Session 4 Er -1- Intro And Eye

Front 1

What is required for a hospital to be considered trauma 1

Back 1

24hr availability of all subspecialties

Front 2

Pt has mucopurulent discharge and inflammation of the conjunctiva and their eyes are stuck together what do they have going on

Back 2

Bacterial Conjunctivitis

Front 3

What is the best tx for bacterial conjunctivitis

Back 3

Poly-Trim opth gtts

Front 4

If your pt has bacterial conjunctivitis and is a contact wearer what do you need to add coverage for

Back 4

pseudomonas with quinolone

Front 5

If you suspect the bacterial conjunctivitis is caused by neisserial what tx should you give

Back 5

urgent referral and Rocephin IM and oral doxy to cover for possible concomitant chlamydial infection

Front 6

Pt has recently had an URI and now has an eye infection what is the likely etiology

Back 6

viral

Front 7

What is the tx for viral conjunctivitis

Back 7

cool compresses, naphcon A, artificial tears

Front 8

Patient has ocular discharge and itching what are they likely suffering from

Back 8

allergic conjunctivitis

Front 9

What is the tx for allergic conjunctivitis

Back 9

Cool compresses, Topical antihistamines/decongestants/mast cell stabilizers

Front 10

Pt has dendrites that show up on fluorescein staining of the cornea what are they likely suffering from

Back 10

HSV keratitis

Front 11

Why don't you want to miss HSV keratitis

Back 11

it can progress to corneal scarring and requires prompt tx with antiviral (Viroptic) if outbreak is less than 4 days old could also use acyclovir

Front 12

T/F steroids are helpful in tx of HSV keratitis

Back 12

F NO topical steroids

Front 13

IF pt presents with shingles on their face what do you need to do

Back 13

make sure you do an eye exam looking for herpes in the cornea

Front 14

What is the most common cause of preseptal/periorbital cellulitis

Back 14

staph aureus

Front 15

T/F preseptal cellulitis is most common in adults

Back 15

F it is most common in kids

Front 16

T/F preseptal cellulitis has extensive involvement of the eye its self

Back 16

F eye itself is not involved but the structures surrounding the eye are

Front 17

Would you send a kid home if they came in with a preseptal cellulitis

Back 17

no admit them for IV Ab and pediatric consult

Front 18

what is the difference between orbital cellulitis and preseptal cellulitis

Back 18

orbital cellulitis will have involvement of the eye. EOM impairment, pain, fever, proptosis where preseptal cellulitis will not have these findings

Front 19

How can you detect a corneal ulcer

Back 19

use fluorescein dye

Front 20

Why do you need to aggressively treat a corneal ulcer

Back 20

if it is caused by pseudomonas it can destroy a cornea in 6-12 hrs tx with topical fluoroquinolone

Front 21

Pt has come in for the third time with an unexplained subconjunctival hemorrhage what may this indicate

Back 21

may be first indication that their INR is out of whack from anticoagulants

Front 22

You have just put fluorescein dye in your pt eye and see vertical scratches you suspect a corneal abrasions what should you do apart from looking in the eye itself

Back 22

flip the eyelid with a cotton swab

Front 23

T/F every corneal abrasion needs to be patched for proper healing

Back 23

F abrasion will heal with or without patch abrasions from organic sources have potential for fungal infections don't patch them

Front 24

IF pt has a corneal foreign body how can you remove it

Back 24

use an 18gauge needle and scrape it out gently

Front 25

If the foreign body was metal and it has left a rust ring what do you need to do

Back 25

drill or buff out the rust ring

Front 26

T/F a lid laceration less than 1mm will heal on its own

Back 26

T they don't need stitching

Front 27

If the lid laceration is a full thickness laceration what needs to happen

Back 27

Pt needs referral to have ophthalmologist repair within 24hrs

Front 28

If a pt has a blunt trauma of the face and a hyphema present what do you need to get

Back 28

ophthalmology consult.

Front 29

If you do a EOM test on a pt with a blunt trauma and they can't look up what might be happening

Back 29

entrapment of the eye because of a blowout fracture

Front 30

T/F the pupil peaks away from the site of penetration or rupture of the globe

Back 30

F it peaks toward site of penetration or rupture

Front 31

What is the first test you should perform on a stable pt with blunt trauma

Back 31

visual acuity

Front 32

If you suspect a ruptured globe what should you do for the pt

Back 32

get an emergency consult and metal shield check tetanus and get them IV Ab

Front 33

Where is the most common location for a blowout fracture

Back 33

inferior wall and medial wall

Front 34

What x-ray view is best for visualization of blowout fx

Back 34

water's view

Front 35

Is a blowout fracture an emergency or outpt referral

Back 35

outpt referral generally

Front 36

T/F a chemical injury to the eye is urgent not an emergency

Back 36

F it is an emergency especially alkali burns because they are generally not painful and can rapidly penetrate the cornea and damage the iris/lens

Front 37

What is the tx for chemical splash in the eye

Back 37

irrigate, irrigate, irrigate check ph and irrigate some more until ph is 7.5-8 then check for particulate matter, corneal clouding, or epithelial defects

Front 38

What is a common cause of spontaneous hyphema

Back 38

sickle cell anemia

Front 39

Pt present with a hyphema what do you want to check

Back 39

elevate pts head and check IOP instill mydriatic to avoid pupillary play

Front 40

What education should you give a pt about hyphema before sending them home

Back 40

that it may rebleed in 3-5 days and if so IOP could increase needing a surgical wash out of anterior chamber

Front 41

You perform a slit lamp exam on a pt and notice superficial punctate keratitis what is the likely cause

Back 41

UV damage to the eye from welding, sun tanning, or Snowblindness

Front 42

What is the tx for UV keratitis

Back 42

cycloplegic, Ab ointment, oral analgesic consider a pressure patch and refer to ophthalmologist

Front 43

Pts presents with cloudy vision, eye ache/pain, HA and N/V You check the IOP and find that it is 50 what is likely going on

Back 43

acute angle closure glaucoma

Front 44

What is the tx for acute angle closure glaucoma

Back 44

miotics (pilocarpine), reduce aqueous humor formation with beta blockers (Timoptic), Alpha agonist (loridine), and carbonic anhydrase inhibitors (acetazolamide) and reduce vomiting volume with mannitol

Front 45

pt complains of HA and sensitivity when they touch the side of their head they are a 65 y/o female with fever, fatigue and anorexia

Back 45

Temporal Arteritis

Front 46

What is the tx for temporal arteritis

Back 46

IV steroids, and Ophthalmology Consult for temporal artery biopsy

Front 47

What cranial nerve is affected in bells palsy

Back 47

CN 7 Facial nerve

Front 48

What is the tx for bell's palsy

Back 48

eye lubricants, consider oral steroids or antiviral (acyclovir) and refer to ophthalmologist for cornea monitoring

Front 49

What is Horner's syndrome

Back 49

ipsilateral ptosis, myosis, and anhidrosis from interruption of sympathetic nerve innervation

Front 50

IF pt has Horner's syndrome and neck pain what do you need to r/o

Back 50

carotid artery dissection

Front 51

Pt has papilledema what does this indicated typically (in general)

Back 51

Increased intracranial pressure

Front 52

What conditions can cause papilledema

Back 52

malignant HTN, pseudotumor cerebri, intracranial tumors, hydrocephalus

Front 53

If pt has unilateral papilledema what is the likely cause

Back 53

Optic nerve edema, papillitis not from elected ICP

Front 54

What is the tx for pseudotumor cerebri

Back 54

weight loss, serial Lumbar Punctures, and diuretics