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CMS- opts > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

sx for allergic conjunctivitis

A

seasonal allergies with clear to white stringy discharge*

  • itching
  • tearing
  • redness
  • FB sensation
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2
Q

treatment for allergic conjunctivitis

A

cromolyn sodium 4% sol.

1-2 drops in each eye 4-6 times daily till controlled, 1 bottle no refill

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3
Q

pt education of allergic conjuctivitis

A

Cool compress, wash hands face etc

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4
Q

where do you see cobblestone on upper tarsal conjuctiva

A

vernal keratoconjuctivitis

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5
Q

chronic seasonal allergies diagnosis

A

vernal keratoconjuctivits

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6
Q

treatment for vernal keratoconjuctivitis

A

cromolyn sod. 4% 1-2 drops in each eye 4-6 times daily for 2 weeks, 1 bottle no RF

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7
Q

s&s of vernal keratoconjuctivitis

A
  • watery to mucoid discharge
  • FB sensation
  • COBBLESTONE
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8
Q

epidemiology for bacterial conjunctivitis

A

Staph aureus, strep pneumonia, Hem. influenza, M. catarrhalis

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9
Q

a mucopurulent discharge with sudden onset is indicative of

A

bacterial conjunctivitis

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10
Q

treatment for bacterial conjunctivitis

A

erythromycin 0.5% ointment 1cm

-4xs a day, 5-7 days, 1 tube no RF

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11
Q

pt education for bacterial conjuctivitis

A

warm compress to infested eye,

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12
Q

referral for bacterial conjuctivitis

A

referral to opth if not improved in 4 days

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13
Q

difference between bacterial and bacterial gonorrhea conjuctiva

A

COPIOUS mucopurulent discharge, sudden onset

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14
Q

epidemiology: bacteria gonorrhoeae

A

Neisseria gonorrhoeae

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15
Q

diagnostic studies for bacterial gono

A

stat gram stain AND culture

-report to public health if pos

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16
Q

complications of bacterial gono conj.

A

vision loss; urgent refer to ophth

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17
Q

treatment for bacterial gono conj.

A
  • Ceftriaxone 1gm IM (pt wt >150 kg) or 500 mg (pt wt <150)
  • Azythromycin 1gm PO now,
  • bacitracin opth ointment every 3-4 hrs for 10 days, 1 tube no RF
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18
Q

pt education for bacterial gono conj.

A

discuss safe sex practices,

  • warm compress, wash face
  • offer STD workup
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19
Q

referral for bacterial gono con.

A

referral to opth urgent (1-2) days

-F/U after optho

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20
Q

epidemiology for chlamydia conjunctivitis

A

chlamydia trachomatis

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21
Q

difference in sx b/w between gono and chlamydia conjunctivitis

A

chlamydia: redness, light sensitivity, CLEAR to mucopurulent discharge and GRADUAL onset 1-4 weeks, no blurring vision
gono: sudden onset, and COPIOUS mucupurulent discharge

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22
Q

diagnostic studies for chlamydia

A

swab discharge - culture

  • report if pos
  • offer STI workup
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23
Q

complications of chlamydia conj.

A
  • corneal vascularization
  • epithelial keratitis
  • corneal scarring
  • inclusion conjuctivitis
  • blindness
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24
Q

treatment for chlamydia

A
  • Azythromycin 1 gm PO now

- Bacitracin ointment 3-4 hours for 10 days

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25
Q

referral for chlamydia

A 
optho urgent (1-2 days)
f/u after
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26
Q

pt fell asleep with contacts in… diagnosis?

A

contact lens conjuctivitis

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27
Q

epidemiology for contact lens

A

pseudomas aeruginosa

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28
Q

s&s for contact lens conj.

A

FB sensation

  • no blurry vision
  • mild discomfort
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29
Q

diagnostic studies for contact lens conj.

A

Fluorescein stain for corneal abrasion or corneal ulcer

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30
Q

complications of contact lens conj.

A

corneal abrasion or corneal ulcer

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31
Q

treatment for contact lens conj.

A 
ciprofloxacin HCL (Ciloxan) 0.3% opth sol, 1 drop (gtts) hourly during the day, and 1 drop every 2 hours at night for 2 days
then 1 drop every 4 hours for 5 days for contact conjunctivitis, 1 bottle no RF

-alternative : tobramycin 0.3% opth sol.

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32
Q

pt education for contact lens conj.

A

don’t sleep with contacts
give tetanus booster if abrasion,
wash hands

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33
Q

essential dx for fungal conj.

A

work in area with fungus and a piece got in eye or not cleaning contacts

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34
Q

s&s of fungal conj.

A

pain, redness, tearing, FB sensation

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35
Q

what should you do when pt comes in with FB sensation

A

evert eye

36
Q

diagnostic studies for fungal conj.

A
  • fluorescein stain

- fungal wet mount and culture**

37
Q

medication for fungal conj.

A

Natamycin 5% opth suspension:

-1 drop 4-6 times daily for 7 days, 1 bottle no RF

38
Q

non Pharma for fungal conj.

A

throw out contacts, clean regularly, wear eye protection

39
Q

follow up for fungal conj.

