psycoopth Flashcards
(80 cards)
Q: What is the diagnosis in a patient with unilateral red eye, headache, blurry vision, mid-dilated pupil, and decreased visual acuity?
A: Acute angle-closure glaucoma
Extra:
Sx: acute unilateral pain and vision loss, headache, vomiting, seeing halos around lights
Clinical: can occur in the setting of significant hyphema
PE: cloudy cornea and fixed mid-dilated pupil
Dx: increased IOP on tonometry
Tx: emergent ophthalmology evaluation, topical beta-blockers (timolol), topical alpha-agonists (apraclonidine), carbonic anhydrase inhibitors (acetazolamide), iridotomy
Q: What is the most accurate statement about primary congenital glaucoma?
A: Most cases are diagnosed within the first year of life
Q: What is the most likely diagnosis in a patient with sudden onset of floaters and fundus image showing intraocular hemorrhage?
A: Vitreous hemorrhage
Presentation: Sudden onset of floaters in one eye, possibly with blurred vision or dark spots
Fundoscopy findings: Dark or hazy opacities in the vitreous, retina may be obscured
Common causes: Proliferative diabetic retinopathy, trauma, retinal tear or detachment
Urgency: Requires prompt ophthalmology referral to rule out retinal tear/detachment
Next step: Avoid anticoagulants, keep head elevated, refer for B-scan if retina not visible
Q: What is the most likely cause of sudden vision loss in the upper half of one eye in a diabetic patient with HbA1c of 9.1?
A: Vascular retinal disease
(e.g., branch retinal artery occlusion or ischemic optic neuropathy)
Q: 26-year-old female with painful eye, loss of color vision, superior visual field loss, and high ESR. What is the most likely diagnosis?
A: Optic neuritis
Most common cause: Multiple sclerosis (MS)
Other causes: Infections (TB, syphilis, Lyme, viral), NMOSD, autoimmune (sarcoidosis, SLE), idiopathic
Clinical features: Unilateral subacute vision loss, retrobulbar pain (↑ with eye movement), dyschromatopsia, central scotoma, usually monocular
Diagnosis: Clinical +
Key tests: Swinging flashlight test (RAPD), ophthalmoscopy (normal in retrobulbar neuritis; disc edema in papillitis),
MRI brain/orbits (1st-line),
Treatment: IV steroids (methylprednisolone 3–7 days), oral prednisone 11–14 days,
neurology consult
What is the most likely diagnosis in a child with unilateral red eye, photophobia, and a history of leaf trauma?
A: Fungal corneal ulceration
Definition:
Fungal infection of the cornea, often after vegetative trauma.
Cause:
Filamentous fungi (Fusarium, Aspergillus) or Candida.
Key features:
Red eye, photophobia, pain, decreased vision, trauma with plant 🪴 matter.
Exam:
Feathery corneal infiltrate, possible satellite lesions, hypopyon.
Diagnosis:
Slit-lamp exam, corneal scraping with fungal stain/culture.
Treatment:
Topical antifungals (natamycin, amphotericin B), avoid steroids early.
What is the best next step for a 4-month-old with bilateral mucopurulent eye discharge since birth?
A: Lacrimal sac massage and topical antibiotics with observation until 6–12 months
Diagnosis: Congenital dacryostenosis (nasolacrimal duct obstruction) (dacryostenosis)
Typical age: Newborns and infants (often noticed since birth)
Presentation: Chronic tearing, mucopurulent eye discharge, no conjunctival injection
Next step: Lacrimal sac massage (Crigler technique) ± topical antibiotics if infected
Definitive treatment: Probing if not resolved by 6–12 months
Q: What is the most likely diagnosis in a contact lens user with red eye, itching, tearing, and foreign body sensation for 2 weeks, with negative fluorescein test?
A: Giant Papillary Conjunctivitis (GPC)
Condition: Giant Papillary Conjunctivitis (GPC)
Cause: Chronic mechanical irritation from contact lenses or exposed sutures
Symptoms: Itching, redness, tearing, mucous discharge, foreign body sensation
Signs: Large papillae on upper tarsal conjunctiva; fluorescein test usually negative /not ulcer
Association: Common in soft contact lens users, especially with poor hygiene
Management: Discontinue lenses temporarily, improve hygiene, switch to daily disposables, topical antihistamines/mast cell stabilizers
Q: What is the appropriate management of corneal abrasion in a child with positive fluorescein stain?
