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Clinical med > HEENT eyes > Flashcards

HEENT eyes Flashcards

1
Q

the globe of the eye is called…

the cornea is more curved ….

A

bulbus oculi

anterior

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2
Q

the cornea curve is the main reason to wear glasses (t/f)

A

True

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3
Q

what is the anterior and posterior segment made of

A

P

A

a: cornea, iris, ciliary body, and lens

P: vitreous retina, choroid, and optic nerve

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4
Q

The two fluid-filled chambers within the anterior segment:
Anterior Chamber: space between ……..
Posterior Chamber: area …..

Both are filled with clear aqueous fluid.

A

A: between cornea and iris

P: behind iris and in front of vitreous

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5
Q

what is the purpose of the chambers of the eye

A

filled with aqueous fluid to nourish the cornea and lens

maintain IOP

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6
Q

blood in the anterior chamber is called

A

hyphema

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7
Q

pus/white cell accum in the AC is called

A

hypopyon

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8
Q

Hordeolum / Chalazion is

associated with

Rx:

A

blepharitis/ acne rosacea

warm/hot compresses with digital massage / Btracin or Emycin

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9
Q

well defined lid nodule is … in hordeolum/chalazion

A

chronic

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10
Q

external hordeolum (stye) is inflammatory lesion of the anterior eyelid due to obstruction of …. glands

tender or nontender?

A

Moll and Zeis

tender

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11
Q

chalazion, which is internal hordeolum, is localized inflammation on the posterior eyelid due to the obstruction of …. gland

tender or nontender?

A

meibomain gland

nontender

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12
Q

blepharitis is common, chronic inflammation of ..

A

eyelid margin

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13
Q

blepharitis Symptoms is

A

flux through day and weeks

burning, itching, FBS, tearing, lid erythema

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14
Q

blepharitis signs

A

crusty, red thickened lid margin with bvs or oil glands

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15
Q

blepharitis is assoc. with ..

A

dry eyes, rosacea, chalazia

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16
Q

blepharitis treatment

A

-Lid scrubs (e.g. Ocusoft; Avenova, dilute baby shampoo) to clean base of lashes

-Hot Compress (e.g. Bruder Mask) 3 x day for 10 min.

-Topical Emycin ung or azithromycin gel drop
or oral doxycycline 100mg bid x 1wk then qd x 3 weeks (if its rlly bad)

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17
Q

entropion

is
symptoms

A

inward turning of eyelid margin

Ocular irritation, FBS, tearing, red eyeSuperficial Punctate Keratitis (SPK), abrasions, scarring can result from lashes contacting globe (sclera/cornea).

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18
Q

ectropion

is
s/s

A

outward turning of eyelid margin

+ Tearing, eye or eyelid irritation or may be asymptomatic, Superior Punctate Keratitis (SPK) inferiorly from corneal exposure

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19
Q

Ectropion / Entropion Treatment

A

Treat if corneal involvement
lubricating agents (artificial tears/gels)
antibiotic ointments (emycin or bacitracin ophthalmic ung qhs)
bandage contact lens
Epilate any inward turning lashes touching cornea (trichiasis)
Definitive treatment may require lid surgery with oculoplastics.

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20
Q

lacrimal system takes tear from external eyes to nasal cavity. it consist of …4…

A

puncta
canaliculi
lacimal sac
nasolacrimal duct

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21
Q

inflammation of the lacrimal sac is

called:
s/s:

tx:

A

Dacryocystitis
pain, swelling, excessive tearing (epiphora)

oral antibiotics cephalexin
hot compress

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22
Q

Acute angle closure glaucoma
Uveitis / Iritis
Herpes simplex keratitis
Conjunctivitis
Subconjunctival hemorrhage

are all causes of …

A

red eye

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23
Q

acute angle closure glaucoma symptoms

A

severe ocular pain
redness
halo rings
N/V
headache
blurred vision

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24
Q

acute angle closure glaucoma, the aqueous fluid can not drain out, therefore the IOP … increases/decreases

