■ Notes on cornea :- ( part 2 )

● the diameter of cornea measured by caliber or pentacam topography
● the thickness of cornea measured by pachymetry
● The bowman layer can't regenerate while descement membrane can regenerate
● Endothelium of cornea decrease in no.  with age & examined by specular M.C
● Pneumococci is the commonest  organism in case  of bacterial keratitis
● double therapy of antibiotics is the 1st line ttt in aggressive disease of bacterial keratitis
● heaped hypopyon is associated with fungal keratitis
● Steriods+ corneal ulcer = corneal perforation
● Keratomalacia  :
♤ there is melting of cornea & eye is quite
And TTT by topical vit A & associated with nutritional deficiency
● Corneal anaesthesia = neurotrophic keratitis :-
♧ Herpes zoster of ophthalmicus is the most common cause
♧ IT treated by median tarsorraphy
● Exposure keratopathy is affect lower 1/3 of the cornea with upper horizontal line
● Degree of corneal opacities :-
♧ nebula , macula, leucoma
♧ nebula affect vision more than macula
● 2ry glucoma :-
♧ Anterior staphyloma ♧ corneal fistula ♧ leucoma adherent 

■ ophthalmology :-

● Cornea :-
https://t.me/med_Notes2/67
https://t.me/med_Notes2/69

● eye lid :-
https://t.me/med_Notes2/28
https://t.me/med_Notes2/34
https://t.me/med_Notes2/61

صباح الخير دي مهمة و ركزوا عليه
دي مقارنة بين ciliary & conjunctival injection

■ الشباتر الصغيرة في الرمد :- من 5 لحد 10 صفحات
Pupil , sclera , orbit , intra ocular tumors , lens , optic nerve
■ الشباتر المتوسطة ب 17 صفحة :-
Glucoma , errors of refraction , squint
لو بديت فيهم هتخلص بدري .

■ Notes on middle ear diseases : ( part1):

● Dehiscene of the bony facial canal is the most common congenital anomaly of the middle ear
● incudostapedial joint is the most common affected joint in ossicular disruption
● Otitic barotraumas happen when the different pressure on both sides of ear drum more than 80 mmHg
● severe cases of otitic trauma ttt by myringoplasty
● longitudinal fracture base of the skull is the most common , while transverese fracture is the most serious
●Haemtympanum is one of sign of transeverse fracture
● E.T is one of the commonest route of infection in case of  otitis media
● Nose is one of the commonest source of infection in case of O.M
● Any Deafness is associated with tinnitus
● Earache with diminution of hearing after common cold may be d.t AOM
●  in case of catarrhal O.M :
♤ congested T.M  with CHL
● in case of suppuration O.M :
♤  after drum perforation : all signs of inflammation and pain & discharge decrease & there ia central perforation
● CT & PTA are most important investigation
● A child with earache or night crying after common cold = AOM
● AOM is common in infant & young children is due to E.T is short &wider& more horizontal
● OToscopy : the drum is thick & doesn't bulge easily & lusterless
● myringotomy is done after faliure of TTT for 48 hrs
● complication is more common d.t misdiagnosis as G.E & low resistence

مساء الخير يا شباب في أكثر من حد بعت متى هنزل الجزء الثاني أنا للاسف مش هقدر انزلها اليوم لأني تعبان و مريض شوي
أنا كتبتها بس مش كلها هنزلها بكرا الصبح بإذن الله بعد ما اكملها
دعواتكم الي أني أكون بخير .

■ Note on middle ear diseases ( part N ) :
● The commonest part to be eroded in CSOM is long process of incus
● Benign tumors of middle ear the most common is glomus tumor 
● Petrous site is the commonest site for cholesteatoma
● Tubo -tympanic disease is the most common type of CSOM
● secretory OM is the commonest cause of bilateral CHL in children
♧ Tympanoplasty should be combined with cortical mastoidectomy if there is discharge
● cholesteastoma :
♧ perforation in pars flaccida
♧ CHL except if there is erosion of inner ear leads to SNHL
♧ Facial paralysis & vertigo& earache  may be 1st presentation
♧ it is always treated surgically and the best is canal wall down technigue
●in case of CNSOM  : the tympanic membrane is intact
● secretory OM : the tympanogram is type B curve while in adhesive OM is type C
● secretory OM that treated by surgical the incision in ear drum should be in Antero superior part
● the early & most common complaint in glomus tumor is pulsating tinnitus
● the cr.nr affected is 7, 8 ,9, 10 , 11 , 12
● A Patient with unilateral conductive deafness & pulsatile tinnitus  : Glomus tumor
● the biopsy is CI in glomus tumor
● SCC of middle ear :
♧ it is common in male above 60 years old
♧ there is mixed hearing loss
 

