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integrative analysis ii > Ocular Trauma, HA, Retinal Breaks > Flashcards

Ocular Trauma, HA, Retinal Breaks Flashcards

1
Q

Symptoms of corneal abrasion

A

pain, photophobia, tearing

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2
Q

Signs of corneal abrasion

A

corneal staining, without infiltration/opacification, injection, possible AC reaction

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3
Q

What does infiltration/opacification mean?

A

infectious process

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4
Q

What is an essential exam step with corneal abraison?

A

evert lids, consider double lid eversion with lid retraction

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5
Q

What are treatments of corneal abrasion?

A

antibiotic gtts/ung, cycloplegia, double pressure patch, bandange CL

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6
Q

When should you not pressure patch?

A

dirty wound: vegetative, fingernail, CL wearer

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7
Q

What pain meds can be given for corneal abrasion?

A

topical NSAIDs, oral opioids, gabapentin, Lyrica (pregabalin)

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8
Q

How can you debride for a corneal abrasion?

A

alger brush or golf spud

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9
Q

What are symptoms of foreign body?

A

FB sensation, pain, history

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10
Q

What are signs of foreign body?

A

FB, staining

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11
Q

What should you check with high velocity FB?

A

intraocular FB, double lid eversion, (-) seidel sign

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12
Q

What is treatment for foreign body?

A

remove FB with sped, needle, magnet, forceps… remove rust ring with alger brush then treat as corneal abrasion

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13
Q

What are signs of conjunctival laceration?

A

redness, with NaFl pooling in lacerated area

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14
Q

What is the treatment for conjunctival laceration?

A

push edges together with applicator and patch, laceration 5-7 mm or large may need suture

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15
Q

What investigation is warranted with intraorbital FB?

A

history of trauma, pupils, VA, seidel, CT imaging, OR consultation

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16
Q

ICD-10 for trauma

A

injury, how it happened, where it happened

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17
Q

With the injury code which character specifies the course of the disease?

A

7th character

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18
Q

What are the codes for the course of the disease in trauma coding?

A

A=initial D=subsequent S=sequelae/later recurrence

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19
Q

What is a primary headache?

A

that which cannot be attributed to known structural, toxic, or metabolic abnormalities

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20
Q

What are examples of primary headaches?

A

migraine, tension, cluster/trigeminal

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21
Q

What are secondary HA?

A

definable structural, toxic or metabolic abnormality causes the HA

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22
Q

What s/s indicate a secondary HA?

A

onset after 55 years, jaw/scalp/chewing pain, ONH swelling, fever, altered mental state, stiff neck, decreased vision, neurologic signs, pre-retinal hemes

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23
Q

What percent of HA are migraines?

A

up to 54%

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24
Q

What percent of the US is affected by migraines?

A

13%, 50% not diagnosed by medical provider

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25
Q

What gender has more migraines?

A

women, especially close to menstrual cycle

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26
Q

What is spreading depression associated with?

A

cortical vascular changes

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27
Q

Aura and migraine

A

classic has aura ~20%, no aura is common migraine

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28
Q

What are symptoms of migraine?

A

headache commonly localized to peri-orbital or retro-orbital region, may also have nausea, photophobia, phonophobia, rapid onset to peak time 20-60 mins

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29
Q

What is spreading depression?

A

wave of cortical excitation followed by wave of inhibition, commonly starting in the visual cortex

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30
Q

What is the vascular theory of migraine?

A

rapid constriction of cerebral arteries, secondary inflammation around vessels, release of chemotactic factors and inflammation around the brain = pain

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31
Q

Three pathophysiologies of migraines

A

neuropeptide release, pain signaling pathway, vessel dilation/contraction

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32
Q

What is neuropeptide release?

A

calcitonin gene-related peptide, vasoactive intestinal peptide, tx: inhibit the neuropeptide release

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33
Q

What is pain signaling pathway?

A

trigeminocervical complex-nociceptor signals to the thalamus

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34
Q

What is vessel dilation/contraction

A

vascular activity occurs, but may not actually play a direct role in migraine, dilation induced in non-migraineurs does not result in headache but does cause headache in migraineurs through peptide activation

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35
Q

What is ocular/retinal migraine?

A

affects only anterior visual pathways yielding monocular visual changes, possible vasospasm in retinal or posterior ciliary circulation resulting in ischemia to retina, choroid, ONH

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36
Q

What may be noted during ocular migrain attack?

A

arterial attenuations and subsequent arterial occlusions

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37
Q

What are the most common causes of TIA that must be excluded to yield diagnosis of ocular migraine?

A

embolus, vascular disease

38
Q

What is the international headache society classification of ocular migraine?

A

at least 2 attacks, fully reversible monocular visual phenomena, HA begins during visual symptoms or within 60 mins, normal eye exam between attacks, no other disorder

39
Q

Aura in the absence of HA are called

A

acephalgic migraines or typical aura without headache

40
Q

Diseases that have been associated with misdiagnosis of retinal migraine

A

CRAO, CRVO, cilioretinal artery occlusion, focal retinal ischemia, ischemic optic neuropathy, optic atrophy

41
Q

What is aura

A

scintillation building in intensity across the visual field, flurry of symptoms common

42
Q

What is the most common HA?

A

tension 90%

43
Q

What gender has more tension HA?

A

women

44
Q

What are tension HAs?

A

unilateral or bilateral tightness or aching in frontal temporal and occipital regions, commonly features associated neck symptoms, abnormalities in sleep may result

45
Q

When do tension HAs usually start?

A

between 4-8 am or 4-8 pm

46
Q

What are cluster HA?

A

clusters of severe pain with remission periods, severe unilateral pain for 45-60 minutes, onset to peak is seconds, occur for 8-12 weeks with remission for 12-18 months

47
Q

When do cluster HAs occur?

