or greater.
  • Long-term exposure to noises; e.g. living next to airport. 90 dB+ can cause temporary or permanent hearing loss.
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25
Q

Hearing Impairment: Catagorisation

A

Conducive

Sensory

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26
Q

Hearing Impairment: Conducive

A

Ear canal obstructions, ossicle abnormalities, ruptured tympanic membrane.

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27
Q

Hearing Impairment: Sensory

A

Poor hair cell function — can be due to a congenital condition, infection or noise trauma.

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28
Q

Hearing Impairment: Causes

A
  • Diseases: Measles, meningitis, mumps (auditory nerve damage), rubella, chlamydia and syphilis (complete loss in foetus), premature birth (usually impaired, not lost).
  • Head injuries can cause hearing loss through damage to the middle ear or auditory nerve.
  • ‘Shaken baby syndrome’.
29
Q

Hearing Impairment: Treatment

A
  • Hearing aids (amplifier).

* Cochlear implant (sometimes called a bionic ear). This stimulates the auditory nerves by electrical impulses.

30
Q

Blepharritis

A

Inflammation of the eyelid margin.
•Can be acute or chronic. Most commonly in adults.
•Often associated with Staphylococcus aureus infection or dermatitis.

31
Q

Blepharitis: Signs and Symptoms

A
  • Red eyelid margins.
  • Sore, gritty eyes, scales and flakes.
  • Eyelids may stick together, often worse in morning.
  • Itching and burning.
  • Loss of eyelashes.
  • Can block sebaceous glands and cause recurrent styes.
32
Q

Blepharitis: Treatment

A
  • Eyelid hygiene. Clean with cotton bud.
  • Warm compress (apply to closed eyes for 5–10 mins).
  • Topical antibiotics.
  • Avoid contact lens use until resolved.
33
Q

Stye

A

Inflammation of sebaceous glands of eyelid.

• Usually a bacterial infection (Staphylococcus).

34
Q

Stye: Risk Factors

A

• Diabetes mellitus, chronic blepharitis.

35
Q

Stye: Symptoms

A
  • Red, swollen and / or painful infection of sebaceous glands of eyelid.
  • Usually affects the upper lid.
36
Q

Stye: Complications

A

• Cyst formation can damage the cornea.

37
Q

Stye: Treatment

A
  • Usually none necessary.
  • Typically will burst and the pus will drain, hot compresses used 3–4 x day eases pain and aids pus removal.
  • Antibiotic ointment if the stye doesn’t resolve.
38
Q

Conjuctivitis

A

A highly-contagious inflammation of the conjunctiva.

39
Q

Conjunctivitis: Causes

A

•Viral, bacterial, often linked with allergies.

40
Q

Conjuctivitis: Symptoms

A
  • Red eye, irritated / uncomfortable, watery (viral/allergic) / purulent discharge (bacterial).
  • Photophobia suggests corneal (deeper) involvement.
41
Q

Conjunctivitis: Treatment

A

Eye bath with salt water or eye-cleansing solution. Antibiotic eye drops or oral antibiotics rarely.

42
Q

Uveitis

A

Inflammation of any part of the uvea (iris, ciliary body, choroid).

43
Q

Uveitis: Causes

A
  • Autoimmune disease (increased with HLA-B27; e.g. AS).
  • Trauma to the eye (includes contact lenses).
  • Viral infection (e.g. herpes), fungal or parasitic.
44
Q

Uveitis: Symptoms

A
  • Progressive unilateral red eye with pain, blurred vision and photophobia.
  • Visual acuity reduced in affected eye. Watery discharge.
45
Q

Uveitis: Treatment

A

Antibiotics, cortisone depending on the cause

46
Q

Corneal Ulcer

A 
An ulcer (open sore) that develops in the cornea.
•Rare due to extensive ocular defence mechanism.
47
Q

Corneal Ulcer: Causes

A
  • Bacterial (e.g. gonorrhoea), viral (e.g. herpes simplex), fungal infection.
  • Trauma (e.g. contact lens), spread from blepharitis.
48
Q

Corneal Ulcer: Symptoms

A

Pain, reduced vision, photophobia, discharge.

49
Q

Corneal Ulcer: Treatment

A
  • Medical emergency — possible loss of sight

* Antibiotics, antifungal or antiviral drugs, keratoplasty (corneal transplant).

50
Q

Strabismus (squint)

A

Mis-alignment of the eyes, which means the retinal image is not in corresponding areas of both eyes.
• ‘Esotropia’ = inward squint
• ‘Exotropia’ = outward squint.

51
Q

Strabismus (squint): Causes

A
  • Genetic (family history of squint).

