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Senior - Ophthalmology > Review Deck 0-97 > Flashcards

Review Deck 0-97 Flashcards

1
Q

If you wanna review anatomy:

A

First five slides of the review

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2
Q

Orbicularis oculi - movement and innervation?

A

Closes the eyelids

CN VII (Facial)

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3
Q

Levator palpebrae superioris - movement and innervation?

A

Opens the upper eyelid

CN III (Oculomotor)

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4
Q

Mueller’s muscle - movement and innervation?

A

Assists in opening the eyelids

Sympathetic NS (running from a tiger - think Muller so you don’t get Mauled by a tiger)

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5
Q

Medial rectus - movement and innervation?

A

Medial (adduction)

CN III

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6
Q

Lateral rectus - movement and innervation?

A

Lateral (Abduction)

CN VI

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7
Q

Superior rectus - movement and innervation?

A

Upward

CN III

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8
Q

Inferior rectus - movement and innervation?

A

Downward movement

CN III

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9
Q

Superior oblique - movement and innervation?

A

Intorsion/downward

CN IV

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10
Q

Inferior oblique - movement and innervation?

A

Extorsion/upward

CN III

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11
Q

Visual EOM chart:

A

Slide 8

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12
Q

Helpful tip for EOM’s

A

Remember “opposite - oblique”

For example, if the patient is looking up and to the LEFT, the oblique is engaged for the RIGHT eye

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13
Q

What is emmetropia?

A

Normal state; eyes see objects at infinity clearly while relaxed

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14
Q

What is myopia?

A

Nearsighted

Eye is too long

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15
Q

What is hyperopia?

A

Farsighted

Eye is too short

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16
Q

What is astigmatism?

A

Corneal curvature is not equal

Football-shaped

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17
Q

What is accommodation?

A

Ability of the eye to change the shape of the lens to read up close

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18
Q

What is presbyopia?

A

The inability of the eye to change the shape of the lens to focus at near (old eyes)

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19
Q

What to examine at MINIMUM during eye exam:

A

Visual acuity
Pupillary reaction
Extraocular movements
Direct ophthalmoscopy

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20
Q

When would you NOT want to dilate somebody’s pupil?

A

If they have a shallow anterior chamber (you’ll cause badness, you could trigger angle-closure glaucoma)

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21
Q

What is phenylephrine opth used for?

A

Adrenergic-stimulating mydriatic

Stimulates the pupillary dilator muscle

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22
Q

What is tropicamide/cyclopentolate ophth used for?

A

Cholinergic-blocking mydriatic

Paralyzes the iris sphincter

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23
Q

What test do you do when foreign body is suspected?

A

Eyelid eversion

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24
Q

When you suspect the cornea might be scratched, what test should you do?

A

Fluorescein drops, then turn on the blacklight and have fun

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25
Q

What is strabismus?

A

Misalignment of the two eyes

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26
Q

What is phoria?

A

Tendency, not constant

Only evident with one eye covered

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27
Q

What is tropia?

A

Constant

Evident with both eyes open and uncovered

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28
Q

Phoria and tropia prefixes?

A

Eso - inward
Exo - outward
Hyper - upward
Hypo - downward

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29
Q

What is ectropion?

A

Outward turning of the lid

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30
Q

What is entropion?

A

Inward turning of the lid

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31
Q

Sxs for ectropion and entropion?

A

Irritation
Burning
Foreign body sensation
Tearing

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32
Q

Txt for ectropion and entropion?

A

Surgery to correct the lid abnormality

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33
Q

What is lagophthalmos?

A

Inability to completely close the eyes

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34
Q

Sxs of lagophthalmos?

A 
Irritation
Burning
Foreign body sensation
Tearing
Failure of the “lacrimal pump”
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35
Q

Txt for lagophthalmos?

A

Mild:
Artificial tears, gels, ointments

Tape the eyes shut at bedtime

Moderate-Severe:
Suture lids (temporarily)
Gold weight surgically inserted into upper lid
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36
Q

Etiologies of ptosis?

A

Congenital - malformation of levator muscle

Acquired - thinning/detachment of levator aponeurosis

Horner Syndrome - small pupil, anhydrosis

CN-III palsy

Myasthenia gravis (ptosis may worsen with sustained upgaze)

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37
Q

Txt for ptosis:

A

If congenital, surgery to tighten or resect the levator muscle

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38
Q

What is blepharitis?

A

Scaling on the lid margins proximal to the lashes

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39
Q

Sxs of blepharitis?

A 
Irritation
Burning
Foreign body sensation
Epiphoria 
Photophobia
Intermittent blurred vision
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40
Q

What is epiphoria?

A

Excessive tearing

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41
Q

Txt for blepharitis?

A

Baby shampoo
Massage

ABX - erythromycin topical for staph

ABX - doxy PO if meibomian gland dysfunction

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42
Q

Hordeolum vs chalazion

A

Hordeolum (stye) PAIN

Chalazion NO PAIN (or minimally tender)

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43
Q

Describe hordeolum:

A

Painful nodule or pustule on the eyelid

External on skin surface or internal on conjunctival surface

Typically staph

Sebaceous gland involvement

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44
Q

Txt of hordeolum:

A

Warm compress
Lid massage
Consider topical erythromycin

Oral doxy if associated blepharitis

Surgical I and D if necessary (comes with risks like scarring, entropion/ectropion)

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45
Q

Describe chalazion

A

Blocked meibomian gland

Minimally tender or no pain

Firm, well-demarcated nodule below lid margin

Grayish discoloration on the conjunctival surface

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46
Q

Txt for chalazion?

A

Warm compress usually works (opens the gland up so it can be expressed)

Triamcinolone injection (steroid)(CI’d in dark-skinned patients)

If no resolution after 1 months, incision and curettage of meibomian gland

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47
Q

What is dacryocystitis?

A

Inflammation of the lacrimal sac

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48
Q

Txt for dacryocystitis?

A

Amoxicillin/clavulanate 500mg PO Q8H

Topicals can be used in addition to oral ABX

Warm compress and lid massage

If large, I and D

If chronic, dacryocystorhinostomy

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49
Q

Dacryocystitis vs dacryoadenitis?

A

Cyst = sac

Ade = gland

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50
Q

Dacryoadenitis:

A

Inflammation of the lacrimal gland

Sxs - lateral lid swelling, pain, tearing, swollen, tender, erythematous lacrimal gland

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51
Q

Txt for dacryoadenitis

A

If unclear, start with systemic ABX and reassess in 24 hrs

If infectious - amox/clav or ceph

If inflammation, steroids if idiopathic

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52
Q

MC lid carcinoma?

A

Basal cell

Squamous is #2

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53
Q

Txt of basal or squamous lid carcinoma?

A

Surgical removal

Radiation therapy (if unwilling or unable to do surgery)

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54
Q

Sxs of viral conjunctivitis

A

Diffuse injection

Watery eyes

Follicular response (small dome-shaped lymphoid nodules)(no central blood vessel)

PREAURICULAR LYMPHADENOPATHY

Subepithelial infiltrates (immune response to viral antigens, causes decrease in vision/photosensitivity)

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55
Q

Viral conjunctivitis txt?

A

TELL PT HOW CONTAGIOUS THEY ARE

Typically self-limiting

Cold compress

Artificial tears

Steroid if pseudomembrane present

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56
Q

MC causes of bacterial conjunctivitis?

A

Staph
Strep
H. flu

BUT always consider gonorrhoeae, meningitidis, chlamydia (these go to ophth ASAP)

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57
Q

Sxs of bacterial conjunctivitis

A

Mucopurulent discharge
Redness
Irritation
Lid adhesion

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58
Q

Txt for bacterial conjunctivitis:

A

Trimethoprim/polymixin B QID x1wk

Fluoroquinolone QID x1wk (Besifloxacin, Moxifloxacin)

If neisseria or chlamydia - ceftriaxone 1gm IM, azithromycin 1g PO (admit and IV Cef if cornea involved)

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59
Q

Sxs of allergic conjunctivitis:

A 
Intense itching
Watery discharge 
Bilateral erythema and edema 
Mild conjunctival injection
Chemosis
Conjunctival papillae (central blood vessel)
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60
Q

What is chemosis?

