The Red Eye
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The document discusses various potential causes of a red eye presented in primary care, including infectious causes like conjunctivitis, non-infectious inflammatory conditions like blepharoconjunctivitis, and traumatic or mechanical issues such as corneal abrasions or foreign bodies. It describes common symptoms, etiologies, diagnoses, and treatments for different red eye conditions that may present to an optometrist. The goal is to provide optometrists with guidance on evaluating red eyes and differentiating between various potential underlying pathologies.
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Viral corneal ulcer
1. Viral corneal ulcers have increased due to antibiotics reducing bacterial flora. Herpes simplex virus is a common cause, initially infecting epithelium and potentially becoming neurotropic. Primary infection involves non-immune individuals while recurrent infections reactivate dormant virus.
2. Herpes simplex keratitis manifestations include punctate epithelial keratitis, dendritic ulcers, and stromal keratitis treated with antivirals like acyclovir along with supportive measures. Herpes zoster ophthalmicus affects the trigeminal nerve causing vesicular skin lesions and ocular complications in 50% of cases like keratitis, treated with antivirals and steroids.
Viral keratitis
Viral keratitis is commonly caused by herpes simplex virus types 1 and 2 and varicella zoster virus. HSV keratitis typically presents as dendritic ulcers or geographic ulcers on the cornea. It can also cause stromal keratitis. Varicella zoster virus causes herpes zoster infection which presents with a painful rash that follows dermatomal patterns, and can also lead to keratitis. Adenovirus is another common cause and presents as punctate epithelial keratitis that may develop into nummular opacities. Treatment involves topical antivirals and steroids depending on the type and severity of infection.
Anterior Uveitis
Anterior uveitis is inflammation of the front part of the eye that can cause eye pain, redness, blurred vision and sensitivity to light. It is often idiopathic but can be associated with trauma or systemic diseases. Diagnosis involves examining the eye for cells and flare in the aqueous humor, keratic precipitates, and other signs of inflammation using a slit lamp. Treatment aims to reduce inflammation and prevent complications through topical corticosteroids and cycloplegics, with systemic steroids for more severe cases.
APPROACH TO RED EYE -DIAGNOSIS AND TREATMENT
This document provides an overview of the anatomy of the eye and various approaches to patients presenting with red eye. It begins with describing the three layers of the eyeball and three chambers of the eye. It then outlines the key components of history taking and physical examination for red eye. Specific conditions covered include subconjunctival hemorrhage, acute angle closure glaucoma, corneal abrasion, viral and bacterial conjunctivitis, uveitis, keratitis, hordeolum, herpes keratitis, and cellulitis. Treatment approaches are provided for each condition.
The Red Eye
This document provides an overview of common causes of a red eye and guidelines for evaluation and management. It discusses various conditions that can affect the eyelids, conjunctiva, sclera, cornea, iris and anterior chamber. Conditions range from self-limiting issues like blepharitis, styes and viral conjunctivitis to more serious conditions like bacterial ulcers, iritis, uveitis and acute angle closure glaucoma which require prompt referral. A basic history of symptoms and external exam can help form a differential diagnosis, while fluorescein staining aids examination of the cornea. Early referral is advised for decreased vision, severe pain, poor response to initial treatment or unilateral red eye.
Causes of proptosis
This document discusses proptosis (forward displacement of the eyeball), its causes, signs, symptoms, and evaluation. Proptosis can be unilateral or bilateral, acute or intermittent. It may be caused by congenital defects, trauma, infections, vascular lesions, cysts, tumors, or endocrine disorders like Graves' disease. Evaluation involves inspection, palpation, tests of eye movement and vision, exophthalmometry to measure protrusion, and diagnostic imaging or biopsy when indicated based on suspected etiology.
Red eye
2. This document presents an overview of red eye conditions and their management. It identifies signs requiring urgent referral, such as absent pupil response or corneal damage. Common differentials discussed include
Hyphema
This document discusses hyphema, which is blood in the anterior chamber of the eye. It defines hyphema and lists its potential causes such as trauma, medical conditions, and surgeries/medications. The document outlines methods for grading hyphema based on the amount of blood in the anterior chamber. It also discusses the clinical features, workup, potential complications like increased eye pressure, and treatment approaches like medical management with anti-inflammatory drugs and surgery if needed to prevent complications. The prognosis depends on factors like the severity of hyphema and any associated eye damage.
