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Senior - Ophthalmology > Review Deck 98-184 > Flashcards

Review Deck 98-184 Flashcards

1
Q

Definition of glaucoma?

A

Group of diseases w progressive

  • optic nerve damage
  • visual field loss
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2
Q

2 categories of glaucoma?

A

Open angle glaucoma
- most common
Angle-closure glaucoma

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3
Q

Difference between open angle and closed angle glaucoma?

A

Open angle glaucoma
- blockage of aqueous outflow

Angle closure glaucoma
- structurally normal outflow pathway

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4
Q

Risk factors for open-angle glaucoma?

A 
Increased age
AA
Family hx
DM
Systemic HTN
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5
Q

AAO risk factor weighting?

A

Charty thing that calculates the level of glaucoma risk

See slide 100

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6
Q

Clinical tests for open-angle claucoma?

A

IOP (may be normal)
Pupillary examination (crescent shadow)
Opthalmoscopy (cup-disk >0.6)

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7
Q

If you suspect POAG?

A

Ophthalmology referral

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8
Q

Treatment approach for lowering IOP?

A

Decreasing production of aqueous fluid

  • B-blocker
  • a2- agonist
  • carbonic anhydrase inhibitors

Increasing outflow of aqueous

  • less-selective sympathomimetics
  • prostaglandins analogs
  • miotic agents
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9
Q

Open angle glaucom meds

A

Chart slide 103

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10
Q

B adrenergic blocker side effects?

A

Decreased CO

Bronchoconstriction (NO COPD/asthma)

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11
Q

Alpha 2 adrenergic agonist SE?

A

Allergic conjunctivitis

Contact dermatitis

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12
Q

Less-selective sympathomimetics SE?

A

Exacerbation of hypertension

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13
Q

Prostaglandin analogs SE?

A

Conjunctival hyperemia

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14
Q

Who gets surgery for open angle?

A

If the optic neropathy worsens

Younger ps

Noncompliant pts

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15
Q

What is a trabeculoplasty?

A

Therapy using

  • Argon laser
  • Selective laser
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16
Q

What is a trabeculectomy?

A

Implant/shunt surgery

Aqueous fluid flows into subconjunctival space (filling bleb)

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17
Q

What is ciliary body ablation?

A

Destroys a portion of the ciliary epithelium

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18
Q

Symptoms of acute angle glaucoma?

A 
Blurred vision (unilateral)
Monocular halos 
Eye pain/photophobia
Frontal HA
Vasovagal symptoms
N/V
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19
Q

Signs of acute angle closure glaucoma?

A 
Mid-dilated pupil
Conjunctival injection
Lid edema
Corneal edema w blurring of light reflex
Elevated IOP (60-80mmHg)
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20
Q

What are the risk factors for acute angle-closure glaucoma?

A 
Women 4x more
55-70 yrs
Short, small, far-sighted eyes
Extreme dilation
Drugs 
- anticholinergics
- sympathomimetics
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21
Q

Treatment of choice for acute angle-closure glaucoma?

A

Laser iridotomy (post attack)

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22
Q

Meds for acute angle closure glaucoma?

A

Timolol (aqueous fluid)
Acetazolamide IV
Isosorbide IV
Mannitol IV

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23
Q

Chronic angle-closure glaucoma signs and symptoms?

A 
Asymptomatic (usually)
Decreased vision/field loss
Elevated IOP
Broad bands of PAS
Optic nerve damage

Normal Pupil

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24
Q

How are broad band PAS diagnosed?

A

With a gonioscopy

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25
Q

Surgical Tx for chronic angle-closure glaucoma?

A 
Surgical
- goniosynechialysis
— strip the PAS 
- iridotomy
— allow drainage

PAS = Peripheral anterior synechiae (PAS) are adhesions of the peripheral iris to the structures in the angle of the anterior chamber.

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26
Q

Medical Tx for congenital glaucoma?

A

Topical levobunolol or timolol

Oral acetazolamide

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27
Q

Surgical treatment for congenital glaucoma?

