Term
|
Definition
steady dull band-like HA
localized symmetrically
symptoms build through day, esp. w/ stress
not aggravated by physical acitivty
treatment: reassurance, stress reduction, EtOH, analgesics
prophylaxis: amitriptyline |
|
|
Term
|
Definition
no aura
gradual onset over minutes to hours
unilateral throbbing moderate to severe HA
lasts 4-72hrs
nausea and vomiting common
photophobia + phonophobia
aggravated by physical activity
period occurrence, usually during relative rest
family hisotry
aggravated by: EtOH, foods, lack of sleep, fasting, OCPs, pregnancy
treatment: triptans, midrin, ergotamine
prophylaxis: propanolol, verapamil, amitriptyline, topiramate, depakote, botulinim toxin injections |
|
|
Term
|
Definition
assoc. aura (Visual)
visual symptoms build up over 10-15min, then gradually disappear as HA develops
duration 20-60 minutes
treatment: triptans, midrin, ergotamine
prophylaxis: proppranolol, verapamil, amitriptyline, topiramate, depakote, botulinum toxin injections |
|
|
Term
| propranolol (for migraines) |
|
Definition
| use for migraines with pt also has anxiety, panic attacks or tremor |
|
|
Term
| verapamil or depakote (for migraines) |
|
Definition
| use with atypical migraine, migraine w/ prlonged aura, or history of stroke |
|
|
Term
| amitriptyline (for migraines) |
|
Definition
| use for mixed/tension HA, insomnia, or depression |
|
|
Term
| avoid depakote for migraines |
|
Definition
| pregnancy, nursing, young woman not on OCP,liver disease, heavy EtOH use |
|
|
Term
| avoid propranolol or verapamil for migraines |
|
Definition
| bradycardia, conduction block, CHF, hypotensive |
|
|
Term
| avoid propRanolol for migraines |
|
Definition
| asthma, COPD, raynaud's, depression, athleet, or IDDM |
|
|
Term
| avoid amytriptyline for migraines |
|
Definition
| seizures, urinary retention, glaucoma, cardiac arrhythmias, recent MI |
|
|
Term
|
Definition
pain is retro-orbital, throbbin or piercing
assoc. w/ watery, bloodshot eye, nasal stuffiness, horner's and urge to stay in constant motion
pain lasts 15min to 3hr
often awakes from sleep and occur in early morning
treatment: 100% oxygen at 7-10ml/min for max 15minutes, DHE, prednisone
prophylaxis: verapamil, methysergide, depakote |
|
|
Term
|
Definition
HA >15days/month
usually have hx or migraine, but now HA more frequently but less severe
less photophobia, phonophobia, nausea
assoc. w/ overuse analgesics, caffeeine and depression
risk: attack frequency, med overuse, low education or socioecon status, stressful life events, head injury, snoring, obesity
treatment: d/c analgesics (taper), treat modifiable risk factors
prophylaxis: amitriptyline, topiramate |
|
|
Term
pseudotumor cerebri
(idiopathic intracranial hypertension) |
|
Definition
impaired reabsorption of CSF at arachnoid villi
w/o tx 50% some degree of visual loss
dull-pressure-like HA
blurred vision, dizziness
daily, morning
overweight
Exam: papilledema, visual obscurations, possible CNVI palsy
Scans: normal
Lumbar punc: markedly elevated opening pressure
treatment: weight loos, acetazolamide (diuretics), monitor visual fields (if dec. surgery) |
|
|
Term
temporal arteritis
(giant cell arteritis) |
|
Definition
new temporal or generalized HA
+/- blindness
fatigue, anorexia, low grade fever, wt loss, multifocal aches and pains
HA or monocular vision loss
scalp tenderness with touching or brushing hair, pain on chewing
polymyalgia rheumatic - sore and stiff all over
elderly
Exam: scalp tenderness, EOM weakness, ptosis, bruits
Lab: ESR elevated
Temporal artery biopsy - necessary
treatment: long-term, high dose steroids |
|
|
Term
|
Definition
abrupt onset of explosive head pain
may have vomiting
transient loss of consciousness possible
possible epileptic seizure and focal neuro symptoms
exam: +/- neuro deficites, if HA and CNIII palsy --> PComm Aneurysm worry about rupture
CT: aneurysm or crescent shaped hematoma
LP: blood
Angiogram: aneurysm
Treatment: support, elevate head of bed, mannitol, hyperventilate, seizure prophylaxis |
|
|
Term
|
Definition
pain in neck, face, and/or head
unilateral horner's syndrome, ipsilateral
assoc. w/ neck twisting or torsion
Exam: normal or horner's
MRI: CRESCENT SIGN
Treatment: anticoagulation |
|
|
Term
|
Definition
| bleed, pituitary apoplexy, AVM, mass lesion |
|
|
Term
| ddx new onset HA after 50y/o |
|
Definition
| temporal arteritis, tumor, subdural hematoma |
|
|
Term
| ddx HA w/ fever, stiff neck, rash |
|
Definition
|
|
Term
| ddx accelerating pattern of HA |
|
Definition
| mass lesion, subdural hematoma, medication overuse |
|
|
Term
