Ophthalmology Test Fall 2009

Front 1

Clinical features of a blow-out fx

Back 1

#1
Patients present with swelling and misalignment. Movement of the globe is restricted, specifically an inability to look up due to entrapment of the infraorbital nerve and the musculature.
#2
Double vision is common.
#3
Subcutaneous emphysema and exophthalmos are present

Front 2

treatment of a blow-out fx

Back 2

* Prompt referral to an ophthalmologist is important.
* Patients should be kept calm and avoid sneezing or anything that would increase pressure.
* Nasal decongestants, ice packs or cold compresses, and antibiotics are started during transport.

Front 3

S/S of retinal detachment

Back 3

*
The patient may report acute onset of blurred or blackened vision that occurs over several hours and progresses to complete or partial monocular blindness.
*
It is classically described as a curtain being drawn over the eye from top to bottom.
*
The patient may sense floaters or flashing lights at the initiation of symptoms.

Front 4

Treatment for retinal detachment

Back 4

*
An emergency consult with an ophthalmologist regarding possible laser surgery or cryosurgery is needed.
*
Patients with retinal detachment should remain supine, with the head turned to the side of the retinal detachment.
*
Prognosis is good: 80% will recover without recurrence, 15% will require retreatment, and 5% will never reattach.

Front 5

General characteristics of retinal detachment

Back 5

*
The underlying pathogenesis is a separation of the retina from the pigmented epithelial layer, causing the detached tissue to appear as flapping in the vitreous humor.
*
The tear usually begins at the superior temporal retinal area.
*
The tear can happen spontaneously or be secondary to trauma or extreme myopia.

Front 6

S/S of cataracts

Back 6

Gradually decreasing best corrected acuity
More glare at dusk and dawn
Decreased contrast with a “washed out” image
Pinholing frequently increases contrast and acuity

Front 7

Chief Complaint: Gradual loss of central vision with or without waviness or distortion

Back 7

Macular degeneration

Front 8

The Amsler grid is used to help diagnose?

Back 8

macular degeneration

Front 9

Drusen deposits are associated with?

Back 9

macular degeneration

Front 10

2 types of macular degeneration

Back 10

Wet - Exudative (wet) form represents new vessel growth beneath the macula that can leak and bleed; 10% of all AMD cases

Dry - 10% Atrophic (dry) form represents a thinning and wasting disease of the macula

Front 11

risk factors for macular degeneration

Back 11

Age, 15% incidence over 43, 30% incidence over 75
Smoking, 2-5x greater incidence than non-smokers
Chronic UV exposure
Ethnicity – people with fair complexions are at > risk
Fruit and vegetable deficient diet
Cardiovascular disease
Diabetes

Front 12

Action of pilocarpine on muscles of the iris and cilia

Receptor that mediates this action:

Back 12

Constriction of the muscles

Muscarinic cholinoreceptor

Front 13

Open-angle glaucoma is a disease caused by?

Back 13

obstruction of the outflow of aqueous humor into the canal of Schlemm, causing an increase in intraocular pressure

Front 14

what is the immediate treatment for angle closure glaucoma?

Back 14

Acetazolamide 500mg IV

Front 15

What is blepharitis

Back 15

A common chronic bilateral inflammatory condition of the lid margins

Front 16

How is anterior blepharitis treated?

Back 16

Controlled by cleaning the lid margins, eyebrows, and scalp

Scales should be removed daily w/hot washcloth or damp cotton applicator and baby shampoo.

Acute exacerbation - bacitracin or EES ointment

Front 17

What is anterior blepharitis?

Back 17

Involves the eyelid skin, eyelashes, and associated glands.
May be ulcerative, because of staph or seborrheic in association w/seborrhea of the scalp brows and ears.

Front 18

What is posterior blepharitis?

Back 18

It results from inflammation of the meibomian glands.
May be bacterial, particularly staphylococci, or primary glandular dysfunction - strong relation to acne rosacea

Front 19

What is a hordeolum?

Back 19

Also called a stye

A staph abscess the is characterized by a localized red, swollen, acutely tender area on the upper or lower lid.

Front 20

How is a hordeolum treated?

Back 20

Warm compresses

Incision if resolution does not begin in 48 hours

Bacitracin or EES ointment q3h may be helpful during the acute phase

Front 21

Internal hordeolum may lead to?

Back 21

Generalized cellulitis

Front 22

What is a chalazion?

Back 22

A lipogranuloma of either a meibomian gland or a Zeis gland.

It may follow an internal hordeolum

Front 23

Dacryocystitis

Back 23

an inflammation of the lacrimal gland caused by obstuction.

Front 24

Dacryocystitis treatment

Back 24

warm compresses and antibiotics

Front 25

Common pathogens seen with dacryocystitis

Back 25

Staph aureus, B-hemolytic strep, Staph epidermidis and Candida

Front 26

Dacryocystitis S/S

Back 26

Pain, swelling, tenderness, redness, and purultent discharge

Front 27

Bacterial conjunctivitis common pathogens include

Back 27

S. pneumoniae,
S.aureus,
H. aegyptius,
Moraxella sp.

Front 28

Bacterial conjunctivitis Rare pathogens include

Back 28

Chlamydia trachomatis and Neisseria gonorrhea.

Front 29

Bacterial conjunctivitis clinical features

Back 29

characterized by the acute onset of copious, purulent discharge from both eyes.

Patients may have a mild decrease in visual acuity and mild discomfort. The eyes may be “glued” shut on awakening.

Front 30

Bacterial conjunctivitis treatment

Back 30

* Specific therapy includes
application of topical antibiotics.

* For the rare pathogens, treatment also may require concurrent systemic antibiotics.

Front 31

Viral conjunctivitis common pathogens include

Back 31

adenovirus type 3, 8, or 19.

