Clinical Opthamology Flashcards

1
Q

What are the Big 3 eye problems?

A

Cataracts
Macular Degeneration
Glaucoma

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2
Q

What is a cataract?

Causes?

A

Opacity of the normally clear lens

caused by age, metabolic disorder, trauma or heredity

Use surgery to replace lens with implant

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3
Q

What is macular degeneration?

A

loss of vision in the center of the visual field (the macula) because of damage to the retina.

A major cause of vision impairment and blindness in older adults

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4
Q

What is the difference between wet and dry macular degeneration?

A

Dry: drusen (tiny yellow or white accumulations of extracellular material)
progressing into: pigmentary retinopathy and atrophy of retina, diminished vision

Wet: It is exudative, defects in deep retinal layers, growth of blood vessels under and in the retina, edema, hemorrhage, fibrosis and scarring. loss of vision

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5
Q

Treatment for dry and wet macular degeneration:

A

Dry Macular Degeneration: quit smoking, nutritional recommendations, AREDS supplements, manage systemic diseases

Wet Macular Degeneration: above recommendations plus conventional laser, photodynamic therapy, anti-vegf drugs(Avastin, Eyelea, Lucentis, Macugen) - these drugs will dry up the exudative stuff

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6
Q

What is glaucoma?

How do you treat it?

A

Increased Ocular Pressure causes optic nerve loss

Treat: lower eye pressure through medicine, surgery or laser

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7
Q

What is a pathological sign that can be monitorred over time to see worsening glaumoma?

A

Optic nerve cupping
Cup is enlarged due to loss of run tissue
(this indicates loss of optic nerve fibers which is common is glaucoma)

(cupping can be other stuff too, watch out!)

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8
Q

How do glaucoma meds work?

A

Decrease IOP by decreasing aqueous production or increasing outflow

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9
Q

How is acute/narrow angle glaucoma more severe than open angle?

A

The onset is acute, it causes severe pain and los of vision
The ocular pressure is extremely high because the narrow angle is actually closed and will not let any fluid outlfow occur

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10
Q

How do you treat acute glaucoma?

A

Pilocarpine
Acetazolamide
Laser iridotomy - opthamologist (opens up iris to allow for aqueous flow once more)

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11
Q

What is diabetic retinopathy?
What is the pathology behind it?

How do you treat it?

A

Increased glucose -> VEGF -> Increased capillary permeability & abnormal vsoproliferation

Prevent with managed blood sugar

Treat with laser , vetrectomy, and anti-VEGF drugs

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12
Q

Detail clinical stages of Diabetic retinopthy:

A

1- Non-proliferative Diabetic Retinopathy
Blot hemorrhage, cotton wools spots, microanyeurisms, macular edema, hard exudate

2 - Pre-proliferative Diabetic Retinopathy
Same, also increaed anteretinal vascular anormalities and venous beading

3 - Proliferative Diabetic Retinopathy
Neovascular vitreoretinopthy, vitreous hemorrhage (new blood vessels leak and block vision) Can even increase risk of retinal detachment

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13
Q

How often should diabetics recieve eye exams?

A

Refer them upon diagnosis of type 2

Should get a yearly dilated eye exam from then on.

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14
Q

What happens in hypertensive retinopthy?

A

Narrowing and sclerosis of arterioles
Flame hemorrhages

Severe Cases
Cotton wool spots
Optic Nerve edema
Silver-wired arterioles
hard exudates
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15
Q

What things can cause sudden visual loss?

A

Amaurosis Fugax (plaque from carotid travels to eye arteries)
Migraine Scotoma (migraine aura)
Retinal Detachment (retina pulls away from supporting tissues)
Retinal Artery Occlusion
Retinal Vein Occlusion
Temporal Arteritis (one or more arteries become inflammed, swollen, and tender)
Stroke

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16
Q

What can be an early warning sign of amaurosis fugax?

A

A hollenhorst Plaque

embolic material within the retinal arteriole

17
Q

True or false - retinal detachment will heal spontaneously?

A

FALSE! never will

18
Q

What does a cherry red spot indicate?

A

Acute central retinal artery occlusion

pale retina with red fovea

19
Q

How do you manage acute arterial occlusion before opthamolgy treatment?

A

Breathing CO2 in a bag causes aterial dilation
Timolol, Levobunolol, and acetazolamide lower ocular pressure
Massage globe with eyes closed

20
Q

Upon examination a patient’s retina looks like a squashed tomato.
You immediately shout:

A

Eureka! It’s Central Retinal Vein Occlusion!

21
Q

Why is a BRVO less serious than a CRVO?

B=branch

A

Less damage in the retina, so less erious vision loss

22
Q

A pateint comes in with headache and scalp tenderness
She has a fever, so you think meningitis?
Then you find out she has jaw claudication and muscle aches
She also is experiencing some vision loss in both eyes with a cherry red spot
What do you think doc?

A

Temporal Ateritis!

vision loss secondary to retinal arteriolar occlusion

23
Q

How do you treat temporal arteritis?

A

Systemic Steroids

24
Q

Patient says:

I do’t know what happened I was eating a chili dog and all the sudden I feel like I can’t see anything to the left.

You think:

A

Hmmm Sounds like a CVA

Either the occipital cortex or anywhere in the visual pathway

25
Q

Cranial nerve palsy in CN3

Symptoms:

A

Ptosis
May have dilated pupil
Eye down and out

26
Q

Cranial nerve palsy in CN4

Symptoms:

A

Paralysis of Superior Oblique muscle
Vertical Diplopia
Subtle findings
-If in doubt, refer to Ophthamology

27
Q

Cranial nerve palsy in CN6

Symptoms:

A

Paralysis of lateral rectus muscle
Affected eye is esotropic (turned in) causing horizontal diplopia
Movement of affected eye partially or totally limited in lateral gaze

28
Q

Worse kind of chemical keratoconjunctivitis?

A

Alkali burn!

29
Q

How do you treat chemicals in eye!

A

flush until ph reads neutral!

30
Q

What tecnique is used to localize abrasions of the cornea?

A

Fluorescein stain under UV light will show where there is an abrasion

31
Q

What is a hyphema?

A

blood in the anterior chamber of the eye

32
Q

What do you NOT prescribe for a corneal abrasion?

A

Topical anesthesia!

33
Q

How do you tell the difference between a bacterial and viral conjunctivitis?

A

Bacterial has purulent discharge

Viral has clear discharge

34
Q

Hallmark of allergic conjunctivitis?

A

Itchy!

ALso will have a longer history, intermittent

35
Q

Diffuse conjunctival injections is most likely a sign of:

A

Conjunctivitis

36
Q

Ciliary injection is likely a sign of?

A

Uveitis

37
Q

Anterior Uveitis Characteristics:

A

Conjunctivitis that wont go away

Ciliary injection
No discharge
Light sensitive
Deep achey pain
Anisocoria (unequal pupil size)
Posterior Synechia (iris adheres to lens)
Associated with systemic disease
38
Q

Lets say a patient arrive in the office with blood on the surface of the sclera(under conjunctiva) without inflammation, pain, or discharge…
what is it?

A

harmless subconjunctival hemorrhage