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*Pance Re-Up * > EENT Precision & Pearls #1 (Eye) > Flashcards

EENT Precision & Pearls #1 (Eye) Flashcards

1
Q

Bacterial conjunctivitis is MCC by what bacteria? What are the symptoms?

A

Staph Aureus

-Purulent discharge
-unilateral
-lid crusting (eye stuck shut in morning)
-no vision changes, no itching

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2
Q

Treatment for Bacterial conjunctivitis (both non-contact lens wearer, and contact lens wearer)

A

-Non contact lens: Topical ABX (Erythromycin ointment, Trim-Poly B, Moxifloxacin, Ofloxacin)

-Contact lens use: Topical Ciprofloxacin or Ofloxacin

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3
Q

What bacteria are you concerned about covering if the patient wears contact lens’?

A

Pseudomonas Aeruginosa

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4
Q

Viral conjunctivitis, MCC by _______, is MC in children. What is something that spreads this condition and what are the symptoms

A

Adenovirus

Swimming pools –> outbreaks

-Starts unilaterally –> bilaterally
-FBS/grittiness
-Copious watery tearing
-Preauricular LAD
-Punctate staining

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5
Q

Treatment for viral conjunctivitis

A

Supportive (cool compresses, artificial tears, antihistamines)

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6
Q

On the other hand, symptoms of allergic conjunctivitis include

A

-Conjunctival erythema with normal vision
-Other allergic symptoms (congestion, sneezing)
-Often bilateral
-Cobblestone mucosa
-chemosis (conjunctival edema)
-watery discharge

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7
Q

Treatment for allergic conjunctivitis

A

-Symptomatic
–Topical antihistamines (Olopatadine, Pheniramine-Naphzoline)

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8
Q

Neonatal conjunctivitis (ophthalmia-neonatorum), is conjunctivitis contracted during delivery. What are the causes in the following time frames:
-Day 1:
-Day 2-5:
-Day 5-7:

A

Day 1: Chemical conjunctivitis caused by silver nitrate

Day 2-5: Gonococcal MCC

Day 5-7: Chlamydia MCC

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9
Q

Management for Gonococcal conjunctivitis

is there anything you can do to prevent this?

A

IM or IV Ceftriaxone

Prophylaxis: Topical Emycin ointment

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10
Q

Management for Chlamydia conjunctivitis in a neonate

is there anything you can do to prevent this?

A

Oral Erythromycin

No prophylaxis effective to prevent this condition

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11
Q

What should you give an adult with chlamydial conjunctivitis?

A

Azithromycin 1000mg single dose, Doxycycline, Tetracycline, or Erythromycin

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12
Q

Cataract is ________ and some of the causes/risks for developing these include….

What are some symptoms of this?

A

Lens opacification (thickening)

Aging (MC), Congenital, Smoking, Corticosteroid use, DM, Trauma

Halos around lights, difficulty driving at night, painless/slow progressive blurry vision, absent red reflex, opaque lens

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13
Q

If the patient has a corneal abrasion, what is seen on slit lamp examination?

A

With fluoroscein stain, ice rink/linear abrasions.

Evert the eyelid to look for foreign bodies

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14
Q

Management for an ocular foreign body/ocular abrasion (contact lens vs non contact lens)

A

-Eye wash and irrigation, topical anesthetic
-Non contact lens: Emycin ointment, Tri-Poly B
-Contact lens: Topical Cipro or Ofloxacin
-DO NOT PATCH if Pseudomonas expected (contact lens use)

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15
Q

When should you remove a rust ring with an ocular foreign body?

A

in 24 hours with a burr

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16
Q

Management for a sub conjunctival hemorrhage

A

-Check VA, EOM’s, slit lamp, IOP
-If history of trauma, rule out ruptured globe and retrobulbar hemorrhage
-Give artificial tears, most resolve spontaneously and on their own

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17
Q

Keratitis is corneal inflammation or a corneal ulcer. If bacterial in nature, what is the MCC in a non-contact lens wearer? How about if they do wear contacts?

What are the risks for this condition?

A

Staph A, Strep

Pseudomonas

Improper contact lens usage (MC), Immunosuppression, dry ocular surface

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18
Q

Symptoms of keratitis include…

What diagnostic is done and what do you see with bacterial keratitis?

What do you see with herpes keratitis?

A

Pain, redness, vision changes, photophobia, FBS, ciliary injection, hazy cornea

Slit lamp: increased uptake of fluoroscein stain

Herpes: dendritic branching with fluoroscein stain

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19
Q

Treatment for bacterial keratitis?

