Module 7: Pathophysiology of Common Diseases and Conditions Flashcards

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1
Q

Diabetes mellitus type 1

A
  • endocrine system
  • unknown cause (possibly autoimmune, genetic, or environmental)
  • polyuria, polydipsia, fatigue, blurry vision, weight loss, elevated blood glucose
  • insulin therapy
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2
Q

Diabetes mellitus type 2

A
  • endocrine system
  • obesity, inactivity, genetics
  • polyuria, polydipsia, fatigue, elevated blood glucose
  • diet modification, exercise, medication, insulin therapy
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3
Q

Polycystic ovary syndrome (PCOS)

A
  • endocrine system
  • unknown causes (possibly genetic, excessive insulin)
  • irregular menstrual cycles, elevated hormone levels, multiple cysts on ovaries
  • weight loss, estrogen and progestin
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4
Q

Hypothyroidism

A
  • endocrine system
  • autoimmune disease, medications, thyroid surgery
  • fatigue, weight gain, muscle aches, bradycardia, depression, elevated cholesterol, dry skin
  • synthetic thyroid hormone medication (levothyroxine)
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5
Q

Hyperthyroidism

A
  • endocrine system
  • Graves disease, thyroiditis, Plummers disease
  • weight loss, tachycardia, anxiety, fatigue, sleep disruption, goiter
  • radioactive iodine, antithyroid medication, beta blockers, thyroidectomy
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6
Q

Basal cell carcinoma (BCC)

A
  • integumentary system
  • light/fair skin, sun exposure
  • new growth/sore that does not heal
  • curettage and electrodesiccation, Mohs surgery, cryosurgery, laser therapy
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7
Q

Squamous cell carcinoma

A
  • integumentary system
  • light/fair skin, sun exposure, less common than BCC
  • spreads to surrounding tissue, most common on the face and head
  • curettage and electrodesiccation, Mohs surgery, cryosurgery, laser therapy
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8
Q

Malignant melanoma

A
  • integumentary system
  • light/fair skin, sun exposure
  • itchy/bleeding mole, new mole, mole with changes
  • depends on stage of lesion, surgery, lymph node biopsy, chemotherapy, radiation therapy, immunotherapy
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9
Q

Acne vulgaris

A
  • integumentary system
  • surge of sex hormones during puberty, excess sebum on skin surface
  • black heads/white heads (comedones), papules/pustules
  • regular cleansing of affected area, OTC benzoyl peroxide products, prescription medication (topical or oral)
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10
Q

Alopecia

A
  • integumentary system
  • often hereditary, hormone changes, chemotherapy, stress, burns, fungal skin infections
  • loss or lack of hair anywhere on the body (typically on the scalp), can include eyebrows and eyelashes
  • no cure, hair transplants and medications can slow progression
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11
Q

Cellulitis

A
  • integumentary system
  • staphylococcal and streptococcal bacterial infections
  • red and tight skin, pain in inflamed area, fever
  • oral/topical antibiotics, hospitalization if at risk for developing systemic infections
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12
Q

Dermatitis

A
  • integumentary system
  • multiple causative agents, contact with irritants
  • inflammation of skin resulting in rash and pruritus
  • based on cause, corticosteroid creams, oral steroids
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13
Q

Eczema

A
  • integumentary system
  • unknown causes (possible allergy or inflammatory condition)
  • chronic dermatitis with vesicular eruptions developing into itchy/red/scaly rash
  • topical or systemic steroids, NSAIDs for discomfort
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14
Q

Folliculitis

A
  • integumentary system
  • shaving or repeated rubbing of shaved area, bacteria or fungi
  • red and itchy hair follicles (pimple appearance)
  • regular cleansing of affected area, topical antibiotics, electric shaver instead of razor
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15
Q

Herpes simplex

A
  • integumentary system
  • contact with herpes simplex virus
  • Type 1: painful blisters on lips/mouth/face
  • Type 2: similar lesions, located in genital area
  • no cure, antiviral medication to decrease frequency of outbreaks
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16
Q

Impetigo

A
  • integumentary system
  • staphylococcal and streptococcal bacteria
  • itchy and oozing skin lesions with honey-like appearing crust
  • antibiotics, frequent cleaning of area
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17
Q