A

Swelling of the conjunctiva

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61
Q

Txt for allergic conjunctivitis?

A

Eliminate the allergen (duh)

Artificial tears

Topical antihistamine-mast cell stabilizer (Olopatadine)

If severe - Loteprednol (steroid)

Also, oral antihistamines (2nd gen)(Zyrtec, Allergra)

62
Q

Questions to ask pt presenting with subconjunctival hemorrhage:

A 
Previous episodes
Meds (ASA, coumadin, etc)
Trauma
Valsalva
Eye rubbing
Heavy lifting
Acute or chronic cough
Constipation
Bleeding or clotting problems
63
Q

Workup for subconjunctival hemorrhage

A 
IOP
BP check
Extraocular movement
PT/PTT (if recurrent)
CT if orbital signs present to r/o orbital mass
64
Q

Txt for subconjunctival hemorrhage

A

Artificial tears if irritation present

D/C elective ASA

No txt req’d for the actual hemorrhage

65
Q

Describe pinguecula and pterygium

A

A whitish-yellowish bump or fleshy “growth” on the exposed conjunctiva often in the 3 or 9 o’clock region of the eye

Highly vascularized

Think dry/sunny environments, chronic irritation 2/2 sunlight exposure

66
Q

How to differentiate between pinguecula and pterygium

A

Pterygium invades the cornea, pinguecula does not

Just think pterygium has a “t”, and it “t”ouches the cornea

67
Q

Txt for pinguecula or pterygium

A

Artificial tears as needed

Topical steroids if severe sxs

Surgical removal IF: pterygium interferes with sight OR pt experiences excessive irritation

68
Q

What is a phlyctenule?

A

A nodular (lesion) growth at LIMBUS

Caused by hypersensitivity to bacterial proteins (staph, tuberculoprotein)

If unable to refer, txt with steroid-ABX combo (TobraDex or Zylet)

69
Q

Txt for conjunctival laceration:

A

MUST R/O RUPTURED GLOBE

If under 1cm in length -> erythromycin ointment TID, monitor

If OVER 1cm in length -> surgical closure

70
Q

Which type of corneal ulcers tend to be extremely painful?

A

Bacterial or fungal

They’re aggressive - can cause damage or blindness in 1-2 days

71
Q

Sxs of HSV keratitis?

A

Irritation
Photophobia
Redness/conjunctival injection

Usually unilateral

EPITHELIAL DENDRITES (SEEN WITH FLUORESCEIN)

If advanced dz - scarring-vascularization

72
Q

Txt for HSV keratitis

A

Refer

Topical antivirals

73
Q

Should i use steroids for my HSV keratitis patient?

A

HELL NO - LEADS TO TISSUE LOSS, POSSIBLE OCULAR PERFORATION

74
Q

Sxs of bacterial keratitis?

A

Ulceration of the epithelium

Increased anterior chamber reaction (with or without hypopyon)

Upper eyelid edema

Surrounding corneal inflammation

Conjunctival hyperemia

Mucopurulent discharge

75
Q

Txt for bacterial keratitis:

A

Refer

Stain

AGGRESSIVE THERAPY

Topical fluoroquinolone

Fortified ABX if vision threatened (tobra or gent - alternate with cef or vanc)

76
Q

Pseudomonas on the eye is commonly seen in:

A

Contact lens wearers

77
Q

When would you suspect fungal keratitis? (Pt hx findings)

A

Recent hx of outdoor eye trauma with vegetative matter involved

Topical corticosteroid use

Cornea surgery

HSV

Contact lens use

78
Q

Sxs of fungal keratitis

A 
Foreign body sensation 
Decrease in vision 
Hypersensitivity to light
Conjunctival injection 
Epithelial defect (FEATHERY WHITE/YELLOW OPACITY)
Anterior chamber reaction (hypopyon)
79
Q

Txt for fungal keratitis

A

Refer

Surgical debridement - scrub that fungus off!

