Tag: Complications

Complications of Intrauterine growth restriction


Complications of Intrauterine growth restriction


1. Oligohydramnios

• Less space for fetus leading to cord compression

• Umbilical artery & vein gets compressed

• Fetal distress & fetus will pass meconium

• Fetal swallows meconium with amniotic fluid

2. Meconium Aspiration Syndrome

3. Low birth weight

4. Fetal distress/ hypoxia

5. Still birth

→In Neonates

1. Loose Skin

2. ↓ Tone

3. ↑ HMD/RDS

4. ↑ IVH

5. Neonatal Death

→Fetal Surveillance in IUGR is done by NST (Non-Stress Test) Biweekly

Battledore placenta


Battledore placenta


  • Battledore placenta is a placenta in which the. umbilical cord is attached at the placental margin; so. called because of the fancied resemblance to the. racquet used in badminton.
  • The shortest distance between the cord insertion and placental edge is within 2cm.
  • The incidence of battledore placenta is 7- 9% in singleton pregnancies, and 24-33% in twin pregnancies.
  • Complications associated with battledore placenta are fetal distress intrauterine growth restriction, preterm labor, and slightly decreased birth weight.

It is associated with:

  1. Fetal distress
  2. IUGR
  3. Preterm labour
  4. Decreased birth weight

Circumcision

CIRCUMCISION


CIRCUMCISION

INDICATIONS-

  • Religious (jews and muslims)
  • Phimosis
  • Paraphimosis
  • Balanitis & balanoposthitis
  • Early carcinoma of prepuce or glans penis
  • STD
  • Recurrent UTI

PROCEDURE-

  • In children, it is done under GA
  • In adults, it is done under LA.

COMPLICATIONS-

  • Reactionary haemorrhage
  • Infection
  • Stricture urethra near external meatus in children
  • Chordee

Exam Important

INDICATIONS-

  • Religious (jews and muslims)
  • Phimosis
  • Paraphimosis
  • Balanitis & balanoposthitis
  • Early carcinoma of prepuce or glans penis
  • STD
  • Recurrent UTI

PROCEDURE-

  • In children, it is done under GA
  • In adults, it is done under LA.

COMPLICATIONS-

  • Reactionary haemorrhage
  • Infection
  • Stricture urethra near external meatus in children
  • Chordee
Don’t Forget to Solve all the previous Year Question asked on CIRCUMCISION

Module Below Start Quiz

Circumcision

Circumcision

Q. 1 Which of the following is/are TRUE about hypospadias?

1. Defect is seen in the ventral part
2. Always associated with chordee
3. Associated with hooded prepuce
4. Circumcision should be avoided

 A

1,2 & 3

 B

2,3 & 4

 C

1,3 & 4

 D

All are true

Q. 1

Which of the following is/are TRUE about hypospadias?

1. Defect is seen in the ventral part
2. Always associated with chordee
3. Associated with hooded prepuce
4. Circumcision should be avoided

 A

1,2 & 3

 B

2,3 & 4

 C

1,3 & 4

 D

All are true

Ans. C

Explanation:

About option 1
Hypospadias results from failure of fusion of the urethral folds on the undersurface of the genital tubercle so defect is seen on the ventral part
.

About option 2
“In the penile variety (not other type- so not always present) the urethra and corpus spongiosum distal to the ectopic opening are absent.

These structures are represented by a fibrous cord. Due to contracture of this fibrous cord, the penis is curved ventrally, which is known as chordee”.
 
About option 3
“In all cases the inferior aspect of the prepuce is poorly developed. As the superior aspect of the prepuce is almost normally developed whereas the inferior aspect is poorly developed, the prepuce takes the form of a hood and is called “hooded prepuce”.
About option 4
“Circumcision should not be done in these patients, as prepuce can be used later in surgical repair (85% of patients)”
Ref: L & B 25/e, Page 1362-63 ; CSDT 11/e, Page 1028 ; Textbook Of Surgery By S. Das 5/e, Page 1322-23

Q. 2 Regarding neonatal circumcision, which one of the following is true:

 A

It should be done without anaesthesia, as it is hazardous to give anaesthesia.

 B

It should be done without anesthesia, as neonates do not perceive pain as adults

 C

It should be done under local anaesthesia only.

 D

General anaesthesia should be given to neonate for circumcision as they also feel pain as adults.

Q. 2

Regarding neonatal circumcision, which one of the following is true:

 A

It should be done without anaesthesia, as it is hazardous to give anaesthesia.