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Viral corneal ulcer
1. Viral corneal ulcers have increased due to antibiotics reducing bacterial flora. Herpes simplex virus is a common cause, initially infecting epithelium and potentially becoming neurotropic. Primary infection involves non-immune individuals while recurrent infections reactivate dormant virus.
2. Herpes simplex keratitis manifestations include punctate epithelial keratitis, dendritic ulcers, and stromal keratitis treated with antivirals like acyclovir along with supportive measures. Herpes zoster ophthalmicus affects the trigeminal nerve causing vesicular skin lesions and ocular complications in 50% of cases like keratitis, treated with antivirals and steroids.
Viral keratitis
Viral keratitis is commonly caused by herpes simplex virus types 1 and 2 and varicella zoster virus. HSV keratitis typically presents as dendritic ulcers or geographic ulcers on the cornea. It can also cause stromal keratitis. Varicella zoster virus causes herpes zoster infection which presents with a painful rash that follows dermatomal patterns, and can also lead to keratitis. Adenovirus is another common cause and presents as punctate epithelial keratitis that may develop into nummular opacities. Treatment involves topical antivirals and steroids depending on the type and severity of infection.
Anterior Uveitis
Anterior uveitis is inflammation of the front part of the eye that can cause eye pain, redness, blurred vision and sensitivity to light. It is often idiopathic but can be associated with trauma or systemic diseases. Diagnosis involves examining the eye for cells and flare in the aqueous humor, keratic precipitates, and other signs of inflammation using a slit lamp. Treatment aims to reduce inflammation and prevent complications through topical corticosteroids and cycloplegics, with systemic steroids for more severe cases.
APPROACH TO RED EYE -DIAGNOSIS AND TREATMENT
This document provides an overview of the anatomy of the eye and various approaches to patients presenting with red eye. It begins with describing the three layers of the eyeball and three chambers of the eye. It then outlines the key components of history taking and physical examination for red eye. Specific conditions covered include subconjunctival hemorrhage, acute angle closure glaucoma, corneal abrasion, viral and bacterial conjunctivitis, uveitis, keratitis, hordeolum, herpes keratitis, and cellulitis. Treatment approaches are provided for each condition.
The Red Eye
This document provides an overview of common causes of a red eye and guidelines for evaluation and management. It discusses various conditions that can affect the eyelids, conjunctiva, sclera, cornea, iris and anterior chamber. Conditions range from self-limiting issues like blepharitis, styes and viral conjunctivitis to more serious conditions like bacterial ulcers, iritis, uveitis and acute angle closure glaucoma which require prompt referral. A basic history of symptoms and external exam can help form a differential diagnosis, while fluorescein staining aids examination of the cornea. Early referral is advised for decreased vision, severe pain, poor response to initial treatment or unilateral red eye.
Causes of proptosis
This document discusses proptosis (forward displacement of the eyeball), its causes, signs, symptoms, and evaluation. Proptosis can be unilateral or bilateral, acute or intermittent. It may be caused by congenital defects, trauma, infections, vascular lesions, cysts, tumors, or endocrine disorders like Graves' disease. Evaluation involves inspection, palpation, tests of eye movement and vision, exophthalmometry to measure protrusion, and diagnostic imaging or biopsy when indicated based on suspected etiology.
Red eye
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Hyphema
This document discusses hyphema, which is blood in the anterior chamber of the eye. It defines hyphema and lists its potential causes such as trauma, medical conditions, and surgeries/medications. The document outlines methods for grading hyphema based on the amount of blood in the anterior chamber. It also discusses the clinical features, workup, potential complications like increased eye pressure, and treatment approaches like medical management with anti-inflammatory drugs and surgery if needed to prevent complications. The prognosis depends on factors like the severity of hyphema and any associated eye damage.
Uveitic glaucoma
This document discusses uveitic glaucoma, including:
1. It affects around 10% of patients with uveitis and can occur in various types of uveitis, most commonly anterior uveitis.
2. Elevated intraocular pressure in uveitis can be temporary or long-lasting, causing optic nerve damage described as uveitic glaucoma.
3. Treatment aims to control intraocular inflammation and lower intraocular pressure through medications and surgery if needed. Managing the underlying uveitic condition is also important to control glaucoma.