RX - Natamycin or amphotericin topical
RX - fluconazole or voriconazole PO

NO TOPICAL STEROIDS

80
Q

When would topical steroids be appropriate for fungal keratitis?

A

They’re NOT

81
Q

Corneal pigmentations are typically caused by:

A

Drugs

Chloroquines, hydroxychloroquine
Amiodarone
Indomethacin
Phenothiazines

82
Q

Amiodarone can cause what ophthalmic condition?

A

Whorl-shaped pigmented deposits

83
Q

Txt of corneal pigmentations?

A

Nada

It goes away when you stop taking the drug that caused it

84
Q

What is recurrent corneal erosion?

A

After an injury, improper healing can lead to recurrent corneal erosion

85
Q

Sxs of recurrent corneal erosion

A

Sharp pain typically upon awakening

Feels like eyelid is stuck to front of eye

86
Q

Txt for recurrent corneal erosion

A

Refer

Hypertonic saline (prevents loosening)

Bandage contact lens if large

Oral analgesics PRN

Severe - laser surg

87
Q

What is keratoconus?

A

Dz of unknown etiology

Progressive THINNING of the central cornea

Degenerative

Can cause myopia, astigmatism

Untreated -> perforation of the cornea

Can lead to scarring and blindess

88
Q

What is Munson’s Sign?

A

Think KERATOCONUS

Bulging of the lower lids from thinning central cornea causing bulging of inferior cornea

89
Q

Fleischer Ring is caused by:

A

Copper deposits

90
Q

Features of episcleritis:

A

Mild pain

No discharge

Focal redness

Acute onset

Systemic symptoms

BLANCHES

91
Q

Features of scleritis

A

SEVERE pain

No discharge

Focal or diffuse redness

Insidious onset

Systemic symptoms

DOES NOT BLANCH

92
Q

Main difference between conjunctivitis and episcleritis/scleritis?

A

Conjunctivitis has discharge, the other two do not

Also, conjunctivitis usually doesn’t have systemic sxs, while the other two do

93
Q

Causes of episcleritis

A

Usually idiopathic

Or

Herpes, RA, SLE, rosacea, thyroid dz, syphilis

Usually young adults

94
Q

Workup for episcleritis:

A

Good hx - ask about rashes, arthritis, STD’s

External exam will show absence of bluish hue (scleritis has the bluish hue, there’s another differentiator for ya)

After you apply phenylephrine topically, the vessels blanch

95
Q

Txt for episcleritis?

A

Refer

Typically self-limited

Cold compress
Artificial tears

If mod-severe -> topical steroids (fluorometholone), NSAIDs

96
Q

Describe scleritis

A

SEVERE, BORING PAIN (prominent feature)(radiating to the jaw, forehead, or brow)

Inflammation (focal or diffuse)

Photophobia
Tearing

BLUISH HUE

97
Q

What must the workup for scleritis include?

A

Actual medicine stuff - skin/joints, CV, respiratory, shotgun labs

98
Q

Txt of scleritis?

A

H2RAs (i.e. Zantac)
Ibuprofen

If no improvement, systemic steroids

Immunosuppresive therapy

If necrotizing, add lubrication and scleral patch graft may be necessary

99
Q

Txt for posterior scleritis?

A

Controversial

Cyclophosphamide
Rituximab
Glucocorticoids

….controversial therapies = probably not on the test (just my guess, before you try and memorize this)

100
Q

Anterior uveitis is AKA:

A

Iritis or iridocyclitis

101
Q

What is anterior uveitis?

A

Inflammation of the iris and iris-ciliary body

Associated risk factors: HLA-B27 (+), JA, infection, malignancy, trauma

102
Q

Sxs of anterior uveitis?