| ddx new onset HA in pt with CA or HIV |
|
Definition
| metastasis, meningitis (chronic or carcinomatosis), brain abscess |
|
|
Term
| ddx focal neuro symptoms or signs + HA |
|
Definition
| mass lesion, AVM, stroke, collagen vascular disease |
|
|
Term
|
Definition
| mass lesion, pseudotumor, meningitis |
|
|
Term
|
Definition
CN VII palsy
jaw pain
vesicles in ear |
|
|
Term
toxic metabolic encephalopathy
(neuro complications) |
|
Definition
confusion and falling down
asterixis - waving hand syndrome
sometimes myoclinic jerk
assoc. w/ liver failure, renal failure, blood sugar, carbon dioxide, hypoxia, street drugs |
|
|
Term
acromegaly
(neuro complications) |
|
Definition
| carpal tunnel syndrome (hand numb and tingling, progressively worse, awakens them, Tinnel or Phalen positive) |
|
|
Term
hypothyroidism
(neuro complications) |
|
Definition
proximal muscle weakness, myopahty
very puffy face, pale and pastey complexion
loss of lateral 1/3rd of eyebrows
Labs: CK elevated, low thyroxine, high cholesterol, high BP |
|
|
Term
Cushing syndrome
(neuro complications) |
|
Definition
proximal muscle weakness
normal reflexes, no sensory deficits
weight gain, central distribution
puffy face
bruise easily
very high BP - petechial hemorrhages from cuff
cataracts
Labs: CK normal |
|
|
Term
Addison's disease
(neuro complications) |
|
Definition
no energy
hyperpigmentation
sleepy, thinned out
progressive over months
orthostatic hypotension |
|
|
Term
myotonic dystrophy
(neuro complications) |
|
Definition
years progressive proximal weakness
elevated CK enzymes
runs in family
long saggy face, frontal balding, temples thin, cataracts
thumb bounces up and stays up for 20s after tap with reflex hammer
squeeze fingers need pried open
trinucleotide repeat - dx by genetic analysis
fatal from cardiac arrhythmias, 10% need defibrillators |
|
|
Term
| Wernicke's encephalopathy (B1 deficiency) |
|
Definition
CONFUSION + EYE MOVEMENT DISORDER + CEREBELLAR ATAXIA
DON'T GIVE DEXTROSE (activates pathways req. thiamine, exacerbates disease state)
dx by thiamine levels and symmetric changes on MRI |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
intraretinal hemorrhages
(dotblot) |
|
|
Term
|
Definition
nerve fiber layer hemorrhages
(flame) |
|
|
Term
|
Definition
pre-retinal hemorrhages
(boat) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Kayser-Fleisher Ring
(Wilson's disease) |
|
|
Term
|
Definition
Stuge Weber Syndrome
(port wine stain and cortical atrophy) |
|
|
Term
|
Definition
subungual fibromata
(tuberosclerosis) |
|
|
Term
|
Definition
adenomatous sebaceum
(tuberosclerosis) |
|
|
Term
|
Definition
cortical tubers
(tuberosclerosis) |
|
|
Term
|
Definition
| Wernicke's encephalopathy |
|
|
Term
|
Definition
|
|
Term
|
Definition
carotid dissection
(crescent sign) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| study of adverse reactions occurring secondary to poisoning of the central or peripheral nervous system |
|
|
Term
| categories of neurotoxins |
|
Definition
pharmaceuticals
chemicals
environmental |
|
|
Term
|
Definition
|
|
Term
| drugs of withdrawal (cause seizure upon withdrawal) |
|
Definition
BENZODIAZEPINES
BARBITUATES
BOOZE (ETHANOL)
BACLOFEN
GHB |
|
|
Term
| status epilepticus inducing drugs |
|
Definition
| buproprion, TCAs, theophylline, isoniazid |
|
|
Term
|
Definition
symmetric pain, parathesias, and fasiculations in stocking-glove distribution
decreased proprioception, vibratory sense and ankle jerk reflexes
sensimotor peripheral neuropathy legs>arms
alopecia later on, blackened hair roots
increased thallium in 24hr urine |
|
|
Term
| common toxic peripheral neuropathies |
|
Definition
#1 DM
#2 alcohol
#3 chemotherapeutics |
|
|
Term
|
Definition
tonic clonic seizure
lab and exams normal
street drug |
|
|
Term
|
Definition
almost always generalized (unless underlying focal seizure disorder)
commonly presents as status epilepticus
ATAVAN - gaba agonist |
|
|
Term
|
Definition
flaccid areflexic coma
bradycardic
pupils sluggish, areflexic
labs normal, CT normal
date-rape drug |
|
|
Term
|
Definition
non-focal examfindings
normal labs and imaging
hypothermia and bradycardia |
|
|
Term
|
Definition
rare
insidious onset, typically chronic exposure
improvement upon removal of toxin
heavy metals (bismuth, lithium, aluminum)
chronic salicylism
solvent abuse
wernicke's |
|
|
Term
| carbon monoxide poisoning |
|
Definition
altered metnal status
gait abnormalities
confused, falls
masked facies, shuffling gate
hyperrrefelxia with bilateral Babinski
frontal release signs
mild cogwheel rigidity
treatment - inpatient rehab, no parkinsonism medication necessary |
