Corneal abrasion

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.
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 “Corneal abrasion”

Attention deficit hyperactivity disorder

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.
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.
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
Education represents the first step in effective treatment Continue reading “Attention deficit hyperactivity disorder”

Tic disorders

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.
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 “Tic disorders”

Brief Summary of Laryngitis

Laryngitis is a common disorder that involves acute or chronic inflammation of the vocal cords. Acute laryngitis may occur as an isolated infection or as part of a generalized bacterial or viral upper respiratory tract infection. Repeated attacks of acute laryngitis cause inflammatory changes associated with chronic laryngitis.
Acute laryngitis usually results from infection (primarily viral) or excessive use of the voice, an occupational hazard in certain vocations (for example, teaching, public speaking, and singing). It may also result from leisure activities (such as cheering at a sports event), inhalation of smoke or fumes, or aspiration of caustic chemicals. Causes of chronic laryngitis include chronic upper respiratory tract disorders (sinusitis, bronchitis, nasal polyps, or an allergy), mouth breathing, smoking, constant exposure to dust or other irritants, and alcohol abuse. Reflux laryngitis is caused by regurgitation of gastric acid into the hypopharynx.
Signs and symptoms
Acute laryngitis typically begins with hoarseness, ranging from mild to complete loss of voice. Associated signs and symptoms include pain (especially when swallowing or speaking), dry cough, fever, laryngeal edema, and malaise. With chronic laryngitis, persistent hoarseness is usually the only sign. With reflux laryngitis, hoarseness and dysphagia are present, but heartburn isn’t
Indirect laryngoscopy confirms the diagnosis by revealing red, inflamed and, occasionally, Continue reading “Brief Summary of Laryngitis”

Corrosive Esophagitis

Inflammation and damage to the esophagus after ingestion of a caustic chemical is called corrosive or caustic esophagitis. Similar to a burn, this injury may be temporary or lead to permanent stricture (narrowing or stenosis) of the esophagus that requires corrective surgery.
Severe injury can quickly lead to esophageal perforation, mediastinitis, and death from infection, shock, and massive hemorrhage (due to aortic perforation).
The most common chemical injury to the esophagus follows the ingestion of lye or other strong alkalies; less commonly, injury follows the ingestion of strong acids. The type and amount of chemical ingested determine the severity and location of the damage.
In children, household chemical ingestion is accidental; in adults, it’s usually a suicide attempt or gesture. The chemical may damage only the mucosa or submucosa, or it may damage all layers of the esophagus.
Esophageal tissue damage occurs in three phases: in the acute phase, edema and inflammation; in the latent phase, ulceration, exudation, and tissue sloughing; and in the chronic phase, diffuse scarring.
Signs and symptoms
Effects vary from none to intense pain in the mouth and anterior chest, marked salivation, inability to swallow, and tachypnea. Bloody vomitus that contains pieces of esophageal tissue signals severe damage. Signs of esophageal perforation and mediastinitis, especially crepitation, indicate destruction of the entire esophagus. Inability to speak suggests laryngeal damage.
The acute phase subsides in 3 to 4 days, enabling the patient to eat again. Fever suggests secondary infection. Symptoms of dysphagia return if stricture develops, usually within weeks.
A history of chemical ingestion and physical examination that reveals oropharyngeal burns (including white membranes and edema of the soft palate and uvula) usually confirm the diagnosis. The type and amount of the chemical ingested must be identified; sometimes this can be done by examining empty containers of the ingested material or by calling the poison control center. Continue reading “Corrosive Esophagitis”

Introduction to Epistaxis

Nosebleed, or epistaxis, may either be a primary disorder or occur secondary to another condition. Such bleeding in children generally originates in the anterior nasal septum and tends to be mild. In adults, such bleeding is most likely to originate in the posterior septum and can be severe. Epistaxis is twice as common in children as in adults.
Epistaxis usually follows trauma from external or internal causes: a blow to the nose, nose picking, or insertion of a foreign body. Less commonly, it follows polyps; acute or chronic infections, such as sinusitis or rhinitis, that cause congestion and eventual bleeding from capillary blood vessels; or inhalation of chemicals that irritate the nasal mucosa. It may also follow sudden mechanical decompression (caisson disease) and violent exercise.
Predisposing factors
Such factors include anticoagulant therapy, hypertension, chronic aspirin use, high altitudes and dry climates, sclerotic vessel disease, Hodgkin’s disease, neoplastic disorders, scurvy, vitamin K deficiency, rheumatic fever, blood dyscrasias (hemophilia, purpura, leukemia, and anemias), and hemorrhagic telangiectasia.
Signs and symptoms
Blood oozing from the nostrils usually originates in the anterior nose and is bright red. Blood from the back of the throat originates in the posterior area and may be dark or bright red (it’s commonly mistaken for hemoptysis because of expectoration).
Epistaxis is generally unilateral, except when caused by dyscrasia or severe trauma. In severe epistaxis, blood may seep behind the nasal septum; it may also appear in the middle ear and corners of the eyes.
Associated effects
Clinical effects depend on the severity of bleeding. Moderate blood loss may produce light-headedness, dizziness, and slight respiratory difficulty; severe hemorrhage causes hypotension, rapid and bounding pulse, dyspnea, and pallor. Bleeding is considered severe if it persists longer Continue reading “Introduction to Epistaxis”