Treatment for herpes keratitis?

A

-Fluoroquinolone topical (Moxifloxacin)

-Herpes: Topical Antivirals (Trifluridine) or PO Acyclovir

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20
Q

What is photokeratitis, what is it from, and what is seen on fluoroscein stain on slit lamp?

A

Excessive UV exposure (snow/sun, welding, sun lamps)

Presents 6-12 hours after exposure

Diffuse defects on staining

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21
Q

Describe a pterygium

What are some risks associated with this condition?

A

Elevated, fleshy, triangular shaped growth that starts medially (nasally) and grows outward

UV exposure in tropical climates, sand, wind, dust exposure

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22
Q

On the other hand, describe a pinguecula and explain some risks associated with it

A

Slowly growing thickening of the conjunctiva. Yellow, slightly elevated nodule on nasal side of sclera that doesn’t grow onto the cornea

Eye irritation (dry, windy, sunny)

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23
Q

Dacryocystitis is an infection of the lacrimal sac due to __________.

The MCC is _____, but other causes are Staph Aureus and GABHS.

A

Obstruction of the nasolacrimal duct

Staph Epidermidis

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24
Q

Symptoms of dacryocystitis

A

-Tearing, tenderness, warmth, swelling to medial/canthal side of lower lid area
-May have purulent discharge

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25
Q

Treatment for dacryocystitis

A

-acute: warm compresses + ABX (Clinda, Vanco + Ceftriaxone)

-Chronic: Dacryocystorhinostomy

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26
Q

Blepharitis is inflammation of the eyelid margin. Some risk factors associated with this condition are….

There are two types. Posterior and Anterior. Explain the different etiologies between them.

Symptoms of this condition

A

Risks: Seborrheic dermatitis, Down’s Syndrome, Rosacea

Posterior: MC type. MGD
Anterior: Infectious. Staph A.

Scaling, crusting of the lids or lid margins. Flaking on lashes. Red rimming of eyelid.

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27
Q

Treatment for blepharitis

A

Eyelid hygiene, artificial tears

If severe: Topical Azithromycin or Erythromycin

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28
Q

Describe a chalazion. What is it from? What are the symptoms? What is the treatment?

A

Painless nodule of internal meibomian gland due to obstruction of meibomian gland

Painless, slowly growing nodule. Eyelid swelling, erythema, recurrent

Warm compresses, eyelid massage

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29
Q

On the other hand, describe a hordeolum (stye) and what is it MCC by?

A

Localized abscess of eyelid margin. Painful, erythematous, warm nodule on the eyelid

MCC by Staph Aureus

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30
Q

Treatment for a stye

A

-warm compresses, I&D if no spontaneous drainage by 48 hours
-May add topical Erythromycin if needed

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31
Q

Explain the pathophysiology of an entropion and an ectropion

A

Entropion: eyelid inverted due to spasms of orbicularis oculi muscle

Ectropion: eyelid everted due to relaxation of orbicularis oculi muscle

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32
Q

Treatment for ectropion/entropion

A

Artificial tears is conservative
Blepharoplasty is definitive

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33
Q

What is papilledema, what are causes, and what are symptoms?

A

Swelling of optic disc due to increased ICP

Brain tumors, intracranial hypertension, etc.

H/a, n/v, AMS, vision loss, diplopia, blurriness

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34
Q

What diagnostics should you get for papilledema?

A

Fundus exam: swollen optic disc with blurred margins, retinal hemorrhages

MRI/CT followed by LP to rule out mass

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35
Q

What medication can be given to lower intracranial pressure and what does it do?

A

Acetazolamide (decreases production of CSF)

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36
Q

Optic Neuritis (CNII Inflammation) is acute inflammatory demyelination of the optic nerve. What are some causes of this condition?

Who does it most commonly occur in?

A

MS, Ethambutol, infections (HSV, Syphillis)

Young females. Remember association with MS and Ethambutol (TB medication)

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37
Q

Symptoms of optic neuritis

Diagnostics that should be done and what confirms it.

Treatment for optic neuritis

A

-Sudden, PAINFUL loss of vision
-Desaturation (loss of color vision)
-Central scotoma
-Unilateral symptoms
-pain worse with eye movement
-Marcus-Gunn Pupil: pupil DILATES with light

Fundus exam: Optic disc swelling. Usually a clinical diagnosis. MRI Confirms diagnosis

IV Methylprednisolone then oral corticosteroids

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38
Q

Orbital (Septal) Cellulitis is an infection of the orbit POSTERIOR to the orbital septum. it is MC in children (7-12 years old). What are the bacteria that cause it?

