Ophthalmology Flashcards
what is a hyphema
trauma causes blood in anterior chamber of the eye (between the cornea and iris) and may cover the iris
how are hyphema’s diagnosed?
orbital CT if indicated + ophthalmology consult
what is the treatment of hyphemas
usually blood is reabsorbed over days/weeks
elevate head at night to 30 degrees
may use beta-andrednergic blockers or carbonic anhydrase inhibiors
what class of medications are contraindicated in the treatment of Hyphema
NSAIDs - may increase bleeding
what is required for clinical diagnosis of AOM
- bluging of TM
- other signs of acute inflammation
- middle ear effusion
what is the first line treatment of AOM
amoxicillin
what is second line treatment of AOM
augmentin
what is the most common cause of acute pharyngitis
adenovirus
what is the Centor Score
used for strep pharyngitis
1. absence of a cough
2. exudates
3. fever (>100.4)
4. cervical lymphadenopathy
what is the first line treatment for strep pharyngitis
penicillin
what condition is associated with gradual painless loss of central vision
macular degeneration
what type of macular degeneration presents with Drusen
Dry macular degeneration
what is the treatment of wet macular degeneration
VEGF inhibitors (bevacizumab)
photodynamic therapy
zinc and antioxidant vitamins
what is the treatment of dry macular degeneration
zinc and antioxidant vitamin
what is the diagnostic test for acute sinusitis
plainview x-ray (waters view)
CT = gold standard
what is the diagnostic tests for mastoiditis
clinical
CT scan temporal bone with contrast
what is the treatment of mastoiditis
IV abx (ceftriaxone)
drainage of middle ear fluid
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
optic neuritis
what is an acute inflammation and demyeliniation of the optic nerve leading to acute monocular vision loss/blurriness and pain on extraocular movements
optic neuritis
What is the most common cause of optic neuritis
multiple sclerosis
what medication is associated with optic neuritis
ethabutol
what test is used to confirm demyelination of optic nerve
MRI
what is the treatment of optic neuritis
IV corticosteroids
refer to neurology for evaluation of MS
what is blepharitis
chronic inflammation of lid margins caused by seborrhea, staph or step = dysfunction of Meibomian glands
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?
ortibtal cellulitis
what confirmatory test is used for orbital cellulitis
Ct scan of orbits
what is the treatment of orbital cellulitis
hospitalization and IV broad spectrum antibiotics (vancomycin)
what is the treatment of otitis externa with perforation or chance of perforation?
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
what is the treatment of an immunocompromised or diabetic patient with maligant otitis medial
hospitalization and IV abx (caused by aspergillus)
what type of conjunctivitis presents with copious watery discharge, scant mucoid discharge
Viral conjunctivitis
what is the presentation of bacterial conjunctivitis
purulent (yellow) discharge
crusting
usually worse inthe morning
what is the treatment of bacterial conjunctivitis
- gentamicin/tobramycin (tobrex)
- erythromycin ointment
- trimethoprim and polymyxin B (polytrim)
- Ciprofloxacin
what condition is due to optic disc swelling that is caused by increase intracranial pressure
papilledema
what are causes of papilledema
Malignant hypertension
brain tumor/abscess
meningitis
cerebral hemorrhage
encephalitis
pseudotumor cerebri
what condition presents with a white spot on the surface of the cornea that stains with fluorscein
corneal ulcer
what is the treatment of corneal ulcers
immediate referral
if not possible - topical ophthalmic antibiotics without delay
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?
Peritonsilar abscess
how are peritonsillar abscess’s diagnosed?
xray
CT
US of neck
may require needle aspiration wiht culture
what condition is caused by inflammation of lacrimal glands that is usually caused by bacteria or virus
dacryoadenitis
what is dacryocystitis
infectious obstruction on nasolacrimal duct
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?
dacryocystitis
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?
retinal detachment
what is myopia
nearsighted
what is the treament of dental abscess
ceftriaxone IM followed by PO amoxicillin
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?
retinal vascular occlusion
what is amaurosis fugax
sudden, painless, unilateral and usually severe vision loss
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?
retinal vein occlusion (blood and thunder fundus)
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?
subperichondrial hematoma
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?
referral for immediate I&D by ENT specialist
bleeding of the sphenopalatine artery causes what kind of epistaxis
posterior
(woodruffs plexus)
what medications are non ototoxic
floxin drops
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
open-angle glaucoma
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
acute angle-closure glaucoma
what is the classic triad of acute narrow angle-closure glaucoma
injected conjunctiva
steamy cornea
fixed and dilated pupil
how are open angle and acute narrow angle closure glaucoma diagnosed
tonometry - increased ICP
may show cupping of optic nerve
what is the gold standard test for diagnosis of angle-closure glaucoma
gonioscopy
what is the first-line agent for treatment of acute narrow angle closure glaucoma
acetazolamide IV - decrease IOP by decreasing aqueous humor production
what is the definitive treament of acute narrow angle-closure glaucoma
peripheral iridtomy
what is the first line treatment for chornic open-angle glaucoma
prostaglanding inhibitors (latanaprost) - increases the outflow of aqueus humor
