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RC: Specialties Woo Hoo > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Give a condition that correspond to following eye condition:

  • Coloboma
  • Dislocated Lens
  • Aniridia
  • Glaucoma
A

Coloboma= CHARGE
- defect in iris

Dislocated Lens= Marfan’s

Aniridia= WAGR
absent iris (aniridia), Wilm, Gonadoblastoma, Retardation

Glaucoma= NF1, Sturge Weber Syndrome

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2
Q

Triad of symptoms for glaucoma?

A

Tearing
+ Photophobia
+ Blepharospasm (involuntaring eyelid closing)

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3
Q

21 mon. left eye conjunctivitis w/ d/c. Normal examination. 36h after cipro exam the same. Next step?

A

Refer to ophtho.

  • if pt doesn’t respond to warm compress + topical ABX x 1-2d= ophtho referral.

Note: fucidic acid= steroid should be prescribed by non ophtho b/c high risk for severe complication.

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4
Q

What are red flags w/ conjunctivitis that suggest ophtho referral?

A
  • *contact lens involved
  • severe purulent d/c
  • *vision loss
  • severe pain
  • severe photophobia
  • *corneal involvement
  • conjunctival scar
  • cutaneous-conjunctival (SJS)
  • *HSV
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5
Q

Key to amblyopia treatment?

A

Patch good eye.

+/- Sx

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6
Q

What is amblyopia?

A

Defect in vision

- that cannot be explained by refractive error

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7
Q

When do you refer strabismus (misalignment like eso or exotropia) to ophtho?

A
  • if > 4 month
  • fixed deviation
  • decreased visual acuity
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8
Q

Child with right esotropia but normal corneal reflex. What is the reflex?

A

Pseudostrabismus

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9
Q

3 month old w/ crusty d/c intermittently. Tx?

A

Likely nasolacrimal duct obstruction.

Tx: massage 2-3X daily
+ cleansing lids warm water
+/- topical Abx mucopurulent drainage
+/- ophthal ointment to lid if macerated

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10
Q

T or F: BB w/ dacrostenosis may develop dacrocystitis.

A

True.

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11
Q

T or F: BB with dacrostenosis is always present at birth.

A

False.

Not always true. Symptoms at birth also then depend if partial or complete block.

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12
Q

3 month old with seromucoid d/c from 1 eye. What do you do?

A

Reassure.

Like nasolacrimal duct obstruction.

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13
Q

Risk factors for nasolacrimal duct obstruction?

A
  • *T21
  • *CHARGE
  • Goldenhar syn
  • Branchiooculofacial syndrome
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14
Q

List two complications of nasolacrimal duct obstruction:

A
  1. Dacrocystitis (acute infection of sac)
  2. Periorbital cellulitis
  3. Pericystitis
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15
Q

T or F: Dacryostenosis resolve by 2 y.o.

A

False.

Resolve by 1 y.o.

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16
Q

List 3 causes of leukocoria (white reflex)?

A
    • Cataract
    • Retinoblastoma
    • Toxocariasis
    • Chronic retinal detachment
  5. Coats Dx (abN retinal vasculature)
    • Advanced retinopathy of prematurity
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17
Q

Which of the following is true about anisocria (unequal size pupils) in child w/ otherwise normal P/E.

  • unequal pupils seen in 25% of N kids
  • AR trait
  • larger pupil abN
  • larger pupil will have abN shape
A

Unequal pupils seen in 25% of normal children.

  • typical AD
  • smaller or larger pupil could be abN
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18
Q

List three aetiologies for anisocoria (unequal pupils):

A
  1. Synechiae (adhesion)
  2. Congenital iris defect (coloboma etc.)
  3. Symph or parasymph defect
    4 Horner (PAM- ptosis, anhidrosis, mitosis)
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19
Q

Which sport is most common cause of eye injury in Canada:

  • baseball
  • hockey
  • soccer
  • golf
  • javelin
  • baseketball
A

Hockey

or Basketball

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20
Q

When is re-bleeding most likely to occur with hyphema:

A

4 days

usually 3-5 d after initial bleed

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21
Q

List 2 steps in immediate management in hyphema.

A
  1. Bed rest
  2. HOB 30 degree
  3. Shield (without patch) on affected eye
  4. Cycloplegic agent
  5. Topical or systemic steroids
  6. Call ophtho!
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22
Q

List two complications if hyphema not treated correct

A
  1. Rebreeding
  2. Glaucoma
  3. Corneal blood staining
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23
Q

Define a hyphema:

A

bleeding in anterior chamber

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24
Q

T or F: most common cause of hyphema is juvenile xanthogranuloma (non langerhans cell histiocytosis)

A

False. Rare Cause.