 B

It should be done without anesthesia, as neonates do not perceive pain as adults

 C

It should be done under local anaesthesia only.

 D

General anaesthesia should be given to neonate for circumcision as they also feel pain as adults.

Ans. D

Explanation:

D i.e. G.A. Should be given to neonate for circumcision as they also feel pain as adults


Q. 3

Circumcision cannot be used in management of 

 A

Phimosis

 B

Severe balanitis xerotica

 C

Paraphimosis

 D

Penile Cancer

Q. 3

Circumcision cannot be used in management of 

 A

Phimosis

 B

Severe balanitis xerotica

 C

Paraphimosis

 D

Penile Cancer

Ans. D

Explanation:

Answer- D. Penile Cancer

  • Phimosis
  • Balanitis 
  • Posthitis
  • Paraphimosis
  • Severe UTIs

Q. 4 Indication of circumcision includes:

 A

Hypospadias

 B

Epispadias

 C

Phimosis

 D

Balanitis

Q. 4

Indication of circumcision includes:

 A

Hypospadias

 B

Epispadias

 C

Phimosis

 D

Balanitis

Ans. C:D:E

Explanation:

Answer- C,Phimosis D,Balanitis E, Balanoposthitis
Indication- religious & phimosis
Medical indications for circumcision in boys include-

  1. recurrent attacks of balanoposthitis
  2. recurrent urinary tract infections
  3. In adults, inability to retract for intercourse, abnormally tight frenulum, balanitis

Quiz In Between



Ectopic Testis

ECTOPIC TESTIS


ECTOPIA TESTIS

  • An ectopic testicle descends normally through the inguinal canal but then moves into an abnormal position in the groin area.
  • The main hazard is liability to injury.
  • Sites of ectopic testis-

a) Superficial inguinal pouch

b) Perineum

c) Root of the penis

d) Femoral triangle (thigh)

  • Ectopic testis is usually fully developed

EMBRYOLOGY-

  • Testis reaches the scrotum by the scrotal tail gubernaculum.
  • The gubernaculums helps to guide the descent of the testicles.
  • Most ectopic testicles are palpable.

TREATMENT-

  • Surgical treatment after age of about 6 months but no later than 2 years
  • Orchidopexy in a new scrotal pouch.
COMPLICATIONS- 
  • Liability to injury (torsion)

Exam Important

  • Sites of ectopic testis-

a) Superficial inguinal pouch

b) Perineum

c) Root of the penis

d) Femoral triangle (thigh)

  • Ectopic testis is usually fully developed
COMPLICATIONS- 
  • Liability to injury (torsion)
Don’t Forget to Solve all the previous Year Question asked on ECTOPIC TESTIS

Module Below Start Quiz

Ectopic Testis

ECTOPIC TESTIS

Q. 1 Ectopic testis is found in all location except ‑

 A

Lumbar

 B

Perineal

 C

Intra abdominal

 D

Inguinal

Q. 1

Ectopic testis is found in all location except ‑

 A

Lumbar

 B

Perineal

 C

Intra abdominal

 D

Inguinal

Ans. C

Explanation:

Ans. is C

  • Sites of ectopic testis-

a) Superficial inguinal pouch
b) Perineum
c) Root of the penis
d) Femoral triangle (thigh)


Q. 2

Complication of ectopic testis is ‑

 A

Seminoma

 B

Atrophy

 C

Torsion

 D

All

Q. 2

Complication of ectopic testis is ‑

 A

Seminoma

 B

Atrophy

 C

Torsion

 D

All

Ans. C

Explanation:

Ans. is ‘c’ i.e., Torsion 

Quiz In Between



Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Q. 1

Positive Schick test indicates

 A

Immune to diphtheria

 B

Immune and hypersensitive to diphtheria

 C

Susceptible and hypersensitive to diphtheria

 D

Susceptible to diphtheria

Q. 1

Positive Schick test indicates

 A

Immune to diphtheria

 B

Immune and hypersensitive to diphtheria

 C

Susceptible and hypersensitive to diphtheria

 D

Susceptible to diphtheria

Ans. D

Explanation:

Susceptible to diphtheria [Ref. Park 19th/e p 137]



Q. 2 Schick test in diphtheria is done to know:
 A Carriers
 B Subseceptibles
 C Diseased
 D Immunized
Q. 2 Schick test in diphtheria is done to know:
 A Carriers
 B Subseceptibles
 C Diseased
 D Immunized
Ans. B

Explanation:

Subseceptibles


Q. 3 “Eleks” test is for:
 A Influenza
 B Diptheria
 C Brucella
 D Cholera
Q. 3 “Eleks” test is for:
 A Influenza
 B Diptheria
 C Brucella
 D Cholera
Ans. B

Explanation:

Diptheria

Quiz In Between


Q. 4

Post exposure prophylaxis in health care professionals is indicated in infections with all except?

