Ophthalmology II highlights

Question 1

Open globe/ Ruptured globe:
1) What should you do if a pt comes in with this?
2) What is the Tx?

Answer 1

1) Requires emergent Ophthalmic consultation; do not put anything into the eye
2) CT scan of orbits, then IV antibiotics (per opthalmology)

Question 2

Diabetic retinopathy:
1) Is it ever asymptomatic?
2) List 2 important Sx

Answer 2

1) Asymptomatic until late stages
2) Hemorrhages and cotton-wool spots

Question 3

What condition majorly contributes to the importance of regular eye exams, especially for those with risk factors (DM, HTN)?

Answer 3

Retinopathy

Question 4

Leading cause of preventable blindness is what?

Answer 4

Retinopathy

Question 5

Blowout Fracture:
1) How is this diagnosed?
2) What does it require?
3) What is a significant consequence of fractures of the orbital floor? What can this cause?

Answer 5

1) CT imaging
2) Ophthalmology referral + hospitalization
3) Entrapment of the inferior rectus muscle and/or orbital fat.
-Muscle entrapment may lead to ischemia and subsequent loss of muscle function

Question 6

Chemical ocular injury:
1) Do acids or alkaline substances usually cause more severe damage?
2) What is the Tx? What is commonly used in emergency departments?

Answer 6

1) Alkaline
2) Profuse continuous irrigation; Morgan lens

Question 7

What condition is characterized by being asymptomatic until late stages, then presenting with the retinal findings of hemorrhages and cotton-wool spots?

Answer 7

Diabetic retinopathy

Question 8

When should you screen for diabetic retinopathy in each type?

Answer 8

1) Type 1 DM: initial screening @ 5 years after diagnosis, then yearly or PRN
2) Type 2 DM: initial screening @ time of diagnosis, then yearly or PRN

Question 9

1) Hypertensive retinopathy is related to what 2 things?
2) What do these lead to?

Answer 9

1) Arteriolar sclerosis and chronic elevated blood pressure
2) Ischemia

Question 10

Hypertensive retinopathy:
1) Is it ever asymptomatic?
2) List 4 important Sx

Answer 10

1) Until late stages when vision is impaired
2) Copper/ silver wiring, flame-shaped hemorrhages, AV nicking, cotton wool spots

Question 11

What condition is asymptomatic until later stages, and later has copper/ silver wiring, flame-shaped hemorrhages, AV nicking, or cotton wool spots on a retinal exam?

Answer 11

Hypertensive retinopathy

Question 12

True or false: cotton wool spots can happen in both types of retinopathy

Answer 12

True

Question 13

What could an absent red reflex or if pupil appears white (when light is shined upon it) indicate?

Answer 13

Retinoblastoma

Question 14

1) What are some findings typical of severe hypertensive retinopathy?
2) What is the mainstay of treatment?

Answer 14

1) Moderate retinopathy findings plus papilledema
2) Control blood pressure and lipids

Question 15

Optic cup: disc ratio > 0.5 is suggestive of what?

Answer 15

Chronic open-angle glaucoma

Question 16

Optic neuritis:
1) Define it & give it’s main symptom
2) What are the other Sx?
3) What is the most common cause?

Answer 16

1) Acute inflammation of optic nerve; pain with eye movement
2) Acute onset of monocular vision loss/blurred vision and pain in affected eye
3) Multiple Sclerosis (MS)

Question 17

Flame-shaped hemorrhages are characteristic of what stage of hypertensive retinopathy?

Answer 17

Moderate

Question 18

Define papilledema

Answer 18

Swelling of the optic disc secondary to increased intracranial pressure

Question 19

List 3 majors causes of chronic vision loss

Answer 19

Glaucoma
Cataracts
Age-related macular degeneration

Question 20

What is normal IOP?

Answer 20

~10-21 mmHg

Question 21

Chronic open-angle glaucoma:
1) What is NOT a valuable screening tool?
2) What is?

Answer 21

1) Measurement of IOP is not valuable
2) Elevated cup : disc ratio seen in fundoscopy

Question 22

1) What type of glaucoma is a sight-threatening medical emergency?
2) Describe the Sx of this type

Answer 22

1) Acute angle-closure glaucoma
2) Acute, unilateral Sx

Question 23

List 2 findings typical of optic neuritis on examination

Answer 23

1) Relative afferent pupillary defect (RAPD, also called Marcus Gunn Pupil)
2) Pupil dilates instead of constricts when light is swung to the eye

Question 24

What is the classic triad of Acute angle-closure glaucoma Sx?

