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Clerkship (CC3) > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

What is the diagnosis?

A

Blepharitis

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2
Q

What is the management of blepharitis?

A

1 Lid hygiene with baby shampoo on QTip

Hot compress nightly

Artificial tears

(Erythromicin BID x 1 week, then nightly for one tube)

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3
Q

What is the diagnosis?

A

Corneal ulcer

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4
Q

How do you manage a corneal ulcer?

A

Topical antiboitics, high strength

Culture gram stain + sensitivity

Refer

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5
Q

What is the difference between a hordeolum and a chalazion?

A

Hordeolum = bacterial infection of meibomian gland

Chalazion = chronic inflammation

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6
Q

What is the diagnosis

A

Hordeolum / chalazion

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7
Q

How is a chalazion / hordeolum managed?

A

Hot compress

+/- topical antibiotics (if hordeolum)

I/D if > 6wks

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8
Q

What examinations would be appropriate to conduct in this case (10yo, unwell, 1 day hx of pain with eye movement)

A

Test vision, pupils, extraocular movements, examine conjuctiva

Vitals, CBC & blood culture, CT head

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9
Q

What is the Ddx for this systemically unwell 10yo who presents with a 1-day hx of pain with eye movement? (4 things)

A
  1. Preseptal cellulitis
  2. Orbital cellulitis
  3. Malignancy
  4. Dysthyroid opthalmopathy (Graves)
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10
Q

How do you differentiate preseptal cellulitis from orbital cellulitis?

A

Orbital cellulitis = decreased vision, extraocular muscle movement & pupil abnormalities. If in doubt, refer urgently!

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11
Q

This 80yo presents with glaucoma presents with increasing irritation and discharge OD, with decreased vision. Currently on cosopt, alphagan, xalatan. What is the diagnosis?

A

Allergic blepharoconjunctivitis

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12
Q

What should you do to manage this glaucoma patient?

A

Identify the cause of the allergic reaction & consult ophtho to change drop regime.

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13
Q

30yo with 4 day hx of red itchy eye originally OD but now OS also. Notes dischrage, decreasing vision, photophobia. What is the diagnosis? What are the 3 possible causes?y

A

Papillary conjunctivitis

  1. Viral
  2. Bacterial
  3. Allergic
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14
Q

What is the diagnosis (40yo, contact lens wearer, severe pain OD, photophobia)

A

Corneal abrasion

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15
Q

What is the management of corneal abrasion? What can you do if you have an abrasion in a contact lens wearer?

A

Debride loose epithelium, lubricate, polysporin + patch

Do NOT patch a contact lens wearer -> can lead to corneal ulcer + topical ocuflox to prevent.

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16
Q

What do you do to manage a corneal foreign body? When is imaging indicated?

A

Removal, polysporin QID, F/U daily until abrasion heals

If any metal-on-metal contact, CT/X-ray to r/o retained intraocular foreign body (do NOT MRI)

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17
Q

Why are topical anaethsetics not recommended for home use?

A

They can lead to breakdown of epithelium and secondary infection; only use in office for diagnosis/treatment

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18
Q

What is the diagnosis in this 35yo with 2day hx of red, painful photophobic OD?

A

Herpes simplex keratitis

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19
Q

How do you manage this patient? What medications should you avoid?

A

Viroptic Q2H up to 9x daily x 1 week

Taper next week.

NO steroids

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20
Q

What is the diagnosis (80yo otherwise healthy)? What is the management?

A

Herpes Zoster Opthalmicus

Acyclovir if <72hrs since onset

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21
Q

How do you record visual acuity from the snellen chart?

A

Record fraction of line when they get at least1 letter.

If they get extra letters (from line above, +, which letters)

If they miss letters, record - which letters

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22
Q

What are the 8 findings that you are looking for on a slit lamp exam

A

External (cheek/eyebrow, orbit)

Lids/Lashes (lid margin, lash line

Conjuctiva, sclera

Cornea (K)

Anterior chamber

Iris

Lens

Vitreous

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23
Q

What is the difference between a hypopyon and a hyphema?

A

Hypropion = pus floating in the bottom of the eye

Hyphema = blood in the bottom of the eyeball

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24
Q

What is the most likely diagnosis? What are the key features?

