TraumaOCE

Question 1

-mullers muscle
-whitnalls ligament
-lockwoods ligament

Answer 1

-minor elevator(sympathetic) ~2mm elevation
-landmark of levator to aponeurosis, superior and anterior support
-lower lid support just like whitnalls. Made of fascia of IR and IO muscles

Question 2

indication for orbital floor repair

Answer 2

> 50% floor and >2mm enopthalmos. diplopia in primary gaze

Question 3

walk me through a transconj with cantholysis

Answer 3

Iris scissors placed inside palpebral fissure and extended down to lateral orbital rim using rim as a stop. Turn scissors vertically to complete cantholysis. conjunctiva can be bluntly dissected inferior to tarsal plate 2-3 mm. until you are 3mm from caruncle. Retract orbital contents and dissect down to rim. Retract eye with malleable. complete surgery. CLosure with 3-0 vycril with lateral canthan tendon.

Question 4

Subciliary options and benefits

Answer 4

skin, skin-muscle or step dissection
Use skin muscle to reduce defect.
Skin incision 2mm below gray line. Dissect deep to orbicularis and lift the pretarsal orbicularis and skin. Dissect to periosteum. Incision periosteum 3mm below rim to protect septum.

Question 5

How to fix entropion and extropion?

Answer 5

Entropion- possible mucosa graft
extropion- tarsal strip

Question 6

what is sympathetic opthalmia

Answer 6

autoantibodies induced injury to uveal tissue in first 3 months.
Haveto enucleate, eviscerate or exenteration

Question 7

Mannitol MOA

Answer 7

Increased blood osmality caused water to leave vitrous humor and go into interstitial space.

Question 8

Hyphema grades and treatment

Answer 8

1/3, 1/3-1/2. 3/4. then full.
Can treat with 1% atropine drops.

Question 9

other name for afferent pupillary defect and Mechanism

Answer 9

Marcus gunn
-Light in affected eye little to no reflex. then swinging to normal eye causes both to constrict. then swinging back to affect eye causes dilation.

Question 10

Horners syndrome

Answer 10

Miosis, ptosis and anhidrosis
injury to sympathetic nerves

Question 11

What is the classification for NOE and types

Answer 11

Markowitz
1- fracture with tendon
2-comminuted fracture with tendon
3-communited without tendon attached

Question 12

how is CSF different than serum?

Answer 12

chloride is greater and glucose is less then serum

Question 13

how would you repair a NOE with a positive bow string

Answer 13

Use closest laceration if available. Place miniplate in a superior and posterior direction and attach ligament with non resorbable suture.
Could also use mitec anchor.

Question 14

how would you obliterate the sinus?

Answer 14

I would remove all of the sinus mucosa including those in foramina of breschet. May have to open up the sinus more to visualize. Place Gelfoam into osteum. Cover with Tisseel(fibrin sealent that converts fibrinogen to fibrin). I would then use autogenous fat from the periumbilical region to completely obliterate sinus.

Question 15

What is meningitis?
What are two named signs of meningitis?

Answer 15

-inflammation of subarachnoid space.
-Stiff neck, confusion
-Kernig signs(cant flex leg with it 90 degrees to body)
-bruzinski-flexion of hips and knees with neck flexed.

Question 16

symptoms of cavernous sinus thrombosis?

Answer 16

headaches, ptosis, parasthesia around orbit. papilledema, ophthalmoplegia.
Treatment: abx, heparin for anticoagulation and drainage.

Question 17

tetanus recommendations

Answer 17

-No vaccine in 10 yrs, did not complete primary tetanus or unclean wound use TETANUS TOXOID
if no history of tetanus then Tetanus Immune globulin administered.

Question 18

Which antibiotic due you want for a dog bite? MOA
What if they are pen allergic? MOA

Answer 18

Augmentin?
Doxycycline and metronidazole:
Doxy- 30s ribosome protein inhibition
metro? i think blocks dna synthesis