trauma and red eye when a patient arrives at the er with a supposed alkali chemical burn to the eye,...

Trauma And red eye

When a patient arrives at the ER with a supposed alkali chemical burn to the eye, what is your first action,

a)Check visionb)Check pupils for afferent pupillary

defectc)Irrigate eye with normal salined)Check PH of the conjunctival fornix

Chemical burn : Acid , coagulate proteins and inhibit

further corneal penetration Alkali worse prognosis never try to neutralize

If a ruptured globe is suspected, the first action to take is to:

a)Shield the eyeb)Patch the eyec)Give topical or systemic antibioticsd)Assess the vision

R/o intraocular foreign body with orbital CT scan, specially in metal on metal hammering

NPO IV antibiotic Tetanus status

Need to be referred,

Decreased visionShallow anterior chamberHyphemaAbnormal pupilOcular misalignmentRetinal damage

The best study to evaluate a patient with intraocular foreign body is

a)Orbital ultrasoundb)MRI scan of the orbitsc) CT scan of the orbitsd) Plain film of the skull

The best study to evaluate a patient with intraocular foreign body is,

a)Orbital ultrasoundb)MRI scan of the orbitsc) CT scan of the orbitsd) Plain film of the skull

Management of orbital floor fracture

a) Is a surgical emergency that requires immediate repair

b)Includes surgical repair only for persistent diplopia add/or cosmetic issues.

c) Does not require ophthalmology consultation because associated ocular damage is rare

d)Always includes topical and systemic antibiotics

Management of orbital floor fracture

a) Is a surgical emergency that requires immediate repair

b)Includes surgical repair only for persistent diplopia add/or cosmesic issues.

c) Does not require ophthalmology consultation because associated ocular damage is rare

d)Always includes topical and systemic antibiotics

Treatment:No cough , no nose blowingSystemic AB, if sinusitisSurgery if fx more than 50% of the floor, diplopia not improving, enophthalmos more than 2 mm,

There might be a picture of a kid with white eye, who can’t look up., blow out fracture

In the case of the contact lens wearer with this cornea

a) Instills antibiotics, patch the eye, and reexamine in 24 hours

b)Antibiotic coverage for gram-positive organism is important.

c) refer to an ophthalmologist only if the case is complicated by a corneal infiltrate.

d)The risk of ulceration is significantly higher than in not –contact Lens wearer

No patch in contact lens induced abrasions , risk of pseudomonas ulcer

No patch for simple abrasion less than 10mm,

Never prescribe topical anesthetics,

Proper treatment for a corneal abrasion includes which of the following?

a)Topical corticosteroidsb)A tight patch over the eye for 48 to 72

hoursc)Topical anesthetic for less then 12

hours onlyd)Oral analgesic if necessary

Conjunctival injection with discharge

a)Should be treated with a topical antibiotic even if discharge is watery.

b)Can be treated with a topical steroid initially if inflammation is significant.

c) Should be treated with parenteral antibiotic if gonococcal.

d) Is probably of viral origin in the presence of prominent itching symptoms

Conjunctival injection with discharge

a)Should be treated with a topical antibiotic even if discharge is watery.

b)Can be treated with a topical steroid initially if inflammation is significant.

c)Should be treated with parenteral antibiotic if gonococcal.

d) Is probably of viral origin in the presence of prominent itching symptoms.

PapillaeAllergic conjunctivitisBacterial conjunctivitis

FolliclesViral conjunctivitisChlamydial conjunctivitis

Remember: Gonococcal conjunctivitis should be

treated with parenteral antibiotic.Why?Risk of corneal perforation

10. which of the following is not characteristic of acute angel closure glaucoma

a)High IOPb)Mild eye painc)Decreased visiond)A fixed and dilated pupil

Primary angle closure glaucoma, risk factors

HyperopiaAge>70FemaleFamily historyAsian, Inuit peopleMature cataractShallow anterior chamberPupil dilation

What is your next plan:Refer to ophthalmologist for laser

iridotomy

What would be the next planLaser iridotomyAqueous suppression with BACHMiotics to reverse the pupillary block

