By U. Jose. Whitworth University. 2018.
Professional practice examination: No Principal lecturer Professor or Associated professor from the department of Ophthalmology safe 200mg floxin. Features of ophthalmology - High demand for ophthalmic care - Complex character - Close liaison with other medical specialties 4 purchase 200 mg floxin. History of ophthalmology 291 - Prehistoric times - Ancient civilizations: Assyria and Babylonia, Ancient Egypt, Judaic culture, Ancient Indian culture; Ancient Chinese culture, ancient cultures in America. Essentials of vision - Definition of light: theory, photometric units - Conversion of light energy into nerve impulses 8. Light perception - Definition: absolute sensitivity, descriminative sensitivity - Adaptation: to light and dark, methods for examination of adaptation - Disturbances in adaptation (hemeralopia): symptomatic, functional. Anatomy of orbit - Composition of the orbit - Features of the walls of the orbit - Major openings in the orbit - Contents of the orbit - Changes in the position of the eyeball 2. Static and dynamic clinical refraction - far point of view in different clinical refractions 7. Accommodation - definition - near point of view - mechanism of accommodation - field of accommodation - range of accommodation 8. Morbid changes in the conjunctiva: hyperemia – conjunctival and ciliary, chemosis, foliculae, papilae, phlyctena, discharge – catarrhal, purulent, fibrinous 4. Tumours of the orbit - Benign: dermoid cyst, holesteatoma, angioma, - Malignant: sarcoma, carcinoma, glioma, meningioma lymphoma. Diseases of the eyelids - Congenital anomalies - Diseases of the eyelid skin: noninflammatory and inflammatory - Diseases of eyelashes - Static and dynamic disorder of the eyelids: entropium, ektropium, blepharospasm, lagoftalm, ptosis of eyelids - Eyelid tumors: benign and malignant. Diseases of the cornea - Function of cornea - Methods for corneal investigation - Pathological changes in cornea: opacities – infiltration, cicatrix, degeneration; vascularisation: superficial, deep 1. Inflammatory corneal diseases - Superficial nonpurulent keratitides - Superficial purulent keratitides - Deep /stromal/ keratitides - Trophyc keratitides 3. Trachoma - distribution - etiology - clinical signs - differential diagnosis - complications - treatment 5. Classification of Uveitis - according to etiology: infectious – exogenous and endogenous, non-infectious - according to duration: acute, subacute and chronic - according to exudation: serous, fibrinous, purulent and hemorrhagic - according to histopathology: granulomatous and nongranulomatous - according to anatomical localization: Anterior uveitis, Intermediate uveitis, Posterior uveitis and Panuveitis 3. Anterior uveitis - subjective symptoms - objective symptoms - exogenous anterior uveitis - endogenous anterior uveitis: acute infectious diseases, chronic infectious diseases, focal infectious, metabolic diseases, rheumatological diseases - therapy of acute anterior uveitis: topical and systemic. Posterior uveitis (chorioretinitis) - subjective symptoms - objective symptoms - clinical types: diffuse, multifocal, focal, central, peripheral, juxtapapillary - complications - therapy 6. Diseases, connected with changes in lens transparency acquired cataract: age-related, traumatic, pathologic, complicated, radiation-induced management of the acquired cataract: medical and surgical congenital cataract: types, clinical features, management. Primary angle-closure glaucoma - pathogenesis: relative papillary block, narrowing anterior chamber angle, plateau iris, vitreo-lenticular block - clinical features 297 - differential doagnosis 2. Primary open-angle glaucoma - pathogenesis: dystrophic changes in different parts of the aqueous drainage system, combined with partial block of the anterior chamber angle by the iris’ root or goniosynechiae. Retinal detachment - Rhegmatogenouse retinal detachment - Exudative retinal detachment - Tumour retinal detachment 10. Classification of ocular traumatism - contusions - injures: penetrating and non-penetrating – with or without foreign body - combustions A. Globe trauma - contusions - injures: non-penetrating and penetrating, with or without foreign bofy - explosive injures D. Types of blindness -absolute 300 -practic -work -professional -pedagogical -monolateral and bilateral -reversible and irreversible 4. Visit to the outdoor patients office: methods of examination of the anterior and posterior segments of the eye, visual charts, correction lenses, direct and indirect ophthalmoscopes, perimeter, tonometer, bio-microscope, instruments. Static and dynamic anomalies in the lids