quiz 5 part 1 Flashcards
proliferative diabeteic retinopathy
-VEGFA drives neovascularization
-new vessels grow on the surface of the retina and can bleed into the eye
-poor prognosis untreated
non proliferative d.r.
-early stage
-dilation of veins, microaneurysms, retinal hemorage
-no new vessels
-due to vessels being weak body releases VEGFA
nonproliferative tx
control blood glucose and photocoagulation
proliferative tx
vegfa and photocoagulation
hypertensive retinopathy
high bp damages the vessels
-they narrow, rupture, optic nerve swells (papilledema), exudate
-vascular wall changes
-arteriovenous nicking on fundoscopy
thicker vascular walls from hypertension
copper wiring
more advanced hardened vessels from hypertension
silver wiring
conditions associated with hypertensive reti.
pheochromocytoma, malignant hypertension and preeclampsia-eclampsia
retinal artery occlusion
-blocked by embolism
-painless blindness
-decrease intraocular pressure
-atherosclerotic plaques and tempral arteritis
how can temporal arteritis cause central retinal artery occlusion
causes inflammation of opthalmic artery that becomes central artery occlusion
physical findings retinal artery occlusion
-poor pupillary response to light on bad eye
-light on the good eye causes both to contract
-arteries may appear bloodless
central artery occlusion tx
-past 72 hrs treatment might not improve vision
-tx within 24 hrs
-once the retina has infarcted it is perm
-occular massage, lay flat, high concentration oxy, iv acetazolamide, anterior chamber paracentesis
conjunctivitis pathogens
-virus, bacteria, fungal, parasite, hsv
-viral can lead to blindness
-sti if follicular conjunctivitis or preaural adenipathy
-gonococcal if neonates (can perforate cornea or be purulent)
main three causes of conjunctivitis
chlamydia, adenovirus, hsv
clear watery discharge
viral conjunctivitis
lots of discharge, minimal pain, staph, strep
bacterial conjunctivitis
what can chlamydia conjunctivitis lead to
scarring, lid derangement, ingrown eyelashes
-trachoma= main cause of blindness
bacteriak, conjunctivitis tx
sulfacetomide
chamidyae conjunctivitis tx
oral azithromycin
gonococcal conjunctivitis
IM ceftriazone
what is there is pain with conjunctivitis
it is viral or bacterial
allergic conjunctivitis
-stringy discharge, no pain, coble stone papillae, vision loss
allergic conjunctivitis tx
topical corticosterois, histamine h1 antagonist, watch for cataracts, glaucomma, hsv
neiserra conjunctivitis
tx with abx to prevent secondary infection, artificial tears
*corticosteroids can be bad if pt has hsv wait for opthalmalogist
episcleritis
-superficial, collagen and vascular disorder, asymptomatic, mild pain
*no symptoms
scleritisi
*symptoms
-deep, idiopathic, collagen vascular disease
-zoster, sarcoids, RA
-deep dull pain wakes them at night
scleritis tx
nsaid or prednisone
shingles
hutchinson sign, acyclovir
uveitis anterior
acute recurrent and chronic
-red eye, low vision, photophobia, idiopathic
-paneuveitis (all 3 uvea layers)
uveitis posterior
-choroditis, vitritis (vitreous inflammation), retinal vasculitis, retinitis, shingles, sarcoids, toxo, tb, syph etc
-pupil can be irregular and small
-not as painful or red
-panuveitis (all 3 uvea layers)
glaucomma open angle
-iop >21, large optic cup, field loss, older women
glaucomma closed angle
-ocular and face pain, headache, vom, abd pain, haloes, fixed mid dilated pupil, shallow anterior chamber
-emergency
open angle tx
timolol, alphagen, prostaglandin agonist
closed angle
acetazolamide, timolol, pilocarpine, prednisone acetate, iridotomy
amaurosis fugax
-temp vision loss due to retinal blood flow
-painless loss unilateral
-returns when blood flow is restored
-fleeting blindness
-curtain across the vision
-CAD or AFIB
retinitis pigmentosa
-rod degenerative disease
-night vision and tunnel vision start
-lose periphery
retinal vein occlusion can cause
-neurovascularization of the retina or iris with a secondary glaucomma weeks to months after the occlusion
what is retinal vein occlusion
-sudden or gradual vision loss dx with fundoscopy, distended veins, congestion, edematous retinal hamorrages, wool spots, optic disc swells
-vision may return if perfusion is restores
pharygitis caused by
-virus or bacteria, viral more common
-tonsillitis can happen simultaneously
-influenza a and b
-h1n1, rsv, adenovirus
rare pharyngitis causes:
hsv, neusseria gonorrhoeae
serious pharyngitis strains?
strep, group a beta hemolytic strep
viral pharyngitis sx
-sneeze, rhinorhea, cough
pharygitis signs
-red tonsils, swollen, yellow or thin white membrane that peels without bleeding, white matter, large lymph, dry mucous membrane
GABHS pharyngitis sx
-headache, exdudate, painful swallowing, gi symptoms, chills, high fever, hoarse,
*NO COUGH
centor criteria
-fever
-exudate
-tender adenopathy
-no cough
1 no abx
2 abx w (+) rapid
4 abx empiric
pharyngitis labs
WBC, monospot, lateral neck radiograph to rule out pharyngeal abscess, culture
pharygitis tx
-salt gargaras, pnc (adult= amoxicillin, IM benzathine/ procraine (not used))
-2ndry: azithromycin, erythromycin, clindamycin
when to get tonsillectomy
if the upper airway is obstructed, dysphagia, sleep disorder or febrile convulsions from tonsillitis
-3 or more infection per yr or being a carrier consider it
complications pharygitis
-RF, glomerulonephritis, preterm deliver
-supperative: peritonsillar abscess, impetigo, OM, mastoiditis, sinusitis, meningitis, nfascitis, cellulitis
mono triad
lymphadenopathy, fever, sore throat w or w out exudate