 A

HBV

 B

Rabies

 C

Diptheria

 D

Measles

Q. 4

Post exposure prophylaxis in health care professionals is indicated in infections with all except?

 A

HBV

 B

Rabies

 C

Diptheria

 D

Measles

Ans. C

Explanation:

Post exposure prophylaxis is used in HIV, HBV, Measles, Rabies, Tetanus, H.influenzae and Meningococcus.

Ref: Park, 20th Edition, Pages 139, 189, 240, 283.

Q. 5

Skin test based on neutralization reaction is/are –

 A

Casoni test

 B

Lepromin test

 C

Tuberculin test

 D

Schick test

Q. 5

Skin test based on neutralization reaction is/are –

 A

Casoni test

 B

Lepromin test

 C

Tuberculin test

 D

Schick test

Ans. D

Explanation:

Ans. is ‘d i.e., Schick test


Q. 6

True about diptheria is –

 A

 Loffer’s serum is highly selective medium for C. diptheria

 B

Elek’s Gel is a precipitation test

 C

Metachromatic granules is produced on stain only by one strain of C. diphtheria

 D

Gm-ve bacilli, non motile, non capsulated

Q. 6

True about diptheria is –

 A

 Loffer’s serum is highly selective medium for C. diptheria

 B

Elek’s Gel is a precipitation test

 C

Metachromatic granules is produced on stain only by one strain of C. diphtheria

 D

Gm-ve bacilli, non motile, non capsulated

Ans. B

Explanation:

Ans. is ‘b’ i.e., Elek’s Gel is a precipitation test 

.  Elek’s is a precipitation test. It is an in vitro test for toxigenicity of the diphtheria bacillus.

.   Selective medium for C. diphtheriae is tellurite blood agar (eg. Mc Leod’s and Hoyle’s media or cystine – tellurite agar – Tinsdale medium).

.  All strains of C. diphtheriae show metachromatic granules on staining.

.  C. diphtheriae is gram (+) ye, nonmotile and non-capsulated.

Based on colonial morphology on tellurite agar and other properties, Mc Leod classified diphtheria bacilli into three bio types – gravis, intermedius and mitis. Gravis causing most serious and mitis the mildest variety of diphtheria.

Quiz In Between


Q. 7

True about Diptheria –

 A

Caused by Gram negative bacilli

 B

Incubation period 2-5 days

 C

Chemoprophylaxis is done with rifampicin

 D

All

Q. 7

True about Diptheria –

 A

Caused by Gram negative bacilli

 B

Incubation period 2-5 days

 C

Chemoprophylaxis is done with rifampicin

 D

All

Ans. B

Explanation:

Ans. is ‘b’ i.e.,Incubation period 2-5 days

.  Diptheria is caused by Gram positive bacilli, Corynebacterium diphtheriae

.   Incubation period of most common form of diphtheria ( faucial/ tonsiliopharyngeal diphtheria) is 2-5 days.

. For chemoprophylaxis erythromycin or penicillin are used.

Previously immunized asymptomatic household contact should receive booster dose of diphtheria toxoid. Those not fully immunized but asymptomatic contacts should receive immunization for their age”.—0.P. Ghai 7th/221 “Lifelong immunity is usually, but not always, acquired after disease or inapparent infection”—health.vic.gov.au> IDAES home > blue book

. So, child recovered from illness is already is immune. No active immunization is required.


Q. 8

The most common ophthalmic effect of diptheria is –

 A

Ptosis

 B

Total ophthalmoplegia

 C

Isolated ocular palsies

 D

Ophthalmoplegia externa

Q. 8

The most common ophthalmic effect of diptheria is –

 A

Ptosis

 B

Total ophthalmoplegia

 C

Isolated ocular palsies

 D

Ophthalmoplegia externa

Ans. C

Explanation:

Ans. is ‘c’ i.e., Isolated ocular palsies 

Complications

o Obstruction of the respiratory tract by pseudomembrane

o Myocarditis

  • Polyneuropathy
  • Post diphtheritic paralysis q Occurs in the 3rd or 4th week

o Palatine and pupillary paralysis is characteristic

Spontaneous recovery is the rule.