Pediculosis

A
  • integumentary system
  • parasitic lice infestation
  • skin itching, nits (eggs) in hair near roots
  • prescription or OTC lice treatments/shampoos
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18
Q

Psoriasis

A
  • integumentary system
  • inherited autoimmune disorder
  • silvery/scaly/severely itchy skin lesions, can cause systemic symptoms such as joint pain and inflammation (psoriatic arthritis)
  • oral NSAIDs, topical creams containing vitamins A and D, hydrocortisone cream, UV treatments
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19
Q

Ringworm

A
  • integumentary system
  • contact with causative fungus
  • flat and circular lesions (dry/scaly or moist/crusty)
  • topical and oral antifungal medication
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20
Q

Rosacea

A
  • integumentary system
  • dilation of small facial blood vessels, cause of dilation is unknown
  • redness, acne-like eruptions on face
  • topical cortisones, antibiotics, vascular laser therapy
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21
Q

Osteoarthritis

A
  • musculoskeletal system
  • inflammatory processes, metabolic disorders
  • joint stiffness and pain, fluid surrounding the joint, grating sound with joint movement
  • NSAIDs, intra-articular injections, arthroscopy, joint replacement surgery
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22
Q

Rheumatoid arthritis

A
  • musculoskeletal system
  • autoimmune
  • destruction of the joint capsule causing scar tissue to form, visible joint deformity, loss of joint mobility
  • NSAIDs, exercise, heat and cold therapies, cortisone injections, surgery to remove scar tissue
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23
Q

Bursitis

A
  • musculoskeletal system
  • overuse, joint trauma, bacterial infection
  • joint pain and swelling
  • rest, pain medication, steroid injection, aspiration of joint fluid, antibiotics
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24
Q

Ewing’s Sarcoma

A
  • musculoskeletal system
  • unknown causes, age 10-20, male sex
  • fever, pain at tumor sight, fractures, bruising
  • surgery, chemotherapy, radiation therapy, bone marrow transplant, stem cell transplant
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25
Q

Gout

A
  • musculoskeletal system
  • deposits of uric acid crystals accumulate in joint spaces
  • joint pain, common in big toe and knee joints, stiffness, swelling
  • dietary changes (avoidance of rich/fatty foods), pain medication, medications to aid in elimination of uric acid in kidneys during urine formation
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26
Q

Kyphosis

A
  • musculoskeletal system
  • growth retardation or improper development of growth plates, aging and degenerative disk disease contribute to adult-onset
  • visible upper back curvature (humpback)
  • exercise, back bracing, Harrington rod, spinal fusion in extreme cases
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27
Q

Lordosis

A
  • musculoskeletal system
  • injury, poor posture, wearing high heels (inward positioning of back when balancing on balls of feet)
  • inward curvature of the lower back (swayback)
  • corrective shoes, exercise
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28
Q

Osteogenesis imperfecta (brittle bone disease)

A
  • musculoskeletal system
  • hereditary
  • dental issues, fractures at birth, loose joints, muscle weakness, respiratory issues, blue sclera of the eye, triangle-shaped face, small stature, spinal curvature
  • fracture repair, surgery with metal rodding, physical therapy, bracing
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29
Q

Osteoporosis

A
  • musculoskeletal system
  • hormone deficiencies, sedentary lifestyle, lack of vitamin D, corticosteroid use (long-term), smoking
  • fractures, most common in spine/wrists/hips, loss of height, can result in kyphosis
  • medications, hormone replacement therapy, exercise, supplements
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30
Q

Osteosarcoma

A
  • musculoskeletal system
  • unknown
  • pain in affected bones (usually legs), swelling with development of tumor growth
  • surgery, chemotherapy/radiation, amputation of affected limb
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31
Q

Paget’s disease

A
  • musculoskeletal system
  • hereditary, viral
  • bone pain and deformity, fractures, excessive bone destruction
  • surgery, medication, physical therapy
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32
Q

Scoliosis

A
  • musculoskeletal system
  • possibly genetic, can be prenatally during formation of vertebrae, muscle weakness
  • bent appearing spine (laterally), back pain
  • back bracing, physical therapy, surgery with rod placement
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33
Q

Fibromyalgia

A
  • musculoskeletal system
  • unknown, exacerbated by sleep deprivation/emotional distress/depression
  • fatigue, point tenderness and trigger points, chronic facial pain, sleep disturbances
  • antidepressants, NSAIDs, physical therapy, trigger point injections
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34
Q

