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CMS > Eye Diseases Lecture 3 > Flashcards

Eye Diseases Lecture 3 Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

Essentials of diagnosis for Blepharitis- Anterior

A

CHRONIC bilateral inflammatory conditions of the lid margins

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2
Q

Epidemiology of Blepharitis- Anterior

A

staph aureus or seborrheic

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3
Q

S&S of Blepharitis- Anterior

A

burning, itching, “red-rimmed” eyes with scales or granulation clinging to lashes “scruff” or collarette scales

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4
Q

Complications of Blepharitis- Anterior

A

Recurrent conjunctivitis, hordeolum, chalazion, abnormal lid or lash position

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5
Q

F/U for Blepharitis- Anterior

A

your nurse will call in 24hrs, F/U 1-3 weeks if improving, sooner w/ PCP if increased symptoms or no improvement after 3 days.

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6
Q

Pharm Tx for Blepharitis- Anterior

A

1st line: Erythromycin Ophthalmic 0.5% Ointment -or- bacitracin ophthalmic ointment applied daily to lid margins
2nd line:
Ophthalmic Fluoroquinolones solution (Levofloxacin 0.5% , or Moxifloxacin 0.5%, Gatifloxacin 0.3%)

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7
Q

Non-pharm Tx for Blepharitis- Anterior

A

warm compresses daily to soften encrustations, removal of scales daily with a warm washcloth, diluted baby shampoo twice daily

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8
Q

Pt Ed for Blepharitis- Anterior

A

clean eyes daily,

wash hands before instilling Rx, chronic condition not cured but controlled. no contacts

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9
Q

Essential of diagnosis for Blepharitis- Posterior

A

chronic bilateral inflammatory condition of the lid margins meibomian glands

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10
Q

Epidemiology of Blepharitis- Posterior

A

may have staphylococcus aureus

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11
Q

S&S of Blepharitis- Posterior

A

lid margins are hyperemic with telangiectasias, meibomian glands, are inflamed, lid margins- entropion, tears may be frothy or greasy

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12
Q

Complications of Blepharitis- Posterior

A

recurrent conjunctivitis, hordeolum, chalazion, abnormal lid or lash position

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13
Q

Tx for MILD Blepharitis- Posterior

A

Erythromycin Ophthalmic 0.5% ointment or Bacitracin ophthalmic ointment

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14
Q

F/U and referral for MILD Blepharitis- Posterior

A

routine to ophthalmologist
F/U: you/nurse call within 24 hours, F/U 1 week if Rx is improving condition; sooner with PCP if increased symptoms or no improvement in 3 days

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15
Q

Non- pharm tx for Blepharitis- Posterior

A

regular meibomian gland expression

warm compresses

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16
Q

referral and Tx for SEVERE Blepharitis- Posterior

A

urgent ophthalmologist referral
Tx 1st line:
long-term, low-dose abx:
Tetracycline 250 mg, one capsule PO BID (renal dosing)
OR
Doxycycline 100 mg, one capsule/tablet PO daily (renal dosing)
OR
Erythromycin 250 mg, one capsule/tablet PO TID

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17
Q

Pt Ed for Blepharitis- Posterior

A

prevent complications by regular meibomian expression, if female, no tetracycline during pregnancy, chronic condition cannot be cured, no contacts

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18
Q

Essentials of diagnosis for Chalazion

A

CHRONIC granulomatous inflammation of a meibomian gland, firm, hard non-tender swelling on the upper or lower eyelid with/without redness

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19
Q

Epidemiology of Chalazion

A

common, blockage of Zeis or meibomian gland

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20
Q

Tx and referral for Chalazion

A

routine consult to an ophthalmologist for inclusion and curettage

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21
Q

Pt ed for Chalazion

A

treat hordeolum quickly, resolved with surgery, but may re-occur, annual eye exam

