opthalmology Flashcards
Primary care suspects retinal detachement - what is the next step?
Refer to opthalmology and dispose with patient with head down position to maintain retinal position.
what is the most common age range for amaurosis fugax?
patients older than 50
what is amaurosis fugax?
“TIA of the retina”
the retina descends and retracts
Unilateral transient acute vision loss
Predisposing factors: A fib, carotid plaques, HTN, DM
What is the number 1 cause of retinal artery occlusion?
Carotid atherosclerosis
Seeing cherry red spots and boxcarring of the arteries on fundus exam should make you think of…
Retinal artery occlusion
What are the predisposing factors for retinal artery occlusion?
clot, sclerosis, HTN, DM, A fib, Temporal arteritis
Treatment for retinal artery occlusion
Emergent referral to opthalmology; Intermittant pressure on eye - to “milk” the clot/blod collection from the eye and improve vision.
What is the treatment for herpes keratitis?
Topical antivirals. STEROIDS ARE CONTRAINDICATED!
A patient describes his vision as painless but if seems that a curtain comes down and then goes back up. This is the hallmark for ….
Amaurosis fugax
Patient presents with a painful red nodule on the upper eyelid. How would you treat?
Suspect hordeolum. Treat with warm compresses and topical antibiotic.
Fundus exam shows cherry red spot. This is pathoneumonic for…
Central retinal artery occlusion
A college student presents to the student health center with a little purulent drainage from the eye and nontender preauricular lymphadenopathy. what is the most likely causative agent?
Chlamydia conjunctivitis
Patient presents to his primary care office with unilateral blurred vision that has deveolped over a few days. Fundus exam shows a “blood and thunder” pattern. What should she be thinking of?
How should it be treated?
Central vein occulsion
This is typically self limited but the underlying cause needs to be addressed and treated.
Is glaucoma more prevalent in males or females?
Females 3:1
Give 2 risk factors for glaucoma
African american heritage and diabetes
Fundal exam shows a cup to disc ratio of >0.5. You also notice vessels bending over the disc. What is most likely diagnosis?
glaucoma
PAtient presents to the after hours clinic with a yellowish fleshy mass on the conjuctiva just outside of the iris. his vision is normal and this mass is painless. What do you tell the patient?
this is Pinguecula. you reassure. no further treatement is neccessary. Counsel on eye protection in the sun and wind.
During the course of the history, a a patient relates that he has glasses for 30 years but no longer seems to need them. What is the most likely diagnosis?
cataracts.
Which quadrant is most likely for retinal detachement?
superior temporal
Patient presents to the office with a central blind spot in his vision. HE also states that sees wavy lines in his vision when looking at something You are concerned for what ?
MAcular degeneration. REfer to opthalmology.
The fundus examination in macular degeneration is likely to show…
drusen deposits
PAtient presents to you busy clinic with unilateral eye pain. When you examine her she has a hazy cornea and fixed pupil. you are thinking….
glaucoma
what is the most common way to test for metamorphopsia?
Amsler grid
What is metamorphopsia?
ITs type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank. People with this condition often first notice this when looking at mini-blinds in their home.
A patient presents with irritation of the eyelids, describes them as burning and increased tearing.
Physical exam shows scurf and scaling at the lash line. fWhat to you counsel them to do nightly?
This is bleoharitis. have them gently scrub the eyelashes with baby wash nightly. Topical antibiotics are not indicated at first.
12 year old boy has a history of multiple stys. At his well child examination, he now has a painless nodule on the eyelid and a mild conjunctivitis. what is your next step.
this is a chalazion. Can be referred to opthalmology for excision
what are the most common colors lost in color blindness.
Red and green
how do you test for color blindness?
Isihara plates
What is the most common preceding event for orbital cellulitis?
URI
A Ct scan of the head shows broad infiltration of orbital fat. what is most likely diagnosis?
Orbital cellulitis
A patient presents with bilateral eye watery discharge and nontender pre-auricular lymphadenopathy. What is most likely diagnosis and most common pathogen?
viral conjunctivitis.
Adenovirus
Describe a pterygium
Triangular / wedge shaped growth on the conjunctiva from nasal corner to iris. IF it breeches the iris it may interfere with vision.
What is the test to measure intraoccular eye pressure in glaucoma?
tonometry
Patient has recently had cataract surgery and now presents to your office with vision loss of the operative eye. what do you do?
likely retinal detachement - refer to opthalmology. for CRAO.
A dendritic lesio is seen with fluorescein stain. What is most likely diagnosis?
Herpes Zoster keratitis
What nerve is involved with herpes zoster opthalmicus?
Trigeminal nerve - CN5
What is Hutchinson sign?