A

Goiniotomy (trabecular meshwork)

Trabeculotomy

Trabeculectomy

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28
Q

What is the medical tx used for with congenital glaucoma?

A

Its temporary measure to hold them until they can get surgery

We dont want kids to have to use drops for their entire life

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29
Q

S/s of neovascular glaucoma?

A 
Asymptomatic (sometimes)
Pain
Red eye
Photophobia
Decreased vision
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30
Q

Treatment for neovascular glaucoma?

A

Timolol
Glaucoma filtration
Surgery

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31
Q

Steroids and glaucoma?

A

Prolonged use of steroids can cause reduction of outflow facility of trabecular meshwork

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32
Q

What types of steroids cause steroid response glaucoma?

A

High-dose skin creams

Inhalers

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33
Q

Treatment for steroid response glaucoma?

A

DC steroid

Decrease steroid dose

Add anti-glaucoma therapy

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34
Q

There are lots of types of glaucoma (technically its anything that plugs up the flow in the eye)

What other types are there?

A

Inflammatory open-angle glaucoma

Exfoliative glaucoma

Phacolytic glaucoma

Postoperative glaucoma

LTG or normal tension glaucoma

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35
Q

Diagnosis of glaucoma requires?

A

Progressive optic nerve damage

Progressive visual field loss

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36
Q

Without progressive optic nerve damage and visual field loss the pt just has?

A

Ocular hypertension

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37
Q

What is hemianopia?

A

Loss of an entire half of the visual field

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38
Q

What is hymonymous hemianopia?

A

Visual field loss on the same side in both eyes

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39
Q

What isis ipsilateral hemianopa?

A

Visual field loss is on the same side the lesion is on

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40
Q

What is contralateral hemianopia/?

A

Visual field loss on the opposite side of the lesion

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41
Q

What is scotoma?

A

An area of reduced or absent vision within an otherwise intact visual field

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42
Q

What is anisocoria?

A

Unequal size of the pupils >1mm

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43
Q

Visual field pathway?

A

Slides 117 and 118, prob worth a look

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44
Q

What is the afferent pathway?

A

CNII

Light travels up CNII, divides in the chiasm

Arrive at pretectal nucleus cross end and EW nuclei

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45
Q

What is the efferent pathway?

A

CN III

Signal sent from EW nuclei down the oculomotor nerve (CNIII)

The pupils constrict

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46
Q

If i tell you that the visual pathway has double decussation you are smart and know that this means …?

A

It first decussates t the chiasm

Second is at the prectal nuclei to the endinger-westphal nuclei

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47
Q

What is responsible for the direct/consensual response?

A

The double decussation

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48
Q

How does neurosyphilis present?

A

Its damage to the cenral pupil pathway so it causes

Argyll Robertson pupil

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49
Q

Argyle robertsons pupil is aka?

Describe it

A

Prostitue’s pupil

The pupil is small
Responds slowly/not at all to light
But Response to near accommodation

I.e. it accommodates but doesnt react

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50
Q

Contrasted with argyle robertson’s pupil adie’s tonic pupil is?

A

Idiopathic and benign

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51
Q

Signs of adie’s tonic pupil?

A

Dilated pupil
Reacts poorly to light
Reacts better to accomidation

Its “sluggish and tonic”

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52
Q

Who gets adie’s pupil?

A

Women

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53
Q

What non optho sign is seen with adie’s pupil?

A

Loss of DTR’s

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54
Q

Adie’s pupil does not have?

A

Abnormal extra-ocular movements
Ptosis

This are signs of CN III palsy

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55
Q

Causes of adies tonic pupil?

A

Idiopathic

Viral etiology

Inflammatory process

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56
Q

How to confirm adie’s pupil?

A

Give 0.125 pilocarpine

Adie’s pupils will constrict

Normal will not constrict

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57
Q

What causes horner’s syndrome (30,000’)

A

Injury to the sympathetic nerves of the face

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58
Q

Sings of horner’s syndrome?

