OPHTHALMOLOGY Flashcards
On slip lamp exam you see this. The blood vessels are normal.
What is the diagnosis?
What should these patients be worked up for?
Dx: cotton wool spot retinopathy
Tx: workup for leukemia, lymphoma, HIV
What is anisocoria?
different pupil sizes
A 45 yo male patient presents to the clinic complaining of mild vision loss. He is on anticoagulants for his A-fib.
What is the diagnosis?
What is the treatment?
Dx: Hyphema
Tx: topical steroid + cycloplegic
make sure to check IOP!
What is the leading cause of blindness in the US?
diabetic retinopathy
A 10 yo presents to the clinic complaining of eye and facial pain.
What is the diagnosis?
What is the treatment?
Dx: dacrocystitis
Tx: oral antibiotics (Keflex/Augmentin)
A patient presents to the clinic complaining of transient monocular vision loss. He says last night he was watching tv when he lost vision in his left eye for a few minutes that then returned to normal. Slip lamp exam is normal. Physical exam is normal.
What is the diagnosis?
What do you need to work him up for?
Dx: Amaurosis Fugax
Tx: refer to neuro = CVA workup
A patient presents to clinic with eye pain without discharge. She denies any allergies or sickness. The eyelids appear normal.
What is the diagnosis?
What is the treatment?
Dx: Episcleritis
Tx: self-limiting
What is heterochromia?
2 different iris colors
Your medical assistant runs into your office stating there is a man with a gross red eye sitting in the waiting room scaring all the other patients. The patient comes to your clinic because he noticed his eye started bleeding out of nowhere. He is asymptomatic. He is on aspirin 81 mg daily.
What is the diagnosis?
What is the treatment?
Dx: Subconjunctival hemorrhage
Tx: Self-limiting
A patient with a PMHx of rheumatoid arthritis presents with eye pain and headaches. On physical exam you do not notice discharge.
What is the diagnosis?
What is the treatment?
Dx: Scleritis
Tx: oral NSAIDs
A patient presents to the ED with a headache. On EOM testing you discover he is unable to look up, down or in. Pupils are not as reactive as they should be.
What is the diagnosis?
What should you work him up for?
Dx: Acute CN 3 palsy
Tx: work up for aneurysm with CTA/MRA
A patient presents to the clinic with unilateral eye pain, tearing, and irritation. She had a blepharitis a few weeks ago that was untreated. You notice a focal area of subcutaneous erythema that is tender to the touch.
What is the diagnosis?
What is the treatment?
Dx: Hordeolum
Tx: Warm compress 10m QID
A patient who is recovering from a viral conjunctivitis now presents with this.
What is the diagnosis?
What is the treatment?
Dx: Corneal infiltrates
Tx: treat according to etiology
A 65 yo patient with a PMHx of smoking presents to the clinic complaining of dramatic vision changes. On slip lamp exam you notice drusens and hemorrhage.
What is the diagnosis?
What is the treatment?
Dx: WET age related macular degeneration
Tx: intravitreal anti-VEGF injection
A 50 yo patient with a PMHx of HTN and T2DM presents to the clinic complaining of left eye vision loss. On physical exam you do not see any redness, discharge or pain. On slip lamp exam you notice focal hemorrhage.
What is the diagnosis?
What is the treatment?
Dx: branch vein occlusion
Tx: ophthalmology + neurology urgent referral
A patient presents to the clinic complaining of tearing and irritation over the eyelids. You notice crusting along the eyelashes.
What is this condition called?
How is this treated?
Dx: Blepharitis
Tx: warm compress 10m QID
A patient presents for his regular yearly eye exam. He denies any changes or symptoms. On physical exam you notice this.
What is the diagnosis?
What is the treatment?
Dx: Pterygium
Tx: Self-limiting
Patient presents with eye irritation and mild injection. On slip lamp exam you see corneal dendrites.
What is the diagnosis?
What is the treatment?
Dx: Viral corneal ulcer (herpes zoster)
Tx: oral antivirals
A 65 yo patient presents complaining of a SINGLE large floater.
