Jack's Opth Flashcards
1
Q
An infection of the eyelid with loss of eyelashes, scaling, and itchy eye?
A
-Blepharitis
2
Q
An external Hordeolum
A
-Sty, a staph abscess in the eyelid on the margin of the eyelid
3
Q
An infection of the meibomian gland and abscess
A
-Hordeolum (internal)
4
Q
Tx of Sty (external Hordeolum) or internal Hordeolum
A
- bacitracin or erythromycin q 3 hrs
- I&D if necessary
5
Q
A cyst of a clogged meibomian gland.
A
-Chalazion
6
Q
Sx and sx of a Chalazion?
A
- painless bump
- often secondary to a sty
7
Q
Tx of a Chalazion
A
-steroid injection or surgical excision
8
Q
Folding in of the eyelid is what and what is the etiology?
A
-Entropion, due to weakening of the eyelid muscle/skin
9
Q
Folding out of the eyelid is what and what causes it?
A
-Ectropion, lossening of the eyelid muscle and skin
10
Q
Teardrop sign on facial/orbit xray? Tx
A
- blowout fx
- antibiotics because fx extends into the sinus
- monitor vs surgery
11
Q
-Rust ring on corneal exam
A
-foreign body, steel causes the rust ring
12
Q
Do you apply an eye patch to a patient with a foreign body?
A
-no, contraindicated
13
Q
To identify a corneal abrasion you do what?
A
-fluorescein stain and abrasion will be darker than the rest of the cornea
14
Q
Inflammation/infection of the nasolacrimal sac?
A
- Dacryocystitis
- usually newborns
- tx, probing or surgical procedure
15
Q
Lab test for Chlamydia conjunctivitis?
A
-Giemsa stain for chlamydia
16
Q
Lab test for Neisseria conjunctivitis?
A
-culture on Chocolate agar
17
Q
Common bugs that cause Orbital Cellutitis?
A
-Strep pneumo and Staph aureus
18
Q
This bug can cause an orbital cellulitis secondary to a chronic sinus infection or dental infection?
A
- H. flu
- vaccination for H. flu now so this isn’t seen often any more
19
Q
Sx of Orbital cellulitis?
A
- Sick/ill person
- fever
- painful swelling around the eye
20
Q
Tx of Orbital cellulitis
A
-admit for IV antibiotics, Vanc, Clindamycin, Doxy
21
Q
Opacification of the eye lens obstructing the flow of light to the retina
A
-Cataract
22
Q
Some causes of cataracts
A
- age, proteins denature over time
- sunlight and radiation
- smoking
- secondary to diabetes
23
Q
Sx of cataracts
A
- difficulty seeing at night
- slow progressing cloudy vision
24
Q
Cataract prevention
A
-sunglasses with UV filtering
25
Tx of cataracts
- glasses with proper prescription (prevent falls in elderly)
- better lighting
- use of magnifying glasses
- surgery
26
Increased intraocular pressure leading to damage to the optic nerve
-Glaucoma
27
Chronic angle glaucoma
-open angle glaucoma
28
Eye c/o of gradual loss of peripheral vision or no sx at all
-open angle glaucoma
29
Eye c/o pain, N/V, blurred vision, ***halos around lights*** and photophobia
-Acute closed angle glaucoma
30
A fixed mid dilated pupil that does not change when you shine light on the pupil
-closed angle chronic glaucoma
31
Bowing of the iris
-open angle glaucoma
32
N Tonometry and cup:disc ratio on eye exam
- IOC > 21 is abnormal
| - cup:disc of > 0.5
33
Visual field shows decreased peripheral vision and bowing of the iris
-open angle glaucoma
34
red or hazy eye and IOP >21
-closed angle glaucoma
35
Glaucoma tx to promote drainage
- Prostoglandins
- Latanoprost (Xalatan)
- Bimatoprost (Lumigan)
36
Glaucoma tx to decrease production of aqueous humor
- Beta Blockers
- Timolol
- Betaxolol
37
Glaucoma tx to decrease production of aqueous humor and to promote drainage
- Alph Adrenergic agonists
- Apraclonidine (iopidine)
- Brimonidine (Alphagan)
38
Sx of Papilledema
- Headache
- noticeable blindspot
- blurred vision
- total vision loss
39
Optic disc swelling secondary to intracranial pressure
-Papilledema
40
Fundal exam for Papilledema
- venous engorgement
- hemorrhages near the optic disc
- blurring of optic disc margins
41
What further study is needed to treat Papilledema?
-CT or MRI of the head to find the intracranial pressure
42
Tx for Papilledema
- Tx the underlying cause of intracranial pressure
- diuretics to decrease pressure (Furosemide)
- keep head of bed elevated
43
Blood in the anterior chamber of the eye
-Hyphema
44
Sx for Hyphema
- vision abnormalities
- pain
- photophobia
45
Tx for Hyphema
- sleep with head of bed at 45 degree angle
- no reading or TV for 3 days
- eye patch
46
Wedge shaped growth of conjunctiva which grows from the nasal side towards the cornea, is starting to grow over the cornea
- Pterygium
| - surgery it disrupts vision
47
Yellowish deposit on the conjunctiva which does not grow over the cornea
-Pinguecula
48
Risk factors for Pterygium and Pinguecula
- wind
- sun exposure
- sand
49
72 y.o. male presents with loss of central vision (scotoma), wavy vision (metamorphopsia), and a decrease in visual acuity? What is the likely Dx?
-Macular Degeneration
50
PE findings for macular degeneration
- decreased visual acuity
- Amsler grid test shows wavy vision (metamopohopia)
- loss of central vision
51
Metamorphopis
-wavy vision
52
Funal exam findings for Macular Degeneration
- Drusen deposits
| - atrophy of the retina--pigment loss
53
What dietary supplements help Macular Degeneration?
