ophthalmology

Question 1

viral vs bacterial conjunctivitis - transmissible? itchy? adenopathy, vision?

Answer 1

viral –> not itchy, easiy transmissible, PREAURICULAR adenopathy, normal vision
bacterial –> itchy, poorly transmissible, no adenopathy, normal vision

Question 2

red eye (opthalmologic emergencies) - types and presentation

Answer 2

1. conjunctivitis: itchy eyes with discharge
2. uveitis autoimmune disease
3. glaucoma: pain
4. abrasion: trauma

Question 3

red eye (opthalmologic emergencies) - types and eye findings

Answer 3

1. conjunctivitis: normal pupil
2. uveitis: photophobia
3. glaucoma: fixed midpoint pupil
4. abrasion: like sand in the eye

Question 4

red eye (opthalmologic emergencies) - types and most accurate test

Answer 4

1. conjunctivitis: clinical diagnosis
2. uveitis: slit lamp examination
3. glaucoma: tonometry
4. abrasion: fluorescein stain

Question 5

red eye (opthalmologic emergencies) - types and best initial therapy

Answer 5

1. conjunctivitis: topical antibiotics
2. uveitis: topical steroids
3. glaucoma: acetazolamide, mannitol, pilocarpine, laser trabeculoplasty
4. abrasion: no specific therapy, patch not clearly beneficial

Question 6

chronic glaucoma - presentation / diagnosed by / confirmed by (findings)

Answer 6

diagnosed by routine screening

confirmation with tonometry –> extremely elevated intraocular pressure

Question 7

chronic glaucoma - drugs

Answer 7

1. prostaglading analogues: latanoprost, travoprost, bimatoprost
2. topical beta blockers: timolol, carteolol, metipranolol, betaxolol, levobunolol
3. topical carboic anhydrase inh: dorzolamide, brinzolamide
4. alpha-2 agonists: apraclonidine
5. pilocarpine
6. laser trabeuloplasty (if medical treatment fail)

Question 8

chronic glaucoma - prostagladin analogues - drugs and purpose

Answer 8

latanoprost, travoprost, bimatoprost

increase outflow of aqueous humor (uveoscleral flow)

Question 9

chronic glaucoma - topical beta blockers - drugs and purpose

Answer 9

timolol, carteolol, metipranolol, betaxolol, levobunolol

decrease synthesis by nonpigmented epithelium on ciliary body

Question 10

chronic glaucoma - topical carboic anhydrase inh - drugs and purpose

Answer 10

dorzolamide, brinzolamide

decrease synthesis by nonpigmented epithelium on ciliary body

Question 11

chronic glaucoma - alpha-2 agonists - drugs and purpose

Answer 11

apraclonidine

decrease synthesis by nonpigmented epithelium on ciliary body

Question 12

chronic glaucoma - pilocarpine - drugs and purpose

Answer 12

pilocarpine

increase outflow of aqueous humor (trabecular ouflow bu cilliary body contraction)

Question 13

epinephrine (a1 agonist on glaucoma)

Answer 13

decreases aqueous humor synthesis via vasoconstriction

Question 14

acute angle-closure glaucoma - clinical presentation

Answer 14

• SUDDEN onset of an extremely painful
• red eye that s hard to palpation
• walking into a dark rook can precipitate pain because of pupillary dialation (SOS)
• steamy cornea
• non-reacting pupil

Question 15

acute angle-closure glaucoma - diagnostic sign

Answer 15

the cup-to-disc ratio is greater than the normal 0.3

optic disc atrophy with charactersiting cupping (thinning of the outer rim of the optic nerve head vs normal

Question 16

acute angle-closure glaucoma - the diagnosis is confirmed by

Answer 16

tonometry

Question 17

acute angle-closure glaucoma - treat with (and why)

Answer 17

1. IV acetazolamide
2. IV mannitol: osmotic driving of fluid out of the eye
3. Pilocarpie, beta-blockers and apracloinidine to constrict the pupil and enchance and enchance drainage)
4. laser iridotomy

Question 18

keratitis - definition / presentation

Answer 18

infection of the cornea

the eye may be very red, swollen and painful, but do not use steroids

Question 19

hepres keratitis - never use …. (why)

Answer 19

steroids –> make it worse / increase the production of the virus

Question 20

hepres keratitis - diagnosis

Answer 20

Fluorecein staining of the eye helps confirm the dendritic pattern seen on examination

Question 21

hepres keratitis - treatment

Answer 21

oral acyclovir, famciclovir or valacyclovir

topical anthepretic treatment is trifluridine and

Question 22

Cataracts - therapy

Answer 22

• no medical therapy
• surgically remove the lens and replace with a new intraocular lens. The lew lens may automatically have bifocal capability.