A

often at onset of sleep, symptoms peak in spring and fall

48
Q

Who is affected by cluster HA?

A

men 20s-30s

49
Q

How is cluster HA pain described?

A

unilateral retro-orbital to temporal, deep burning or boring, trigeminal autonomic symptoms may occur

50
Q

What are trigeminal autonomic symptoms of cluster HA?

A

lacrimation, rhinorrhea ptosis, pupil constriction, facial flushing, conjunctival injection

51
Q

What is WWOP?

A

gray/white appearance of peripheral retina, sharp demarcation from adjacent normal retinal, possible vitreoretinal interface

52
Q

What is happening at a abnormal vitreoretinal interface?

A

hyper-reflectance of ellipsoid portion of photoreceptor inner segments

53
Q

What is lattice degeneration?

A

8% of population, found midway between ora serrata and equator, thinning of inner retinal layers

54
Q

What retinal layers are affected with lattice?

A

abnormal pigmentation/RPE hyperplasia with yellow/white surface flecks, associated vessels become attenuated and sheathed, loss of inner retinal layers down to outer nuclear layer with associated vitreous liquefaction

55
Q

Where is a strong vitreal adhesion?

A

at the edge of lattice

56
Q

What percent of lattice is associated with atrophic retinal holes?

A

25-35%

57
Q

What percent of lattice is related to tractional retinal tears?

A

1%

58
Q

What is snailtrack degeration?

A

degeneration of the neural elements of retina leading to an atrophy of the tissues with lipid deposits in the internal retinal layers, sharply demarcated, at or near equator

59
Q

What is snailtracking made of?

A

microglial cells containing lipoproteins on the surface

60
Q

Does snail tracking have a stronger or weaker vitreous traction than lattice?

A

weaker, less risk of retinal trauma

61
Q

What are atrophic retinal holes?

A

a break in the retina not associated with traction forces, rather progressive retinal thinning, creases potetntial for liquified vitreous to invade and yield RD

62
Q

What percent of the population has atrophic retinal holes

A

2-3% … 20% likelihood of presence in fellow eye

63
Q

What is the red base in an atrophic retinal hole?

A

RPE-choroid showing

64
Q

What surrounds an atrophic retinal hole?

A

often surrounded by cuff of intra-retinal edema or sub-clinical RD, pigment surrounding hole indicates it has been present 3+ months, this is reactive RPE hyperplasia

65
Q

What possible causes atrophic holes?

A

focal vascular compromise

66
Q

What are operculated holes?

A

vitreoretinal traction pulls a plug or operculum of retinal tissue away yielding a retinal hole, red area with overlying retinal floater that looks smaller than the hole

67
Q

What is intrabasal

A

within vitreous bases, may be due to traction from lens zonules and are lower risk for RD because they are within strong adhesions of vitreous base

68
Q

What is juxtabasal?

A

next to vitreous base and higher risk of RD when there’s a PVD because the cause is the VR traction

69
Q

What amount of fluid with a hole should be referred?

A

> 2DD, symptomatic, aphakic or past Hx of hole consider phtocoagulation

70
Q

What is retinoschisis?

A

splitting of internal layers of sensory retina, commonly bilateral and inferotemporal, usually asymptomatic

71
Q

What is flat vs bullous retinoschisis?

A

flat: split occurs at outer plexiform layer, bullos: split occurs anterior to OPL leaving a very thin inner wall

72
Q

How to distinguish retinoschisis from retinal detachment

A

schisis will not move with eye movement and when illuminated, schisis has honeycomb appearance

73
Q

What is rhegmatogenous retinal detachment?

A

included retinal break, commonly starts as PVD yielding traction from vitrous at peripheral retina causing tear… leads to separation between photoreceptors and sensory retina

74
Q

What is non-rhegmatogenous (traction/serous) detachment?

A

disease yielding tractional entities such as PDR allowing tension on retina giving away to RD, disease where fluid/hemorrhage develops between sensory retina and RPE

75
Q

What are s/s of retinal detachment?

A

flashes and floaters, APD, reduced IOP, iritis, opaque or corrugated retina

76
Q

Why do flashes occur?

A

retina moving resulting in stimulation of photoreceptors, phosphene effect

77
Q

What is a greater emergency, macular on or off?

A

ON

78
Q

What are signs an RD has been there for awhile?

A

pigmented demarcation line, taut surface of RD thinned retina, intraretinal exudates, intraretinal cysts and fixed retinal folds

79
Q

What are preventative medications for migraine?

A

NSAIDs, TCAs, beta blockers, anti-depressants, botox

80
Q

What medication are abortive for HA?

A

pain relievers, ergotamine and triptans

81
Q

Retinotomy

A

incision to remove fluid from beneath the retinal detachment

82
Q

pneumatic retinopexy

A

gas bubble placed in eye to place pressure against detachment area

83
Q

cryo/photocoagulation

A

induce scars to seal edges of RD down

84
Q

vitrectomy

A

removal of vitrous to relieve traction

85
Q

fluid-gas exchange

A

outpatient fluid-gas exchange is a treatment option for patients suffering from post vitrectomy retinal detachment

86
Q

scleral buckle

A

band around peripheral retina to relieve tension w/ elongation of axial lengs

87
Q

Common adverse effect of RD surgery?

A

cataract

88
Q

Ophthalmia nodosa

A

name for the nodular granulomatous inflammation reaction of the palpebral or bulbar conjunctiva to hair

89
Q

What is management of ophthalmia nodosa?

A

ocular lubricants, topical steroids, removal of hairs if possible, surgical intervention if localized intense inflammation response

90
Q

Caring for the patient with autism

A

social stories, describe what you are goin to do, distractors

integrative analysis ii (5 decks)

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