Front 32

Viral conjunctivitis clinical features

Back 32

characterized by acute onset of unilateral or bilateral erythema of the conjunctiva, copious watery discharge, and ipsilateral tender preauricular lymphadenopathy.

Front 33

Viral conjunctivitis general characteristics

Back 33

usually caused by adenovirus type 3, 8, or 19.

highly contagious. Transmission is by direct contact, usually via the fingers, to the contralateral eye or other persons.

can be transmitted in swimming pools (epidemic keratoconjunctivitis), and it is most common in midsummer to early fall.

Front 34

Treatment for viral conjunctivitis

Back 34

* Eye lavage with normal saline twice a day for 7–14 days; vasoconstrictor-antihistamine drops also may have beneficial effects.

* Hot compresses reduce discomfort.

* Ophthalmic sulfonamide drops may prevent secondary bacterial infection but are not routinely prescribed.

Front 35

Herpes zoster opthalmicus Treatment

Back 35

oral antiviral drugs, mydriatics, and topical corticosteroids

Front 36

Herpes zoster opthalmicus S/S

Back 36

may be intense and include dermatomal forehead rash and painful inflammation of all the tissues of the anterior and, rarely, posterior structures of the eye

Front 37

General characteristics of Orbital cellulitis

Back 37

S. aureus, S. pneumoniae, and H. Influenza are the most commonly involved organisms.

Ethmoidal sinusitis is claimed to be source of as much as 80% of all orbital cellulitis cases

Front 38

Orbital cellulitis clinical features

Back 38

ptosis, eyelid edema, exophthalmos, purulent discharge, and conjunctivitis

Examination will reveal fever, decreased range of motion in the eye muscles, and a sluggish pupillary response.

Front 39

Laboratory studies for Orbital cellulitis

Back 39

CBC, blood cultures, and cultures of any drainage.

Sinus radiography and CT
Visual acuity, External, Ocular motility
Nasal culture

Front 40

S/S of orbital cellulitis

Back 40

Frequently associated hordeolum, sinusitis, periodontitis
Proptosis, diplopia and fever/malaise indicate progression to orbital infection

Front 41

Management of orbital cellulitis

Back 41

High dosage IV antibiotics (ticarcillin/clavulanate)‏

Front 42

Take Home Pearl: A painful, immobile, bulging eye with hot, swollen lids needs admission and IV antibiotics

Back 42

memorize this!

Front 43

TWO true ocular emergencies are?

Back 43

Chemical splashes 
Central retinal artery occlusion

Front 44

Chief Complaint with central retinal artery occlusion

Back 44

Sudden onset of painless, profound loss of vision in one eye

Front 45

Signs & Symptoms of central retinal artery occlusion

Back 45

Finger counting to light projection or perception acuity
Minimal peripheral field
Marked ipsilateral afferent pupil defect
Characteristic “cherry-red spot” retinal appearance without hemorrhaging
Significant arteriolar constriction and segmentation

Front 46

Typical time of obstruction with central retinal artery occlusion

Back 46

midnight to 6:00 am

Front 47

central retinal artery occlusion is non-reversible after?

Back 47

90-120 minutes

Front 48

Management:of :central retinal artery occlusion, if <1 hour since symptoms

Back 48

Digital Massage—apply pressure for 30 seconds followed by 30 seconds off for 10-15 minutes if patient presents within first hour of obstruction
Acetazolamide 500mg IV or PO
Paracentesis
Odds are still about 50/50 of any significant improvement in visual function
No other proven treatment methods

Front 49

first symptom with open angle Glaucoma

Back 49

Loss of peripheral vision, usually worse in one eye

Front 50

Optic nerve head appears ____ via ophthalmoscope with open angle glaucoma

Back 50

pale and depressed

Front 51

Risk factors for open angle Glaucoma

Back 51

Family history—sibling, maternal, and paternal in order of importance
Age—population risk in general is 0.5%, by the 80s is 15-20%
Race—African-Americans have a 6-10x greater risk compared to those of European heritage
Intraocular pressure—average IOP is 16mmHg
<21mmHg risk is 1/1000
>21mmHg risk is 1/10
>30mmHg risk is 1/2

Front 52

Primary Open Angle Glaucoma
Management:

Back 52

Lowering intraocular pressure is the only method of glaucoma treatment currently

First line of treatment is topical medication
If lower pressures are needed, argon laser trabeculoplasty can help in conjunction with medications

Front 53

Topical Medications--four main groups used for open angle glaucoma

Back 53

Prostaglandin analogs
Carbonic anhydrase inhibitors
Alpha agonists
Beta blockers

Front 54

Optic Neuritis presentation

Back 54

Sudden, severe, unilateral vision loss after 1-3 days of tenderness exacerbated by palpation

Front 55

Ischemic Optic Neuropathy presentation

Back 55

Sudden, unilateral, painless vision loss—usually altitudinal –either superior or inferior, not both

Front 56

Papilledema presentation

Back 56

Headache, nausea, vomiting with other focal neurological symptoms. Transient visual obscurations may be a part of the chief complaint. Vision usually isn’t affected that much

Front 57

Papilliedema is always?

Back 57

bilateral

Front 58

“drill going thru my head, centered right on my eye” Comes in waves of pain. This is associated with?

Back 58

Angle closure glaucoma

Front 59

Chief Complaint: Intense, boring headache centered on affected eye with steamy vision and colored halos around light sources. What is the cause?

Back 59

Angle closure glaucoma

Front 60

most common source of infant conjunctivitis progressing to meningitis is by what organism?

Back 60

H. influenza

Front 61

What medication should you never start with corneal ulceration unless you have instruction from an OD/MD?

Back 61

Steroids