Diabetic Retinopathy

Microaneurysms

Dot and blot hemorrhages

Nonproliferative diabetic retinopathy

Mild: Indicated by the presence of at least 1 microaneurysm

Moderate: Includes the presence of hemorrhages, microaneurysms, and hard exudates

Severe (4-2-1): Characterized by hemorrhages and microaneurysms in 4 quadrants, with venous beading in at least 2 quadrants and intraretinal microvascular abnormalities in at least 1 quadrant

Proliferative diabetic retinopathy

Neovascularization: Hallmark of PDR

Preretinal hemorrhages: Appear as pockets of blood within the potential space between the retina and the posterior hyaloid face; as blood pools within this space, the hemorrhages may appear boat shaped

Hemorrhage into the vitreous: May appear as a diffuse haze or as clumps of blood clots within the gel

Fibrovascular tissue proliferation: Usually seen associated with the neovascular complex; may appear avascular when the vessels have already regressed

Traction retinal detachments: Usually appear tented up, immobile, and concave

Macular edema

Intravitreal triamcinolone is being used in the treatment of diabetic macular edema.

diabetic retinopathi other treatment

Other medications used in clinical practice and in clinical trials include intravitreal bevacizumab (Avastin) and ranibizumab (Lucent)

Chronic hypertensive retinal changes

Chronic hypertensive changes to the retina include the following (see Hypertensive Vascular Changes):

Arteriolosclerosis - Localized or generalized narrowing of vessels

Copper wiring and silver wiring of arterioles as a result of arteriolosclerosis (See Assessment.)

Arteriovenous (AV) nicking as a result of arteriolosclerosis

Retinal hemorrhages

Nerve fiber layer losses

Increased vascular tortuosity

Remodeling changes due to capillary nonperfusion, such as shunt vessels and microaneurysms

In the presence of hypertensive optic neuropathy, a rapid reduction of blood pressure may pose a risk of worsening ischemic damage to the optic nerve

an oval yellowish area surrounding the fovea near the centre of the retina in the eye, which is the region of keenest vision.

Senile cataract is an age-related, vision-impairing disease characterized by gradual, progressive thickening of the lens of the eye.

cateract features

decrese visual acuity,

glary-reduce contrast sensitivity

miopia

moniculer diplopia

3:41 PM

Slit lamp examination - Should concentrate on the evaluation not only of lens opacity but also of other ocular structures as well (

Extracapsular cataract extraction (ECCE) - Involves the removal of the lens nucleus through an opening in the anterior capsule, with retention of the integrity of the posterior capsule

Phacoemulsification - Also involves extraction of the lens nucleus through an opening in the anterior capsule; an ultrasonically driven needle is used to fragment the nucleus of the cataract; the lens substrate is then aspirated through a needle port in a process termed phacoemulsification

The definitive management for senile cataract is lens extraction

HRT

medoxy progesterone acetate

 If a woman has varied length of cycles from 24 to 30 days ovulatuon occurred 14 days prior to shortest cycle

sperm survive in about 6days in female genital tract

urge incontinence

due to detrusor instability

danazole cause virilization

at age of 45 years heavy menstrual bleeding due to dysfunctional uterine bleeding or or adenomyosis

Medically treat with norethisterone day 5 to day25

levonogesterone releasing iucd also can use.. merena

HSP will not cause thrombocytopeania..It cause only nonthrombocytopenic perpura,,

HSP cause atharalgia, nephitis, anaphylactoid purpura,, abdomilal colicy pain, melaena

Clubbing

pulmonary.. broncogenic Ca

   chronic suppurative lung dx ..eg.cystic fibrosis

fibrosing alveolitis

cardiac

subacute bacterial endicarditis

cyanoyic heqrt dx with rihht to left shunt

artero venus malformation

GI... hepatic cirrhosis

ulcerative colitis

BA and SLE wil not cause to clubbing

Acute non perforated otitis media treated with panadol and amoxicillin.

Chronic perforated otitis media treated with topical ciprofloxacin

Normal range of head circumference between 50th percentiles

That mean between 3rd and 97th percentile

Foreign body usually block in right middle lobe

osteochondritis is a self-limiting conditions

Usually age around 10 years

Complain of chronic pain

Sites for juvenile osteochondritis

tibial tuberocity=Osgood schlatter dx

hip= perthes dx

carpal lunate=Kienbock dx

calcaneum=sever dx

Serum complement (C3) is low in acute post streptococal gloerulonepritis due to activation of the classical comlement pathway.. but not in neprotic syndrome

50% of term babies and 85%of premature babies having jaundice in first week of life.

physiological jaundice is the commonest cause

ABO incompatibility usually occur in 24 hours

Usually use macrolide for micoplasma pneumoniae infection.. but if child is more than 10 u can use TETRACYCLINE

microplasma Ig M level elevated in 1st week of illness

Commonest bacterial  causes for pnumonia is children are

 1. streptococcus pneumoniae

2.H.influenza