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Emed > #7: Opthalamology > Flashcards

#7: Opthalamology Flashcards

1
Q

Ophthalmology Terms

  1. urgent = w/in ____
  2. emergent = w/in ___
  3. biomicroscopy = ____ or _____
  4. lid hygiene = _____ + ______
A

Ophthalmology Terms

  1. urgent = w/in 24 hrs
  2. emergent = w/in 4 hrs
  3. biomicroscopy = slit lamp or woods lamp
  4. lid hygiene = warm compress + gentle shampoo
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2
Q

Central Retinal Artery Occlusion (CRAO) and Central Retinal Vein Occlusion (CRVO)

  1. how are they similar
  2. how are they both dx (2 things)
  3. what is the difference for types of referral
  4. which type is a/w emboli, AI vasculitis, atheroma in situ
  5. which type is a/w HTN, DM, smoking, hypercoag states
A

Central Retinal Artery Occlusion (CRAO) and Central Retinal Vein Occlusion (CRVO)

  1. both: PAINLESS, sudden, monocular vision loss
  2. Dx w/ dilated fundoscope exam, retinal angiography
  3. CRA = emergent referral
    CRV = urgent referral
  4. CRA = a/w emboli, AI vasculitis, atheroma in situ
  5. CRV = a/w HTN, DM, smoking, hypercoag states
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3
Q

Pt presents w/sudden monocular vision loss. On fundoscopic exam you note pale retina with a cherry red fovea

dx?

A

Dx = Central Retinal Artery Occlusion

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4
Q

Pt presents w/sudden monocular vision loss. On fundoscopic exam you note a “blood and thunder fundus”, retinal hemorrhages and disc edema.

dx?

A

Dx = Central Retinal Vein Occlusion

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5
Q
  1. ocular massage
  2. paracentesis
  3. intra-arterial fibrinolytic therapy

are tx for _____

A

Central Retinal Artery Occlusion Tx

  1. ocular massage
  2. paracentesis
  3. intra-arterial fibrinolytic therapy

NONE have proven efficacy

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6
Q

What are 2 tx options for Central Retinal Vein Occlusion

A

Central Retinal Vein Occlusion Tx

  1. intravitreal VEGF inhibitor therapy
  2. photocoagulation
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7
Q

acute inflammation of intraorbital tissue w/ or w/out abscess formation

A

Orbital cellulitis

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8
Q

Orbital Cellulitis

  1. 2 organisms that cause it
  2. 2 other causes
  3. what type of referral needed and for what
    - why
A

Orbital Cellulitis

  1. 2 organisms = Staph, strep
  2. 2 other causes
    - extension of infectious sinusitis
    - dental/facial trauma
  3. emergent referral for surgical drainage
    - b/c can lose site
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9
Q

toxic looking pt presents w/ chemosis, proptosis, afferent pupillary defect and pain w/EOM and dysconjugate gaze

dx?
what type of ABX needed?

A

Dx = Orbital Cellulitis

Tx = broad spectrum IV ABXs

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10
Q

when aqueous humor outflow is obstructed –> intraocular HTN –> ocular ischemia/infarct –> which causes what d/o

A

when aqueous humor outflow is obstructed –> intraocular HTN –> ocular ischemia/infarct –> Acute Closed Angle Glaucoma

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11
Q

Pts presents w/ photophobia, HA, nausea and mid-fixed dilaed pupil w/sluggish light reflex

Dx?

A

Dx = Acute Angle Closure Glaucoma

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12
Q

Acute Angle Closure Glaucoma

  1. 2 ways to Dx it
  2. what 2 meds are oculotoxic and can cause this
  3. what type of referral need and for what procedure
A

Acute Angle Closure Glaucoma

  1. 2 ways to Dx it = applanation tonometry, gonioscopy
  2. oculotoxic meds as cause
    - topiramate
    - beta agonists
  3. emergent referral for iridotomy
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13
Q

Acute Angle Closure Glaucoma Tx: meds given to constrict pupil and decr aqueous humor produced

