Patho Exam 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:
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:
