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DDX > Surgery > Flashcards

Surgery Flashcards

1
Q

DDX of orbital inflammation

A
  • infectious
    • bacterial - be wary of TB and nec fas
  • autoimmune
    • TED
    • IgG4
  • vasculitic
    • wegners
    • GCA
    • PAN
    • other
  • granulomatous
    • sarcoid
  • NSOI
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2
Q

Intraocular calcium

A
  • PFV
  • Phthisis
  • RB
  • retinocytoma
  • osteoma
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3
Q

Toric lens rotation

A
  • each degree of rotation decreases toric lens astig by 3% OR
    10 degrees off axis decreases by 1/3 OR at 45 degrees cyl power is nil
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4
Q

IOL power and refractive error

A

1D error in value of lens equals 0.67 D in refractive error

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5
Q

unilateral cataract DDX

A

idiopathic

masked bilateral

rubella

traumatic

ocular abnormality: PFV, ant seg dysgenesis, post lenticonus, post pole tumour

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6
Q

Drugs and cataracts

A

steriods

phenothiazines

amiodarone

statins

tamoxifen

pilocarpine/echothiophate

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7
Q

Post op CE IOL see increased inflam

A

PXF

PDS

DM

kids

prev surgery

prev pilo

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8
Q

Floppy iris sydrome

A

adrenergic antagonists

Ex: Tamsulosin (alpha 1a antagonist), antihypertensives: Doxazosin, Terazosin, Prazosin, labetalol, antipsychotics: chlopromazine

Triad: miosis billowing prolaps

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9
Q

signs of explusive SCH

A

dark red reflex

incision gape

iris prolapse

expulsion of lens/v/blood

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10
Q

Risk factors for CME

A
  1. VMT
  2. UV light
  3. PCR
  4. v loss
  5. iris prolapse
  6. hypotony
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11
Q

Risk of endophthalmitis

A
  1. wound leak
  2. V loss
  3. DM
  4. PCR
  5. prolonged surgery

SEE TABLE

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12
Q

Risk factors for ret detachment

A

axial myopia

younger age

male

lattice

prev tear

fam hx of RD

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13
Q

qualities of visco elastics cohesives (healon, amvisc) vs dispersives (viscoat, cellugel)

A

self adherence

viscosity/molecular mass (higher resists more force) (ability to resist flow or force)

surface tension/coating

ease of aspiration

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14
Q

Refractive surgery numbers

A

Munnerlyn: myopia x optical zone2 / 3

large pupils increase risk of glare

EBMD increase flap complications

conj scar incrase issues with microkeratome suction

Flat k - <40D small flap and free caps

Steep k - >48 button hole flaps

<34 or >50 ks = poor quality va …. for myopia substract 80%, for hyperopia add 100%

Need to leave stromal bed 250

RK incisions 90% thickness - get diurnal flucuation of vision and progressive flattening effect

coupling ratio: amount of flattening in the meridian of the incision divided by the induced steepening in the opposite direction…if 1- then SE unchanged, if + ratio- greater than 1 then hyperopic shift occurs

AK: 95% depth in steep meridian at 7mm optical zone

LRI: 600 um depth just anterior to limbus

PRK and LASIK treat -14- + 6

** to increase effect of LRI, increase length of incision, to increase effect of AK increase length, depth, use multiple incision, reduce the distance between incisions, make it more central

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15
Q

ortho K

A

overnight use of rigid has perm CL that are fitted at base curve flatter than K curvature…causes temporary flattening of K epi to treat myopia

approved for -0.50–> -6 with up to 1.75 astig

do not treat hyperopia or astig

in studies 1/3 had to discontinue and 75% experienced pain

complications: astigmatism, HOA, recurrent erosins, IK

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16
Q

PRK vs LASIK

A

PRK

  • who can get it : irregular or thin corneas, EBMD , previous K surgery (PKP RK), treatment of LASIK flap complications
  • eliminates potential for stromal flap related complications and HOA
  • may have decreased incidence of dry eye and ectasia
  • corneal haze is major risk, has decreased with MMC (see more with higher refractive error)
  • increased risk of infection compared to lasik due to longer epi healing
  • cx: persistent epi defect, sterile infiltrates, K haze

