Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3SP: Pre And Post Op > Final > Flashcards

Final Flashcards

1
Q

Why would you want to consider doing a forehead lift before you do an eyelid lift?

A

A forehead lift needs to be completed before an eyelid lift so that the patient will be able to close their eyelids. If an eyelid lift is completed before a forehead lift, the eyelids will be stuck with a “stare” appearance due to the skin being extremely tight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is one way to determine if eyelid ptosis is obstructing vision in patients with dermatochalasis

A

To assess the visual loss caused specifically by the dermatochalasis you should do a tape and untaped visual field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the main precaution you need to take into consideration when evaluating a cutaneous horn?

A

The main concern is that the base of the horn could be a SCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most useful component of a VF in determining insurance coverage for ptosis surgery

A

Although we do not usually use the grey scale, insurance companies use the grey scale to determine if a ptosis surgery should be covered or not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A patient presents ortho upon arrival, however after measuring unilateral VAs, you notice a small XT OD that recovers in 6 seconds. What is their score on the Holmes Control Scale?

A

Their score is a 2 on the Holmes scale. There is no XT until dissociation and recovered in more than 5 seconds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What would you suspect if a patient presents with a Duane’s-like deviation post strabismus surgery and what should you do?

A

A slipped muscle. Refer back to surgeon ASAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 3 examples of scenarios when an unsatisfactory alignment following strabismus surgery should be sent back to the surgeon?

A
  1. If patient is outside if monifixation range.
  2. If patient has diplopia
  3. If patient still has a constant strabismus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some things to try before referring an exotropic patient for strabismic surgery

A

Monitor
Patch
Over minus glasses
Amblyopia therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In order to qualify for strabismus surgery, why must the patient have at least 10 prism diopters of deviation at distance or near ?

A

Because it still falls within panum’s circle so they have some binocularity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why can a patient with a congenital cataract not have an IOL implant immediately following cataract surgery and what is a great alternative treatment option?

A

A patient with a congenital cataract cannot have an IOL implant immediately after surgery due to complications later with the IOL, due to the eye still growing the IOL could dislocate , and not being certain of the refractive power needed. As Dr. Sanders recommended, an alternative option would be a contact lenses, specifically RGPs being more successful due to customizability, and easier insertion and removal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the over-refraction goal for an aphakic baby? And why?

A

-3.00 Diopters because a baby’s world is up close. This way she can see her mommy’s face clearly :)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common type of esotropia?

A

The most common type is an accommodative esotropia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A patient comes in with a slipped muscle, what will be observed in EOM’s and saccades? What should be done immediately after?

A

The EOMs and saccades will be limited in the field of that muscle’s action. This could potentially act like Duane’s syndrome. This should be immediately sent back to the surgeon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In a case of pediatric nystagmus, what kind of lenses show more potential for correction (spectacle or contact lenses)? According to Dr. Sanders, why might this be the case?

A

Contact lenses because the patient will have edge awareness and will create a feedback loop to dampen the nystagmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

This is the type of surgery where a muscle is tightened by removing the anterior part of the muscle and reattaching the shortened muscle to the original insertion site?

A

Muscle resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

According to Dr. Sanders, which test is the best way to find out if a patient would benefit from a bifocal?

A

MEM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Soemmering’s Ring and what condition is it associated with? What are management options for this condition?

A

It’s the ring that is formed by the fusion of the anterior and posterior capsule of the lens. It is associated with aphakia and can be managed by the insertion of an IOL, or the use of a contact lens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

You’re performing a follow up examination after a strabismus surgery on a 10 year old patient. You notice corneal edema, uveitis, and folds in descemet’s membrane. What do you do next?

A

You would treat with steroids, then refer back to the surgeon because these are signs of ischemia due to anterior ciliary artery compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A child presents to your clinic with an accommodative esotropia. You do a wet retinoscopy and find +0.75 DS OD and +0.50-0.25x160 OS. Would you prescribe this prescription?

A

Yes, you would prescribe the full plus prescription since the patient has an esotropia in order to promote good fusion and relax the patient’s accommodation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

According to Dr. Cowen, what is an important ocular surface condition to consider before a patient has ptosis surgery?

A

Dry eye, because widening the palpebral fissure can induce or worsen dry eye symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is important to remember when referring patients to plastics for ptosis in regards to insurance paying for treatment?

A

It has to affect their daily life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the best type of visual field to perform on a patient when evaluating whether or not they are eligible for surgery for ptosis?

A

64-point superior screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the Kestenbaum procedure?

