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Clerkship (CC3) > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is the diagnosis?

A

Blepharitis

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2
Q

What is the management of blepharitis?

A

1 Lid hygiene with baby shampoo on QTip

Hot compress nightly

Artificial tears

(Erythromicin BID x 1 week, then nightly for one tube)

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3
Q

What is the diagnosis?

A

Corneal ulcer

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4
Q

How do you manage a corneal ulcer?

A

Topical antiboitics, high strength

Culture gram stain + sensitivity

Refer

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5
Q

What is the difference between a hordeolum and a chalazion?

A

Hordeolum = bacterial infection of meibomian gland

Chalazion = chronic inflammation

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6
Q

What is the diagnosis

A

Hordeolum / chalazion

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7
Q

How is a chalazion / hordeolum managed?

A

Hot compress

+/- topical antibiotics (if hordeolum)

I/D if > 6wks

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8
Q

What examinations would be appropriate to conduct in this case (10yo, unwell, 1 day hx of pain with eye movement)

A

Test vision, pupils, extraocular movements, examine conjuctiva

Vitals, CBC & blood culture, CT head

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9
Q

What is the Ddx for this systemically unwell 10yo who presents with a 1-day hx of pain with eye movement? (4 things)

A
  1. Preseptal cellulitis
  2. Orbital cellulitis
  3. Malignancy
  4. Dysthyroid opthalmopathy (Graves)
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10
Q

How do you differentiate preseptal cellulitis from orbital cellulitis?

A

Orbital cellulitis = decreased vision, extraocular muscle movement & pupil abnormalities. If in doubt, refer urgently!

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11
Q

This 80yo presents with glaucoma presents with increasing irritation and discharge OD, with decreased vision. Currently on cosopt, alphagan, xalatan. What is the diagnosis?

A

Allergic blepharoconjunctivitis

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12
Q

What should you do to manage this glaucoma patient?

A

Identify the cause of the allergic reaction & consult ophtho to change drop regime.

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13
Q

30yo with 4 day hx of red itchy eye originally OD but now OS also. Notes dischrage, decreasing vision, photophobia. What is the diagnosis? What are the 3 possible causes?y

A

Papillary conjunctivitis

  1. Viral
  2. Bacterial
  3. Allergic
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14
Q

What is the diagnosis (40yo, contact lens wearer, severe pain OD, photophobia)

A

Corneal abrasion

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15
Q

What is the management of corneal abrasion? What can you do if you have an abrasion in a contact lens wearer?

A

Debride loose epithelium, lubricate, polysporin + patch

Do NOT patch a contact lens wearer -> can lead to corneal ulcer + topical ocuflox to prevent.

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16
Q

What do you do to manage a corneal foreign body? When is imaging indicated?

A

Removal, polysporin QID, F/U daily until abrasion heals

If any metal-on-metal contact, CT/X-ray to r/o retained intraocular foreign body (do NOT MRI)

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17
Q

Why are topical anaethsetics not recommended for home use?

A

They can lead to breakdown of epithelium and secondary infection; only use in office for diagnosis/treatment

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18
Q

What is the diagnosis in this 35yo with 2day hx of red, painful photophobic OD?

A

Herpes simplex keratitis

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19
Q

How do you manage this patient? What medications should you avoid?

A

Viroptic Q2H up to 9x daily x 1 week

Taper next week.

NO steroids

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20
Q

What is the diagnosis (80yo otherwise healthy)? What is the management?

A

Herpes Zoster Opthalmicus

Acyclovir if <72hrs since onset

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21
Q

How do you record visual acuity from the snellen chart?

A

Record fraction of line when they get at least1 letter.

If they get extra letters (from line above, +, which letters)

If they miss letters, record - which letters

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22
Q

What are the 8 findings that you are looking for on a slit lamp exam

A

External (cheek/eyebrow, orbit)

Lids/Lashes (lid margin, lash line

Conjuctiva, sclera

Cornea (K)

Anterior chamber

Iris

Lens

Vitreous

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23
Q

What is the difference between a hypopyon and a hyphema?

