Ophthalmology II scenarios Flashcards
A pt’s chart says they have had a full thickness break of the eye wall. You know this includes what parts?
Sclera and cornea
A pt comes in with an open/ ruptured globe. What do you do?
Immediately send to ophthalmology, do not put anything in the eye, cover the eye to protect it if needed.
(ophthalmology will start IV antibiotics).
You see flame-shaped hemorrhages and copper/silver wiring. These are telltale signs of what Dx and stage?
Hypertensive retinopathy (moderate)
What Dx would the finding of “AV nicking with cotton wool spots” support?
Hypertensive retinopathy
A pt has a form of preventable blindness. What are they statistically most likely to have?
Retinopathy (caused by HTN or DM)
You see dot and blot hemorrhages & cotton-wool spots on the back of a pts retina. What do they likely have?
Diabetic retinopathy
A 19 year old baseball player comes in with pain, bruising, and soft tissue swelling around the orbit. What may they have, and how would you diagnose it?
Blowout fracture; diagnosed w. CT imaging
1) A pt. comes in with a blowout fracture. Statistically, they have a 50/50 chance of what?
2) What would this put them at high risk for?
1) Inferior orbit floor involvement
2) Entrapment of the inferior rectus muscle and/or orbital fat (& subsequent ischemia).
Your pt complains of monocular blurred vision and pain in the affected eye with movement. You are concerned they have what?
Optic neuritis
At what stage of diabetic retinopathy would you start to see blood leaking into your pt’s retina?
Nonproliferative
At what stage of diabetic retinopathy would you start to see abnormal new vessels growing onto the retina?
Proliferative (needs immediate Tx)
A pt has Marcus-Gunn pupil (relative afferent pupillary defect (RAPD)). This is a Sx of what condition we talked abt?
Optic neuritis
If an MD says a pt has papilledema you know what?
They have swelling of the optic disc secondary to increased intracranial pressure
A pt comes in with an acute, unilateral red eye, hazy cornea, and a fixed dilated pupil. What classic triad is this?
Acute angle-closure glaucoma
Your pt is older, african american, and has increased IOP. What sight-threatening medical emergency are they at risk for?
What would be the focus of your Tx for this?
1) Acute angle-closure glaucoma
2) Decreasing IOP via decreased aqueous humor production
After routine exams, a pt has a demonstrated gradual increase in IOP, and optic nerve damage is now evident. They have also complained about peripheral vision loss encroaching on their central vision.
What are you suspicious of? Can you Dx them right now? Explain.
Chronic open-angle glaucoma; can Dx based off optic nerve damage or the best indicator (elevated cup: disc ratio on fundoscopy)
A pt has glaucoma. Just statistically, they have a 90% chance of having what kind?
Chronic open-angle glaucoma
You’re suspicious a pt has chronic open-angle glaucoma. What is NOT an effective screening tool?
Measurement of IOP
A pt has acute angle-closure glaucoma. What are the Tx options?
1) Pressure-lowering topical and systemic agents are administered
-Topical B-blocker (Timolol): decreases IOP via decreased AH production without affecting visual acuity
-Miotics/cholinergic (pilocarpine): affect vision
2) Definitive treatment is laser peripheral iridotomy (performed same day by ophthalmologist) – holes in iris
Your pt has chronic open-angle glaucoma. You know management of this condition focuses on slowing progression and preserving quality of life, but what are your specific options? How does each work?
1) Prostaglandin analogs (Latanoprost): increase AH outflow
2) Topical B-blocker (Timolol): decrease production of AH
3) Smoking marijuana (cannabis) can lower IOP: however not clinically indicated because it does not change the course of the disease, is short-acting, and has other adverse effects.
An older pt with slowly progressive visual impairment has diminished red reflex & clouding of lens on exam. What is the likely Dx?
Cataracts
An 85 year old pt complains they can’t see well at night. You know that most pt’s over the age of 70 have some degree of what condition that may cause this?
Cataracts
A pt, who is a smoker, has very slow loss of central vision.
1) What is the most likely Dx?
2) What can slow the progression?
1) Dry AMD (age-related macular degeneration) (more common & more chronic type)
2) Smoking cessation
A pt has the less common and more acute form of AMD. You know this has what Tx option?
Anti-VEGF drugs (for wet AMD)
What condition will you never see in a pt under 50?
Giant cell arteritis
A pt has Polymyalgia Rheumatica (PMR). They are at risk for what condition that, when left untreated, can cause blindness?
Giant Cell Arteritis
A pt has new onset headaches, scalp tenderness, claudication (jaw pain), unexplained fever, and vision problems.
1) What may they have and how can it be diagnosed?
2) Tx?
1) Giant Cell Arteritis; elevated ESR (sed rate)
2) IV steroids (methylprednisolone), hospital admission for temporal artery biopsy
A pt, age 55 with myopia, experiences painless, sudden vision loss. They describe it as a curtain-like shadow descending over the visual field and peripheral field defect. They suddenly have a ton of floaters too.
Is this an emergency or not? What do you do? Explain
Retinal detachment; an ophthalmologic emergency
-Keep patient supine, head turned toward side of detached retina.
A child has an absent red reflex and their pupil sometimes appears white (when light is shined upon it). What may they have?
Retinoblastoma