Eales’ Disease
Eales' disease is an idiopathic inflammatory retinal vasculitis that primarily affects young males in India. It involves peripheral retinal perivasculitis and ischemia leading to neovascularization and recurrent vitreous hemorrhage. While its exact etiology is unknown, it has been associated with tuberculosis and hypersensitivity to tubercular proteins. Treatment involves corticosteroids to reduce inflammation, laser photocoagulation to ablate new vessels and reduce hemorrhage risk, and vitrectomy for non-resolving hemorrhage or retinal detachment.
INTRAOCULAR FOREIGN BODY
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Anterior uveitis is inflammation of the iris and ciliary body. It is classified as iritis, iridocyclitis, or cyclitis. Clinical features include pain, redness, photophobia, and vision loss. Signs include cells in the anterior chamber, keratic precipitates, posterior synechiae, and complicated cataracts. Treatment involves cycloplegics, corticosteroids, and immunosuppressants to reduce inflammation and treat underlying causes or complications.
Malignant Glaucoma
Malignant glaucoma, also known as aqueous misdirection syndrome, is a secondary glaucoma that occurs when aqueous humor takes an abnormal posterior route behind the lens and vitreous instead of flowing normally through the pupil. It presents with a shallow anterior chamber despite high intraocular pressure. Potential causes include prior eye surgery or laser treatment. Diagnosis involves examining for signs of anterior chamber shallowing and ruling out other conditions. Treatment begins with cycloplegic drugs but may require Nd:YAG laser or vitrectomy if unresponsive. Prognosis depends on severity and underlying anatomy.
Viral keratitis
This document discusses viral keratitis, specifically herpes simplex virus (HSV) keratitis. It describes that HSV is a common cause of corneal blindness. HSV can cause a variety of ocular manifestations including dendritic ulcers, geographic ulcers, neurotrophic keratitis, stromal keratitis, and endothelitis. Treatment involves topical antiviral medications like acyclovir. Recurrent infections may lead to complications such as stromal scarring.
Bacterial keratitis
Bacterial keratitis is a sight-threatening condition caused by various bacteria that leads to progressive corneal destruction if left untreated. It is characterized by corneal inflammation and ulceration. Common risk factors include contact lens wear, trauma, and ocular surface diseases. Clinical features may include a purulent corneal ulcer without hypopyon or a hypopyon corneal ulcer, the latter seen more often with more virulent organisms and in immunocompromised patients. Prompt treatment is necessary to prevent corneal perforation or extension of infection.
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Proptosis in ophthalmology
- Proptosis refers to forward displacement of the eyeball beyond the orbital rim, usually due to an increased mass or volume within the orbit. Common causes include tumors, inflammation, trauma, thyroid eye disease, and vascular lesions.
- Examination involves measuring exophthalmometry, inspecting for signs of mass effect, pulsation or displacement of the globe, and evaluating for neurologic deficits. Imaging with CT or MRI is important to characterize the lesion causing proptosis.
Red eye
This document discusses the differential diagnosis and approach to evaluating red eye. It begins by listing conjunctivitis, scleritis, ocular foreign body, and angle closure glaucoma as possible causes of red eye. For acute onset painful red eye, common unilateral causes include corneal abrasion, foreign body, and trauma, while bilateral causes include chemical injury, contact lenses, dry eyes, and allergies. Acute painless unilateral red eye may be viral conjunctivitis or subconjunctival hemorrhage, while bilateral causes are blepharitis and allergies. Chronic red eye may result from blepharitis, dry eye, conjunctivitis, contact lenses, or thyroid eye disease.
Uveitits classifications and Approach
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- The anatomy of the uveal tract and classifications of uveitis based on anatomy, clinical course, etiology, and histology.
- The epidemiology, clinical presentation, signs and symptoms, and common causes of the three main types of uveitis - anterior, intermediate, and posterior uveitis.
- Guidelines for taking a thorough history and performing an examination of a uveitis patient.
- A case example is presented of a patient with bilateral uveitis.
Red eye
The document outlines the role of family physicians in assessing and treating red eye. It discusses differentiating urgent from non-urgent causes of red eye and provides details on examination techniques. Key parts of the examination include assessing vision, using a penlight to examine soft tissues, and evaluating the pupil, iris, cornea, sclera, conjunctiva and eyelids. Common conditions like conjunctivitis, keratitis and iritis are described. The document emphasizes that a thorough history and physical are important to identify potential emergencies like acute glaucoma that require prompt referral.
