Oc Emergency

Front 1

One of the most important sequelae of GCA

Back 1

vision loss

Front 2

_____ is considered a prime ohthamlic medical emergency as blindness is preventable

Back 2

GCA

Front 3

Race GCA is prevalent in

Back 3

WHITE, european

Front 4

T/F Men are twice as effected as women in GCA

Back 4

FALSE
opposite is true

Front 5

What age does GCA usualyl occur?

Back 5

>55 mean presentation is 71

Front 6

__________% vision loss occurs in GCA

Back 6

15-20%

about 8.5 days until loss usually occurs

Front 7

T/F GCA is usually bilateral

Back 7

FALSE

Front 8

Most common complaint of patient with GCA

Back 8

headache occipital loe

Front 9

Headache and _______ are strong indicators of GCA

Back 9

jaw (50% of patients)

Front 10

_% of patients with GCa experiency polymyalgia rhuematica

Back 10

50

fever of unknown orgin, respiratory symptoms and facial pain

Front 11

fever of unknown orgin, respiratory symptoms and facial pain are traits of what?

Back 11

polymyalgia rheumatica

Front 12

T/F APD present with GCA

Back 12

FALSE

Front 13

T/F GCA is a painless loss of vision

Back 13

FALSE


PAINFUL

Front 14

Optic disc swelling in GCA is due to

Back 14

AION
anterior ischemic optic neuropathy

Most common cause of vision loss in GCA

Front 15

Most common cause of vision loss in GCA

Back 15

AION

Front 16

T/F AION is characterized by high erthyrocyte sedimentation rate

Back 16

T

Front 17

What test confirm GCA?

Back 17

Erythrocyte Sedimentation Rate and Temopral artery biopsy

Front 18

Average ESR for male

Back 18

age/2

Front 19

ESR average for women

Back 19

(agee+10)/2

Front 20

Perferred method of ESR

Back 20

Westergren method

Front 21

T/F A patient with GCA may experience diplopia

Back 21

T

may also experience amarosis fugax

Front 22

How do you treat GCA?

Back 22

Corticosteriods

reduce symptoms butdo not shorten course of disease

daily oral dose 40-80 mg

Azathiprine, Methotrexate, and cylcosporine, dapsone have also been used

Front 23

Intravenous methlypreidnisone is the preferred treat for patients with GCA that have experienced

Back 23

visual loss

Front 24

CRAO presents with

Back 24

sudden, unilateral, painless loss of vision

Front 25

T/F CRAO is a painless loss of vivsion

Back 25

T

Front 26

T/F CRAO tends to be bilateral

Back 26

FALSE

unilateral

Front 27

A cherry red spot and a pale ONH with mild retinal edema are signs of

Back 27

Central Retinal ARtery Occlusion

Front 28

What causes CRAO

Back 28

thrombosis in retobulbar portion of CRA

Front 29

Restoration of vision not possible if retinal circulation has been completely interrupted for more ______ minutes!!!

Back 29

100

Front 30

To help patient with CRAO, give paitnet

Back 30

Topical drops to lower IOP, IV Diamox, IV mannitol, and possible IV steriods

Front 31

Patients with hyphema should be considered to have a ______________________ until proven otherwise

Back 31

ruptured globe

Front 32

Low intraocular pressure is known as

Back 32

hyptony

Front 33

MRIs are contraindicated when

Back 33

ferromagnetic FB is suspected

Front 34

The gold standard for imaging

Back 34

CT`

Front 35

Degree of damage is directly proportional to the _________of the FB and inversely proportional to its ______-

Back 35

velocity

size

Front 36

The retaining of copper or lead in eye is known as

Back 36

chalocosis

Front 37

Removing a foreign body with the external electromagnet is known as

Back 37

pars plana virectomy

Front 38

A rapid rise in abdominal pressure especialyl against a closed glottis is characterstic of the

Back 38

Valsalva maneuver

Front 39

What type of hemorrages are present in Valsalva retinopathy?