What is the MC etiology?

Symptoms of this condition

A

-Polymicrobial: Staph, Strep, Hflu

-Secondary to sinus infection (ethmoid sinus)

-Pain with eye movement, ophthalmoplegia (EOM weakness), diplopia, proptosis, eyelid erythema/edema

39
Q

What diagnostic should be done for orbital cellulitis?

What is the treatment?

A

High resolution CT scan of orbits

Admission + IV ABX (Vanco + Ceftriaxone/Cefotaxime)

40
Q

On the other hand, preseptal (periorbital) cellulitis is an infection ANTERIOR to orbital septum. What are the symptoms of this condition?

A

-Unilateral ocular pain, eyelid edema
-NO PROPTOSIS, OPTHALMOPLEGIA, or PAIN WITH EOM

41
Q

Treatment for preseptal cellulitis

A

-Outpatient if older than 1 year old
–Oral Clindamycin or Bactrim + Amoxicillin

42
Q

If the patient has bitemporal hemianopsia, where would you expect the optic lesion to be?

A

Lesion of the optic chiasm

43
Q

Risk Factors for a retinal detachment.

What is the MC Type of RD and what does that mean?

Symptoms of an RD

A

Myopia (nearsightedness), Age, Trauma, Previous Cataract surgery

Rhegmatogenous (full thickness tear of retina)

Photopsia (flashes), floaters, progessive unilateral peripheral vision loss, curtain or veil coming down, no ocular pain

44
Q

What is seen on fundoscopy of a patient with a retinal detachment?

What is the treatment and what should you do with the patient?

A

Fundoscopy: tissue flapping in vitreous. Shafer sign: clumping of brown pigment cells in anterior vitreous that looks like tobacco dust

Ophthalmic emergency – Referral! Keep patient supine with head turned to the side of the detachment.

45
Q

Macular degeneration is the MCC of permanent legal blindness and vision loss in older adults. What are the symptoms of this condition?

A

Bilateral, progressive central vision loss (detailed and colored vision)

Metamorphsia (curvy lines)

Micropsia (objects are smaller than they actually are)

46
Q

On Fundoscopy, what is seen with both types of macular degeneration?

A

Dry (atrophic): drusen bodies, small round yellow/white spots

Wet (Exudative): new, abnormal vessels that cause hemorrhage and scarring

47
Q

Treatment for both types of macular degeneration

A

-Dry: Zinc and antioxidant vitamins (C & E)

-Wet: Intravitreal VEGF inhibitors (Bevacizumab) which decreases new vessel formation

-Laser photocoagulation can be done as well

48
Q

Risk Factors for macular degeneration

A

Females, smoking, >50 years old, Caucasians

49
Q

What is the MCC of new, permanent vision loss in ages 20-74

A

Diabetic retinopathy

50
Q

What are the two types diabetic retinopathy? Explain them.

A

Nonproliferative: micro aneurysms, cotton wool spots, hard exudates, blot and dot hemorrhages, flame shaped hemorrhages

Proliferative: neovascularization (new vessels) that lead to vitreous hemorrhage

51
Q

Treatment for both types of diabetic retinopathy

A

Nonproliferative: glucose control, laser
Proliferative: VEGF inhibitors, laser

52
Q

How often should those with diabetes get an eye exam?

A

Annually (once per year)

53
Q

Hypertensive retinopathy is due to chronic, uncontrolled hypertension. There are three severities of this condition. What are the symptoms of each?

A

Mild: copper wiring (moderate narrowing), silver wiring (severe narrowing) AV nicking

Moderate: hemorrhages, cotton wool spots, hard exudates, MCA’s

Severe: All of the above with papilledema (blurring of optic disc)

54
Q

What is a hyphema? What are some etiologies of this condition?

A

Collection of RBC’s in the anterior chamber

Trauma, post-op, coagulopathy (sickle cell)

55
Q

What is one thing to remember in a patient with a hyphema (What is one association you should keep in mind)

A

Sickle Cell can have a hyphema as a complication of trauma

56
Q

What should you keep in mind when treating a hyphema?

A

Bed rest with head elevation > 45’
Analgesics, eye shield

57
Q

Explain symptoms of amaurosis fugax and what is it commonly associated with?

A

Transient, monocular vision loss that lasts minutes, with complete recovery

Commonly associated with stenosis of internal carotid artery (retinal emboli)

58
Q

An orbital floor (blowout fracture) occurs due to blunt trauma (baseball to the eye, etc.) What is the MC type of fracture? What is a complication of this?

