Optoprep part II

Question 1

CC: 34 year-old Asian female. Right eye is very painful, watery, and light sensitive. (+) pain, irritation, photophobia, and watering OD. Worse when she blinks. Quality: severe. Onset: acute, after a bottle of vinegar dropped and the contents splashed into her eye. Duration: 5 mins ago - patient ran over from a house down the street. Frequency - first occurrence. Unremarkable ocular hx. Medical history: history go GI bleeding. Meds: Mallox, multivitamins. Allergies: penicillin. Fam hx: dad - cardiovascular disease. Mental status - oriented, nervous mood, affect agitated. Clinical findings: VA SC OD: 20/30, OS: 20/20. AC - deep & quiet OU, IOPs OD: 13, OS: 12 via icare @ 3:35 pm. Fundus: 0.25/0.25 c/d OU, otherwise unremarkable. BP 137/86 RAS, Pulse 86 bpm regular.

Which of the following best describes the solution that caused the corneal chemical burn in the above patient?

1. irritant with a neutral pH
2. alkaline solution with a pH < 4
3. Alkaline solution with a pH > 10
4. Acidic solution with a pH < 4
5. Acidic solution with a pH > 10

Answer 1

3. acidic solution with a pH <4

Question 2

CC: 34 year-old Asian female. Right eye is very painful, watery, and light sensitive. (+) pain, irritation, photophobia, and watering OD. Worse when she blinks. Quality: severe. Onset: acute, after a bottle of vinegar dropped and the contents splashed into her eye. Duration: 5 mins ago - patient ran over from a house down the street. Frequency - first occurrence. Unremarkable ocular hx. Medical history: history go GI bleeding. Meds: Mallox, multivitamins. Allergies: penicillin. Fam hx: dad - cardiovascular disease. Mental status - oriented, nervous mood, affect agitated. Clinical findings: VA SC OD: 20/30, OS: 20/20. AC - deep & quiet OU, IOPs OD: 13, OS: 12 via icare @ 3:35 pm. Fundus: 0.25/0.25 c/d OU, otherwise unremarkable. BP 137/86 RAS, Pulse 86 bpm regular.

Which of the following is true regarding the pathophysiology of ocular chemical burns?

1. acid burns may continue to penetrate the cornea long after the initial trauma
2. acids tend to bind with tissue proteins and coagulate the surface epithelium
3. acid burns occur more frequently than alkali burns
4. alkaline burns are typically confined to superficial tissues

Answer 2

2. acids tend to bind with tissue proteins and coagulate the surface epithelium

Question 3

CC: 34 year-old Asian female. Right eye is very painful, watery, and light sensitive. (+) pain, irritation, photophobia, and watering OD. Worse when she blinks. Quality: severe. Onset: acute, after a bottle of vinegar dropped and the contents splashed into her eye. Duration: 5 mins ago - patient ran over from a house down the street. Frequency - first occurrence. Unremarkable ocular hx. Medical history: history go GI bleeding. Meds: Mallox, multivitamins. Allergies: penicillin. Fam hx: dad - cardiovascular disease. Mental status - oriented, nervous mood, affect agitated. Clinical findings: VA SC OD: 20/30, OS: 20/20. AC - deep & quiet OU, IOPs OD: 13, OS: 12 via icare @ 3:35 pm. Fundus: 0.25/0.25 c/d OU, otherwise unremarkable. BP 137/86 RAS, Pulse 86 bpm regular.

Which of the following best describes the first action that should be taken when the above patient presents to your office?

1. copious irrigation with saline solution
2. detailed case history
3. copious irrigation with a weak basic solution to neutralize the acidic chemical
4. careful examination of the corneas with slit-lamp bio microscope
5. copious irrigation with a weak acidic solution to neutralize the alkaline chemical

Answer 3

1. copious irrigation with saline solution

Question 4

CC: 34 year-old Asian female. Right eye is very painful, watery, and light sensitive. (+) pain, irritation, photophobia, and watering OD. Worse when she blinks. Quality: severe. Onset: acute, after a bottle of vinegar dropped and the contents splashed into her eye. Duration: 5 mins ago - patient ran over from a house down the street. Frequency - first occurrence. Unremarkable ocular hx. Medical history: history go GI bleeding. Meds: Mallox, multivitamins. Allergies: penicillin. Fam hx: dad - cardiovascular disease. Mental status - oriented, nervous mood, affect agitated. Clinical findings: VA SC OD: 20/30, OS: 20/20. AC - deep & quiet OU, IOPs OD: 13, OS: 12 via icare @ 3:35 pm. Fundus: 0.25/0.25 c/d OU, otherwise unremarkable. BP 137/86 RAS, Pulse 86 bpm regular.

which of the following topical medications is not indicated in the treatment of patient’s suffering from a corneal chemical burn?

1. moxifloxacin
2. scopolamine
3. prednisolone acetate
4. pilocarpine
5. ketorolac

Answer 4

4. pilocarpine

Question 5

CC: 34 year-old Asian female. Right eye is very painful, watery, and light sensitive. (+) pain, irritation, photophobia, and watering OD. Worse when she blinks. Quality: severe. Onset: acute, after a bottle of vinegar dropped and the contents splashed into her eye. Duration: 5 mins ago - patient ran over from a house down the street. Frequency - first occurrence. Unremarkable ocular hx. Medical history: history go GI bleeding. Meds: Mallox, multivitamins. Allergies: penicillin. Fam hx: dad - cardiovascular disease. Mental status - oriented, nervous mood, affect agitated. Clinical findings: VA SC OD: 20/30, OS: 20/20. AC - deep & quiet OU, IOPs OD: 13, OS: 12 via icare @ 3:35 pm. Fundus: 0.25/0.25 c/d OU, otherwise unremarkable. BP 137/86 RAS, Pulse 86 bpm regular.

Which of the following oral pain management meds should be used with caution in the above patient?

1. Tylenol
2. Motrin
3. aspirin
4. Advil
5. aleve

Answer 5

1. aspirin