Back 39

red, doma shaped
vitreous hemorrhage

Front 40

T/f Valsalva retinoapthy tends to be self limiting

Back 40

T

Front 41

T/F An APD is usually present with Diabetic paopllopathy

Back 41

T

see indistinct disc margin with diffuse swelling and elevation with fine telangiesctatic patten of vessels

Front 42

T/F most casses of idaetic papillopathy occur early 2nd-3rd decade of life

Back 42

T

tend to see in longstanding juvenile onset diabetes

Front 43

VF defect seen with diabetic papillopathy

Back 43

enlarged blidn spot, central scotoma

Front 44

T/F perseptal cellulitis is most common in geriatric populations

Back 44

FALSE

pediatric

Front 45

Suppurative means

Back 45

pus containing

Front 46

preseptal suppurative cellulitis is most commonly due to what bacteria?

Back 46

Staph auerues
Strep pyogenes

Front 47

T/F anaerobes and polymicrobial infections are common causes of preseptal suppurative cellulitis

Back 47

FALSE

LEAST likely causes

Front 48

Pediatric nonsuppurative preseptal cellulitis most likely due to

Back 48

Hemophlus influenza and Strep Pneumoniae

Front 49

Normal position of the globe finding allows us to differentiate preseptal cellulitis from

Back 49

orbital cellulitis

Front 50

T/F VA should be unaffected in preseptal cellulitis

Back 50

T

Front 51

An infection within theorbit, posterior to the orbital septum is know nas

Back 51

orbital cellulitis

Front 52

Most common cause of orbital cellulitis

Back 52

extension of infection form NASAL sinuses

> 90% of cases

Front 53

Post-traumatic and post surgical orbital cellulitis is usually due to

Back 53

Staph aureus

Front 54

T/F Pain upon eye movement is a feature of preseptal cellulitis

Back 54

FALSE

orbital

Front 55

T/F Diplopia is present in orbital cellulitis

Back 55

T

Front 56

Rhinorrhea is a symptom of

Back 56

sinusitis (leakage of CSF into nasal cavity)

implies orbital cellulitis

Front 57

T/F Orbital cellulitis patients have diminished sensation in CN V1

Back 57

T

also see reduced color vision
poptosis

Front 58

If signs of orbital cellulitis occur BILATERALLY, consider the possibility that the patient has

Back 58

cavernous sinus thrombosis

Front 59

Cavernous sinus thrombosis involves pareisis of what CN?

Back 59

3,4, and 6, as well as decreased V sensory function

dilated sluggish pupil present

Front 60

An accumulation of purulent material between the periobital and the bony walls of the orbit is known as

Back 60

Subperiosteal abcess

Front 61

Subperiosteal abcess is usually due to

Back 61

sinuisits, especially ethmoidal

Front 62

What can differentiate Subperiosteal abscess from oribtal cellulitis?

Back 62

CT scan
Ultrasound

Front 63

T/F Angle Closure Glaucoma tends to occur more often in women, and more often in hyperopic patients

Back 63

T

Front 64

T/F Angle Closure Glaucoma is a common occurance in caucasians

Back 64

FALSE
higher rate in East Asia, Alaska, Greenland

Front 65

An AC < _____ mm is a high risk for angle closure

Back 65

2
Refer for laser peripheral iridotomy


2.1-2.5 mm AC depth should be reffere dto glaucoma specialist

Front 66

irido-lenticular touch cuasing an obstruction of aqueous circulation in midperipheral region of lens is known as

Back 66

pupillary block

Front 67

If pupillary block is associated with lax peripheral iris tissue, iris ___ may result, which leads to obstruction of angle structures and closure of trabeculum

Back 67

bombe

Front 68

Type S puppillary block starts at _____ and does NOT occlude trabecular structures

Back 68

schwalbe's line

a more bening form of closure

Front 69

T/F Type S puppilary block is a more benign form of closure

Back 69

T

does NOT occlude trabecular structures

Front 70

Type ___ pupillary block produces a continuous zone of touch between iris and trabeculum

Back 70

B

Associated with PAS (peripheral anterior synechiae)

Front 71

This type of puppillary block is associated with peripheral anterior synechiae

Back 71

B

Front 72

Angle closure due to physical crowding of angle by superfluous iris tissue following pupillary dilation is known as

Back 72

Plateau Iris

Due to anterior insertion of iris producing type B obstruction of TM

Front 73

Pupillary block due to tumescence and enlargement of lengs, forcing iris and ciliary body into anterior chamber is known as