What is the diagnosis?
What is the treatment?
Dx: posterior vitrous detachment
- dilate eye and again at 6 weeks to ensure no damage to retina
Painful horner’s syndrome should have you concerned for this can’t miss diagnosis?
- carotid dissection
A patient presents to the clinic complainig of a bunch of flashes and floaters.
What is the diagnosis?
What is the treatment?
Dx: retinal detachment
Tx: refer to eye specialist
A 45 yo patient presents to the clinic complaining of left eye vision loss. On physical exam you do not see any redness, discharge or pain. On slip lamp exam you notice the retina looks white in segments.
What is the diagnosis?
What is the treatment?
Dx: branch artery occlusion
Tx: urgent referral to ophthalmology + neurology
A patient presents with this finding and diplopia. What CN palsy should be concerned with?
CN 3 palsy
A patient presents to the clinic complaining of pink, watery eyes and photophobia. He said it started in the left eye but now involves both eyes.
What is the diagnosis?
What is the treatment?
Dx: Viral conjunctivitis
Tx: cool compress
HIGHLY CONTAGIOUS!!
A 16 yo patient who wears contacts presents to the clinic complaining of eye pain. She says she doesn’t do a good job of taking out her contact lens when she takes naps everyday after school.
What is the diagnosis?
What is the treatment?
Dx: Giant papillary conjunctivitis
Tx: discontinue contact lens
A 24 yo male presents to the clinic with bilateral eye pain. On physical exam you notice a profuse, disgusting, purulent discharge. He says this started so soon it’s been less than 12 hours.
What is the diagnosis?
What is the treatment?
Dx: Hyperacute bacterial (N. Gonorrhoeae)
Tx: (Topical cephalosporin or FQ) AND (oral ceftriaxone + Azithromycin)
A 65 yo patient with T2DM presents to the clinic complaining of vision loss. On slip lamp exam you notice these yellow spots outside the macula, cotton wool spots, microaneurysms, but no new grown blood vessels.
What is the diagnosis?
What is the treatment?
Dx: non-proliferative T2DM
Tx: refer to eye doc + stress glycemic control
A 65 yo male presents to the clinic with this finding. He is asymptomatic. What is the diagnosis?
Dermatochalasis
A 76 yo female with a PMHx of diabetes and chronic steroid use presents to the clinic complaining of painless, progressive blurry vision.
What is the diagnosis?
What is the treatment?
Dx: Cataract
Tx: glasses change OR cataract surgery
What is coloboma
incomplete closure of the iris during development
A patient with a PMHx of MS presents to the clinic with painful eye movements and vision loss. However, the slip lamp exam is benign.
What is the diagnosis?
What is the treatment?
Dx: Optic neuritis
Tx: IV steroids + refer to ophthalmology/neurology for emergent MRI
A 65 yo patient presents to the clinic with HTN emergency. On slip lamp exam you see this.
What is the diagnosis?
What is the treatment?
Dx: Hypertensive retinopathy
Tx: send to ED for BP management
Florida man presents to your clinic complaining of a yellow dot in his eye. He loves being out in the sun. He has no symptoms but doesn’t like the way it looks.
What is the diagnosis?
What is the treatment?
Dx: Pinguecula
Tx: None
A patient returns to the clinic for a follow up. He has been dealing with a hordeolum but is now getting worse.
What is the diagnoses?
What is the treatment?
Dx: Preseptal cellulitis
Tx: Oral antibiotics (Keflex or Augmentin)
warm compress 10m QID
A patient presents with acute bilateral eye pain. On physical exam you notice redness and a mucopurulent, sticky yellow discharge. She has been dealing with urethritis over the last few weeks.
What is the diagnosis?
What is the treatment?
Dx: Acute bacterial conjunctivitis
Tx: topical broad spectrum antibiotics
A patient suffered an accidental chemical burn injury at work.
What is the immediate treatment?
Which one is worse: alkali or acidic?
