Ophthalmology

Question 1

Right eye pain and discharge

Difficulty remove lens last week

Thick globular yellow discharge

Cornea: edematous, hazy, and ulcerated

Extensive scleral injection

A. Angle closure glaucoma
B. Anterior uveitis
C. Episcleritis
D. Pneumococcal conjunctivitis
E. Pseudomonal keratitis
F. Subconjuctival hemorrhage
G. Viral conjunctivitis

Answer 1

E. Pseudomonal keratitis

Painful red eye and opacification and ulceration of cornea= contact lens associated keratitis

Due to Gram negative organisms

• Pseudomonas
• Serratia

Medical emergency —> Vision loss

Question 2

Decreased vision in both eyes

Hx DM for 10 years

Microaneurysms, dot and blot hemorrhages, hard exudates, macular edema

A. Central retinal vein occlusion
B. Diabetic retinopathy
C. Macular degeneration
D. Retinal detachment
E. Open angle glaucoma

Answer 2

B. Diabetic retinopathy

Question 3

Central retinal vein occlusion

Answer 3

Sudden unilateral visual impairment usually noted upon waking in the morning

Question 4

Open angle glaucoma vision change

Answer 4

Gradual loss of peripheral vision

Resulting in tunnel vision

Cupping of optic disc

Question 5

Herpes zoster ophthalmicus

what is it?
Who?
Characteristics?
MOA?
Seen in eye?

Answer 5

Infection by varicella zoster virus

Elderly

Fever, malasie and burning itching sensation in periorbital region

Vesicular rash in distribution of cutaneous branch of first division of the trigeminal nerve

Conjunctivitis and dendriform corneal ulcers

Question 6

HIV patient

Rapidly progressive bilateral vision loss

Mark keratitis

Widespread, pale peripheral retinal lesions and central necrosis of the retina

A. Pseudomonas
B. CMV
C. Herpes simplex
D. Candida albicans
E. EBV

Answer 6

C. Herpes simplex

HSV rapidly progressing bilateral necrotizing retinitis

Question 7

HIV patient

Painless vision loss

Fluffy granular retinal lesions

Answer 7

CMV retinitis

Question 8

Sudden vision loss

Hx DM

Visual acuity reduced to light perception in right eye

Loss of fundus details, floating debris and dark red glow

A. Retinal detachment
B. Diabetic retinopathy
C. Vitreous hemorrhage
D. Central retinal vein occlusion
E. Age related macular degeneration

Answer 8

C. Vitreous hemorrhage

Caused by diabetic retinopathy

Clue: fundus hard to visualize

Question 9

Blurred vision and right eye pain

Eye pain, photophobia, decreased visual acuity

Redness of sclera, most prominent at the junction between the cornea and the sclera in the right eye.

Answer 9

Anterior uveitis

Get pelvic x ray (akylosing spondylitis)

Get CXR and serum rapid plasma reagin for sarcoidosis and syphilis

Question 10

Tx Viral conjunctivitis

Answer 10

Warm or cold compresses

Question 11

Elevated intraocular pressure

Thinning of optic disc rim and asymmetry of cup/disc

What to do?

Answer 11

Open angle glaucoma

Start latanoprost ophthalmic solution

(topical prostaglandin)

• latanoprost
• Bimatoprost

Question 12

Burst of flashing light and blurred vision in left eye

This morning

Small spots in field of vision

Curtain came down

Retinal tears and grayish appearing retina

Answer 12

Retinal detachment

Question 13

Sign of central retinal artery occlusion

Answer 13

Sudden painless vision loss in one eye

Pallor of optic disc

Cherry red fovea

Boxcar segmentation of blood in retinal veins

Question 14

Yellow crust along eye margin

Gritty sensation

Answer 14

Blepharitis

Question 15

Loss of vision in right eye

Cover left eye, small on grid lines

Lines are being away

Answer 15

Macular degeneration

Question 16

Eye condition associated with sturge weber syndrome

Answer 16

Glaucoma in children

Question 17

67 y.o difficulty driving at night for several months, see halos around street lights and excessive glare from headlights

Difficulty driving in bright sunlight

Reading at night worse

HTN
DM

A. Drusen deposits in the macula
B. Hemorrhage in the shape of a flame
C. Increased optic cup/disc ratio
D. Loss of red reflex
E. Retinal microaneurysms

Answer 17

D. Loss of red reflex

Cataract

[Drusen are lipoproteinaceous deposits, yellow spots= age related macular degeneration]

[Flame hemorrhage= HTN retinopathy]

[Microaneurysms= diabetic retinopathy]