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Clinical: Emergency Medicine > Ophthalmology > Flashcards

Ophthalmology Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

what is a hyphema

A

trauma causes blood in anterior chamber of the eye (between the cornea and iris) and may cover the iris

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2
Q

how are hyphema’s diagnosed?

A

orbital CT if indicated + ophthalmology consult

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3
Q

what is the treatment of hyphemas

A

usually blood is reabsorbed over days/weeks
elevate head at night to 30 degrees
may use beta-andrednergic blockers or carbonic anhydrase inhibiors

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4
Q

what class of medications are contraindicated in the treatment of Hyphema

A

NSAIDs - may increase bleeding

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5
Q

what is required for clinical diagnosis of AOM

A
  1. bluging of TM
  2. other signs of acute inflammation
  3. middle ear effusion
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6
Q

what is the first line treatment of AOM

A

amoxicillin

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7
Q

what is second line treatment of AOM

A

augmentin

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8
Q

what is the most common cause of acute pharyngitis

A

adenovirus

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9
Q

what is the Centor Score

A

used for strep pharyngitis
1. absence of a cough
2. exudates
3. fever (>100.4)
4. cervical lymphadenopathy

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10
Q

what is the first line treatment for strep pharyngitis

A

penicillin

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11
Q

what condition is associated with gradual painless loss of central vision

A

macular degeneration

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12
Q

what type of macular degeneration presents with Drusen

A

Dry macular degeneration

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13
Q

what is the treatment of wet macular degeneration

A

VEGF inhibitors (bevacizumab)
photodynamic therapy
zinc and antioxidant vitamins

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14
Q

what is the treatment of dry macular degeneration

A

zinc and antioxidant vitamin

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15
Q

what is the diagnostic test for acute sinusitis

A

plainview x-ray (waters view)
CT = gold standard

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16
Q

what is the diagnostic tests for mastoiditis

A

clinical
CT scan temporal bone with contrast

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17
Q

what is the treatment of mastoiditis

A

IV abx (ceftriaxone)
drainage of middle ear fluid

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18
Q

a 47-year-old school teacher with a cough, hemoptysis, fever, chills, and weight loss that has persisted since he returned from a summer trip to China. A chest radiograph is concerning for infection, and a sputum culture is positive for acid-fast organisms. Treatment for this patient’s condition is begun. Three weeks later, the patient returns to the clinic with decreased visual acuity for one day in his right eye. He also reports pain in the eye with movement but no other symptoms. The patient has a family history of glaucoma, diabetes mellitus, factor V Leiden, and stroke. On physical examination, when a penlight is shined into the affected eye, there is no pupillary constriction in either eye.
what is the most likely diagnosis

A

optic neuritis

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19
Q

what is an acute inflammation and demyeliniation of the optic nerve leading to acute monocular vision loss/blurriness and pain on extraocular movements

A

optic neuritis

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20
Q

What is the most common cause of optic neuritis

A

multiple sclerosis

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21
Q

what medication is associated with optic neuritis

A

ethabutol

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22
Q

what test is used to confirm demyelination of optic nerve

A

MRI

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23
Q

what is the treatment of optic neuritis

A

IV corticosteroids
refer to neurology for evaluation of MS

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24
Q

what is blepharitis

A

chronic inflammation of lid margins caused by seborrhea, staph or step = dysfunction of Meibomian glands

25
Q

a 2-year-old who arrives at the ED with a swollen and erythematous eyelid, proptosis, pain with movement of the eye, and an inability to adduct or abduct his eye.
What is the most likely diagnosis?

A

ortibtal cellulitis

26
Q

what confirmatory test is used for orbital cellulitis

A

Ct scan of orbits

27
Q

what is the treatment of orbital cellulitis

A

hospitalization and IV broad spectrum antibiotics (vancomycin)

28
Q

what is the treatment of otitis externa with perforation or chance of perforation?

A

Ciprofloxacine 0.3% and dexamethasole 0.1% : 4 drops BID x 7 days
or
ofloxacin 0.3% solution, 10 drops once a day for 7 days

29
Q

what is the treatment of an immunocompromised or diabetic patient with maligant otitis medial

A

hospitalization and IV abx (caused by aspergillus)

30
Q

what type of conjunctivitis presents with copious watery discharge, scant mucoid discharge

A

Viral conjunctivitis

31
Q

what is the presentation of bacterial conjunctivitis

A

purulent (yellow) discharge
crusting
usually worse inthe morning

32
Q

what is the treatment of bacterial conjunctivitis

A
  1. gentamicin/tobramycin (tobrex)
  2. erythromycin ointment
  3. trimethoprim and polymyxin B (polytrim)
  4. Ciprofloxacin
33
Q

what condition is due to optic disc swelling that is caused by increase intracranial pressure

A

papilledema

34
Q

what are causes of papilledema

A

Malignant hypertension
brain tumor/abscess
meningitis
cerebral hemorrhage
encephalitis
pseudotumor cerebri

35
Q

what condition presents with a white spot on the surface of the cornea that stains with fluorscein

A

corneal ulcer

36
Q

what is the treatment of corneal ulcers

A

immediate referral
if not possible - topical ophthalmic antibiotics without delay

37
Q

a 19-year-old male who you are seeing for follow-up from the urgent care where he was seen 2 days earlier with a sore throat. The patient is febrile (102°F), has a muffled (hot potato) voice, and extreme difficulty opening his mouth (trismus). He opens it just far enough for you to note uvular deviation.
what is the most liekly diagnosis?