A

Hypropion = pus floating in the bottom of the eye

Hyphema = blood in the bottom of the eyeball

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24
Q

What is the most likely diagnosis? What are the key features?

A

Iritis; limbal flush (dilated conjunctival vessels), anterior chamber flare

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25
Q

What must you rule out if you see iritis?

A

Systemic inflammation (more likely if recurrent attacks or bilateral ons first presentation)

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26
Q

This patient presents with RAPD OD and hx of vision loss asymptomatic to patient.What is the most likely diagnosis?

A

Advanced atrophy, likely late-stage glaucoma

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27
Q

What is the most likely diagnosis in this person with a 4-hour hx of N/V & severe pain OD w decreased vision? What are the key findings?

A

Acute angle-closure glaucoma

Note fixed, mid-dilated pupil, hazy cornea

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28
Q

How do you manage acute angle closure glaucoma?

A

Urgent ophtho referral

Diamox, glycerin PO (1mg/kg), mannitol IV (1mg/kg)

Mannitol

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29
Q

What is this sign? What is the fluid leaking out?

A

Seidel sign,(fluid wave) penetrating eye injury, dark liquid is aqueous humor

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30
Q

What is the concern in this patient who is 5 days post-op from cataract extraction?

A

Endophthalmitis

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31
Q

How do you treat this eye? What is the likely etiology

A

Irrigate until pH normal

Streroid + antibiotics

“egg white” eye appearance suggests alkali burn

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32
Q

What do you look for in a fundoscopy

A

Start with the nerve, then the vessels, then the macula, then the rest of the retina

33
Q

What is the typical progression of symptoms in a retinal detachment?

A

Flashing lights, floaties, then “curtain” of vision loss progressing

34
Q

What is this spot? What is the cause? What do you worry about in an older patient?

A

Cherry red spot.

Central retinal artery occlusion (CRAO)

Giant cell arteritis

35
Q

What is the diagnosis?

A

Central retinal vein occlusion

36
Q

What is the differential for this?

A

Papilledema

Non eye related: hydrocephalus, intracranial mass, cerebral sinus thrombosis, meningitis, SDH or SAH, malignant hypertension

Eye related: drusen, optic neuritis / optic nerve tumor.

37
Q

What is the diagnosis?

A

Diabetic retinopathy

Hard/soft exudates, pre, intra and postretinal hemorrhage, neovascularization (if proliferative)

38
Q

Trauma hx. What is the diagnosis?

A

Hyphema & subconjunctival hemorrhage, conservative management

NO ASA, no strenouous activity, atropine/steroids

39
Q

What is this? What is the diagnosis?

A

Drusen, age-related macular degeneration

40
Q

What are the risk factors for AMD?

A

Age, FH, caucasian, smoking, UV light exposure

41
Q

Describe the nerve

A

Glaucoma: disc to cup ratio

42
Q

What supplements do you encourage for patients with dry macular degeneration?

A

A, E, zinc

43
Q

What is the diagnosis? What is the progression of symptoms?

A

Dysthyroid opthalmology

NOSPECS

No signs

only lid retraction, lag, edema

Soft tissue swelling

Proptosis

Extraoccular involvement

Corneal exposure

Sight loss

44
Q

What is the diagnosis? Do you image this patient?

A

CN III palsy

Image them.

45
Q

What is the sign. What is DDx for this?

A

Leukocoria

Retinoblastoma until proven otherwise–could be a cataract

46
Q

Does dysthyroid ophthalmopathy always correlate to systemic condition? What do you need to counsel patients about?

A

No.

Stop smoking!

47
Q

What is a normal intraocular pressure?

A

12-22 mmHg

48
Q

What is the differential for leukocoria

A

Retinoblastoma

Congenital cataract, coloboma, coat’s

Intraocular infections

49
Q

Why do pediatric cataracts need to be assessed by paeds ophtho?

A

Can result in amblyopia if not treated.

50
Q

What is the most common cause of tearing in infants?

A

Nasolacrimal duct obstruction

51
Q

When should you suspect congenital glaucoma?

A

Tearing, photophobia, blepharospasm with a big eye or cloudy cornea.

52
Q

What is the normal cup-to-disc ratio?

