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USMLE Step 2 - Top 5% > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Mx of Stye (hordeolum)

A

Warm compress to speed up process of bursting. If non resolving, do curettage

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2
Q

Dendritic ulcers are seen in?

A

Viral keratitis

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3
Q

Treatment for acute closed angle glaucoma

A

Apraclonidine, timolol, pilocarpine, azetazolamide. Laser iridotomy is definitive.

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4
Q

Two ways to investigate closed angle glaucoma. Mention what they measure

A

Tonometry (pressure), gonioscopy (corneal angle)

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5
Q

Relief of Shoulder pain when place hand on head…. Diagnostic of what

A

Cervicle radiculopathy.

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6
Q

Tx of cervicle radiculopathy

A

Conservative

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7
Q

First Signs of macular degeneration, and contrast this for dry and wet

A

For dry, our central scotoma . For wet, it’s more straight line distortion

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8
Q

Halos at night, is a sign of what?

A

Cataracts

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9
Q

When to treat cataracts

A

When it affects life

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10
Q

In strabismus is it normal to have one eyes red reflex more intense

A

Yes

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11
Q

General Mx for open angle glaucoma

A

Topical latanoprost first. Then add topical timolol as a step up. If that doesn’t work consider laser therapy. (Tim and his Latino)

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12
Q

Patient has impact to eye/branch in eye etc…. What’s the best invx and why

A

Flouresin stain…. To Dx abrasion, but also to rule out open globe laceration!!

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13
Q

What are boxcar retinal vessels, where do we see them

A

In central retinal artery occlusion. Essentially segmentation of the vessels

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14
Q

Tx for retinal detachment

A

Laser Tx and cryo Tx. To adhere the neursensory retina and RPE

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15
Q

Tremorlous iris with movement of eye left and right, is a sign of?

A

Lens dislocation

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16
Q

Intial Mx of corneal pH burn. (Bleach for eg.)

A

Irrigate with normal saline… use litmus to ensure pH normal

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17
Q

What is blepharitis . Some of the causes

A

Inflam of the eye lid margin. Due to seb derm, HSV, staph, rocasea, allergy, dermodex

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18
Q

What is dacryostenosis. Mx?

A

Stenosis of the nasolacrimal duct in infants. Massage the duct

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19
Q

Differences in presentation between viral conj and allergic conj

A

Viral conj : bilateral or unilateral, usually prodrome before, and has 5 days of continuous symptoms

Allergic conj : always bilateral, often atopic and has exposure, intermittent for longer

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20
Q

Strabismus, cover test? And Tx. Significance of 4 month old mark. Red reflex sign.

A

Where you cover normal eye and see the bad eye move medially . Tx with corrective lenses if bad eye has low visual acuity, and patch cover the good eye to strengthen the bad eye to prevent ambylopia. Only Dx at >4 mo old. Red reflex will be present but greater in the bad eye

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21
Q

How to distinguish between vitreous hemorrhage and optic nerve injury after head injury

A

Red reflex remains in optic nerve injury, whereas it’s gone in vitreous hem

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22
Q

Invx and Tx for optic nerve injury scodanry to head injury

A

Ct orbit. Then do conservative therapy, and some may need surgical decompression

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23
Q

Two ways a patient can get traumatic optic nerve damage

A

Penetrative (usually surgery) or in head injury where the shearing forces transmit to optic canal

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24
Q

What is neonatal chemical conjunctivitis and what causes it? Mx?

A

Often from silver nitrate being given for gonorrhoea prophylaxis. This is banned in the US though. Presents in first 24 hours, Tx with eye lubrication

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25
Q

Periorbital echymosis (raccoon eyes) suggests?

A

Orbital fracture

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26
Q

Acute corneal opacification is a sign of what

A

Acute closed angle glaucoma

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27
Q

Signs of acute global perforation

A

Fixed teardrop pupil, low acuity, low IOP, extrusion of AH (seen on floruensin), RAPD,

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28
Q

Causes of subconj hem and Tx

A

Sneeze, cough, HTN, rubbing eye, coagulopathy. Just observe (very benign)

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29
Q

Young patient has strabismus… what needs to be ruled out

A

Rb…. Do a dilated fundo exam

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30
Q

Hordeolum vs charlazion

A

H - granulomatous inflam on eye lid. Painless but uncomfortable nodule

C - abscess on eye, localised

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31
Q

How does dacryostenosis present, and how is it managed

A

Presents with excess Eye tearing and discharge. May even cause eyelash/eyelid crusty. You can do a fluorescent dye, which will show the fluorescent dripping down the cheek and not draining. Management is to massage daily, and if unresolved in six months surgery

32
Q

What is ambylopia And what are its causes

A

Essentially a reduced vision due to a vision issue in that eye. So either cataracts, strabismus, refractive error will cause cortical changing to enhance the other eyes vision., but will then neglect the bad eye.

