Opthalmology Reverse Cram

Question 1

How are lid lacerations Tx

When do these need to be referred to opthalmology for Tx?

Answer 1

Tetanus prophylaxis
PO ABX if contaminated/foreign body

Canalicular system involvement
Levator involved (ptosis)
Visible orbital fat= penetrated septum
More than 1/3 of lid tissue gone

Question 2

When is a CT ordered for lid lacerations?

What else is done during a work up?

Answer 2

Globe involevement

Dilated exam
Canalicular/lacrimal exam
Lid function

Question 3

Define Hyphema

What can cause these to spontaneously occur?

Answer 3

Blood collection in anterior chamber

Retinoblastoma
Leukemia
Clotting d/o
Child w/ spontaneous- abuse

Question 4

What is the MC and other causes of hyphema?

African American PTs w/ hyphemas need to be screened for ?

Answer 4

Blunt trauma- MC
Neovascularization

Sickle Cell

Question 5

How are hyphemas Tx

What needs to be avoided during Tx

Answer 5

Bed rest w/ head elevation
Shield eye w/ clear plastic/fox shield
Homatropine/Atropine/Scopalamine 2x/day

ASA
NSAIDs

Question 6

What are the two types of blow out Fx

What will PT present complaining of after initial blunt trauma?

Answer 6

Direct- Fx of orbital rim extending posteriorly involving the floor
Indirect- compression of orbit soft tissue w/ no orbital rim involvement

Pain w/ movement
Binocular vision

Question 7

What do PTs need to avoid after Dx of blow out Fx

What image is used for Dx and what image can not be used

Answer 7

Sneezing/blowing nose- communication between orbit/sinus

CT, not x-ray

Question 8

How are blow out Fxs Tx

How doe intraocular foreign bodies present?

Answer 8

Refer/ice packs
Nasal decongestants x 3 days
Cephelexin

Peak pupil pointing to site of injury

Question 9

What abnormal finding will be seen on PE of an intraocluar foreign body

How are these Tx

Answer 9

Red reflex where there shouldn’t be one

Shield eye
Vancomycin
Cycloplegics
Recommended surgical removal

Question 10

Define Siderosis

What image is ordered for high speed injuries causing corneal foreign bodies?

Answer 10

Deposition of iron in tissue from long standing foreign body retention (intraocular)

CT scan

Question 11

How are corneal foreign bodies Tx

What ABX are given post-tx?

Answer 11

Penetration- refer
Superficial- remove under topical anesthesia w/ saline irrigation, CTA and Jelewlers forceps

Polymyxin B/Trimeth/Fluroquinolone

Question 12

How are chemical injuries in the eye Tx

What drug can be used to help with this process?

Answer 12

Irrigation x 30min
Wait 5-10min, check fornices pH w/ litmus paper
Continue irrigation until pH is neutral

Proparacaine

Question 13

What meds are given for chemical burns after Tx?

What type of chemicals cause more severe burns?

Answer 13

Homatropine/Scopalamine
Erythromycin

Alkali- Lye Ammonia Lime Bleach

Question 14

What can cause UV Keratitis

When are these conditions more severe?

Answer 14

Welding
Indoor tanning
Snow blindness

6-12hrs post-activity

Question 15

How is UV keratitis Tx

PTs need to avoid contacts for ? long after removal for contact lens irritation Tx

Answer 15

Cyclopentaolate
Erythomycin ointment
Patch more affected eye
PO anesthetics

x14 days

Question 16

If PT w/ contact lens irritation has abrasions, what meds are used?

What drugs are avoided in corneal abrasion?

Answer 16

Pseudomonas
Genta/Tobramycin and,
Cefazolin/Vancy
Alt drops of Gent/Vanc q30min

Topical anesthesia, melts cornea

Question 17

How are corneal abrasions Tx

What Tx step is avoided if abrasion was from vegetative/finger nail/contact lens source?

Answer 17

Vegetative source: Fluoroquinolone
All others- Polymyxin B/Trimeth
Ciclopentaolate

Do not patch

Question 18

Define Retinal Tumor

How do these present

Answer 18

Rare tumor of retina in PTs under 5y/o, usually 18mon

Leukoria

Question 19

What other form of Ca presents as leukoria but is not a blastoma

What can cause orbital cellulitis

Answer 19

Astrocytoma- non-malignant tumor of CNS made of astrocytes

Hordeolum
Dacryocystitis
Trauma

Question 20

How does orbital cellulitis present?

How are they Dx and Tx

Answer 20

Proptosis
Restricted ocular motility

CT of orbit, sinus and brain
Admit, broad sprectum ABX

Question 21

How does preseptal cellulitis present?

What sing are absent and necessary for Dx

Answer 21

Tender red lid
Periorbital swelling
Mild fever

No Proptosis Restricted motility Pain w/ movement Neuropathy

Question 22

What ABX is used for mild preseptal cellulitis

When do these PTs need to be admitted

What ABX are used inpatient?

Answer 22

Amox/Clavu

Toxic
<5y/o
Noncompliant
No improvement after 48hrs

Vanc and Ceftriax

Question 23

Define Amaurosis Fugax

What type of plaque may be seen on PE exam?

Answer 23

Loss of vision in one eye from TIA w/ spontaneous resolution

Hollenhorst

Question 24

How does a CN3 palsy present, causes and work up

Answer 24

Ptosis/HA
Eye down/out

Vascular/Compression

MRI stat if pupil dilated
Cerebral angiography
Observe and eval if pupil spared

Question 25

How does a CN4 palsy present, causes and work up

Answer 25

Vertical/oblique diplopia
Objects appear tilted, PT may tilt head

Idiopathic Trauma Tumor Vascular

MRI if:
<45
45-55 no RFs or more than one CN involved

Question 26

How does a CN6 palsy present, causes and work up

Answer 26

Horizontal diplopia
HA
Esotropia
Adopted head turn

Tumor Idiopathic Cavernous sinus dz
Tumor Vascular

MRI if w/out vascular RFs

Question 27

Optic neuritis

Answer 27

<50y/o Female w/ frontal HA
VA 20/200 or better
Central scotoma MC defect
Pain w/ movement

Question 28

NAION

Answer 28

> 50y/o PT w/ sudden unilateral vision loss upon waking
VA 20/400 or better
Inferior altitudinal defect
No pain

Question 29

AAION

Answer 29

> 60y/o female w/ HA and scalp/jaw tenderness
VA 20/400 w/ inferior altitudinal defect
Painful

Question 30

What is usually the first sing of Multiple Sclerosis?

Answer 30

Demyelinating optic neuritis