|
|
Term
| neurotoxic parkinsonism agents |
|
Definition
MPTP
carbon monoxide
cyanide/hydrogen sulfide
manganese
methanol
neuroleptics |
|
|
Term
|
Definition
|
|
Term
|
Definition
8-12 cps
alpha waves
(looks regular with low voltage) |
|
|
Term
|
Definition
3-7cps
theta waves - like cardiac cell wave
(random outside of the theta waves) |
|
|
Term
|
Definition
12-14ccps
sleep spindles and K complexes
(periods of rapid peaks, large amplitude wave) |
|
|
Term
|
Definition
1/2 to 2 cps
delta waves >75uV
(large amplitude waves) |
|
|
Term
|
Definition
low voltage
random with fast saw tooth waves
(looks like awake, key is the saw teeth) |
|
|
Term
|
Definition
sympathetic tone increase
metabolism increased
response to stimuli is the greatest |
|
|
Term
|
Definition
body temp and metabolism decreased
parasympathetic tone increased (sympathetic dec.)
growth hormone is greatly increase
greatly increased prolactin
TSH decreased |
|
|
Term
|
Definition
body temperatrue and metabolism decreased, but brain metabolism increased
parasympathetic tone greatly increased (sympathetic greatly dec.)
prolcatin levels are greatly increased
TSH levels decreased
muscle atonia - paralyzed except eyes and diaphragm |
|
|
Term
|
Definition
|
|
Term
|
Definition
determines if sleepy
(not why sleepy) |
|
|
Term
|
Definition
abnormal mean sleep latency test
airway at back of throat is certain size, muscles get floppy during sleep, collapse of airways
usually don't present until >15x/hr awakening won't lead to asphyxiation unless CNS suppressed by alcohol or drugs and prevents the awakening
weight gain plays a role
treatment - CPAP, applies enough pressure to keep airways open |
|
|
Term
|
Definition
CO2 lowers/raises but doesn't induce breathing changes or wakening stimulus
hypo or hyperventilation types
assoc. w/ HF or brain lesion
not many symptoms, not waking up, not as much daytime sleepiness |
|
|
Term
| sleep related hyperventilation disorder |
|
Definition
shallow breathing
morning HA, sleepy during day, long sleeping
most sleep studies don't find this unless they measure CO2 |
|
|
Term
|
Definition
O2 levels get low during sleep
assoc. w/ COPD, HF, something else interfering with oxygen getting into blood
all breathing problems are worse at night with sleep |
|
|
Term
|
Definition
unpleasant (subjective) sensation in legs
appears at rest with an irresitaible ruge to move legs
sleep onset insomnia
moving legs improves sensation
test - sleep study to measure # of leg movements |
|
|
Term
|
Definition
etiology - unknown, maybe autoimmune
pathophys - loss of hypocretin cells
loss of sleep boundaries --> over sleepy
(sleep when don't want to, trouble sleeping when want to; sleepwalking during night, paralyzed during unwanted daytime sleep)
cataplexy
localized usually
HYPERREFRESHING NAPS |
|
|
Term
|
Definition
| paralyzed state but brain is awake |
|
|
Term
|
Definition
easily fall asleep, but no abnormal behaviors during night
UNREFRESHING NAPS
other autonomic symptoms - orthostatic hypotension |
|
|
Term
| circadian rhythm disorder |
|
Definition
delayed, advanced or irregular sleep-wake rhythm/phase
adolescents - delayed
shift work
jet lag
supsected by sleep study - go into slow wave and REM faster than those not sleep deprived |
|
|
Term
|
Definition
complaint of difficulty initiating or maintaining sleep that is chronically non-restorative or poor in quality
occurs despite adequate opportunity and circumstances to sleep
daytime impairment related to sleep difficulty (subjective, perform well on objective neurocog tests) |
|
|
Term
|
Definition
undesirable physical events or experiences that occur during entry into, within or out of sleep
movements, behaviors, emotions, perceptions, dreaming or autonomic system functions
occurs during overlap of sleep awake periods |
|
|
Term
|
Definition
type of parasomnia
most peopel experience occaisional
only disorder if recurrent and causing dysfunction |
|
|
Term
|
Definition
type of parasomnia
eyes open to take in environment
behaviors are typical, but at a weird time of day
can include sex, usually just with person in bed with them |
|
|
Term
|
Definition
type of parasomnia
not assoc. w/ bad dreams
autonomic symptoms of fear
go back to sleep after without realizing it happened |
|
|
Term
| sleep related eating disorders |
|
Definition
sleepwalk until they find food
eat weird things - frozen pizza, raw meat, butter, cigarettes
sometimes they are aware, but can't stop it
assoc. w/ benzo agonists (ambian, lunesta; mistreating for insomnia but they really just had RLS) |
|
|
Term
| REM assoc. behavior disordres |
