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30 Cards in this Set

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462. Open-angle glaucoma is characterized by what pathophysiologically?
a. Impaired outflow of aqueous humor from the eye.
b. Absence of symptoms early in course can lead to delay in diagnosis and “silent” progression.
463. Closed-angle glaucoma is characterized by what pathophysiologically?
a. Very rapid increase in IOP due to occlusion of narrow angle and obstruction of outflow of aqueous humor.
b. May be precipitated by dilation of the iris in a patient with the pre-existing anatomically narrow anterior chamber angle.
c. This is an ophthalmologic emergency that can lead to your irreversible vision loss within hours, if untreated.
464. Glaucoma risk factors?
a. Older age (over 50 years)
b. African-American race (increased incidence of open angle glaucoma)
c. Asian or Eskimo ancestry (increased incidence of acute angle closure glaucoma)
d. Family history of glaucoma
e. History is significant eye trauma or intraocular inflammation.
f. Steroid medications
465. Presentation of open-angle glaucoma?
a. Painless, increased IOP (may be the only sign-characteristic changes in optic nerve
b. Progressive and insidious visual field loss (usually sparing central vision until end-stage disease)
466. Presentation of closed-angle glaucoma?
a. Red, painful eye
b. Sudden decrease in visual acuity (blurred vision)
c. Seeing halos
d. Markedly elevated IOP
e. Nausea and vomiting (common)
f. Headache
467. How does the pupil appear with acute closed-angle glaucoma?
a. Dilated and nonreactive (in mid-dilation)
468. Diagnosis of glaucoma?
a. Tonometry
b. Ophthalmoscopy
c. Gonioscopy
d. Visual field testing should be performed in all patients in whom glaucoma is suspected and regularly in everyone with glaucoma to monitor disease progression.
469. Tonometry for glaucoma?
a. Tonometry measures IOP
b. Should be performed regularly in patients with or at risk for glaucoma
470. Value of ophthalmoscopy for glaucoma?
a. Evaluate the optic nerve for glaucomatous damage
471. Gonioscopy for glaucoma?
a. Gonioscopy is used to visualize the anterior chamber and helps determine the cause of glaucoma
b. It requires skill to perform
472. Treatment of chronic open-angle glaucoma (in escalating order)?
a. Topical medications: most patients are first treated topically with a β-blocker, α-agonist, carbonic anhydrase inhibitor, and/or prostaglandin analogue singly or in combination, to reach the target pressure.
b. Laser or surgical treatment for refractory cases.
473. Treatment of chronic closed-angle glaucoma?
a. An ophthalmic emergency- Refer to an ophthalmologist immediately.
b. Emergently lower the IOP.
c. Medical treatment includes:
1. Pilocarpine drops
2. IV acetazolamide
3. Oral glycerin.
d. Laser or surgical iridectomy is a definitive treatment.
474. Goal of treatment of open-angle glaucoma?
a. Control IOP, and thereby prevent damage to the optic nerve and visual field.
475. What is the most common cause of non-reversible blindness in African-Americans?
a. Glaucoma
476. Other symptoms that may be seen w/angle-closure glaucoma?
a. Severe abdominal pain and nausea
b. They are occasionally misdiagnosed as having an acute surgical abdomen (e.g., appendicitis)
477. Prevalence of cataracts?
a. Half of people over age 75 have cataracts
478. Pathophys of cataracts?
a. Opacification of the natural lens of the eye.
b. There is loss of visual acuity that progresses slowly over many years.
479. What may patients complain of with cataracts?
a. Glare and difficulty driving at night.
480. Risk factors for Cataracts (9)?
1. Old age
2. Cigarette smoking
3. Glucocorticoid use
4. Prolonged UV radiation exposure
5. Trauma
6. Diabetes
7. Wilson’s disease
8. Down syndrome
9. Certain metabolic diseases
481. Cataract treatment?
a. Surgery is the definitive treatment and is very effective in restoring vision.
b. It is indicated if visual loss is significant to the patient and interferes with daily or occupational activities.
c. It involves extraction of the cataract w/implantation of an artificial intraocular lens.
482. “Second sight”?
a. Some patients with cataracts become increasingly nearsighted and may no longer require reading glasses.
b. This is referred to as “second sight”
c. This phenomenon is due to increased refractive power of the lens of the eye caused by the cataract
483. Use of steroid eye drops?
a. In general, steroid eye drops should be given by an ophthalmologist.
484. General characteristics of red eye management?
a. Many causes of red eye are benign, the initial goal in evaluation should be to identify the conditions that require referral (emergent or non-emergent) to an ophthalmologist.
485. Most common cause of red eye?
a. Conjunctivitis, but always attempt to exclude other, more serious causes.
486. Redeye conditions that require a referral to an ophthalmologist?
a. I pain. It does not respond to therapy
b. Flashers, floaters, or a sudden decrease in visual acuity
c. Corneal opacification, corneal ulcer, or corneal foreign body that cannot be removed.
d. History of penetrating trauma or significant blunt trauma.
e. History of chemical exposure (especially alkali agents)
f. Orbital Cellulitis
487. Exam for redeye?
a. Always check visual acuity, pupil size, and reactivity.
b. Evert eyelids to look for foreign body.
488. 10 items in the differential diagnosis of Red eye?
1. Conjunctivitis
2. Subconjunctival hemorrhage
3. Keratoconjunctivitis sicca (dry eye)
4. Acute angle closure glaucoma
5. Blepharitis
6. Episcleritis
7. Scleritis
8. Acute anterior uveitis
9. Herpes simplex keratitis
489. Subconjunctival hemorrhage cause?
a. Caused by rupture of small conjunctival vessels
b. Usually induced by:
1. Valsalva maneuver (coughing, straining with shitting, vomiting)
2. Trauma
3. Coagulopathies or HTN (less commonly)
490. Presentation and prognosis of subconjunctival hemorrhage?
a. Causes focal unilateral blotchy redness of the conjunctiva (looks worse than it is)
b. Usually self-limiting and resolves in a few weeks
491. Keratoconjunctivitis sicca (dry eye) causes?
a. Very long differential diagnosis, including:
1. Medications i.e. Anticholinergics or antihistamines
2. Sjogren's syndrome
3. CN V or VII lesions.