33
Q

Quick recap on some of the ophthalmological Checks we do in infants and children

A

Shortly after birth the eyes fixate on stuff. Around three months eyes should be tracking. We should also be doing red reflex testing and strabismus checking. At around 3 to 4 years old we can do visual acuity testing with Snellen chart. 20 out of 40 is concerning for refractive error. Up at five years old 30/40 as concerning

34
Q

If a patient who had cataract surgery starts to get blood vision, what is this most likely

A

Posterior capsule opacification. To get cataracts again after surgery is highly unlikely

35
Q

What is a traumatic hyphema, and what’s the treatment

A

Blood collection between the cornea and the lens. Usually from blunt trauma, rarely penetrative. Use an eye shield, bed rest, elevate head, glucocorticoid eyedrop. And monitor pressure since glaucoma is a complication

36
Q

What is the treatment for a trachoma

A

Azithromycin orally conclude the chlamydial infection. The whole village should be treated in theory. If the patient has trichiasis, then surgery is required of course

37
Q

 Most common cause of vitreous haemorrhage and how does it present

A

Most common course is a diabetic retinopathy. Present with loss of vision in one eye, a decrease perception to light, decrease fundal details (SOS), floaters, and a red glow on fundoscopy

38
Q

How to manage CMV retinitis

A

Must start ganciclovir. Lesions near the surveyor or optic nerve require direct injection. A couple of weeks after this treatment we can start antiretroviral therapy if AIDS patient

39
Q

Mention the three main causes of keratitis (infectious), and a sentence on how to distinguish them

A

HSV – Immuno compromised, watery discharge, dendritic alteration on fluorescent

Staph/pseudomonas – In foreign body or contact lens wearers, will be purulent

Candida – in amino compromised, with soil exposure. Feathery margins and satellite lesions

40
Q

Hutchinson’s sign for Hsv opthalmicus

A

If the vesicles of shingles involve the nose tip, it will likely involve the eye

41
Q

Name three different techniques to treat central retinal artery occlusion

A

Anterior chamber paracentesis, ocular massage, revascularisation. Remember to do ultrasound of the carotid valuate for stenosis

42
Q

Contrast the appearance of vision loss in a central retinal artery occlusion and retinal detachment

A

In retinal artery occlusion we tend to get vertical dropping of the visual field. In retinal detachment we have curtains across (both sides peripherally to central)

43
Q

Anterior vs posterior uveitis symptoms

A

Anterior causes eye redness and pain

Posterior is painless and causes floaters

44
Q

Other than CVT, what are other causes of cavernous sinus syndrome

A

Pituitary mass, fistula

45
Q

Orbital blowout fracture. Risk of what

A

Inferior rectus and orbital fat entrapment. Infraorbital nerve can be caught too

46
Q

First order horners syndrome causes

A

Pontine hemorrhage. Lateral medullary syndrome. Spinal cord lesion above T1. Late syringomuelia

47
Q

What else can cause Marcus Gunn apart from MS

A

GCA

48
Q

In Papilledema. What else can be seen on Fundoscopy

A

Dilated tortuous veins

49
Q

Retinitis pigmentosa is associated with what genetic disease

A

Abetaliproteinemia

50
Q

Papilledema in a HTN patient? Do what

A

This is malignant HTN. So must immediately lower BP

51
Q

Black spots and cobweb shapes in visual field

A

Vitreous haemorrhage

52
Q

Curtain down over eye vision. Sudden, and flashing lights. Had preceding floaters

A

Retinal haemorrhage

53
Q

Causes of central retinal artery occlusion

A

AF, Behcets, GCA, SCD,

54
Q

Biggest risk factor for central vein occlusion in retina

A

HTN

55
Q

Drugs causing optics neuritis

A

Methanol, ethambutol, linezolid, infliximab

56
Q

Fundoscopy finding in optic neuritis

A

Usually normal, but can have Disc swelling similar to papilledema

57
Q

Metamorphopsia

A

Straight lines appear wavy. Seen early on in age related macular degen

58
Q

Headache worsened by darkness vs brightness

A

Brightness is obviously migraine. But darkness could be closed angle glaucoma

59
Q

Myopia needs what lens?

A

Concave

60
Q

Hyperopia needs which lens

A

Convex

61
Q

Keratitis Dx test and what we see

A

Slitlamp. And will see white clumps (WBCs in the anterior chamber or vitreous chamber)

62
Q

Redness and pain of eye. Especially seen at limbus .

A

Anterior uveitis

63
Q

Main complication of acute dacrocysttitis

A

Orbital cellulitis

64
Q

Bac causing acute dacryocystitis

A

Strep and staph

65
Q

Bac causing contact lens keraitis

A

Pseudomonas

66
Q

Orbital cellulitis vs periorbital cellulitis

A

Orbital has: painful eye movement, lower acuity, Diplopia, proptosis, RAPD

67
Q

Patient with orbital cellulitis and signs of nasal or mucosal ulceration or ethmoidao/maxillary sinusitis….

A

Mucormycosis or Rhizopus

68
Q

Dacro cystitis, Maine bacterial cause

A

Strep and staff

69
Q

First line for open-angle glaucoma

A

Latanoprost. Timolol also ok

70
Q

What is blepharitis.

A

Inflammation of the eyelid Marjan. Just to warm compress and lid massage

71
Q

Treatment for neo Nate chlamydial conjunctivitis

A

Oral erythromycins.

72
Q

Overview of symptoms for acute globe perforation

A

Decrease security, teardrop pupil, fluid moving out from the eye. RAPD. Drop in intraocular pressure.

73
Q

If a patient has strabismus, what sort of investigation should I do

A

Should do a funduscopic exam, to rule out things like retinoblastoma

74
Q

Name some infectious causes of keratitis

A

Pseudomonas, staphylococcus, Canada, HSV

75
Q

Keratitis with linear Dritic alteration

A

Dendritic alteration. HSV

76
Q

Somebody with keratitis with soil exposure, feathery margins and satellite lesions

A

Candida

77
Q

Someone has bleeding in the joint, but the coagulation studies and LFTs a normal. They also had a gastric bypass surgery six months ago

A

Could be scurvy.

USMLE Step 2 - Top 5% (34 decks)

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