* Damage to nerves supplying extra-ocular muscles (e.g. stroke, brain tumour).

52
Q

Strabismus (squint): Treatment

A
  • Glasses to correct visual problems and patching the normal eye (forces the brain to use the affected eye).
  • Surgery to tighten muscles around the eye.
53
Q

Cataracts

A

Cataracts describe the opacity of the lens.
• Cataracts are the leading cause of blindness in the world.
• A healthy lens is transparent due to regular arrangement of lens fibres. In cataracts, new fibres are produced and become disorganised within cytoplasm.
• Treated with surgery to replace the lens.

54
Q

Cataracts: Causes

A
  • Age related deterioration of lens. Congenital.

* Diabetes mellitus, smoking, steroids.

55
Q

Cataracts: Symptoms

A

Gradual painless loss of vision, diplopia

56
Q

Age-Related Macular Degeneration

A

Age-related macular degeneration (AMD) describes the ageing changes that occur in the central areas of the retina (macula).
• Occurs in people aged 55 years and older.
• Advancing age is the most significant risk factor. Smoking, cardiovascular disease risk factors and family history are also thought to play a role.
• AMD is a progressive chronic disease that is also a leading cause of vision loss worldwide.

57
Q

Age-Related Macular Degeneration: Symptoms

A
  • Reduced visual acuity, particular difficulty with near vision.
  • Gradual (and progressive) loss of central vision.
58
Q

Age-Related Macular Degeneration: Diagnosis

A
  • Diagnosis of AMD can be assisted with the use of an ‘Amsler grid’.
  • Patients are asked to look into the grid (as shown on the left).
  • Patients with AMD may describe observing an image similar to that displayed on the right 
  • Diagnosis can also be made using ophthalmoscopy.
59
Q

Muscae Volitantes (‘Floaters’)

A

Opacities floating in the field of vision.
• Small, dark, shadowy shapes (can look like spots, thread-like strands, or squiggly lines).
• They move with eye movements and seemingly dart away when trying to look at them directly.
• Visible because of the shadows they create on the retina.

60
Q

Muscae Volitantes (‘Floaters’): Causes

A
  • Usually shrinkage of the vitreous humour causing collagen to become fibrils which present as a floater (age-related).
  • Vitreous haemorrhage with haemorrhaging in diabetic retinopathy.
61
Q

Retinal Detachement

A

Separation of the neurosensory layer of the retina from the pigmented epithelium.
• Results in accumulation of sub-retinal fluid in the potential space (vitreous seeps in).
• Presents as floaters in vision, flashing lights, curtains descending over vision.
• Ocular emergency — usually requires surgery. If minor retinal break can use laser.
• Can result in blindness or visual impairment.
• Most common in middle-aged and elderly.

62
Q

Glaucoma

A

Increased intraocular pressure caused by inadequate drainage (IOP should be 10–21 mmHg. >40 = significant damage caused) .
• Glaucoma causes compression of the retina and optic nerve.

63
Q

Glaucoma: Causes

A
  • Can be congenital or acquired (uveitis, intraocular haemorrhage).
  • Obstruction of the canal of Schlemm.
  • Smoking will moderately increase pressure.
64
Q

Glaucoma: Complications

A

• Damage to the optic nerve and retina leads to permanent blindness.

65
Q

Glaucoma (Acute): Signs and Symtpoms

A
  • Mild: Pain in the eyes and haloes around lights, relieved by sleep.
  • Severe: Rapid deterioration of vision, intense eye pain, redness and watering of the eye, sensitivity to bright light, nausea and vomiting.
66
Q

Glaucoma (Chronic): Signs and Symtpoms

A
  • Often no symptoms until permanent damage has occurred.

* Late symptoms: Loss of peripheral vision, blurring of objects directly in front of the person. Loss of night vision.

67
Q

Glaucoma: Treatment

A
  • Eye drops / tablets to reduce fluid production (reduces eye pressure).
  • Laser or surgical treatment if this is ineffective.
68
Q

Diabetic Retinopathy

A

Diabetic retinopathy is a progressive, potentially sight-threatening disease of the retinal microvasculature.
• Diabetic retinophropathy occurs as a result of chronic hyperglycaemia.
• Microvascular damage occurs, which occludes branches of the retinal artery, causing neovascularisation (new vessel formation in an attempt to re-vascularise).
• The vessel walls become physically weak and leaky, leading to micro-aneurysms,
oedema and haemorrhaging.
• May retain normal sight, or present as a decline in vision and ‘floaters’ (if haemorrhages).

Biomedicine II (16 decks)

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