x files Flashcards
(127 cards)
1
Q
how do you manage corneal ulcer
A
give topical antibiotic eye drops, swab, refer to ophto
2
Q
how do you manage globe penetration
A
my need IV abx
URGENT refer to ophtho
3
Q
best dilator to use in adults
A
tropicamide
4
Q
best dilator to use in kids
A
cyclopentolate
5
Q
most concerning drug for someone about to have cataract surgery?
A
flomax–floppy iris syndrome
6
Q
what are the signs of parinaud’s
A
convergence/retraction nystagmus and upward gaze palsy
7
Q
is cataracts reversible or irreversible vision loss
A
reversible because surgery
8
Q
how do you distinguish between preseptal and orbital cellulitis
A
orbital causes pain and affects eye movements
9
Q
how do you test for sarcoidosis?
A
ACE levels
serum Ca
CXR
then either serum protein electrophoresis or lacrimal gland bx
10
Q
what do you do if an exotic dancer and contact lens user complains of spot on cornea that lights up with flouresciene
A
refer to ophtho
11
Q
most common cause of loss of vision in HIV positive patient with low CD4 count
A
CMV retinitis
12
Q
what eye pathology should you suspect in an asian lady
A
closed angle glaucoma
13
Q
what is a concomitant strabismus
A
manifest eye deviation
14
Q
if you have trauma to the orbit and patient presents with subcutaneous emphysema of eyelid, what should you suspect
A
ethmoid bone fracture
15
Q
what is a common symptom of cataracts
A
difficulty driving at night
16
Q
what medications should you worry about in a patient going for cataract surgery
A
TAMSULOSIN–floppy iris syndrome
is an alpha-1 antagonist
17
Q
what drug is contraindicated in a patient with HTN and renal calculi
A
diamox
it is a carbonic anhydrase inhibitor which increases the risk of renal calculi and is also used to treat glaucoma
18
Q
which of the following is NOT a cause of leukocoria? cataract retinoblastoma high refractive error not aligning ophthalmoscope properly
A
high refractive error is NOT a cause of leukocoria
19
Q
what muscles are involved when the patient looks down and to the left
A
left eye–IR
right eye–SO
20
Q
in a patient who has had HTN for a long time, what would you expect to see on retina exam
A
copper/silver arterioles
21
Q
in a patient with less long standing HTN, what might you expect to see on retina exam
A
flame hemorrhages and exudates
22
Q
what effect does HTN have on the retina
A
get arteriolar sclerosis–> thickening of vessel wall–> increased width of central light reflex
this progresses to the light reflex occupying the width of the vessel–> copper wire arterioles
when the light reflex is totally obscured, you get silver wire arterioles
severe A/V nicking can lead to BRVO–> retinal hemorrhages and cotton wool spots
23
Q
what effect can an acute rise in BP have on the retina
A
fibrinoid necrosis of the vessel wall–> exudates, cotton wool spots, and flame shaped hemorrhages
24
Q
what is the difference between a tropia and a phoria
A
tropia–> manifest (always present)
phoria–> latent, only comes out during crossover test or when take away ability of eyes to communicate with each other
25
if a patient's left eye is slightly misaligned, approximately to the same degree in all directions, what do they have?
concomitant strabismus
26
what is the treatment of strabismus
patching and glasses
27
what causes amblyopia in a kid
strabismus
refractive error
form deprivation (i.e cataracts, corneal scarring, ptosis)
28
should you treat amblyopia with pilocarpine?
NO
this is a cholinergic and will thus cause constriction not dilation
29
what is true about amblyopia
can be present in both eyes
30
can you still do patching in a kid with amblyopia who is 10 years old
yes tho may not work as well
31
will a patient need cataracts after surgery?