A

increases

normal is 10-21
bad IOP >50

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25
Q

high risk groups for acute angle glaucoma is

A

Shallow anterior chamber
Hyperopia (farsightedness)
Elderly /Thickening cataract with age
(+) family hx of angle closure
Asian / Inuits

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26
Q

treatment for acute angle glaucoma

A

Lower IOP with meds (all topical IOP gtts and oral acetazolamide two 250mg tabs)
-Immediate but temporizing

Peripheral Iridotomy (PI)
-Definitive

Remember the fellow eye

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27
Q

Swelling/inflammation of uvea (middle layer of eye)
Pain, red eye, photophobia

A

Anterior Uveitis:

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28
Q

choroid/retina involvement
Floaters, visual disturbance

A

Posterior Uveitis:

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29
Q

s/s of uveitis, which is often caused by underlying systemic conditions and can lead to permanent vision loss are

A

red eye, blurry vision, photophobia, floaters

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30
Q

when looking at an eye with uveitis, you will see

A

Keratic precipitates (KPs are white cells on
corneal endothelium)

cells & flare in AC, synechiae

ciliary flush

vitritis, retinal hemes

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31
Q

cause of Uveitis

A

autoimmune disorders, infections, malignancy, toxins, or idiopathic.

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32
Q

Common etiology of anterior uveitis is

A

HLA-B27 positive autoimmune disease

Ankylosing spondylitis

JRA = juveniles rheumatoid arthritis

Crohn’s disease = inflame. Bowel disease
Ulcerative colitis = inflame. Bowel disease = inflame + ulcers

Reiter’s syndrome – reactive arthritis = men

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33
Q

cause for posterior uveitis are

A

Sarcoidosis, Lyme, Toxoplasmosis

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34
Q

you see iris and lens synechiae. the treatment for uveitis is

A

Cycloplegic (cyclopentolate 1% tid or atropine 1% if severe)

topical steroid (pred acetate 1% q 1-6 hrs or Durezol tid.

Taper based on response.

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35
Q

you see unilateral red eye, FBS, photophobia, and history of previous episodes. you do corneal staining and see macro punctate and classic dendritic keratitis. the pt has

A

Herpes simplex keratitis

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36
Q

HSV type 1 reactivation causes

A

herpetic keratitis (classic dendritic ulcer)

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37
Q

to treat dendritic keratitis, you should use

A

topically with trifluridine drops 9x/d or ganciclovir gel 5x/d

Oral antivirals: acyclovir 400mg po 5x/d or valacyclovir 500mg po tid x 7d
Avoid topical steroids = makes it worse

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38
Q

conjunctive covers the front of the eyes and lines the inside of the…

A

eyelids

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39
Q

3 types of conjunctivitis

A

Bacterial
Viral
Allergic

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40
Q

t/f all 3 types of conjunctivitis (bacterial, viral, allergic) has hyperemia

A

true

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41
Q

t/f all 3 types of conjunctivitis (bacterial, viral, allergic) has discharge

A

true

bacterial -purulent
viral - serous
allergy - stringy

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42
Q

t/f all 3 types of conjunctivitis (bacterial, viral, allergic) has preauricular lymphadenopathy

A

F,

only viral

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43
Q

t/f all 3 types of conjunctivitis (bacterial, viral, allergic) has Upper respiratory symptoms

A

False

bacterial = none
viral - URI
allergy - hay fever

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44
Q

conjunctivitis treatment for bacterial is

A

Topical antibiotics

Polytrim, ofloxacin, q4h
polysporin ointment tid
fluoroquinolones

Cool compresses

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45
Q

viral conjunctivitis treatment

A

Cool compresses
Topical lubrication
Caused by adenovirus
Antibiotics will not help

CONTAGIOUS Precautions to prevent spread
Handwashing
Clean with alcohol or dilute bleach

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46
Q

allergy conjunctivitis treatment

A

Topical antihistamines/mast cell stabilizers (Pataday, Zaditor, Bepreve) for acute and chronic allergies

(steroid gtts can be used but IOP needs to monitored!)