A

Inferior (MC)

Orbital fat and inferior rectus muscle may prolapse into maxillary sinus

59
Q

Symptoms of an orbital floor fracture

A

-Diplopia with upward gaze (inferior rectus muscle entrapment)
-Decreased VA
-Orbital emphysema (eyelid swelling after blowing nose)
-Anesthesia to anteromedial cheek due to stretching of infraorbital nerve

60
Q

What diagnostic should you get for a suspected orbital floor fracture and what is the treatment?

A

CT scan: Teardrop sign

Nasal decongestants, avoid blowing the nose
-ABX (Ampicillin-Sulbactam or Clindamycin)
-Surgical repair

61
Q

Symptoms of a globe rupture

A

Pain suddenly after injury or trauma

Teardrop or irregular pupil

Severe conjunctival hemorrhage (360’ bulbar)

Positive Seidel’s Test: parting of fluoroscein dye by clear stream of aqueous humour

62
Q

Management for a globe rupture

A

-Leave impaled objects undisturbed
-Rigid eye shield
-Emergent oph consult
-Tetanus prophylaxis

63
Q

A central retinal artery occlusion (CRAO) is MC due to _______.

Symptoms of this are:

A

Emboli from carotid artery

-Acute, sudden painless monocular vision loss
-Ipsilateral carotid bruit

64
Q

What is seen on a fundoscopy exam for a CRAO?

What is the treatment for CRAO?

A

Pale retina with cherry red macula. Boxcar appearance of vessels

ocular massage, oxygen, lower IOP, Poor prognosis

65
Q

On the other hand, a CRVO, has symptoms similar to that of a CRAO? What are they?

What is seen on a fundoscopy exam?

What is the treatment for a CRVO?

A

Sudden, painless monocular vision loss

Fundus exam: extensive retinal hemorrhages (blood and thunder appearance). May have a Marcus-Gunn Pupil, optic disc swelling

Good prognosis. Anti-VEGF injections, surgery, laser

66
Q

What is the pathophysiology of chronic open angle glaucoma?

What are the symptoms?

A

Decreased aqueous humor drainage through the TM damages the optic nerve

Slow, progressive, painless bilateral peripheral vision loss
-Tunnel vision
-Cupping of optic discs
-Increased CD ratio
-Notching of disc rim

67
Q

Treatment for chronic open angle glaucoma

A

-Prostaglandin analogs (Latanoprost) first line
-Beta Blockers (Timolol), Acetazolamide
-Laser therapy (Trabeculoplasty), Surgery

68
Q

The leading cause of preventable blindness in the US is _____.

Risks for this include…

A

Acute angle closure glaucoma

Hyperopia (far sighted), females, age > 60

69
Q

Precipitating factors for acute narrow angle closure glaucoma?

What will likely be the scenario in which this is presented on the exam?

A

Mydriasis (dilation), Dim lights, anticholinergics

Walking outside into a dimly lit movie theater

70
Q

Symptoms of acute narrow angle closure glaucoma

A

-Sudden onset of severe, unilateral eye pain
-Halos around lights
-Loss of peripheral vision
-Cloudy cornea
-Mid-dilated fixed pupil
-Eye hard on palpation

71
Q

Diagnostics for acute narrow angle closure glaucoma

What is the treatment?

A

-Tonometry: IOP > 21mmHg
-Fundoscopy: optic disc blurring or cupping

-Treatment: combination of topical agents (Timolol, Pilocarpine) with systemic agents (PO or IV Acetazolamide or IV Mannitol)

-Definitive treatment: Iridotomy

72
Q

Diagnostics for acute narrow angle closure glaucoma

What is the treatment?

A

-Tonometry: IOP > 21mmHg
-Fundoscopy: optic disc blurring or cupping

-Treatment: combination of topical agents (Timolol, Pilocarpine) with systemic agents (PO or IV Acetazolamide or IV Mannitol)

-Definitive treatment: Iridotomy

73
Q

What is amblyopia? What are three common etiologies (SOS)? When should you refer a child with amblyopia?

A

Unilateral abnormal visual development during childhood (lazy eye)

-Etiologies: Spectacles (refractive error), Obstruction (cataract, retinal disease), Strabismus

Refer if > 2 lines difference between the eyes in VA, abnormal red reflex, or ptosis in one eye

74
Q

What is the treatment for amblyopia?

A

Patch the good eye to strengthen the weak one!

75
Q

What may be a on a history of a patient with color blindness?

What test can be done to assess?