  • Pneumonia

o Other less common complications are renal failure, encephalitis, cerebral infarction, pulmonary embolism and bacteremia or endocarditis.


Q. 9

Commonest age group for diptheria is –

 A

1-2 Years

 B

2-5 Years

 C

2-7 Years

 D

2-9 Years

Q. 9

Commonest age group for diptheria is –

 A

1-2 Years

 B

2-5 Years

 C

2-7 Years

 D

2-9 Years

Ans. B

Explanation:

Ans. is ‘b’ i.e., 2-5 years 

Diphtheria

o Diphtheria is an acute infectious disease caused by toxigenic strains of corynebacterium diphtheriae.

o Source of infection –> cases or carriers; carriers are common sources of infection, their ratio is estimated to be 95 carriers for 5 clinical cases.

o Infective period              –> 14 – 28 days from the onset of disease.

o Age group                                     —> 1 to 5 years

o Sex                                    –> Both sexes

o Incubation period            –> 2 – 6 days

Quiz In Between


Q. 10

Regarding schick’s test which of the following is false –

 A

Erythematous reaction in both arms indicates  Allergic type interpreted as Schick type

 B

Positive test means that person is immune to hypersensitivity diphtheria

 C

Diphtheria antitoxin is given intradermal

 D

All

Q. 10

Regarding schick’s test which of the following is false –

 A

Erythematous reaction in both arms indicates  Allergic type interpreted as Schick type

 B

Positive test means that person is immune to hypersensitivity diphtheria

 C

Diphtheria antitoxin is given intradermal

 D

All

Ans. B

Explanation:

Ans. is ‘b’ i.e., Positive test means that person is immune to diphtheria 


Q. 11

Which of the following organism can penetrate the normal cornea :

 A

Gonococcus

 B

Pseudomonus

 C

Diptheria

 D

a and c

Q. 11

Which of the following organism can penetrate the normal cornea :

 A

Gonococcus

 B

Pseudomonus

 C

Diptheria

 D

a and c

Ans. D

Explanation:

A i.e. Gonococcus; C i.e. Diptheria 

The only organisms known to be able to invade normal corneal epithelium are N. gonorrhoea & Cornybacterium diptheria Q

Quiz In Between



Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment


Introduction

  • Most common in children of 2-5 years.

Incubation period

  • 2-5days

Mode of transmission

  • Droplet spread

Types

  • Faucial(commonest )
  • Laryngeal
  • Nasal
  • Conjunctival
  • Otitic
  • Vulvovaginal
  • Cutaneous mainly around mouth and nose

Respiratory Diphtheria

  • MC type Tonsillopharyngeal (Faucial)
  • Symptoms
    • Fever
    • sore throat
    • Weakness
    • Malignant or hypertoxic or bull neck appearance
  • Complications
  • Mechanical complication
    • Pseudomembrane may extend to the larynx
    • Lead to laryngeal obstruction, asphyxia and death.
  • Systemic effects
    • Myocarditis:Cardiac damage permanent
    • peripheral polyneuropathy of descending type.
  • Risk
    • Involvement larynx or tracheobronchial tree 
    • Children(because of small airway size).
  • First muscle involve in paralysis – palatopharynges.
  • Ciliary paralysis occur but not pupillary paralysis
  • Most common ophthalmic effect of diphtheria is Isolated ocular palsies 
  • Blurred vision with preserved light reflex.
  • Degenerative changes in adrenal, kidney and liver may occur.
  • Cause of death
    • circulatory failure.

Cutaneous Diphtheria

  • Punched out ulcers
  • Caused by non-toxigenic strains.

 Invasive infection

  • Rare
  • Risk factors are 
    • preexisting cardiac abnormalities
    • IV drug abusers
    • alcoholic cirrhosi

Prevention

  • Active immunization by Toxoid
  • Immunization cannot prevent carrier stage.
  • Active immunization –
    • Combined DPT.
  • Perfussis component in DPT increase potency of diphtheria toxoid.
  • Toxoid of diphtheria shows Danysz phenomenon and Ehrlich phenomenon
  • contact isolation is must.

DIAGNOSIS:

Culture:

  • Respiratory diphtheria diagnosis clinical
  • Cutaneous diphtheria requires lab confirmation.

The throat swabs are inoculated on the following culture media:

  • Loefflers serum slope
  • Tellurite blood agar
  • Blood agar

Virulence tests:

  • These tests demonstrate the production of exotoxin by bacteria isolated on culture.

