ER -1- Intro/ocular trauma

Question Answer
What is required for a hospital to be considered trauma 1 24hr availability of all subspecialties
Pt has mucopurulent discharge and inflammation of the conjunctiva and their eyes are stuck together what do they have going on Bacterial Conjunctivitis
What is the best tx for bacterial conjunctivitis Poly-Trim opth gtts
If your pt has bacterial conjunctivitis and is a contact wearer what do you need to add coverage for pseudomonas with quinolone
If you suspect the bacterial conjunctivitis is caused by neisserial what tx should you give urgent referral and Rocephin IM and oral doxy to cover for possible concomitant chlamydial infection
Pt has recently had an URI and now has an eye infection what is the likely etiology viral
What is the tx for viral conjunctivitis cool compresses, naphcon A, artificial tears
Patient has ocular discharge and itching what are they likely suffering from allergic conjunctivitis
What is the tx for allergic conjunctivitis Cool compresses, Topical antihistamines/decongestants/mast cell stabilizers
Pt has dendrites that show up on fluorescein staining of the cornea what are they likely suffering from HSV keratitis
Why don't you want to miss HSV keratitis it can progress to corneal scarring and requires prompt tx with antiviral (Viroptic) if outbreak is less than 4 days old could also use acyclovir
T/F steroids are helpful in tx of HSV keratitis F NO topical steroids
IF pt presents with shingles on their face what do you need to do make sure you do an eye exam looking for herpes in the cornea
What is the most common cause of preseptal/periorbital cellulitis staph aureus
T/F preseptal cellulitis is most common in adults F it is most common in kids
T/F preseptal cellulitis has extensive involvement of the eye its self F eye itself is not involved but the structures surrounding the eye are
Would you send a kid home if they came in with a preseptal cellulitis no admit them for IV Ab and pediatric consult
what is the difference between orbital cellulitis and preseptal cellulitis orbital cellulitis will have involvement of the eye. EOM impairment, pain, fever, proptosis where preseptal cellulitis will not have these findings
How can you detect a corneal ulcer use fluorescein dye
Why do you need to aggressively treat a corneal ulcer if it is caused by pseudomonas it can destroy a cornea in 6-12 hrs tx with topical fluoroquinolone
Pt has come in for the third time with an unexplained subconjunctival hemorrhage what may this indicate may be first indication that their INR is out of whack from anticoagulants
You have just put fluorescein dye in your pt eye and see vertical scratches you suspect a corneal abrasions what should you do apart from looking in the eye itself flip the eyelid with a cotton swab
T/F every corneal abrasion needs to be patched for proper healing F abrasion will heal with or without patch abrasions from organic sources have potential for fungal infections don't patch them
IF pt has a corneal foreign body how can you remove it use an 18gauge needle and scrape it out gently
If the foreign body was metal and it has left a rust ring what do you need to do drill or buff out the rust ring
T/F a lid laceration less than 1mm will heal on its own T they don't need stitching
If the lid laceration is a full thickness laceration what needs to happen Pt needs referral to have ophthalmologist repair within 24hrs
If a pt has a blunt trauma of the face and a hyphema present what do you need to get ophthalmology consult.
If you do a EOM test on a pt with a blunt trauma and they can't look up what might be happening entrapment of the eye because of a blowout fracture
T/F the pupil peaks away from the site of penetration or rupture of the globe F it peaks toward site of penetration or rupture
What is the first test you should perform on a stable pt with blunt trauma visual acuity
If you suspect a ruptured globe what should you do for the pt get an emergency consult and metal shield check tetanus and get them IV Ab
Where is the most common location for a blowout fracture inferior wall and medial wall
What x-ray view is best for visualization of blowout fx water's view
Is a blowout fracture an emergency or outpt referral outpt referral generally
T/F a chemical injury to the eye is urgent not an emergency F it is an emergency especially alkali burns because they are generally not painful and can rapidly penetrate the cornea and damage the iris/lens
What is the tx for chemical splash in the eye irrigate, irrigate, irrigate check ph and irrigate some more until ph is 7.5-8 then check for particulate matter, corneal clouding, or epithelial defects
What is a common cause of spontaneous hyphema sickle cell anemia
Pt present with a hyphema what do you want to check elevate pts head and check IOP instill mydriatic to avoid pupillary play
What education should you give a pt about hyphema before sending them home that it may rebleed in 3-5 days and if so IOP could increase needing a surgical wash out of anterior chamber
You perform a slit lamp exam on a pt and notice superficial punctate keratitis what is the likely cause UV damage to the eye from welding, sun tanning, or Snowblindness
What is the tx for UV keratitis cycloplegic, Ab ointment, oral analgesic consider a pressure patch and refer to ophthalmologist
Pts presents with cloudy vision, eye ache/pain, HA and N/V You check the IOP and find that it is 50 what is likely going on acute angle closure glaucoma
What is the tx for acute angle closure glaucoma miotics (pilocarpine), reduce aqueous humor formation with beta blockers (Timoptic), Alpha agonist (loridine), and carbonic anhydrase inhibitors (acetazolamide) and reduce vomiting volume with mannitol
pt complains of HA and sensitivity when they touch the side of their head they are a 65 y/o female with fever, fatigue and anorexia Temporal Arteritis
What is the tx for temporal arteritis IV steroids, and Ophthalmology Consult for temporal artery biopsy
What cranial nerve is affected in bells palsy CN 7 Facial nerve
What is the tx for bell's palsy eye lubricants, consider oral steroids or antiviral (acyclovir) and refer to ophthalmologist for cornea monitoring
What is Horner's syndrome ipsilateral ptosis, myosis, and anhidrosis from interruption of sympathetic nerve innervation
IF pt has Horner's syndrome and neck pain what do you need to r/o carotid artery dissection
Pt has papilledema what does this indicated typically (in general) Increased intracranial pressure
What conditions can cause papilledema malignant HTN, pseudotumor cerebri, intracranial tumors, hydrocephalus
If pt has unilateral papilledema what is the likely cause Optic nerve edema, papillitis not from elected ICP
What is the tx for pseudotumor cerebri weight loss, serial Lumbar Punctures, and diuretics

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