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This document summarizes various types of orbital inflammation including preseptal cellulitis, orbital cellulitis, idiopathic orbital inflammatory disease, orbital myositis, dacryoadenitis, thyroid orbitopathy, Tolosa-Hunt syndrome, and rhino-orbital mucormycosis. It describes the presentations, risk factors, pathogenesis, diagnostic evaluations, and treatment approaches for each condition. The document emphasizes that orbital inflammatory diseases encompass a broad spectrum and can affect people of all ages, with varying degrees of visual impairment, proptosis, ophthalmoplegia, and pain depending on the specific condition and extent of inflammation present.
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Ocular injuries can be classified as open globe, closed globe, or periocular injuries. Open globe injuries involve a full thickness break in the eye wall, while closed globe injuries do not penetrate the full thickness. Periocular injuries involve the tissues surrounding the eye. Common closed globe injuries include conjunctival and corneal abrasions, hyphema, and retinal detachment. Lid lacerations may require repair depending on their location. Blunt eye trauma requires examination of visual acuity and eye anatomy to check for injuries like ruptured globe or optic nerve damage. Suspected open globe injuries or those with vision loss require emergent ophthalmology referral.
Scleritis1
This document discusses scleritis, an inflammation of the sclera. It defines scleritis and notes it is less common than episcleritis. Scleritis can be classified as anterior or posterior, with anterior scleritis subdivided into non-necrotizing diffuse/nodular or necrotizing forms with or without inflammation. Associated systemic diseases are common in 45% of patients. Signs, symptoms, investigations, and treatment are described depending on the classification of scleritis. Surgical treatment may be needed for extreme scleral thinning or corneal complications.
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This document discusses uveitic glaucoma, including:
1. It affects around 10% of patients with uveitis and can occur in various types of uveitis, most commonly anterior uveitis.
2. Elevated intraocular pressure in uveitis can be temporary or long-lasting, causing optic nerve damage described as uveitic glaucoma.
3. Treatment aims to control intraocular inflammation and lower intraocular pressure through medications and surgery if needed. Managing the underlying uveitic condition is also important to control glaucoma.
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Eales' disease is an idiopathic inflammatory retinal vasculitis that primarily affects young males in India. It involves peripheral retinal perivasculitis and ischemia leading to neovascularization and recurrent vitreous hemorrhage. While its exact etiology is unknown, it has been associated with tuberculosis and hypersensitivity to tubercular proteins. Treatment involves corticosteroids to reduce inflammation, laser photocoagulation to ablate new vessels and reduce hemorrhage risk, and vitrectomy for non-resolving hemorrhage or retinal detachment.
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Anterior uveitis
Anterior uveitis is inflammation of the iris and ciliary body. It is classified as iritis, iridocyclitis, or cyclitis. Clinical features include pain, redness, photophobia, and vision loss. Signs include cells in the anterior chamber, keratic precipitates, posterior synechiae, and complicated cataracts. Treatment involves cycloplegics, corticosteroids, and immunosuppressants to reduce inflammation and treat underlying causes or complications.
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This document discusses viral keratitis, specifically herpes simplex virus (HSV) keratitis. It describes that HSV is a common cause of corneal blindness. HSV can cause a variety of ocular manifestations including dendritic ulcers, geographic ulcers, neurotrophic keratitis, stromal keratitis, and endothelitis. Treatment involves topical antiviral medications like acyclovir. Recurrent infections may lead to complications such as stromal scarring.
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- Proptosis refers to forward displacement of the eyeball beyond the orbital rim, usually due to an increased mass or volume within the orbit. Common causes include tumors, inflammation, trauma, thyroid eye disease, and vascular lesions.
- Examination involves measuring exophthalmometry, inspecting for signs of mass effect, pulsation or displacement of the globe, and evaluating for neurologic deficits. Imaging with CT or MRI is important to characterize the lesion causing proptosis.
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This document discusses the differential diagnosis and approach to evaluating red eye. It begins by listing conjunctivitis, scleritis, ocular foreign body, and angle closure glaucoma as possible causes of red eye. For acute onset painful red eye, common unilateral causes include corneal abrasion, foreign body, and trauma, while bilateral causes include chemical injury, contact lenses, dry eyes, and allergies. Acute painless unilateral red eye may be viral conjunctivitis or subconjunctival hemorrhage, while bilateral causes are blepharitis and allergies. Chronic red eye may result from blepharitis, dry eye, conjunctivitis, contact lenses, or thyroid eye disease.
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This document provides an overview of uveitis, including:
- The anatomy of the uveal tract and classifications of uveitis based on anatomy, clinical course, etiology, and histology.