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22
Q

Essential of diagnosis for Ectropion

A

advanced age, outward turning of the lower lid, dry eyes

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23
Q

Tx and referral for Ectropion

A

routine consult to ophthalmologist for surgery

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24
Q

Pt Ed for Ectropion

A

use artificial tears in the morning, no contacts, wear sunglasses

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25
Q

Essentials of diagnosis for Entropian

A

Advanced age, FB sensation, inward turning of the lower eyelid

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26
Q

complications of Entropian

A

conjunctivitis

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27
Q

Tx and referral for Entropian

A

routine ophthalmology consult for surgery

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28
Q

Essentials of diagnosis for Hordeolum

A

acute, painful, redness

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29
Q

Risk factors for Hordeolum

A

Blepharitis, previous hordeolum, contact wearer, make-up, smoke, and dust exposure

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30
Q

Epidemiology of Hordeolum

A

staphylococcus aureus

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31
Q

S&S of Hordeolum

A

acute, painful, redness, pustule

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32
Q

F/U for Hordeolum

A

72 hours if not resolved- send to ophthalmologist for incision

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33
Q

Tx for Hordeolum

A

1st line: do NOT express it, warm compresses

2nd line: may give erythromycin ophthalmic 0.5% ointment

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34
Q

Essentials of diagnosis for Xanthelasma

A

Yellow lesions on the eyelid

35
Q

Risk factors for Xanthelasma

A

hyperlipidemia

36
Q

Tx for Xanthelasma

A

ophthalmology can surgically remove if wanted

control hyperlipidemia (PCP)

37
Q

Essentials of diagnosis for Nystagmus

A

rhythmic regular oscillation of the eye (horizontal, vertical, circular)

38
Q

Risk factors for Nystagmus

A

side effect of Rx, ETOH, infarct, demyelination, neoplasms, hydrocephalus

39
Q

Epidemiology of Nystagmus

A

jerk = slow drift of eyes in one direction, repeatedly corrected with fast movement in the reverse direction, congenital or acquired

40
Q

S&S of Nystagmus

A

eye movement, blurred vision

41
Q

Diagnostic Studies for Nystagmus

A

MRI R/O mass,

Check serum B12 (low), magnesium (low), HIV

42
Q

Tx and management for Nystagmus

A

consult neurosurgeon, tx varies based on the cause

43
Q

Essentials of diagnosis for Optic Neuritis

A

UNILATERAL central vision loss, pain with eye movement

44
Q

Risk factors for Optic Neuritis

A

presenting symptoms for multiple sclerosis; consider hypoparathyroidism

45
Q

Epidemiology for Optic Neuritis

A

inflammation associated with demyelination

46
Q

Disposition and referral for Optic Neuritis

A

inpatient, admit to hospital
emergent consult to ophthalmologist/ neurologist (MS)
or endocrinologist if hypoparathyroidism

47
Q

Pharm tx for Optic Neuritis

A

IV Methylprednisolone x 3 days, then oral tapered dose (MS)

48
Q

Essentials of diagnosis for Third Nerve Paralysis

A

Sudden dysfunction of muscles associated with CN III (oculomotor)

49
Q

Epidemiology of Third Nerve Paralysis

A

subarachnoid hemorrhage, midbrain lesions, intracranial aneurysm, ischemia, trauma

50
Q

S&S of Third Nerve Paralysis

A

diplopia, droopy eyelid (ptosis), HA (worst HA of my life = subarachnoid hemorrhage due to aneurysm)

51
Q

Diagnostic studies for Third Nerve Paralysis

A
  • MRI to r/o lesion
  • Contrast MRI with MRA angiogram) or CTA (CT angiogram) to r/o aneurysm
  • non-contrast CT & LP to r/o meningitis (HA, stiff neck & decreased LOC)
52
Q

Disposition and referral for Third Nerve Paralysis

A

admit to hospital

emergent consult to neurosurgeon, tx based on cause

53
Q

Essentials of diagnosis for Fourth Nerve Paralysis

A

Diplopia and lack of superior oblique m. (unilateral or bilateral), innervated by CN IV (trochlear)

