Eye Disorders- Abby Hyatt(numerous eye disordersfollowed by specialist discussed in the textbook)
Bulbar or palpebral conjunctival injection is a common
... [Show More] presentation, which can be unilateral or
bilateral.
differential diagnosisshould include allergy, conjunctivitis, infection, foreign body, chemical
exposure, or systemic inflammatory disease, irritation of the conjunctiva or cornea, and
congenital glaucoma.
Watery discharge can occur with allergies, nasolacrimal obstruction, foreign bodies, viral
infection, and iritis.
Purulent or mucoid discharge can be noted with chronic dacrocystitis or nasolacrimal
obstruction.
Advanced allergic conjunctivitis can have some mucoid production.
To differentiate, microscopic investigation of discharge may lead to other clues.
Photophobia is a symptom common of trauma and in infants with glaucoma or retinal disease.
Other non-eye related causes of photophobia include migraines and meningitis.
A white pupil, or leukocoria serious finding and demands immediate referral to the pediatric
ophthalmologist.
Causes of leukocoria include retinal detachment, cataract, retinal dysplasia, retinopathy of
prematurity, and in newborns retinoblastoma.
All newbornsshould have a fundoscopic examination within 24 hours of birth and yearly on
physical examinations.
Common eye traumas that may present to primary care are asfollows:
Scratch or laceration to the cornea
Blunt trauma to the orbit; note that an orbital fracture can cause muscle entrapment,
compartment syndrome
Hyphema
Chemical or heat-related burns
Musculoskeletal Injuries- assessment & treatment- Abby Hyatt
Osgood-Schaltter Disease
Aseptic necrosis of the tibial tubercles and apophysis.
Signs and symptoms: painfulswelling of tibial tubercle, limp, intermittent pain over months, hip
pain may be aggravated by extension of knee against resistance, worsens with squatting, stair
walking, forceful contraction of the quadriceps, usually due to overuse injury associated with
athletic activity during rapid growth of tibial tuberosity, relived by rest. More common in males.
Diagnostics: X-ray, MRI if osteochondral lesion.
Treatment
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NR 602 Final Exam Study Guide
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Rest, modified activity, ice, NSAIDs, Quadricepsstrengthening and stretch, tibial band during
activity.
Talipes Equinovarus Congenita (Clubfoot)
Adduction of forefoot with plantar flexed at ankle (equines), or curvesin (varus). Clinical
Diagnosis: X-ray
Treatment Ortho, casting
Tibial torsion or femoral inversion
Foot turnsin during walking or running. Pigeon-toed appearance. May be congenital or
acquired from increased load on femur due to sitting in utero incorrectly, or FHx.
Diagnostics: usually clinical or leg and hip X-ray.
Treatment Reassurance, braces,specialshoes, and/or cast. Refer to ortho of severe deformity.
Excellent prognosis.
Growth Pains
Idiopathic.
Signs and symptoms: pain at the lower limbs, bilateral, intermittent, localized to the muscles.
Rule out neuro disorders.
Treatment Reassurance, massage, heat, NSAIDs ifsevere.
Overused injury “Little League” elbow
Physical stress producesforces in and around the elbow during throwing motion (baseball or
softball), valgus stress is placed on elbow resulting in tension on the medial structures,
repetition causes pathological changes. Signs and symptoms: pain in elbow, decreased elbow
ROM, mild flexion contracture, point tenderness,swelling, decreased performance.
Diagnostics: X-ray.
Treatment Ice, resting arm, NSAIDs.
Genu Varum
Alignment of the knee with the tibia medially (varus) in relation to the femur. Bowlegged
appearance asresult of uterine position. Measure distance between knees with feettogether,
distance should be less than 5 inches. An angular deformity is physiologic and normal up to 3
y.o. Pathologic if more than 15 degrees. Associated with shortstature, rapidly progressing
Treatment Brace/splint, NSAIDsfor pain, and strengthening exercise. If rickets-prescribe Vitamin
D. If overweight- weight management.
Genu Valgum
Alignment of the knee with the tibia laterally deviated (valgus) with relation to the femur.
Commonly known as knock-kneed. Physiologic (over the first 3 years, 10-15 degrees, more
common in girls) or pathologic (before age of 2 y.o, valgus angle >15 degrees, increasing in
severity. Associated with shortstature, obesity and asymmetry, due to metaphyseal dysplasia
or injury).
Treatment Bracesfor angles more than 15 degrees. In some cases, resolves spontaneously by
age 6. Refer to orthopedic for suspected pathology.
Toxic Transient Synovitis
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Unilateral inflammatory arthritis of the hip with acute onset, decreased hip ROM-extension and
internal rotation, painful limp, crying at night, more common in boys 3-6 y.o.
Clinical diagnosis: WBC w/leukocytosis, ^ESR, hip X-ray normal.
TreatmentBedrest, no weight bearing on affected hip, NSAIDs,self-limiting
Legg-Calve Perthes Disease (LCPD)
Avascular necrosis of the femoral head epiphyses associated w/ trauma, transient synovitis,
coagulation abnormalities. Associated with low birth weight and socioeconomic status, and
white race. Insidious onset of painful limp of thigh, knee, hip, worst with activity and not
relived by rest. Restriction of voluntary motion limited passive motions, abduction and rotation
of affected hip, atrophy of thigh or calf may be noticed.
Diagnostics: Hip X-ray, MRI
Treatment Abduction brace or long leg cast,surgery for bone reconstruction.
Muscular Dystrophy (MD)
Inherit muscle disorders-Congenital (6 types with CNS involvement), X-linked recessive
(Duchenne’s MD is most common and Becker’s MD milder form manifests after exercise w/
muscle ache).
Signs and symptoms: hypotonia, muscle weakness, contractures, motor deficit. Diagnostics: CK
is a good screening test-elevated, muscle biopsy, MRI, EMG.
Treatment IP involvement, no effective Tx as goal is maximal functioning. Corticosteroids slo [Show Less]