- The epidemiology, clinical presentation, signs and symptoms, and common causes of the three main types of uveitis - anterior, intermediate, and posterior uveitis.
- Guidelines for taking a thorough history and performing an examination of a uveitis patient.
- A case example is presented of a patient with bilateral uveitis.
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The document outlines the role of family physicians in assessing and treating red eye. It discusses differentiating urgent from non-urgent causes of red eye and provides details on examination techniques. Key parts of the examination include assessing vision, using a penlight to examine soft tissues, and evaluating the pupil, iris, cornea, sclera, conjunctiva and eyelids. Common conditions like conjunctivitis, keratitis and iritis are described. The document emphasizes that a thorough history and physical are important to identify potential emergencies like acute glaucoma that require prompt referral.
Ocular manifestations of tuberculosis infection
Ocular manifestations of TB can affect any part of the eye. Secondary ocular TB results from hematogenous spread from a distant site. Presentations include adnexal lesions like lupus vulgaris and eyelid granulomas. Anterior segment involvement includes conjunctivitis, granulomas, keratitis and iridocyclitis. Posterior segment manifestations are choroidal tubercles, tuberculomas, serpiginous-like choroiditis and subretinal abscesses. Neuro-ophthalmic signs consist of optic nerve tubercles or neuritis. Complications include cataracts, glaucoma, cystoid macular edema and retinal detachment. Treatment involves antitubercular drugs
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This document discusses scleritis, an inflammation of the sclera. It defines scleritis and notes it is less common than episcleritis. Scleritis can be classified as anterior or posterior, with anterior scleritis subdivided into non-necrotizing diffuse/nodular or necrotizing forms with or without inflammation. Associated systemic diseases are common in 45% of patients. Signs, symptoms, investigations, and treatment are described depending on the classification of scleritis. Surgical treatment may be needed for extreme scleral thinning or corneal complications.
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Dry eye
Dry eye is a multifactorial disease that results in ocular discomfort and visual disturbance. It is caused by decreased tear production or increased tear evaporation, which leads to ocular surface inflammation and damage. Dry eye ranges in severity from mild intermittent symptoms to severe constant symptoms that limit daily activities. It is more common in older adults and women, and environmental factors, medications, contact lens use, and autoimmune diseases can trigger or exacerbate dry eye.
Corneal Ulcer.pptx
This document discusses different types of corneal ulcers including bacterial, fungal, viral, and exposure keratitis. Bacterial corneal ulcers are often caused by Staphylococcus aureus or Pseudomonas and present with pain, photophobia, and vision changes. Fungal ulcers are usually caused by Aspergillus or Candida and treated with antifungal medications. Viral ulcers include herpes simplex and zoster varieties, presenting with vesicles, conjunctivitis, or stromal keratitis. Exposure keratitis develops from inadequate eyelid closure and causes desiccation and ulceration.
Red eye (high risk) by thann
This document discusses red eye conditions with a high risk of vision loss, including infectious keratitis/corneal ulcer, anterior uveitis, and acute angle closure glaucoma. It provides details on the causes, signs, symptoms, investigations, and treatment approaches for each condition. Infectious keratitis can be caused by bacteria, viruses, fungi or parasites and results in eye pain, discharge and corneal infiltration. Anterior uveitis commonly presents with eye pain and redness, and can be caused by infections, autoimmune disorders or injuries. Acute angle closure glaucoma presents as eye pain, blurred vision and rainbow halos, and requires prompt medical or surgical treatment to lower intraocular pressure.
Eye Ophthalmologic Emergencies..........
This document provides an overview of common ophthalmologic emergencies that present to the emergency department. It discusses the challenges of eye complaints, including differentiating between benign and vision-threatening issues. A general approach to eye exams is outlined, including history and physical exam components. Common eye disorders like blepharitis, styes, and chalazions are described. Causes of red eye are reviewed along with exam findings for conditions like conjunctivitis, iritis, keratitis, and acute angle closure glaucoma. Traumatic eye injuries and their treatments are also covered.
Episcleritis & Scleritis
This document discusses episcleritis and scleritis. It defines episcleritis as an inflammatory condition affecting the episcleral tissue between the conjunctiva and sclera. Scleritis is characterized by edema and cellular infiltration of the scleral and episcleral tissues. The document classifies episcleritis and scleritis, describes their signs and symptoms, potential causes, diagnostic testing, and treatment options which may include topical or systemic corticosteroids and immunosuppressive medications. Complications are also outlined.