yes
32
define amblyopia and management
loss of VA in absence of detectable organic disease (strabismic or refractive)
manage by detecting early and referring to ophtho
33
define strabismus and management
misalignment of the eyes
refer to ophtho
34
define esotropia/esophoria
deviating inwards towards the nose (most common)
35
define exotropia
outward deviation
36
how do you detect a tropia
cover tests (does eye move when the cover is removed?...if moves in, exotropia/moves out, esotropia/moves up, hypotropia/moves down, hypertropia)
37
how do you detect a phoria
alternating cover test--> esophoria if uncovered eye moves out/exophoria is uncovered eye moves in
38
how do you perform a swinging light test
have patient look/focus on a distant object in a low light room
39
27 year old patient has left dilated pupil, right constricted pupil in bright light. what does she have
left adie tonic pupil--> dilated pupil that is slow to constrict and re-dilate and decreased reflexes
nothing we can do
is benign, idiopathic, found in young women, unilateral
40
what lens would you give to a patient who cant see at a distance and cant read up close
myopic and presbyopic
41
a patient presents post cataract surgery with some sort of opacification/haziness on ophthalmoscopy. what is the problem
posterior capsule opacification
42
how does NPDR (non proliferative diabetic retinopathy) present
first manifestation--> micro aneurysms
retinal findings--> dot and blot hemorrhages, hard exudates, cotton wool spots (infarct of the nerve fibre layer) and macular edema
43
how does PDR (proliferative diabetic retinopathy) present
retinal ischemia leads to neovascularization over the optic disc or elsewhere--> fragile vessels can bleed into the vitreous and can lead to traction retinal detachment
44
how do you treat NPDR
laser and anti-VEGF
45
how do you treat PDR
laser burns---can do panretinal photocoagulation (PRP laser) and anti VEGF
46
how do you manage a corneal ulcer as a family doc
patch eye and evaluate in the morning
47
what do you use to evaluate macular degeneration
amsler grid
48
how does acute angle closure glaucoma present
```
red eye that is painful
fixed mid dilated pupil
tearing
nausea/vomiting
halos
headache
```
49
what medication should you NOT use in a patient with both glaucoma and asthma/COPD
beta adrenergic blockers (-"olol")
these treat glaucoma by reducing formation of aqueous humour but can cause bronchospasm in asthmatics
50
how does pilocarpine work in treating glaucoma
cholinergic
increases aqueous humour flow through trabecular meshwork
can cause decreased vision and headaches
51
name an alpha 2 andrenoreceptor agonist and how does it work to treat glaucoma
brimonidine tartrate
decreases aqueous production and increases uveoscleral aqueous outflow (non trabecular meshwork)
can cause dry mouth, headache, fatigue
52
what med should you not use in a patient with HTN and glaucoma
epinephrine (adrenergic stimulators)
causes cardiac arrhythmias and increased BP
53
how do prostaglandin analogues treat glaucoma and what are the side effects
-"prost"
increases aqueous flow outflow though the uveoscleral path
can cause darkening of iris
54
name the only oral glaucoma drugs
carbonic anhydrase inhibitors -"amide"
55
what are side effects of carbonic anhydrase inhibitors used to treat glaucoma
-"amide"
paresthesias, anorexia, GI disturbance, headache, predisposes to renal calculi
dont use in HTN
56
lady comes in with new onset floaters, whats the cause
either retinal detachment or PVD
57
what condition is characterized by a cherry red spot
CRAO
spot forms due to ischemia to the rest of the retina but the macula is supplied by the choroidal artery (from the posterior ciliary artery) instead of the central retinal artery so when you get CRAO only the macula is well perfused causing it to appear as a cherry red spot
58
what condition is suggested by flame hemorrhages
HTN retinopathy
59
how does wet AMD differ from dry
in wet AMD, you get choroidal neovascularization
60
where do people notice vision loss in AMD
changes tend to be confined to the posterior pole so losses in central vision often are more pronounced
61
how do you manage hyphema
refer URGENTLY
62
how do you manage an orbital puncture
hard shield
| NO antibiotic
63
if a woman has herpes simplex keratitis and had vesicles above her forehead, what could she also have
iritis
64
what condition requires the most urgent treatment in the ER
lye splash in the eye
65
how do you treat chemical burns
irrigate excessively and refer
66
patient comes in with a deep lid laceration close to the canthus--what is most likely also damaged
lacrimal canaliculi
67
patients has thyroid eye disease and massive proptosis. what symptoms would they NOT have
pain on eye movement
WILL have:
dry eyes
corneal abrasions likely
diplopia on side gaze
68
what vision abnormality is caused by thyroid eye disease
horizontal diplopia
69
if a young woman who is morbidly obese, what will you most likely find on ophthalmoscopy?
papilledema (pseudotumour cerebri predisposition)
70
what abnormality is caused by an optic chiasm lesion? (i.e is a person has a pituitary tumour close to the optic chiasm)
bitemporal hemianopsia
71
what symptoms are associated with amaurosis fugax
transient sudden monocular vision loss
72
when is a person considered legally blind
20/200 after corrected vision
73
what should you NOT give a person with macular degeneration
anti-metabolites
74
patient comes in after blunt trauma to the eye--what do you do
get more history
75
what do you do if you see RBCs in the anterior chamber on ophthalmoscopy
URGENT referral (hyphema)
76
what should you use to dilate a patients eye
tropicamide 0.5%... lasts only 6 h
77
what should you do if a patient comes in with allergies?
oral antihistamine (not topical)
78
what do you do for penetrating globe injuries?
shield and refer
| do NOT manipulate the eye
79
lady in an accident, loses glasses, face mashed up. vision in ER is 20/200. ifn o eye damage, what improvement can you expect on pinhole
unsure--20/30?