A 
Ptosis 
Pupillary miosis (constricted)
Facial anhydrosis (lack of sweating)
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59
Q

What are some common causes of horner’s?

A 
Stroke of brainstem
Injury to carotid artery
Tumor in lung
Cluster HA
Congenital
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60
Q

Diagnosis of horner’s?

A

10% cocaine

  • dilates normal pupil
  • no dilation in horner’s

Horner doesnt do cocaine

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61
Q

What happens during the swinging flashlight test if the pt has marcus gunn pupil?

A

When light is shone in the affected eye the pupils dilate bc the brain never receives the signal

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62
Q

Papilledema must be?

A

Bilateral

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63
Q

Causes of papilledema?

A

Intracranial mass

Impediment of CSF flow

Idiopathic intracranial hypertension

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64
Q

Symptoms of papilledema?

A 
HA
N/V
Transient vision loss
Pulsatile tinnitus
Horizontal diplopia

Secondary to intracranial mass

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65
Q

Signs of papilledema?

A 
Optic disk edema 
Blind spot
Visual field/acuity loss (chronic)
Pseudotumor cerebri
Sixth nerve palsy
66
Q

If you suspect papilledema you should order?

A

BP (1st step)

MRI w contrast

Lumbar puncture (pressure)

Neuro consult

Opthalmology consult

67
Q

Tx for papilledema involves?

A

Treating the underlying disease

68
Q

Tx fo pseudotumor cerebri?

A

Wt loss

Acetazolamide

Furosemide

Neurosurgical shunt

69
Q

What is ischemic optic neuropathy?

A

Papillitis (optic disk swelling)

70
Q

What causes ischemic optic neuropathy?

A

Atherosclerotic/thrombic occlusion

Hemodynamic compromise

71
Q

Sudden painless vision loss, usually upon waking you need to suspect?

A

Ischemic optic neuropathy

72
Q

Types of ischemic optic neuropathy?

A

Arteritic AION

Non-arteritic NAION

73
Q

Pt population for ischemic optic neuropathy?

A

> 60 AION-GCA

Middle age NAION

74
Q

S/S of ischemic optic neuropathy?

A

Unilateral swollen optic disc (initially)
- progresses to bilateral
Flame shaped hemorrhages
Optic disc pallor

75
Q

Blood work for ION present?

A

Vasculitis

  • Westergren ESR
  • CRP

Anemia

DM

76
Q

Who gets neuroimaging?

A

Uncertain or progressive cases

77
Q

Treatment for ischemic optic neuropathy?

Hint its different based on the type

A

NAION: (8 weeks)

  • observation
  • aspirin

AION:
- systemic steroids
— (methylprednisolone then prednisone)
-temporal artery biopsy

78
Q

What causes optic neuritis?

A

Demyelination of the optic nerve

  • idiopathic
  • MS
  • postviral origin
79
Q

Symptoms of optic neuritis?

A

Unilateral vision loss
- over hours - days
Orbital pain (w movement)
Transient neuro disturbances

80
Q

Cure for optic neuritis?

A

I dont know pray to the universe or god or cheese burgers, doesnt matter b/c it has spontaneous recover

81
Q

Age for optic neuritis?

A

18-45yrs

82
Q

Signs of optic neuritis?

A 
Disk edema (only 1/3 of pts)
Central visual field loss
Relative pupillary defect

Decreased color vision

83
Q

Workup for optic neuritis?

A

Opthalmic eval

MRI w contrast

Non-diagnostic labs

  • CBC
  • CXR
  • electrolytes
84
Q

Tx for optic neuritis

A

MRI found 1 area

  • pulsed IV steroid
  • no long term change in vision

MRI found 2+
- interferon

No lesions:
- IV steroids

85
Q

When treating optic neuritis you should not?

A

Start therapy w oral steroids

There is an increased recurrence rate

86
Q

CN III palsy effects?

A

The oculomotor nerve

  • extraocular muscles (SR, IR, IO, MR)
  • levator palpebrae
  • pupillary sphincter
87
Q

Etiology of CN III palsy?

