ENOT/Ophthalmology

Question 1

Neisseria gonorrhea conjunctivitis 
Path:
Pt:
Dx:
Tx:

Answer 1

Path: N. gonorrhea transmitted to eye from hands after contact with infected genitalia

Pt: <5d newborn, sexually active adult
hyper-purulent discharge
corneal ulceration/perforation

Dx: gram stain-> gram - diplococci

Tx: immediate ophthalmologic referral
IV ceftriaxone + topical abx

Question 2

Viral conjunctivitis
Path:
Pt:
Tx:

Answer 2

Path: adenovirus

Pt: foreign body sensation, erythema, pruritus, normal vision
Preauricular LAD, copious watery discharge, scant mucus discharge

Tx: Supportive: cool compress, artificial tears, +/- antihistamine (olopatadine) from itching/redness

Question 3

Bacterial conjunctivitis
Path:
Pt:
Tx:

Answer 3

Path: S aureus, Strep pneumo, H flu
contact lense wearer-> pseudomonas

Pt: Conjunctival injection (segmentally or diffuse)
Purulent discharge, mattering of lid margins (difficulty opening eyes), photophobia

Tx: topical abx- erythromycin, trimethoprim and polymyxin B, sulfacetamide, ciprofloxacin, ofloxacin, gatifloxacin

Question 4

Allergic conjunctivitis
Pt:

Tx:

Answer 4

Pt: bilateral conjunctival erythema +/- other allergic symptoms (rhinorrhea, etc)
Cobblestone mucosa (inner/upper eyelid), itching tearing, redness, stringy discharge, +/- chemosis (conjunctival swelling)

Tx:

• Topical antihistamines (H1 blockers)- olopatadine (patanol- antihistamine/mast cell stabilizer), pheniramine/Naphazoline (Naphcon A- antihistamine/decongestant), emedastine
• Topical NSAIDs- ketorolac
• Topical corticosteroids (risk of glaucoma, cataracts, HSV keratitis w/ long term use)

Question 5

Meniere Disease
Path:
Pt:
Dx:
Tx:

Answer 5

Path: Idiopathic distention of end-lymphatic compartment of the inner ear by excess fluid

Pt:
Episodic vertigo: peripheral, lasting min-hrs, horizontal nystagmus +/- N/V
Tinnitus and fluctuating hearing loss

Dx: CLX
Transtympanic electrocochleography - most accurate during an episode, loss of nystagmus w/ caloric testing

Tx:
Symptomatic- antiemetic antihistamines (meclizine, prochlorperazine), benzodiazepines (diazepam) anticholinergics (scopolamine)
Decompression (tympanostomy tube, labyrinthectomy)- refractory to meds or severe
Prevention- Low salt diet, diuretics (HCTZ) reduced endolymphatic pressure

Question 6

Parotitis
Path:
Pt:
Tx:

Answer 6

Path: S aureus, Polymicrobial

Pt: Sudden onset firm, erythematous swelling of pre and post auricular areas that extends to the angle of the mandible
trismus, dysphagia
High fever, chills, marked toxicity
Risk: post-op elderly who are dehydrated and intubated

Tx: Admit for IV anti staphylococcal antibiotics-> Nafcillin + metronidazole or clindamycin