Ophthalmology

Question 1

Tx of anterior uveitis?

Answer 1

Atropine + phenylephrine

Question 2

Consequences of ROP?

Answer 2

Retinal detachment

Retinal vascular angiogenesis

Question 3

Hallmark of congenital glaucoma?

Answer 3

Watering eye with photophobia

Cornea becomes hydrated and oedematous w/the elevation of intraocular presssure. It will also be cloudy

Question 4

Mgmt of childhood squint?

Answer 4

1st line is conservative: patch the good eye and correction of refractive error

Surgical correction if conservative mgmt fails

Note: often runs in families

Question 5

What is Duane syndrome?

Answer 5

A rare type of congenital strabismus (failure of abduction)

Characteristic feature is the eyeball with retract into the socket on adduction

Question 6

Characteristic features of Moebius’ syndrome?

Answer 6

Facial paralysis and inability to move eyes form side to side. This is as cranial nerves VI and VII are under developed

Other features: clubbed feet, missing digits and chest wall abnormalities

Question 7

How does brown syndrome present clinically?

Answer 7

Inability to look up particularly on adduction

Note: congenital or post infectious; defect in the superior oblique tendon sheath

Question 8

In acute infective conjunctivitis most children will get better without antibiotic therapy in how many days?

Answer 8

7-14 days

Question 9

Mgmt of orbital cellulitis?

Answer 9

CT of sinuses + orbit (if intracranial abscess suspected)
Broad spectrum IV abx +/- surgery (if evidence of orbital infection)
Ref to ophtho + ENT

Question 10

Features of orbital cellulitis?

Answer 10

Fever, headache and systemic malaise
Proptosis
Pain + blurred vision (painful ophthalmoplegia)
Evidence of optic neuropathy (optic disc edema)

Question 11

With relation to squints what if the difference between a phoria and a tropia?

Answer 11

Tropia is present at rest (AKA manifest)
Phoria is not present at rest (AKA latent)

Note: exo = lateral/external deviation
eso = medial/internal deviation

Question 12

Newborn with altered red reflex, main differential diagnosis?

Answer 12

Congenital cataract

Note: retinoblastoma more commonly presents later, median of 2 year and before 5 yrs

Question 13

What infants require screening for retinopathy of prematurity?

Answer 13

Born before 32 weeks gestation

Birth weight less than 1501g

Question 14

When should infants get screening for retinopathy of prematurity?

Answer 14

If born before 27 weeks : 30 - 31 weeks corrected for screen

If born 27 1/7 - 32 weeks: 4-5 weeks post natal age

Question 15

At what age should a child with a squint be referred to ophthalmology?

Answer 15

8 weeks

Question 16

Most squints are divergent or convergent?

Answer 16

Convergent (when one eye turns in)

They are also usually concomitant (non-paralytic)

Question 17

Head tilt to right, trouble walking down stairs and vertical diplopia in left eye. What pathology?

Answer 17

Left trochlear nerve palsy (4th CN)

Controls superior oblique only

Question 18

Alagille syndrome is associated with what eye abnormality?

Answer 18

Posterior embryotoxon - thin grey white arcuate ridge on the inner surface of the cornea, adjacent to the limbus. Can be seen on slit lamp exam

Question 19

Features of optic glioma on physical exam?

Answer 19

RAPD on the side of the lesion - due to slowing of signal conduction through the optic nerve
Visual loss
Optic disc will be swollen early but it is usually atrophied by the time of diagnosis

Question 20

Both a corneal abrasion and ulcer will light up under fluorescein T/F

Answer 20

T

Note: w/o fluorescein abrasion will be transparent and ulcer will be opaque

Question 21

Management of corneal abrasion is topical anaesthetic and antibiotics ointment several times a day T/F

Answer 21

F - can apply topical anaesthetic in office for examination but do not send home with it as it can be toxic.

Note: cycloplegia drops are also no longer recommended as they have not been shown to be beneficial

Question 22

Common locations of a branchial cleft cyst?

Answer 22

Most often: lower 1/2 anterior margin of the sternocleidomastoid muscle
Less commonly pre auricular or angle of mandibular

Question 23

Any child < 12 with nasal polyps needs to be evaluated for CF T/F

Answer 23

T - even in the absence of other features concerning for CF

Question 24

What is the initial management for bilateral choanal atresia?

Answer 24

Place an oral airway

Question 25

What is the most common kind of strabismus?

Answer 25

Esotropia (eye deviated inwards)

Question 26

Potential complication and treatment of hyphema?

Answer 26

Complication- glaucoma (it is caused by RBCs clogging the trabecular meshwork and causing increased intraocular pressure)

Tx: topical steroids and cycloplegic drops. Also ondansetron and analgesia to alleviate emesis/pain which can further increase intraoccular pressure

Question 27

Non painful, nodular mass of eyelid chalazion or hordeolum?

Answer 27

Chalazion - this is a chronic granulomatous inflammatory lesion of meibomian gland. Usually not tx indicated

Note: hordeolum is purulent painful mass. May need antibiotics to treat