Heent

Front 1

what is the vital sign of the eye, how do you test for it?

Back 1

visual acuity, it is determined by teh smallest line a patient can read w/ one half of the letters correct; if someone can't read eye chart, do finger-counting at 3 feet, hand motion at 2 feet, or light perception

Front 2

how to test for hysterical blindness

Back 2

test for optokinetic nystagmus and palcing thick balck lines about 1in apart on a 2ft strip of monitor paper and is pased back and forth at eye level about 1 foot from patient

Front 3

what causes monocular diplopia?

Back 3

corneal irregularity, lens problem, or malingnerng

Front 4

tear-drop shaped pupil usually indicates what?

Back 4

prolapse of iris due to trauma nad rupture of iris

Front 5

if you find an afferent pupillary defect, what could that indicate?

Back 5

optic neuritis or central retinal artery occlusion

Front 6

steps of thorough eye exam

Back 6

visual acuity

confrontational eye fields

EOM

pupillary reactions

lids and adnexa

slit lamp

IOP

funduscopic exam

Front 7

OD vs OS:

Back 7

OD - right eye

OS - left eye

Front 8

adjusting slit of light for slit lamp

Back 8

adjust to the height of cornea and width of aprox 1mm

Front 9

what do you look for in the corneal slit lamp exam:

Back 9

follicles (allergic and viral conjunctivitis), chemosis (subconjunctival edema) infection/inflammation, discharge, trauma, foreight body

Front 10

how to look at cornea in slit lamp

Back 10

angle light at 45 degrees from optics

Front 11

how to test depth of ant chamber

Back 11

shine oblique light or pen light while looking through optics; if shadow is cast by bulging iris then it is a shallow anterior chamber

Front 12

how to look for cells and flare in the anterior chamber:

Back 12

1) narrow beam to 1mm

2) shut off room lights and set high magifiication to your optics

3) place light source at 45 degrees to optics (like in cornea testing)

4) place light source at border of pupil and focus on cornea

5) slowly advance forward till your between cornea and iris, and you might see cells floating in aqueous like snowlfakes in car beam

Front 13

what condition do you often see hypopyon, WBC, and flare in anterior chamber?

Back 13

iritis

Front 14

what is flare?

Back 14

described as headlights in a fog, when you see the path of light thru ant chamber

Front 15

layers of RBC in the ant chamber is called what?

Back 15

hyphema

Front 16

what is iridodialysis:

Back 16

when iris is pulled away from ciliary body, pupil is compressed and appears as slit at apex of iridodialysis, can appear "D" shaped pupil

Front 17

when should you never test for intra-ocular pressure:

Back 17

when globe rupture is suspected bc pressing on globe can worsen extrusion of intraocular contents

Front 18

normal intra-ocular pressure:

Back 18

10-20mm Hg

Front 19

the only way to differnetiate pre and post septal cellultis

Back 19

with CT scan

Front 20

which is worse, pre or post septal cellultis

Back 20

post-septal (orbital) is worse than pre-septal (periorbital)

Front 21

what is one physical exam way to differentiate pre and post septal cellultis

Back 21

by visual acuity and pupillary reaction, which are maintained in periorbital, as well as painless ocular movement which is also maintained

Front 22

abx to use for conjunctivits if is or is not a contact wearer

Back 22

no contacts - erythromycin ophthalmic ointment

contact wearer - cipro or tobramycin

Front 23

treatment of stye

Back 23

erythromycin eye drops and warm compresses

Front 24

important thing to do in exam of conjuncctivits:

Back 24

exam w/ flourescin to avoid missing herpetic dendrite

Front 25

treatment of viral conjunctvitis:

Back 25

ocular decongestants - Naphcon A

artificial tears - 5-6 times a day

Front 26

treatment of hsv keratitis

Back 26

topical acyclovir derivatives (Viroptic), NO steroids

Front 27

what is herpes zoster ophthalmcius and treatment?

Back 27

shingles involving V1 of trigeminal nerve; treatment is acylcovir, possibily topical steroids w/ ophthalmc consultation

Front 28

treatment for corneal uclers:

Back 28

emergent ophto consult to scrap ulcer and culture and institution of abx should be considered, but if not start:

1) Cipro drops every hour

2) cyclopegic drops such as cyclopentolate 1% to relieve pain from associated iritis

3) DO NOT patch the eye, because pseudomonas can melt the cornea, yikes

4) see opthalmologist in 12-24 hours

Front 29

diagnosis of iritis/uveitis

Back 29

typical history and cell and flare on slit lamp exam

Front 30

DDx of iritis:

Back 30

systemic dz - rheumatic, UC, reiter syndrome, behcet, sarcoid, JRA, ankylosing spondylitis

infection dz - TB, lyme, HSV, varciella, syphyllis, adonovirus

Malignancy - lymphoma / leukemia / melanoma

Trauma - corneal foreign body, blunt trauma, welding (UV light)

Front 31

treamtent of irits / uveitis:

Back 31

blocking pupillary sphincter and spaspsm w/ long acting cyclopligic (homatropine) and f/u w/ ophtho in 1-2 days