11. The finding that best distinguishes orbital cellulites from preseptal cellulitis is,

a)Profound skin erythema with swelling extending above the eyebrow

b)Limited ocular motilityc)Feverd)Pain around the eye

11. The finding that best distinguishes orbital cellulitis from preseptal cellulitis is,

a)Profound skin erythema with swelling extending above the eyebrow

b)Limited ocular motilityc)Feverd)Pain around the eye

Ocular motility Vision RAPD Sinusitis can cause orbital cellulitis and

trauma , skin abrasoin any skin lesion can cause preseptal.

All of the following are part of the evaluation and management of orbital cellulitis except

a)Ophthalmologic consultationb)Orbital CT scanc)Blood cultured)Outpatient administration of oral

antibiotics in an immunocompetent patient

Request stat ophthalmology and ENT consultations to rule out a life–threatening fungal infection (mucoromycosis)

Diabetic patient with ketoacidosi, Frozen globe, + RAPD

12. which of the following is least consistent with the diagnoses of temporal arteritis?

a)Jaw claudicationb)diabetes mellitusc)age over 65 years d)Scalp or forehead tenderness

In a patient who presents with unilateral visual loss with scalp tenderness

a)A temporal artery biopsy should be performed before steroids are started.

b)An erythrocyte sedimentation rate(ESR) should be obtained immediately.

c)Involvement off the second eye is rare.d)Temporal arthritis is unlikely if the

patient is older than 65.

In giant cell arteritis all of the following are true except

a)A low or normal sedimentation rate does not exclude the diagnoses

b)The most common cranial nerve paralysis that occur involves the third cranial nerve.

c)A deficit in choroidal circulation is typically seen on fluorescein angiography.

d)This condition typically affects people under age 60.

F > 60 y/o Abrupt monocular loss of vision, pain

over temporal artery , jaw claudication, scalp tenderness, PMR, constitutional

Diagnosis : temporal artery biopsy Treatment high dose steroid, start

immediately , before the biopsy

Hx: Jaw claudication and diplopia, On exam: temporal a. beading,

prominence of a. tenderness

13. Possible causes for sudden Visual loss include all of following except

a)Temporal arteritisb)Retinal detachmentc)Glaucomad)Nonarteritic optic neuropathy

. The best method for evaluating a 50-year-old patient for best-corrected vision without his or her glasses is,

a)Near cardb)Distance chart with pinholec)Distance chart with both eye opend)Magazine or newspaper

What mechanism of action do cycloplegic use to relieve pain?

a) Topical anestheticb)Paralysis of pupillary dilationc)Paralysis of ciliary spasmd)Decrease production of inflammatory

cells in anterior chamber

This patient presents with sudden unilateral vision loss. All of the following are treatment options except

a)Continues digital massage of the globe to dislodge an embolus

b)Topical beta blockersc) AC paracenthesis by an ophthalmologist a) Re-breathing CO2

Emboli from carotid a. Emboli heart( arrhythmia, valvular,

endocarditis)ThrombosisTemporal arteritis

In the elderly the most come source of emboli to ophthalmic or retinal arterioles is

a) Fibrin or cholesterol from an ulcerated carotid plaque.

b)A calcified heart valvec)Fibrin -platelet emboli from mitral valve

prolapse d)Fibrin- platelet emboli from the aorta

All of the following statements regarding this trauma case are true except

a)It is the result of a tear in an iris vessel.b)It can be associated with other ocular

injuries.c) It is treated with the antibiotics and

routine activities.d)It should be referred to ophthalmologist.

All of the following statements regarding this trauma case are true except

a)It is the result of a tear in an iris vessel.b)It can be associated with other ocular

injuriesc)It is treated with the antibiotics and

routine activities.d)It should be referred to ophthalmologist.