A: Topical antibiotic drops (no patching)
What is the most likely diagnosis in an elderly patient with sudden painless vision loss and a systolic murmur, and fundus shows a cherry red spot?
A: Central retinal artery occlusion (CRAO)
Q: What is the treatment for a patient with red eyes, eyelids stuck on waking, and mucopurulent discharge?
A: Topical chloramphenicol
First-line treatment: Topical erythromycin ointment or topical trimethoprim-polymyxin B drops
Alternative: Topical chloramphenicol (commonly used in UK and other regions)
For contact lens users/severe cases: Fluoroquinolones (e.g., moxifloxacin) to cover Pseudomonas
Q: What is the most likely diagnosis in a young male with photophobia, blurry vision, tearing, and unequal pupil size, with a background of psoriasis and topical steroid use?
A: Anterior uveitis
Definition: Inflammation of the iris and/or ciliary body (iritis or iridocyclitis); most common type of uveitis.
Etiology: Idiopathic (most common), HLA-B27 diseases (e.g., ankylosing spondylitis, IBD), infections (HSV, TB, syphilis), trauma, post-op, rare drug-induced
Symptoms: Eye pain, redness (ciliary injection), photophobia, blurred vision, tearing
Signs: Cells & flare in anterior chamber, miosis, keratic precipitates, hypopyon (severe), may cause posterior synechiae (irregular pupil)
Complications: Synechiae, glaucoma, cataract
Diagnosis: Clinical (slit lamp); investigate if bilateral, recurrent, or severe
Management: Urgent ophthalmology referral, topical steroids + cycloplegics, treat infection if present
Mnemonic: RSVP = Redness, Sensitivity to light, Vision changes, Pain
Redness, tearing, irritation, Dx?
Diagnosis: Entropion
Key feature: Inward turning of the lower eyelid
Symptoms: Foreign body sensation, tearing, redness, risk of corneal abrasion from lashes
Redness, tearing, irritation, Dx?
Diagnosis: Ectropion
Key feature: Outward turning of the lower eyelid
Symptoms: Redness, tearing, irritation due to exposed conjunctiva
Q: What is the most likely diagnosis in a patient with night blindness, tunnel vision, and a positive family history, Dx?
Retinitis pigmentosa
Definition: A group of inherited retinal dystrophies characterized by progressive peripheral vision loss and night blindness.
Inheritance: Most commonly autosomal recessive, but may be autosomal dominant or X-linked.
Symptoms: Night blindness (nyctalopia), tunnel vision, eventual central vision loss.
Fundoscopy:
Bone-spicule pigmentation, arteriolar narrowing, waxy pallor of optic disc.
Diagnosis: Clinical + ERG (electroretinogram shows reduced scotopic response).
Management: No cure; supportive with low-vision aids, vitamin A may slow progression in some types.
Complications: Cataracts, macular edema, complete blindness in advanced stages.
Q: 54 years old known to have DM, C/O chronic hx of decreased vision, later on he developed central vision loss (picture attached). What is the most likely diagnosis?
macular degeneration
other case ::::
Extra:
Condition: Diabetes-Related Retinopathy (Diabetic Retinopathy)
History: History of diabetes
Early stage: Often asymptomatic
Symptoms with progression: Seeing spots, floaters, vision loss
Types: Nonproliferative, proliferative
Funduscopic exam: Microaneurysms, hemorrhages, cotton-wool spots, neovascularization (with proliferative type)
Treatment options: Glucose control, anti-VEGF agents, laser photocoagulation, vitrectomy (depending on type and presence of macular edema)
Screening: At time of type 2 diabetes diagnosis; within 5 years of type 1 diabetes diagnosis
In mild nonproliferative diabetic retinopathy, what can slow progression? Fenofibrate
Not MCQs
In corneal abrasion with significant pain, which is preferred for pain relief?
