Ophthalmology

Question 1

sudden eye pain, nausea, vomiting, headache, blurred vision, injected eye, edematous cornea, mid-dilated pupil. Dx and Tx?

Answer 1

Dx : Acute Gluacoma Tx : Immediate Ophth consult.

1st line : topical beta blocker (timolol, carteolol)

other options

• pilocarpine 4% eye drop : cholinergic effect to - constrict pupil
• IV acetazolamide 500mg : carbonic anhydrase inhibitor to reduce the production of aqueous humor.

acute closed angle glaucoma, long term Tx?

laser iridotomy

Question 2

sudden onset of floaters, flashes, painless loss of vision. a curtain came down over the eye. Dx?

Answer 2

retinal detachment

Question 3

painful red eye, photophobia, normal pupil light reflex reflex lacrimation, Hx of foreign body

Answer 3

acute keratitis

Question 4

(moderate) painful red eye, photophobia, normal cornea, constricted pupil

Answer 4

acute iritis

(=anterior uveitis)

Question 5

ptosis, a large unreactive pupil,

horizontal diplopia, normal indirect light reflex.

Answer 5

CN III oculomotor

*pupil light refex

afferent : optic n,

efferent : oculomotor

Question 6

binocular horizontal diplopia

worsens with a gaze toward the paretic lateral lectus muscle

Answer 6

CN VI (Abducens)

*eye motor : LR6SO4

Question 7

binocular vertical diplopia and subjective torsional diplopia

Answer 7

CN IV (trochlear)

Question 8

extraocular motor dysfuntion

pupilary reflex intact

Answer 8

diabetic third nerve palsy

Question 9

sudden-onset decreased vision, especially color vision

retro-orbital pain

a young female

Dx? Dx test?

Answer 9

suspect optic neuritis d/t multiple sclerosis

test : MRI, exclude MS (demyelination brian resions)

Visual evoked potentias is the most sensitive and accurate diatnostic test for optic neuritis.

Question 10

Answer 10

diabetic retinopathy

Question 11

Answer 11

malignant hypertension

Question 12

what is the finding?

what disease can cause this?

Answer 12

papiloedema

raised ICP : intracranial mass, lesion, optic neuritis, malignant hypertension, uveitis (sarcoidosis, tuberculosis)

Question 13

Answer 13

central retinal vein occlusion

Question 14

Answer 14

central artery occlusion

Question 15

Answer 15

age-related macular degeneration

Question 16

Answer 16

optic nerve atrophy

Primary optic nerve atrophy is caused by inflammation (optic neuritis), glaucoma or general retinal ischaemia.

Secondary optic nerve atrophy is caused by longstanding papilloedema.

Question 17

Answer 17

glaucoma

Question 18

60 yo, gradual loss of ability to see clearly, the center of vision blurry,

horizontal lines look wavy

Dx?

Answer 18

age-related macular degeneration

Question 19

optic pathyway glioma

+

eye lesions

Dx?

Answer 19

Neurofibromatosis type I

(Lisch nodules in the eyes)