|
Definition
acting out dreams
sleep related injurious behaviors |
|
|
Term
| REM assoc. acting out dreams |
|
Definition
fully asleep, eyes are closed
not paralyzed during sleep
dreaming in their environment
actions first, dream comes second
sleep apnea can trigger the events (must treat to see if persists) |
|
|
Term
|
Definition
parasomnia - only 1x/night, NREM assoc during first half, REM assoc during second half of nigh
seizures - more than one per night, only during REM, can occur at any during time of night |
|
|
Term
| type I dizziness - vertigo |
|
Definition
peripheral-ear or vestibular nerve, attacks of motion sickness, N, V, dysphoria
central - brainstem or cerebellar, less severe than peripheral, assoc. w/ other CNS symptoms |
|
|
Term
|
Definition
recurrent episodes of intense vertigo
tinnitus, hearing loss
fullness in the ears
(peripheral type I dizziness) |
|
|
Term
|
Definition
recurrent episodes (every few years), lasting several days of intense vertigo
no deafness or tinnitus
due to debris in semicircular canals
treat by clearing out debris (Epley)
(type I peripheral dizzines) |
|
|
Term
acute labrynthitis
(vestibular neuronitis) |
|
Definition
follows upper respiratory infection
intense vertigo
lasts a few days
tends not to recur
treat - meclizine or diazepam, short course seroids |
|
|
Term
| type II dizziness - presyncopal |
|
Definition
feel lightheaded
as if they might pass out
might have what looks like a mini-seizure for 3-5sec
causes: hypotension, vasovaagal attacks, cardiac arrhythmias, orthostatic hypotension, medications |
|
|
Term
| type III dizziness - disequilibrium |
|
Definition
balance is off
floating feeling
causes: medications, brainstem or cerebellar dsyfunction, loss of position sense (peripheral neuropathy or myelopathy) |
|
|
Term
| type IV dizziness - nonspecific |
|
Definition
doesn't conform to any of the other categories
patient is vague
multiple somatic complaints
anxiety and hyperventilation can produce this type of dizziness |
|
|
Term
|
Definition
information to brain that is inconsistent
3 systems: visual, vestibular, prioprioceptive
boats, heights, cars, lots |
|
|
Term
Neurofibromatosis 1
(neuro complications) |
|
Definition
Auto Dom
Neuro - gliomas in optic nerve, brain and spinal cord
Bumps, cafe-au-lait spots, axillary freckling, CV complications, Lisch nodule, orbital dysplasia, hunchback, long bone problems, kyphoscoliosis, sarcomas, Wilms tumor, leukemia |
|
|
Term
Neurofibromatosis 2
(neuro complications) |
|
Definition
AutoDom, chromosome 22
bilateral acoustic neuromas - sensineural hearing loss |
|
|
Term
Tubersclerosis
(neuro complications) |
|
Definition
AutoDom
Neuro (non-dx): seizures (familial epilepsy), mental retardation)
adenomatous sebaceum, ash leaf spots, subungual fibromata, cortical tubers, yellow-gray plaques in optic disc, increased risk of tumors
CT - calcified subependymal nodules |
|
|
Term
Ataxia telangiectasia (Louis-Bar disease)
(neuro complications) |
|
Definition
AutoRec
Neuro - present with cerebellar ataxia that is slowly progressive, nystagmus, dysarthria, developmental delay, hypoactive reflexes, degenerative brain disease (can't fix neurons)
young people, vascular markings on skin and eyes due to neovascularity, IgA and IgE deficiency, frequent pulm infections, hematological malignancy
DNA mismatch repair defect, |
|
|
Term
Stuge Weber syndrome
(neuro complications) |
|
Definition
Neuro - present with focal seizures, port-wine stain in V1 +/- V2 or V3; cerebral hemispheric atrophy, calcium deposits on surface of hemisphere due to vascular malformation; onset during 1st year of life
congenital glaucoma that can lead to blindness |
|
|
Term
Wilson's disease
(neuro complications) |
|
Definition
AutoRec, chromosome 13
Neuro - parkinsonism in childhood/teenage/young adult, tremor (wing beating), dementia, personality change; hits basal ganglia har
Kayser Fleisher ring, brain and liver failure, lower serum ceruloplasmin, increased renal copper excretion, aminoaciduria, liver biopsy w/ inc. copper |
|
|
Term
Shingles
(neuro complications) |
|
Definition
severe lancinating radicular pain (precedes skin rash by 1-5days)
maculopapular rash progresses to clusters of clear vesicles, unilateral, does not cross midline |
|
|
Term
Von Hippel Lindau disease
(neurocomplications) |
|
Definition
AutoDom, variable penetrance
Neuro - cerebellar hemangioblastomas, angioma of spinal cord
Retinal hemangiomas, sudden intraocular hemorrhage in 20s, polycythemia, congenital cysts of pancreas and kidney, renal carcinoma |
|
|
Term
|
Definition