A 
Vasculopathic
- DM
- HTN
Trauma
Compression
- aneurysm
- tumor
88
Q

CNIII s/s?

A 
Ptosis
Diplopia (turned down and out)
HA or periorbital pain
Deficiencies in eye movement
Dilated pupils
89
Q

Dialed pupil with CN III palsy?

A

This is a bad sign

Stat MIR to r/o aneurysm

90
Q

Besides blown pupil who else gets MRI?

A

Pts without obvious vascular risk factors

91
Q

Who gets a cerebral angiography?

A

Suspected aneurysm

92
Q

When do pts only need observation?

A

When there is no evidence of vasculitis

Pupil is spared

93
Q

Tx for CN III palsy?

A

Fix the underlying etiology

94
Q

S/s of 4th nerve palsy?

A

Vertical/oblique diplopia

Objects appear tilted

Pt tilts head

Eyes dont depress well when adducted
(Dont look as far down)

95
Q

Workup for CN IV palsy?

A

MRI if <45
Opthalmic evaluation
- ocular alignment

96
Q

Tx for CN IV palsy?

A

Treat the underlying disorder

Glasses

97
Q

S/S of CN VI palsy?

A
  • Horizontal diplopia
  • HA - periorbital pain
  • esotropia
  • abduction deficit
  • head turn position
    — minimize the diplopia
98
Q

Workup for CN VI palsy?

A

opthalmic eval

MRI

99
Q

Leading cause of blindness for ages 20-64?

A

DM

100
Q

2 classifications of DM retinopathy?

A

Non-proliferative diabetic retinopathy

  • hemorrhages,
  • microaneurisms,
  • exudates

Proliferative diabetic retinopathy
- new blood vessels grow

101
Q

When does vision loss appear with Diabetic retinopathy?

A

Late stage of proliferative diabetic retinopathy

102
Q

Neovascularization comes from proliferative diabetic retinopathy, what causes this?

A

The ischemia

  • compromised perfusion = angiogenic factor release
  • stimulates growth of new vessels
103
Q

MC place for neovascularization to occur?

A

Vascular arcades

104
Q

Signs of proliferative diabetic retinopathy?

A 
Fine lacy blood vessels seen on:
- optic nerve
- retina
- iris 
Pre retnal hemorrhages
Cotton wool spots
Dot and blot intra-retinal hemorrhages
Loss of red reflex
Floaters
105
Q

What are pre-retinal hemorrhages?

A

Boat shaped hemorrhages that are anterior to retinal vessels

106
Q

Tx for proliferative diabetic retinopathy?

A

Tight glycemic control

If neovascular changes then send to optho
- pan retinal photocoagulation (PRP)

107
Q

Earliest signs of diabetic eye problems?

A

Diabetic macular edema
- micro-aneurysms
— increased permeability
Vascular endothelium “tight junctions”

108
Q

What is hypertensive retinopathy?

Hallmark?

A

Changes from chronicity of hyptertension

- hallmark is diffuse arterolar narrowing

109
Q

What changes are made by chronic hyptertension?

A 
Thickening of vascular wall
Cocominant narrowing of vessel lumen
A:V ratio changes 
Copper-wire vessel
- Yellowing of the linear light reflex
Silver wire - sclerosis of the vessel
110
Q

How does giant cell arteritis cause vision problems?

A

Vision loss is secondary to vasculitic occlusion specifically to the arteries of the optic disk

111
Q

Symptoms of giant cell arteritis?

A

EXTREME sudden vision loss
HA
SCALP AND TEMPLE TENDERNESS
And some other common constitutional symptoms

112
Q

Signs for giant cell aerteritis?

A
  • 60’s
  • pale optic disc swelling
  • temporal arteries are:
    — firm
    — tender
    — pulsless
  • esr >50
  • mild anemia
  • 3,4,6th nerve palsy
  • relative afferent pupillary defect
113
Q

What bloodwork needs to be done immediately?