Muscular dystrophy

A
  • musculoskeletal system
  • hereditary
  • muscle weakness leading to eventual paralysis of muscle groups
  • physical therapy, bracing, ambulatory devices, medications
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35
Q

Myasthenia gravis

A
  • musculoskeletal system
  • autoimmune
  • double vision, muscle weakness, dysphagia, difficulty swallowing, difficulty chewing
  • avoiding excessive stress, rest, eye patch, medication
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36
Q

Tendonitis

A
  • musculoskeletal system
  • sports or activity related
  • pain in joints, limited range of motion in joint
  • rest, ice, NSAIDs
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37
Q

Tetanus

A
  • musculoskeletal system
  • toxin produced by Clostridium tetani
  • muscle spasms in jaw and neck, dyspnea, fever, irritability, sweating and drooling
  • antitoxin and antibiotic medications
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38
Q

Asthma

A
  • respiratory system
  • allergens, pollutants, dust mites, cigarette smoke
  • wheezing, coughing, feeling of tightness in chest
  • avoiding allergens/irritants, rescue inhaler for bronchodilation, anti-inflammatory steroid inhalers, leukotriene-receptor antagonists, steroid injection for an acute episode
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39
Q

Atelectasis

A
  • respiratory system
  • cystic fibrosis, COPD, pleurisy, lung cancer, spontaneous
  • dyspnea, cyanosis, diaphoresis, pain
  • thoracentesis, chest percussion, deep breathing exercises, intermittent positive-pressure breathing
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40
Q

Bronchitis

A
  • respiratory system
  • viral, environmental pollutants, cigarette smoke
  • yellow-gray or green productive cough, chest tightness, dyspnea, fever
  • cough medicine, humidifier, inhalers, antibiotics in some cases
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41
Q

Chronic obstructive pulmonary disease (COPD)

A
  • respiratory system
  • smoking, environmental pollutants
  • dyspnea, hypoxia, fatigue, cough
  • smoking cessation, inhalers, lung transplant in extreme cases
42
Q

Emphysema

A
  • respiratory system
  • damage to alveoli caused by cigarette smoke, pollutants, specific types of dust
  • shortness of breath, chronic cough, fatigue
  • smoking cessation, avoiding cold environments, antibiotics for secondary lung infections
43
Q

Influenza

A
  • respiratory system
  • respiratory virus
  • fever, muscle pain, fatigue, sore throat, rhinorrhea
  • symptomatic, OTC analgesics for aches and fever, antiviral medication
44
Q

Legionnaires’ disease

A
  • respiratory system
  • legionella bacteria that grow in standing water
  • dyspnea, cough, headache, fever
  • antibiotics, respiratory medications, oxygen, fever medication (antipyretic)
45
Q

Pneumonia

A
  • respiratory system
  • bacterial, viral, parasitic
  • thick and colored sputum, dyspnea, fever, cough
  • rest, antibiotics, OTC analgesics
46
Q

Pulmonary edema

A
  • respiratory system
  • congestive heart failure, myocardial infarction, heart valve disorder, drowning, injury
  • orthopnea, dyspnea, wheeze, productive cough, weight gain, pallor
  • oxygen therapy, diuretics
47
Q

Pulmonary embolism

A
  • respiratory system
  • blood clot blocking an artery in the lung
  • dyspnea, chest pain, cough, fainting, rapid onset of shortness of breath, diaphoresis
  • circulation support (compression hose), rest, anticoagulant medication, surgically implanted filter
48
Q

Severe acute respiratory syndrome (SARS)

A
  • respiratory system
  • viral
  • fever, headache, dry cough
  • rest, antiviral medication
49
Q

Tuberculosis (TB)

A
  • respiratory system
  • bacterial
  • chronic cough, weight loss, fatigue, night sweats, painful or difficult breathing
  • isolation if symptomatic, medication therapy for 6 to 12 months
50
Q

Hypertension

A
  • cardiovascular system
  • narrowing of arteries, increased arterial pressure, risk factors (obesity, smoking, stimulant use, kidney disease, high sodium intake, excessive alcohol consumption)
  • excessive sweating, fatigue, muscle cramps, headaches, dizziness
  • treatment of underlying cause, lifestyle modifications (diet, exercise, stress management, smoking cessation), antihypertensive medication
51
Q

