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PANCE 2024 > EYES Review FINAL > Flashcards

EYES Review FINAL Flashcards

1
Q

Symptoms of Acute Dacryocystitis Vs Chronic

A

-Acute: tearing, edema, erythema, warmth to medial canthal (nasal) side of the lower lid area. Purulent discharge.

-Chronic: mucopurulent drainage without other signs of infection

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2
Q

Treatment for Dacryocystitis
-Acute
-Chronic

A

-Acute: Warm compresses + Clindamycin or Vancomycin + Ceftriaxone

-Chronic: Dacryocystorhinostomy

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3
Q

Two types of Blepharitis. Which is more common?

A

Posterior (MC): Meibomian Gland Dysfunction

Anterior: Infectious (Staph Aureus) Or Seborrheic

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4
Q

MCC of Hordeolum (Stye)

A

Staph Aureus

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5
Q

Symptoms of a Globe Rupture

A

-Enopthalmos or Exophthalmos
-Positive Seidel Test
-Teardrop or irregular shaped pupil
-Severe conjunctival hemorrhage (360 degrees bulbar)
-VA markedly reduced

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6
Q

What is the best diagnostic for a orbital floor “blowout” fracture?

A

CT san: Teardrop sign (inferior herniation of orbital fat inferiorly)

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7
Q

Treatment for a orbital floor fracture

A

-Nasal decongestants (avoid blowing nose or sneezing)
-Antibiotics (Ampicillin-Sulbactam or Clindamycin)

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8
Q

Symptoms and Diagnostics for a retinoblastoma

A

-Leukocoria: presence of abnormal white reflex instead of normal red reflex. Strabismus or Nystagmus.

-Ocular US: intraocular calcified mass

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9
Q

What is one unique finding on funduscopy that can be seen in a retinal detachment?

A

Schafer’s Sign: clumping of brown-colored pigment vitreous cells in the anterior vitreous humor resembling tobacco dust

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10
Q

Risk Factors for a retinal detachment

A

Myopia (nearsightedness), previous cataract surgery, advancing age, trauma

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11
Q

Managemnet for a retinal detachment

A

Ophthalmologic emergency: keep patient supine, head turned toward side of the detachment

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12
Q

Neonatal Conjunctivitis
-Day 1
-Day 3-5
-Day 5-7

Treatments and prophylaxis for all

A

-Day 1: Chemical conjunctivitis due to silver nitrate. Give AT’s

-Day 3-5: Gonorrhea. IM or IV Ceftriaxone as treatment. Topical E-mycin as prophylaxis.

-Day 5-7: Chlamydia. Oral E-mycin for the infection. No prophylaxis effective.

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13
Q

Treatment for Ocular Foreign Body and Bacterial Conjunctivitis if:

-Contact Lens Wearer
-Non-Contact Wearer

A

-Contact: Cover Pseudomonas (Topical Ciprofloxacin or Ofloxacin)

-No Contacts: Topical Erythromycin

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14
Q

Symptoms of Viral Conjunctivitis

A

-Caused by Adenovirus
-Swimming pools, direct contact
-Preauricular LAD, copious watery tearing, punctate staining on slit lamp

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15
Q

Symptoms of Allergic Conjunctivitis

A

-Marked pruritus, sneezing, congestion, cobblestone mucosa, watery or mucoid discharge, chemosis (conjunctival edema)

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16
Q

Treatment for Allergic Conjunctivitis

A

-Topical Antihistamines (Olopatadine) or Pheniramine-Naphazoline

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17
Q

Ocular Chemical Burns
-Alkali Burns:
-Acidic Burns:

Treatment

A

-Alkali Burns: worse than acids, causes liquefactive necrosis.
-Acidic Burns: coagulative necrosis

Immediate irrigation until pH 7.0-7.4 (neutral) with lactated ringers or normal saline, then topical ABX (Polymyxin-Trimethoprim, E-mycin ointment, or Moxifloxacin)

18
Q

Referral for strabismus needed if persists > what age?

A

> 4-6 months of age

19
Q

Strabismus initial screening

What other test can be done?

A

Hirschberg corneal light reflex testing

Cover-uncover test: misaligned eye will deviate inward or outward

20
Q

Orbital (Septal) Cellulitis
-Symptoms
-Diagnostics
-How to differentiate from Pre-Septal
-Treatment

A

-Symptoms: ocular pain with eye movement, ophthalmoplegia (EOM weakness), diplopia, proptosis, visual changes
-High resolution CT scan
-PreSeptal Cellulitis has no proptosis, ophthalmoplegia, or ocular pain with eye movements
-Treatment: Admission + IV Vanco + Ceftriaxone/Cefotaxime

21
Q

Pre-Septal Cellulitis
-Symptoms
-Diagnostics
-Treatment

A

-Symptoms: unilateral ocular pain, eyelid erythema, and edema
-CT scan to differentiate
-Treatment: Outpatient management if > 1 year old and mild = Oral Clindamycin mono therapy or Bactrim + Amoxicillin

22
Q

Bacterial keratitis is ______________ and the pathogen that is increased in contact lens wearers is ________. Risk factors include ______, dry ocular surfaces, and ________.