Virulence testing may be done by:                        

  • In vivo: Guinea pigs and rabbits- by subcutaneous or intracutaneous.
  • In vitro: Eleks gel precipitation test ( test for toxigenicity)and tissue culture tests
  • Schick test:
  • Done to demonstrate circulating diptheria antitoxin.
  • Skin test based on neutralization reaction 
CONTROL ARM TEST ARM INFERENCE
No Reaction No Reaction  Immune
No Reaction Positive

Red flush of 1-5 cms diameter,

generally appears within 24-36 hr

reaching its maximum develop-

ment by 4-7 day. 

This fades slowly

Susceptible to

infection

Red flush but less circumscribed

than positive fades by 4th day

Pseudo positive

Red flush equally in both arms

less circumscribed

Allergic type

interpreted as

Schick type

Pseudo positive reaction  Show positive reaction

Combined reaction

 Susceptible

TREATMENT:

  • Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or
  • Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing10 kg).
  • Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.
  • Diphtheria antitoxin is given intradermal
  • Post exposure prophylaxis in health care professionals is not  indicated in infections with diphtheria

Exam Important

Introduction

  • Most common in children of 2-5 years.

Incubation period

  • 2-5days

Mode of transmission

  • Droplet spread

Types

  • Faucial(commonest )
  • Laryngeal
  • Nasal
  • Conjunctival
  • Otitic
  • Vulvovaginal
  • Cutaneous mainly around mouth and nose

Respiratory Diphtheria

  • MC type Tonsillopharyngeal (Faucial)
  • Complications
  • Mechanical complication
    • Pseudomembrane may extend to the larynx
    • Lead to laryngeal obstruction, asphyxia and death.
  • Systemic effects
    • Myocarditis
    • Peripheral polyneuropathy of descending type.
  • First muscle involve in paralysis – palatopharynges.
  • Ciliary paralysis occur but not pupillary paralysis
  • Most common ophthalmic effect of diphtheria is Isolated ocular palsies 

Cutaneous Diphtheria

  • Punched out ulcers
  • Caused by non-toxigenic strains.

 Invasive infection

  • Rare

DIAGNOSIS:

Culture:

  • Respiratory diphtheria diagnosis clinical
  • Cutaneous diphtheria requires lab confirmation.
  • The throat swabs are inoculated.
Virulence tests:

Virulence testing may be done by:                        

  • In vivo: Guinea pigs and rabbits- by subcutaneous or intracutaneous.
  • In vitro: Eleks gel precipitation test ( test for toxigenicity)and tissue culture tests

Schick test:

  • Done to demonstrate circulating diptheria antitoxin.
  • Skin test based on neutralization reaction 
CONTROL ARM TEST ARM INFERENCE
No Reaction No Reaction  Immune
No Reaction Positive

Red flush of 1-5 cms diameter,

generally appears within 24-36 hr

reaching its maximum develop-

ment by 4-7 day. 

This fadesslowly

Susceptible to

infection

Red flush but less circumscribed

than positive fades by 4th day

 Pseudo positive

Red flush equally in both arms

less circumscribed

Allergic type

interpreted as

Schick type

Pseudo positive reaction  Show positive reaction

Combined reaction

 Susceptible

TREATMENT:

  • Erythromycin DOC
  • Procaine penicillin G .
  • Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.
  • Diphtheria antitoxin is given intradermal
  • Post exposure prophylaxis in health care professionals is not  indicated in infections with diphtheria
Don’t Forget to Solve all the previous Year Question asked on Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Module Below Start Quiz

SENILE CATARACT- Pathophysiology, Symptoms, Complications

SENILE CATARACT- Pathophysiology, Symptoms, Complications

Q. 1

Which is not a cause for Hamarlopia?

 A

Polar cataract

 B

Congenital deficiency of cones

 C

Peripheral cortical cataract

 D

Central corneal opacity

Q. 1

Which is not a cause for Hamarlopia?

 A

Polar cataract

 B

Congenital deficiency of cones

 C

Peripheral cortical cataract

 D

Central corneal opacity

Ans. C

Explanation:

Peripheral cortical cataract causes Nyctalopia. Central vitreous opacity, Congenital deficiency of cones and Central nuclear or polar cataracts can cause Hamarlopia (Day blindness).

Ref: A K Khurana, 2nd Edition, Page 11.

Q. 2

Which of the following type of cataract is most commonly associated with ageing?