Most= trauma
- blunt or perforating injury

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25
T or F; all hyphema to be evaluated and managed by ophtho.
True
26
Periocular infantile hemangioma. List two things you would do in immediate management.
1. Ophtho consult 2. Topical beta blocker 3. Intralesional steroid 4. +/- Sx excision
27
5 y.o. M with serious mucoid d/c from left eye. No periorbital edema or red. Mom and bro had same thing 1 week ago. Tx?
Reassure. - likely viral
28
Contact lens conjunctivitis. Management?
Referral to ophtho
29
Most serious condition associated with contact lens wearer?
Infectious keratitis - bacterial - symptom in 24h - conjunctivitis - poor vision - pain - topical Abx + Ophtho
30
List two steps in managing baby with corneal abrasion seen on fluorescein dye.
1. Topical ABX 4X/day x 3-5 d i. e. erythromycin, Trimethoprim-polymyxin B 2. Pain med i. e. NSAID i. e. large abrasion give cycloplegia agent 3. Ophtho F/U PATCHING not recommended. +/- tetanus (only for penetrating trauma)
31
T or F: you should patch an eye with corneal abrasion.
False. - BUT do you want to avoid squeezing and rubbing
32
Which is T regarding retinal hemorrhage: - need to dx abusive head trauma - occur in vag delivery - do not occur after C/S - always associated w/ trauma - can happen with CPR
Occur in vag delivery (25% higher if vacuum assist) - can happen w/ C/S - not needed for abusive head trauma dx - can be atraumatic - rare for CPR to be cause
33
T or F: non traumatic causes of retinal hemorrhage go away within 6-8 weeks of age.
True.
34
List 3 causes of retinal hemorrhage:
* 1. child birth * 2. abusive head trauma * 3. bleeding dx (hemophilia, vitamin K deficiency, vWF) 4. metabolic (*glutaric aciduria type 1, galactosemia) 5. cerebral malaria, meningitis
35
Name the eye condition associated w/: toxoplasmosis
Chorioretinitis | white, black, grey cloud
36
Name the eye condition associated w/: Abusive head trauma
Retinal hemorrhages | red ill-defined areas
37
Name the eye condition associated w/ late ROP
tortuous vessels | thick, squiggly
38
Name the eye condition associated w/: Tay-sachs disease
Cherry red spots | flame red with yellow cloud around
39
Name red flags P/E for orbital cellulitis:
- *relative afferent pupillary defect (due to optic nerve defect) - *visual acuity change - *ophthalmoplegia (wk muscle = EOM) +/- diplopia - *pain w/ EOM - *proptosis - chemosis
40
When do you consider Sx approach for blocked nasolacrimal duct obstruction?
If approaching 1 year. Consider referral after 9 mo. as most resolve by 1 y.o. - can do probe in office= 90% cure rate
41
Which nerves innervate eye movements?
``` All CN3 EXCEPT LR6-SO4 (lateral rectus CN6) (superior oblique CN4) ```
42
Child with CN 7 palsy will typically: - be unable to open - be unable to close - poor corneal sensation - reduced tearing - poor vision acuity
Unable to close affected eye
43
List 5 causes of Ptosis:
Ptosis= lid doesn't elevate - congenital: *dystrophic levator muscle (no eye lid crease) - *hemangioma - trauma - *muscular dystrophy - myasthenia gravis - *CN 3 palsy (ptosis + exotropia) - *Horner (PAM) - Idiopathic
44
T or F: you can have normal vision in orbital cellulitis.
True. If abN= orbital. but can be Normal.
45
What is the clear divider between orbital + periorbital cellulitis?
Orbital septum
46
What are common causes of orbital versus periorbital cellulitis
Orbital: sinus infection. + unwell, fever, painful EOM, red eye. Preseptal/Periorbital: lid wound, bite. + no fever typically w/ white eye.. Full EOM. no sinus opacification.
47
Is blepharitis or chalazoin associated with corneal scaring complication?
Blepharitis.
48
T or F: most causes of nasolacrimal duct obstruction resolve spontaneously.
True
49
R pupil < L in healthy 3 month old. Which suggest Horner? a. Severe right ptosis b. right iris lighter than left c. mild R proptosis d. optic disc edema R e. limited abduction R eye
Horner= PAM - ptosis (mild though because Horner affect sympathetic but CN 3 does a lot of work so only drop 1-2mm) - anihidrosis - miosis ** sympathy also drive colour of iris. So answer= B. iris lighter on R than L
50
T or F: bilateral retinal hemorrhage is pathognomonic for abusive head trauma.
False. No pathognomonic. But multiple b/l retinal hemorrhage raise concern.
51
Who is at risk of ROP:
1. GA < 31 wk GA | 2. OR BW < 1250 g
52
What are kids with ROP at risk of later?
Strabismus Amblyopia Refractive Error *see them @ 1 y.o. If good- community check @ 3-5 y.o.
53
What is the most common intraocular CA of childhood?
Retinoblastoma. Cause leukocoria.
54
T or F: you can electively refer ophtho for abN red reflex.
False. | EMERGENT!
55
Obese teen with new h/a. AbN fundoscopy. Dx? other Symp?
Papeilledema. Likely idiopathic intracranial HTN. Symp: - transient visual obstruction - horizontal diplopia - pulsatile tinnitus - N/V
56
"My baby only opens their eyes at night"
Congenital glaucoma
57
Pituitary Mass cause what visual defect?
Bilateral hemianopia. B/L outter halves gone.
58
Best test to confirm dx of "esotropia"
Cover test
59
Myopia means what?
My My= i can see up close. but can't see far | -= Near-sighted.
60
T or F: constant nystagmus can be physiologic.
False. - Constant mvmt= NOT normal. - suggest benign congenital dx, low vision, structural lesion etc.
61
T or F: it's normal to still have physiologic strabismus at 4 months.
False. 3-4 month: eyes properly aligned. NO strabismus. Fix and follow well.
62
Name some red flags for ophtho:
- strabismus - visually disinterested +/- stare at bright light - forcefully rub or poke eye - nystagmus constantly - sunsetting
63
Q: 2 y.o. F. Considering JIA. Which dx helpful to confirm: a. b/l episcleral injection near limbus ("ciliary flush") b. b/l photophobia c. prominent blepharitis d. mild enlargement of globes e. mild WBC rxn of anterior chamber of both eyes
E. Mild WBC rxn of anterior chamber of both eyes. JIA= Chronic uveitis - asymptomatic (no pain, no red) - Slit Examine - Tx early - No Tx= blind

RC: Specialties Woo Hoo (31 decks)

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