- Vit A, C, E, B6, B12
- zinc
- copper
- lutein
- omega 3 fatty acids
54
What is the tx for wet Macular Degeneration?
-Vascular endothelial growth inhibitors given by intravitreal injection
55
What surgical procedure is for Macular Degeneration?
-Laser photocoagulation
56
If really concerned about nystagmus what test would you get?
-CT or MRI to check for mass effect
57
Tx for nystagmas
- observation
- glasses
- surgery for brain mass
58
Misalignment of both eyes, eyes don't move together
-Strabismus
59
PE for Strabismus
- Cover/uncover test
| - Hirshberg corneal reflex test
60
Why tx Strabismus as a child?
-so it doesn't lead to Amblyopia (blindness in the affected eye)
61
A loss of vision in the otherwise normal eye
-Amblyopia
62
Patient presents with acute vision loss (or blurred vision), loss of color vision, pain before the visual symptoms began, and pain with eye movement? Dx and Tx
- Optic Neuritis
- vision test, color vision test and MRI of the brain
- tx treat underlying cause (infection)
- ? IV steroids
- usually resolved in 2-3 mo
63
What causes Optic Neuritis?
- Autoimmune-- MS #1 cause
- fungal infection
- bacteria infection--lyme, TB, syphilis
- viral infection-herpes zoster, mumps, rubella
- Vitamin B deficiency
64
What are the 2 ways people get a detached retina?
-trauma, older pts have a spontaneous detachment
65
62 y.o. male presents with painless vision loss and feels like "the curtain coming down". What is the likely Dx and Tx?
-Dx is torn retina
- Refer to Ophth
- surgery
66
PE findings for detached retina?
- Retina may appear to be hanging down
| - asymmetric red reflex
67
5 causes of Retinopathy (damage to the retina)
- HTN
- DM-DM type 1 screen annually, DM type 2 screen 3-5 yrs
- Premature birth
- Radiation/sun damage (pain 6-12 hrs after sunburn)
- Sickle Cell
68
Fundus exam shows hemorrhages, and Cotton Wool Spots
- DM (Preproliferative changes)
| - Dx is diabetic retinopathy
69
Fundus exam shows copper wire, silver wire sclerosis and AV nicking
- HTN (arteriolar narrowing)
| - Dx is HTN retinopathy
70
Who gets Reinal Artery Occlusion
- Atrial Fib
- Temporal arteritis
- DM
- HTN
- Sclerosis
- Clot
71
DM patient presents with Acute vision loss and no pain. Fundal exam shows Boxcarring, Cherry Red Spot, optic atrophy and a pale disc. What is the likely Dx and how do you tx?
-Retinal artery occlusion
- TX, emergency get to Opth.
- intermittent pressure
- tPA
72
HTN or sickle cell patient presents with vision loss and/or blurred vision. Fundal exam shows ***blood under the fundus***, dilated veins, exudates and neovascularization.
Central vein occlusion
tx underlying cause -- DM, Sickle Cell, HTN, Glaucoma
73
Who gets Amaurosis Fugas (TIA of the eyeball)?
- people with Carotid plaques
| - people with atrial fibrilation
74
A patient known to have A Fib (or would have carotid plaques) presents with transient ACUTE vision loss, sees the Curtain descend and then goes back up in just one eye. Dx and tx
-Amaurosis Fugas
Tx, tx the A fib or carotid plaques
-heparin
75
Retinal lines that have the appearance of a "ripple on a pond" or a "billowing sail" are fundascopic findings consistent with what Dx?
-Retinal Detachment
76
A fundal exam that shows a pale or milky retina with a cherry-red fovea is consistent with what Dx?
- central retinal artery occlusion as a result of small emboli breaking loose from sclerotic plaque and lodging in the retinal arterioles.
- transient visual loss (amaurosis fugax) often occurs
77
A swollen disc with blurred margins, and physiologic cup is not visible on fundal exam is consistent with what Dx?
-Papilledema--get a head CT
78
An enlarged physiologic cup, occupying more than half of the disc's diameter is consistent with what Dx?
-Glaucoma
79
Yellowish-orange to creamy-pink disc with sharp margins and a centrally located physiologic cup on fundal exam is consistent with what Dx?
-Normal Exam
80
Symptoms of difficulty keeping eyelids (often only one eyelid) open but improves with a nap are consistent with what Dx?
- myasthenia gravis
| - get a Tensilon (edrophonium test)
81
Describe the Tensilon test (endrophonium) for myasthenia graves.
-adult dose is 0.2 cm3 endophonium chloride IV and eyelids are then assessed for improvement of function. Additional dosing is provided in 0.2 cm3 increments to a total of 1.0 com3.
82
Who gets myasthenia graves?
-young adults, 20-40 yrs of age and often after an illness, stress, injury or pregnancy
83
What is the pathology for myasthenia graves?
-cholinesterase destroying acetylcholine at the myoneural junction.
84
26 y.o. male presents with bilateral conjunctivitis, dysuria, and low back and achilles tendinitis? What is the probable Dx?
-Reiter Syndrome (Reactive Arthritis)
| triad of arthritis, conjunctivitis, urinary tract sx
85
When is Seidel test performed on the eye?
-when a perforated globe is suspected
86
How do you perform the Seidel test for a possible perforated globe?
-a moistened fluorescein dye strip is gently applied to the site of injury. Slit-lamp exam is performed with cobalt blue light. If a perforation or leak is present, the flourescein stain dye will be diluted by aqueous fluid from the injured site. It will appear as a dark (diluted) stream with a pool of bright green (concentrated) dye.