54
Q

Epidemiology of Fourth Nerve Paralysis

A

lesion

55
Q

Diagnostic studies for Fourth Nerve Paralysis

A

MRI to r/o lesion

56
Q

Tx and management of Fourth Nerve Paralysis

A

emergent consult neurosurgeon

57
Q

Essentials of diagnosis for Sixth Nerve Paralysis

A

diplopia and lack of lateral rectus m. (unilateral or bilateral), innervated by CN VI (abducens)

58
Q

Epidemiology for Sixth Nerve Paralysis

A

lesion

59
Q

Diagnostic studies for Sixth Nerve Paralysis

A

MRI to r/o lesion

60
Q

Tx and management of Sixth Nerve Paralysis

A

emergent consult to neurosurgeon

61
Q

Essentials of Diagnosis for Papilledema

A

disc swelling, due to severe HTN or RX side effects or increased intracranial pressure (ICP), VF changes

62
Q

Complications of Papilledema

A

vision loss

63
Q

Tx and management of Papilledema

A

admit to hospital, control causative (BP, Rx, ICP)

64
Q

Essentials of diagnosis for Periorbital Cellulitis

A

infection of the anterior portion of the eyelid, redness, pain, eyelid swelling

65
Q

Other name for Periorbital Cellulitis

A

preseptal cellulitis

66
Q

Epidemiology of Periorbital Cellulitis

A

common Staphylococcus aureus or Streptococcus pneumoniae

67
Q

Diagnostic studies for Periorbital Cellulitis

A

contrast-enhanced CT

68
Q

Pharm TX for Periorbital Cellulitis

A

PO Clindamycin 300 mg PO TID or Bactrim DS PO BID plus augmentin 875 mg PO BID; if not improved in 24 hr, admit to hospital for IV antibiotics

69
Q

Essentials of diagnosis for Posterior Orbital Cellulitis

A

proptosis, swelling, pain with eye movement, redness

70
Q

Risk factors for Posterior Orbital Cellulitis

A

bacterial rhinosinusitis, dacryocystitis, teeth infection, middle ear infection

71
Q

Epidemiology of Posterior Orbital Cellulitis

A

S. pneumoniae, H. influenza, M. catarrhalis, Staphylococcus aureus

72
Q

S&S of Posterior Orbital Cellulitis

A

proptosis, swelling, pain with eye movement, redness, edema, diplopia, vision loss

73
Q

Diagnostic studies of Posterior Orbital Cellulitis

A

contrast-enhanced CT

74
Q

Complications of Posterior Orbital Cellulitis

A

abscess and death if untreated

75
Q

Pharm Tx and management of Posterior Orbital Cellulitis

A

admit to hospital
emergent consult to ophthalmologist

pharm: IV Vancomycin plus ceftriaxone; then discharge on clindamycin 300 mg PO TID or Bactrim DS PO BID plus augmentin PO BID for 2-3 weeks

76
Q

Essential of diagnosis for Thyroid Eye Disease

A

BILATERAL proptosis (exophthalmos)

77
Q

Risk factors for Thyroid Eye Disease

A

Graves disease- hyperthyroidism; Rx

78
Q

Diagnostic studies for Thyroid Eye Disease

A

labs TSH, FT4

79
Q

S&S of Thyroid Eye Disease

A

proptosis, lid lag, stare, +/- enlarged thyroid

80
Q

Tx and management of Thyroid Eye Disease

A

treat thyroid disease, consult ophthalmologist, may have to consult an endocrinologist to control thyroid

81
Q

Essentials of diagnosis for Arygyll Robertson Pupil

A

bilateral small pupils, constrict on accommodation but do not constrict when exposed to bright light (do not “react” to light)

82
Q

Epidemiology of Arygyll Robertson Pupil`

A

Treponema pallidum; neurosyphilis

neurosyphilis can be asymptomatic to meningitis

83
Q

Diagnostic studies for Arygyll Robertson Pupil

A

LP (lumbar puncture)- [Vernal disease research laboratory (VDRL) and Rapid plasma reagin (RPR) may be nonreactive]

84
Q

Tx for Arygyll Robertson Pupil

A

if neurosyphilis:
(report to public health)
STD/STI work-up, treat partner

Pharm: CDC algorithm (IV antibiotics for 10-14 days)

CMS (1 decks)

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