Soft contact lens complications
Soft contact lens complications can include ocular discomfort, inflammation, infection, and other issues. Ocular discomfort is the most common complication and has many potential causes, both physical and physiological. Inflammation like bulbar redness, corneal infiltrates, and contact lens peripheral ulcers can occur due to factors like tight lenses, deposits, hypoxia, or infection. Proper lens care and frequent replacement are important to prevent complications, along with addressing any underlying causes like dryness or infection. Complications generally require discontinuing lens wear until signs and symptoms resolve.
Immune diseases
This document outlines various immune diseases, including autoimmune diseases and primary immune deficiencies. For autoimmune diseases, it discusses immunologic tolerance and autoimmunity, then covers specific diseases like lupus, rheumatoid arthritis, Sjögren's syndrome, and scleroderma. For primary immune deficiencies, it introduces basic concepts and then describes specific deficiencies including X-linked agammaglobulinemia, common variable immunodeficiency, isolated IgA deficiency, hyper-IgM syndrome, DiGeorge syndrome, and severe combined immunodeficiency.
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Principles of Clinical Medicine - Disorders of the eye
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This document discusses a case of potential heparin-induced thrombocytopenia (HIT) in a 43-year-old male patient who underwent a kidney and pancreas transplant. After being started on IV heparin due to his mechanical aortic valve, his platelet count dropped to 31 after 11 days of heparin treatment. A HIT assay was positive. Heparin was discontinued and alternatives like apixiban and fondaparinux were considered due to his aortic valve replacement.
Case Report: Capgras Syndrome
This case report describes a 50-year-old Hispanic female admitted to the hospital for agitation and passive suicidal ideation. She has a history of brain meningioma in 2001, Capgras syndrome diagnosis in 2009, and multiple psychiatric hospitalizations. Her symptoms have worsened with non-compliance to treatment. Her examination shows intact cognition but poor insight. She is diagnosed with medical/surgical induced psychotic disorder and has significant psychosocial stressors. The treatment plan is to restart olanzapine and engage in various therapies with a guarded prognosis due to her history of non-compliance.
Alcohol & Amphetamines
This document discusses alcohol and amphetamines (specifically methamphetamines). For alcohol, it provides global statistics on alcohol use and lists various health effects. It describes diagnostic tools like CAGE and AUDIT. It also discusses pathophysiology, comorbidities like liver disease and fetal alcohol syndrome, and treatments. For methamphetamines, it discusses use trends, pathophysiology, signs and symptoms of toxicity, challenges in treatment, and health risks.
Case Report: Prostate Cancer/Septic Shock
Mr. C.E. is a 79-year-old man who presented with septic shock and was found unresponsive at home. He has a history of metastatic prostate cancer, for which he underwent radical prostatectomy and cystectomy with an ileal conduit placement. In the ICU, he was diagnosed with septicemia from both gram-positive and gram-negative bacteria, acute kidney injury, uremia, and metabolic acidosis. Testing showed obstruction of the ureter leading to infection. Though aggressive treatment was planned, after discussing his living will with family, all life-saving interventions were withdrawn and he was made comfort care only, passing away comfortably later that day.
Case Report: Embolic Stroke
Mr. H.B., an 84-year-old man, was admitted to the ICU for sudden onset right-sided weakness and speech problems. Imaging showed a left frontal-parietal stroke caused by an embolism, likely from carotid artery disease as he had 80-99% occlusion of the right internal carotid artery and 100% occlusion of the left. He was treated with tPA but it was likely ineffective given the subacute nature of his stroke. The plan was to continue monitoring, treat his underlying conditions, and discharge him to a rehabilitation center without carotid intervention due to the risk of further embolic events.
Case Report: Dementia
This document summarizes the case of a 91-year-old woman with dementia who was admitted to the hospital after experiencing paranoid delusions. Upon admission, she was dehydrated and hypotensive. Treatment for these issues and a change in her psychotropic medication resulted in improvement in her mental state. She is now awaiting discharge to a skilled nursing facility for continued care and monitoring of her conditions.
Case Report: Atrial Fibrillation with Rapid Ventricular Response
Mr. D.W., a 63-year-old man, was admitted to the hospital for recurrent heart palpitations. He had previously been diagnosed with atrial fibrillation and treated unsuccessfully with metoprolol. In the hospital, an attempted cardioversion was unsuccessful so he was started on sotalol, diltiazem, and apixaban. Several hours later, his heart achieved sinus rhythm with a regular rate. He was discharged to continue the new medications.
