Monday - Opthamologist doc

Question 1

Cataracts

Answer 1

You know what cataracts are

Question 2

Macular degeneration

Age?
Dry vs Wet
Tx?

Answer 2

Anytime after 50, usually >70

Dry - Drussen, not as bad
Wet - exudative, edema and hemorrhage of blood vessels under/in retina

Quit smoking, AREDS (vitamins), Anti-vegf drugs

Question 3

Glaucoma

What gets thicker as we get older, and is probably one of the main causes of glaucoma?

Answer 3

Trabecular meshwork

Question 4

Glaucoma

Findings on fundoscopic exam?

Answer 4

Optin nerve cupping due to loss of rim tissue

Question 5

Acute angle Glaucoma

SSx

Answer 5

acute onset, severe pain, nausia, halo around lights, corneal redness

Question 6

Acute angle Glaucoma

non surgical Tx - two main ones

Answer 6

Pilocarpine - drop
acetazolamide - pill

after both, ophtha refer

Question 7

Acute angle Glaucoma

surgical Tx

Answer 7

laser iridotomy - poke a hole in the retina

Question 8

REVIEW AYY LMAO

What is a prostaglandin derivative eye drop that you give someone?

what does it do?

Answer 8

Latanoprost

increases outflow of aqueous humor

Question 9

Diabetic retinopathy

Two types
fundoscopic findings in each?

Answer 9

Non-proliferative and proliferative

NPDR & PDR
microaneurysms 
Cotton wool spots
blot hemorrhages
macular edema
hard exudates (bright yellow deposits)

PDR
Venous bleading/vitreous hemorrhage

Question 10

How do you treat proliferative diabetic retinopathy (PDR)

Answer 10

Panretinal photocoagulation (PRP)

kill all the blood vessels

Question 11

Hypertensive retinopathy

Findings of fundoscopic exam

Answer 11

Narrowing and sclerosis of arterioles (silver wire)

flame hemorrhages

cotton wool spots

optic nerve edema in severe cases

Question 12

Sudden vision loss in one eye generally lasting only minutes.

What do you do first?
Second?

Answer 12

Amaurosis fugax

Cardiovascular workup first - carotid ultrasound, echocardiogram

ophthalmology workup second

Question 13

Name of an embolitic material in a retinal arteriole

Answer 13

Hollenhorst plaque

Question 14

What can you find in the eye that is a warning sign of future disaster in the vascular system?

is it occlusive?

what do you do after you find it? (this is known as a workup in the biz)

Answer 14

Retinal cholesterol emboli

non-occlusive

carotid ultrasound, echocardiogram

Question 15

Hallmark of an ophthalmic migrane

Answer 15

Scintillating scotoma - painless temporary hemianopsia (decreased vision in half of the visual field) due to spasm of arteriole in occipital cortex

looks like a jagged line in your vision

Question 16

What is the hallmark of a central retinal arterial occlusion (CRAO)

Clinical presentation example from class

Answer 16

Cherry red spot

“i woke up and i could not see my lower visual field”

Question 17

Tx for acute Central retinal arterial occlusion

Answer 17

somehow get interoccular pressure down

rebreath CO2
timolol or other beta2 blocker
acetazolamide IV
massage globe

get that occlusion broken up if you can

Question 18

Hallmark of central retinal vein occlusion

Answer 18

squashed tomato looking retina

Question 19

Temporal arteritis

SSx

what do you find in the ateries

Answer 19

headache and scalp tenderness

fever, weight loss

jaw claudication

polymyalgia rheumatica (pain in shoulder and hips usually)

Vision loss that can effect one or both eyes

find giant cells in the arteries

Question 20

Temporal arteriris

how to diagnose

How do treat

Answer 20

erythrocyte sed rate (ESR) first
C-reactive protein (CRP) second

Start high dose systemic steroids immediately even before test results get back

Question 21

What is it called if you have bleeding into the retina?

Answer 21

Hyphema

Question 22

Should you prescribe topical anesthetics for someones eye?

Answer 22

No, what the hell dude.

Not cool.

Question 23

What is one weird thing on the face that you can get secondary to VIRAL conjuctivitis?

Answer 23

preauricular lymphadenopathy