 A

Nuclear cataract

 B

Intumescent cataract

 C

Morgagnian cataract

 D

Posterior subcapsular cataract

Q. 2

Which of the following type of cataract is most commonly associated with ageing?

 A

Nuclear cataract

 B

Intumescent cataract

 C

Morgagnian cataract

 D

Posterior subcapsular cataract

Ans. A

Explanation:

Nuclear cataract is the most common and type and the one most commonly associated with ageing. It consist of a central diffuse opacification and coloration that involve the lens nucleus.
  • Intumescent cataract is a form of cortical cataract where the nucleus is white and the capsular bag is swollen because of fluid absorption. 
  • Morgagnian cataract is a hypermature cataract in which entire lens capsule is wrinkled and total liquefaction of the cortex allows the nucleus to move freely in the bag and sink inferiorly due to effects of gravity.
Ref: Cataract Surgery from Routine to Complex: A Practical Guide By George J. C. Jin, page 21.

Q. 3

Which type of senile cataract is notorious for glaucoma formation?

 A

Incipient cataract

 B

Hypermature morgagni

 C

Intumescent cataract

 D

Nuclear cataract

Q. 3

Which type of senile cataract is notorious for glaucoma formation?

 A

Incipient cataract

 B

Hypermature morgagni

 C

Intumescent cataract

 D

Nuclear cataract

Ans. C

Explanation:

In intumescent cataract, the lens may take up fluid during cataractous change, increasing markedly in size. It may then encroach upon the anterior chamber, producing both pupillary block and angle crowding and resulting in acute angle closure. Treatment consists of lens extraction once the intraocular pressure has been controlled medically.
 
Ref: Salmon J.F. (2011). Chapter 11. Glaucoma. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e.

 

Quiz In Between


Q. 4

Steroid induced cataract is

 A

Posterior subcapsular cataract

 B

Anterior subcapsular cataract

 C

Nuclear cataract

 D

Cupulliform cataract

Q. 4

Steroid induced cataract is

 A

Posterior subcapsular cataract

 B

Anterior subcapsular cataract

 C

Nuclear cataract

 D

Cupulliform cataract

Ans. A

Explanation:

A i.e. Posterior subcapsular cataract 

Steroid induced lens opacities are posterior subcapsularQ. Whereas anterior polar cataract is caused by perforating cornea/ injuriesQ.


Q. 5

Good vision in dim light and clumsy in day lights seen in:

 A

Cortical cataract

 B

Morgagnian cataract

 C

Nuclear cataract

 D

a and c

Q. 5

Good vision in dim light and clumsy in day lights seen in:

 A

Cortical cataract

 B

Morgagnian cataract

 C

Nuclear cataract

 D

a and c

Ans. D

Explanation:

A. Cortical cataract; C. i.e. Nuclear cataract

  • In nuclear cataract opacity is central so the vision is poor in daytime (due to miosis) & good in dim light (due to mydriasis) Q
  • Patients with central opacities (eg. cupuliform cataract) see better when the pupil is dilated due to dim light in the evening(day blindness)-Khurana, p192
  • Cupuliform cataract is a type of cortical cataract-Parsons, p253
  • In nuclear cataract opacity is central so the vision is poor in daytime (due to miosis) & good in dim light (due to mydriasis)-Neema, p204
  • Loss of ability to see in broad daylight, blinding due to oncoming headlights while driving are features of posterior sub-capsular cataract (Steroid induced cataract)-Parsons’, p 251(t)

 

Symptom

Pathogenesis

Condition

Reduced visual acuity usually

gradual, painless, progressive

Reduction in transparency of the lens

All types of cataract

Visual field loss

Generalized reduction in sensitivity

due to loss of transparency

All types of cataract

Frequent change of glassesQ

Rapid change in refractive index of

Cortical or nuclear

 

the lens

cataractQ

Monocular diplopia or

Cortical spoke opacities in

Cortical cataract

polyopiaQ

conjunction with water clefts that

form radial wedges containing a fluid

of m lower refractive index than the

surrounding lens

(spoke or cuneiform)

Colour shift (becomes more

Blue end of the spectrum is absorbed

Cortical cataract

obvious after surgery)

more by the cataractous lens

 

Glare

Increased scattering of light

Cortical and posterior

subcapsular cataract

Loss of ability to see objects in

Loss of contrast sensitivity, which is

Posterior subcapsular

bright sunlight, blinded by

greater at higher spatial frequencies;

cataract

light of oncoming headlamps

constriction of pupil cuts off

 

when driving at night

peripheral vision from non‑

cataractous area

 

