Ophthalmology

Question 1

the big three

Answer 1

cataracts, macular degeneration, glaucoma

Question 2

indications for cataract surgery

Answer 2

severity of visual loss, functional needs of patient, need to improve view of posterior segment of eye to care for ocular pathology

Question 3

macular degeneration causes ______

Answer 3

decreased central vision (affects macula)

Question 4

dry vs wet ARMD

Answer 4

dry - not as bad

wet - worse, includes hemorrhage or fluid (serum, or blood)

Question 5

age range armd

Answer 5

50, usually >70 (75-85)

Question 6

tx dry MD

Answer 6

quit smoking, nutritional recom., AREDS 2 supplementation, manage systemic disease

Question 7

tx wet MD

Answer 7

quit smoking, nutritional recom., AREDS 2 supplementation, manage systemic disease
++++ anti-vegf drugs or
rarely conventional laster, photodynamic tx

Question 8

vitamins in macular degeneration

Answer 8

high dose antioxidant vitamins (C, E) and minerals (Zinc, copper)

beta carotene –> lung cancer
use lutein/xeaxanthin now (carotenoids)

Question 9

glaucoma

Answer 9

increased ocular pressure causes optic nerve loss

Question 10

2 types of glaucoma

Answer 10

open angle - slow d/t trabecular meshwork

narrow angle - emergency (closure of narrow angle)

Question 11

tx for acute glaucoma

Answer 11

pilocarpine (constrict pupil)
acetazolamide (diuretics)
oral glycerine or isosorbide (osmotic)
refer to ophthamology - laser peripheral iridotomy

Question 12

sudden loss of vision in one eye for only minutes

Answer 12

amaurosis fugax

Question 13

work up amaurosis fugax

Answer 13

first - see CV workup (usually temporary vascular insufficiency) - worry about stroke, etc.
then opth

Question 14

duration ophthalmic migraine

Answer 14

20-30 minutes (HALLMARK)

Question 15

etiology ophth migraine

Answer 15

spasm of arterioles in occipital cortex

Question 16

____ are worse that _____ (bases acids)

Answer 16

bases worse than acids

Question 17

test to look at nerve fiber defects before visual field loss

Answer 17

optical coherence tomorgraphy

Question 18

_______ sighted people get angle closure more

Answer 18

far sighted (hyperopia)

Question 19

tx diabetic retinopathy

Answer 19

prevention (manage BSL)
laser therapy
surgical - vitrectomy
anti-vegf drugs

Question 20

diabetic retinopathy

Answer 20

increased glucose –> vegf –> increased capillary permeability/abnormal vasoproliferation

Question 21

clinical stages diabetic retinopathy

Answer 21

nonproliferative diabetic retinopathy
preproliferative diabetic retinopathy
proliferative DR

Question 22

NPDR

Answer 22

microaneurysms, blot hemorrhages, hard exudates, macular edema (vision), lipid deposits
eye may see fine if macula spared

Question 23

test to see vessels in eye (DR)

Answer 23

fluorescein angiogram

Question 24

tx NPDR

Answer 24

intravitreal steroids, antivegf

Question 25

preproliferative DR

Answer 25

venous bleeding, intraretinal microvascular changes, ischemic areas with cws

Question 26

proliferative DR

Answer 26

boat hemorrhage large retinal hemorrhages neovascularization fibrosis, retinal traction and wrinkling

Question 27

tx PDR

Answer 27

laser pan-retinal photocoagulation to stop release of vegf

Question 28

eye exams for diabetics

Answer 28

type 1 - annually after 5 years of disease | type 2 - at diagnosis and annually

Question 29

hypertensive retinopathy signs

Answer 29

narrowing and sclerosis of arterioles --> flame hemorrhages, cotton wool spots, papilledema in severe cases hard exudates, silver wired arterioles, disc edema in advanced

Question 30

tx hypertensive retinopathy

Answer 30

control blood pressure!

Question 31

causes of sudden visual loss

Answer 31

migraine scotoma, retinal detachment, retinal artery occlusion, retinal vein occlusion, temporal arteritis, stroke

Question 32

retinal cholesterol emboli

Answer 32

non-occlusive warning sign for vascular disaster w/u: carotid doppler, ECG, serum cholesterol, triglyceride levels, angiography

Question 33

sudden partial vision loss in one eye, painless, always sustained, floaters and photopsias, myopia...

Answer 33

retinal detachment

Question 34

tx retinal detachment

Answer 34

refer immediately to ophth for surgery

Question 35

sudden severe loss of vision in one eye, painless, permanent but may recover if treated quickly, cherry red spot

Answer 35

acute central retinal artery occlusion

Question 36

cherry red spot happens why

Answer 36

rest of retina is pale/swollen/opacified and fovea is not as thick so you can see intact choroidal circulation beneath retina

Question 37

tx acute arterial occlusion

Answer 37

rebreathing CO2 - arterial dilation --> go further out timolol to lower occular pressure IV acetazolamide massaging of globe with lids closed

Question 38

retinal vein occlusion

Answer 38

``` central or branch more common w/ htx or dm tx underlying diseases refer squashed tomatos ```

Question 39

temporal arteritis

Answer 39

ha and scalp tenderness fever, weight loss jaw claudication vision loss d/t retinal arteriolar occlusion or optic nerve infarct giant cell arteritis

Question 40

dx temporal arteritis

Answer 40

STAT ESR and CRP | temporal artery biopsy to look for PMNs in arterial wall

Question 41

tx temporal arteritis

Answer 41

HIGH DOSE SYSTEMIC STEROIDS ASAP (before biopsy)

Question 42

biopsy results temporal arteritis

Answer 42

inflammation of arterial wall fragmentation/disruption of internal elastic lamina +/- multinucleated giant cells

Question 43

visual stroke

Answer 43

sudden painless loss of vision causing hemianopsia usually involves occipital cortex visual field loss occurs bilaterally on contralateral side of cortical lesion

Question 44

thyroid ophthalmopathy

Answer 44

``` dry eyes proptosis ocular injection chemosis lid retraction ocular muscle restriction --> diplopia ```

Question 45

tx thyroid ophthalmopathy

Answer 45

tears, monitor TH, monitor ophth, corticosteroids, orbital irradiation or surgical decompression, surgery

Question 46

tx chemical injury

Answer 46

anesthetize and irrigate immediately and profusely measure and remeasure pH until neutral research chemical bases worse

Question 47

corneal laceration

Answer 47

irregular pupil, cover with shield and refer immediately ( no flurescien)

Question 48

what to do with blood in anterior chambeR?

Answer 48

hyphema - refer immediately

Question 49

corneal abrasion tx

Answer 49

topical abx, pressure patch, oral analgesics, promote healing (cyclopentolate)

Question 50

topical anesthetics for eye?

Answer 50

NO - only for your exam, don't give to the, - will get worse and scar

Question 51

preauricular lymphadenopathy signals

Answer 51

viral conjunctivitis

Question 52

ciliary injection concentrated at limbus, indicates _______

Answer 52

iritis (anterior uveitis) rather than conjunctivitis | systemic disease, large ddx

Question 53

overall issue with temporal arteritis

Answer 53

ischemia to nerve

Question 54

changes in retina in DR

Answer 54

cholesterol deposits and microaneurysms, basal proliferation and cotton wool spots