  1. 2 types of topical meds
  2. 2 types of systemic meds
A

Acute Angle Closure Glaucoma Tx: meds given to constrict pupil and decr aqueous humor produced

  1. 2 types of topical meds
    - beta antagonist
    - cholinergic agonist
  2. 2 types of systemic meds
    - acetazolamide
    - osmotic diuretic
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14
Q

What d/o is a/w HA, jaw claudication, amaurosis fugax, diplopia or scotoma and fever. Labs show elevated ESR and CRP. Dx made w/ temporal Bx and US shows halo sign or occlusion

A

Acute Temporal Arteritis

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15
Q

What is Tx for Acute Temporal Arteritis

A

High dose prednisone

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16
Q

separation of neurosensory retina from pigmented retinal epithelium that is caused by vitreous contraction/liquefaction/desiccation

A

Retinal detachment

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17
Q

Pt presents w/ painless monocular vision loss occuring peripherally but now blocking central vision as well that was preceded by floaters a few hours ago

Dx?

A

Dx = Retinal Detachment

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18
Q

How to Dx Retinal Detachment (2 ways)

A

How to Dx Retinal Detachment

  1. Bedside US
  2. indirect ophthalmoscopy
19
Q

Retinal Detachment Tx

  1. what type of referral needed
  2. 4 tx options
A

Retinal Detachment Tx

  1. emergent referral needed
  2. 4 tx options
    - surgical photocoagulation
    - cryotherapy
    - vitrectomy
    - insert scleral buckle
20
Q

Pt presents w/ diffuse erythema around conjunctiva and mucopurulent discharge

dx?

A

conjunctivitis

21
Q

Conjunctivitis Causes

  1. what is the viral cause/name
  2. clues that its an allergen cause (3)
  3. 3 organisms
A

Conjunctivitis Causes

  1. viral = adenovirus (pink eye)
  2. allergen cause –> itchy, rhinitis, seasonal
  3. 3 organisms
    - staph
    - pseudomonas
    - gonococcus
22
Q

Conjunctivitis Causes: Bacterial

  1. which is a/w contact len use
  2. which is a/w GU dz and “hyper acute”
A

Conjunctivitis Causes: Bacterial

  1. pseudomonas = a/w contact len use
  2. gonococcus = a/w GU dz
23
Q

Conjunctivitis Tx

  1. Tx for atopy
  2. Tx for staph
  3. Tx for gonococcal
  4. which 2 types need urgent referral
A

Conjunctivitis Tx

  1. Tx for atopy = topical antihistamines + vasoconstrictor
  2. Tx for staph = +/- topical fluoroquinolone
  3. Tx for gonococcal = late gen ceph (IV Ceftriaxone)
  4. which 2 types need urgent referral
    - Pseudomonas or gonococcal
24
Q

What typically causes the corneal epithelial defect seen w/corneal abrasions

A

blunt globe trauma = cause of corneal abrasions

25
Q

Pt presents w/ photophobia, blurred vision, pain and corneal irreg after trauma to their eye.
Dx?

A

Corneal abrasion

26
Q

Corneal Abrasion Dx

  1. main way to Dx
  2. how to identify FBs
  3. what test used for ballistic FBs
A

Corneal Abrasion Dx

  1. main way to Dx = Fluorescein-assisted UV biomicroscopy
  2. how to identify FBs = lid eversion
  3. what test used for ballistic FBs = CT
27
Q

Corneal Abrasion Tx

  1. what used for pain and what used to dilate eyes
  2. what type of ABXs (gen/spp)
  3. what should you cover if its contact lens related
A

Corneal Abrasion Tx

  1. topical NSAIDs for pain and cycloplegics to dilate eyes
  2. topical ABXs –> erythromycin
  3. cover for pseudomonas if contact lens related
28
Q

Pt who wears contacts presents w/ pain, photophobia, blurred vision, eye irritation, conjuctival hyperemia, chemosis, corneal white-yellow infiltration. you examine the pt w/fluorscein stain and UV light

Dx?

