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physical exam II > optometry and LP > Flashcards

optometry and LP Flashcards

1
Q

chalazion

A
  • non-infectious
  • inflammation of meibomian gland
  • tx- hot compress
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2
Q

hordeolum

A
  • infection of lash follicle and glands of zeis/moll

- tx- hot compress, topical abx, drain

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3
Q

preseptal cellulitis

A
  • infection of tissue anterior to orbital septum
  • tender, red, swollen
  • eye exam normal*
  • tx- abx for sinusitis
  • refer w/ in 24 hours
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4
Q

orbital cellulitis

A
  • infection of tissues ant/ post to orbital septum
  • decreased visual acuity and EOM function
  • proptosis
  • STAT hospitalization
  • tx- meningitis dose abx
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5
Q

slit lamp width

A
  • narrow= slice through tissue

- wide= view gross structures

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6
Q

slit lamp height

A
  • long= view in front of pupil

- short= view behind pupil and ant chamber angle

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7
Q

low mag on slit lamp

A
  • 6-10 X
  • lids/ lashes
  • bulbar conjunctiva and sclera
  • cornea
  • tear film
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8
Q

med mag on slit lamp

A
  • 16-25 X
  • corneal epithelium
  • stroma
  • conjunctiva
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9
Q

high mag on slit lam

A
  • 25-40 X
  • corneal fine detail/ abnormalities
  • stromal striae or folds
  • endothelial cell changes
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10
Q

what is the cobalt blue filter used for on slit lam

A
  • abrasions
  • ulcers
  • superficial punctate keratitis
  • used with NaFl which will glow green
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11
Q

what types of conditions do contact lens wearers get

A
  • neovascularization
  • bacterial conjunctivitis
  • microbial keratitis- pseudomonas esp, penetrates cornea in < 72 hours, requires intensive quinolone tx
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12
Q

what is the test used for leaking aqueous humor

A
  • sidel test

- put fluorescein into conjunctiva

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13
Q

retinal detachment signs

A
  • flashes then floaters
  • veil or shade pulled over visual field
  • requires same day consult
  • high risk: assoc with trauma, high myopia, younger pt, recent ophthalmic surgery
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14
Q

posterior vitreous humor detachment signs

A
  • flashes then floaters
  • NO loss of vision or peripheral fields
  • usu in pts > 50, normal in aging d/t vitreous fluid shrinking
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15
Q

migraine signs

A
  • flashes that last 20 min

- +/- visual distortion

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16
Q

viral conjunctivitis

A
  • most common*
  • bilat, mild photophobia, tearing, injection
  • usu assoc with URTI
  • self limited 7-10 d
  • supportive tx
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17
Q

epidemic keratoconjunctivitis

A
  • highly contagious viral conjunctivitis
  • treat with support +/- antivirals
  • follows the rule of 8’s
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18
Q

rule of 8’s

A
  • used for epidemic keratoconjunctivitis
  • first 8 d: red eye with fine corneal staining
  • second 8 d: lesions/ pseudomembranes
  • third 8 d: infiltrates, highly contagious
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19
Q

what does leukocoria indicate

A
  • retinoblastoma

- appears as white glow instead of red reflex on PE

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20
Q

what is the PE findings for congenital cataracts

A
  • no red light reflex
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21
Q

corneal abrasions

A
  • secondary to FB or poke
  • use topical anesthetic to examine but DONT prescribe
  • clean irregular edges from outside in
  • requires borad spectrum abx QID
  • eye consult within 24 hours
22
Q

microbial keratitis

A
  • aka corneal ulcers
  • pain, photophobia, tearing, +/- mucopurulent d/c
  • can be central or marginal
  • decreased vision if on/near visual axis
  • whitish infiltrate
  • aggressive in contact lens wearers
23
Q