A

It is a surgical procedure for nystagmus. It is used to rotate the eyes in the direction of the head turn. This is to produce a gaze palsy towards the side to which the eyes are normally directed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you grade a patient on the Homles Control Scale? What is worse, a 0 or 5?

A

You want to look at the patient for 30 seconds because once they are dissociated with a cover test there is no control over the eyes. You are looking at if the eye is turned in and if so, how long/does it ever regain fixation. A 5 is worse because that is a constant exotropia, where as 0 is an exophoria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When would a hypertropic patient be ready for surgery?

A

If the patient is diplopic/symptomatic, has decreased stereo, and/or a significant head tilt.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which two binocular vision conditions has VT been PROVEN to work for?

A

Convergence insufficiency and TBI have been proven to be helped by vision therapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why is a pterygium most likely seen on the nasal conjunctiva?

A

Because light is reflected off the side of the nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the best way to prevent recurrence of a pterygium?

A

Wear UV blocking sunglasses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the most appropriate course of treatment for Salzmann’s Nodular Degeneration?

A

Superficial keratectomy, good sir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

According to Dr. Sander‘s lecture, during strabismus surgery what can cause a mild chorioretinal scar and what should be done during post-op to look for this finding?

A

Scleral Perforation. Although rare needles can perforate into the superchoroidal space or the choroid causing a chorioretinal scar. A retinal exam should be performed after surgery to check for this finding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Under what circumstances would keratoprosthesis be indicated for a patient?

A

Anytime there a corneal transplant has failed or there’s a risk of an unsuccessful transplant, Student Doctor Jacob Webster!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Dr. Cowen described the surgeries he preforms as relatively safe however, what is one major complication that he discussed that would lead to a decrease in vision, severe pain and proptosis?

A

Retrobulbar Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Why would you not want to use fluorescein on a rust ring?

A

The fluorescein will settle into where the foreign body is and cover the rust ring’s borders. It makes it more difficult to remove the entire ring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

According to Dr. Cowen, what is the ideal post-op follow up time to see the oculoplastic surgeon?

A

1 week!

You want to do cold compresses for 3-5 days to prevent bruising and after 5 days you want to give them warm compresses for their tear film and bruising. So at 7 days it would allow for them to have the bruising and some of the swelling to be reduced for a proper evaluation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are possible complications from the iStent?

A

Cataract, hyphema/IOP spike, inflammation/angle synechiae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Hi. Muscle resection, as described by Dr Sanders, has two main goals. One is to move the muscle insertion closer to the muscle origin, while the other is..?

A

Student doctor Jeremy Penn, it also weakens the muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are four complications of Kahook Dual Blade Goniotomy (KDB)?

A

The complications are cataract, hyphema/IOP spike, inflammation/angle synechiae and cyclodialysis cleft.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What was the disadvantage of a standard Baerveldt tube when considering the ripcord?

A

The IOP would not be lowered until the ripcord was removed in order to open the pathway.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are some of the differences between micro pulse vs. G probe

A

The micropulse does not sit in one spot (move 180 degrees every 10 seconds that) and is used to delay more risky surgeries. Micropulse has much less popping because it has less energy (not cooking), micropulse has less IOP reduction and less inflammation. Phthisis is not common. Micro-pulse cannot be used to NVG. Post op for micropulse you use steroids q12 hours and taper accordingly.
G probe has more popping due to higher energy. Phthisis is more common with this procedure. Post op steroids are used q1-2 h and taper more slowly. This can be used in NVG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the proper needle insertion position when performing an emergency pericentesis?

A

Well Trav, with an open ended 30 gage needle, insert horizontally through the limbus inferior to the pupil. Slightly tilt up to avoid damage in case the patient has a Bell’s Phenomenon.

41
Q

What do you give to “steroid responders” postop from their fistulizing blebs?

A

Give the steroids anyway. It’s important to monitor for any IOP spikes while administering the steroids and respond with the appropriate treatment when it occurs. The benefit outweigh the risk, especially if you carefully monitor the patient during the treatment process.

42
Q

What technique can be used to identify angle structures when the angle is minimally pigmented?

A

Corneal light wedge

43
Q

If a TM is normal, how much angle must be closed in chronic ACG before the IOP rises above normal?

A

270 degrees

44
Q

What quadrant closes last in CACG from narrow angles?

A

Inferior

45
Q

What iris type sheds the most pigment with a PI (pigment storm)?

A

Dark brown iris

46
Q

If there is PAS in the angle is a PI indicated?

A

A PI will not help and is not indicated

47
Q

Your patient is considering SLT surgery. While performing gonioscopy, at first glance you believe you see your corneal light wedge terminate at the trabecular meshwork. What other, sometimes pigmented and speckled structure, might you be really seeing?