Angina

A
  • cardiovascular system
  • coronary artery narrowing, atherosclerosis
  • pain/tightness in chest
  • sublingual nitroglycerin, treatment of underlying condition
52
Q

Coronary artery disease (atherosclerosis)

A
  • cardiovascular system
  • buildup of fat and cholesterol in arteries, risk factors (high-fat diet, high LDL levels, smoking, obesity, sedentary lifestyle)
  • usually no symptoms prior to heart attack
  • lipid-lowering medications, low-fat diet, exercise, smoking cessation, coronary artery bypass grafting in severe cases
53
Q

Myocardial infarction (heart attack)

A
  • cardiovascular system
  • coronary artery blockage, atherosclerosis, blood clot
  • squeezing chest pain that can radiate to shoulder/arm/neck/jaw, shortness of breath, diaphoresis, dizziness nausea
  • aspirin, CPR if unconscious, defibrillation, anticoagulant medication, immediate emergency protocol
54
Q

Aneurysm

A
  • cardiovascular system
  • atherosclerosis, smoking, high cholesterol diet, obesity
  • usually none, possible back pain, tachycardia, dizziness
  • surgery
55
Q

Congestive heart failure (CHF)

A
  • cardiovascular system
  • smoking, obesity, sedentary lifestyle, high cholesterol diet, hypertension
  • shortness of breath, wheezing, peripheral edema in legs, irregular heartbeat
  • medications to address tachycardia, diuretic medication to treat edema, antihypertensive medications
56
Q

Mitral valve prolapse

A
  • cardiovascular system
  • usually unknown, hereditary or related to nervous system disorders
  • mild cases usually have no symptoms, severe cases can have shortness of breath and palpitations
  • none for mild cases, medications to treat symptoms, surgery to repair
57
Q

Thrombophlebitis

A

-cardiovascualr system
- prolonged periods of inactivity, hormone replacement therapy, cancer, paralysis, thrombophlebitis
- pain in affected area, redness, swelling
- heat, compression stockings, anticoagulant medication, surgery

58
Q

Acquired immunodeficiency syndrome (AIDS)

A
  • lymphatic/immune system
  • HIV virus
  • low T cell counts, fever, diaphoresis, susceptibility to frequent infections, weight loss
  • antiretroviral medication to slow progression, treatment of secondary infections with antibiotics, no cure
59
Q

Lymphedema

A
  • lymphatic/immune system
  • parasitic infection, trauma, surgical removal of lymph nodes
  • persistent tissue swelling
  • compression stockings, lymphedema pump, surgery
60
Q

Mononucleosis

A
  • lymphatic/immune system
  • Epstein-Barr virus, cytomegalovirus
  • extreme fatigue, sore throat, fever
  • supportive care
61
Q

Systemic lupus erythematosus

A
  • lymphatic/immune system
  • medications, bacterial infections, autoimmune
  • fatigue, body pain, butterfly rash on face, headaches, nausea, hair loss, weight loss, anemia, shortness of breath
  • NSAIDs (steroids, topical creams)
62
Q

Celiac disease

A
  • lymphatic/immune system
  • genetic defect, lack of enzyme that breaks down gluten, consumption of gluten triggers autoimmune reaction
  • weight loss, bloating, loose stools, eventual systemic organ wasting due to lack of nutrients, malabsorption
  • gluten free diet
63
Q

Alzheimer’s disease

A
  • nervous system
    degenerative brain disease, possibly genetic or environmental
  • confusion, memory loss, impaired judgement, personality change, worsens over time
  • physical activity, socialization, medication to slow the progression, no cure
64
Q

Bell’s Palsy

A
  • nervous system
  • unknown cause
  • weakness or paralysis of facial muscles, facial numbness and drooping, headache
  • NSAIDs, pain relievers, usually self-resolving
65
Q

Seizures

A
  • nervous system
  • birth trauma, infections, brain injury, head trauma, drug withdrawal
  • uncontrolled muscle contractions, loss of consciousness, visual disturbances
  • medication, brain surgery
66
Q

Meningitis

A
  • nervous system
  • bacterial/viral/fungal infection causing inflammation of the meninges
  • stiff neck, headache, fever, vomiting
  • appropriate medications for type, bacterial can be fatal
67
Q

Multiple sclerosis (MS)

