ENT and Ophtho Flashcards
Give a condition that corresponds to the following eye conditions:
a. Coloboma
b. Dislocated Lens
c. Aniridia- absent iris
d. Glaucoma
a. Coloboma- defect in iris- CHARGE
b. Dislocated Lens- Marfan’s
c. Aniridia- absent iris- WAGR (Wilms Tumour-aniridia syndrome)
d. Glaucoma- NF1, SWS (Sturge Weber)
What underlying diagnosis would you suspect in a child with tearing, photophobia and blepharospasm?
Glaucoma
blepharospasm is twitching/contraction of eyelid
21 m with crusty yellow discharge from Left eye and conjunctivitis. Normal visual acuity, no propotosis, no periorbital swelling, normal EOM. You prescribe cipro topical drops. At 36 h exam, unchanged. What is your next step?
a. Refer to ophto
b. Prescribe IV antibiotic
c. Continue and return in 48 h
d. Prescribe fucidic acid drops
a. Refer to ophto - should see response in 1-2 days - if no response then refer to ophtho
* note - fucidic acid is a steroid antibiotic drop - only ophthalmologists should put steroids in eyes!
What is the management of bacterial conjunctivitis?
warm compresses; topical antibiotics (gent/tobra or cipro)
What type of bacteria would you suspect are causing this eye infection and how should it be treated? - significant conjunctival injection, edema (chemoses), gritty sensation, purulence, tenderness on palpation.
Neisseria gonorrhea or meningitidis
Needs treatment with systemic antibiotics (not topical)
Child 3 y/o referred for behaviour problems. Mom concerned because child refuses to wear patch for
amblyopia for the past 8 months. What do you do?
1. Refer to social work
2. Immediate referral to ophthalmology for other treatment modalities
3. Refer to ophthalmology once child has started to wear patch again
4. Refer to parenting class through public health to learn skills to make child wear patch
- Immediate referral to ophthalmology for other treatment modalities
Can do chemical patching with atropine drops
When would your refer a child with esotropia or exotropia to an ophthalmologist (2 lines)?
o Refer if: (goal- normal sight, straight looking eyes, binocular vision)
▪ Decreased visual acuity
▪ Fixed deviation
▪ >4 months of age (strabismus is normal up to 4 months of age)
Picture of child. Apparent right esoptropia but normal corneal reflex. What is the diagnosis?
pseudostrabismus
3 mo Baby with crusty yellow eye discharge, no conjunctivitis, on and off for past 3 months. What is your management? a. Refer to ophto b. Massage tear duct c. Topical abx daily d. Dacryrhinostomy
b. Massage tear duct
blocked tear duct (nasolacrimal duct obstruction; dacryostenosis)
Tx: massage 2-3 times daily; cleanse any discharged liquids with warm water; can use topical antibiotics for mucopurulent drainage but IF red/hot/swollen/tender/febrile needs systemic abx
A baby has congenital nasolacrimal duct obstruction (dacrostenosis). What statement is true about this condition?
a) it is present at birth
b) baby may develop dacrocystitis
c) it should be treated with topical antibiotics
d) it is always symptomatic at birth
b) baby may develop dacrocystitis
3mos with Nasolacrimal duct obstruction, what to do:
a) observe
b) refer to ophtho
c) topical abx
d) systemic abx
a) observe
96% resolve by one year of age
Treatment for nasolacrimal duct obstruction?