Oral antihistamines
Cool compresses, artificial tears

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47
Q

causes of Subconjunctival Hemorrhage

A

Valsalva: coughing, sneezing; rubbing
Idiopathic

Blood thinners (aspirin, warfarin)

Blood clotting disorder (rarely)

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48
Q

do you need to treatment Subconjunctival Hemorrhage

A

No, unless recent trauma and recurrent

goes away in 1-2 weeks by itself

49
Q

Pinguecula/Pterygium
Dry eyes (keratoconjunctivitis sicca)
Corneal abrasions/ulcers
Corneal foreign bodies

causes

A

red eye

50
Q

Pinguecula /Pterygium s/s

A

irritation, redness, without s/s

51
Q

Yellow-white, flat or slightly raised conjunctival lesion NOT involving cornea
is…

A

Pinguecula

52
Q

Wedge shaped fold of fibrovascular tissue arising from the interpalpebral conjunctiva and extending onto the cornea.

A

Pterygium

53
Q

Pinguecula/Pterygium Treatment

A

Protect eyes from sun, dust, wind, UV c sunglasses / safety goggles

Lubricate with artificial tear drops to reduce irritation (qid)

If inflamed can use NSAID (ketorolac qid) or topical antihistamine/mast cell stabilizer (Pataday qd)

Surgical removal only if severe or if pterygium threatens visual axis

54
Q

s/s of dry eye syndrome

A

itching, dry eyes, burning sensation, FBS, excessive tearing following by dryness, burning, redness

unlateral

worsened by wind, smoke, low humidity prolonged reading

55
Q

dry eye treatment is

A

Artificial tears, refresh, systane, or blink

stop smoking

humidifer

restasis, xiidra, ceque

punctal plugs

EFA (fish oil/flax)

56
Q

pt has pain, photophobia, tearing, redness and a hx of itching their eyes.

what is it and how do you treat it

A

corneal abrasion

Fluoroquinolone gtt or ophthalmic ung at least qid

Cycloplegic agent if iritis

Never Rx topical anesthetic (delays healing)

57
Q

pt has pain, redness, photophobia, tearing and a Hx of contact lens use. upon staining the eye, you see a white lesion.

what is it and how do you treat it

A

corneal ulcer

Fluoroquinolone gtt or ophthalmic ung at least qid

Cycloplegic agent if iritis
Never Rx topical anesthetics
Discard and d/c CL use

58
Q

what is the most common cause of contact lens related corneal infection

A

pseudomonas aeruginosa

59
Q

danger signs for the eye that are not conjunctivitis are

A

reduced visual acuity = serious ocular disease
refer pt esp if acutely reduced

ciliary flush = redness maximal near cornea

60
Q

abnormal pupils needs

A

referral

61
Q

therapeutic warns to not use topical anesthetics because

A

its toxic and can cause corneal ulceration

never prescribe
use only for exam

62
Q

topical steroids should only be prescribed by eye doctor bc it causes

A

cataracts
glaucoma
makes HSV and fungal infections worse

63
Q

what is the leading cause of legal blindness in the usa, and the risk factors

A

macular degeneration (ARMD)

heredity
advanced age
drusen body
tobacco

64
Q

ARMD etiology is unknown, but it is manifested by

A

drusen
retinal pigment epithelial atrophy
subretinal neovascular membrane
loss of central vision

65
Q

what are the two types of ARMD?

