Opthal

Question 1

purulent discharge, eyelashes stuck together in the morning, blurring of vision clears with blinking

Answer 1

bacterial conjunctivitis

Question 2

17 y/o girl, hay fever history, no discharge and itchiness, conjunctival injection. Glassy appearance

Answer 2

atopic conjunctivitis

Question 3

treatment of allergic conjunctivitis

Answer 3

mast cell stabilizers: olopatadine

Question 4

what eye condition is associated often with seborrhoeic dermatitis and/or rosacea? What is the treatment for it?

Answer 4

blepharitis.
Tx: lid hygiene (clean eyelid with warm water and wash away crusting on the lashes and eyelid margins) + topical lubricants. Oral tetracyclines - can give for 2 - 3 months in severe cases

Question 5

gritty uncomfortable eyes when straining eyes (reading, watching TV, driving). what is it and how do we treat it?

Answer 5

dry eyes

tx: w/ artificial teardrops

Question 6

spontaneous, painless, normal vision, retinal bleeding (in patches)

Answer 6

sub conjunctival hemorrhage - harmless, reassure and will resolve
tx: may be associated with HTN and heavy coughing/straining

Question 7

what not to give during corneal abrasion and why?

Answer 7

topical anesthesia - because it reduces wound healing and it is toxic to the epithelium

Question 8

what is the treatment for recurrent corneal abrasion?

Answer 8

use lubricating eye ointment at night and tear drops during the day

Question 9

what is wearing lenses associated with

Answer 9

corneal ulcer - often assoc. with wearing lenses on too long

Question 10

eye pain and wearing contact lenses. what is the next most important form of investigation

Answer 10

fluorescein staining of the eye

Question 11

What treatment do you NOT give when patient presents with possible HSV viral keratitis. Why?

Answer 11

no steroid drops - may cause perforation

Question 12

painful eye (boring pain), mild photophobia, redness localized around the limbus (edge of cornea), reduced visual acuity, 35 y/o man

Answer 12

iritis, anterior uveitis, irido-cyclitis

Question 13

what are the gene assoc. w/ iritis?

Answer 13

HLA-B27 - only worth investigating with recurrent episodes

Question 14

posterior synechiae (irregular shaped pupil) with slight redness. what is it?

Answer 14

iritis - late sign of iritis.

Question 15

what are some recurrent eye disease?

Answer 15

iritis
herpes simplex
corneal abrasion

Question 16

what is the treatment of iritis?

Answer 16

topical steroids

topical cyclopentolate

Question 17

82 y/o, acute eye pain behind the eye, radiates to forehead, abdominal pain and vomiting, impaired vision

Answer 17

acute closed angle glaucoma - emergency

Question 18

risk factors for acute glaucoma?

Answer 18

age older than 40 - 50 y/o 
female 
positive fmhx 
hx of acute glaucoma 
hypermetropia/long sightedness

Question 19

acute eye pain, mid dilated, fixed pupil, abdominal pain and vomiting

Answer 19

acute closed angle glaucoma

Question 20

what is the treatment of acute glaucoma?

Answer 20

reduce aqeous secretion with IV acetazolamide
pupillary constriction w/ pilocarpine drops
surgical/laser iridotomy

Question 21

78 y/o women with 3 day Hx of painful rash on the RHS side of forehead. RHS eye is inflamed and photophobic.

Answer 21

shingle (herpes zoster opthalmicus)

Question 22

what is the organism usually associated with a stye/

Answer 22

s. aureus

Question 23

what is the treatment of a stye?

Answer 23

hot compresses w. flannel 3 - 4 times daily, ease pain and draw pus to head
no real treatment

Question 24

superifical tissue swelling around eye, painful eye movement, slight proptosis, quite unwell

Answer 24

orbital cellulitis - often caused by existing sinusitis

Question 25

Bilateral eye swelling aroudn the periorbital area. most possible dx?