What is seen on examination with this condition?

A

Corneal inflammation and ulceration.

Pseudomonas Aeruginosa is increased in contact lens wearers.

-RF: Improper contact lens use (MC), topical corticosteroid use, immunosuppression.

Symptoms: ocular pain, photophobia, eye redness, vision changes. Ciliary injection (limbal flush), hazy cornea/opacification, increased fluorescein uptake on slit lamp

23
Q

Treatment for bacterial keratitis

A

Fluoroquinolone topical (Moxifloxacin, Gatifloxacin). Do NOT patch the eye.

24
Q

With herpes keratitis, what is seen with fluorescein staining?

A

Dendritic branching corneal ulceration

25
Q

Treatment for herpes keratitis

A

-Topical Trifluridine, Ganciclovir ointment, or PO Acyclovir.

26
Q

Uveitis (Iritis)
-Etiologies
-Symptoms
-What is seen on slit lamp?
-Management

A

-Etiologies: Systemic inflammatory and autoimmune diseases (IBD, Sarcoidosis, HLA-B27, etc.)

-Symptoms: unilateral severe ocular pain, photophobia, eye redness, blurry vision, ciliary injection, consensual photophobia, constricted pupil (miosis)
-Slit Lamp: inflammatory cells and flare (WBC’s and proteins in vitreous humor)

-Treatment: Topical glucocorticoids for anterior. Systemic glucocorticoids for posterior.

27
Q

Risk Factors for Cataracts

A

-Aging, smoking, glucocorticoid use, Diabetes, UV light, malnutrition, trauma.

28
Q

What is seen on exam with a cataract?

A

Absent red reflex
Opaque lens

29
Q

Optic Neuritis
-Etiologies
-Symptoms

A

-Etiologies: Multiple Sclerosis, Autoimmune, Ethambutol, Chloramphenicol

-Symptoms: Painful loss of vision, decrease in color vision (desaturation), central scotoma (blind spot), unilateral.

-Exam: Ocular pain worse with movement, Marcus-Gunn Pupil

30
Q

What is a Marcus-Gunn Pupil?

A

During swinging flashlight test from unaffected eye to the affected eye, the pupils appear to dilate

31
Q

What can be seen on funduscopy for optic neuritis?

What confirms the diagnosis with MS is the cause?

A

Optic disc swelling/blurring (papillitis)

MRI confirms when MS is the diagnosis

32
Q

Treatment for optic neuritis

A

IV Methylprednisolone followed by oral corticosteroids

33
Q

What is a way to remember Relative Afferent Pupillary Defect (RAPD)?

A

Ray in the Affected Pupil Dilates

34
Q

What is an Argyll-Robertson Pupil?

What is the MCC?

A

Pupil constricts on accommodation but does not react to bright light

Neurosyphillis is the MCC, Diabetic neuropathy is another cause

35
Q

What is the pathophysiology of acute narrow angle-closure glaucoma?

What are precipitants of an attack?

Symptoms?

A

Decreased drainage of aqueous humor via trabecular meshwork and canal of Schlemm

-Mydriasis (pupillary dilation), dim lights, sympathomimetics, anticholinergics

-Sudden onset of severe, unilateral ocular pain. Halos around lights and loss of peripheral vision. Nausea, vomiting, headache. Conjunctival erythema, steamy cornea, mid-dilated fixed pupil, eye hard on palpation.

36
Q

Diagnostics for acute narrow angle glaucoma
-Tonometry
-Funduscopy
-What is gold standard?

A

-Tonometry: increased IOP > 21

-Funduscopy: optic disc blurring, cupping of nerve (0.9)

Gonioscopy is GOLD

37
Q

Management of ANAG

-Definitive?

A

-Topical agent (Timolol, Apraclonidine, Pilocarpine) + systemic agent (PO or IV Acetazolamide or IV Mannitol)

-Definitive: Iridotomy

38
Q

Symptoms of chronic open angle glaucoma

-First line treatment?

A

-Slow, progressive painless bilateral peripheral vision loss progressing to central loss

-Prostaglandin analogs first line (Latanoprost)

39
Q

CRAO
-Etiologies
-What does the patient normally have a history of?
-Symptoms
-What is seen on Funduscopy?
-Management?

A

-Etiologies: embolic from carotid artery atherosclerosis MC, cardiogenic embolic MCC in young patients and those without atherosclerosis

-History of atherosclerotic disease

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

-Funduscopy: pale retina with cherry red macula. Boxer appearance of retinal vessels (segmentation of blood flow).

-No consensus on optimal management.

40
Q

CRVO
-Risk Factors
-Symptoms
-Funduscopy
-Management

A

-RF: Hypertension, DM, Glaucoma, Hypercoagulable states, smoking
-Sudden onset of painless monocular vision loss
-Funduscopy: extensive retinal hemorrhages (blood and thunder appearance). May have Marcus-Gunn Pupil.
-Management: No definitive management

PANCE 2024 (12 decks)

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