position: entropion, ectropion, blepharospasmus, lagophthalmus, ptosis of the eyelids. Pathologic changes in the conjunctiva: hyperemia- conjunctival and cilliary, edema, follicules, papillas, phlyctenas, secretion – catarrhal, purulent, fibrin. Inflammation of the conjunctiva ( conjunctivitis ) – acute, mild, chronic conjunctivitis, catarrhal, purulent, membranous, pseudo membranous, chlamidial, allergic conjunctivitis, conjunctiva-corneal damage in skin diseases, other conjunctivitis. Examination of the lachrymal pathway: - Canalicule test - nasal test - Anel test – demonstration. Pathologic changes in the cornea: opacities – infiltration, cicatrix, degeneration, pathologic vessels: superficial, deep. Inflammatory diseases of the cornea: - superficial, non purulent keratitis - superficial purulent keratitis - deep ( parenchimal ) keratitis - trophic keratitis 4. Pathologic changes in iridocyclitis – changes of the structure of the iris, precipitates, Tyndall effect, posterior synechiae, opacities. Differential diagnosis between iridocyclitis, conjunctivitis, keratitis and acute closure angle glaucoma. Examination of a patient with a cataract in one eye and transparent lens in the other eye by focal illumination, trans illumination and bio microscopy. Demonstration of patients and differential diagnosis between open angle glaucoma and cataract. Optic nerve head edema, optic neuritis, retrobulbar neuritis – ophthalmoscopy, clinical picture, treatment.
Cognition People with eating disorders appear to have problems with global processing of information proven 200mg floxin. An example of overgeneralization includes the belief that the slightest use of carbohydrates would cause obesity quality 200 mg floxin. All-or-nothing reasoning includes the idea that the slightest weight gain will snowball toward obesity. An example of excessive self- reference would be ‘I feel embarrassed when other people watch me eat’. In magical thinking a sweet is considered to be automatically and instantly converted to fat. Expressed emotion in the family, if excessive, should be the subject of intervention. The reasons why patients are admitted more or less readily in different jurisdictions may be more to do with financial and litigation considerations than any scientifico-medical thinking. Re-feeding syndrome 1946 Set-shifting, an important executive function, is the ability to move back and forth between many tasks, operations, or mental sets. It may show as inflexible thinking (concrete, rigid, stimulus-bound) or responding (perseverative or stereotyped). Also, if purging is suddenly stopped rebound oedema may increase a patient’s weight. However, operant approaches have been criticised as being coercive and are now less popular. Patients may secrete food on their person or elsewhere, or 1951 carry weights to weigh down the scales. Drugs (trimipramine, 1952 1953 chlorpromazine , cyproheptadine [Periactin ], and insulin) were commonly used in the past but were generally ineffective. As a general rule, drug treatments are best delayed until following weight restoration or at least until hepatic function and electrolyte balance are normalised. A disturbing development is the presence of internet (‘pro-ana’) sites that promote anorexigenic eating practices and divert people from seeking profession help. The predictors for death were lowest reported weight and repeated hospital admissions. Suicide seems to be more common among bingeing/purging patients than among restricting types. Predictors of poor outcome were lowest weight, length of illness, older age at onset, and disturbed family relationships. Patients may be arrested for stealing food, 1956 clothes, laxatives , or other items. If oral feeding fails the nasogastric feeding may be necessary; feeding via gastrostomy or jujunostomy have been used rarely; and total parenteral nutrition tends to be avoided because of attendant complications. Possibilities might relate to a later age at puberty, testosterone, and a society that advocates fitness rather than thinness. In a large series of cases the males make up a third, which is markedly different from the male to female ratio found in older age groups. They may have failure to gain weight rather than loss of weight, and hormonal changes are not as obvious. If recovery occurs, puberty will often be completed normally but the onset of menses will be delayed. Early feeding difficulties may be elicited, and there may be a history of feeding problems (such as fads) in the family. They may have a history of early behavioural difficulties with poor peer relationships. There is also a high level of family disturbance with an excess of