Question 23

Cataracts - diagnosis

Answer 23

early Cataracts: ophthalmoscope or slit lamp exam

advanced: visible on examination

Question 24

diabetic retinopathy - how to prevent / definition and types

Answer 24

• annual screening (before serious visual loss)
  retinal damage due to chronic hyperclycemia:
  1. prolferative
  2. nonproliferative (or background)

Question 25

nonprolferative vs proliferative diabetic retinopathy - treatment

Answer 25

nonprolif: blood glucose control prolif: laser photocoagulation and VEGF inh(to control neovascularization, surgery

Question 26

diabetic retinopathy - surgery

Answer 26

vitrectomy (remove the vitreous gel from the middle of the eye): to remove vitreal hemorrhage obstructing vision

Question 27

diabetic retinopathy - most accurate test

Answer 27

flurescein angiography

Question 28

retinal artery and vein occlusion - presentation

Answer 28

both conditions present with the sudden loss of monocular visual loss

Question 29

retinal artery and vein occlusion - diagnosis

Answer 29

cannot diagnose without retinal examination

Question 30

retinal examination - findings in retinal artery occlusion

Answer 30

the macula is described as "cherry red" because the retina is pale and macula is dark

Question 31

retinal examination - findings in retinal vein occlusion

Answer 31

extravasation of blood into retina

Question 32

retinal artery occlusion - treatment

Answer 32

1. 100% O2 2. ocular massage 3. acetazolamide 4. anterior chamber paracentiesis (decreased IOP) 5. thrombolytics 6. evaluate embolic source

Question 33

retinal vein occlusion - treatment

Answer 33

ranibizumab (VEGF-A inh)

Question 34

Retinal detachment - risks

Answer 34

1. trauma of the eye 2. extreme myopia that changes the shape of the eye 3. diabetic retinopathy ANYTHING THAT PULLS THE RETINA CAN DETACH IT

Question 35

Retinal detachment - presentation

Answer 35

sudden onset of painless, unilateral loss of vision that is described as "A CURTAIN COMING DOWN"

Question 36

Reattachemen of retina is attempted ...

Answer 36

with a number of mechanical methods such as: 1. surgery 2. laser 3. cryotherapy 4. injection of an expansile gas that pushes the retina back up against the globe of the eye

Question 37

The MCC of blindness in older person in the US

Answer 37

Macular degeneration

Question 38

causes of Macular degeneration / diagnosis

Answer 38

unknown | diagnosed only by visualization of the retina

Question 39

Macular degeneration - types

Answer 39

1. atrophic (dry) | 2. neovascular (wet)

Question 40

Macular degeneration - characteristics of visual loss

Answer 40

1. far more common in older patients 2. bilateral 3. Normal external appearance of the eye 4. loss of central vision

Question 41

Macular degeneration - atrophic dry vs neovascular regarding the progression and the severity (DESCRIBE)

Answer 41

neovascular is more rapid and more severe --> New vessels grow between the retina and the underlying Bruch membrane. The neovascular or wet type causes 90% of permanent blindness from macular desegregation

Question 42

atrophic dry Macular degeneration - treatment

Answer 42

no proven effective therapy

Question 43

neovascular or wet Macular degeneration - treatment

Answer 43

best initial: VEGF inh (ranibizumab, bevasizumab, aflibercept. Injected directly into the vitreous chamber every 4-8 wks.

Question 44

neovascular or wet Macular degeneration - results of the treatment

Answer 44

1. over 90% of patients will expereience a halt (stop) of progression 2. 1/3 will have improvement in vision