Case History: Guillain-Barré Syndrome
Ms. O.L. is a 62-year-old woman who presented with gradual onset of bilateral lower extremity weakness, parathesia, and radiating pain over the past week. She has also experienced increasing difficulty walking and constipation. Her symptoms are consistent with a diagnosis of Guillain-Barre Syndrome (GBS). She has no significant past medical history other than hyperlipidemia. Her review of systems is otherwise unremarkable except for her presenting neurological symptoms in the lower extremities.
Case Report: Uterine Fibroids
This document summarizes the medical case of a 36-year-old African American woman who presented to the emergency department experiencing dizziness, faintness, and possible transient loss of vision and leg weakness. Her medical history was significant for a previous diagnosis of anemia about 8 years prior, as well as a 5-year history of heavy menstrual bleeding. A physical exam in the emergency department revealed elevated blood pressure but was otherwise normal.
Case History: SLE/Renal Transplantation
A 46-year-old African American woman with a history of lupus nephritis, kidney transplant, and immunosuppression was admitted with elevated creatinine levels. She had been hospitalized previously for C. difficile colitis and CMV viremia, which caused acute kidney injury. Her creatinine remained elevated upon discharge and during follow up visits, leading to her current admission to evaluate ongoing kidney dysfunction.
Case History: Retinal Arteriolar Embolism
This document summarizes the medical history of a 61-year-old woman. It describes her diagnoses of Hashimoto's thyroiditis, depression, and a retinal embolism in 2010. Her thyroiditis is now resolved and she is euthyroid. She has had resolution of her visual field defect but retains a chronic embolic plaque. Her current medications include atorvastatin, aspirin, citalopram, and alprazolam as needed. She has a history of smoking but recently resumed at 6 cigarettes per day.
Recurrent Pregnancy Loss
This document presents a case study of a 35-year-old African American woman with a history of recurrent pregnancy loss who is currently experiencing her ninth pregnancy loss at 22 weeks gestation. It summarizes her medical history including previous pregnancies and losses, current pregnancy, and initial evaluation. The document then provides an overview of recurrent pregnancy loss including definitions, prevalence, evaluation, and potential etiologies such as uterine anomalies, autoimmune factors, alloimmune factors, endocrine issues, genetic factors, thrombophilia, lifestyle factors, and other considerations. Management strategies are discussed including surgical correction of anatomic issues, treatment of endocrine abnormalities, anti-coagulation for anti-phospholipid syndrome, empiric treatments, and
Twins
This document discusses key statistics and information about twin pregnancies. Some key points include:
- Twin pregnancies account for 1% of all pregnancies and have increased risks of mortality and morbidity compared to singletons.
- Zygosity, chorionicity, and amnionicity determine the type and risks associated with different twin pregnancies.
- Monitoring for conditions like twin-twin transfusion syndrome is important in managing high-risk aspects of multiple gestations.
- Factors like discordant growth, vascular connections between twins, and single fetal demise can impact the health of twins.
Pediatrics/Case Report: SLE
This document summarizes a case involving a 17-year-old African American female (M.M.) who presented to the emergency department with worsening headaches. She has a history of systemic lupus erythematosus (SLE) diagnosed in 2008, along with related conditions including membranous glomerulonephritis and hypertension. She was admitted for evaluation of her chronic severe headaches, which had been worsening over the past week. Her past medical history and current medications for managing her SLE and related conditions are detailed.
Pediatrics/Case Report: Cardiomyopathy
A 3-year-old boy presented with swelling of his left eyelid. He had undergone a heart transplant one year prior for heart hypoplasia and requires lifelong immunosuppression medication. He was admitted to monitor for potential orbital involvement given his symptoms and fever. His medical history also included anemia requiring transfusion as well as neutropenia. He takes multiple medications daily to prevent transplant rejection and for other conditions.
Pediatrics/Case Report: Sickle Cell Disease
An 8-year-old African American female presented to the emergency department with severe lower back pain radiating to both legs, consistent with a sickle cell crisis. She has a history of sickle cell disease and was previously hospitalized twice for sickle cell crises. During this admission, she received IV fluids, antibiotics, and pain medications to manage her symptoms.