overinvolvement and a disturbance in parent-child relationships, and evidence of problems in intrafamilial communication. The ward milieu should provide a safe environment with age-appropriate firm handling. Certain factors, such as depressive features and one-parent families, are associated with a poor outlook. Therefore the prevalence rates remained stable between their autumn and spring surveys. His diagnostic criteria are no loss of insight, bouts of subjectively excessive overeating, dieting, vomiting, purging, abuse of diuretics or anorectics, and awareness of and upset by slight increases in weight and/or shape. Sullivan ea (1998) suggested that bingeing and vomiting in their population-based sample of female twins (n=1897) were due to the influence (mainly) of multiple genes and (less so) individual-specific environmental influences. Patients seek help either if the condition is severe (they spend quite a lot of money on food) or if there is associated severe anxiety or depression. They view themselves as expert dieticians, may pride themselves on their cooking prowess, and may work in the catering trade. They may vomit up their food later, spit it out there and then, or drink large amounts of fluids to assist vomiting.
Non-compliance Calculation of the shortest and longest interval between two doses generic floxin 200 mg line,the percentage of days with This patient takes the prescribed medication very correct number of doses taken discount floxin 400mg visa,and the distribution irregularly. These limits are,for tients can be expected to have at least one such most drugs,undefined,although progress is being treatment-free phase within a 4 week treatment made with studies that define these limits. Health professionals have an import- Skewed Dosing ant role to play in helping patients comply properly and thus get the fullest possible benefit from their This uncommon type of patient continually prescribed medicines. The result is a high ardy and the costs of care rise,due to the needless fluctuation of the plasma levels and an inadequate addition of second or third agents,unnecessary therapeutic effect. This is especially true for the dose escalations,or repeated diagnostic tests to induction phase of preparations with a protracted ascertain the nature of a clinical problem that has onset of effect,but also for substances with a short been created simply by persistent,clinically unrec- half-life. Many studies have shown that patients undergo- ing long-term treatment in particular do not Skipped Dosing succeed in taking their medication correctly over a long period of time,and the scale of this problem The patient frequently omits a dose unit,e. The most frequent consequence scriptions filled then do not take the prescribed is therapeutic deficits occurring at intervals,which medication at all or do not take it correctly; 30% can lead to a considerable reduction of the overall of all prescriptions are used incorrectly and cause therapeutic success. Overall,it appears that there are four times The daily intake of the medication is not at a as many errors of dose omission than errors of regular,set time but with large temporal deviations excess dosing. Many patients fail to realize that The prevalence of suboptimal compliance in all it is important to take medication regularly and fields of chronic,ambulatory pharmacotherapy is that they can make hazardous mistakes in the well-established. The compliance of the patient is the Results to the Patient Enhances not only influenced by this array of different Compliance factors,but these factors are also under dynamic change. This step is and that the only way to compile a correct record wholly new,for prior efforts to improve compliance is to pay careful attention to the prescribed regimen have relied on patients (self-reported compliance), and link it closely to established routines in daily which is subject to errors due to imperfect memory, life. Despite the disciplinary aspect of the review,the If the results of treatment are unsatisfactory,the vast majority of patients regard the review as a following basic questions must be answered: logical extension of the interest of the prescribing physician in their care. Is the cause pharmacological,due to failure of tate communication between pharmacist and correctly taken drug to work as hoped,or is the doctor,increasing the attention to the patient cause due to inadequate compliance? Individualization of the treat- Many studies have clearly shown that the ment,adapting dose timings to the habits of the compliance of most patients deteriorates as treat- patient,and thus enhancing his compliance,can ment duration