Back 73

Phacomorphic glaucoma

Front 74

Malignant glaucoma occurs when

Back 74

forces posterior to lens (vitreous pressure) pushes the iris diaphragm forward. SEe contact between lens equator and ciliary body

CANNOT benefit from iridotomy

Front 75

T/F Malignant glaucoma is treated with iridotomy

Back 75

FALSE

does not help

Treat with hyperosmotics, atropine (indefinitely), b-blockers, CAI, Chandler's procedure, etc

Front 76

Symptoms:
Pain
photophobia
halo
blur
abdominal pain
vomiting
RED EYE
Partial mydrasis
EXTREMELY high IOP

Likely diagnosis?

Back 76

Acute angle closure- stage 1

sudden extreme IOP elevation > 50


if pupils are small and no mydriasis exists, it is probably only uveitis

Front 77

Immediate treatment of Acute angle clusre

Back 77

Iridotomy
B-blocker+ alpha 2 adrenergic+ topical CAI
Oral CAIs
Analgesic and anti0emetic
topcial steriod
SUPINE position 1 hour followed by miotic

Front 78

T/F Miotics do not work on iris sphincter when IOP > 40

Back 78

T

due to ischemia and paralysis of sphincter
this is why you do not give a patient a miotic for the first hour with acute angle closure

Front 79

Stage 2 of acute angle closure, expect to see IOP

Back 79

< 35 or by 25% of presentiong IOP

if not, give 50% glyerol or 20% mannitol

Front 80

Idiopathic inflammaiton involving the orbita apex is known as

Back 80

Oribtal apex syndrome

Front 81

T/F Orbital apex syndrome involves pain behind globe, + APD, and marked restriction of ocular motlity

Back 81

T

Front 82

Tolosa-Hunt syndrome is a specific form of apical idiopathic inflammation involving the superior orbital fissure and the

Back 82

CAVERNOUS syinus

rapid progression
acute onset

Front 83

If a patient has pain behind globe, multiple cranial nerve involvement (KEY DIAGNOSIS), eyelid edema and congunctival chemosis unilaterally with an APD it is probably what syndrome?

Back 83

Tolosa Hunt

Front 84

Monofixation snydrome is tested with

Back 84

4 pd base out.
Patient does not maintain binocular vision so there is no fusion of eyes. Patient has a central suppression scotoma

Front 85

Giant paving stone papillae are often seen with this kind of conjunctivitis

Back 85

vernal

Front 86

treatment for vernal conjunctivitis

Back 86

prednisolone acetate qid
erythromycin tid
lodoxamide qid
scopolamine bid
artifical tears
coolr compress

Front 87

Traumatic optic neuropathy occurs in approximately __% of head trauma cases

Back 87

3%

Front 88

What is the most common cause of optic nerve trauma?

Back 88

motor vehicle and bike accidents

Front 89

Direct optic nerve trauma is usually caused by

Back 89

falling onto a pointed object

Front 90

T/F Optic Nerve Trauma always has an APD present

Back 90

T

Front 91

The complete disinversion of the entire optic nerve is known as ____ and there is a total APD present, as well as widesprea retinal infarction

Back 91

Optic nerve avulsion.
Follows a diffuse impact on globe or injury from a blunt instrument.

occurs when there is partial or complete tearing of the optic nerve from the globe at the level of the lamina cribrosa.

Front 92

T/F Anterior optic neuropathies occur more frequently that posterior indirect optic neuropathies

Back 92

FALSE

Posterior indirect occurs more often than either direct or indirect anterior optic neuropathies

-damage typically due to fracture of sphenoid which damages intracanicular section of the ON

Front 93

T?F young males tend to have ore posterior indirect optic neuropathies

Back 93

T

follows blow to face, forehead or temporal

Front 94

T/F Fundus of patient with posterior indirect optic neuropathies appear normal

Back 94

T

optic atrophy supervenes only after weeks have past

Front 95

Choice of imaging orbits and head in trauma cases

Back 95

CT

Front 96

International Optic Nerve Traumma study found that

Back 96

no clear enefit was found for either corticosteriod therapy or optic canal decompresion surgery

Front 97

If patient has an aneurysm in the pshenoid sinus, patient will have ____ and loss of vision

Back 97

Epistaxis (nosebleed)

Front 98

The ABC's of orbital injuries

Back 98

Priority:
establish an AIRWAY,
control for BLEEDING,
restore CIRCULATION

Front 99

During an orbital injury, if any reduction in eye movement is present, this test should be performed to distinguish entrapemtn and muscle contusion from paresis

Back 99

Forced duction

Front 100

Emphysema and crepitus could suggest what type of fracture?