- immediate Tx: rinse eye with sterile saline
- alkali is worse
A patient with a recent corneal abrasion presents for a follow-up complaining of worsening pain and tearing.
What is the diagnosis?
What is the treatment?
Dx: bacterial corneal ulcer
Tx: broad spectrum topical antibiotics (e.g. Vigamox)
MOST COMMON CAUSE OF AN ULCER IS BACTERIAL!!
A 65 yo old patient with a PMHx of smoking presents to the clinic complaining of trouble with near reading and a central blur. On slip lamp exam you notice drusen, pigment changes and atrophy.
What is the diagnosis?
What is the treatment?
Dx: DRY age related macular degeneration
Tx: AREDS vitamins
This is defined as involuntary rhythmic oscillation of the eyes.
nystagmus
A 6 yo boy presents with left eye pain. He also has associated lymphadenopathy and a fever.
What is the diagnosis?
What is the treatment?
Dx: Dacroadenitis
Tx: oral antibiotics
A patient presents with acute onset eye pain, headache, and blurry vision. On physical exam you notice cloudy corneas, unclear iris, pupils are mid dilated. IOP >50.
What is the diagnosis?
What is the treatment?
Dx: acute angle closure
Tx: patent peripheral irodotomy
A patient was playing soccer when he collided head-to-head with another player. He seems to have suffered an orbital fracture. What imaging do you want to order next?
CT head
A patient returns to the clinic for a follow-up for a hordeolum. She says she feels great and her eye is no longer painful. She states she now notices a painless bump on the eye lid.
What is the diagnosis?
What is the treatment?
Dx: Chalazion
Tx: Warm compresses 10m QID
treat underlying rosaea or meibomitis
PO doxycycline if recurrent
if no improvement = surgical removal
A patient presents to the clinic complaining of right eye pain. On physical exam you notice hyperemia, eyelid edema, and chmosis. He believes it could be a result of him itching his eyes while doing yard work this weekend.
What is the diagnosis?
What is the treatment?
Dx: Acute allergic conjunctivitis
Tx: antihistamines
A patient presents to the ED with this.
What is the diagnosis?
What is the treatment?
Dx: open globe
Tx: urgent antibiotics treatment + potential surgery
A patient who wears contacts presents with left eye pain, tearing, and discomfort. He states he began feeling this after his friend hit him in the head with a stick of wood.
What is the diagnosis?
What is the treatment?
Dx: corneal abrasion
Tx: topical antibiotics
A 26 yo patient presents to the clinic complaining of severe itchy eyes. He works outdoors and we are in the middle of the summer. On physical exam you notice injected, puffy eyes.
What is the treatment?
What is the diagnosis?
Dx: Allergic Conjunctivitis
Tx: cool compress AND antihistamines (maybe)
A 45 yo patient with a PMHx of HTN and T2DM presents to the clinic complaining of left eye vision loss. On physical exam you do not see any redness, discharge or pain. On slip lamp exam you notice widespread hemorrhage and cotton wool spots.
What is the diagnosis?
What is the treatment?
- Dx: central vein occlusion
Tx: opthalmology + neurology urgent referral
A patient with a PMHx of T2DM and HTN presents with vision loss of the left eye. He says he only lost vision from the top half. On slip lamp exam you notice pink swelling of the optic nerve.
What is the diagnosis?
What is the treatment?
Dx: non-arteritic anterior ischemic optic neuropathy
Tx: treat underlying disease
A 65 yo patient presents to clinic complaining of eye irritation.
What is the diagnosis?
What is the treatment?
Dx: Ectropion
Tx: artificial tears for symptoms AND refer to oculopastic specialist for repair
A 20 yo male patient presents unilateral eye pain. He has been dealing with this pain for a few weeks. On physical you notice follicles in the inner eyelids.
What lab test do you want to order?
What is the diagnosis?
What is the treatment?
order a culture!
Dx: Chronic bacterial conjunctivitis (chlamydia)
Tx: Azithromycin 1 mg PO OR Doxycycline 100mg BID
A patient with a PMHx of T2DM and HTN presents with vision loss of the left eye. He says he only lost vision from the top half. On slip exam you notice a whie swollen optic nerve.
