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Corneal Reflex

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521. Rheumatoid Arthritis (RA)

your knowledge Sciatica Which of the following deficits is the most objective finding in sciatica? CNS Motor Reflex Sensory NEWS & VIDEOS FDA: Pulmonary Embolism Risk Up With Tofacitinib 10 mg for RA THURSDAY, Feb. 28, 2019 (HealthDay News) -- A safety clinical trial has revealed that tofacitinib (Xeljanz, Xeljanz XR) 10 mg twice daily is associated with an increased risk for pulmonary embolism... 3D Model The Foot Video How to Examine the Hand SOCIAL MEDIA Add to Any Platform Loading , MD (...) activity. Patients should be fully apprised of the risks of DMARDs and monitored closely for evidence of toxicity. Table Other Drugs Used to Treat Rheumatoid Arthritis Drug Dosage Adverse Effects Traditional disease-modifying antirheumatic drugs (DMARDs) Hydroxychloroquine 5 mg/kg po once/day (eg, with breakfast or dinner) or in 2 divided dosages (eg, 2.5 mg q 12 h) Usually mild dermatitis Myopathy Corneal opacity (generally reversible) Occasionally irreversible retinal degeneration Leflunomide 20 mg

2013 Merck Manual (19th Edition)

522. Overview of Lysosomal Storage Disorders

disease Treatment: Supportive care Sialolipidosis (phospholipidosis; mucolipidosis IV, Berman disease; 252650) MCOLN1 (19p13.3-p13.2)* Onset: 1st yr Urine metabolites: No mucopolysaccharides Clinical features: Severe (Berman disease) and mild forms Developmental delay, corneal opacities, visual deficiency, strabismus, hypotonia, increased deep tendon reflexes; no radiographic skeletal abnormality, macrocephaly, or organomegaly Treatment: Supportive care Mannosidosis Onset: In type I, 3–12 mo In type (...) metabolites: Dermatan sulfate, heparin sulfate Clinical features: Corneal clouding, stiff joints, contractures, dysostosis multiplex, coarse facies, coarse hair, macroglossia, organomegaly, intellectual disability with regression, valvular heart disease, hearing and vision impairment, inguinal and umbilical hernia, sleep apnea, hydrocephalus Treatment: Supportive care, enzyme replacement, stem cell or bone marrow transplantation MPS II (Hunter syndrome; 309900) Iduronate sulfate sulfatase IDS (Xq28

2013 Merck Manual (19th Edition)

523. Strabismus

in Philadelphia. The university... 3D Model Cystic Fibrosis: Defective Chloride Transport Video How to do Neonatal Resuscitation SOCIAL MEDIA Add to Any Platform Loading Topic Resources Strabismus is misalignment of the eyes, which causes deviation from the parallelism of normal gaze. Diagnosis is clinical, including observation of the corneal light reflex and use of a cover test. Treatment may include correction of visual impairment with patching and corrective lenses, alignment by corrective lenses (...) difficulty in fusing images from misaligned eyes and to reduce diplopia. Some children with tropias have normal and equal visual acuity; however, amblyopia frequently develops with tropias and is due to cortical suppression of the image in the deviating eye to avoid confusion and diplopia. Diagnosis Physical and neurologic examinations at well-child checkups Tests (eg, corneal light reflex, alternate cover, cover-uncover) Prisms Strabismus can be detected during well-child checkups through the history

2013 Merck Manual (19th Edition)

524. Crying

, or decreased breath sounds on auscultation Chest x-ray (UTI) Fever Possible vomiting Urinalysis and culture Trauma Corneal abrasion Crying with no other symptoms Fluorescein test Fracture ( ) Area of swelling and/or ecchymoses Favoring of a limb Skeletal survey x-rays to check for current and old fractures Hair tourniquet Swollen tip of a toe, finger, or penis with hair wrapped around the appendage proximal to the swelling Clinical evaluation Head trauma with intracranial bleeding Inconsolable, high (...) -pitched cry Localized swelling on skull with underlying deformity Head CT (shaken baby syndrome) Inconsolable, high-pitched cry Lethargy Seizure activity Head CT Retinal examination Skeletal survey Other Cold drugs History of recent cold drug therapy Clinical evaluation Swollen erythematous asymmetric scrotum, absent cremasteric reflex Doppler ultrasonography or nuclear scanning of the scrotum Vaccine reaction History of recent immunization Clinical evaluation S 3 = 3rd heart sound. Evaluation History

