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Clinical Medicine: Ocular Manis of Cardiovascular and Hematologic Disorders
Terms in this set (25)
Systemic Hypertension (via JNC 7):
a) Adult (18 years and older): What are ranges for high blood pressure? Prehypertension? Normal Adult?
a) Greater than or equal to: 140/90 (Stage 2 >160/100)
Signs and Symptoms of HTN: Asymptomatic, ________, fatigue, confusion, nausea and vomiting. (Anxiety, perspiration, tremor and chest pain are more signs of pre-HA).
Ocular Signs and Symptoms:
a) Retinal Vascular Changes: _________, _______, ______ retinopathy, ______ shaped hemorrhages. Can also result in retinal detachment.
b) Choroidal Vasculature: ____ and _____ (hyperpigmentation following BV)
c) Ocular Changes: ____ _______ (disc edema and exudation) and macula.
a) Vasoconstriction, sclerosis, exudative, flame
b) Elschnig Spots and Siegrist Streak
c) Optic nerve
HTN Retinopathy can result in: Hemorrhages, ____ ____ spots, macular ____, edema of optic disc, and A-V ____.
a) Cotton Wool
Diagnosis of Systemic Hypertension: Clinical and lab findings, pulse, electrocardiography, chest x-ray, cerebral involvement, DFE. What should you do with BP measurements?
Take them multiple times
Non-Pharmacological Treatment of Systemic HTN: Lose _______, get regular physical activity, avoid excessive ____, stop _________, manage your stress, decrease ___ intake; DASH diet; discuss the use of some _______ (oral contraceptives) with your doctor.
Pharmacological Treatment of Systemic HTN: Diuretics, _ ____, calcium antagonists, ________ ____ receptor and ACE antagonists, vaso(_______), and _______ nerve inhibitors.
b) Angiotensin II
c) dilators (vasodilators)
Virchow's Triad (Predisposing Factors for Thrombosis):
1. What type (Arterial or venous) is most common in the eye? Most common in the lungs?
2. Triad: ______, _____ wall, and ____ of blood
a) Arterial; Venous
b) Flow, Vessel Wall, Coagulability of Blood
When ATC of the carotid artery forms an emboli, it travels to the retina and may result in what two things?
b) Ocular ischemic syndrome
Classic Definition of TIA: A neurologic deficit caused by focal brain ischemia that completely resolves within ______ hours.
New Definition of TIA (not universally accepted): A brief episode of neurologic dysfunction caused by focal brain or retinal ischemia with clinical symptoms lasting less than ____ hour and without evidence of acute infarction.
a) Venous origin: Systemic veins; comes from what side of the heart? Portal veins. Results in problems in what organ?
b) Arterial Organs: Affect organ that feeds it, larger arteries, comes from what side of the heart?
c) Which of the above is most likely to affect the retina?
a) Right side of heart; Pulmonary
b) Left side of heart
Retinal Arterial Embolism:
a) Where is the most common source? It is also called what?
b) Cause No Symptoms: causal finding in a routine vision exam
c) Symptoms: __ ___ or permanent loss of vision
d) Outcomes: What are four possible outcomes?
a) Carotid Artery, Hollenhorst plaque
b) Amaurosis Fugax
c) Ischemia, Infarction, Neovascularization, and edema
Diagnosis and Treatment of an Embolism: Ophthalmoscopy, carotid artery _____ (bilateral) (search for bruit and circle it; only present if vessel occluded between 50-85%), referral to FP in 48-72 hours.
Tx: Drugs that deplete functional clotting factors (name 2). Drugs that accelerate clot ____ (t-PA). Antiplatelet drugs (acetyl salicyclic acid -- aspirin).
a) Auscultation (listening to sounds)
b) Warfarin and Heparin
This is decreased ability of red blood cells to carry oxygen throughout the body .Sickle hemoglobin S (_____ replaces glutamic acid in the Hb Beta Polypeptide Chain) gives up its oxygen to the tissues then Hb S sticks together. Sickle RBC become hard and ____ shaped. Become clogged in the small blood vessels and therefore do not deliver appropriate oxygen to tissues. What kind of anemia is sickle cell?
a) Anemia (Sickle Cell Anemia)
Clinical Complications of sickle cell anemia:
2. _____ episodes
4. Increased infections
5. Leg ulcers
6. Bone damage
8. Early _____
9. Lung Blockage
10. Kidney damage and loss of body water in urine
11. Painful erections in men (priapism)
12. Blood blockage in the spleen (________)
13. Eye damage
14. Delayed growth
Ocular Signs of Sickle Cell Anemia:
a) Venous _______
b) Vascular occlusion
c) RPE changes
d) Vitreous Hemorrhage
e) __________ (proliferative retinopathy) leads to what?
Note: Veins affected first due to high blood viscosity and ischemic area where there is vessel engorgement.
c) Retinal Detachment
This is the most common cancer in children.
a) Acute or chronic (adult)
b) Lymphocytic (child) or Myelogenous (adult)
c) What is the most common form in children?
d) What type (in general) is more common in adults?
a) ALL (All kids survive)
b) Chronic (insidious)
Systemic Signs of Leukemia: ______ and ____ pain (due to bone marrow expansion); generalized lymphadenopathy, spenomegaly, hepatomegaly, _________ state, easy bruising or bleeding, paleness or fatigue, malaise and _____.
Think: Malignant tumor of WBC
a) Joint and bone
Acute Leukemias (CNS Symptoms):
a) ________ (increased CSF)
c) Optic nerve ______ (also known as?)
b) Edema (papilledema)
Chronic Leukemia (Systemic)
a) (Symptomatic or asymptomatic) in early stages?
b) Insidious onset
c) Symptoms: fatigue, weakness, fever, night sweats, anorexia, weight loss and sense of abdominal fullness
a) Asymptomatic (in general, less symptoms)
Ocular Involvement in Leukemia: Duke-Elder found that ____% of patients with leukemia have fundus involvement at some point in their disease process. Ocular involvement is _____ more frequent in ACUTE than chronic (_______ that are intraretinal and white centered and CWS). Often different bleeding at different levels of retina.
Findings in Leukemic Retinopathy: What is the first change? _______ color to arteries and veins and fundus (due to decreased RBC count and increased WBC count). Retinal hemorrhages (related to thrombocytopenia, stasis and leukemic infiltration). ________ (may be related to increased viscosity from elevated WBC count).
a) Veins become more dilated and tortuous
Findings in Leukemic Retinopathy: Retinal vasculature _____ (gray-white streaks along retinal vessels that include perivascular infiltration of leukemic cells). Hard yellow-white _____ (indicative of vascular insufficiency). Soft _______/CWS (due to ischemia from anemia, hyperviscosity and leukemic infiltration). Peripheral retinal _______. A LOT OF BLEEDING.
All retinal areas can be affected by leukemia. The inner retinal area produces what type of hemorrhages? The outer retinal area produces what type of hemorrhages? Subretinal can be affected too. Which is more likely to produce RD: Outer or Inner retinal?
a) Flame Shaped
b) Dot Blot
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