Hutchinson’s sign is defined as skin lesions at the tip, side, or root of the nose. This is a strong predictor of ocular inflammation and corneal denervation in HZO, especially if both branches of the nasociliary nerve are involved.
A 16 year old girl presents with painful right eye. She has been wearing her contacts. You note a dense corneal infiltrate and epithelial defect on fluorescein stain. what are you conerned with ?
Corneal ulceration.
what is the treatment for subconjuctival hemorrhage
Reassurance
A patient is in the recovery room after spine surgery. She is currently complaining of severe photophobia and feels like there is something in her eye. what is the most likely diagnosis?
Corneal abrasion
A patient complains of seeing halos and rainbows around lights. Additionally her has moderate photophobia. what test do you need to perform for you most likely diagnosis?
tonometry for glaucoma
6 year old girl presents to the urgent care clinic with blood in the anterior chamber of the eye. What do you suspect?
Child abuse until proven otherwise due to this hyphema.
16 year old wrestler is brought to your office after practice. he caught an elbow to his eye during practice. there is no swelling but there is blood in the anterior chamber of the eye. How do you treat?
Bed rest, elevate head of bed to keep blood at inferior portion.
Concern is for rebleeding when the clot releases and for increased intraocular pressure from the increased fluid - would then refer opthalmology.
16 yo baseball player presents with swollen left side of the face after being hit with a baseball as it took a bad hop. he has pain and diplopia nd can’t look up while testing EOMS. what is most likely diagnosis and test to confirm?
orbital fracture.
CT scan
Refer
WHat is the term for near-sightedness?what type of lens to correct it?
Myopia, use concave lens
When you are nearsighted - where can’t you see?
you cant see far
what is the term for far sighted?
hyperopia, - you can’t see near. correct with convex lens
What is first, second and third line treatment for chemical burn of the eye?
irrigate, irrigate, irrigate.
Color blindness is what genetic pattern?
recessive , X-linked.
What is the first line treatment for orbital cellulitis?
iv antibiotics followed by 2 weeks po antibiotics.
Orbital cellulitis is hallmarked by…
ptosis, edema, exopthalmos and painful EOMS. More likely in kids than adults. Infection can spread.
if EOMS are not painful then it is periorbital cellulitis.
What is treatment for Dacrocystitis?
infection of the tear ducts. Warm compresses and antioiotics.
What is the common patholgen in corneal abrasion/ulceration from contact lens?
Pseudomonas
PAtient presents with unilateral eye pain after work. Flourescein stain shows FB, what is the treatment
antibiotic ointment, pain medication, no longer patching.
Patient presents to clinic with acute painful right eye accompanied with vision loss. on examination there is a steamy cornea, fixed mid-dilated pupil and decreased visual acutity. during the physical examination he has an episode of nausea and emesis. What test should be performed for the suspected diagnosis and how should it be treated?
Schiolitz tonometry shoulde e performed after topical anesthesia for eye. The IOP is acutely elevated.
Correct diagnosis is acute angle closure glaucoma - which is an opthalmologic emergency to lower the eye pressure.
Treat with IV Carbonic anhydrase, topical Bblocker and osmotic diureses
No mydriatics should be used.
Describe open angle glaucoma
chornic , asymptomtic, potenetially blinding. gradual increase to IOP, defects in peripheral cisial and increased cup-to-disc ratios.
Increased prevalence in African Americans> 40 yo
They should be referred to opthalmology, kand treatedwith totical or systemic medications to decrease IOP by decreaseing aqueous production and increaseing outflow.
a 4 week old comes in for its well child check ans is noted to have swelling and discharge at the medial epicanthus. there is tenderenss and redness present as well - how would you treat?
warm compresses - can do antibiotics as well.. Obstruction of the lacrimal system usually resolved by 9 months.
Dx: Dacryostenosis
what is it called when the eyelashes and lid are turned in toward the eye due to scar tissue or spasm of the orbicularis oculi muscles?
Entropion - can cause corneal abrasion
Describe Ectropion, its causes and treatment
the edge of the eyelid is everted dueadvances age, infection , Bells palsy
Treatment is surgical repair.
What is amblyopia?
Decreased visual acuity not correctable by refractory means
if there is a tumor or clot along the right optic tract what type of visual loss will occur?
Right homonymous Hemanopsia
If the tumor is present at the optic chiasm what will be the visual loss?
Bitemporal heteronymous hemanopsia
what type of visual defect occurs when there is a lesion of only right half of the optic nerve?
right nasal hemanopsia
What age should strabismus be corrected by to prevent amblyopia?
2 years old - treated with patchying, or surgery in severe cases