■ Note on complication of SOM :
● Stapedial otosclerosis is the commonest type
●Stapedectomy is the TTT of choice in otosclerosis , while NaF used if surgery is CI 
● Sagging of  EAC is the early & diagnostic sign of Acute mastoiditis
● The post auricular groove is preserved in acute mastoiditis
● _ve fistula test :
* dead ear & very small & closed by cholesteastoma
● Labyrinthine fistula & diffuse serous :
♧ the nystagmus to the same side of lesion
While in diffuse suppurative to normal side
● Diffuse serous labyrinthitis :
♧Mixed HL
♧ will be improved with medical TTT
● Pertrositis & Extradural abscess is commonly associated with mastoiditis
●  In Extradural abscess :
♧ the granulations over the dura should be left intact for fear of CSF leak & infection
● Do CT before Lumber puncture in case of meningitis to exclude SAH
● Tempral lobe is the more common affected in case of brain abscess
● Griesinger's sign : it is edema over the mastoid
● MRA is the most diagnostic in case of Lateral sinus thrombophelibitis
● Lateral sinus thrombophelibits : Anemia & leucocytosis
● Given Anticoagulants  after removal thrombus & Cavernos sinus thrombosis
 

■ NOTES On TBL : -

● Part 1 :
https://t.me/med_Notes2/83
● part 2 :
https://t.me/med_Notes2/92
● Part 3 :
https://t.me/med_Notes2/94

صباح الخير يا شباب كده كل النوتس كتبتها اللي دخلة ف TBL و حاولت اركز على الحاجات اللي بتيجي ف MCQ فيها
دعواتكم و لا تنسوني من صالح دعائكم نلتقي في أيام قادمة بإذن الله و بالتوفيق لينا جميعاً .

■ Tympanogram : -

● ossicular disruption : type Ad ( hypermoile)

● secretory OM : type B

● adhesive OM : type C

● E T dysfunction : type C

● otosclerosis : type As ( restricted curve)

Affect last 4 cranial nerves : 9 , 10, 11 and / or 12

I say that again more & more
● hemotympanum is one of signs of transverese fracture
بمعنى لما يحصل الدم اللي جاي من ال inner ear بيتجمع ف middle ear وراء ear drum
Which mean the ear drum is intact
يعني مش هشوفها غير لما ادخل بالمنظار و هشوف ال blood وراءها
اعتقد كده وصلت و مش محتاجه يعني شرح .

■Notes on EOM :-
● The nearest EOM to macula is IO
● The nearest EOM to limbus is MR
● when you bring viusal axis to longitudunial axis to ms is called main action
● when the viusal axis is perpendicular to longitudinal axis of ms is called subsiadiary action
● MR is the largest & strongest ms in the eye
● So is the only depressor when the eye is adducted
● SR is the only elevator when the eye is abducted
● All EOM supplied by oculomotor nerve except ( SO by IV nerve , LR by VI nerve) 
● insertion of EOM :
*MR > 5.5 mm
* IR > 6.5 mm
*LR > 7mm
*SR > 7.7mm
From limbus
● Action of EOM :-
*SO & SR : intortion
* IO & IR : extortion
♧ Recti ms : Adduction except LR ( Abduction)
♧ oblique ms : Abduction
♧ SO & IR : depression
♧ IO & SR : elevation 

ده جدول مقارنة مهم لل types of squint

■ Notes on squint ( part 1 ) :

● the most important procedure in a child with unilateral squint is fundus examinaton
● Pseudo squint : two  visual axises are normal  , while true squint  the abnormal direction of visual axis of one or both eyes
■ Apparent squint :
♧ high mypia : angle alpha are -ve
♧ hypermetropia: angle alpha are + ve
♧ Angle alpha is b.t  visual axis & optical axis & it is normally + 5 degree & measured by ambyloscope
♧ corneal light reflex in the center of pupil
♧ TTT of cause such as epicanthus by skin re-distribution not Excision
■ Latent squint :-
● the most common cause is errors of refraction
● if not treated lead to manifest squint
● correct of errors of refraction is the most important step in ttt
● surgical TTT is done in case of large deviations
● examination :
♤ firstly the pt has no squint before & even after the examination but during the examination the pt has it
♤ Cover test is done to detect manifest squint in other eye
♧ un-cover test is done to detect latent squint in affected eye which mean the eye is cover
♧ Maddox Rod & maddox wing is done for dissociation of binocular vision for far object & near object respectively .