A

Sampaolesi’s line

48
Q

Which has lower IOP results: Trabeculectomy or Tube? Which is more prone to infection?

A

Trabs for both. Blebs are more exposed and can leak

49
Q

A 45 year old white male presents to clinic with a new vertical deviation. What tests should be ordered as part of an adult strabismus work-up?

A

MRI Brain/Orbits with and without contrast, CT of the orbits, CVA imaging, ESR, CRP, TSH, Free T4, Anti-Acetylcholine Esterase
antibodies (blocking, binding, modulating), and ESR, CRP, Platelets

50
Q

What does it mean to have a patient with a “perfect storm” in terms of IOP, gonio findings, and pigmentation? Why would a slight elevation (IOP of, say, 19 to 24 OU) worry you in this otherwise seemingly healthy patient?

A

The perfect storm is considered normal to low 20s in IOP, gonio showing 270 degree closure, and darkly pigmented eyes. A quick elevation in pressure is indicative to act quickly in order to reduce the risk of damage.

51
Q

What is the most important thing to consider when treating Salzmann nodules?

A

They should be resected before they reach the optic zone

52
Q

What are some conditions that can be related to neurological disease and manifest as ocular motility disorders

A

Strab and nystagmus

53
Q

What are the criteria for diagnosing infantile nystagmus syndrome? (INS)

A

Infantile onset and ocular motor recordings show diagnostic (accelerating) slow phases

54
Q

Usually side effects from strab surgery happen in less than what percent of the population?

A

5%

55
Q

What are the 4 common post op complications seen with strab surgery? (There are more than 4)

A

Under/Over-corrections, slipped muscles, infection, new deviation (including paradoxical UHARC)

56
Q

What is the treatment of choice in a case of congenital glaucoma

A

Usually some type of angle surgery to help outflow of aqueous rather than pharmacotherapy

57
Q

What is the most common vitreoretinal condition they see at Akrons Children’s

A

ROP

58
Q

What aspects of basic surgical technique are included in the Halstead Principle

A

Identify tissue
Gentle handling
Hemostasis
Asepsis

59
Q

Why are proline sutures preferred material/stitch for oculoplastics repair?

A

They are preferred because in post op day 7, all you have to do is remove the tape and pull the string then the suture will come right out. There is also minimal inflammation with this

60
Q

If you are performing gonio on a patient and the most posterior structure you see is Schwalbes line (no visible TM), would you educate the patient on an LPI or SLT? Why?

A

Educate the patient on an LPI, as an SLT shouldn’t be performed if the TM isn’t visible because that’s your target for SLT.

61
Q

What’s the typical time of onset for infantile esotropia? How many months?

A

0 to 6 months

62
Q

When closing a tissue, what are some things you as a dr must do before letting the patient leave ?

A

remove draping, apply additional betadine over wound to sterilize it, apply antibiotic onto incision site, drape and cover with sterile gauze to protect.

also provide proper patient education on what they should expect in terms of pain, how to clean properly, as well as what to look for when it comes to signs of infection.

63
Q

What should be done when removing a pterygium to the firing conjuncgiva below it

A

Cut a square out and rotate it and suture it back on.

Treat the area with MMC and then rinse away before rotating the flaps

Put a CL on at the end

64
Q

Post op for pterygium

A 
BSCL
Antibiotics QID
Slide BSCL to check epi beneath it 
If healed, ABX BID until BSCL removed 
Steroid QID tapered one dose per week
65
Q

Treatment for pterygium

A

If not painful, not noticeable not affecting vision LEAVE IT ALONE

66
Q

Pterygium and cataract surgery

A

If planning custom cataract surgery,remove the pterygium, even if its not bothersome

67
Q

What is the most important thing to consider in treating Salzmanns nodules and pterygia

A

Both should be resected beforethey reach the corneal optical zone

68
Q

Indications for emergency paracentesis

A

Emergent IOP
Formed AC
Have equipment and meds
Call surgeon first

69
Q

Technique for emergency paracentesis

A 
Reassuring tone 
Topical anesthesia 
Betadine and abx
Lid speculum 
Extra drop if betadine 
Open ended, sterile, 30 gauge needle 
Horizontal through limbal cornea inferior to pupil, parallel to iris
Wait for IOP to drop
Withdraw need 
Compress needle tract 
Betadine chaser 
Hourly ABX drops
70
Q

Reason for the slightly upward tilt of the needle for emergency paracentesis

A

If they have a bells phenomenon, the needle will just come out

71
Q

Why does the needle need to be parallel to the iris for emergency paracentesis

A

Longer tract, self sealing

Takes 20s

72
Q

Ideal MIGS

A

Fast and easy procedure
Quick recovery, no blurry vision
Minimal risk
Efficacious

