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Patho II > Eye/ Ear > Flashcards

Eye/ Ear Flashcards

1
Q

General Manifestations of Visual Impairment: Diagnosis

A 
Hx
Opthalmoscopic examination
Visual acuity testing; central visual field testing
Slit lamp
Retinal angiography
Dilated retinal examination
Intraocular pressure measurement
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2
Q

Geriatric Considerations

A

Changes in the eyes:
Decrease in colour vision and discrimination, reduced contrast, sensitivity, and diminished accommodation
Slowing of dark adaption, decrease i ability to discern brightness and colours (particularly blues and greens)
Development of presbyopia

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3
Q

Visual Dysfunctions

A 
Alterations in ocular movements
Alterations in visual acuity
Alterations in accommodation
Alterations in refraction
Alterations in colour vision
Neurologic disorders
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4
Q

Alterations in Ocular Movement

A

Strabismus

Nystagmus - Pendular or Jerk

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5
Q

Glaucoma

A

Increased intraocular pressure caused by excessive accumulation of aqueous humour
Types:
Acute: Angle closure
Chronic: Open angle

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6
Q

Glaucoma: Angle closure glaucoma

A

Occurs when angle between pupil and lateral aspect of cornea is narrow; blocks aqueous humour outflow when pupil dilated

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7
Q

Glaucoma: Open-Angle Glaucoma

A

Intraocular pressure increased by a decrease in the outflow of aqueous humour
Gradual loss of vision in the periphery resulting in tunnel vision

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8
Q

Manifestations of Glaucoma

A

Acute Angle closure:

  • Severe acute pain
  • Blurred or cloudy vision
  • N/V
  • Halos around lights
  • Affected eye red, cornea clouded
  • Fixed pupil (nonreactive)
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9
Q

Manifestation of Glaucoma

A

Chronic Open Angle

  • Painless, gradual loss
  • Difficulty adapting light to dark
  • Blurred vision
  • Halos around lights
  • Difficulty focusing on near objects
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10
Q

Macular Degeneration

A

Progressive loss of central vision due to atrophic (dry) or exudative (wet) changes to the macula of the retina
Combination of genetic factors and environmental exposure
With aging the neurone of the macula may atrophy or separate from the choroid
When the macula is damaged, central vision becomes blurred, depth perception is affected but peripheral vision remains intact

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11
Q

Errors of Refraction: Presbyopia

A

Loss of accommodative capacity
Inability to see near objects clearly
Corrected with reading glasses

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12
Q

Errors of Refraction

A

Visual acuity depends on the formation of discrete patterns of light on the retina
Errors of refraction such as Myopia and Hyperopia cause light to focus in front of or behind the retina
Irregular curvature of the cornea results in Astigmatism

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13
Q

Errors of Refraction

A

Astigmatism
Caused by irregularity in the curvature of the cornea or lens
Produces distorted imaged
Corrected with lenses or glasses that are formed with the opposite curvature

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14
Q

Visual Field Deficits: Visual Field Loss

A

Caused by lesions anywhere along the visual pathways
Location of lesion determines monocular or binocular involvement and the portion of vision lost
- Monocular: disease of the retina or optic nerve
- Bilateral: boh field losses or loss of half o the visual field (hemianopsia)

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15
Q

Age-Related Disorders: Cataracts

A

Progressive opacity or clouding of the lens leads to gradual, painless blurred vision, eventual loss of sight
Proteins in the lens change and become less soluble
Increased glare at night, blurred vision, and altered colour perception
As the lens ages, its cells become less clear from edges to centre
- Edges only (immature)
- Entire lens (mature)
With mature cataracts, the pupil appears cloudy gray or white rather than black

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16
Q

Cataracts: Risks

A 
Age
Exposure to sunlight
Cigarette smoking
Alcohol consumption
Congenital condition
Eye trauma
DM
Certain medication
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17
Q

Cataracts: Diagnostics

A

Red reflex is lost

Hx and eye exam

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18
Q

Retinopathy

A

Any disorder affecting the retina

Causes: trauma and vascular disorders such as DM, hypertension

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19
Q

Retinopathy: Retinal Detachment

A

Tearing of the retina from the choroid layer with seepage of virtuous humour behind retina causing further detachment
Types:
- Exudative (or serous): accumulation of serous or hemorrhagic fluid in the sub retinal space
Traditional: mechanical forces caused by fibrosis and scarring pull retina away from the underlying epithelium
Spontaneous or rhegmatogenous: vitreous humour shrinks and traction develops causing separation

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20
Q

Detached Retina

A

1) Retina separates from choroid
- intact but separate
- folds back on self
2) Hold/ tear
- fluid seeps between layers (retina and choroid)

Concern: if the layers remain separated, the neurone of the retina become ischemic and die causing permanent vision loss

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21
Q

Retinopathy

A

Diabetic retinopathy
Disorder of the retinal vessels
Formation of micro aneurysms and hemorrhage (nonproliferative) or neovascularizaion and subsequent leakage and retinal detachment (proliferative)
Blurred, darkened, distorted vision; visual changes fluctuating

22
Q

External Eye Disorders

A 
Blepharitis
- Inflammation of the eyelids
Hordeolum (stye)
- Infection of the sebaceous glands of the eyelids
Conjunctivitis
- Inflammation of the conjunctiva
23
Q

Corneal Disorders: Keratitis

A

Corneal inflammation
Severe pain and photophobia (lots of pain receptors), tearing and discharge
Cause:
- Infection (Herpes simplex)
- Chemicals, splashes, fumes)
- Trauma
Increased risk of ulceration eroding with the cornea and of scar tissue interfering with vision
Blepharospasm (spasm of the eyelid and inability to open the eye)

24
Q

Corneal Disorders: Corneal Ulcers

A 
Causes:
- Infection
- Trauma
- Contact lens overuse
- Herpes virus (shingles)
Superficial or deep
Scarring may occur with clouding
With perforation infection and vision loss may occur
25
Q

Corneal Disorders: Uveitis/ Iritis

A 
Uveitis
- Inflammation of the middle vascular layer of the eye
Iritis
- Inflammation of the iris
For both:
- Severe eye pain; photophobia
- Blurred vision
- Constricted pupil; red limbus
26
Q

Eye Trauma: Corneal Abrasion

A

Scratch of the cornea
- Contact lenses, eyelashes, small foreign bodies, fingernails
Pain, photophobia, tearing
Often heal rapidly without scarring

27
Q

Eye Trauma: Burns

A

Chemical/ thermal/ UV/ light burns
- Ammonia, drain cleaner/explosion/ snow blindness, Welder’s arc burn
Pain, vision changes
Swollen eyelids: red oedematous conjunctiva
Cornea often appears cloudy/ hazy

28
Q

Eye Trauma: Perforation

A

Causes:
Metal flakes; glass shards or weapons
Injury not always obvious if small
Result in: pain; partial or complete loss of vision, possible bleeding, loss of eye contents

29
Q

Eye Trauma: Blunt Trauma

A

Sport injuries are a common cause
Injuries vary:
- Lid ecchymosis (black eye) to a subconjunctival hemorrhage (bleeding into the conjunctiva)- often not treated
- Hyphema bleeding into the anterior chamber of the eye may cause a reddish tint to the clients vision and visible blood in the chamber
- Fractured Orbit - diplopia and pain with eye movement - the eye may appear sunken (enopthalmos)

30
Q

Function of the ear

A

Controlled by hair cells contained in the semicircular canals
Stimulation of these cells by head movement causes nerve impulses to be transmitted to the brain to keep individuals upright and control eye movement

31
Q

Geriatric Considerations: Changes in Hearing

A

Ankylosis of ossicles: functional decrease in transmission of sound to the inner ear
In the inner ear or cochlea, degeneration of hair cells, changes in the basilar membrane, or atrophic changes cause decreased hearing of higher tones and a decline in pitch discrimination
Eventually even lower pitch tones will be difficult to hear
Loss of auditory neurone in spiral ganglia of organ of Carti
Decreased vascularity of cochlea

32
Q

General Manifestations of Hearing Impairment

A

Inattentiveness
Speaking out of turn in conversations, withdrawal from social situations
Increased volume of voice when speaking. Increased volume of radio or television
Confusion
Loss of reaction to loud sounds
Emotional outbursts
Children: inattentiveness, difficulty with articulation and speech development

33
Q

General Manifestations of Hearing Impairment: Diagnosis

A

History
Hearing tests
Audiometric studies

34
Q

Otitis External

A

Infection or inflammation of the ear canal and pinna of the outer ear
Cerumen is water repellent and has an antibacterial effect
Risk Factors:
- moisture, cleaning or drying of the ear canal can remove ear wax and increase risk of infection
- also irritation like use of earphones and ear plugs

35
Q

Otitis External

A

Manifestations: pain, purulent discharge and a hearing deficit, ear canal may appear inflamed and swollen; often have a feeling of fullness
Diagnosis: can be differentiated from otitis media because pain is increased with movement of the pinna

36
Q

Otitis Media

A

Inflammation/ infection of the middle ear
Most common middle ear disorder - usually affects infants and young children
While the eardrum protects the middle ear from the environment the Eustachian tube actually connects it to the nasopharynx
Children especially susceptible due to shorter, more flexible, and horizontally positioned eustachian tubes