uveitis

A
  • red at edge of cornea- circumlimbal flush
24
Q

herpes simplex keratitis

A
  • similar to microbial but less pain d/t nerve damage
  • dendritic lesions with terminal end bulbs on exam
  • requires topical and PO antivirals
  • refer for consult within 24 hours
25
Q

emergent eye complaints

A
  • refer within 1 hour
  • chemical burns
  • sudden painless vision loss
  • acute trauma, penetrating eye injury
  • severe eye pain with N/V and/or halos
26
Q

urgent eye complaints

A
  • requires care within 4-6 hours
  • FB, corneal abrasions
  • sudden onset double vision, flashes/ floaters
  • sudden onset red eye +/- pain, vision changes
27
Q

semi-urgent eye complaints

A
  • requires care within 24 hours
  • painful bump on eyelid
  • itchy eyes
  • mild eye pain with no change in vision over 2-3 days
28
Q

anatomic land marks for LP

A
  • from out to in:
  • spinous process
  • supraspinal ligaments
  • interspinal ligaments
  • ligamentum flavum (causes pop)
  • epidural space
  • dura mater
  • arachnoid mater
29
Q

how do you obtain an opening pressure

A
  • lateral recumbent position
30
Q

what is a normal opening pressure

A
  • 18- 20 mmHg
31
Q

WBCs on LP

A
  • > 5 cells/UL suggests possible infection
  • bacterial: increased neutrophils
  • viral: increased lymphocytes
32
Q

RBC on LP

A
  • normal= < 10 cells/UL

- traumatic tap ruled out by xanthochromia

33
Q

glucose on LP

A
  • normal= 50-80 mg/DL
  • low: bacterial meningitis, sarcoidosis, syphilis, SAH
  • viral: variable
  • serum hyperglycemia may mask depressed CSF glucose
34
Q

protein on LP

A
  • normal= 15-45 mg/DL

- elevated suggests infection

35
Q

GN diplococci on LP

A
  • n miningitidis
36
Q

GN bacilli on LP

A
  • h flu
37
Q

GP bacterial on LP

A
  • s pneumo

- other strep and staph spp

38
Q

xanthochromia on LP

A
  • d/t RBC lysis

- orange yellow discoloration of CSF

39
Q

what does opening pressure > 30 indicate

A
  • bacterial infection

- pseudotumor cerebri

40
Q

diagnostic indications for LP

A
  • CNS infection
  • inflammatory processes
  • suspected spontaneous SAH
  • unexplained seizure
  • certain malignancy or paraneoplastic syndrome
41
Q

therapeutic indications for LP

A
  • relieve sx from increased ICP

- deliver meds

42
Q

absolute c/i for LP

A
  • local skin infx
  • intracranial or SC mass lesion
  • elevated ICP - risk of herniation
  • uncontrolled bleeding diathesis or coagulopathy
  • coumadin
43
Q

relative c/i for LP

A
  • raised CIP with known cerebral herniation
  • SC deformities
  • body deformities at LP site
  • suspected epidural abscess
  • thrombocytopenia
  • elevated INR
44
Q

tube sequencing for LP

A
  • 1: cell count and diff
  • 2: glucose and protein
  • 3: culture and gram stain
  • 4: cell count and diff
45
Q

how long does it take to regenerate CSF after LP

A
  • one hour
46
Q

how do you prevent post LP HA

A
  • put pt in recumbent position for 1 hour

- hydrate and caffeine

47
Q

what should you alway do before and after an LP

A
  • neuro exam
48
Q

subarachoid hemorrhage

A
  • 2-10% not detected on CT
  • stabilize pt first
  • presents as worst HA of my life, thunderclap HA
49
Q

what is the normal pH of the eye

A
  • 7-7.3
50
Q

what type of chemical burn is the worst

A
  • alkali
51
Q

why should you not prescribe anesthetics for the eye

A
  • can cause cornea to melt -> permanent damage
52
Q

parallelepiped

A
  • mid width with narrow beam

- best for general exam of the eye

physical exam II (5 decks)

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