A

ESR

Then do a biopsy and chem panel etc

114
Q

Tx for giant cell?

A

IV methylprednisolone 250mg iv q 6hrs x 72hrs

Then

Prednisone 80-100mg po qd

115
Q

What is myasthenia gravis?

A

Autoimmune disorder of the NMJ

It improves w rest, worsens w activity

Causes lots of muscle weakness

116
Q

Signs of mysanthenia gravis?

A

Ocular motility measurements vary

Variable ptosis

Fatigue w sustained upgaze

117
Q

How can you test for MG?

A

Edrophonium chloride (tensilon) test

Ice test

  • over eyes x 2 min
  • if ptosis gets better its positive test
118
Q

Tx for MG?

A 
Alternate eye occlusions
Pyridostigmine
Low dose prednisone
Thymectomy 
Azathioprine (immunosuppressant)
119
Q

Symptoms of thyroid disease; mild, moderate, severe

A

Mild

  • irritation
  • foreign body sensation
  • burning
  • tearing

Moderate

  • double visoni
  • blurred vision
  • ache

Severe

  • vision loss
  • corneal ulcerations
120
Q

Signs of thyroid disease?

A
  • Bilateral
  • proptosis/exophthalmos
  • lid retraction
  • lagophythalmos
  • exophthalmos
  • restricted ocular motility
  • swollen conjunctiva/lids/brow
  • loss of visual acuity/visual fields
121
Q

What will you see on CT with thyroid disease?

A

Muscle thickening in the orbit

- causes the eyes to bulge out

122
Q

Tx of eye problems from thyroid?

A

Moderate-severe

  • oral prednisone
  • orbital decompression
  • repair of lid retraction
  • orbital radiation
  • strabismus surgery
123
Q

Common vision symptoms of aids patients?

A

Floaters
Blurred/decreased vision
Blind spots
Flashes (retinal detachment)

124
Q

Signs found in HIV/AIDS pts?

A

Cotton wool spots (MC)
Keratic precipates (stellate shaped)
Vitreous cells
Hemorrhages

125
Q

HIV tx?

A

IV ganciclovir
IV foscarnet

Or a combo of these

126
Q

RA S/S in the eyes?

A
  • foreign body sensation
  • corneal ulcer
  • anterior uveitis
  • necrotizing scleritis
  • scleral thinning (scleromalacia)
127
Q

Difference between necrotizing scleritis and scleromalacia?

A

Necrotizing scleritis
- painful

Scleral thinning

  • slow and painless
  • minimal inflammation
128
Q

Never give RA ____

A

Topical steroids

129
Q

2 MC eye cancers?

A

Basal cell carcinoma
- MC eye malignancy

Squamous cell carcinoma
- MC conjunctival malignancy

130
Q

Other rare eye cancers?

A

Malignant melanoma
Astrocytoma
Retinoblastoma (kids)

131
Q

Signs of wilson’s disease?

A

Kayser-fleischer ring
- brown red deposit on cornea

Sunflower cataract
- subcapsular copper deposit

132
Q

3 MC drugs that cause ocular effects?

A

LSD (just kidding)

  1. Amiodarone
  2. Chloroquine
  3. Corticosteroids

Chart on slide 163

133
Q

Preseptal cellulitis vs orbital cellulitis?

A

Preseptal cellulitis

  • inflammation/infection of eyelid
  • doesnt go past orbital septum

Orbital cellulitis

  • gets into the orbit
  • emergency
134
Q

With preseptal cellulitis you will not see:

A

NO proptosis
NO restricted ocular motility
NO pain w eye movement
NO optic neuropathy

135
Q

Signs/symptoms of orbital cellulitis

A

Signs:

  • fever
  • WBC
  • PROPTOSIS
  • RESTRICTED OCULAR MOTILITY
  • pain w movement

Symptoms

  • pain
  • diplopia
  • warm tender etc
  • periorbital swelling
136
Q

Tx for orbital cellulitis?

