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Patho Exam 4 UNMC.
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PathoExam
4
UNMC
Strabismus
-
ANS-Definition:
"crossed
eyes"
deviation
of
one
eye
from
the
other
when
looking
at
an
object
Incidence:
can
be
normal
in
infant
until
4
months,
after
needs
evaluation
Normal
A&P:
extraocular
muscles
attach
eyeball
to
orbit
and
allow
for
straight
and
rotary
movement;
each
muscle
from
one
eye
is
coordinated
with
a
muscle
from
the
other
eye,
which
produces
conjugate
movement,
and
results
in
one
image
being
produced
Patho:
most
commonly
caused
by
weak
or
hypertonic
muscle
in
affected
eye
Manifestations:
deviation
of
eye,
diplopia
(double
vision)
Treatment:
early
detection
critical
to
prevent
complications;
may
involve
exercises,
glasses,
patching,
and
surgery
Cataracts
-
ANS-Definition:
development
of
opacities
(cloudiness)
of
the
ocular
lens
Incidence:
some
formation
expected
by
age
70;
if
you
live
long
enough
you
will
have
them
Patho:
young
lens
is
transparent
and
has
consistency
of
hardened
jelly;
becomes
more
stiff
and
opaque
with
age;
most
common
form
is
degenerative;
can
occur
congenitally
Manifestations:
decreased
visual
acuity
with
blurred
vision,
increase
in
glare,
decrease
in
color
perception,
white
light
reflex
(instead
of
red)
in
pupil
area
Treatment:
removal
of
lens
with
intraocular
implant
(outpatient
surgery)-takes
20
minutes
for
one
eye
(other
eye
repaired
one
month
later)
in
kids-less
use
of
implants
and
more
use
of
contacts/external
correction
Glaucoma
-
ANS-Definition:
increased
intraocular
pressure
in
anterior
eye
above
normal
13-22
mmHg
of
aqueous
fluid
Incidence:
increase
between
45-60
years
of
age,
second
leading
cause
of
blindness Normal
A&P:
aqueous
humor
helps
to
maintain
pressure
in
eye
and
supply
nutrients
to
lens
and
cornea
Patho:
obstruction
to
outflow
of
aqueous
humor
with
resulting
increase
in
amount
of
fluid
and
pressure
in
eye;
pressure
in
eye
impairs
blood
flow
to
retina
with
subsequent
loss
of
acuity
Open
Angle
Glaucoma
-
ANS-90%,
chronic
obstruction
Manifestations:
chronic-develops
slowly
without
obvious
symptoms,
loss
of
peripheral
vision,
loss
of
central
vision,
blindness;
acute-sudden
severe
eye
pain,
nausea/vomiting,
and
decrease
in
vision
Medications:
miotics
that
constrict
pupil
and
increase
outflow
of
aqueous
humor
(pilocarpine);
carbonic
anhydrase
(diamox)
and
B
adrenergic
blockers
(timoptic)
that
decrease
production
of
aqueous
humor
without
effect
on
pupil;
if
meds
don't
work-surgery
Otitis
Media
-
ANS-Definition:
inflammation
of
middle
ear
Incidence:
71%
of
kids
had
one
episode
before
age
3;
increase
in
premature
birth,
children
with
Down's
Syndrome,
babies
fed
in
supine
position
Normal
A&P:
Eustachian
tube
is
normally
flat
and
closed;
opens
with
yawning
and
swallowing
to
equalize
pressure;
through
Eustachian
tube,
mucosa
of
middle
ear
is
continuous
with
mucosa
of
throat,
thus
allowing
organisms
to
move
in;
in
kids,
tubes
are
shorter,
more
horizontal,
more
distensible,
which
predisposes
kids
to
otitis
media
Suppurative
Otitis
Media
-
ANS-post
upper
respiratory
infection
(URI)
Exam:
red
bulging
immobile
tympanic
membrane
(TM)
Treat:
antibiotics
Complications:
perforation
and
sclerosis
of
TM
with
hearing
loss
and
delayed/poor
speech
Manifestations:
fever,
fussiness,
ear
pain,
pulls
on
ear,
hearing
loss
Effusion
Otitis
Media
-
ANS-can
follow
suppurative
or
seen
chronically
with
allergies Exam:
dull
gray
or
yellow
TM;
trapped
air
and
fluid
with
closure
of
Eustachian
tube,
fluid
thickens
and
forms
"glue
ear"
Manifestations:
doesn't
look
sick,
decreased
hearing,
ear
feels
"full"
Treatment:
may
resolve
spontaneously ,
may
use
antibiotics
(especially
if
suppurative),
or
decongestants
(question
effectiveness),
surgery-myringotomy
(incision
in
TM
with
insertion
of
plastic
tubes
to
drain
fluid)
Coronary
Artery
Disease
(CAD)
-
ANS-definition:
atherosclerosis
of
coronary
arteries;
disease
of
the
intima
(inner
lining),
chronic,
progressive;
inflammation
starts
the
process
Coronary
Artery
Disease
(CAD)
-
ANS-Pathophysiology:
1.
Inflammation-endothelium
damaged-lipids
deposit;
lipids
are
oxidized
and
attract
monocytes;
monocytes
enter
the
intima,
become
macrophages
which
ingest
LDL,
then
are
transformed
into
foam
cells
which
leads
to
the
release
of
cytokines
which
cause
inflammation
and
injury
2.
Fatty
streak
(yellow,
lipid-filled
smooth
muscle
cells-an
organized
collection
of
foam
cells);
starts
causing
some
narrowing
3.
Fibrous
plaque
(fatty
streak,
collagen,
elastic
fibers)
causes
further
narrowing
4.
Complicated
(advanced)
lesion-
fibrous
plaque
(lesion)
hemorrhages,
causes
clot
formation
and
obstruction
Coronary
Artery
Disease
(CAD)
-
ANS-3
main/most
dangerous
risk
factors:
1.
Cigarette
smoking
(direct
and
passive
2nd
hand
smoke;
nicotine
causes
release
of
epinephrine
leads
to
increased
HR
and
vasoconstriction;
increased
platelet
adhesiveness
leads
to
increased
clot
formation;
carbon
monoxide
attaches
to
Hgb
molecule
and
less
O2
is
carried
to
tissues)
2.
HTN
(increase
peripheral
vascular
resistance,
increased
workload
of
heart
accelerates
process
of
atherosclerosis)
3.
Hyperlipidemia
(advanced
age,
male
gender
under
60,
then
male/female
risk
equal,
genetic
predisposition;
hyperlipidemia
caused
by
increased
dietary
fat
intake,
diabetes,
and
genetics;
lipoproteins=lipids,
phospholipids,
cholesterol,
and
triglycerides
bound
to
carrier
proteins,
formation
of
fatty
streak
and
plaque)
Coronary
Artery
Disease
(CAD)
-
ANS-Other
risk
factors:
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