Back 100

paranasal sinus

Front 101

Anosmia is the loss of this and can be an indication of a dural tear in the roof of the ethmoid sinus or cribiform plate

Back 101

smell

Front 102

The most common type of conventional radiography used for assessing orbital flor and rim is

Back 102

Water's conventional radiography

Front 103

What kind of images are taken with a CT

Back 103

3 mm axial and coronal images through the sella

Coronal images are crucial!!

Front 104

Approximate 1/3 to 1/2 of orbital blowout fractures are associated with fractures of

Back 104

lamina papyracae

Front 105

T/F Medial wall is thinner than the orbital floor and is a common site of blowout fractures

Back 105

FALSE

it is NOT a common site of blowout fractures because it has added support of ethmoid

Front 106

Zygomatic fractures are also known as _____ fractures because of the dislocation of the zygoma from frontal bone, arch, and maxilla

Back 106

tripod or tripartite

Do surgery if patient cannot open mouth or there is a lot of facial asymmetry

Front 107

Patients with blow-out fractures are put on a cours eof antibiotics to prevent

Back 107

orbital cellulitis

Front 108

T/F whited eye vlowout fractures are common in children who have marked motility restriction up and down, lack enopthalmous and have minimal soft tissue signs of trauma

Back 108

T must to surgery

Front 109

T/F MRI is senstitive to calcifiation

Back 109

FALSE

lacks fine cortical bone details

Front 110

T/F CT is cheaper than MRI

Back 110

T
has higher spatial rsultion and GREAT bone imaging

Front 111

Treatment for scleritis

Back 111

topcial steriods and cycloplegic, NSAIDS
FU 6 weeks

Front 112

A chronic problem where the cornea continuously gets injured. The desmosome and hemidesmosome junctions thus are not repairing correctly. This is known as

Back 112

Recurrent corneal erosion is the ANSWER in the test. they should be repairring but because they dont, and you get RECURRENT CORNEAL EROSION.

Front 113

What do you do when a patient comes in after getting something in their eye?

Back 113

THIS IS ON THE TEST: IDENTIFY THE POISON/CHEMICAL AND USE COPIOUS IRRIGATION

o Identify the problem, then irrigate.
o Some dusts cannot be washed away and must be dusted off away.
-Photochemicals CAN injury eyeball.

Front 114

or any corneal or anterior segment injuries base management includes

Back 114

Antibiotics and AntiInflammatory --> 4th generation quinolone antibiotic, CYCLOPLEGIA, STERIOD FOR 1-2 WEEK, Bandage contact lens, motrin

Front 115

CONTACT LENS ASSOCIATED ACUTE RED EYE CAN COMe FROM:

Back 115

TEST QUESTION All of the above with CLAARE.
Hypoxia, mechanical, toxic are ALL POSSIBLE MECHANISMS.

Front 116

Injury due to burn is known as

Back 116

Test: ESCHAR KERATOPATHY

BURN question=THE ANSWER IS ESCHAR!!!! USE BASE MANAGEMENT AND ALSO NEED TO GET RID OF DEAD TISSUE via DEBRIDEMENT.

Front 117

Test: Rust ring needs to be removed when foreign body is removed.
Ihe instrument of choice

Back 117

is a 27.5 inch needle in a half gauge syringe

Front 118

A PENETRATING INJURY leading to a D SHAPED PUPIL IS DUE TO

Back 118

BLUNT TRAUMA
see a
PEAKED PUPIL

Front 119

Approximately _% of injuries occur in workplace, mostly construction sites

Back 119

50

Front 120

The leading cause of blindess in young adults is due to

Back 120

trauma

Front 121

T/F Standardization Classification of ocular trauma is used to asses mechanical, chemical, electrical, and thermal ocular injuries

Back 121

FALSE

NO chemical, electrical or thermal injuries are assessed using this system

Front 122

An open globe, full thickness wound caused by a blunt object is known as

Back 122

a Rupture gloe

Front 123

A perforating injury involves _____ full thickness wounds (entrance and exit) of eye wall

Back 123

two

both wounds are caused by same agent

Front 124

A closed globe injury of the eye wall or bulbar conj that is caused by a sharp object whose wound is at the impact site is known as a ____ laceration

Back 124

lamellar

Front 125

The most prognostic basis of final visual outcome with an eye injury is

Back 125

VA!!