2013 Merck Manual (19th Edition)

525. Ocular Emergencies

to the immediate environment preceding the injury. Small, sharp, high velocity objects, for example, resulting from hammering metal on metal, or through the use of a grinder, often lead to penetrating injuries. 1 An accident or fall may cause blunt trauma and present different issues. This knowledge is vital and will direct further testing. Observation of the patient can be performed with a bright light and pen torch. Particular care should be given to noticing the presence of foreign bodies, chemosis, corneal (...) haze and the presence of blood or pus in the anterior segment of the eye. 2 Fluorescein staining and examination under a blue light helps determine the extent of corneal injury. If full thickness corneal injury is present, aqueous humour may be seen to leak (Seidel test). This requires emergency referral. Pupil examination is a particularly useful objective assessment of the afferent and efferent visual pathways. 3 The presence of a pupillary defect is an important diagnostic sign. Pupil

2008 The Royal Australian College of General Practitioners

526. General anaesthesia

, also known as surgical anaesthesia , the skeletal muscles relax, vomiting stops, respiratory depression occurs, and eye movements slow and then stop. The patient is unconscious and ready for surgery. This stage is divided into four planes: The eyes roll, then become fixed; Corneal and laryngeal reflexes are lost; The pupils dilate and light reflex is lost; Intercostal paralysis and shallow abdominal respiration occur. Stage 4 Stage 4, also known as overdose , occurs when too much anaesthetic (...) or more general anaesthetic agents. It is carried out to allow medical procedures that would otherwise be intolerably painful for the patient; or where the nature of the procedure itself precludes the patient being awake. A variety of may be administered, with the overall aim of ensuring , , , loss of reflexes of the , and in some cases of . The optimal combination of drugs for any given patient and procedure is typically selected by an , or another provider such as an operating department

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2012 Wikipedia

527. Graves' ophthalmopathy

/100,000 in women, 3/100,000 in men. About 3–5% have severe disease with intense pain, and sight-threatening corneal ulceration or compression of the optic nerve. Cigarette smoking, which is associated with many autoimmune diseases, raises the incidence 7.7-fold. Mild disease will often resolve and merely requires measures to reduce discomfort and dryness, such as artificial tears and if possible. Severe cases are a medical emergency, and are treated with (steroids), and sometimes . Many anti (...) is spastic. (1842–1932) Ballet's sign Paralysis of one or more EOM (1853–1916) Becker's sign Abnormal intense pulsation of retina's arteries (1828–1890) Boston's sign Jerky movements of upper lid on lower gaze (1871–1931) Cowen's sign Extensive hippus of consensual pupillary reflex Jack Posner Cowen, American ophthalmologist (1906–1989) Dalrymple's sign Upper eyelid retraction (1803–1852) Enroth's sign Edema esp. of the upper eyelid Emil Emanuel Enroth, Finnish ophthalmologist (1879–1953) Gifford's sign

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2012 Wikipedia

528. Hyperkinesia

: Head turning to shift eye position Facial movements, including grimaces Slow, uncontrolled movements Quick, sudden, sometimes wild jerking movements of the arms, legs, face, and other body parts Unsteady gait Abnormal reflexes “prancing,” or a wide walk The disease is characterized further by the gradual onset of defects in behavior and cognition, including dementia and speech impediments, beginning in the fourth or fifth decades of life. Death usually occurs within 10–20 years after a progressive (...) -onset DRPLA presents with ataxia and symptoms consistent with progressive myoclonus epilepsy (myoclonus, multiple seizure types and dementia). Other symptoms that have been described include cervical , corneal endothelial degeneration , and surgery-resistant . Management [ ] Athetosis, chorea and hemiballismus [ ] Before prescribing medication for these conditions which often resolve spontaneously, recommendations have pointed to improved skin hygiene, good hydration via fluids, good nutrition

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2012 Wikipedia

529. Fundus camera

, and prominent corneal reflexes that reduced the clarity detail. It would be several decades before these problems could be rectified. There has been some controversy regarding the first ever successful human fundus photo. Most accounts state William Thomas Jackman and J.D. Webster since they published their technique along with a reproduction of a fundus image in two photography periodicals in 1886. Three other names played a prominent role in early fundus photography. According to some historical accounts

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2012 Wikipedia

530. Keratoconjunctivitis sicca

cause the eyes to water. This can happen because the eyes are irritated. One may experience excessive tearing in the same way as one would if something got into the eye. These reflex tears will not necessarily make the eyes feel better. This is because they are the watery type that are produced in response to injury, irritation, or emotion. They do not have the lubricating qualities necessary to prevent dry eye. Because blinking coats the eye with tears, symptoms are worsened by activities in which (...) in dry eye, one of which is . Topical lacritin promotes tearing in rabbit preclinical studies. Also, topical treatment of eyes of dry eye mice (Aire knockout mouse model of dry eye) restored tearing, and suppressed both corneal staining and the size of inflammatory foci in lacrimal glands. Additional causes [ ] Aging is one of the most common causes of dry eyes because tear production decreases with age. Several classes of medications (both prescription and OTC) have been hypothesized as a major