Brief Summary of Multiple myeloma

Multiple myeloma is also known as malignant plasmacytoma, plasma cell myeloma, and myelomatosis. It’s a disseminated neoplasm of marrow plasma cells that infiltrates bone to produce osteolytic lesions throughout the skeleton (flat bones, vertebrae, skull, pelvis, ribs); in late stages, it infiltrates the body organs (liver, spleen, lymph nodes, lungs, adrenal glands, kidneys, skin, GI tract). Multiple myeloma strikes mostly men older than age 40.
The prognosis is usually poor because the disease is commonly diagnosed after it has already infiltrated the vertebrae, pelvis, skull, ribs, clavicles, and sternum. By then, skeletal destruction is widespread and, without treatment, leads to vertebral collapse. Early diagnosis and treatment prolong the lives of many patients by 3 to 5 years. Death usually follows complications, such as infection, renal failure, hematologic disorders, fractures, hypercalcemia, hyperuricemia, or dehydration.
Multiple myeloma is characterized by excessive growth and malformation of plasma cells in bone marrow. The growth of these extra cells interferes with the production of red blood cells, white blood cells, and platelets, resulting in anemia, susceptibility to infection, and increased tendency toward bleeding. As the cancer cells grow and expand, pain and destruction of bone occurs.
Signs and symptoms
The earliest symptom of multiple myeloma is usually back pain. This disease should be considered in diagnosis or treatment of elderly patients with new onset of lower back pain. Arthritic symptoms may also occur: achiness, joint swelling, and tenderness, possibly from vertebral compression. Other effects include fever, malaise, slight evidence of peripheral neuropathy (such as peripheral paresthesia), pathologic fractures, and easy bruising.

As multiple myeloma progresses, symptoms of vertebral compression may become acute, accompanied by anemia, weight loss, thoracic deformities (ballooning), and loss of body height—5? (12.7 cm) or more—due to vertebral collapse.
Renal complications such as pyelonephritis (caused by tubular damage from large amounts of Bence Jones protein, hypercalcemia, and hyperuricemia) may occur. (See Bence Jones protein.) Severe, recurrent infection, such as pneumonia, may follow damage to nerves associated with respiratory function.
After a physical examination and a careful medical history, the following diagnostic tests and Continue reading “Brief Summary of Multiple myeloma”

Introduction to Osteomyelitis

A pyogenic bone infection, osteomyelitis may be chronic or acute. It commonly results from a combination of local trauma—usually quite trivial but resulting in hematoma formation—and an acute infection originating elsewhere in the body. Although osteomyelitis may remain localized, it can spread through the bone to the marrow, cortex, and periosteum.
Acute osteomyelitis is typically a blood-borne disease that usually affects rapidly growing children. Chronic osteomyelitis, although rare, is characterized by multiple draining sinus tracts and metastatic lesions.
The incidence of both chronic and acute osteomyelitis is declining, except in drug abusers. With prompt treatment, the prognosis for acute osteomyelitis is good; for chronic osteomyelitis, which is more prevalent in adults, the prognosis is still poor.
The most common pyogenic organism in osteomyelitis is Staphylococcus aureus; others include Streptococcus pyogenes, Pneumococcus, Pseudomonas aeruginosa, Escherichia coli, and Proteus vulgaris. Typically, these organisms find a culture site in a hematoma from recent trauma or in a weakened area, such as the site of local infection (for example, furunculosis), and spread directly to bone.
As the organisms grow and form pus within the bone, tension builds within the rigid medullary cavity, forcing pus through the haversian canals. This forms a subperiosteal abscess that deprives the bone of its blood supply and eventually may cause necrosis. In turn, necrosis stimulates the periosteum to create new bone (involucrum); the old bone (sequestrum) detaches and works its way out through an abscess or the sinuses. By the time sequestrum forms, osteomyelitis is chronic.
Signs and symptoms
Onset of acute osteomyelitis is usually rapid, with sudden pain in the affected bone, and tenderness, heat, swelling, and restricted movement over it. Associated systemic signs and symptoms include tachycardia, sudden fever, nausea, and malaise.
Generally, the signs and symptoms of both chronic and acute osteomyelitis are the same, except that chronic infection can persist intermittently for years, flaring up spontaneously after minor trauma. Sometimes, however, the only symptom of chronic infection is the persistent drainage of pus from an old pocket in a sinus tract.
Patient history and physical examination reveal bone tenderness, swelling, and redness. The Continue reading “Introduction to Osteomyelitis”