gastric bypass or zinc supplement assoc.
spinal cord malfunction, ataxia, peripheral neuropathy |
|
|
Term
| age-related macular degeneration |
|
Definition
leading cause of severe vision loss in peopel >65y/o
part of natural aging process
macula loses effectiveness over time or abnromal vessels grow under retina affecting central vision
CENTRAL VISION LOSS |
|
|
Term
| dry age-related macular degeneration |
|
Definition
Bruch's membrane damaged by drusen (subretinal deposits of protein)
no treatment, slow progression to wet
(quitting smoking can slow progression to wet form) |
|
|
Term
| wet age-related macular degeneration |
|
Definition
new vessels grow through choroid
treatable |
|
|
Term
|
Definition
leading cause of blindness in US
disease of optic nerve usually due to increased intraocular pressure
LOSE PERIPHERAL VISION
slow progressive disease, some subtypes progress faster
Treatment - eyedrops, laser surgery |
|
|
Term
|
Definition
age-related is most common form
lens becomes cloudy preventing light from entering and sharply focusing on retina
not treatment to slow progression, only surgery to remove
Symptoms - blurry vision, glare or sensitivity, poor night vision, yellowing or fading of colors |
|
|
Term
| relative afferent pupillary defect |
|
Definition
pupil constricts with consenual but dilates with direct
Marcus-Gunn pupil
problem in optic nerve of affected eye |
|
|
Term
|
Definition
eye turns in
assoc. w/ VI palsy |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
involuntary jerking of eyes
can indicate pathology in eyes, brain, nerve or congenital motor defect |
|
|
Term
|
Definition
layer of cornea
if breached will result in scar |
|
|
Term
|
Definition
pumps out water
failure --> opacification --> vision loss |
|
|
Term
| anterior bowing of pupil/iris |
|
Definition
|
|
Term
| retroillumination w/ spokes |
|
Definition
|
|
Term
|
Definition
normal <0.5
>0.5 --> needs further evaluation for glaucoma |
|
|
Term
| congenital diseases with ophthalmological complications |
|
Definition
| down, marfan, myotonic dystrophy, tuberous sclerosis, lysosomal storage diseases, carbohydrate metabolism diseases, neurofibromatosis |
|
|
Term
|
Definition
<3y/o
intraocular hemorrhages + intracranial hemorrhages + no other medical explanation
intraretinal + nerve fiber layer + pre-retinal hemorrahges = ALMOST pathognomonic |
|
|
Term
|
Definition
flame hemorrhages (nerve fiber layer)
cotton wool spots
anterio-venule knicking
arteriole sheathing
exudates
blurred disc margins
central vein occlusion can develop (also seen in DM) |
|
|
Term
| central retinal artery occlusion |
|
Definition
cherry red spott
accompanied by whitening of optic nerve
assoc. w/ HTN
embolus is blocking flow |
|
|
Term
|
Definition
monocular dimming of vision
temporary arterial obstruction
sudden, transient, painless vision loss |
|
|
Term
|
Definition
cholesterol plaque
usually broken off from carotid
ALWAYS SEND FOR CAROTID ULTRASOUND |
|
|
Term
|
Definition
results from intracranial hypertension
borders of disc ar obscured, hemorrhages at periphery of disc |
|
|
Term
hyperviscosity syndromes
(ophthalmologic complications) |
|
Definition
retinal vein dilation - engorged and tortuous
hemorrhages
disc edema |
|
|
Term
|
Definition
hyperviscosity syndrome
(dilated retinal vein, hemorrhages, disc edema) |
|
|
Term
|
Definition
can involve anterior or posterior segments
sometimes must remove whole eye, sometimes not that drastic |
|
|
Term
|
Definition
assoc. uncontrolled rheumatoid arthritis
sclera amacia perforans possible
refer to reumatologist for better control\
tx - steroids, if failes -- graft |
|
|
Term
|
Definition
high probablity of globe perforation
sclera with exposure of underlying chroid |
|
|
Term
| juvenile idiopathic arthritis iritis |
|
Definition
few signs or symptoms
usually chronic
2* cataract or glaucoma
refer for periodic ophthalmic screening |
|
|
Term
| thyroid eye disease scale |
|
Definition
NO SPECS
0 - no signs/symptoms
1 - only signs
2 - soft tissue involvement
3 - proptosis
4 - EOM involvement
5 - corneal damage
6 - sight loss |
|
|
Term
|
Definition
assoc. w/ IV drug use
used as organic filler in heroin or coocaine
little micro infarcts around deposits of talc |
|
|
Term
| DM retinopathy - causes of vision loss |
|
Definition
macular edema - leaky capillaries in fovea
vitreous hemorrhage - bleeding into vitreous humor from fibrovascular proliferation
retinal detachment - fibrovascular proliferation elevates retina off nerve |
|
|
Term
| non-proliferative DM retinopathy |
|
Definition
microaneurysms
retinal edema (macular)
intraretinal hemorrhages