80
risk factors for open angle glaucoma
age
| african american heritage
81
patient working with nail gun...now foreign body sensation. see corneal abrasion with fluorescein. what do you do
URGEN X RAY of skull bones
82
girl with orbital fracture blows nose and feels crepitus. what did she also break
ethmoid
83
how do you diagnose glaucoma in the office
ophthalmoscopy (cup:disc ratio)
...or vision field testing
84
what test does not test for sarcoid
protein electrophoresis
85
neighbour in cariboo doing lawn work, gets stuff in his eye, on inspection there is no corneal abrasion, normal red reflex, everything normal. what do you do
urgent/same day ophtho referral
86
you are on call hospitalist... 92 year old lady has red eye but swats everyone away when they come near. what do you do
evaluate her yourself as could be acute angle closure glaucoma
87
person comes to office with some conjunctival injection and discharge--otherwise normal. no corneal damage. what do you prescribe
topical abx--broad spectrum for bacterial conjunctivitis
88
what is a change you do NOT expect with aging
increased contrast sensitivity
89
patient has gradual change in vision loss starting to affect function, especially driving at night. whats the problem
cataracts
90
management of corneal ulcer
patch
91
management of globe perf
shield, no drops
92
what does a white eye reflex suggest
absence of red reflex is a cataract or retinoblastoma
93
what is optic neuritis
inflammation and demyelination of optic nerve
causes acute vision loss with peri-ocular pain exacerbated by eye movement
RAPD if fellow optic nerve healthy
associated with MS
recover vision within weeks to months
use IV corticosteroid not oral
94
what condition is optic neuritis associated with
MS
95
what is the treatment for optic neuritis
IV corticosteroid (not oral
96
what is ION
acute vision loss from microvascular infarction of optic nerve
sudden, PAINLESS, UNILATERAL loss of vision
anterior portion of nerve most vulnerable (AION) --> arteritic AION is associated with GCA and non arteritic AION which is also associated with disc ededma, unilateral vision loss upon waking either upper or lower vision
97
what condition is characterized by unilateral vision loss on waking that is either the upper or lower area
non arteritic ION
98
management of CRAO
urgent referral
EMERGENCY
99
presentation of BRAO
partial vision loss
100
presentation of CRVO
blood and thunder
NOT an emergency
101
how does optic neuritis present
sudden decrease in VA
clear ocular media
swollen disc
RAPD (disc swollen and hyperemic)
102
management of optic neuritis
refer non urgently and give IV steroids
103
what are the signs of GCA (giant cell arteritis)
```
over 60
temporal headaches
jaw claudication
neck discomfort
sudden vision loss
RAPD
swollen disc
loss of vision
```
104
define RAPD
relative afferent pupillary defect
105
management of GCA
order ESR/CRP
| if elevated, give high dose systemic steroids and IMMEDIATE ophtho referral
106
what conditions should you refer URGENTLY
retinal detachment
acute CRAO
ischemic optic neuropathy if suspected to be related to GCA
107
signs of retinal detachment and management
floaters
flashing lights
peripheral visual field loss
URGENT referral
108
what is the first thing you can detect in glaucoma?
peripheral visual field loss--> scotomas
hard to detect early on
109
symptoms of chronic angle closure glaucoma
intermittent
| low grade sx--headaches, blurred vision
110
when to refer someone with AMD to ophtho
recent decrease in VA
recent metamorphosia
recent scotoma
ophthalmoscopic findings of drusen, degenerative changes in RPE, choroidal neovascularization, poor central vision
111
what are drusen
yellow hyaline nodules
can be associated with AMD
112
danger symptoms of the red eye
blurred vision
severe pain
photophobia
colored halos
REFER
113
danger signs of red eye
```
reduced VA
ciliary flush
corneal opacification
corneal epithelial disruption
pupillary abnormality
shallow AC depth
elevated IOP
proptosis
```
REFER
114
what should you do for a traumatic optic neuropathy (i.e maxillofacial trauma)
refer
115
how urgent are orbital factures
semi urgent
116
does uveitis cause changes in vision
posterior uveitis does cause visual field loss and scotoma
117
patient with bump on eyelid, painful. doc had given abx PO. no effect. what do you do?
apply warm compresses 4x daily
massage the lid
apply topical abx
refer for incision and curretage if no resolution in 4 weeks
118
symptom of bilateral INO
nystagmus of both eyes
119
how do you investigate Horners
carotid U/S
120
management of temporal arteritis
IV corticosteroids and bx
121
what are symptoms of a cranial nerve III palsy
complete paralysis of the oculomotor nerve
causes both horizontal and vertical diplopia, severe ptosis of the upper eyelid, inability to move eye inward, upward or downward
pupil may be dilated and unresponsive
122
common causes of CN III palsy
```
intracranial aneurysm
microvascular infarction within nerve
trauma
cerebral herniation
brain tumour
```
123
management of CN III palsy
emergent imaging and angiography
124
what muscle is affected when a person has a lac in their upper eyelid and cannot open eye
levator palpebrae superioris
125
in a question about brainstem and the orbits, which statement is false
something about syphilis
126
which conditions mimic functional blindness with all eye exams being normal
cortical blindness
127
guy comes in with high BP, no previous eye problems, wakes up one morning with decreased vision in one eye
NAION