A

dry and wet

66
Q

explain characteristics of dry ARMD

A

slowly
drusen, pigment layer atrophy
bilateral
peripheral vision intact

can lead to wet type of ARMD

67
Q

ARMD dry type management

A

no cure

vitamins AREDS1 - reduce progression by 25 %. does not contain beta-carotene which can increase lung cancer in smokers

low vision aids

monitor for wet type with AMSLER grid

68
Q

ARMD wet type characteristics

A

choroidal neovascular membrane (CNV)

edema, hemorrhage

metamorphopsia = sudden decrease of vision

fibrosis

macular scar

69
Q

ARMD wet type management

A

changes to wet type = ER

F1 angiography/ OCT imaging

Anti-VEGF injections: Avastin, lucentis, eylea, macugen

PDT or laser obliteration of CNV

unilateral so monitor for recurrence and other eye

70
Q

what test can detect early retinal conditions

A

OTC - optical coherence tomography

71
Q

dry age related macular degeneration is also called

A

nonexudative

72
Q

diabetics can develop

A

diabetic macular edema

73
Q

what is the leading cause of irreversible blindness in the world?

A

glucoma

74
Q

what causes glaucoma

A

IOP that damages the optic nerve = visual field loss

75
Q

Primary open angle glaucoma characteristics

A

mostly no S/S

S/s noticed when late in disease

early detecting = important if blindness is to be prevent

76
Q

glaucoma risk factors

A

age, FHx, diabetics, CV, surgery, steriods, truama

77
Q

Characteristics of Glaucomatous ONH

A

Enlarged cup; c/d ratio >0.65 (average is 0.3)

Hemorrhage within 1dd of ONH

Thinning of neuro-retinal rim esp. sup. / inf.
(does not obey the ISNT Rule)

Asymmetric cupping between patients eyes

78
Q

how does vision loss happen in POAG

A

loss of retinal ganglion cells leads to enlarged cup to disk ration.

this happens typically at the superior and inferior poles, leading to a vertical oval cup or notching

79
Q

what test would you do to test visual field in POAG

A

automated perimetry

youll see loss of vision in the bottom

80
Q

how to treat POAG

A

medications to lower BP = IOP lowering eye drops
prostaglandins, beta-blockers, alpha agonists, carbonic anhydrase inhibitors (CAI) , combinations

Laser Trabeculoplasty (SLT, ALT)
*hole in the trabecular meshwork to release pressure

Filtration Surgery (Trabeculectomy)

MIGS (Minimally-invasive Glaucoma Surgeries)
i-Stent, Cypass, Trabectome)
istent = for awueous to drain out and to lower pressure

81
Q

what causes floaters and flashes in the eyes

A

Vitreous separates from the anterior retinal (floaters)

Some strands remain attached to retina (flashes)

82
Q

typical horseshoe tear of the retina will be shown on

A

retinal detachment

83
Q

untreated retinal detachment can lead to

A

to partial or total loss of retinal function (blindness)

84
Q

retina detachment is an emergent condition because once the macula is off, the prognosis for good vision ….

treatment include

A

decreases

surgical repair with laser, cryopexy, buckle, or pneumatic retinopexy

85
Q

risk factors for RD

A

high myopia (near sight)

trauma

age

prepvous ocular surgery

86
Q

RD symptoms

A

Sudden appearance of many floaters

Sudden flashes of light, typically in the periphery

A shadow or curtain blocking part of your field of vision

87
Q

cataracts is

A

an opacity (clouding) of the normal clear lens

88
Q

risk factors for cataracts include

A

age
uv
radiation
steriods
uveitis
diabetes
trauma

89
Q

cataract symptoms are

A

glare, esp in night driving

90
Q

cortical cataract is

A

PERIPHERAL SPICULES EARLY,
VISION GOOD INITIALLY

91
Q

nuclear cataract is

A

shift toward myopia and color shift to yellow

92
Q

subcapsular cataract is

A

early trouble reading

93
Q

cataract management if s/s/vision loss interfere with job is

A

surgery

multifocal and toric implant

94
Q

posterior capsular opacification is common after… and is …

A

cataract surgery

secondary clouding of posterior capsule = decrease in vision/ glare

95
Q

tx for posterior capsular opacification is

A

YAG laser capsulotomy

96
Q

diabetes mellitus is a

A

diabetic retinopathy and leading cause of blindness

97
Q

Risk factors for diabetic retinopathy are

A

duration of diabetes

control of blood sugar

insulin dependency

hypertension

anemia

98
Q

after 5 years of TYPE 1 Diabetics, people will have a … percent chance of having diabetic retinopathy (DR)

after 15 years of TYPE 1 Diabetics, people will have a … percent chance of having diabetic retinopathy (DR)