73
Q

Examples of MIGS

A 
Cataract surgery 
ECP
TS-CPC
Istent
KDB
74
Q

Cataract surgery as MIGS

A

Efficacy of about 1/3 glaucoma drop

35% of people being able to stop one drop

75
Q

ECP for MIGS

A

Efficacy of just under one drop
8% IOP reduction
Without 40% stopping at least one drop

76
Q

ECP general info for MIGS

A
  • fiber optic endoscope, 175 Watt xenon light, 810nm diodelaser
  • 360 degrees treatment of anterior ciliary processes
  • processes shrink and whiten some
  • lessens aqueous production
  • approved for phakic and pseudo-phakic
77
Q

Complications of ECP for MIGS

A
  • inflammation (iritis, CME, angle synechiae)
  • hyphema
  • IOP spike (pigmentary debris and inflammation)
78
Q

Contraindications for ECP for MIGS

A

Uveitis
CME
Angle neo

79
Q

Post op for ECP for MIGS

A

More inflammatory prone so we need durezol

  • q2h x 2 weeks
  • TID x 1 week
  • BID x 1 week
  • qd x 1 week
80
Q

TS-ECP for MIGS

A

Avoids cooking too long like the G probe when using the micropulse

81
Q

TS-ECP MIGS efficacy

A

G Probe: more IOP reduction (40-70% r3duction)

MicroPulse Probe (15-30% IOP reduction)

82
Q

Complications for TS-ECP

A

Inflamamtion
Phthisis bulbi 1-4%
Can use G probe with NVG/ischemia (not micropulse)

83
Q

Post op for TS-ECP

A

G probe

  • q1h or q2h steroid drops
  • slow taper

MicroPulse Probe
-QID steroid tapered weekly

84
Q

IStent MIGS

A

Smallest FDA approved
Titanium (safe for MRI)
L shaped stent bypasses TM
Approved for pseudophakia

85
Q

Istent complications

A

Cataracts
Hyphema/IOP spike
Inflammation/angle synechiae

86
Q

Contraindications of istent

A

Phakic
Neo
Closed angle (can try GSL first)

87
Q

Post op for istent

A

Just cataract drops (and prior glaucoma meds

Efficacy just under 1 drop or so
4.5% IOP reduction
With 50% of that data pool stopping at least one drop

88
Q

KDB MIGS efficacy

A

1.5 drops or so
20% reduction of IOP with 28% of people stopping one drop

Wide range (10-60% drop)

Causes more heme

89
Q

Post op for KDB MIGS

A 
Durezol 0.05%
QID x 1 week 
TID
BID
QD
90
Q

Post opt meds for fistulizing surgery can hope prevent

A

Scarring of blebs

ESP if thick, non elevated, non translucent, vascularized

Steroids
(Steroid responders need steroids to prevent scarring of their blebs)

91
Q

Signs of infection after incision

A

Excessive discomfort, drainage, redness more than 5mm beyond wound margins, swelling, induracton, tenderness, lymphatic streaks, lymph node enlargement, and fever

92
Q

Post op meds for biopsy

A

Erythromycin ung QID x 7 days

RTC 1-4 weeks for evaluation of resolution

93
Q

Patient instructions post op biopsy

A

Pain should subside after 24-48 hours, come back if it doesnt

Remove patch before bedtime and reapply ointment

Clean gently after 12-24 hours, do not submerge

94
Q

Chalazion steroid post op

A

Erythromycin BID x 3-5 days
Resume hot compresses in 2-3 days
RTC2-4 weeks for eval

Pain should subside 24-48 hours
Clean gently after 12-24 hours

95
Q

Chalazion I/C post op

A

Erythromycin ung QID x 7 days
Resume hot compresses in 2-3 days
Rtc 1-4 weeks for evaluation of resolution

96
Q

Lesion ABCDE

A 
Asymmetry 
Borer
Color
Diameter
Evolving
97
Q

Preseptal cellulitis tx (topical)

A

Warm compresses TID
Polymyxin B/bacitracin ung QID(if bacterial conjunctivitis is present)
Tetanus toxoid PRN

98
Q

Abx tx for mild preseptal

A

Augmentin
Cefpodoxime
Cefdinir

If allergic to PCN

  • TMP/sulfa
  • moxi
99
Q

What oral meds can be used for someone who has orbital cellulitis and is improving with IV

A

Augmentin

Cefpodoxime

3SP: Pre And Post Op (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions