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a) Check vision
b) Check pupils for afferent pupillary defect
c) Irrigate eye with normal saline
d) Check PH of the conjunctival fornix
When a patient arrives at the ER with a
supposed alkali chemical burn to the eye,
what is your first action,
a) Check vision
b) Check pupils for afferent pupillary defect
c) Irrigate eye with normal saline
d) Check PH of the conjunctival fornix
Chemical burn :
Acid , coagulate proteins and inhibit further
corneal penetration
Alkali worse prognosis
never try to neutralize
If a ruptured globe is suspected, the first
action to take is to:
Decreased vision
Shallow anterior chamber
Hyphema
Abnormal pupil
Ocular misalignment
Retinal damage
The best study to evaluate a patient with
intraocular foreign body is
a) Orbital ultrasound
b) MRI scan of the orbits
c) CT scan of the orbits
d) Plain film of the skull
The best study to evaluate a patient with
intraocular foreign body is,
a) Orbital ultrasound
b) MRI scan of the orbits
c) CT scan of the orbits
d) Plain film of the skull
Management of orbital floor fracture
a) Topical corticosteroids
b) A tight patch over the eye for 48 to 72 hours
c) Topical anesthetic for less then 12 hours
only
d) Oral analgesic if necessary
Proper treatment for a corneal abrasion
includes which of the following?
a) Topical corticosteroids
b) A tight patch over the eye for 48 to 72 hours
c) Topical anesthetic for less then 12 hours
only
d) Oral analgesic if necessary
Conjunctival injection with discharge
Follicles
Viral conjunctivitis
Chlamydial conjunctivitis
Remember:
Gonococcal conjunctivitis should be treated
with parenteral antibiotic.
Why?
Risk of corneal perforation
10. which of the following is not characteristic
of acute angel closure glaucoma
a) High IOP
b) Mild eye pain
c) Decreased vision
d) A fixed and dilated pupil
10. which of the following is not characteristic
of acute angel closure glaucoma
a) High IOP
b) Mild eye pain
c) Decreased vision
d) A fixed and dilated pupil
Primary angle closure glaucoma, risk factors
Hyperopia
Age>70
Female
Family history
Asian, Inuit people
Mature cataract
Shallow anterior chamber
Pupil dilation
What is your next plan:
Refer to ophthalmologist for laser iridotomy
a) Ophthalmologic consultation
b) Orbital CT scan
c) Blood culture
d) Outpatient administration of oral antibiotics
in an immunocompetent patient
All of the following are part of the evaluation
and management of orbital cellulitis except
a) Ophthalmologic consultation
b) Orbital CT scan
c) Blood culture
d) Outpatient administration of oral
antibiotics in an immunocompetent
patient
Request stat ophthalmology and ENT
consultations to rule out a life–threatening
fungal infection (mucoromycosis)
Diabetic patient with ketoacidosi,
Frozen globe, + RAPD
Request stat ophthalmology and ENT
consultations to rule out a life–threatening
fungal infection (mucoromycosis)
Diabetic patient with ketoacidosi,
Frozen globe, + RAPD
12. which of the following is least consistent
with the diagnoses of temporal arteritis?
a) Jaw claudication
b) diabetes mellitus
c) age over 65 years
d) Scalp or forehead tenderness
12. which of the following is least consistent
with the diagnoses of temporal arteritis?
a) Jaw claudication
b) diabetes mellitus
c) age over 65 years
d) Scalp or forehead tenderness
In a patient who presents with unilateral visual
loss with scalp tenderness
a) Temporal arteritis
b) Retinal detachment
c) Glaucoma
d) Nonarteritic optic neuropathy
13. Possible causes for sudden Visual loss
include all of following except
a) Temporal arteritis
b) Retinal detachment
c) Glaucoma
d) Nonarteritic optic neuropathy
. The best method for evaluating a 50-year-old
patient for best-corrected vision without his
or her glasses is,
a) Near card
b) Distance chart with pinhole
c) Distance chart with both eye open
d) Magazine or newspaper
. The best method for evaluating a 50-year-old
patient for best-corrected vision without his
or her glasses is,
a) Near card
b) Distance chart with pinhole
c) Distance chart with both eye open
d) Magazine or newspaper
What mechanism of action do cycloplegic
use to relieve pain?
a) Topical anesthetic
b) Paralysis of pupillary dilation
c) Paralysis of ciliary spasm
d) Decrease production of inflammatory cells
in anterior chamber
What mechanism of action do cycloplegic
use to relieve pain?
a) Topical anesthetic
b) Paralysis of pupillary dilation
c) Paralysis of ciliary spasm
d) Decrease production of inflammatory cells
in anterior chamber
This patient presents with sudden unilateral
vision loss. All of the following are treatment
options except
Treatment
Oral antiviral
In cases of conjunctival involvement ,erythromycin
Refer to ophthalmologist and steroid should be
prescribed by ophthalmologist.
A 30 y/o M, presents with
redness, pain photophobia and
decreased vision. If this is the
photo of his eye,the next step is
a) Iritis
b) Corneal damage
c) Open-angle glaucoma
d) Reactivation of a latent herpes simplex virus
infection
Prolonged use of topical ophthalmic
anesthetics can cause
a) Iritis
b) Corneal damage
c) Open-angle glaucoma
d) Reactivation of a latent herpes simplex virus
infection
Side effects of topical steriod
corneal fungal ulcers
Cataracts
Open-angle glaucoma
Progression of herpes keratitis, dendrites
Treatment of a chalazion ,
which presents as an acute
tender swelling of the lid usually
a) Adult onset
b) Open and normal appearing anterior
chamber angels
c) The absence of secondary causes for
glaucoma
d) An IOP of 25 mm Hg
Primary open angel glaucoma is defined by
each of the following except
a) Adult onset
b) Open and normal appearing anterior
chamber angels
c) The absence of secondary causes for
glaucoma
d) An IOP of 25 mm Hg
Secondary a glaucoma is caused by each of
the following except
a) Myopia
b) Uveitis
c) Chronic steroid use
d) Trauma
Secondary a glaucoma is caused by each of
the following except
a) Myopia
b) Uveitis
c) Chronic steroid use
d) Trauma
Remember IOP is a risk factor not a definition
Remember myopia is a risk factor not a cause
, (even a minor risk factor )
An optic nerve with glaucomatous damage
may have all of the following except
a) A disc hemorrhage
b) Marked pallor of the neuroretinal rim
c) Displacement of the retinal vessels to the
margin of the disc
d) Thinning of the neuroretinal rim
An optic nerve with glaucomatous damage
may have all of the following except
a) A disc hemorrhage
b) Marked pallor of the neuroretinal rim
c) Displacement of the retinal vessels to the
margin of the disc
d) Thinning of the neuroretinal rim
•beta-adrenergic agonist
•alpha-2 adrenergic antagonists
•cholinergic agonists
•carbonic anhydrase agonists
a) Conjunctival hyperemia
b) Ptosis
c) Increased iris pigmentation
d) Lengthening of the eyelashes
Latanoprost (xalatan) can cause any of the
following side effects except
a) Conjunctival hyperemia
b) Ptosis
c) Increased iris pigmentation
d) Lengthening of the eyelashes
Topical parasympathomimetic
Risk factor
HTN, DM, glaucoma,
arteriosclerotic vascular disease,
hyperviscosity, (PV, OCP, sickle
cell, lymphoma, leukemia,
Teratment of underlying disease
RD , retinal detachment
Rhegmatogeneous (most
common)
caused by tear or hole,
Treatment, scleral buckle,
rtinopexy
Tractional
In diabetic retinopathy, CRVO, sickle cell, ROP,
trauma
Exudative
posterior uveitis, central serous retinopathy
tumor
Retinal tear
Supratemporal retina , most common site for
horseshoe tears
Caused by PVD, trauma,
Posterior vitreous detachment may be
associated with which of the following?
a) macular edema
b) macular ischemia
c) vitreous hemorrhage
d) all of the above
In diabetic retinopathy vision loss may be
caused by
a) macular edema
b) macular ischemia
c) vitreous hemorrhage
d) all of the above
All of the following are signs of
nonproliferative diabetic retinopathy except
a) Microaneurysm
b) Hard exudates
c) Neovascularization of the disc
d) Intraretinal hemorrhages
All of the following are signs of
nonproliferative diabetic retinopathy except
a) Microaneurysm
b) Hard exudates
c) Neovascularization of the disc
d) Intraretinal hemorrhages
Patient with type 2 diabetes should be
evaluated by an ophthalmologist
Treatment
Occlusion of the good eye
Ptosis
Miosis
Anhydrosis
Heterochromia
DDx
DDx
Retinoblastoma
Cataract
Retinal
coloboma
ROP
Toxocariasis
Retinal
detachment
Kawasaki disease
No to steroid
Yes Aspirin
conjunctivits
Conjunctivitis
Oral mucosal
rash
Manifestations
of systemic diseases
All of the following are false regarding ocular
malignancies except
a) The most common intraocular malignancy in
adult is a primary ocular melanoma.
b) The most come primary site of origin of cancer
metastatic to the eye in males is the colon.
c) The most common primary site or origin of
cancer metastatic to the eye in females is the
breast
d) Enucleation is the primary treatment for
solitary metastases to the eye.
All of the following are false regarding ocular
malignancies except
a) The most common intraocular malignancy in
adult is a primary ocular melanoma.
b) The most come primary site of origin of cancer
metastatic to the eye in males is the colon.
c) The most common primary site or origin of
cancer metastatic to the eye in females is the
breast
d) Enucleation is the primary treatment for
solitary metastases to the eye.
The most common site for metastasis to the
eye is the
a) Iris
b) Choroid
c) Retina
d) Optic nerve
The most common site for metastasis to the
eye is the
a) Iris
b) Choroid
c) Retina
d) Optic nerve
Metastasis , most common intraocular
malignancy in adult
Breast in F, lung in M ,
Neuroblastoma in children
a) Iris
b) Choroid
c) Retina
d) Optic nerve
The most common site for metastasis to the
eye is the
a) Iris
b) Choroid
c) Retina
d) Optic nerve
Metastasis , most common intraocular
malignancy in adult
Breast in F, lung in M ,
Neuroblastoma in children
a) It is painless.
b) It always spontaneously resolves.
c) It may be initial manifestation of multiple
sclerosis
d) It usually results in permanent visual loss
All of the following statements about optic
neuritis are false except
a) It is painless.
b) It always spontaneously resolves.
c) It may be initial manifestation of multiple
sclerosis
d) It usually results in permanent visual loss