cotton wool infarcts
hard exudates
intraretinal microvascular abnormalities |
|
|
Term
| proliferative DM retinopathy |
|
Definition
FIBROVASCULAR PROLIFERATION
VITREOUS HEMORRHAGE (later stage)
RETINAL TRACTION AND DETACHMENT (later stage)
FLOATERS
microaneurysms, retinal edema (macular), intraretinal hemorrhages, cotton wool infarcts, hard exudates, intraretinal microvascular abnormalities |
|
|
Term
|
Definition
gets rid of peripheral retina, decreases VEGF load
sacrifice peripheral vision to preserve central
treatment option for DM retinopathy
macular edema --> small light spots in edematous areas around macula
PDR --> larger intense burns around retinal periphery |
|
|
Term
|
Definition
decrease in visual acuity due to deprivation
abnormal binocular interaction
visual loss at brain level
susceptible birth to 7-9yrs
etiologies: strabismus, deprivation
treatment: remove underlying pathology, patch or atropine drops on good eye |
|
|
Term
|
Definition
| asymmetric refractive errors |
|
|
Term
|
Definition
most common cause of amblyopia
persistence after 2mo for dx
do not grow out of
early (<24mo) surgical intervention improves outcomes |
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Definition
a cause of amblyopia
onset 2-3y/o
caused by farsightedness
treatment is optical (glasses) |
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| retinal detachment esotropia |
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Definition
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Definition
white pupil
usually found in well-child check
etiology: retinoblastoma, toxocara, coat's disease, cataract |
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Definition
leans toward affected side during gait
seen in arthritic hip
leaning over affected joint b/c makes it 1x weight instead of 3-4x weight with levers of pelvis in normal gait |
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| leg length discrepancy limp |
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Definition
| steps into hole or vaults leg over longer leg |
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Definition
| knees become more bowlegged with weight bearing |
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| grinding sensation in joint or at fracture site |
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| joint issue effect on ROM |
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Definition
| decreased passive and active ROM |
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| muscle weakness effect on ROM |
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Definition
| normal passive, decreased active ROM |
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Definition
steady femur and pulling tibia anteriorly
moves a lot if aCL compromised
can move more in Marfan's |
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Definition
pt lying supine
lift leg (flex at hip) for them --> stretches sciatic nerve
pain is positive for sciatica |
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Term
| shoulder apprehension test |
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Definition
externally rotate shoulder
pt becomes apprehensive that shoulder is going to dislocate
rotator cuff weakness |
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| x-ray as imaging modality in ortho |
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Definition
always order first
best view of bony anatomy
2 orthogonal view
traumatic - get joint above and below
foot, ankle, and knee should be weight bearing if possble |
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| MRI as imaging modality in ortho |
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Definition
soft tissue anatomy (t1), areas of inflammation (t2)
order only when looking for specific injury |
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| CT as imaging modality in ortho |
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Definition
excellent for detailed anatomy
for planning approach for surgery
can render 3D reconstructions from |
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| bone scan as imaging modality in ortho |
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Definition
radio-isotope taken up wherever bone turnover is high
TAGGED WBC can be used to look for evidence of acute infection (for chronic osteomyelitis) |
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| ultrasound as imaging modality in ortho |
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Definition
evaluating fluid collections, esp. in soft tissues
