Case 21- SAP and Physiology Flashcards
How ones own prejudice can impact clinical decision making?
Decreased doctor patient relationship
Missed diagnosis
Lack of empathy towards patient
Incomplete diagnosis
Attribution
Refers to the fact that humans are motivated to assign causes to their actions and behaviours, as either being internal or external
E.g. is someone angry because something bad happened or because they have a bad temper - it is up to us to attribute an answer to this
Interpersonal attribution
The tendency for individuals to tell a story in a way that characterises them in the best light possible
Predictive attribution
We assign things in ways that allow us to make future predictions
E.g. if your car is broken in to you attribute it to the fact you parked in a particular place so wont park there again
Explanatory attribution
The tendency for us to make attributions that help us make sense of the world around us (i.e. explaining something as God’s plan)
Origins and nature of stereotyping
Stereotyping is creating an oversimplified image of a particular group of people by making one rule and assuming everyone else in the group fits under this rule
Stigmas are labels that form these stereotypes
Origins and nature of prejudice
Prejudice is having a preconceived opinion that is not based on reason or actual experience
Attribution value model of prejudice
People are prejudiced against groups that they feel they have some negative attribute for which they are held responsible for
E.g. thinking overweight people are lazy
Origins and nature of discrimination
Discrimination is unjustifiable negative behaviours and treatment towards a group and its members which leads to adverse consequences
Pathology- conjunctiva
Conjunctiva- lines the inside of the eyelids and reflects to cover the sclera, attaching at the limbus (where the sclera and cornea join)
Pathology: Conjunctivitis
Pathology- Subconjunctival area
Subconjunctival region- under the conjunctiva
Pathology: Subconjunctival haemorrhage
Pathology- Sclera and cornea
Outer fibrous layer of the eyeball-sclera and cornea
Pathology: Episcleritis (outer/superficial layer of sclera), Scleritis (deeper layers), Corneal ulcer/abrasion.
Pathology- Anterior chamber
Anterior chamber-chamber between the iris and cornea
Pathology: Glaucoma-closed angle
Pathology- Uvea/middle layer of the eyeball
Uvea/Middle layer of the eyeball-choroid, ciliary body and process, iris
Pathology: Uveitis
Painful red eye- Bacterial keratitis
Inflammation of the cornea.
Anything that disrupts the epithelial surface of the cornea can predispose it to infection e.g. trauma or contact lens wear.
Features: Pain Blurred vision Photophobia Gritty sensation Forms a round lesion on fluorescein staining
Bacterial keratitis- Management
Diagnosis- Use fluorescein eye drops to visualise infective keratitis. It stains any defects in the corneal epithelium.
Management- Refer the patient to the emergency eye service for same-day assessment due to the risk of visual loss. Do not continue to wear the contact lenses and take the lenses to the hospital to be swabbed.
Painful red eye- viral keratitis
History of cold sores
Dendritic/branching ulceration
Reduced corneal sensation
Management- Refer the patient to the emergency eye service for same-day assessment due to the risk of visual loss. Do not continue to wear the contact lenses and take the lenses to the hospital to be swabbed.
Painful red eye- Anterior scleritis
Uncommon, Associated with autoimmune disease, infections and trauma.
Features:
Severe boring pain with globe tenderness.
Worse at night waking the patient from sleep.
Reduction in vision.
Photophobia
Sectoral or diffuse redness
Sclera may appear blue/grey- the sclera becomes more translucent
Anterior scleritis- management
Refer patients with severe eye pain and a significant reduction in vision immediately for same-day assessment
Painful red eye- acute angle closure glaucoma
The iris pushes forward against the trabecular meshwork preventing the drainage of aqueous humour.
Features: Pain Blurred vision Nausea and vomiting Haloes Mid dilated fixed pupil Cloudy cornea Conjunctival injection
Acute angle closure glaucoma- management
Refer the patient to the emergency eye service for same-day assessment due to the risk of visual loss
Occurs in individuals with risk factors- narrow anterior chamber, long sighted, cataracts
Painful red eye- Anterior uveitis
Inflammation of the iris and ciliary body
Causes= Idiopathic, Trauma, infection, autoimmune conditions-HLA-B27
Features:
Photophobia-due to the movement of an irritated iris
Pain
Blurred vision-due to debris in the anterior chamber
Headache
Watery eye
Peri-limbal hyperaemia
Abnormal pupil shape
Hypopyon- inflammatory cells in the anterior chamber
Anterior uveitis- management
Refer patients with severe eye pain and a significant reduction in vision immediately for same-day assessment
Painful red eye- Endophthalmitis
Infection of the aqueous and vitreous humour.
Post surgery
Post trauma
Endogenous – associated with severe systemic infection or intravenous drug use
Features: Blurred vision Red eye Pain Photophobia Swollen lid Hypopyon- inflammatory cells in the anterior chamber Hazy appearance
Endophthalmitis- management
Refer patients with severe eye pain and a significant reduction in vision immediately for same-day assessment. Patients with endogenous endophthalmitis can become very unwell