A
  • nervous system
  • viral, genetic, immune system dysfunction
  • loss of ability to speak/walk, double vision, loss of balance, weakness in arms/legs
  • supportive, medications to slow progression, no cure
68
Q

Parkinson’s disease

A
  • nervous system
  • lack of neurotransmitters, brain tumors, drugs, head trauma
  • arm/leg muscle and joint stiffness, lack of coordination, tremor
  • supportive, medications to slow progression, no cure
69
Q

Stroke

A
  • nervous system
  • blockage of artery in neck or brain
  • paralysis, confusion, memory impairment, some symptoms can be permanent
  • physical therapy, occupational therapy, speech therapy
70
Q

Migraine headache

A
  • nervous system
  • hormones, stress, dietary, familial
  • dull to throbbing head pain, sensitivity to light/sound, nausea/vomiting, visual aura
  • medications, alternative methods (acupuncture, biofeedback, magnesium)
71
Q

Benign prostatic hyperplasia (BPH)

A
  • reproductive system
  • increased age, increased level of dihydrotestosterone
  • feeling of full bladder after urinating, weak urine flow, needing to urinate often
  • alpha blockers, minimally invasive surgical procedures, transurethral resection of the prostate (TURP)
72
Q

Hydrocele

A
  • reproductive system
  • failure of inguinal ring to close properly in development, injury or swelling of the scrotum
  • few symptoms, pain, increased size of scrotum
  • surgery if symptomatic
73
Q

Prostate cancer

A
  • reproductive system
  • unknown, genetics
  • pain, erectile dysfunction, dysuria
  • hormone therapy, radiation therapy, surgery, cryosurgery, chemotherapy
74
Q

Sexually transmitted infections

A
  • reproductive system
  • unprotected contact with infected tissue or fluids
  • varies depending on infection/disease, pelvic or penile pain, sores, itching or discharge, dysuria, body rash, infertility
  • varies depending on infection/disease, medication, cryosurgery, immunizations
75
Q

Endometriosis

A
  • reproductive system
  • unknown
  • most have no symptoms, pelvic pain (especially during menses), painful urination and defecation, infertility issues
  • NSAIDs, gonadotropin-releasing hormone agonists, oral contraceptives, progestins, surgical intervention
76
Q

Pelvic inflammatory disease

A
  • reproductive system
  • untreated STDs/STIs, multiple sexual partners, frequent douching
  • lower abdominal pain, back pain, fever, rapid pulse, vaginal discharge, pain during sexual intercourse
  • antibiotic treatment, surgical intervention to treat scarring
77
Q

Cervical cancer

A
  • reproductive system
  • particular strains of human papillomavirus (HPV)
  • abnormal vaginal bleeding, lower abdominal or pelvic pain, abnormal vaginal discharge, pain during sexual intercourse
  • surgical intervention (partial or complete hysterectomy, removal of lymph nodes in affected regions), chemotherapy, radiation therapy
78
Q

Acute kidney failure

A
  • urinary system
  • burns, dehydration, hemorrhage, low blood pressure, trauma
  • little to no urine production, swelling in extremities, mental confusion, coma, seizures, nose bleeds
  • increase dietary protein, fluid and potassium intake regulation, dialysis
79
Q

Chronic kidney disease

A
  • urinary system
  • diabetes, hypertension, kidney stones, polycystic kidney disease
  • headache, seizures, confusion, fatigue, anemia, abnormal heart or lung sounds
  • antibiotics, blood transfusion, control of blood pressure, dialysis, kidney transplant
80
Q

Incontinence

A
  • urinary system
  • nervous system disorders, urinary tract infection (UTI), bladder cancer, prostate disorders
  • involuntary urination
  • medication, surgical removal of the prostate, kegel exercises, surgery
81
Q

Polycystic kidney disease

A
  • urinary system
  • enlarged kidneys due to cysts, inherited
  • hypertension, fatigue, anemia, heart murmurs
  • medication, draining of cysts, surgical removal of kidney
82
Q

Pyelonephritis

A
  • urinary system
  • bladder infection that spreads to kidneys
  • fatigue, fever, painful urination, cloudy or bloody urine
  • antibiotics
83
Q

Renal calculi

A
  • urinary system
  • highly concentrated urine, UTI, gout
  • severe back or abdominal pain, fever, nausea, urgency
  • medication, surgery, lithotripsy
84
Q

