Diabetic retinopathy micro aneurysms are caused by

Diabetic Retinopathy
 Micro-aneurysms are caused by neovascularization (new fragile arteries in the retina that
rupture and bleed).
 Cotton wool spots- look like fluffy yellow-white patches on the retina.
Cataracts
 Opacity of the lens of the eye (central or on the sides (cortical)).
 Difficulty with glare (with headlights when driving at night or sunlight) , halos around lights,
blurred vision.
Koplik’s Spots
 Cluster of small red papules with white centers inside the checks by the lower molars that is
usually indicative of Measles.
Hairy Leukopenia
 Elongated papilla of the tongue that is usually indicative of HIV infection that is caused by
the Epstein-Barr Virus.
Cheilosis
 Painful skin fissure at the corners of the mouth due to excessive moisture (most common in
elderly with dentures).

 Secondary infections with yeast of bacteria can occur, but also multiple etiologies such as
over salvation, poorly fitting dentures, nutritional deficiencies, lupus, autoimmune disease,
irritant dermatitis, squamous cell carcinoma, and pacifier us in children.
 TXT-
o treat underlying cause (i.e. yeast, bacteria, use of pacifiers, or dentures no fitting
correctly).
o Once underlying cause is treated use barrier creams with zinc or petroleum jelly
applied at night b/c there is a high rate of reoccurrence.
Testing Vision
 Distant vision – Snellen chart (abnormal if less than 4/6 letters correct).
 Near Vision- just ask patient to read small print.
 Color blindness- use Ishihara chart.
 Legal Blindness- 20/200 or less or a visual field less than 20* (tunnel vision).
 NOTE: by age 6 children should be 20/20 visual acuity in both eyes – use Snellen chart for
them.
Hearing
 Weber Test: place the tuning fork midline on the forehead.
o Normal- no lateralization
o Abnormal – lateralization (sound is only in one ear).
 Rinne Test: place the tuning fork on the mastoid process, then at the front of the ear.
o Normal – Air conduction lasts longer than bone conduction (pt can hear longer in
front of the ear than on the mastoid bone).
o Abnormal: bone conduction last longer than air conduction. (pt can hear longer on the
mastoid than in front of the ear)
Exam Tips
 Rinne Test
o BC greater than AC is conductive hearing loss- cerumenosis or AOM
o Normal finding- Air conduction last longer than bone conduction AC > BC
 Weber Test
o Results in lateralization (an abnormal finding) to the bad/affected side with
conductive hearing loss.
 Both weber and Rinne test cranial nerve 8
 Lateralization – is defined by hearing sound louder on one side
Types of Hearing Loss
 Conductive (outer and middle ear) – any type of obstruction of the sound waves that will
cause conductive hearing loss (i.e. ceruminosis, otitis externa, fluid inside the middle ear
(otitis media, serous otitis media).