A

Can be either acute or insidious, unilateral or bilateral

Redness

Photophobia

Ciliary injection

Keratic precipitates (fine and whitish = nongranulomatous, “mutton fat” = granulomatous)

Floating cells

Hypopyon

Irregular pupil shape

On iris - Koeppe nodules and Busacca nodules

103
Q

Anterior uveitis workup:

A

H and P

R/o systemic causes

Shotgun labs (especially if bilat)

104
Q

Txt for anterior uveitis?

A

Refer

Topical - predinsolone

Cycloplegic - Scopolamine

If severe -> atropine

105
Q

Prognosis for anterior uveitis?

A

First time, nongranulomatous = excellent

Recurrent granulomatous = poor

106
Q

Sxs posterior uveitis:

A

Either acute or insidious, unilateral or bilateral

Decreased vision

Floaters

Occasional redness and pain

Optic disc swelling with edema

Retinal/choroid hemorrhages

107
Q

Txt of posterior uveitis?

A

Refer

Topical cycloplegic if anterior involvement

Topical steroid if anterior involvement

Treat the underlying cause

108
Q

Risk factors for cataracts?

A 
Age
Diabetes
Trauma
Toxins
Inflammation
Radiation
Tumor
Degenerative dz
109
Q

Nuclear cataracts:

A

Usually age-related

Yellow or brown discoloration of central part

Blurs distant vision more than near vision

110
Q

Posterior subcapsular cataracts

A

Opacities near posterior aspect of lens

Glare and difficulty reading

DM, trauma, radiation, inflammation

111
Q

Cortical cataracts

A

Spokelike opacities

Often asymptomatic (until develops centrally)

112
Q

Sxs of congenital cataract:

A

Mild-severe decrease in vision

Infants may keep eyes closed or squint

Leukocoria

Absent or diminished red reflex

113
Q

Txt of congenital cataract:

A

This is an EMERGENCY

Untreated can lead to IRREVERSIBLE amblyopia

So….you know…fix it

114
Q

MC cause of lens dislocation?

A

Trauma

Other causes: Marfan, homocystinuria, syphilis

Results in subluxation of the lens (25% of zonular fibers ruptured)

115
Q

What are “floaters”?

A 
Dookies that float 
.
.
.
.
.
.
.
.
.
.
.
.
.
.
But, for eye folks, they’re: small aggregates of protein in the vitreous cavity that cause visual anomalies
116
Q

Causes of acute floaters?

A

Uveitis

Bleeding into the vitreous (DM, sickle cell)

Posterior vitreous detachment

Retinal tear

117
Q

Flashers suggest:

A

Traction of the vitreous on the peripheral retina

May occur during the evolution of a posterior vitreous detachment or as the vitreous pull on a tear in the retina

Flashers can also happen with migraines

118
Q

Risk factors for vitreous detachment

A

DM retinopathy

Trauma

Cataract surgery

119
Q

What is a Weiss Ring?

A

Seen with vitreous detachment

120
Q

Sxs of vitreous detachment

A

Sudden appearance of black spots or flashing lights

Pt complains of floaters

121
Q

Txt for vitreous detachment

A

Refer

Txt the problem

If retinal break/tear/detachment -> photocoagulation or cryotherapy may be necessary

122
Q

Where is the optic nerve seen?

A

On the nasal side (medial)

Macula is lateral

123
Q

Appx size of optic nerve?

A

1.5mm diameter

124
Q

How do arteries appear?

A

Thinner, more orange/red

125
Q

How do veins appear?

A

Thicker, darker (more crimson)

126
Q

Normal AV ratio:

A

2:3

127
Q

Veins and arteries travel together, meaning:

A

Veins to do not cross veins

Arteries do not cross arteries

128
Q

What does the central retinal artery supply?

A

The INNER RETINA (towards center of eye)

Remember CENTRAL-INNER

129
Q

What does the choroid supply?