also newborn hips for dysplasia |
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Definition
Hx - varied, usually underlying hip abnormality (septic, toxic synovitis, Legg-Calve-Pethes, SCFE)
PE - knee normal, hip causes significant pain, frequently pt holds in EXTERNALLY ROTATED AND SLIGHTLY FLEXED AT HIP
Radiographs - knee normal, hip depends on dx |
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Definition
potential cause of referred knee pain
bacteria in joint
EMERGENCY
surgical debridement and removal of bacteria |
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Definition
potential cause of referred knee pain
inflammation from viral illness
self-limited
NSAIDs and supportive |
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Definition
potential cause of referred knee pain
avascular necrosis of femoral head |
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| SCFE (slipped capital femoral epiphysis) |
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Definition
potential cause of referred knee pain
non-traumatic slippage of epiphysis of femoral ball through growth plate |
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Definition
inflammation of tibial tubercle apophysis
usually self-limiting
Hx - pain in anterior knee related to activity, freq. sports related, occasionally painful w/ prolonged sitting, usually can walk w/o limp/pain, male:female 3:1
PE - tender bump over tibial tubercle, usually enlarged tubercle often bilaterally, normal ROM, normal stability
RAdiographs - not necessary, normal or thickening of soft tissues |
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Term
Patellofemoral syndrome
(condromalacia patella) |
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Definition
anterior knee pain related to maltracking of patella in trochlear groove
anatomic or muscle weakness, women>men
Hx- diffuse anterior knee pain, typically worse with steps or rising from seated position, pain not as bad with walking on level surface, worse with running
PE - vastus medialis obliquus atrophy, positive patellar grind test, pain under lateral facet of patella or meidal retinaculum, Q angle, patellar tilt laxity
Scans - xray normal or lateral tracking on merchant vie4w |
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Definition
positive in patellofemoral syndrome
pressure on knee-cap while knee extended, fire quad muscle --> extreme pain |
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Definition
angle between patellar tendon and quadriceps
abnormal >15*
worry when >20* |
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Definition
asses laxity of patella movement side to side
laxity of retinaculum |
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Definition
Hx - TWISTING INJURY WITH KNEE BENT, effusion several hours to days later, locking or catching of knee
PE - effusion, decreased ROM, joint line tenderness, positive McMurray/Appley grind/Thessaly test |
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Definition
test for meniscal tear
MEDIAL - knee fully flexed, EXTERNALLY rotate foot, slowly extend knee while applying axial and VARUS force
LATERAL - knee fully flexed, INTERNALLY rotate foot, slowly extend knee while applying axial and VALGUS force
positive - painful click or pop
Scans - x-ray may be normal may show DJD or fracture; MRI best to evaulate for tear |
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Definition
tests for meniscal tear
patient lies prone with knees flexed to 90*
downward force on foot with twisting motion
pain is positive sign |
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Definition
tests for meniscal tear
patient stands on one leg with knee at 20* flexion
then internally and externally rotates three times
recreates popping and pain
sensitivity >85%
can also be positive in septic knee |
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Definition
Hx - TWISTING INJURY WITH PLANTED FOOT or valgus force with foot planted or hyperextension of knee and came down on it weird; pt and other hear pop, unable to continue activity, RAPID EFFUSION, instability or looseness
PE - large effusion, decreased ROM, positive Lachman's or anterior drawer, may have assoc. MCL or meniscal tears
Scans - xray for fracture eval, MRI best for seeing ACL |
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Definition
Hx - insidious onset of knee pain, worse with activity, START-UP PAIN, stiff in morning or after rest, +/- swelling, progressive deformity
PE - antalgic gaint +/- thrust, decreased ROM, effusion, deformity, no laxity assoc.