Risk of re-bleed highest on days 2-5 , resulting in

Increased IOP, corneal staining, iris necrosis,

Never asiprin , risk of re-bleed, no valsalva

Herpes zoster involving the ophthalmic devision of cranial nerve V is more likely to have ocular involvements if

a)The tip of the nose is involvedb)The upper lid is involvedc)The lower lid is involvedd)Either lid margin is involved

In presence of Hutchinson sign there is significantly high risk of eye involvement.

Treatment Oral antiviral In cases of conjunctival

involvement ,erythromycin Refer to ophthalmologist and steroid should

be prescribed by ophthalmologist.

A 30 y/o M, presents withredness, pain photophobia and decreased vision. If this is the photo of his eye,the next step is

a)Patch the eye and give assurance of spontaneous resolution

b)Prescribed a topical corticosteroidc)Prescribed a topical antibiotic

ointmentd)Referral to an ophthalmologist

A 30 y/o M, presents withredness, pain photophobia and decreased vision. If this is the photo of his eye,the next step is

a)Patch the eye and give assurance of spontaneous resolution

b)Prescribed a topical corticosteroidc)Prescribed a topical antibiotic

ointmentd)Referral to an

ophthalmologist

Treatment by ophthalmologist Antiviral preferably oral ,Steroid not at the beginning and with

caution , by the ophthalmologist

Lid laceration repair should include

a)Assessment of possible canalicular injury

b)Foreign body removalc)Tetanus prophylaxisd) All of the above

Lid margin laceration Medial lid laceration with canalicular

involvement

Sunconjunctival hemorrhages

a)Are usually a sign of underlying hematologic or coagulation abnormalities, even in the absence of retinal hemorrhages that require extensive Systemic workup.

b)Are sometimes associated with severe pain and or loss of vision.

c)Require cessation of any NSAID or Systemic anticoagulant for resolution.

d)Resolve spontaneously in 2-3 weeks.

Prolonged use of topical ophthalmic anesthetics can cause

a) Iritisb) Corneal damagec) Open-angle glaucomad) Reactivation of a latent herpes

simplex virus infection

Side effects of topical steriod corneal fungal ulcers CataractsOpen-angle glaucomaProgression of herpes keratitis,

dendrites

Treatment of a chalazion , which presents as an acute tender swelling of the lid usually

a)Requires incision and drainageb)Requires topical antibioticsc)Requires a short course of

systemic antibioticsd)Includes warm compresses and

lid hygiene for 2 weeks

Treatment of a chalazion , which presents as an acute tender swelling of the lid usually

a)Requires incision and drainageb)Requires topical antibioticsc)Requires a short course of

systemic antibioticsd)Includes warm compresses

and lid hygiene for 2 weeks

Still a chalazion

Neonatal Chlamydial conjunctivitis

a)Has become rare the advent of silver nitrate prophylaxis

b)Occurs only after 21 days of agec)Maybe treated with topical

erythromycin aloned)Requires two weeks of systemic

erythromycin for effective treatment

Ophthalmia neonatarum

Toxic , 1 day, silver nitrate or erythromycin , no treatment neede

Gonococcal 5-7 days, is the most serious threat 5

Chlamydial , need systemic treatment always

Herpes simplex after 2-3 weeks

Which of the following statements about pterygium is true

a) It is a malignant transformation of bulbar conjunctiva in response to environmental irritants

b) It is prevalent in white collar workers who use computers extensively

c) It is most commonly found on the temporal side of the bulbar conjunctiva

d) In an early stage into maybe managed with use of artificial tears and topical vasoconstrictors

Which of the following statements about pterygium is true

a) It is a malignant transformation of bulbar conjunctiva in response to environmental irritants

b) It is prevalent in white collar workers who use computers extensively

c) It is most commonly found on the temporal side of the bulbar conjunctiva

d)In an early stage into maybe managed with use of artificial tears and topical vasoconstrictors

Patients with episcleritis

a)Usually complain of severe deep pain.b)Are very likely to have a systemic

connective tissue diseasec)Have engorged superficial vessels

overlying the sclera below the conjunctiva.

d)Can develop necrosis and melting of the sclera with perforation.

To differentiate, Place a drop of Phenyephrine 2.5% , re-examine after 10-15 min , episceleral vessel should blanch.