A

a) 23 %

b) 80%

99
Q

if the capillaries leak and are occluded, and you see the following

RED SPOTS (HEMORRHAGES, MICROANEURYSMS)

HARD EXUDATES IN CIRCINATE CONFIGURATION

COTTON WOOL SPOTS

MACULAR EDEMA = vision affected

VENOUS ENGORGEMENT, BEADING

then the pt has

A

nonproliferative DR

100
Q

if you see
INCREASED RETINAL ISCHEMIA
NEOVASCULARIZATION, INITIALLY AT OPTIC DISC
FIBROUS TISSUE PROLIFERATION
VITREOUS HEMORRHAGE
TRACTION RETINAL DETACHMENT

then the pt has

A

proliferative DR

101
Q

how do you treat DR

A

yearly dilated eye exam

control glucose levels

control HTN

Anti VEGF injections or Laser treatment of the focal leakage areas

Pan Retinal photocoagulation (PRP)

vitrectomy

102
Q

what are the complications for DR

A

NEOVASCULAR GLAUCOMA

TRACTION RETINAL DETACHMENT

VITREOUS HEMORRHAGE

CATARACT

103
Q

central retinal artery is a ..

A

true end artery

104
Q

Hypertension changes in the eyes, you wil see

A

arterial narrowing

flame (splinter) hemorrhages

cotton wool spots

hard exudates, macular star

edema of the disc

105
Q

ARTERIOSCLEROTIC CHANGES

A

WIDENING OF ARTERIAL STRIPE

A/V NICKING

COPPER COLORED ARTERIES

SILVER WIRE ARTERIES

106
Q

AMAUROSIS FUGAX is

A

Transient loss of vision in one eye (monocular)

107
Q

AMAUROSIS FUGAX is characteristic

A

No pain
Lasts 1-10 minutes
Total or altitudinal vision loss (“like a window shade”)
Vision returns to normal

108
Q

what causes AMAUROSIS FUGAX

A

vascular or hear disease

temporary lack of blood flow to retina from emboli in central retinal artery

Often no emboli visible on fundus exam

109
Q

is AMAUROSIS FUGAX a form of TIA? and how do you treat is

A

yes

ASAP ER/ Stroke center

MRI, urgent carotid and cardiac studies
neurology consultation

110
Q

Uncorrected ….. are a leading cause of visual impairment worldwide.

A

refractive errors

111
Q

what is refractive errors

A

a problem with focusing light onto the retina due to the shape of the eye

112
Q

is emmetropia a refractive error?

A

no, this is 20/20 vision. the eye is able to focus light on retina with effort

113
Q

what are the 4 types of refractive errors

A

Myopia (nearsighted)
Hyperopia (farsighted)
Astigmatism (nonspherical curvature)
Presbyopia (loss of focusing ability of lens)

114
Q

if the cornea is spherical and light is refracted and focused equally in all meridians , then the person will have

A

zero astigmatism

115
Q

In astigmatism, the surface of the cornea has a …. in one meridian than in the other meridian.

A

stronger curvature

116
Q

what causes presbyopia, farsightedness

A

normal result of age

lens of eyes becomes thicker and less flexible

117
Q

lens that cannot adjuct in presbyopia, causes the image to be focused …. the retina

A

beyond

118
Q

what test do you do to determine the Rx for glasses

A

a refraction

119
Q

what is the most common refractive surgery procedures

A

Laser in situ keratomileusis (LASIK) and
Photorefractive keratectomy (PRK)

Clinical med (6 decks)

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