Scans - plain films MUST BE WEIGHT BEARING, no other scans necessary |
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Definition
aka frozen shoulder
idiopathic loss of both active and passive ROM
Hx - severely decreased ROM with pain, insidious onset, 40-60y/o, DM is risk factor
PE - decrease active and passive ROM of at least 50%, motion painful esp at extremes, tenderness at deltoid insertion
Scans - xray to rule out arthritis |
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Term
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Definition
aka - impingement syndrome, rotator cuff tendonitis
inflammation of bursa and rotator cuff tendon
Hx - gradual onset of shoulder pain, worse with overhead activity, nigh pain
PE - palpation at greater tuberosity is painful, positive Neer and Hawkins signs if impinging, weakness and/or pain on testing of rotator cuff muscle strengths |
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Definition
test for subacromial bursitis
arm flexed 90*, thumb down, push up against resistance
pain is positive |
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Definition
test for subacromial bursitis
arm flexed 90*, elbow flexed 90*
examiner stabilizes elbow with outside hand and holds wrist with other
quickly move arm into internal rotation
pain in subacromial area is positive |
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Term
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Definition
tearing of one of four muscles
Hx - acute injury (rarer) or age-related degeneration, usually specific injury triggers the pain, nigh pain, difficulty sleeping on affected sid, weakness, difficulty with overhead activity
PE - atrophy of supra or infraspinatus, passive ROM normal, active ROM reduced, tenderness over greater tuberosity, weakness of supraspinatus
Scans - x-ray might show high-riding humerus |
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Term
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Definition
recurrent episodes of subluxation and/or dislocation of shoulder
typically anterior
traumatic and atraumatic types |
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Term
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Definition
traumatic, unidirectional, Bankart lesion, surgery
Hx - first event is assoc. with significant trauma, recurrent dislocations, easier and easier to dislocate
PE - acute = painful, anterior dislocation --> hold in neutral position, apprehension test positive, sulcus sign positive, generalized ligamentous laxity |
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Term
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Definition
atraumatic, multidirectional, bilateral, rehabilitation, inferior capsular shift (indicates procedure if PT fails)
Hx - symptoms vague, activity related, voluntary dislocation is poor prognositc
PE - painful, neutral position, apprehension test positive, sulcus sign positive, generalized ligamentous laxity |
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Definition
dimpling of soft tissue with humeral inferior dislocation
possibly normal if only mild |
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Definition
open fracture
dislocated joint
septic arthritis
compartment syndrome
spinal injuries |
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Definition
aka compound fracture
can be obvious or pin-hole sized opening
ooze like crazy (marrow bleeding)
tx - surgical debridement, wound bath, closer her up |
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Definition
need to be reduced emergently to protect blood supply to bone and cartilage of joints
should get x-rays prior to reduction unless vascular compromise present |
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Definition
infection in joint
range of motion is extremely painful
diagnosis confirmed by aspiration of joint
if not treated can results in development of severe/permanent arthritis and cartilage damage |
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Definition
increased pressure in muscular compartment of body
(lower leg most common, then forearm)
usually traume related
Pain, Pallor, Poiklothermia, Pulselessness, Paralysis
high level of suspicion in unconscious pt |
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Definition
pressure on nerves in low back due to spinal stenosis
loss of bladder/bowel control
weakness
numbness, esp. in perianal areas and around feet |
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