A

Usually inherited - ask about family history
-Difficulty distinguishing between shades of red and green
-Chemical exposure may be a cause

Ishihara test for red-green deficiencies

76
Q

Strabismus is a misalignment of one or both eyes. What is esotropia and what is exotropia?

What diagnostics/tests can be done for this condition?

What is the treatment?

A

-Esotropia: convergent = deviated inward (nasally)
-Exotropia: divergent = deviated outward (temporally)

Hirschberg Corneal light reflex testing: asymmetric deflection of light reflex
-Cover uncover test!

Patch normal eye to strengthen weak eye!

77
Q

An ocular chemical burn is an ophthalmic emergency. Is an alkali burn or an acid burn worse? What should you do for this condition?

A

Alkali burns are worse = liquefactive necrosis and denaturing of proteins

Irrigation started ASAP with LR or Normal Saline for 30 minutes and at least 2 L of fluid. Until pH of 7.0-7.4 is achieved.

Then, give ABX: Moxifloxacin, Trim-Poly, Emycin Ointment

78
Q

Scleritis is MC in young women and has an association with what? Name some symptoms of this condition as well.

A

Associated with autoimmune or connective tissue diseases (RA, SLE)

Deep/boring eye pain. Pain with eye movement. Deep violaceous patches beneath bulbar conjunctiva.

79
Q

Scleritis should be referral to an ophthalmologist ASAP. What is the treatment they will likely be started on?

A

Topical corticosteroid drops

80
Q

There are two types of uveitis (iritis). Name them, explain them, and describe the symptoms associated with them.

A

Anterior: inflammation of iris.
-Unilateral severe eye pain, photophobia, redness, blurriness, decreased vision

Posterior: inflammation of choroid.
-Blurriness, may not be painful

Symptoms of both: mitosis, ciliary injection, photophobia

81
Q

Uveitis may be associated with what conditions?

A

Systemic inflammatory and autoimmune
–HLA-B27, Sarcoidosis, IBD
–CMV, TB, Syphillis

82
Q

What is seen on fundus exam in a slit lamp of a patient with uveitis?

What is the treatment for both types of uveitis?

A

Inflammatory cells and flare
-WBC and proteins

Anterior: topical glucocorticoids
Posterior: systemic glucocorticoids

83
Q

What is the MC interocular malignancy of childhood?

What gene mutation is this due to ?

A

Retinoblastoma

Mutation in RB1 gene on chromosome 13

84
Q

Symptoms of a retinoblastoma

A

-Leukocoria (abnormal white reflex)
-Nystagmus, strabismus (+/-)

85
Q

What diagnostic is done for a retinoblastoma?

Treatment?

A

Ocular US = intraocular mass

Radiation, chemo, enucleation

86
Q

What is another name for epidemic keratoconjunctivitis? What are the main causes?

A

Viral conjunctivitis

Adenovirus (types 8, 19, 37, and 54)

87
Q

What is retinitis? What are two types and what symptoms can be associated with these conditions?

A

Disease that damages that retina

Retinitis Pigmentosa (genetic), CMV retinitis (herpes virus)

Floaters, blurry vision, loss of central vision at first and then peripheral vision, can affect color vision too

88
Q

What is one health maintenance thing to remember for retinitis pigmentosa?

A

Protect the eyes from UV by wearing sunglasses, etc.

89
Q

What is conjunctival chemosis and what is it commonly from?

A

Swelling of the tissue that lines the conjunctiva

Usually from irritation, allergies, watery eyes, itchiness, etc.

90
Q

What is an Argyll-Robertson Pupil?

What is it MCC by?

A

Pupil that constricts on accommodation but does not react to bright light

Neurosyphillis

91
Q

Describe the 6 EOM muscles, where they are located, and what motions they each perform.

A

MR: Adduction (middle)
LR: Abduction (outer)
SR: Elevation, Adduction, Intorsion
IR: Depression, Adduction, Extorsion
IO: Elevation, Abduction, Extorsion
SO: Depression, Abduction, Intorsion

92
Q

Xanthelasma
-Define
-Causes
-Treatment

A

Soft yellow plaque filled with cholesterol on medial canthus of eye

Associated with hyperlipidemia, DM, and thyroid dysfunction

Treatment: Lower lipids, excision, cauterization if needed

93
Q

Ocular melanoma risk factors and exam findings

A

-RF: Sun exposure, tanning, outdoor activities. occurs in choroid or iris of the eye

Exam: blurry vision, color change of iris, pain, pressure like sensation

Surgical resection and chemotherapy are treatment

*Pance Re-Up * (76 decks)

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