Grades the injury

Front 126

4 variables of ocular trauma the system is based on

Back 126

Type of injury
Grade of injury (VA)
Presence of RAPD
Zone of injury

Front 127

T/F While Using VA's to grade eye injuries, a grade of 4/200 to light perpection is the most severe

Back 127

T

Front 128

A VA of 20/50-20/100 following an eye injury implies that the injury is

Back 128

moderate

Front 129

A VA of 19/100-5/200 following an eye injury implies that the injury is

Back 129

severe

Front 130

The zone of injury with an open gloe injury is defined by the location of the most ________ full thickness aspect of the globe opening

Back 130

POSTERIOR

Front 131

A zone 1 open globe injury is limited to

Back 131

the cornea or corneoscleral limbus

Front 132

This zone of an open globe injury is limited to the anterior 5 mm of the sclera

Back 132

2

Front 133

Zone 3 of this type of injury extends the full thickness into the sclera more than 5 mm posterior to the limbus

Back 133

OPEN globe

Front 134

T/F You do not describe a closed globe injury as penetrating, perforating or ruptured globe

Back 134

T

no full thickness opening of the globe has occured

Front 135

Closed gloe injuries involve blunt force resulting in ________ injury, while sharp forces result in ____ injuries

Back 135

contusion

lamellar-lacerating

Front 136

Because closed globe injuies do not involve full thickness wounds, zones of injury are based on

Back 136

the tissues injuried

Front 137

Zone 1 closed globe injuries are limited to

Back 137

bulbar conj, sclera, or cornea

aka corneal abrasions, conj hemes, intracorneal FB

Front 138

This zone for closed globe injuries involes structures in anterior seg up to and including the lens, zonules, and pars plicata of ciliary body

Back 138

2

Front 139

Zone 3 of this type of injury inclues plars plana, choriods, retina, vitreous, or optic nerve

Back 139

closed globe

Front 140

When media opacity precludes the assessment of posterior structures following an eye injury, use a _______ to determine zone of injury

Back 140

B scan ultrasonography

Front 141

Damage caused by direct contact with eyeball by any blunt object is known as a

Back 141

contusion injury

Front 142

T/F a contusion injury refers to a blow NOT directly striking the eye, but more commonly, by a strike to the head

Back 142

FALSE
Concussion injury!

Front 143

Vossius' ring is a sign of

Back 143

iris change during ocular trauma

a mild concussion can cause scattering of IPE, leaves an imprint on lens capsul

Front 144

Iris changes during ocular trauma include

Back 144

Voissius ring
Acute anterior uveitis
Irdiodialysis (tear at iris root)
Iridoschisis (splitting of itis)
Sphincter tears

Front 145

When erythroytes settle into the anterior chamber, a _____ is formed.

Suspension of erythrocytes in aq is known as

Back 145

hyphema



microscopic hyphema

Front 146

T/F Re-bleeding is more severe than the initial hemorrhage

Back 146

T

Front 147

T/F Blacks and those with higher IOPs are more likely to experience seciary henirrhages

Back 147

T

Front 148

Initially IOP raises due to bleeding into a limited space and then pressure falls to subnormal levels during what traumatic event?

Back 148

Traumatic hyphema

IOP often remains low for several days due to shutdown of ciliary body function

Front 149

T/F microhyphema is visible without a slit lamp

Back 149

FALSE


use 3 mm wide beam

Front 150

Grade 4 hyphema

Back 150

total clotted hyphema

Front 151

When blood fills 1/2 of aq chamber its what grade?