Scleritis, causses vision loss , sever pain , wakes patient up at night tiem, thining(blue hue) and necrosis of sclera

Glaucoma

POAG

Common 95% Chronic Painless Moderate IOP Normal cornea , pupil No symptom

PACG

Rare 5% Acute onset Painful red eye Extremely IOP Haze cornea,

middilated pupil , N/V, halo around light

Risk factor for open-angel glaucoma include each of the following except

a)African racial heritageb)genderc)Age greater than 60 yearsd)Positive family history for glaucoma

Primary open angel glaucoma is defined by each of the following except

a)Adult onsetb)Open and normal appearing anterior

chamber angelsc)The absence of secondary causes for

glaucomad)An IOP of 25 mm Hg

Secondary a glaucoma is caused by each of the following except

a)Myopiab)Uveitisc)Chronic steroid used)Trauma

Remember IOP is a risk factor not a definition

Remember myopia is a risk factor not a cause

, (even a minor risk factor )

An optic nerve with glaucomatous damage may have all of the following except

a)A disc hemorrhageb)Marked pallor of the neuroretinal rimc)Displacement of the retinal vessels

to the margin of the discd)Thinning of the neuroretinal rim

An optic nerve with glaucomatous damage may have all of the following except

a)A disc hemorrhageb)Marked pallor of the neuroretinal

rimc)Displacement of the retinal vessels to

the margin of the discd)Thinning of the neuroretinal rim

All of the following statements regarding topical beta blockers are true except

a)Beta blockers can worsen congestive heart failure

b)Betaxolol is relatively selective beta 1 blockers

c)Topical beta blockers increase the outflow of the aqueous humor

d)The duration of action of beta blockers is 12 to 36 hours, thus patients are dosed once or twice a day

Topical medications used in the treatment of glaucoma include•beta-adrenergic agonist•alpha-2 adrenergic antagonists•cholinergic agonists•carbonic anhydrase agonists

Latanoprost (xalatan) can cause any of the following side effects except

a)Conjunctival hyperemiab)Ptosisc)Increased iris pigmentationd)Lengthening of the eyelashes

Topical parasympathomimetic

Decrease the production of aqueous humor

Can produce eye or brow pain from induced ciliary muscle spasm

Such as echothiophate can allow quicker extubation of patients paralyzed with succinylcholine

Have no known effect on the gastrointestinal system

CRVO Blood and thunder Second most common

retinopathy after DM,

Risk factor HTN, DM, glaucoma,

arteriosclerotic vascular disease, hyperviscosity, (PV, OCP, sickle cell, lymphoma, leukemia,

Teratment of underlying disease

RD , retinal detachment Rhegmatogeneous (most common) caused by tear or hole,Treatment, scleral buckle, rtinopexy

Tractional In diabetic retinopathy, CRVO, sickle

cell, ROP, trauma

Exudative posterior uveitis, central serous

retinopathy tumor

Retinal tearSupratemporal retina , most

common site for horseshoe tearsCaused by PVD, trauma,

Posterior vitreous detachment may be associated with which of the following?

a)Darkness in the central divisionb)Retinal tear or detachmentsc)Athersclerosisd)Temporal arteritis

Posterior vitreous detachmentNormal aging of vitreous liquefaction Floater , flasheh Complication:Tear, RD, more in high myopes

Refere to ophthalmologist, dilated exam , F/U

No specific teratment

Drusen sign of :

Leading cause of blindness, cause metamorphopsia,

Risk factors F, age, family hx, smoking,

caucasian, blue eye

Dry (non-exudative): medical. Monitor, antioxidants

Wet (exudative): laser, PDT, intravitreous injection of anti-VEGF

In diabetic retinopathy vision loss may be caused by

a)macular edema b)macular ischemiac)vitreous hemorrhaged)all of the above

All of the following are signs of nonproliferative diabetic retinopathy except

a)Microaneurysmb)Hard exudatesc)Neovascularization of the discd)Intraretinal hemorrhages

Patient with type 2 diabetes should be evaluated by an ophthalmologist

a)Beginning five years after diagnosesb)Every two years after diagnosesc)At the time of diagnosesd)Not before puberty

A diabetic patient with symptoms of floaters needs to be examined by an ophthalmologist

because of

a)These are typical symptoms of macular edema

b)Probably has suffered a retinal detachmentc)Needs to be evaluated by an

ophthalmologist to rule out the presence of a retinal detachment or vitreous hemorrhage

d)Does not need to be seen by an ophthalmologist because symptoms are usually short-lived

Dx? Triad?