a . Nasolacrimal massage 2 – 3 times per day with cleaning lids with warm water
b. 96% resolve by 1 year of age
c. Ophthalmology referral during the first 6 months is not necessary unless there are multiple cases of acute dacryocystitis or large congenital mucocele
d. Most Ophthalmologist advise referral between 6 – 13 months because during this period simple probing of the duct is curative in 95%
e. After 13 months the cure rate with probing alone falls to 75% and silicone intubation of the duct is necessary
a . Nasolacrimal massage 2 – 3 times per day with cleaning lids with warm water
This is the right “treatment” option, but everything else here is true as well
3 causes of leukocoria
Leukocoria = white pupillary reflex (white instead of red)
- cataract
- retinoblastoma
- chronic retinal detachment
- advanced ROP (cictricial)
A child is found to have different sized pupils. The physical exam is otherwise normal. Which statement is true:
a. unequal pupils are seen in 25% of normal children - seems most correct
b. it is an autosomal recessive trait - autosomal dominant per OMIM
c. the larger pupil is abnormal - no could be the larger or the smaller
d. the larger pupil will have an abnormal shape - not necessarily, though maybe if associated
with coloboma
CORRECT: a. unequal pupils are seen in 25% of normal children (anisocoria)
b. it is an autosomal recessive trait - autosomal dominant per OMIM
c. the larger pupil is abnormal - no could be the larger or the smaller
d. the larger pupil will have an abnormal shape - not necessarily, though maybe if associated with coloboma
What are pathologic causes of anisocoria? (name 2)
Horner syndrome (can be caused by underlying neuroblastoma)
congenital iris defects (coloboma, aniridia)
medications (topical)
- err on the side of referring to ophtho
What are features of physiologic/simple anisocoria?
less than 0.4mm difference between the sides usually persistent (look back through old photos and see if it has always been there)
Which sport is the most common cause of eye injury in Canada:
a. baseball
b. hockey
c. soccer
d. golf
e. javelin
f. basketball
b. hockey
- then racket sports and baseball
Child with hyphema, when is rebleeding most likely to occur
a) 24 h
b) 4 days
c) 1 week
d) 2 week
b) 4 days
Mgmt: head of bed to 30 degrees, bed rest, shield without underlying patch on affected eye, consult ophtho (they will prescribe topical steroids and cycloplegia agent)
If there is a hyphema, list 2 steps in your immediate management. What is 1 complication if not treated properly?
Bed rest, HOB to 30 degree, Shield (without patch) on affected eye, Cycloplegic agent,
topical or systemic steroids, arrange ophtho assessment
Complication: loss of vision due to: rebleeding, glaucoma, corneal blood staining
Picture of a stye. What is this? How do you treat it?
Stye AKA hordeolum - inflammation and infection (staph) of sebaceous glands in the eyelid
- treat with warm compresses and consider topical antibiotics
- I&D may be needed if no improvement
What is a chalazion and how do you treat it?
chronic inflammation of sebaceous glands (it is a lipogranuloma)
- tx: referral to ophtho for surgical excision
Description of an infant with a hemangioma on the eye lid. List 2 thing you would do for immediate management
- evaluation by ophthalmologist for potential for vision compromise
- assess for other hemangiomas on face, especially in beard distribution
5year old boy, with serous and mucoid discharge from left eye (exact words). No periorbital edema or erythema. Mom and brother had a similar episode a week ago. How do you manage? a. reassure b. start antibiotics drops c. po keflex d. CT orbits
a. reassure
Contact lens kid on cipro drops. Exam unchanged after 48 hours. Mgt?
a) ref to ophtho - with contact lenses should always err on side of sending to ophtho
5 yo girl holding 2 month old baby sister who accidentally pokes her eye (corneal abrasion on fluorescein)? List 2 steps in managing.
- topical antibiotic ointment (e.g. erythromycin) 4x/day for 3-5 days
- ibuprofen for pain
- plan follow-up to ensure resolved
symptoms of corneal abrasion: pain, tearing, photophobia, decreased vision
Which is true regarding retinal hemorrhages:
a. needed to diagnose shaken baby syndrome
b. can occur in a vaginal delivery
c. do not occur after a C-section
d. always associated with trauma
e. can occur with CPR
b. can occur in a vaginal delivery - yes, 25%, higher if vacuum assisted - 100% will be resolved by 6-8 weeks
Can occur with C/S but less likely; CPR is a rare if at all true cause of retinal hemorrhage; can be atraumatic