LASIK

  • faster visual recovery
  • decreased photoperative discomfort
  • cx: microkeratome, epi sloughing or defects, striae, traumatic flap, DLK, PISK, epi ingrowth, interface debris, ectasia

*** Lasik wait 3 mo for retreatement, PRK wait 6 mo for retreatment

17
Q

epi ingrowth increases in

A
  1. epi defect at time of procedure
  2. re treatment with lifting of pre existing flap
  3. traumatic flap dehisence
18
Q

antibiotic choices

A

3 year old - preseptal cellulitis, sinus origin?

amox-clav 40mg/kg/day po div bid consult ENT

pen allergic: septra8/60 mg/kg div bid

Adult - Preseptal cellulitis, from lid wound?

if mild Amox-Clav 875/125 mg po bid

pen allergic: TMP/SMX DS 1-2tabs po bid.

Adult - preseptal cellulitis CAMRSA ?

Suspect MRSA TMP/SMX DS 2 tabs po bid

Suspect MRSA clinda 400 mg po TID

Adult- pre septal cellulitis HA MRSA?

vancomycin or linezolid

5 year old with mild pain with EOM, N vision and small Subperiosteal Abcess (SPA).

Cefrtiaxone 100mg/kg/day IV div q12 + Vanco 60mg/kg/day IV div q6 +/- metronidazole 30mg/kg/d IV div q8h.

10 year old with enlarging SPA on CT, increasing proptosis and slight decrease in colour vision.

Start IV Abx as above but consider lateral canth/cantholysis and book for urgent drainage.

Adult with orbital cellulitis, no vision or EOM compromise. Vancomycin 1g q12 h + Ceftriaxone 2g IV q12h + metronidazole 500mg IV q8h

Nec Fas: broad spectrum gram negative and gram positive and anaerobes and clindamycin

19
Q

patient with blepharospasm during cataract surgery, what do you do?

A

van Lint block (A)

Anesthetize the terminal branches of the facial nerve

1.5inch, 25-gauge needle is inserted 1 cm lateral to lateral orbital rim as well as superior and inferior orbital margins, inject 3-6cc total

O’Brien (B)

Anesthetize the facial nerve at proximal trunk, done at the level of the neck of the mandible near the condyloidprocess just anterior to the tragus of the ear.

1inch, 27-gauge needle inserted at center of condyloid process to periosteum; inject 3 cc

Nadbath-Ellis block (C)

Anesthetize the facial nerve where it emerges from the stylomastoid foramen

Insert 5/8inch 25-gauge needle into the tympanomastoid foramen, inject 2-cc

Atkinson

This was introduced to overcome the disadvantage of Van Lint and O’Brien’s block. Van Lint causes ballooning and distortion of the lids and ocular adnexa while that of O’Brien produces postoperative pain at site of anaesthesia . The superior branch of the facial nerve is blocked by injecting the anaesthetic solution at the inferior margin of zygomatic bone subcutaneously with a 23g needle .

20
Q

adverse events associated with nuclear fragment dislocation or v loss

A

Increased risk of endophthalmitis

increased risk of retinal tear and detachment

uveitis

K edema

increase post-op CME increase

increased risk of sub-optimal post-op visual recovery

risk of elevated IOP

vitreous opacities

recall: if PC rupture associated with 2X endophthalmitis and 20X risk of RD

21
Q

DSAEK over PK

A

No open sky results in decrease risk of Suprachoroidal hmg

Not full thickness means better wound integrity and less risk of rupture

Less risk of rejection

reduction in suture related problems

greater accuracy in selection of intraocular lens for triple procedures

Rapid visual recovery

Less induction of astigmatism

DDX (6 decks)

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