Dx? Triad?APOArteriolar

narrowingPerivascular

bony-spiculeOptic disc pallor

Remembre that 3th nerve palsy:Exotropia and

hypotropia , ptosis,

6th: Esotropia

4th :hypertropia and head tilt

Remember that need imaging if in young pt or associated with

neurological signs,

Amblyopia ,Reductoin of best corrected visual

acuity due to cortical suppression of sensory input

Etiologies Strabismus , Refractive, Deprivation

TreatmentOcclusion of the good eye

PtosisMiosisAnhydrosisHeterochromia

DDx Retinoblasto

ma Cataract Retinal

coloboma ROP Toxocariasis Retinal

detachment

Kawasaki disease No to steroid Yes Aspirin

conjunctivits

Conjunctivitis

Oral mucosal rash

Manifestations of systemic diseases

All of the following are false regarding ocular malignancies except

a)The most common intraocular malignancy in adult is a primary ocular melanoma.

b)The most come primary site of origin of cancer metastatic to the eye in males is the colon.

c)The most common primary site or origin of cancer metastatic to the eye in females is the breast

d)Enucleation is the primary treatment for solitary metastases to the eye.

The most common site for metastasis to the eye is the

a)Irisb)Choroidc)Retinad)Optic nerve

Metastasis , most common intraocular malignancy in adult

Breast in F, lung in M , Neuroblastoma in children

Malignant melanoma , most common primary intraocular tumor in adult

BCC of lid most common lid malignany

All of the following are true regarding intracranial hypertension except

a)The most common ocular manifestation is optic disc edema.

b)Visual deficits that occur during presentation are usually sever.

c)The most common visual symptoms are transient visual obscurations.

d)Idiopathic intracranial hypertension can be associated with vitamin A or D toxicity, tetracycline therapy, and steroid withdrawal.

Papilledema , bilateral disc swelling Nausea/Vomiting/HeadacheTransient visual obscurationPulsatile tinnitus

Sjogren syndrome

a)Is a complex disorder involving the retina and choroid.

b)Is associated with antibodies such as anti -SS-A antibodies

c)Requires surgical excision as primary treatment

d)Effects man five times more often than woman

In patients with connective tissue disorder, dry eye

a)Are the most common ocular manifestations.

b)Are usually associated with permanent visual loss.

c)Can be appropriately treated initially topical antibiotics solutions.

d)Occur most commonly during acute inflammatory episodes.






Keratoconjunctivitis sicca,

Visual symptoms in migraine

a)Are always accompanied by headache

b)Usually have a poor Visual prognosis.c)Vary from scintillations to total

bilateral loss of vision.d)Are always accompanied by

photophobia.

Optic disc swelling in the malignant hypertension

a)Often occurs even in the presence of mild hypertension.

b)Should be treated the high-dose steroids.c) Indicates that the patient is at increased

risk for developing heart failure and hypertensive encephalopathy.

d)Occurs only in the setting of renal failure.



b)Should be treated the high-dose steroids.c)Indicates that the patient is at

increased risk for developing heart failure and hypertensive encephalopathy.


Retinopathy the most common ocular manifestation of HTN.