‘Second sight’ or myopic shift

Change in refractive index of the

nucleus causes index myopia,

improving near vision

Nuclear cataractQ

Coloured halos around light

Irregularity in the refractive index of

different parts of the lens

Nuclear cataract

Fluctuation of refractory error

High level of aqueous glucose is

metabolized by aldose reductaseQ into

sorbitol which then accumulates with

in lens resulting in secondary osmotic

over hydration of lens. Hypeglycemia

leads to fluctuating myopia

Diabetic cataractQ

Shield like cataract

May also result in a Posterior

subcapsular cataract resembling a

complicated cataract

A topic dermatitisQ

Frequent change of presbyopic

Early non-specific complaint

Open angle glaucoma

glasses

 

Q


Q. 6

Polychromatic Lustre is seen in

 A

Posterior cortical cataract

 B

Zonular cataract

 C

Cuppliform cataract

 D

Posterior subcapsular

Q. 6

Polychromatic Lustre is seen in

 A

Posterior cortical cataract

 B

Zonular cataract

 C

Cuppliform cataract

 D

Posterior subcapsular

Ans. A

Explanation:

A i.e. Posterior cortical cataract

Quiz In Between


Q. 7

Polyopia is a symptom of:

 A

Cortical cataract

 B

Cupuliform cataract

 C

Radiational cataract

 D

Electrical cataract

Q. 7

Polyopia is a symptom of:

 A

Cortical cataract

 B

Cupuliform cataract

 C

Radiational cataract

 D

Electrical cataract

Ans. A

Explanation:

Ans. Cortical cataract


Q. 8

In a patient, highest visual morbidity is seen in:

 A

Nuclear cataract

 B

Intumescent cataract

 C

Posterior subcapsular cataract

 D

Anterior subcapsular cataract

Q. 8

In a patient, highest visual morbidity is seen in:

 A

Nuclear cataract

 B

Intumescent cataract

 C

Posterior subcapsular cataract

 D

Anterior subcapsular cataract

Ans. C

Explanation:

Ans. Posterior subcapsular cataract


Q. 9

Most visually handicapping cataract is:

 A

Rosette cataract

 B

Nuclear cataract

 C

Posterior subcapsular cataract

 D

Cortical cataract

Q. 9

Most visually handicapping cataract is:

 A

Rosette cataract

 B

Nuclear cataract

 C

Posterior subcapsular cataract

 D

Cortical cataract

Ans. C

Explanation:

Ans: C i.e. Posterior subcapsular cataract

Reduced visual acuity (gradual, painless, progressive) & visual field loss are manifestations of all types of cataracts

Cataracts & their effects

  • Nuclear cataract manifest as colour shift (more obvious after surgery), second sight/ myopic shift, frequent change of glasses etc.
  • Loss of ability to see objects in bright sunlight, blinding by light of oncoming headlamps when driving at night or glare may be the symptom of posterior subcapsular cataract
  • Cortical cataract may manifest as frequent change of glasses, monocular diplopia/ polyopia, glare or coloured halos around light

Quiz In Between


Q. 10

Second sight phenomenon is seen in:

 A

Nuclear cataract

 B

Cortical cataract

 C

Senile cataract

 D

Iridocyclitis

Q. 10

Second sight phenomenon is seen in:

 A

Nuclear cataract

 B

Cortical cataract

 C

Senile cataract

 D

Iridocyclitis

Ans. A

Explanation:

Ans. A i.e. Nuclear cataract

Symptoms of nuclear cataract

  • Blurring of distance more than near vision (typically, but others may notice worsening of reading more than distance
  • Increasing myopia (“Second-sight” phenomenon of improved uncorrected distance vision in hyperopes and improved uncorrected near vision in emetropes
  • Poor vision in dark settings such as night driving
  • Decreased contrast and decreased ability to discern colors
  • Glare
  • Monocular diplopia

Q. 11

In senile nuclear cataract what type of myopia is seen‑

 A

Curvature myopia 

 B

Index myopia

 C

Axial myopia

 D

Positional myopia

Q. 11

In senile nuclear cataract what type of myopia is seen‑

 A

Curvature myopia 

 B

Index myopia

 C

Axial myopia

 D

Positional myopia

Ans. B

Explanation:

Ans. is ‘b’ i.e., Index myopia

  • Nuclear changes of aging induce a modification of refractive index of lens and produce an index myopia.
  • “Nuclear cataracts cause a general decrease in the transperancy of the lens nucleus.They are associated

withindexmyopia”                                                                                                  — Ophthalmic study guide

Causes of errors of refraction

  • Possible causes of ametropia are : ‑

1) Axial

  • It is the commonest form of ametropia (both myopia and hypermetropia). In hypermetropia, there is an axial shortening of eyeball. So, image is formed behind the retina. In myopia, there is an axial lengthening of eyeball. So, image is formed in front of the retina. 1 mm change in axial length leads to ametropia of 3D. For example 1 mm shortening in axial length causes hypermetropia of 3D.