Front 32

most frequent cause of endophthalmitis:

Back 32

post surgical or penetrating trauma of globe like from grinders, weed-wackers

Front 33

diagnosed of endophthalmitis , and treatment

Back 33

it's usually suspected w/ history of trauma and uveitis, eye pain, chemosis, hypopyon, scleral injection ect.

tx - aspiration of virterous and pars plana vitrectomy, and intravitreal abx and steroids and systemic abx and admission

Front 34

most common cause of viterous hemorrhage :

Back 34

diabetic retinopathy, posterior vitreous detachment in elderly, ocular trauma such as shaken baby syndrome

Front 35

vitreous hemorhage history:

Back 35

painless vision loss, black spots, cobwebs, hazy vision

Front 36

test for globe rupture w/ fluorescein stain is called:

Back 36

seidel test

Front 37

superfiical conjunctival abrasion treatment:

Back 37

erythromycin eye drops for 2-3 days

Front 38

symptoms of corneal abrasion:

Back 38

intense pain, tearing, phoophotbia, foreign body sensation

Front 39

exam for corneal abrasion:

Back 39

cell and flare if it's a large abrasion and >24 hours old, bright green on fluorescin stain

Front 40

a series of linear, fine-lined corneal abrasions suggest what?

Back 40

foreign body imbedded in the tarsal conjunctiva of the upper lid

Front 41

treatment of corneal abrasion:

Back 41

1) THE mainstay - cycloplegia and reduction of ciliary spasm - cyclopentolate 1% of homatropine 5%) every 6-8 hours

2) topical NSAID such as ketorolac

3) topical abx - cipro of contact wearers, erythromycin if not

optho f/u in 24 hours if central visual axis effeted, in 48 hours if not

Front 42

treatment for UV keratitis:

Back 42

usualy begins 6-12 hours after exposure w/ foreign body sensation ,tearing, blurry vision

Tx - cycloplegia, topical erythromycin, and oral analgesics; healing will occur in 24-36 hours

Front 43

when a metallic foreign body has been in the corena for a few hours, what develops

Back 43

a visible rust ring around the piece of metal

Front 44

how to remove corneal foreign body:

Back 44

1) apply topical anesthetic (0.05% properacaine)

2) irrigate w/ normal saline as some foreign bodies are superficial and will come off

3) try dislodging it w/ moisten cotten tip applicator

4) if that doesn't work, insepct w/ slit lamp to make sure it's not full thickness corenal foreign body

5) use 25g needed bevel up under slit lamp, dislodge it

Front 45

what eyelid lacs require optho repiar:

Back 45

1) involve the lid margins

2) within 6mm of medial canthus or involing lacrimal duct or sac

3) inner surface of eyelid

4) wounds associated w/ ptosis

5) involving tarsal plate or levator palpebrae

Front 46

how to repair uncomplicated partial thicness lid lacs in ED:

Back 46

Use 6-0 or 7-0 absorbable suture

Front 47

how to you evaluate blunt trauma to eye:

Back 47

1) pry it open w/ paper clips bent

2) look for flatness of anterior chamber - if it is than it's ruptured

3) hyphema - consult optho

4) check upward gaze - if limited get Ct to r/o blowout fracture

5) do flourescin exam

traumatic iritis is common in blunt trauma

Front 48

sponteaneous hymphemas are associated w/ what?

Back 48

sickle cell dz

Front 49

treatment of hyphema:

Back 49

1) elevate bed so person is sitting up

2) after discussion w/ ophtho, dilate pupil to prevent "pupillary play"

3) Give topical BB, IV mannitol, A-adrenergic agnoist (apraclonidine) and PO/topical/IV carbonic anhydrase inhibitors. ***DO NOT GIVE CAI in sickle cell patients

Front 50

how to treat blowout fracture

Back 50

If there's no entrapment --> refer to pthamology for reapir within next 3-10 days and consider thin slice CT scan of orbit

Front 51

where does the globe tend to rupture in blunt trauma

Back 51

limbus and at the insertion of extraocular muscles

Front 52

What iop to consider lateral canthotomy I'm retrobulbar hematoma

Back 52

Iop > 40

Front 53

Lens used to irrigate eye

Back 53

Morgan lens

Front 54

How to remove crazy glue (cyanoacrylates) from eye

Back 54

Apply lots if erythromycin eye drop to eye and the clumps should losen

Front 55

Treatment of acute angle closure glaucoma

Back 55

Block production :

Topical BB - timolol 0.5% 1 drop

Alpha agonist - apraclonidine 1% 1 drop

CAI - acetazolamide 500mg po

Facilitate outflow:

Parasym mitotic - pilocarpine 1% 1 drop every 15 min

iv mannitol works great 1-2 g/kg

Front 56

Cherry red spot on macula may indicate what?

Back 56

CRAO

Front 57

Blood and thunder is associated with

Back 57

CRVO

Front 58

Diagnose retina detachment within what timeframe

Back 58

See ophtho within 24 hours