Key features of chronic HTN: AV nicking, blot hemorrhages, cotton wool spots, microaneurysm

Thyroid eye disease

a)Occurs only when the patient has abnormal serum thyroid hormone level.

b)Can result in severe visual loss from optic nerve compression or corneal damage.

c)Should be treated surgically in its early congestive phase.

d)Will always improve with maintenance of a euthyroid state

NO SPECS No sign Only sign lid retraction, lag Soft tissue swelling periorbital edema Proptosis Extraocula muscle weakness (diplopia) Corneal exposure Sight loss

Manifestations of systemic diseases

All of the following are false regarding ocular malignancies except

a)The most common intraocular malignancy in adult is a primary ocular melanoma.

b)The most come primary site of origin of cancer metastatic to the eye in males is the colon.

c)The most common primary site or origin of cancer metastatic to the eye in females is the breast

d)Enucleation is the primary treatment for solitary metastases to the eye.

The most common site for metastasis to the eye is the

a)Irisb)Choroidc)Retinad)Optic nerve

Metastasis , most common intraocular malignancy in adult

Breast in F, lung in M , Neuroblastoma in children

Malignant melanoma , most common primary intraocular tumor in adult

BCC of lid most common lid malignany

All of the following are true regarding intracranial hypertension except

a)The most common ocular manifestation is optic disc edema.

b)Visual deficits that occur during presentation are usually sever.

c)The most common visual symptoms are transient visual obscurations.

d)Idiopathic intracranial hypertension can be associated with vitamin A or D toxicity, tetracycline therapy, and steroid withdrawal.

Papilledema , bilateral disc swelling Nausea/Vomiting/HeadacheTransient visual obscurationPulsatile tinnitus

Sjogren syndrome

a)Is a complex disorder involving the retina and choroid.

b)Is associated with antibodies such as anti -SS-A antibodies

c)Requires surgical excision as primary treatment

d)Effects man five times more often than woman






Keratoconjunctivitis sicca,

Visual symptoms in migraine

a)Are always accompanied by headache

b)Usually have a poor Visual prognosis.c)Vary from scintillations to total

bilateral loss of vision.d)Are always accompanied by

photophobia.



b)Should be treated the high-dose steroids.c) Indicates that the patient is at increased

risk for developing heart failure and hypertensive encephalopathy.




b)Should be treated the high-dose steroids.c)Indicates that the patient is at

increased risk for developing heart failure and hypertensive encephalopathy.


Retinopathy the most common ocular manifestation of HTN.

Key features of chronic HTN: AV nicking, blot hemorrhages, cotton wool spots, microaneurysm

Thyroid eye disease

a)Occurs only when the patient has abnormal serum thyroid hormone level.

b)Can result in severe visual loss from optic nerve compression or corneal damage.

c)Should be treated surgically in its early congestive phase.

d)Will always improve with maintenance of a euthyroid state

NO SPECS No sign Only sign lid retraction, lag Soft tissue swelling periorbital edema Proptosis Extraocula muscle weakness (diplopia) Corneal exposure Sight loss

Cotton-wool Patches in AIDS patients

a)Indicate obstruction of the pre-capillary arterioles with infarction of the superficial retina

b)Occur only in patient with advanced disease

c) Represent active cytomegalovirus (CMV) retinal infection.

d)Often result in profound vision loss

DDFx of CWS Diabetic retinopathyHTN retinopathyHIV

All of the following statements about optic neuritis are false except

a)It is painless.b)It always spontaneously resolves.c) It may be initial manifestation of

multiple sclerosisd)It usually results in permanent visual

loss

All of the following statements about optic neuritis are false except

a)It is painless.b)It always spontaneously resolves.c) It may be initial manifestation

of multiple sclerosisd)It usually results in permanent visual

loss * In MS diplopia can be 2º to internuclear ophthlmoplegia (INO)

Young female Blurred vision , decreased color vision,

2º to optic neuritis, Diplopia 2º to internuclear

ophthalmoplegia RAPD, ptosis, uveitis, optic atrophy,

nystagmus, optic neuritis

In optic neuritis, treatment with oral steroid will increase the risk of MS

[email protected] notes

trauma and red eye when a patient arrives at the er with a supposed alkali chemical burn to the eye,...

Documents

vision slide

red eye slide

fracture slide

skull slide

lens wearer slide

systemic antibiotics

conjunctival fornix

white eye