Ophthalmology

Question 1

Viral conjunctivitis

Answer 1

bilateral

watery discharge

easily transmissable

normal vision

itchy

preauricular adenopathy

no specific changes

Question 2

bacterial conjunctivitis

Answer 2

unilateral

purulent, thick discharge

poorly transmissible

normal vision

not itchy

no adenopathy

topical antibiotics

Question 3

the must know subjects in ophthalmology are

Answer 3

the red eye (emergencies)

diabetic retinopathy

artery and vein occlusion

retinal detachment

Question 4

etiologies of the red eye

Answer 4

conjunctivitis

uveitis

glaucoma

abrasion

Question 5

conjuctivitis

presentation-

eye findings -

most accurate test -

best initial therapy -

Answer 5

presentation- itchy eyes, discharge

eye findings - normal pupils

most accurate test - clinical diagnosis

best initial therapy - topical antibiotics

Question 6

uveitis

presentation-

eye findings -

most accurate test -

best initial therapy -

Answer 6

presentation- autoimmune disease

eye findings - photophobia

most accurate test - slit lamp examination

best initial therapy - topical steroids

Question 7

glaucoma

presentation-

eye findings -

most accurate test -

best initial therapy -

Answer 7

presentation- pain

eye findings - fixed midpoint pupil

most accurate test - tonometry

best initial therapy - acetazolamide, mannitol, pilocarpine, laser trabeculoplasty

Question 8

abrasion

presentation-

eye findings -

most accurate test -

best initial therapy -

Answer 8

presentation - trauma

eye findings - feelsl ike sand in eyes

most accurate test - fluorescein stain

best initial therapy - no specific therapy, patch not clearly beneficial

Question 9

chronic glaucoma

Answer 9

most often asymptomatic on presentation and is diagnosed by routine screening. confirmation is with tonometry indicating extremely elevated intraocular pressure, trat with medications to decrease the production of aqueous humor or to increase its drainage

Question 10

glaucoma treatment

Answer 10

prostaglandin analogues: latanoprost, travoprost, bimatoprost

topical beta blockers: timolol, cateolol, metipranolol, betaxolol, or levobunolol

topical carbonic anhydrase inhibitiors: dorzolamide, brinzolamide,

alpha 2 agonists: apraclonidine

pilocarpine

laster trabculoplasty: performed if medical therapy is inadequate

Question 11

acute angle closure glaucoma

Answer 11

look for sudden onset of an extremely painful, red eye that is hard to palpation. walking into a dark room can precipitate pain bc of pupillary dilation. the cornia is described as steamy and the pupil does not react to light bc it is stuck. the cup to disc ratio is greater than the normal 0.3, the diagnos is cofirmed with tonometry

Question 12

treat acute angle closure glaucoma with

Answer 12

iv aceazolamid

iv mannitol to act as an osmotic draw of gluid aout of the eye

pilocarpine, bblockers, and apraclonidine to constrict the pupil and enhance drainage

laser iridotomy

Question 13

herpes keratitis

Answer 13

infection of the cornea

the eye may be very red, swollen, and painful

do not use steroids

fluorescein staining of the eye helps confirm the dendritic pattern seen on examination

steroids markedly increase the production of the virus

Question 14

herpes keratitis

treatment

Answer 14

oral acyclovir, famciclovir, or valacyclovir

topical antiherpetic treatment is trifluridine and idoxuridine

Question 15

dont use what with herpes keratitis

Answer 15

steroids it makes it worse

Question 16

cataracts

Answer 16

there is no medical therapy for cataracts

surgically remove the lens and replace with a new intraocular lens

the new lens may automatically have a bifocal capability

early cataracts are diagnosed with an ophthalmoscope or slit lamp exam

advanced cataracts are visible on examination

Question 17

diabetic retinopathy

Answer 17

annual screening exams should detect retinopathy before serious visual loss has occurred.

nonproliferative or background retinopathy is managed by controlling glucose elvel.

the most accurate test is fluorescein angiography

proliferative retinopathy is treated with laser photocoagulation

vegf can be injected to control neovascularization

vitrectomy may be necessary to remove a vitreal hemorrahge obstructing vision

Question 18

retinal artery and vein occlusion

Answer 18

both conditions present with the sudden onset of monocular vision loss

you cannot make the diagnosis wihtout retinal examination

there is no conclusive theraphy for either condition

Question 19

treatment of retinal artery occlusion

Answer 19

100% o2, ocular massage, acetazolamide, or anterior chamber paracentesis to decrease intraocular pressure, and thrombolytics

Question 20

treatment of retinal vein occlusion

Answer 20

ranibizumab

Question 21

describe the macular in retinal artery occlusion

Answer 21

cherry red bc the rest of the retinal is pale

Question 22

retinal detachment

etiology

Answer 22

tisks include tramua to the eye, extrmee myopia that changes the shape of the eye, and diabetic retinopathy. anything that pulls on the reina can detach it

Question 23

retinal detachment

presentation

Answer 23

sudden onset of painless, unilateral loss of vision that is described as a curtain coming down

Question 24

retinal detachment

reattachment

Answer 24

attempted with a number of mechanical methods such as surgery, laser, cryotherapy, and th einjection of an expansile gas that pushes the retina back up against the globe of the eyse.

Question 25

Macular degeneration

overview

Answer 25

the ost common cause of blindness in older persons in the united states.

the cause is unknown

there is an atrophic (dry) type and a neovascular (wet) type, these combined cause 90% of blindness from MD

Question 26

visual loss in macular degeneration

Answer 26

far more common in older pts

b/l

normal external appearance of the eye

loss of central vision

Question 27

neovascular macular degeneration

Answer 27

more rapid and severe

new vessels grow between the retinal and the underlying bruch membrane.

Question 28

atrophic macular degeneration has no

Answer 28

proven efffective therapy

Question 29

Best initial therapy for neovascular macular degeneration

Answer 29

vegf inhibitor such as ranibizumab, bevacizumab, or aflibercept. they are injected directly into the vitreous chamber q 4-8 weeks. over 90% of pts will experiencea halt of progression, and one-third of pts will have improvement in vision