A

f/u in 2-3 days, ER if change in vision

40
Q

epidemiology with adenovirus is indicative of

A

Viral (non herpetic) conjunctivitis

41
Q

a FB sensation with COPIOUS clear watery discharge is indicative of

A

Viral (non herpetic) conjunctivitis

42
Q

risk factors of Viral (non herpetic) conjunctivitis

A

contacts schools,, swimming pool or public places

43
Q

complications ofViral (non herpetic) conjunctivitis

A

can get secondary bacterial conjunctivitis

44
Q

treatment for Viral (non herpetic) conjunctivitis

A

none- self limiting, don’t rub eyes, wash hands

contagious

45
Q

a pt with pain, blurry vision*, watery discharge and

an injection near the limbs and dendrites appear on fluorescein stain is indicative of

A

viral (HERPETIC) conjunctivitis

46
Q

epidemiology of viral (HERPETIC) conjunctivitis

A

herpes simplex 1

47
Q

diagnostic studies of viral (HERPETIC) conjunctivitis

A

fluorescein stain with dendrites

48
Q

complications of viral (HERPETIC) conjunctivitis

A

herpes zoster opthalmicus

49
Q

treatment for viral (HERPETIC) conjunctivitis

A

trifluridine 1% opth soln.
1 drop every 2 hours up to 9 drops for 2 days, then 1 drop every 4 hours for 5 days
STEROIDS ARE CONTRAINDICATED

50
Q

referral for viral (HERPETIC) conjunctivitis

A

EMERGENT referral to optho (today)

51
Q

diagnosis for pt with CNV1 extremely painful, unilateral

A

herpetic zoster opthalmicus

52
Q

epidemiology for herpetic zoster opthalmicus

A

Varicella- zoster virus (VZV)

contagious

53
Q

s&s for herpetic zoster opthalmicus

A

Hutchison sign-lesion***

  • CNV
  • pain
  • photophobia
  • tearing
  • ocular redness
  • blurred vision
54
Q

diagnostic studies for Herpetic Zoster

A

tzanck smear OR polymerase chain rxn (PCR) or direct fluorescent antibody (DFA) testing

55
Q

complications of Zoster

A

vision loss, herpes zoster postherpetic neuralgia

56
Q

treatment for Zoster

A

acyclovir 800 mg PO 5 times a day for 7 days,

or valacyclovir 1 g PO TID x 7 days or famciclovir 500 mg PO TID x 7 days (renal dosing adjustment*)

57
Q

non pharm for Zoster

A

keep eye covered in public, clean area with vesicles, don’t scratch, wash hands

58
Q

keratoconjuctivitis Sicca (KCS) s&s

A

chronic dryness bilateral and dry mouth

59
Q

risk factors of Keratoconjuctivitis Sicca (KCS)

A

hx of sjogren’s syndrome (can have dry mouth too)

60
Q

epidemiology of Keratoconjuctivitis Sicca (KCS)

A

autoimmune inflammatory disorder

61
Q

diagnostic studies of Keratoconjuctivitis Sicca (KCS)

A

schrimer test x 5 min

62
Q

referral for KCS

A

routine consult

  • possible punch plugs
  • rheumatologist routine
  • f/u after opth
63
Q

treatment for Keratoconjuctivitis Sicca (SCC)

A

OTC artificial tears

-dont wear contacts

64
Q

keratitis s&s

A

red eye, painful eye, CORNEAL OPACITY

65
Q

epidemiology of keratitis

A

viral, bacterial (s aureus, pseudomonas aerginosa, staph, strep pneumo), fungal, or parasites

66
Q

treatment for keratitis

A

emergent consult to opth

-can spread

67
Q

pinguecula s&s

A

yellow bump/growth on conjuctiva of eye, rarely grows

68
Q

epidemiology of Pinguecula

A

deposit of protein, FAT, or calcium caused by aging

69
Q

treatment for pinguecula

A

none: reassurance

70
Q

pterygium symptoms

A

triangular* wedge on conjuctiva that crosses cornea

71
Q

risk factors (might cause) of pterygium

A

surfers, farmers, lawn care workers, construction workers, increase sun, sand, or dust exposure

72
Q

treatment for pterygium

A

routine optho consult once it crosse VA

  • wear eye protection
  • no tx until cross VA*
73
Q

treatment for corneal abrasion

A

erythromycin opth 0.5% ointment
1 ribbon 4-6 times per day, continue for 48 hrs after healed
*tetanus booster
-f/u in 24 hrs

74
Q

epidemiology of corneal ulcer

A

pseudomonas aeruginosa, moraxella species and staphy

75
Q

pt came in with acute painful red eye and circum-corneal injection, excess tearing is indicative of

A

corneal ulcer

76
Q

treatment for corneal ulcer

A

-fluoroquinolones
-levofloxacin 0.5% opth sol. (Quixin) 2 drops every two hours while awake
-Ciprofloxacin 0.3% opth sol. (ciloxan) 2 drops every 15 min for 6 hours
-tetanus booster
——-
wear eye protection, no contacts

77
Q

UV keratitis epidemiology

A

burns into cornea

78
Q

UV keratitis s&s

A

not aware of UV exposure until 6-12 hrs later

79
Q

diagnostic studies of UV keratitis

A

fluorescein- punctate staining to both cornea

80
Q

treatment for UV keratitis

A

emergent consult optho- both eyes may need to be patched

81
Q

infection of the lacrimal sac can lead to

A

dacryocystitis

82
Q

epidemiology of dacryocystitis

A

staph aureus

83
Q

complications of dacryocystitis

A

orbital cellulitis

84
Q

treatment for dacryocystitis

A

emergent consult to optho for surgery

85
Q

a secondary to blunt or penetrating ocular trauma, with instant vision change on a younger pt indicated

A

cataract- traumatic

86
Q

diagnostic studies for traumatic cataract

A

dilated eye exam with slit lamp- glass blowers cataract

87
Q

a gradually progressive blurred vision with no pain or redness, lens opacities (no red reflex w white pupil) in a pt >60 yo with DM can be indicative of

A

cataracts (non traumatic)

CMS- opts (3 decks)

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