A

Ulcer

29
Q

Ulcer Tx

  1. what type of consult
  2. what is main Tx
A

Ulcer Tx

  1. urgent consult
  2. main Tx = ABX
30
Q

Foreign Bodies in Eye

  1. what is main Sx (other than FB sensation)
  2. what stain used to dx, where to look
  3. how to r/o intraocular FB
  4. how to remove superficial FB
  5. how to remove superficially embedded FB
  6. what to do if FB is deep/vision changes present
  7. what type of ABX given
A

Foreign Bodies in Eye

  1. what is main Sx (other than FB sensation) = pain
  2. dx = fluorescein stain, look under eyelids
  3. how to r/o intraocular FB = XR or CT
  4. how to remove superficial FB = moist cotton swab
  5. how to remove superficially embedded FB = hypodermic needle
  6. what to do if FB is deep/vision changes present = refer
  7. what type of ABX given = ophthalmic ABX ointment
31
Q

pooled blood in w/in aqueous humor of the anterior chamber

A

hyphema

32
Q

Hyphema

  1. 2 causes
  2. 2 main ways to Dx
    - how to Dx penetrating trauma
  3. what type of referral/why
A

Hyphema

  1. 2 causes = trauma, coagulopathic states
  2. 2 main ways to Dx = biomicroscopy, applanation tonometry
    - Dx penetrating trauma w/CT
  3. emergent referral –> blood can stain cornea permanently
33
Q

pt presents w/ photophobia, anisocoria, “blood and thunder fundus” and dependent red cell meniscus

Dx?

A

Dx = Hyphema

34
Q

Hyphema Tx

  1. why need HOB to 30 degrees
  2. where should they be
A

Hyphema Tx

  1. HOB to 30 degrees to prevent pooling
  2. eyeshieldment in dark room
35
Q

inflammation of cornea w/corneal haze and corneal opacification

A

keratitis

36
Q

Keratitis Causes

  1. viral (3)
  2. bacterial (3)
  3. other (2)
A

Keratitis Causes

  1. viral
    - adeno
    - HSV or VZV
  2. bacterial
    - staph
    - strep
    - pseudomonas
  3. other
    - chemical
    - UV
37
Q

Keratitis Dx

- what type has a dendritic pattern on fluorescein assisted UV biomicroscopy

A

dendritic pattern on fluorescein assisted UV biomicroscopy = HSV or VZV Keratitis

38
Q

Keratitis Dx

  1. how to idenfity FBs
  2. what to do if suspect viral/bacterial cause
A

Keratitis Dx

  1. how to idenfity FBs = lid eversion
  2. suspect viral/bacterial cause –> culture
39
Q

Keratitis Tx

  1. gen Tx for viral cause
  2. Tx for spp HSV or VZV viral cause
  3. Tx for bacterial cause
  4. Tx for chemical/UV cause
  5. what type of referral

Other Tx = topical NSAIDs + cycloplegics

A

Keratitis Tx

  1. gen Tx for viral cause = ppx topical ABX (topical erythromycin)
  2. Tx for spp HSV or VZV viral cause = PO acyclovir
  3. Tx for bacterial cause = topical fluoroquinolone (late gen)
  4. Tx for chemical/UV cause = irrigation
  5. emergent referral
40
Q

Keratitis

- when should you suspect VZV

A

dermatomal V1 distribution (

41
Q

what condition is a/w aqueous humor and proteinaceous precipitates, ciliary flush, hypopyon and meniscus of pus/blood and hazy light line

A

Irisitis

42
Q

Irisitis Causes

  • MOI
  • 2 d/o as causes
  • 1 viral cause
A

Irisitis Causes

  1. trauma
  2. spondyloarthropathies
  3. sarcoidosis
  4. viral = HSV
43
Q

Irisitis Tx

  1. main target is ____
  2. what type of referral
  3. what 2 things given as needed
A

Irisitis

  1. main target = tx underlying condition
  2. referral = urgent
  3. 2 things given as needed
    - topical NSAIDs + cycloplegics

Emed (10 decks)

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