A

Iritis; limbal flush (dilated conjunctival vessels), anterior chamber flare

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25
What must you rule out if you see iritis?
Systemic inflammation (more likely if recurrent attacks or bilateral ons first presentation)
26
This patient presents with RAPD OD and hx of vision loss asymptomatic to patient.What is the most likely diagnosis?
Advanced atrophy, likely late-stage glaucoma
27
What is the most likely diagnosis in this person with a 4-hour hx of N/V & severe pain OD w decreased vision? What are the key findings?
Acute angle-closure glaucoma Note fixed, mid-dilated pupil, hazy cornea
28
How do you manage acute angle closure glaucoma?
Urgent ophtho referral Diamox, glycerin PO (1mg/kg), mannitol IV (1mg/kg) Mannitol
29
What is this sign? What is the fluid leaking out?
Seidel sign,(fluid wave) penetrating eye injury, dark liquid is aqueous humor
30
What is the concern in this patient who is 5 days post-op from cataract extraction?
Endophthalmitis
31
How do you treat this eye? What is the likely etiology
Irrigate until pH normal Streroid + antibiotics “egg white” eye appearance suggests alkali burn
32
What do you look for in a fundoscopy
Start with the nerve, then the vessels, then the macula, then the rest of the retina
33
What is the typical progression of symptoms in a retinal detachment?
Flashing lights, floaties, then "curtain" of vision loss progressing
34
What is this spot? What is the cause? What do you worry about in an older patient?
Cherry red spot. Central retinal artery occlusion (CRAO) Giant cell arteritis
35
What is the diagnosis?
Central retinal vein occlusion
36
What is the differential for this?
Papilledema Non eye related: hydrocephalus, intracranial mass, cerebral sinus thrombosis, meningitis, SDH or SAH, malignant hypertension Eye related: drusen, optic neuritis / optic nerve tumor.
37
What is the diagnosis?
Diabetic retinopathy Hard/soft exudates, pre, intra and postretinal hemorrhage, neovascularization (if proliferative)
38
Trauma hx. What is the diagnosis?
Hyphema & subconjunctival hemorrhage, conservative management NO ASA, no strenouous activity, atropine/steroids
39
What is this? What is the diagnosis?
Drusen, age-related macular degeneration
40
What are the risk factors for AMD?
Age, FH, caucasian, smoking, UV light exposure
41
Describe the nerve
Glaucoma: disc to cup ratio
42
What supplements do you encourage for patients with dry macular degeneration?
A, E, zinc
43
What is the diagnosis? What is the progression of symptoms?
Dysthyroid opthalmology NOSPECS No signs only lid retraction, lag, edema Soft tissue swelling Proptosis Extraoccular involvement Corneal exposure Sight loss
44
What is the diagnosis? Do you image this patient?
CN III palsy Image them.
45
What is the sign. What is DDx for this?
Leukocoria Retinoblastoma until proven otherwise--could be a cataract
46
Does dysthyroid ophthalmopathy always correlate to systemic condition? What do you need to counsel patients about?
No. Stop smoking!
47
What is a normal intraocular pressure?
12-22 mmHg
48
What is the differential for leukocoria
Retinoblastoma Congenital cataract, coloboma, coat's Intraocular infections
49
Why do pediatric cataracts need to be assessed by paeds ophtho?
Can result in amblyopia if not treated.
50
What is the most common cause of tearing in infants?
Nasolacrimal duct obstruction
51
When should you suspect congenital glaucoma?
Tearing, photophobia, blepharospasm with a big eye or cloudy cornea.
52
What is the normal cup-to-disc ratio?
\<0.5 0.3 in children
53
Where does pre-septal cellulitis originate from?
Usually lids or periorbital skin
54
Where does orbital cellulitis usually come from?
Spread from paranasal sinuses.
55
What must you rule out in the child with proptosis or orbital signs without inflammatory involvement?
Rhabdomyosarcoma
56
How can you screen for strabismus?
Hirschberg test (light reflexes of corneas should be centered on the pupil of each eye)
57
What are the most common types of esotropia
Infantile esotropia (\<6mos, req surgery) Accomodative esotropia (starts in infancy, but usually later in childhood). Correctable with glasses. Can also be CNVI palsy
58
Is intermittent exotropia a reason for urgent referral?
Not necessary; very common esp if tired or distracted or looking far. Just follow.
59
What is amblyopia?
Vision loss due to an abnormal visual experience in early life.
60
What causes amblyopia?
Stimulus deprivation Strabismus Anisometropia (asymmetric or high refractive error)
61
How do you manage amblyopia?
Fix underlying cause Penalize good eye (patch or use atropine)
62
What do you suspect in this child?
CN III palsy
63
What are common causes of head tilt?
MSK CN IV palsy
64
What is the diagnosis? Management?
Dacryocystitis (often due to NLD obstruction) Cephalexin 250 mg QID x7days
65
What is the diagnosis?
Dacryoadenitis
66
What is the diagnosis? What management is indicated?
Pinguecula Suggest lubricants or vasoconstrictors if inflamed, but often no treatment req'd
67
How do you distinguish between episcleritis and scleritis?
Episcleritis often presents in the younger patient with mild pain, no vision changes, and a sectorial redness. Scleritis is associated with older patients and systemic diseases and can present with vision loss, marked pain, and diffuse redness.
68
What diseases are associated with scleritis?
Rheumatoid arthritis, lupus, granulomatosis with polyangiitis, polyarteritis nodosa, gout, syphilis, zoster
69
Steroids are the first line management for both episcleritis and scleritis. What are the differences in their management?
Episcleritis can use topical steroids, scleritis should be treated with NSAIDs and requires referral to ophthalmology.
70
What is the diagnosis? What visual symptoms might the patient complain of?
Angle closure glaucoma. Symptoms include eye pain, blurred vision, rainbow coloured halos around light, headache, nausea, vomiting.
71
What are the major risk factors for primary open angle glaucoma?
Elevated intraocular pressure, African descent, family history, age, myopia and diabetes
72
What are the four classes of medications used in treating glaucoma?
Prostaglandin analogues (latanoprost - first line) beta-blockers (timolol) and also alpha-2 adrenergic agonists (brimonidine) carbonic anhydrase inhibitors (acetazolamide, dorzolamide)
73
What are the secondary causes of open angle glaucoma?
Ocular causes: uveitis, neovascularization non-ocular: Steroids, trauma, pseudo-exfoliation syndrome, and pigment dispersion syndrome.
74
What is the difference between dry AMD and wet AMD?
What AMD occurs due to neovascularization under the retina (in the choroid)
75
How is AMD managed?
Intraocular injections of anti-VEGF medications
76
How is diabetic retinopathy classified?
Non-proliferative versus proliferative. Proliferative is more advanced DR with abnormal growth of extra retinal fibro vascular tissue.
77
Use of what drugs long-term requires regular ophthalmology f/u?
Hydroxychloroquine and chloroquine (after 5 yrs of therapy, annually thereafter)
78
What do you need to do in the older patient that presents with new onset temporal headaches and vision loss?
ESR and CRP with a CBC to rule out temporal arteritis
79
In a patient with CN3 palsy, pupil involvement indicates what cause?
Posterior communicating artery aneurysm or another compressive lesion.

Clerkship (CC3) (12 decks)

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