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2012 Wikipedia

531. Keratoconus

of different factors: genetic, environmental or cellular, any of which may form the trigger for the onset of the disease. Once initiated, the disease normally develops by progressive dissolution of , which lies between the corneal and . As the two come into contact, cellular and structural changes in the cornea adversely affect its integrity and lead to the bulging and scarring characteristic of the disorder. Within any individual keratoconic cornea, regions of degenerative thinning coexisting with regions (...) undergoing wound healing may be found. Scarring appears to be an aspect of the corneal degradation; however, a recent, large, multicenter study suggests abrasion by contact lenses may increase the likelihood of this finding by a factor over two. A number of studies have indicated keratoconic corneas show signs of increased activity by , a class of that break some of the cross-linkages in the stroma, with a simultaneous reduced of protease . Other studies have suggested that reduced activity by the enzyme

2012 Wikipedia

532. Facial nerve

Nerve's innervation of the muscles of facial expression, namely , responsible for blinking. Thus, the corneal reflex effectively tests the proper functioning of both Cranial Nerves V and VII. Additional images [ ] Inferior view of the human brain, with the cranial nerves labelled. Mandibular division of the trifacial nerve. Plan of the facial and intermediate nerves and their communication with other nerves. The course and connections of the facial nerve in the . Upper part of medulla spinalis (...) as both upper and lower facial weakness on the same side of the lesion. Taste can be tested on the anterior 2/3 of the tongue. This can be tested with a swab dipped in a flavoured solution, or with electronic stimulation (similar to putting your tongue on a battery). . The afferent arc is mediated by the General Sensory afferents of the . The efferent arc occurs via the Facial Nerve. The reflex involves consensual blinking of both eyes in response to stimulation of one eye. This is due to the Facial

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2012 Wikipedia

533. Eyeblink conditioning

(the (CS)) with an eye -eliciting (US) (e.g. a mild puff of air to the cornea or a mild shock). Naïve organisms initially produce a reflexive, (UR) (e.g. blink or extension of nictitating membrane) that follows US onset. After many CS-US pairings, an association is formed such that a learned blink, or (CR), occurs and precedes US onset . The magnitude of is generally gauged by the percentage of all paired CS-US that result in a CR. Under optimal conditions, well-trained animals produce a high (...) onset precedes the US onset and the two stimuli overlap and coterminate, with the stimuli converging in the cerebellar cortex and interpositus nucleus . In the trace EBC, the CS precedes the US and there is a stimulus free period (trace interval) between CS offset and US onset. While both of these procedures require the , the trace procedure also requires the and medial prefrontal cortex. Neural circuitry [ ] The blink reflex [ ] When a US is delivered to the cornea of the eye, sensory information

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2012 Wikipedia

534. Familial dysautonomia

help by . Unsourced material may be challenged and . ( March 2009 ) ( ) Clinical diagnosis [ ] inheritance A clinical diagnosis of FD is supported by a constellation of criteria: No fungiform papillae on the tongue Decreased deep tendon reflexes Lack of an axon flare following intradermal histamine No overflow tears with emotional crying Genetic testing [ ] Genetic testing is performed on a small sample of blood from the tested individual. The is examined with a designed probe specific to the known (...) of corneal problems as well as the use of punctal cautery. This education has resulted in decreased corneal scarring and need for more aggressive surgical measures such as , conjunctival flaps, and . Epidemiology [ ] Familial dysautonomia is seen almost exclusively in Jews and is inherited in an autosomal fashion. Both parents must be carriers in order for a child to be affected. The carrier frequency in Jewish individuals of Eastern and Central European (Ashkenazi) ancestry is about 1/30, while

2012 Wikipedia

535. Visual acuity

and functioning of the , and (iii) the sensitivity of the interpretative faculty of the brain. A common cause of low visual acuity is , or errors in how the light is refracted in the eyeball. Causes of refractive errors include aberrations in the shape of the or the , and reduced flexibility of the . Too high or too low refractive error (in relation to the length of the eyeball) is the cause of or (normal refractive status is referred to as ). Other optical causes are or more complex corneal irregularities (...) special attention to. A simple but less-used technique is checking oculomotor responses with an drum, where the subject is placed inside the drum and surrounded by rotating black and white stripes. This creates involuntary abrupt eye movements ( ) as the brain attempts to track the moving stripes. There is a good correspondence between the optokinetic and usual eye-chart acuities in adults. A potentially serious problem with this technique is that the process is reflexive and mediated in the low-level