What is the diagnosis?
What is the treatment?
Dx: giant cell arteritis
Tx: send to ED for high dose steroid + Temporal artery biopsy (TPA) to look for inflammatory cells
risk of bilateral blindness!!
A patient presents with this finding. She is asymptomatic but she says her eye droops more towards the end of the day. What condition should you be concerned about?
myasthenia gravis
A 26 yo man rpesents to the clinic complaining of left eye pain. He said it started a few days ago when he was poked in the eye with a plant in his garden. On slip lamp exam you notice satellite infiltrates with feathery edges.
What is the diagnosis?
What is the treatment?
Dx: Fungal corneal ulcer
Tx: topical anti-fungal + same day referral
A patient who is recovering from an infection presents to the clinic complaining of left eye pain and decreased vision.
What is the diagnosis?
What is the treatment?
Dx: hypopyon
Tx: aggressive antibiotics + cycloplegic
What is horner’s syndrome?
- ptosis
- miosis
- anhidrosis
What is the most common virus causing conjunctivitis?
adenovirus
A 65 yo patient with T2DM presents to the clinic complaining of vision loss. On slip lamp exam you notice these yellow spots outside the macula, cottol wool spots, neovascular growth and vitreous hemorrhage.
What is the diagnosis?
What is the treatment?
Dx: Proliferative diabetic retinopathy
Tx: Anti-VEGF treatment via laser
A patient presents to the ED with a big,red, beefy hot eye lid. He also appears ill and has an associated fever.
What is the diagnosis?
What is the treatment?
- Dx: Orbital cellulitis
Tx: admit for IV antibiotics: Nafcillin + Ceftriaxone or Unasyn
Refer ASAP for eye consult
A 26 yo female patient presents with bilateral visual disturbances, tinnitus, and headaches. On slip lamp exam you notice Paton’s folds.
What is the diagnosis?
What is the treatment?
Dx: papilledema
Tx: emergent head CT then LP if negative to rule out IC process
A patient presents complaining of painless bilateral visual field loss and confrontational field defects.
What is the diagnosis?
What is the treatment?
Dx: Glaucoma
Tx: referral + topical ocular hypotensive drugs
A 45 yo patient presents to the clinic complaining of left eye vision loss. On physical exam you do not see any redness, discharge or pain. On slip lamp exam you notice the retina looks white, and the fovea looks like a dark cherry spot.
What is the diagnosis?
What is the treatment?
Dx: central artery occlusion
Tx: urgent referral ophthalmology + neurology for stroke work up
This is defined as reduced vision in one eye caused by abnormal visual development early in life.
amblyopia
A patient presents to clinic complaining of pink, watery eyes with SEVERE photophobia. On physical exam you notice corneal infiltrates.
What is the diagnosis?
What is the treatment?
Dx: Epidemic Keratoconjunctivitis
Tx: cool compress + steroids (maybe)
HIGHLY CONTAGIOUS
A 22 yo college swimmer who wears contacts presents to the clinic with excruciating 10/10 left eye pain. On slip lamp exam you notice a ring infiltrate. He says he barely ever removes his contacts when in the pool.
What is the diagnosis?
What is the treatment?
Dx: parasitic corneal ulcer (acanthamoeba)
Tx: topical biguanide + same day referral
A 65 yo presents to the clinic with eye irritation and pain.
What is the diagnosis?
What is the treatment?
Dx: Entropion
Tx: artifical tears AND refer to oculoplastic specialist for surgery
A 35 yo construction worker presents to the clinic complaining of a foreign body sensation.
What is the diagnosis?
What is the treatment?
What test should you do to make sure the globe is intact?
Dx: corneal foreign body
Tx: remove foreign body
Test: Seidel test
What is the difference between blepharitis and meibomitis?
- blepharitis = anterior at base of lashes
- meibomitis = posterior at meibomian glands
*both are inflammation of the eyelids*
