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CMS- opts > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

a 50 > yo smoker with acute or chronic deterioration of central vision presents with drusen: diagnosis and treatment

A

age related Macular degeneration

tx: emergent consult to ophtho and Ranibizumab (Lucentis) - ophtho

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2
Q

the epidemiology of Age Related Macular Degeneration

A

dry (85-90%) and wet (neovascular)

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3
Q

deterioration of central vision and drusen bodies are indicative of

A

Age Related Macular Degeneration

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4
Q

complication of Age Related Macular Degeneration

A

blindness

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5
Q

pt education for Age Related Macular Degeneration

A

wear sunglasses

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6
Q

rapid loss of vision in one eye, “curtain” spread across visual fields, no pain or redness dx

A

retinal detachment

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7
Q

risk factors for retinal detachment

A

> 50 y/o, recent cataract surgery, blunt or penetrating trauma

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8
Q

diagnostic studies for retinal detachment

A

ophthalmoscopy - vitreous looks like a gray cloud

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9
Q

complications of Retinal Detachment

A

vision loss

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10
Q

treatment for Retinal Detachment

A

Emergent consult to ophthalmology, if central vision is affected
- transport with head position so that gravity will cause retina to fall back

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11
Q

a CD4 <50/ mvL with yellow-white patches is indicative of

A

Retinopathy - Cytomegalovirus (CMV)

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12
Q

Epidemiology of Retinopathy - Cytomegalovirus (CMV)

A

opportunistic infection that causes death of retina cells

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13
Q

Referral for Retinopathy - Cytomegalovirus (CMV)

A

Emergent consult to ophtho and infectious dz doctor

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14
Q

a DM patient with retinal changes; with/without vision loss is indicative of

A

Retinopathy - Diabetic

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15
Q

Risk factors for retinopathy - Diabetic

A

DM, can be any age

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16
Q

what is the leading cause of blindness in the world

A

nonproliferation and proliferative

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17
Q

s&s for Retinopathy Diabetic - non proliferative

A

micro aneurysms, intraretinal hemorrhages, cotton wool spots, hard exudates (yellow) and retinal edema

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18
Q

s&s for Retinopathy Diabetic - proliferative

A

neovascularization*** vitreous hemorrhage, possible retinal detachment

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19
Q

prevention for Retinopathy Diabetic

A

MUST examine eye w fundoscopic exam every visit

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20
Q

complications for Retinopathy - Diabetic

A

cataracts and blindness

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21
Q

pharmacological and non tx for Retinopathy Diabetic

A

PCP control DM, HTN, hyperlipidemia

non: preserve renal fx and eyesight

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22
Q

referral for retinopathy diabetic

A

routine at onset of DM; emergent if change in VA

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23
Q

pt comes back with + HIV test and confirmatory test, fundoscopic exam, shows cotton-wool spots, dx?

A

Retinopathy - HIV

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24
Q

complications of Retinopathy - HIV

A

CMV and Blindness

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25
Q

tx and management for Retinopathy - HIV

A

Urgent consult to optho and infection control MD

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26
Q

a pt had AV nicking, flame hemorrhage, copper wire, silver wire, papilledema, cotton wool spots and hard exudates after a fundoscopic exam
dx?

A

Retinopathy - Hypertension

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27
Q

risk factors for Retinopathy - Hypertension

A

HTN, pheochromocytoma, preeclampsia-eclampsia, severe HTN

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28
Q

complications for Retinopathy - Hypertension

A

blindness

29
Q

referral for Retinopathy - Hypertension

A

chronic HTN - routine consult to optho and IM

30
Q

treatment for Retinopathy - Hypertension

A

control HTN; annual exams

31
Q

after a fundoscopic exam, pt had sea fan, salmon patches or black sunburst. How would you dx this pt?

A

Retinopathy - Sickle cell

32
Q

treatment for Retinopathy - Sickle cell

A

prevent sickle cell crisis

- if pt has crisis - look in eye and emergent consult to ophto

33
Q

pt comes in with a unilateral leukocoria

A

Tumor - Retinoblastoma

34
Q

Tumor - Retinoblastoma risk factors

A

genetics

35
Q

epidemiology of Tumor - Retinoblastoma

A

most commonly intraocular malignancy, +/- genetics

36
Q

treatment and management for Tumor - Retinoblastoma

A

urgent consult pediatric ophtho and oncologist

37
Q

diagnostic studies for Tumor - Retinoblastoma

A

CT showing tumor intraocular

38
Q

pt has unilateral proptosis, lid edema, vision loss, non tender mass what would the diagnosis be?