37
Q

Otitis Media: Acute Otitis Media

A

Collection of fluid and mucous in the middle ear. Bacteria enter from the nasopharynx, growing and multiplying
The infection causes pus, which causes increased pressure and can rupture the ear drum
Risk factors: pacifiers, second-hand cigarette smoke, GERD, daycare attendance, propped bottles, upper respiratory infections and eustachian tube dysfunction. Allergies can also cause it to swell, impairing its function

38
Q

Otitis Media: Acute Ottitis Media

A

Characterized by sudden onset of ear pain in association with symptoms of upper respiratory tract infection
Irritability, difficulty eating and sleeping, or tugging at the affected ear as well as fever and pain
Fever, hearing loss, vertigo, tinnitus
Eardrum is red and inflamed or dull and bulging. It does not move normally and may rupture
Usually of short duration

39
Q

Otitis Media: Chronic Otitis Media

A

Inflammation in the middle ear lasting longer than 12 weeks
Damage due to atrophy or perforation of tympanic membrane or adhesions causing membrane retraction
Purulent drainage from ear

40
Q

Otitis Media: Complications

A

Acute mastoiditis:
Pus fills and destroys the air cells of the mastoid process of the temporal bone causing recurrent earaches/ hearing loss
May complain of tinnitus, headache, fever, and the mastoid process may be painful, red, and swollen
Chronic otitis media:
Permanent eardrum perforation with destruction of the middle ear structures
Results in recurrent ear infections and conductive hearing loss

41
Q

Otitis Media: Serous Otitis Media

A

Obstructive eustachian tube
Negative pressure draws fluid
Manifestations:
Decreased hearing, “snapping, popping” sensation; Retracted/ bulging ear drum which moves less freely
Changes in atmospheric pressure (flying, diving) can cause acute pain/ bleeding in middle ear and a possible ruptured rum

42
Q

Auditory Dysfunction

A 
Conductive hearing loss
Sensorineural hearing loss
Mixed hearing loss
Functional hearing loss
Méniére disease
43
Q

Conductive Hearing Impairment

A 
Occurs when sound cannot reach the cochlea
Decreased sensitivity to sound
Dysfunction in the external or middle ear
4 mechanisms:
- Obstruction (cerumen impaction)
- Mass loading (middle ear effusion)
- Stiffness effect (otosclerosis)
- Discontinuity (ossicular disruption)
44
Q

Conductive Hearing Impairment: Otosclerosis

A

Progressive conductive sensorineural or mixed hearing impairment caused most often by stapedial fixation
Occurs due to an imbalance between bone formation and reabsorption
Stapes becomes fixed
Conduction is blocked to the cochlea
Genetic factor
Tinnitus may be present

45
Q

Sensorineural Hearing Impairment: Loss caused by trauma

A

Chronic, repeated exposures of loud sounds can damage most structures of the inner ear; sounds exceeding 85 dB are considered potentially injurious
Sensory hair cells and supporting cells are lost with overexposure
Clinical manifestations: unable to discriminate words, particularly in noisy environments; tinnitus; typically bilateral and affects higher frequencies first

46
Q

Sensorineural Heating Impairment: Loss Caused by Ototoxic medications

A

Most common drugs include amino glycoside antibiotics, salicylates, quinine and related antimalarials, and cytotoxic antineoplastic drugs
Affect the hair cells of the cochlea
Ototoxicity may also be unilateral

47
Q

Sensorineural Hearing Impairment: Presbycusis

A

Most common form in older adults
Gradual onset, bilateral, and result in difficulty hearing high-pitched tones and conversational speech; hearing aids helpful
Four categories:
- Sensory: atrophy and degeneration of sensory and supporting cells
- Neural loss of neurone in cochlea and CNS
- Metabolic: atrophy of the wall of the cochlea
- Mechanical: middle ear undergoes changes in properties

48
Q

Sensorineural Hearing Impairment: Meniere Disease

A

Excessive accumulation of endolymph in the membranous labyrinth; cochlea degernates; chronic inner ear disease
Clinical Manifestations
- Tinnitus, vertigo, sensations of ear fullness, fluctuating sensorineural hearing loss
- Onset of vertigo usually sudden, arches maximal intensity within a few minutes, usually lasts for an hour or more
Tinnitus is typically low buzzing or blowing sound; frequently louder before vertigo attack

49
Q

Vestibular Disorders: Vertigo

A

Sensation of motion with no actual movement/ exaggerated sense of motion
Cardinal symptom of disorders of the vestibular system
Often associated with nystagmus and nausea, vomiting, sweating

50
Q

Inner Ear Disorders: Diagnostic Testing

A

Electronystagmography
X-rays/ CT-scan
Glycerol test

Patho II (9 decks)

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