Ophthomology 1

Question 0

Patient presents with red itchy eyes with discharge. Pupils normal – suspected diagnosis? Most accurate test? Best initial therapy?

Answer 0

Conjunctivitis

Clinical diagnosis (no testing necessary)

Topical antibiotics

Question 1

Viral versus bacterial conjunctivitis –

1. # of eyes?
2. Type of discharge?
3. Transmissibility?
4. Vision?
5. Pruritic?
6. Adenopathy?
7. Treatment?

Answer 1

1. Both versus unilateral
2. Watery versus thick, purulent
3. Easily versus poorly transmissible
4. Normal in both
5. Itchy versus not itchy
6. Preauricular versus none
7. None versus topical antibiotics

Question 2

Patient presents with red eyes and photophobia. History of autoimmune disease. Suspected diagnosis? Most accurate test? Best initial therapy?

Answer 2

Uveitis

Slit lamp exam

Topical steroids

Question 3

Patient presents with painful eye. Pupil fixed at midpoint. Suspected diagnosis? Most accurate test? Best initial therapy?

Answer 3

Glaucoma

Tonometry

#Acetazolamide 
#Mannitol (osmotically draw fluid out of eye )
#Pliocarpine, beta blockers or apraclonidine (constrict pupil)
#Laser trabeculoplasty

Question 4

Presentation of chronic glaucoma? Confirm diagnosis with? Medications?

Answer 4

Asymptomatic

Tonometry indicating elevated IOP

#-prost (Prostaglandin analog)
#Topical beta blockers
#-amides (Carbonic anhydrase inhibitors)
#a2 agonists
#Pliocarpine
#Laser trabeculoplasty

Question 5

Patient presents with a red eye and complains of sensation of “sand in the eyes” – suspected diagnosis? Most accurate test? Best initial therapy?

Answer 5

Trauma

Fluorescein staining

No specific therapy (patch not clearly beneficial)

Question 6

Normal Cup-to-disc ratio? In acute angle-closure glaucoma?

Answer 6

0.3

Over 0.3

Question 7

Patient presents with red, swollen, and painful eye. Fluorescein staining shows dendritic pattern – suspected diagnosis? Oral Treatment? Topical treatment?

Answer 7

Herpes Keratitis

ORAL Acyclovir, famcyclovir, valacyclovir

Topical trifluridine or idoxuridine

Question 8

Do not treat herpes keratitis with? (Will make condition worse?)

Answer 8

Steroids

Question 9

Diagnosed cataracts with? Treatment?

Answer 9

Ophthalmoscope or slitlamp

No medical treatment – surgery to remove intraocular lens

Question 10

Diabetic retinopathy – most accurate test? Treatment if non-proliferative? If proliferative?

Answer 10

Fluorescein Angiography

Tight glucose control

Laser photocoagulation and anti-VEGF injections

Question 11

Diabetic presents with vitreal hemorrhage – management?

Answer 11

Vitrectomy

Question 12

Management of retinal artery occlusion?

Answer 12

#O2
#ocular massage
#acetazolamide
#anterior chamber paracentesis
#thrombolytica

Question 13

Treatment of retinal vein occlusion?

Answer 13

Ranibizumab (anti-VEGF)

Question 14

Patient presents with sudden onset of painless, unilateral vision loss – suspected diagnosis? Management?

Answer 14

Retinal detachment
#Mechanical reattachment (surgery, leisure, cryotherapy)

Question 15

Most common cause of blindness in the US? Unilateral or bilateral? External appearance of the eye?

Answer 15

Macular degeneration

Bilateral

Normal external appearance

Question 16

Types of macular degeneration?

Type that causes permanent blindness? Mechanism?

Answer 16

Dry (atrophic) versus wet (neovascular);

Wet - new vessel growth between the retina and underlying Bruch membrane

Question 17

Initial treatment for neovascular macular degeneration? Atrophic macular degeneration?

Answer 17

VEGF Inhibitor (ranibizumab, bevacizumab, aflibervept) injected directly into vitreous chamber