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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
Q

T or F; all hyphema to be evaluated and managed by ophtho.

A

True

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26
Q

Periocular infantile hemangioma. List two things you would do in immediate management.

A
  1. Ophtho consult
  2. Topical beta blocker
  3. Intralesional steroid
  4. +/- Sx excision
27
Q

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?

A

Reassure.

  • likely viral
28
Q

Contact lens conjunctivitis. Management?

A

Referral to ophtho

29
Q

Most serious condition associated with contact lens wearer?

A

Infectious keratitis

  • bacterial
  • symptom in 24h
  • conjunctivitis
  • poor vision
  • pain
  • topical Abx + Ophtho
30
Q

List two steps in managing baby with corneal abrasion seen on fluorescein dye.

A
  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

  1. Ophtho F/U

PATCHING not recommended.

+/- tetanus (only for penetrating trauma)

31
Q

T or F: you should patch an eye with corneal abrasion.

A

False.

  • BUT do you want to avoid squeezing and rubbing
32
Q

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
A

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
Q

T or F: non traumatic causes of retinal hemorrhage go away within 6-8 weeks of age.

34
Q

List 3 causes of retinal hemorrhage:

A
    1. child birth
    1. abusive head trauma
    1. bleeding dx (hemophilia, vitamin K deficiency, vWF)
      1. metabolic (*glutaric aciduria type 1, galactosemia)
      2. cerebral malaria, meningitis
35
Q

Name the eye condition associated w/: toxoplasmosis

A

Chorioretinitis

white, black, grey cloud

36
Q

Name the eye condition associated w/: Abusive head trauma

A

Retinal hemorrhages

red ill-defined areas

37
Q

Name the eye condition associated w/ late ROP

A

tortuous vessels

thick, squiggly

38
Q

Name the eye condition associated w/: Tay-sachs disease

A

Cherry red spots

flame red with yellow cloud around

39
Q

Name red flags P/E for orbital cellulitis:

A
  • *relative afferent pupillary defect (due to optic nerve defect)
  • *visual acuity change
  • *ophthalmoplegia (wk muscle = EOM)
    +/- diplopia
  • *pain w/ EOM
  • *proptosis
  • chemosis
40
Q

When do you consider Sx approach for blocked nasolacrimal duct obstruction?

A

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
Q

Which nerves innervate eye movements?

A 
All CN3
EXCEPT 
LR6-SO4
 (lateral rectus CN6)
(superior oblique CN4)
42
Q

Child with CN 7 palsy will typically:

  • be unable to open
  • be unable to close
  • poor corneal sensation
  • reduced tearing
  • poor vision acuity
A

Unable to close affected eye

43
Q

List 5 causes of Ptosis:

A

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
Q

T or F: you can have normal vision in orbital cellulitis.

A

True.

If abN= orbital.
but can be Normal.

45
Q

What is the clear divider between orbital + periorbital cellulitis?

A

Orbital septum

46
Q

What are common causes of orbital versus periorbital cellulitis

A

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
Q

Is blepharitis or chalazoin associated with corneal scaring complication?

A

Blepharitis.

48
Q

T or F: most causes of nasolacrimal duct obstruction resolve spontaneously.

49
Q

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

A

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
Q

T or F: bilateral retinal hemorrhage is pathognomonic for abusive head trauma.

A

False.

No pathognomonic.
But multiple b/l retinal hemorrhage raise concern.

51
Q

Who is at risk of ROP:

A
  1. GA < 31 wk GA

2. OR BW < 1250 g

52
Q

What are kids with ROP at risk of later?

A

Strabismus
Amblyopia
Refractive Error

*see them @ 1 y.o.
If good- community check @ 3-5 y.o.

53
Q

What is the most common intraocular CA of childhood?

A

Retinoblastoma.

Cause leukocoria.

54
Q

T or F: you can electively refer ophtho for abN red reflex.

A

False.

EMERGENT!

55
Q

Obese teen with new h/a. AbN fundoscopy. Dx? other Symp?

A

Papeilledema.

Likely idiopathic intracranial HTN.

Symp:

  • transient visual obstruction
  • horizontal diplopia
  • pulsatile tinnitus
  • N/V
56
Q

“My baby only opens their eyes at night”

A

Congenital glaucoma

57
Q

Pituitary Mass cause what visual defect?

A

Bilateral hemianopia.

B/L outter halves gone.

58
Q

Best test to confirm dx of “esotropia”

A

Cover test

59
Q

Myopia means what?

A

My My= i can see up close. but can’t see far

-= Near-sighted.

60
Q

T or F: constant nystagmus can be physiologic.

A

False.

  • Constant mvmt= NOT normal.
  • suggest benign congenital dx, low vision, structural lesion etc.
61
Q

T or F: it’s normal to still have physiologic strabismus at 4 months.

A

False.

3-4 month: eyes properly aligned. NO strabismus. Fix and follow well.

62
Q

Name some red flags for ophtho:

A
  • strabismus
  • visually disinterested +/- stare at bright light
  • forcefully rub or poke eye
  • nystagmus constantly
  • sunsetting
63
Q

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

A

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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