2) Curvature

  • Change in the curvature of cornea or lens will cause ametropia. In hypermetropia, the curvature of cornea or lens is lesser than normal. In myopia, there is increase in curvature of cornea or lens./ mm change in corneal curvature leads to 6-7 D ametropia.

3) Index

  • If refractive index of optical system is low, it will result in hypermetropia and high refractive index will result in myopia.

4) Positional (Due to relative position of the lens),

  • A forward shift of lens causes myopia, backward shift result in hypermetropia. Absence of lens (aphakia) causes hypermetropia.

5) Excessive accommodation

  • Excessive accommodation due to spasm of accommodation causes myopia.

Quiz In Between



SENILE CATARACT- Pathophysiology, Symptoms, Complications

SENILE CATARACT- Pathophysiology, Symptoms, Complications


PATHOPHYSIOLOGY OF SENILE CATARACT

  • Pathophysiology of loss of transparency of lens is different for nuclear & cortical senile cataract:

A) Cortical senile cataract:

The main biochemical features are:

  1. Decreased levels of total protein, amino acids & potassium.
  2. Increased concentration of sodium & marked hydration of lens.
  3. Coagulation & denaturation of lens proteins

B) Nuclear senile cataract:

  • Usual degenerative changes are intensification of the age related nuclear sclerosis.
  • Associated with dehydration & compaction of the nucleus resulting in a hard cataract.
SYMPTOMS OF SENILE CATARACT
 

SYMPTOMS

CONDITIONS

Visual field loss All types of cataract
Frequent change of glasses Cortical or nuclear cataract
Monocular diplopia or polyopia Cortical cataract (Incipient stage)      (spoke or cuneiform)
Colour shift (becomes more obvious after surgery) Cortical cataract
Glare Cortical & posterior subcapsular cataract
Loss of ability to see objects in bright sunlight, blinded by light of oncoming headlamps when driving at night. Posterior subcapsular cataract

Nuclear cataract

‘Second sight’ or myopic shift

(change in refractive index of the nucleus causes index myopia improving near vision)

Nuclear cataract
Index myopia Nuclear cataract
Index Hypermetropia Cortical cataract

COMPLICATIONS OF SENILE CATARACT

1. Lens induced Glaucoma: Cataract can give rise to secondary glaucoma in following ways:

i) Phacomorphic glaucoma:

  • Lens may swell up by absorbing fluid resulting in shallow anterior chamber (intumescent cataract).
  • Most common type of lens induced glaucoma.
  • Beside intumescent stage of senile cataract, phacomorphic glaucoma is also seen in anterior subluxation/dislocation of lens & spherophakia (congenital small spherical lens).

ii) Phacolytic glaucoma: 

  • In hypermature stage the lens proteins leak out into the anterior chamber & engulfed by macrophages.
  • A type of secondary open angle glaucoma.

iii) Phacotopic glaucoma:

  • Hypermature lens subluxation/ dislocation may cause glaucoma by blocking the pupil or angle of anterior chamber. 

2. Lens induced Uveitis

3. Subluxation or Dislocation of Lens

  • In stage of of hypermaturity the zonules of the lens may weaken & break.
  • This leads to subluxation of the lens or dislocation.

Exam Important

  • Intumescent cataract is the most common type of lens induced glaucoma.
  • Visual deterioration due to senile cataract is painless and gradually progressive in nature.
  • Second sight phenomenon is seen in Nuclear cataract.
  • Polyopia is a symptom of Cortical cataract.
  • Most visually handicapping cataract is Posterior subcapsular cataract.
  • Highest visual morbidity is seen in Posterior subcapsular cataract.
  • Steroid induced cataract is Posterior subcapsular cataract.
  • Nuclear cataract is most commonly associated with ageing.
  • In senile nuclear cataract Index myopia  is seen.
  • Polychromatic Lustre is seen in Posterior cortical cataract.
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