Answer 25

allergy - most commonly chloramphenicol

Question 26

what are some eye conditions that require urgent referral?

Answer 26

``` corneal ulcer iritis acute closed angle glaucoma herpes zoster opthalmicus w/ orbital involvement hyphaema d/t injury penetrating eye injury - high speed injury, welding etc. severe chemical burns orbital cellulitis any patient w/ SEVERE eye pain ```

Question 27

what are some high risk factors for eye conditions in history taking?

Answer 27

metal welding contact lens wearers haloes, vomiting, pain past medical history (corneal abrasion, iritis, herpes simplex keratitis)

Question 28

what symptoms should we refer for patients?

Answer 28

pain photophobia blurred vision

Question 29

young child with squinting eye, what important ddx to rule out?

Answer 29

retinoblastoma | neurofibromatosis

Question 30

what are the important diagnoses to consider in the unilateral red eye?

Answer 30

FUGIT: foreign body, ulcer, glaucoma, iritis, trauma

Question 31

management of foreign body (post care)

Answer 31

put gauze over eye uniocular - cannot drive use chloramphenicol drops + ointment - 2 hours see daily - fluorescein stain

Question 32

management of chemical injury

Answer 32

1st aid: irrigation for 20 minutes -buffered normal saline | referral to opthalmo

Question 33

what is the fundoscopy finding of a patient w/ glaucoma?

Answer 33

increased cup to disc ratio | Asymmetry of the cup:disc ratio in the optic nerve between 2 eyes

Question 34

ddx: painless LOV w/ loss of direct pupil response (Marcus Gunn)

Answer 34

optic neuritis central retinal artery occlusion temporal arteritis

Question 35

ddx: LOV that is corrected by 1mm pinhole

Answer 35

refractive error

Question 36

dangerous ddx of the unilateral red eye

Answer 36

foreign body, penetrating eye injury corneal ulcer acute glaucoma iritis

Question 37

complication of eyelid ulcer?

Answer 37

BCC

Question 38

treatment of penetrating eye injury

Answer 38

sterile pad - do not use eye drops or ointments NBM if treatment has to be delayed, give ttetanus, systemic antibiotics give analgesics, anti-emetics, and sedation if required urgent referral

Question 39

what is the treatment of chemical burns

Answer 39

irrigation with saline or water for 15 minutes instill local anesthetic to evert and swab the eyelids urgent referral to ED

Question 40

what is the sign of hutchinson's sign and its significance?

Answer 40

Herpes zoster opthalmicus involvement of the nose (nasociliary nerve) which means that there is very likely to be involvement of the eye requires early systemic treatment and assessment by the opthalmologist

Question 41

spot diagnosis: LOV w/ flashing lights

Answer 41

retinal detachment | posterior vitreous detachment

Question 42

spot diagnosis: LOV w/ colored haloes around

Answer 42

glaucoma

Question 43

spot diagnosis: LOV w/ zigzag lines

Answer 43

migraines

Question 44

spot diagnosis: central scotoma and LOV

Answer 44

macular disease | optic neuritis

Question 45

spot dx: LOV with repeated walking into a side of the vision

Answer 45

homonymous hemiapnoia | bitemporal hemiapnia

Question 46

spot dx: peripheral LOV first

Answer 46

glaucoma

Question 47

spot dx: LOV w/ headache

Answer 47

temporal arteritis migraine benign intracranial HTN

Question 48

spot dx: distortion, wavy straight lines on the Amsler chart

Answer 48

Macular degeneration (wet, dry)

Question 49

what are some iatrogenic cause of LOV

Answer 49

ethambutol quinine/chloroquinine amiodarone

Question 50

spot dx: LOV w/ problems with glare while driving

Answer 50

cataracts

Question 51

common causes of LOV in a child

Answer 51

cortical blindness optic atrophy choroidoretinal degeneration cataracts

Question 52

urgent referrals required for children?

Answer 52