Case Report: Urogenital Carcinoma
This document describes the case of an 84-year-old African American woman who presented with blood in her urine for 4-6 months. Medical imaging found a mass in her left bladder wall. Her past medical history includes ulcerative colitis, deep vein thrombosis, transient ischemic attacks, and a stroke. A physical exam and labs were performed. Cystoscopy was planned to investigate the bladder mass further.
Case Report: Carotid Stenosis
Ms. LA, a 77-year-old African American woman, presented with respiratory failure and pulmonary edema due to long-standing uncontrolled hypertension resulting in left ventricular hypertrophy and congestive heart failure. During her hospital stay, a carotid bruit was detected and further evaluation found severe asymptomatic right carotid artery stenosis of 80-99%. She underwent successful carotid endarterectomy without complications. Uncontrolled hypertension can lead to serious cardiac and vascular complications like pulmonary edema and carotid stenosis if left untreated. Routine examination for carotid bruits is important for detection of asymptomatic disease.
Case Report: AV Fistula
A 45-year-old man presented with increasing swelling and pain in his right arm over one month. He has a history of end stage renal disease and receives dialysis through a fistula in his right arm. Imaging showed a thrombus and stenosis in the fistula. He has multiple medical problems including HIV, hypertension, and hyperlipidemia. On examination, his right arm was edematous, erythematous, warm, and tender. He was diagnosed with a thrombosed arteriovenous fistula requiring surgical intervention.
Case Report: ERCP
This document summarizes the case of a 29-year-old Asian American male (DS) who presented with severe abdominal pain immediately following an ERCP procedure done for choledocholithiasis. He was diagnosed with probable post-ERCP pancreatitis based on his symptoms and elevated lipase level. He was admitted and his pain improved with IV fluids and pain medication. He underwent a robotic cholecystectomy the next day without complications and was discharged same day.
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Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
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Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
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The Red Eye
- 1. THE RED EYE …IN PRIMARY CARE John R. Martinelli, OD, FAAO SGUSOM (T4)
- 2. Doc, my eye’s RED! • Careful Ocular & Systemic History • Duration of Symptoms • Subj & Obj VA • 1 Eye or 2 Eyes • Pain vs. No Pain
- 3. History • Pain Keratopathy? (Cornea) • 1 EYE Infectious? • 2 EYES Allergy?
- 4. Visual Acuity • Subjective • Objective • 20/20 with Correction • Pinhole VA
- 5. Conjunctiva vs Episclera • Conjunctiva Mobility • Episclera Immobile
- 6. Conjunctivitis? No! PINK EYE • Lid Disease GPC Blepharitis Meibomianitis Entropion Ectropion • Keratopathy Hypoxia Corneal Epithelial Abrasion/Erosion Foreign Body Keratitis Herpes Simplex Keratitis • Autoimmune Disease Keratitis Sicca (Inflammatory Dry Eye) Neurotrophic Corneal Melt Episcleritis Iritis Uveitis • Previous Surgery • Lag Ophthalmos • Trichiasis • …and many others!
- 7. Blepharoconjunctivitis • Symptoms • Flaky Lids • Redness of Lids • Stuck in AM • “Red Eye” • Etiology • Staph Exotoxins • Meibomian Gland Dys • Acne Rosacea • Poor Lid Hygiene
- 8. Keratoconjunctivitis • Symptoms • Pain/FB sensation • Photophobia • Mucopurulent • Epiphora • “Red Eye” • Etiology • Bacterial • Viral • Autoimmune • Toxic
- 9. Corneal Abrasion • Significant Hx • Symptoms • PAIN! • “Red Eye”
- 10. Subconjunctival Hem • Symptoms • No Pain • Patient notices in mirror • Friends/Family notice • Etiology • HT • Anticoagulation Tx • Hematologic • Cough/Sneeze/Vomiting • Rubbing/Allergies • Birth
- 11. Conjunctivitis • Bacterial Mucopurulent Papilla • Viral Epiphora Follicles Lymphadenopathy • Allergic Epiphora Itchy • Nasolacrimal Occlusion • Chlamydia/Pediculosis
- 12. Uveitis • History • Autoimmune • Trauma • Ocular Surgery • Symptoms • Pain • Photophobia • Red Eye • Episcleral Injection
- 13. Superficial Punctate Keratitis (SPK)
- 14. FB Tracking
- 15. Conjunctival FB
- 17. Rust Ring
- 24. Thygeson’s SPK & MCE
- 25. Keratoconus
- 26. s/p LASIK (DLK)
- 28. Deer Tick