progresses. In the forefront is the treating physician, doctors often fail to recognize partial compliance who has to make sound decisions about the pre- or non-compliance in their patients. It seems highly unlikely Weber 1990; Matsui et al 1992; Matsuyama et al that a single type of electronically monitored pack- 1993; Cramer 1995; Feinstein 1990). Accurate understanding of compliance by ically monitored packages to emerge as the recog- physicians can reduce the probability that they will nized need for such information grows. Perhaps,with practice,the patient poor compliance will sooner or later attract serious develops a strong routine of drug intake,linked to attention from insurers and other payers for health some regular routine in his/her life. Prescription drugs,after all,are a principal the reminder device becomes superfluous,although interventional arm of modern medicine,and their it has served its purpose during the start-up phase actions are invariably dose-dependent. Stefan quences of missing an occasional dose of choles- Norell,a pioneer in this field,wrote in 1980: terol-lowering drug are,as far as anyone knows, negligible. Moderate±severe congestive heart failure radically change the medical and economic impli- appears to be one such situation (Kruse and Weber cations of compliance errors. When a strong routine past decade of research on patient compliance,it is exists,this device may be used then only spor- to put uppermost the question: non-responder or adically to check whether the patient is con- non-complier? An electronic dose organizer will help the eld- ing understanding of the medical and economic erly patients with multiple diseases and mul- advantages of correctly answering this basic ques- tiple medications,and may help them cope tion in situations where the wrong answer is very with the more complex regimens. That problem We should not forget,in this world of technol- has been solved by a variety of approaches,which ogy,that the patient should still come before,not integrate time-stamping,recording microcircuitry after,the technology. Technology by itself will not into a variety of drug packages,to record times solve all the problems created by erratic compli- when the package is used in the manner needed ance. Electronic professionals to identify,track,and potentially monitoring is an indirect method of measuring solve many of the issues created by partial and drug intake in ambulatory patients (Bond and poor compliance. It will not be helpful to over long periods of time,and has proved itself in have the patient forced into a world that he/she a variety of settings to be the superior method does not understand. Kruse W,Weber E (1990) Dynamics of drug regimen compli- Cramer J (1991) Overview of methods to measure and enhance anceÐits assessment by microprocessor-based monitoring. Van der Stichele R (1991) Measurement of patient compliance Urquhart J (1991) Therapeutic coverage: a parameter for ana- and the interpretation of randomized clinical trials. Adherence to oral tamoxifen: a comparison of patient self- Urquhart J (1994) Partial compliance in cardiovascular disease: report,pill counts,and microelectronic monitoring. The ethical aspects of this area of medicine are as Their relevance to pharmaceutical medicine is that: varied as the therapies themselves, and could be debated almost ad infinitum. Many patients in clinical trials will be using this short chapter is to alert pharmaceutical phys- complementary therapies (and we often omit icians to this topic, discuss the most commonly to ask on the case report form). There is no reason why comple- Even in the developed world, most good hospices mentary therapies may not be subject to evidence- will have complementary therapists on staff. However, it is believed that the pharmaceut- Zollman and Vickers (1999) have pointed out that ical method, which is at least as rigourous as for the the same patient may be described as having defi- manufacture of allopathic drugs, creates an emer- cient liver Qi by an acupuncturist, as having a gent property in the administered vehicle that still pulsatilla constitution by a homeopath, or having has the therapeutic effect. Associate members of dified and relies on the accumulated experience of the Faculty of Homeopathy may include any clin- both ancient and modern practitioners (Cheng ician with statutorily registered qualifications; the 2000). Licence of the Faculty is available by examination, The complementary therapies themselves also again to all clinicians, usually after study at any of vary in their degree of characterization.
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