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Lecture 4 Flashcards

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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
tx and management for Retinopathy - HIV
Urgent consult to optho and infection control MD
26
a pt had AV nicking, flame hemorrhage, copper wire**, silver wire**, papilledema, cotton wool spots and hard exudates after a fundoscopic exam dx?
Retinopathy - Hypertension
27
risk factors for Retinopathy - Hypertension
HTN, pheochromocytoma, preeclampsia-eclampsia, severe HTN
28
complications for Retinopathy - Hypertension
blindness
29
referral for Retinopathy - Hypertension
severe HTN - admit, emergent cardiology and optho consults --- chronic HTN - routine consult to optho and IM
30
treatment for Retinopathy - Hypertension
control HTN; annual exams
31
after a fundoscopic exam, pt had sea fan, salmon patches or black sunburst. How would you dx this pt?
Retinopathy - Sickle cell
32
treatment for Retinopathy - Sickle cell
prevent sickle cell crisis | - if pt has crisis - look in eye and emergent consult to ophto
33
pt comes in with a unilateral leukocoria
Tumor - Retinoblastoma
34
Tumor - Retinoblastoma risk factors
genetics
35
epidemiology of Tumor - Retinoblastoma
most commonly intraocular malignancy, +/- genetics
36
treatment and management for Tumor - Retinoblastoma
urgent consult pediatric ophtho and oncologist
37
diagnostic studies for Tumor - Retinoblastoma
CT showing tumor intraocular
38
pt has unilateral proptosis, lid edema, vision loss, non tender mass what would the diagnosis be?
Tumor - Rhabdomyosarcoma
39
the epidemiology of Tumor - Rhabdomyosarcoma
rare
40
treatment and management for Tumor - Rhabdomyosarcoma
urgent consult pediatric optho and oncologist
41
diagnostic studies for Tumor - Rhabdomyosarcoma
CT scan usually shows boney involvement, complete work up for metastases
42
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
Blowout Fracture, Orbital
43
diagnostic studies for Blowout Fracture, Orbital
immediate CT scan
44
complications for Blowout Fracture, Orbital
eye muscle/nerve entrapment
45
treatment for Blowout Fracture, Orbital
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
work up for Blowout Fracture, Orbital
- 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
s&s for Blowout Fracture, Orbital
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
f/u and Rx discussion for Blowout Fracture, Orbital
admitted, optho emergent consults; f/u PCP | rx may cause nausea and diarrhea
49
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?
chemical injury
50
complications for chemical injury
dependent of the irritant chemical - blindness
51
treatment for chemical injury to the eye?
copious irrigation with sterile NS | -no contacts until cleared by optho
52
pt has a FB sensation, pain, redness after working in construction. You everted the eye and found a fb. How will you treat this?
-emergent consult to optho to remove and prevent rust ring ------ 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
complications for FB?
corneal abrasion/ulcer, if object embedded - possible globe rupture
54
prognosis for FB?
non embedded- good recovery | embedded- varies
55
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 globe rupture; -AVOID putting drops into eye or removing any objects -refer to optho emergent --- give morphine for pain no NSAIDS** -tetanus ```
56
why would you not give NSAIDS to globe rupture
it inhibits platelets
57
what is the sedation medication
lorazepam 0.05 mg/kg (max 2mg)
58
a pt had trauma to the eye and has blood in the anterior chamber, most likely diagnosis?
hyphema
59
how would you treat hyphema?
``` INPatient* emergent consult to optho -eye shield, bed rest w bathroom privileges, -dim light, -elevate head of bead* ```
60
can NSAIDS be given to a pt with Hyphema, what would you give?
NO | give cycloplegic drops x3/days
61
complications for hyphema?
immediate threat to vision, pt with sickle cell have increased risk, glaucoma
62
a pt comes in with blood between sclera and conjuctiva, what is diagnosis?
Subconjuctival Hemorrhage
63
what are risk factors to Subconjuctival Hemorrhage
* anything w increased pressure* - childbirth - coughing - vomiting - HTN (uncontrolled) - DM (uncontrolled) - blunt trauma - anticoag therapy (uncontrolled)
64
treatment for subconjuctival hemorrhage for childbirth, coughing, and vomiting
resolves by self in 2-4 weeks; PCP tx for cough/vomit
65
treatment for Subconjuctival Hemorrhage for HTN/DM
control disease
66
treatment for Subconjuctival Hemorrhage with blunt trauma
urgent optho consult
67
treatment for Subconjuctival Hemorrhage for anticoagulation therapy
f/u for evaluation of therapy PCP
68
difference between hyphema and Subconjuctival Hemorrhage
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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