A

Admit
Iv abx
Erythromycin ointment
Surgical drainage

137
Q

How to examine for corneal abrasions?

A

A slit lamp exam

  • anestetic
  • fluorsecein stain
  • examine anterior chamber
  • Examine for corneal laceration/penetrating trauma

Evert the eyelid and look for FB

138
Q

Tx for corneal abrasions

A

Topical abx: polymyxinB or fluoroquinolong

Cycloplegic agent - traumatic iritis

Eye patching

139
Q

Never eye patch an abrasion if?

A

Vegetative matter/fingernails are involved

Pt wears contact lease

Just give floroquinolone

140
Q

Workup for contact lens irritation?

A

Eye exam
Slit lamp
Fluorscein stain
Eversion of lid

141
Q

Tx for contact lens irritation?

A

General:
- remove x 14 days

W abrasion

  • Gm Neg coverage
  • pseudomonas
  • referral
142
Q

Eye drugs for pseudomonas?

A

Fortified gentamicin or fortified tobramycin

And

Fortified cefazolin or vancomycin

Alternate drops q 30 min

Fortified just means they had to compound it b/c its not available in eye drops normally

143
Q

Every pt with corneal foreign body gets?

A

Visual acuity
Bilateral eye exam
IOP
Slit lamp

144
Q

What should you do for a “high speed” corneal foreign body?

A

CT Scan

145
Q

Tx for foreign body of cornea?

A

Globe penetration : PUNT

Superficial

  • anesthesia and remove
  • remove rust ring
  • topical abx
146
Q

Intraocular foreign body treatment?

A

Protective shield on eye while you get them to the hospital

Tetanus shot

147
Q

What will opthomology do for an intraocular FB?

A

vancomycin
Cycloplegic
- accommodation and pain mgment
Surgical removal

148
Q

What is ultraviolet keratitis?

A

Basically a sunburn of the eyeball

  • welding
  • sunlamp
  • snow
  • drugs (maybe)
149
Q

Tx of ultraviolet keratitis?

A

Cycloplegic agents
Abx ointments
Patching
Oral analgesics

150
Q

The workup for chemical injury?

A

Conducted after you flush the eyes x 30 min

151
Q

Tx for chem injury?

A

First flush

Cycloplegic agents (scopolamine)
Topical abx (erythromycin)
Oral pain meds
IOP control PRN
Artificial tears PRN
152
Q

What is hyphema?

A

Blood in the anterior chamber

  • severe trauma
153
Q

When could you see spontaneous hyphema?

A

Retinoblastoma
Leukemia
Clotting disorder
Spontaneous in child (child abuse)

154
Q

Tx for hyphema?

A

Optho consult is MANDATORY

  • Bed rest w head elevated
  • shield eye (clear not patch)
  • cycloplegic agent bid
    — atropine, scopolamine
  • analgesia/anti-emetics prn

NO NSAIDS or ASPIRIN

155
Q

What is a blow out fracture?

A

An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall, typically resulting from impact of a blunt object larger than the orbital aperture

156
Q

Workup for blow out fracture?

A

Evaluate

  • EOM’s
  • r/o rupture globe
  • eyelid crepitus
  • measure IOP
  • retina for artery occlusion/optic nerve

Monitor visual changes

CT scan

157
Q

Tx for blow out fx?

A

Referral to optho

Nasal decongestant

Abx (cephalexin)

Ice

158
Q

Workup for lid laceration?

A

Examine both eyes

  • dilate
  • r/o optic nerve injury
  • r/o ruptured globe

Eval canalicular and lacrimal system
CT scan if globe involvement
Evaluate ptosis

159
Q

Tx for lid laceration:

A

Tetanus shot
Oral abx

Referral

160
Q

Referral conditions for lid laceration?

A 
Involves canalicular system
Rupture globe
Intraoccular FB
Involves levator (ptosis present)
Visible orbital fat
Extensive tissue loss (1/3 of lid)
161
Q

Why did the phone wear glasses?

A

Because it lost all its contacts

Senior - Ophthalmology (3 decks)

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