Answer 24

1) Red eye
2) Hazy cornea
3) Fixed, dilated pupil

Question 25

Chronic open-angle glaucoma:
1) Define this condition
2) What % of glaucoma cases does it make up?
3) What is one way to diagnose it?
4) What is the classic Sx?

Answer 25

1) A gradual increase in IO
2) Common ~ 90% of glaucoma cases
3) Optic nerve damage [on fundoscopy]
4) Progressive peripheral vision loss that moves to central vision loss

Question 26

Macular degeneration (AMD):
1) What is the key visual change?
2) What is the strongest modifiable risk factor for developing AMD?

Answer 26

1) Mostly affecting central vision
2) Smoking

Question 27

1) What is the focus of Acute angle-closure glaucoma Tx?
2) What is the definitive Tx?

Answer 27

1) Decreasing IOP via decreased aqueous humor production
2) Laser peripheral iridotomy

Question 28

Which 3 groups of glaucoma meds increase aqueous outflow/ drainage?

Answer 28

1) Cholinergic agents
2) Prostaglandin analogs
3) Alpha agonists (both mechanisms)

Question 29

List the categories of glaucoma medications and give an example of each

Answer 29

1) Cholinergic agents
-Pilocarpine
2) Prostaglandin analogs
-Xalatan (latanoprost)
3) Beta blockers
-Timolol
4) Alpha agonists
-Brimodine
5) Carbonic anhydrase inhibitors (CAIS)
-Acetazolamide

Question 30

1) Cataracts present with _________________ visual impairment.
2) What are 2 things you may see on exam of a cataract pt?

Answer 30

1) Slowly progressive
2) Diminished red reflex, may note clouding of lens

Question 31

Chronic open-angle glaucoma:
1) Is it reversible?
2) What is the Tx focus?

Answer 31

1) Irreversible disease
2) Reducing IOP and maintaining normal ocular pressure

Question 32

Which is greater in macular degeneration, central or peripheral vision loss?

Answer 32

Central

Question 33

Drusen are associated with what?

Answer 33

Macular degeneration

Question 34

Name one of the most successfully treated conditions in all of surgery

Answer 34

Cataracts

Question 35

Giant cell arteritis:
1) Name 1 diagnostic study
2) How do you treat?

Answer 35

1) Elevated ESR (sed rate)
2) IV steroids (methylprednisolone), hospital admission for temporal artery biopsy

Question 36

Cataracts:
1) What is a key visual change a pt might tell you?
2) What is it very closely related to?

Answer 36

1) Can’t see well at night
2) Age; most persons over the age of 70 will have some degree of cataracts

Question 37

What are the 2 types of macular degeneration? Which is more common? Which is more acute?

Answer 37

1) Dry AMD: more common (chronic)
2) Wet AMD: less common (acute)

Question 38

Macular degeneration:
1) What is a key thing you may see on fundoscopy?
2) What is a screening tool?
3) Who is it the most common cause of central visual loss & permanent blindness in?

Answer 38

1) Drusen
2) Amsler Grid test
3) Elderly

Question 39

Giant cell arteritis:
1) What are 2 risk factors?
2) Who does it never occur in?
3) Why should it be treated?

Answer 39

1) Age (> 60-70 years old); Polymyalgia Rheumatica (PMR)
2) Never occurs in individuals under 50 years of age
3) Left untreated, can cause blindness

Question 40

Painless, sudden vision loss described as a curtain-like shadow descending over the visual field is a hallmark of what?

Answer 40

Retinal detachment

Question 41

What are two signs of retinoblastoma on PE?

Answer 41

1) Absent red reflex
2) If pupil appears white (when light is shined upon it)

Question 42

Retinal detachment:
1) List 2 hallmark Sx descriptions
2) What does it often present with?

Answer 42

1) Painless, sudden vision loss
-A curtain-like shadow descending over the visual field
2) Peripheral field defect

Question 43

True or false: retinal detachment is an ophthalmologic emergency

Answer 43

True

Question 44

1) What is retinoblastoma?
2) Who is it most commonly found in?

Answer 44

1) Malignant eye cancer
2) Children