Back 151

3

Front 152

Grade 2 hyphema

Back 152

blood fills 1/3-1/2 chamber

Front 153

Grade 1 hyphema has this much blood in chamber

Back 153

< 1/3 of chamber

Front 154

Duration of uncomplicated hyphema is

Back 154

5-6 days

pt presents with acute pain, reduced VA elevated IOP

Front 155

Meds for hyphema

Back 155

atropine TIB
prednisolone qid-q2h if no corneal defects
topical beta blocker or Alphagan P, if still high IOP give system CAI ad possibly IV mannitol


inpatient meds:aminocaprioc with an antiemetic

AVOID asprins or nsaids

Front 156

T/F ciliary Body trauam shows an increase in IOP

Back 156

FALSE

decrease aq production occurs and leads to hypotony

Front 157

When the ciliary body detaches from the sclera, it is known as

Back 157

cyclodialysis

Front 158

What type of glaucoma is gonio CONTRAINDICATED fors in the first few day?

Back 158

angle recession glaucoma. 71-86% ave hyphema and should no do gonio for the first few days to do change of bleeding into anterior chamber

Front 159

The most common cause of unilteral cataracts in youth is

Back 159

traumatic cataracs

Front 160

T/F The further back in the lens capsule the contusion cataract is located, the earlier the time of inury

Back 160

T

Front 161

The name of a traumatic cataract=

Back 161

Rosette

Front 162

What is the primary cause of retinal dettachment?

Back 162

A PVD

Front 163

A DIRECT rupture of the choroid is known as ______- and is a tear anteriorly at the site of injury oriented parallel to _______

Back 163

COUP

ora serrata

Front 164

T/F A Coup choroidal rupture occurs posteriorly away from the site of injury generally crescent in shape and concentrated with the optic nerve head

Back 164

FALSE

Contrecoup!!

Front 165

3-4 weeks after a choriodal rupture expect to see

Back 165

choriodal neovascualrization

treatwith photocoagulation

Front 166

A simultaneous brak in the choriod and retina resulting from a high velocity missile penetrating the orbit but not the globe is known as

Back 166

Chorioretinitis Sclopeteria

concussion type, nonpenetration
2 areas of injury: area adjacent to path of missile and macular area

Front 167

A macula hole is what color?

VA is usually around

Back 167

orange to red orange due to exposure of choriocapillaris

20/100-20/400

Front 168

Commotio Retinae is a transient _____ or opacification at the level of deep sensory retina after blunt trauma

Back 168

whitening! The blood vessels should still be visible over whitening because damage is DEEP. In CRAO, blood vessels are obscured

Front 169

T/F Blood vessels are visible over whitening of retina that occurs during commotio retinae

Back 169

T
The blood vessels should still be visible over whitening because damage is DEEP. In CRAO, blood vessels are obscured

http://www.opt.pacificu.edu/ce/catalog/10310-SD/Trauma%20Pictures/Commotio%20Retinae.jpg
versus
http://eyelearn.med.utoronto.ca/ClinicalSkills/images/Fundo12.jpg

Front 170

Retinal dialysis occurs _____% during traumatic retinal breaks

Back 170

53%

root to root break from otra to ora

Front 171

T/F Rhegmatogenous retinal detachment is the most common type of retinal detachment.

Back 171

T
t occurs when a break (tear or hole) in the retina allows fluid from the vitreous humor to enter the potential space beneath the retina. This causes the retina to separate from the layer beneath, known as the retinal pigment epithelium (RPE).

Front 172

This type of retinal detachment is most common in the advanced stages of diabetic retinopathy,

Back 172

Tractional retinal detachment occurs when fibrous membranes (essentially scarring processes) in the vitreous humor and retina produce mechanical traction on the retina, literally pulling the retina from the underlying layer, the retinal pigment epithelium (RPE).

Front 173

_______retinal detachment occurs with conditions that disturb the blood-retinal barrier, i.e., conditions that allow the build-up of fluid beneath the retina.

Back 173

Exudative

Front 174

3 Treatments of Retinal Detachments

Back 174

Scleral buckling
Pneumatic retinpexy
Vitrectomy

Front 175

Shaffer's sign

Back 175

PIGMENT in vitreous. Retinal detachment occurs as proliferation changes have begun

Front 176

After laser surgery what color are the spots initially?

Back 176

white, as they have not healed, then it turns into black spots.

Front 177

Treatment of Hydrops

Back 177

Lower IOP via CAIS
fit 1 week later with RGP
PK may be indicated