Appendicitis

A
  • digestive system
  • idiopathic inflammation of the appendix
  • RLQ pain, loss of appetite, nausea
  • antibiotics, appendectomy
85
Q

Cirrhosis

A
  • digestive system
  • scarring of liver, can be autoimmune, medication, alcohol, hepatitis B or C
  • anemia, fatigue, fever, enlarged liver, jaundice, weight loss
  • avoid alcohol consumption, antibiotics, diuretics
86
Q

Cholelithiasis (gallstones)

A
  • digestive system
  • insoluble cholesterol and bile salt
  • can be asymptomatic, radiating right upper quadrant pain, fever, nausea/vomiting
  • laparoscopic cholecystectomy, lithotripsy
87
Q

Colitis (inflammation of the large intestine)

A
  • digestive system
  • viral or bacterial infection
  • diarrhea, abdominal pain, bloating
  • treatment of underlying cause, surgery
88
Q

Constipation (difficulty eliminating feces)

A
  • digestive system
  • inactivity, lack of fiber and water in diet, medications
  • bloating, abdominal pain, hard feces
  • increased dietary fiber and water, physical activity
89
Q

Crohn’s disease

A
  • digestive system
  • inflammatory bowel disease, autoimmune
  • fever, joint pain, tender gums, abnormal abdominal sounds, constipation or diarrhea, intestinal bleeding
  • dietary changes, antibiotics, surgery
90
Q

Diverticulitis (abnormal out-pouching of intestinal wall)

A
  • digestive system
  • bacterial, viral, parasitic
  • constipation or diarrhea, bloody stools, abdominal pain, nausea
  • high-fiber diet, antibiotics
91
Q

Hemorrhoids (varicose vein of the rectum or anus)

A
  • digestive system
  • constipation, straining during bowel movements, pelvic pressure during pregnancy/childbirth
  • itching/pain in anal area, blood with bowel movements, visible protrusion from the anus
  • high-fiber diet, stool softeners, surgical removal
92
Q

Hiatal hernia (part of stomach protrudes through diaphragm into chest cavity)

A
  • digestive system
  • unknown causes, smoking, obesity
  • heartburn, chest pain, excessive burping, nausea/vomiting
  • weight reduction, medication, surgical repair
93
Q

Stomach ulcer

A
  • digestive system
  • bacterial infection, smoking, medication
  • nausea/vomiting, abdominal pain
  • antibiotics, antacid medication, surgery
94
Q

Anterior cruciate ligament (ACL) tear

A
  • common injury
  • plant and twist motion of the foot and knee
  • pain, swelling, knee buckling
  • physical exam, radiographic confirmation (typically MRI)
  • RICE, surgical repair, allograft, physical therapy
95
Q

Concussion

A
  • common injury
  • head impact
  • loss of balance, disorientation, headache
  • physical exam, neurologic testing, CT of the brain
  • rest, treatment of symptoms
96
Q

Muscle strain

A
  • common injury
  • overexertion of a muscle not properly warmed up for activity level
  • pain, swelling, tight feeling
  • physical exam, MRI
  • RICE, avoiding physical strain to the area
97
Q

Epicondylitis (tennis elbow)

A
  • common injury
  • overuse of elbow causing tiny ligament tears
  • swelling, tenderness, grip weakness
  • physical exam, X-ray, MRI
  • rest, ice, NSAIDs, forearm strap, extended break from aggravating activity
98
Q

Rotator cuff tear

A
  • common injury
  • repetitive stress of the shoulder joint
  • pain, weakness, inability to raise arm over head
  • physical exam, X-ray, MRI
  • rest, NSAIDs, cortisone injection to shoulder joint, surgery
99
Q

Bone fracture

A
  • common injury
  • impact injury resulting in bone cracking or breaking, stress fractures: overuse or repetitive stress
  • pain, swelling, loss of function
  • physical exam, X-ray, CT if plain films are not clear
  • immobilization with internal or external device (cast, splint, pins, plates, screws)
100
Q

Joint dislocation (subluxations)

A
  • common injury
  • impact injury removing bones from proper joint alignment
  • pain, loss of sensation, immobility
  • physical exam, X-ray, MRI, CT
  • realignment of bones, immobilization, physical therapy to strengthen surrounding muscles, surgery for repeated incidences