2012 Wikipedia

536. Bell's palsy

the first two weeks nearly always remit entirely. When remission does not occur until the third week or later, a significantly greater part of the patients develop . A third study found a better prognosis for young patients, aged below 10 years old, while the patients over 61 years old presented a worse prognosis. Major complications of the condition are chronic loss of taste ( ), chronic facial , facial pain and corneal infections. To prevent the latter, the eyes may be protected by covers, or taped (...) shut during sleep and for rest periods, and tear-like eye drops or eye ointments may be recommended, especially for cases with complete . Where the eye does not close completely, the blink reflex is also affected, and care must be taken to protect the eye from injury. Another complication can occur in case of incomplete or erroneous regeneration of the damaged facial nerve. The nerve can be thought of as a bundle of smaller individual nerve connections that branch out to their proper destinations

2012 Wikipedia

537. Optic nerve

information is relayed to the visual cortex, while other axons terminate in the and are involved in reflexive eye movements. Other axons terminate in the and are involved in regulating the sleep-wake cycle. Its diameter increases from about 1.6 mm within the eye to 3.5 mm in the orbit to 4.5 mm within the cranial space. The optic nerve component lengths are 1 mm in the globe, 24 mm in the orbit, 9 mm in the optic canal, and 16 mm in the cranial space before joining the optic chiasm. There, partial (...) from the contralateral inferior visual field terminate more superiorly, to the [ ] . Function [ ] The optic nerve transmits all visual information including brightness perception, color perception and contrast (visual acuity). It also conducts the visual impulses that are responsible for two important neurological reflexes: the and the . The light reflex refers to the constriction of both pupils that occurs when light is shone into either eye; the accommodation reflex refers to the swelling

2012 Wikipedia

538. Cavernous sinus thrombosis

are abrupt onset of unilateral periorbital , , , and bulging of the eye ( ). Other common signs and symptoms include: , , (III, IV, V, VI). Sixth nerve palsy is the most common. Sensory deficits of the ophthalmic and maxillary branch of the fifth nerve are common. Periorbital sensory loss and impaired corneal reflex may be noted. , , and decreased visual acuity and blindness may occur from venous congestion within the retina. , and may be present. Headache with may occur. may be dilated and sluggishly

2012 Wikipedia

539. List of cutaneous conditions

) (generalized lichen myxedematosus, sclerodermoid lichen myxedematosus, scleromyxedema) (cutaneous mucinosis of infancy) (midline mucinosis, plaque-like cutaneous mucinosis, REM syndrome) (congenital fascial dystrophy) Neurocutaneous [ ] See also: Neurocutaneous conditions are due disease or are in . (dysmorphic syndrome, dysmorphophobia) (reflex sympathetic dystrophy) (delusions of parasitosis, Ekbom syndrome, monosymptomatic hypochondriacal psychosis) (dermatitis artefacta, factitial dermatitis) (burning (...) seed dermatoses, palmar keratoses, papulotranslucent acrokeratoderma, punctate keratoderma, punctate keratoses of the palms and soles, maculosa disseminata) (erythrokeratodermia progressiva Burns, ichthyosiform erythroderma with corneal involvement and deafness, KID syndrome) (acral keratoderma, Gamborg–Nielsen keratoderma, mutilating palmoplantar keratoderma of the Gamborg–Nielsen type, palmoplantar ectodermal dysplasia type VIII, palmoplantar keratoderma of the Norrbotten type) (diffuse non

2012 Wikipedia

540. Creutzfeldt-Jakob disease

, and . This is accompanied by physical problems such as impairment, balance and coordination dysfunction ( ), changes in , rigid . In most people with CJD, these symptoms are accompanied by and the appearance of an atypical, diagnostic tracing. The duration of the disease varies greatly, but sporadic (non-inherited) CJD can be fatal within months or even weeks. Most victims die six months after initial symptoms appear, often of due to impaired coughing reflexes. About 15% of people with CJD survive for two or more years (...) of suspected CJD was published in 1974. Animal experiments showed that corneas of infected animals could transmit CJD, and the causative agent spreads along visual pathways. A second case of CJD associated with a corneal transplant was reported without details. In 1977, CJD transmission caused by silver electrodes previously used in the brain of a person with CJD was first reported. Transmission occurred despite decontamination of the electrodes with ethanol and formaldehyde. Retrospective studies

2012 Wikipedia

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