A

Tumor - Rhabdomyosarcoma

39
Q

the epidemiology of Tumor - Rhabdomyosarcoma

A

rare

40
Q

treatment and management for Tumor - Rhabdomyosarcoma

A

urgent consult pediatric optho and oncologist

41
Q

diagnostic studies for Tumor - Rhabdomyosarcoma

A

CT scan usually shows boney involvement, complete work up for metastases

42
Q

a pt has a fracture on one or more of the bones surrounding the eye, with a traumatic deformity of the orbital floor or medial wall due to blunt trauma

A

Blowout Fracture, Orbital

43
Q

diagnostic studies for Blowout Fracture, Orbital

A

immediate CT scan

44
Q

complications for Blowout Fracture, Orbital

A

eye muscle/nerve entrapment

45
Q

treatment for Blowout Fracture, Orbital

A

Amoxicillin- caluvulanate (augmentin) 600 mg solution for IV (after surgery 500 mg 1 tablet TID or 875, 1 tablet PO BID)
IF ALLERGIC TO PENICILLIN –>
- Azithromycin 500 mg or 1 gram IV then after surgery 250 mg PO daily
—-
tetanus booster

46
Q

work up for Blowout Fracture, Orbital

A
  • rule out ruptured eye (globe) positive Seidel’s sign*
  • examine eyelid for crepitus
  • monitor for progressive proptosis/visual changes
  • exam retina for central retinal artery occlusion
47
Q

s&s for Blowout Fracture, Orbital

A

hx of sig trauma, pain with movement, diplopia, swelling of eyelids with sneezing
enopthalmos (posterior displaced globe), point tenderness, numbness or tingling of upper lip/cheek, extra ocular movements are restricted, Positive Seidel’s sign - globe rupture anterior chamber

48
Q

f/u and Rx discussion for Blowout Fracture, Orbital

A

admitted, optho emergent consults; f/u PCP

rx may cause nausea and diarrhea

49
Q

pt was in severe pain and eyelid spasms after exposed to an irritant in their eye after cleaning the bathroom with bleach, this is indicative of?

A

chemical injury

50
Q

complications for chemical injury

A

dependent of the irritant chemical - blindness

51
Q

treatment for chemical injury to the eye?

A

copious irrigation with sterile NS

-no contacts until cleared by optho

52
Q

pt has a FB sensation, pain, redness after working in construction. You everted the eye and found a fb. How will you treat this?

A

Erythromycin opth 0.5% ointment, 1 ribbon in affected eye 4-6 times a day, continue until 48 hrs after healed, 1 tube no RF
—
tetanus shot prophylaxis

53
Q

complications for FB?

A

corneal abrasion/ulcer, if object embedded - possible globe rupture

54
Q

prognosis for FB?

A

non embedded- good recovery

embedded- varies

55
Q

a pt comes in with severe pain, decreased VA, and tear in pupil. He said he had blunt trauma, causing a laceration to the globe, how would you diagnose and treat this pt?

A 
A globe rupture;
-AVOID putting drops into eye or removing any objects
-refer to optho emergent
--- give morphine for pain 
no NSAIDS**
-tetanus
56
Q

why would you not give NSAIDS to globe rupture

A

it inhibits platelets

57
Q

what is the sedation medication

A

lorazepam 0.05 mg/kg (max 2mg)

58
Q

a pt had trauma to the eye and has blood in the anterior chamber, most likely diagnosis?

A

hyphema

59
Q

how would you treat hyphema?

A 
INPatient*
emergent consult to optho
-eye shield, bed rest w bathroom privileges, 
-dim light,
-elevate head of bead*
60
Q

can NSAIDS be given to a pt with Hyphema, what would you give?

A

NO

give cycloplegic drops x3/days

61
Q

complications for hyphema?

A

immediate threat to vision, pt with sickle cell have increased risk, glaucoma

62
Q

a pt comes in with blood between sclera and conjuctiva, what is diagnosis?

A

Subconjuctival Hemorrhage

63
Q

what are risk factors to Subconjuctival Hemorrhage

A
  • anything w increased pressure*
  • childbirth
  • coughing
  • vomiting
  • HTN (uncontrolled)
  • DM (uncontrolled)
  • blunt trauma
  • anticoag therapy (uncontrolled)
64
Q

treatment for subconjuctival hemorrhage for childbirth, coughing, and vomiting

A

resolves by self in 2-4 weeks; PCP tx for cough/vomit

65
Q

treatment for Subconjuctival Hemorrhage for HTN/DM

A

control disease

66
Q

treatment for Subconjuctival Hemorrhage with blunt trauma

A

urgent optho consult

67
Q

treatment for Subconjuctival Hemorrhage for anticoagulation therapy

A

f/u for evaluation of therapy PCP

68
Q

difference between hyphema and Subconjuctival Hemorrhage

A

hyphema: blood inside anterior chamber, emergent*

Subconjuctival Hemorrhage: blood b/w sclera and conjuctiva, mainly self limiting

CMS- opts (3 decks)

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