A

<0.5

0.3 in children

53
Q

Where does pre-septal cellulitis originate from?

A

Usually lids or periorbital skin

54
Q

Where does orbital cellulitis usually come from?

A

Spread from paranasal sinuses.

55
Q

What must you rule out in the child with proptosis or orbital signs without inflammatory involvement?

A

Rhabdomyosarcoma

56
Q

How can you screen for strabismus?

A

Hirschberg test

(light reflexes of corneas should be centered on the pupil of each eye)

57
Q

What are the most common types of esotropia

A

Infantile esotropia (<6mos, req surgery)

Accomodative esotropia (starts in infancy, but usually later in childhood). Correctable with glasses.

Can also be CNVI palsy

58
Q

Is intermittent exotropia a reason for urgent referral?

A

Not necessary; very common esp if tired or distracted or looking far. Just follow.

59
Q

What is amblyopia?

A

Vision loss due to an abnormal visual experience in early life.

60
Q

What causes amblyopia?

A

Stimulus deprivation

Strabismus

Anisometropia (asymmetric or high refractive error)

61
Q

How do you manage amblyopia?

A

Fix underlying cause

Penalize good eye (patch or use atropine)

62
Q

What do you suspect in this child?

A

CN III palsy

63
Q

What are common causes of head tilt?

A

MSK

CN IV palsy

64
Q

What is the diagnosis? Management?

A

Dacryocystitis (often due to NLD obstruction)

Cephalexin 250 mg QID x7days

65
Q

What is the diagnosis?

A

Dacryoadenitis

66
Q

What is the diagnosis? What management is indicated?

A

Pinguecula

Suggest lubricants or vasoconstrictors if inflamed, but often no treatment req’d

67
Q

How do you distinguish between episcleritis and scleritis?

A

Episcleritis often presents in the younger patient with mild pain, no vision changes, and a sectorial redness.

Scleritis is associated with older patients and systemic diseases and can present with vision loss, marked pain, and diffuse redness.

68
Q

What diseases are associated with scleritis?

A

Rheumatoid arthritis, lupus, granulomatosis with polyangiitis, polyarteritis nodosa, gout, syphilis, zoster

69
Q

Steroids are the first line management for both episcleritis and scleritis. What are the differences in their management?

A

Episcleritis can use topical steroids, scleritis should be treated with NSAIDs and requires referral to ophthalmology.

70
Q

What is the diagnosis? What visual symptoms might the patient complain of?

A

Angle closure glaucoma. Symptoms include eye pain, blurred vision, rainbow coloured halos around light, headache, nausea, vomiting.

71
Q

What are the major risk factors for primary open angle glaucoma?

A

Elevated intraocular pressure, African descent, family history, age, myopia and diabetes

72
Q

What are the four classes of medications used in treating glaucoma?

A

Prostaglandin analogues (latanoprost - first line)

beta-blockers (timolol) and also alpha-2 adrenergic agonists (brimonidine)

carbonic anhydrase inhibitors (acetazolamide, dorzolamide)

73
Q

What are the secondary causes of open angle glaucoma?

A

Ocular causes: uveitis, neovascularization

non-ocular: Steroids, trauma, pseudo-exfoliation syndrome, and pigment dispersion syndrome.

74
Q

What is the difference between dry AMD and wet AMD?

A

What AMD occurs due to neovascularization under the retina (in the choroid)

75
Q

How is AMD managed?

A

Intraocular injections of anti-VEGF medications

76
Q

How is diabetic retinopathy classified?

A

Non-proliferative versus proliferative.

Proliferative is more advanced DR with abnormal growth of extra retinal fibro vascular tissue.

77
Q

Use of what drugs long-term requires regular ophthalmology f/u?

A

Hydroxychloroquine and chloroquine (after 5 yrs of therapy, annually thereafter)

78
Q

What do you need to do in the older patient that presents with new onset temporal headaches and vision loss?

A

ESR and CRP with a CBC to rule out temporal arteritis

79
Q

In a patient with CN3 palsy, pupil involvement indicates what cause?

A

Posterior communicating artery aneurysm or another compressive lesion.

Clerkship (CC3) (12 decks)

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