A

The OUTER retina (towards the outer wall)

Supplies the photo receptors

High O2 demand

130
Q

The retina is mostly:

A

Transparent tissue

131
Q

Sxs of retinal artery occlusion

A

Unilateral acute vision loss

Afferent pupillary defect

Painless

Happens over seconds

MARKED opacification or whitening of the retina

CHERRY RED spot in the center of the macula (the fovea)

Box-car (segmentation in arterioles)

132
Q

Workup for retinal artery occlusion?

A

IMMEDIATE ESR (giant cell arthritis)

Full dilated exam

BP check

SBG, CBC, Lipids, A1C, PT/PTT, RF

US of carotid artery

Cardiac exam

133
Q

Txt of retinal artery occlusion

A

No proven effective treatment

Goals: decrease ocular pressure, disrupt/break the occlusion

Ocular massage, anterior chamber paracentesis, Acetazolamide PO, Timolol topical

HIGH DOSE STEROIDS if it’s giant cell arteritis

134
Q

Retinal vein occlusion sxs

A

Painless, unilateral vision loss
Afferent pupillary defect possible

“Blood and Thunder” fundus

Flame-shaped hemorrhage

*this is the most metal description of an eye issue i’ve ever seen, btw…

Cotton wool spots and exudates

135
Q

Workup for retinal vein occlusion?

A

Complete ocular exam

IOP measurement

Angiography

Systemic hx

136
Q

How will the presence of an afferent pupillary defect help you differentiate ischemic from non-ischemic retinal vein occlusion?

A

APD will be present with ischemic retinal vein occlusion

If it’s non-ischemic, no APD

137
Q

Txt of retinal vein occlusion?

A

Mandatory full ophth evaluation

Discontinue OCPs

Reduce IOP if increased

Txt the underlying cause

If neovascularization, PRP

Once daily ASA (rx’d often but no evidence that is works)

138
Q

MC cause of legal blindness age 60+?

A

Age Related Macular Degeneration (ARMD)

139
Q

What are the two main types of ARMD?

A

Nonexudative (dry)

Exudative (wet)

140
Q

What is MC abnormality seen with ARMD?

A

Drusen (yellowish deposits deep in the retina - looks like speckles around the macula)

Limits the nutritional support to the outer retina

141
Q

Sxs of dry ARMD

A

Gradual loss of central vision

Macular drusen

Clumps of pigment on the outer retina

142
Q

Sxs of wet ARMD?

A

Distortion of straight-line edges

Rapid onset visual loss

Drusen

Choroidal neovascularization

Subretinal hemorrhages

143
Q

What is Amsler grid testing used for?

A

ARMD

It documents the degree of central field loss

Performed daily during follow up period

144
Q

When is IV fluorescein angiography performed?

A

If sub-retinal neovascularization membrane is present or suspected

145
Q

Txt for dry ARMD?

A

High-dose vitamin C, E, beta-carotene, and zinc

NO BETA CAROTENE FOR SMOKERS

146
Q

Txt for wet ARMD?

A

Laser photocoagulation, performed within 72hrs of angiography

147
Q

What are the three different types of retinal detachment?

A
  1. Rhegmatogenous - vitreous separates from retina, causing break of tear, the liquified vitreous dissects the retina
  2. Exudative - leakage without a break, usually from something (i.e. tumor) below the retinal layer
  3. Traction - with proliferative diabetic retinopathy
148
Q

Pt has flashers and floaters - must r/o:

A

Retinal detachment

149
Q

Sxs of retinal detachment

A

Flashes and floaters

“Curtain or shade” pulled down over eyes

Decreased vision

Visual field loss

Metamorphopsia (wavy, distorted vision)

“Ripples on a pond”

150
Q

Workup for retinal detachment

A

Complete ocular exam

Difficult to dx with direct ophthalmoscopy alone

Eye with detachment will have a lighter red reflex

151
Q

Txt for retinal detachment

A

Refer

Rest

Expeditious surgery

152
Q

I’m calling in sick because i’m having an eye problem.

A

Eye cant see myself coming in to work today

Senior - Ophthalmology (3 decks)

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