``` strabismus nystagmus wandering eyes lack of fixation or following of movements photophobia opacities ```

Question 53

ddx acute loss of vision less than 1h

Answer 53

``` amaurosis fugax CVA acute glaucoma migraine central retinal artery occlusion vitreous hemorrhage ```

Question 54

ddx slow gradual loss (chronic) of vision

Answer 54

``` compression of visual pathways chronic glaucoma (open angle) cataracts diabetic maculopathy retinitis pigmentosa macular degeneration refractive errors ```

Question 55

difference between wet and dry macular degeneration

Answer 55

dry (mostly painless, develops slowly) wet (acute, neovascularization of mebrane under the retina of the macular area, serious disorder that requires urgent referral)

Question 56

signs of optic neuritis?

Answer 56

central scotoma discomfort while eye movement afferent pupillary defect on affected eye

Question 57

treatment of optic neuritis?

Answer 57

IV steroids - hasten recovery and protective effect against development of further demyelinating episodes other management steps: test visual field of other eye, use MRI

Question 58

what is normal ocular pressure? what is glaucoma ocular pressure?

Answer 58

12 - 22 mmhg. glaucoma > 40

Question 59

opthalmoscopy finding of retinal vein thrombosis

Answer 59

multiple retinal hemorrhages w/ stormy sunset apperance | swollen optic disc

Question 60

what are the associations with retinal vein thrombosis?

Answer 60

``` HTN DM Anemia Glaucoma Hyperlipidemia ```

Question 61

afferent pupillary defect is found in?

Answer 61

optic neuritis central retina artery occlusion temporal arteritis

Question 62

what does myopia predispose you to?

Answer 62

retinal detachment

Question 63

treatment of chronic open angled glaucoma?

Answer 63

``` acetazalomide timolol drops pilocarpine drops latanodrops dipivefrine drops ```

Question 64

treatment of central retinal artery occlusion

Answer 64

massage eye area through closed eyelids (rhythmic massage) rebreathe CO2 in bag IV acetazolamide 500mg urgent referral

Question 65

findings of diabetic retinopathy (prolif and non prolif)

Answer 65

prolif: neovascularization, hard exudates, vitreous hemorrhage non prolif: cotton wool spots, dot and blot hemorrhages, microaneurysms

Question 66

eye condition assoc. wiht ank spond

Answer 66

anterior uveitis

Question 67

treatment of diabetic retinopathy

Answer 67

most pt do not need treatment preventive treatments: modify risk factors and good diabetic control

Question 68

ddx: acute LOV in the painless eye

Answer 68

``` amaurosis fugax CVA optic neuritis retinal artery occlusion retinal vein occlusion wet acute macular degeneration vitreous hemorrhage ```

Question 69

ddx: acute painful red eye

Answer 69

``` glaucoma iritis corneal ulceration/abrasion foreign body, penetrating injury scleritis/episcleritis conjunctivitis herpes zoster opthalmicus, herpes simplex endopthalmitis ```

Question 70

ddx: eyelid bump and lump

Answer 70

``` stye chalazion lipoma preseptal, orbital cellulitis molluscum contagiosum dacryocysititis neoplasm: BCC blepharitis ```

Question 71

ddx: chronic LOV in quiet eye

Answer 71

``` corneal scarring - trachoma cataracts diabetic retinoathy open angled glaucoma posterior vitreous detachment macular degeneration (dry) optic atrophy optic chiasm pathology iatrogenic cause: drugs ```

Question 72

ddx: things in the eye

Answer 72

``` conjunctivitis scleritis/episcleritis entropion keratoconjunctivitis secca (dry eyes) foreign body corneal ulcer, abrasion bell's palsy herpes simplex keratitis ```

Question 73

ddx: flashes and floaters

Answer 73

``` posterior vitreous detachment retinal detachment migraines optic neuritis retinal artery occlusion vitritis diabetic retinopathy ```