2012 February » Family Medicine Help

Corneal abrasion

Opthalmology Comments Off

Feb 272012

Commonly caused by a foreign body, a corneal abrasion is a scratch on the surface epithelium of the cornea. An abrasion or foreign body in the eye is the most common eye injury. With treatment, the prognosis is usually good.

Causes

A corneal abrasion usually results from a foreign body, such as a cinder or a piece of dust, dirt, or grit, which becomes embedded under the eyelid. Even if the foreign body is washed out by tears, it may still injure the cornea.

A small piece of metal that gets in the eyes of workers who don’t wear protective glasses quickly forms an abrasion and then forms a rust ring on the cornea. Abrasions also commonly occur in the eyes of people who fall asleep wearing hard contact lenses. A corneal scratch produced by a fingernail, a piece of paper, or another organic substance may cause a persistent lesion. The epithelium doesn’t always heal properly, and a recurrent corneal erosion may develop, with delayed effects more severe than those of the original injury.

Signs and symptoms

Typically, corneal abrasions produce redness, increased tearing, a sensation of “something in the eye” and, because the cornea is richly endowed with nerve endings from the trigeminal nerve (cranial nerve V), pain disproportionate to the size of the injury. A corneal abrasion may affect Continue reading »

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Attention deficit hyperactivity disorder

Pediatrics, Psychiatry Comments Off

Feb 262012

The patient with attention deficit hyperactivity disorder (ADHD) has difficulty focusing his attention or engaging in quiet, passive activities, or both. Although the disorder is present at birth, diagnosis before age 4 or 5 is difficult unless the child shows severe symptoms. Some patients, though, aren’t diagnosed until adulthood. Males are three times more likely to be affected than females.

Causes

ADHD is commonly thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from disturbances in neurotransmitter levels in the brain.

Signs and symptoms

Typically, the patient is characterized as someone who fidgets and daydreams. Other descriptive terms include inattentive and lazy. Although the patient may be highly intelligent, his school or work performance patterns are sporadic, and he may jump from one partly completed project, thought, or task to another. Some patients have an attention deficit without hyperactivity; they’re less likely to be diagnosed and treated.

In a younger child, signs and symptoms include an inability to wait in line, remain seated, wait his turn, or concentrate on one activity until it’s completed. An older child or an adult may be described as impulsive and easily distracted by irrelevant thoughts, sounds, or sights. He may also be characterized as emotionally labile or inattentive. His disorganization becomes apparent when he has difficulty meeting deadlines and keeping track of school or work tools and materials.

Diagnosis

Commonly, the child with ADHD is referred for evaluation by the school. Diagnosis of this disorder usually begins by obtaining data from several sources, including the parents, teachers, and the child himself. Complete psychological, medical, and neurologic evaluations rule out other problems. Then the child undergoes tests that measure impulsiveness, attention, and the ability to sustain a task. The combined findings portray a clear picture of the disorder and of the areas of support the child will need

Treatment

Education represents the first step in effective treatment Continue reading »

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Tic disorders

Psychiatry Comments Off

Feb 252012

Including Tourette syndrome, chronic motor or vocal tic disorder, and transient tic disorder, tic disorders are similar pathophysiologically but differ in severity and prognosis. All tic disorders, commonly known simply as tics, are involuntary, spasmodic, recurrent, and purposeless motor movements or vocalizations. These disorders are classified as motor or vocal and as simple or complex.

Tics may begin as early as age 2, with average onset being age 7. All tic disorders are three times more common in boys than in girls. Transient tics usually are self-limiting, but Tourette syndrome follows a chronic course with remissions and exacerbations.

Causes

Although their exact cause is unknown, tic disorders occur more frequently in certain families, suggesting a genetic cause. Tics commonly develop when a child experiences overwhelming anxiety, usually associated with normal maturation. Tics may be precipitated or exacerbated by the use of phenothiazines or central nervous system stimulants or by head trauma.

Signs and symptoms

Assessment findings vary according to the type of tic disorder. Inspection, coupled with the patient’s history, may reveal the specific motor or vocal patterns that characterize the tic, as well as the frequency, complexity, and precipitating factors. The patient or his family may report that the tics occur sporadically many times a day.

Note whether certain situations exacerbate the tics. All tic disorders may be exacerbated by stress, and they usually diminish markedly during sleep. The patient also may report that they occur during activities that require concentration, such as reading or sewing.

Determine whether the patient can control the tics. Most patients can, with conscious effort, control them for short periods.

Psychosocial assessment may reveal underlying stressful factors, such as problems with social Continue reading »

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