A

Peritonsilar abscess

38
Q

how are peritonsillar abscess’s diagnosed?

A

xray
CT
US of neck
may require needle aspiration wiht culture

39
Q

what condition is caused by inflammation of lacrimal glands that is usually caused by bacteria or virus

A

dacryoadenitis

40
Q

what is dacryocystitis

A

infectious obstruction on nasolacrimal duct

41
Q

a 58-year-old woman presents to the emergency department with a 3-day history of increasing pain, redness, and swelling in the inner corner of her left eye. She also reports some purulent discharge from the same eye. She denies any vision changes or trauma. On physical examination, you note localized erythema, warmth, and swelling over the medial canthal area of her left eye. Her visual acuity is normal.
what is the most likely diagnosis?

A

dacryocystitis

42
Q

a 65-year-old man complaining of a sudden unilateral vision loss, which he describes as a “curtain or dark cloud lowering over my eye.” This was preceded by small moving flashing lights and floaters.
What is the most likely diagnosis?

A

retinal detachment

43
Q

what is myopia

A

nearsighted

44
Q

what is the treament of dental abscess

A

ceftriaxone IM followed by PO amoxicillin

45
Q

a 74-year-old man with sudden vision loss in his right eye. He has a medical history of hypertension, coronary artery disease, and new-onset atrial fibrillation. On physical exam, a carotid bruit is auscultated. His visual acuity is light perception. Confrontational visual fields reveal a dense scotoma, and a penlight examination shows an afferent pupillary defect. Dilated funduscopic examination shows retinal whitening with a cherry-red spot in the fovea.
What is the most likely diagnosis?

A

retinal vascular occlusion

46
Q

what is amaurosis fugax

A

sudden, painless, unilateral and usually severe vision loss

47
Q

a 65-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department complaining of unilateral sudden, painless vision loss in his right eye that started 2 hours ago. On examination, his visual acuity in the right eye is 20/200, and fundoscopy reveals retinal hemorrhages, dilated and tortuous retinal veins, and cotton-wool spots. There is no evidence of neovascularization.
What is the most likely diagnosis?

A

retinal vein occlusion (blood and thunder fundus)

48
Q

a 17-year-old on the high school varsity wrestling team who was injured during a match. On physical exam, you note a fluctuant, tender edematous lesion of the anterior-superior outer portion of the right pinna
What is the most likely diagnosis?

A

subperichondrial hematoma

49
Q

a 17-year-old on the high school varsity wrestling team who was injured during a match. On physical exam, you note a fluctuant, tender edematous lesion of the anterior-superior outer portion of the right pinna
given the most likely diagnosis, what is the treatment options?

A

referral for immediate I&D by ENT specialist

50
Q

bleeding of the sphenopalatine artery causes what kind of epistaxis

A

posterior
(woodruffs plexus)

51
Q

what medications are non ototoxic

A

floxin drops

52
Q

a 47-year-old African American male presents for an ophthalmic examination. Medical history is significant for hypertension and type II diabetes mellitus. On slit-lamp examination, there is cupping of the optic disc, with a cup-to-disc ratio > 0.6. Tonometry reveals intraocular pressure of 45 mmHg (normal is 8-21 mmHg). Peripheral field vision loss is noted on the visual field exam.
What is the most likely diagnosis

A

open-angle glaucoma

53
Q

a 60-year-old Asian American woman presents with sudden ocular pain. She reports she was visiting the planetarium when the pain started, and when she walked outside, she saw halos around the street lights. The pain was so bad that she began to vomit. She reports her vision is decreased. Physical examination reveals conjunctival injection, a cloudy cornea, and pupils
what is the most likely diagnosis

A

acute angle-closure glaucoma

54
Q

what is the classic triad of acute narrow angle-closure glaucoma

A

injected conjunctiva
steamy cornea
fixed and dilated pupil

55
Q

how are open angle and acute narrow angle closure glaucoma diagnosed

A

tonometry - increased ICP
may show cupping of optic nerve

56
Q

what is the gold standard test for diagnosis of angle-closure glaucoma

A

gonioscopy

57
Q

what is the first-line agent for treatment of acute narrow angle closure glaucoma

A

acetazolamide IV - decrease IOP by decreasing aqueous humor production

58
Q

what is the definitive treament of acute narrow angle-closure glaucoma

A

peripheral iridtomy

59
Q

what is the first line treatment for chornic open-angle glaucoma

A

prostaglanding inhibitors (latanaprost) - increases the outflow of aqueus humor

Clinical: Emergency Medicine (13 decks)

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