Cycloplegics (more effective than NSAIDs for pain from ciliary spasm - sever or photophobia)
Q: A patient with psoriasis, acute unilateral photophobia, tearing, and normal fluorescein uptake – what is the likely diagnosis?
A: Anterior uveitis
A child presents with unilateral eye swelling post-URTI — what test has the highest diagnostic value?
A: CT orbit with contrast
Orbital cellulitis’s :
Definition: Serious infection posterior to the orbital septum; medical emergency needing IV antibiotics and urgent ophthalmology consult.
Epidemiology: More common in children; peaks in winter.
Etiology: Local spread (sinusitis, dental), trauma/surgery, hematogenous spread.
Clinical Features: Unilateral eyelid swelling, pain, fever; red flags: proptosis, ophthalmoplegia, ↓ visual acuity, chemosis, RAPD.
Diagnostics: Clinical + CT orbit/sinuses with contrast; labs (CBC, cultures); MRI if CNS spread suspected.
Differential Diagnosis: Preseptal cellulitis, orbital abscess, CST, hemorrhage, tumor, autoimmune.
Management: Urgent ophthalmology; empiric IV vancomycin + ampicillin/sulbactam or ceftriaxone + metronidazole; antifungal if immunocompromised; decongestants, lubricants; steroids if guided.
Complications: Orbital abscess, vision loss, intracranial abscess, CST, endophthalmitis.
Disposition: Admit for IV therapy; multidisciplinary care as needed.
Q: Elderly patient with unilateral SNHL, vertigo, fullness, and nystagmus without tinnitus or facial symptoms. Diagnosis?
Vestibular schwannoma
=Acoustic neuroma
Key features: Unilateral sensorineural hearing loss, vertigo, ear fullness, and nystagmus in an elderly patient
Audiogram clue: Asymmetrical SNHL (left ear worse) with normal right ear hearing
CN involvement: Affects CN VIII (vestibulocochlear); facial nerve (CN VII) involved only in advanced cases
Distinguishing from Ménière’s: Ménière’s usually has tinnitus and fluctuating hearing loss; schwannoma is progressive and often lacks tinnitus
**Best initial test: ** Audiometry showing asymmetric SNHL
Confirmatory test: MRI with gadolinium of the internal auditory canal
Q: What is the most likely diagnosis in a head trauma patient with clear nasal discharge and nasal bone fracture on X-ray?
A: CSF rhinorrhea due to ethmoid (cribriform plate) fracture
Q: What is the next step if anterior nasal packing fails to control epistaxis?
Posterior packing
to control posterior nasal bleed.
Extra :
Epistaxis
Most common source: Anterior bleeds: Kiesselbach plexus
Posterior bleeds: Sphenopalatine artery
Treatment:
Anterior bleeding: direct pressure, topical vasoconstriction (oxymetazoline), chemical cautery with silver nitrate (if vessel visualized), packing
Posterior bleeding: packing (nasal balloon or Foley catheter)
Admit patients with posterior packing to a monitored bed
Possible complications: septal necrosis (if both sides of septum cauterized), toxic shock syndrome (prolonged packing), infection
Q: A heavy smoker presents with hoarseness, dysphagia, and a non-tender neck mass. Most likely diagnosis?
A: Laryngeal carcinoma
Q: What is the next step for a patient with sinusitis >3 weeks and high-grade fever but stable, no red flags?
A: Start oral Augmentin.
Extra :
Acute Sinusitis
Sx: nasal congestion, pain or pressure over sinuses, ear pain or pressure, headache, fever
PE: purulent rhinorrhea
Most commonly caused by: viral URI
If viral, Tx: supportive care
Diagnostic features of acute bacterial rhinosinusitis:
Persistent: symptoms ≥ 10 days without improvement
OR
Severe: symptoms, fever ≥ 39°C (102°F), purulent nasal discharge, or face pain ≥ 3 days
OR
Worsening: symptoms ≥ 5 days after initially improving viral upper respiratory infection
Tx: Amoxicillin-clavulanate
Complications: frontal bone osteomyelitis (Pott puffy tumor), orbital cellulitis, sinus venous thrombosis, extension into meninges or brain
Q: What are common viral etiologies of acute rhinosinusitis?
A: Rhinovirus, influenza, and parainfluenza.
