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PAK BOARDS Ocular Disease
NBEO Board-based ocular disease questions
32
Medical
Graduate
01/10/2011

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Cards

Term
Chemical Burns
Sx and Signs
Definition
Sx:
1) normal or decrease VA
2) pain
3) FBS
4) photophobia
5) tearing

Signs:
- scattered SPK
- conj injection
- ciliary injection
- AC reaction (cells and flare)
- scleral and limbal blanching (severe burns)

Severe burns can increase IOP
Term
Chemical Burns
Pathophysiology/Diagnosis
Definition
alkali burns: worse Px than acidic burns because can breakdown fatty acids in the cell membrance and penetrate the cornea better
- Alkali burns are twice as common because of accessibility
Term
Chemical Burns
Tx
Definition
Immediately irrigate BEFORE starting exam (Hx, VA, etc).
Use SALINE, RINGER's LACTATE SOLUTION, NON-STERILE WATER

avoid phenylephrine and other vasoconstrictors
Term
Corneal abrasion
Sx and Signs
Definition
Sx:
- sharp pain (especially after blinking)
- FBS
- photophobia, tearing
- blurred vision
- mild AC rxn
- mild miotic pupil

Signs:
- stains with FL
- NO underlying subepithelial infiltrate
Term
Presentation of upper lid FB
Definition
Linear, vertical corneal scratches
Term
What should you ALWAYS do before removal of a FB?
Definition
Check VA! To CYB
Term
Commotio Retinae
Definition
grey-white discoloration that can affect any location on the retina. May or may not be accompanied by hemorrhages or choroidal rupture.
*not damaging to surround bv's.
*typically resolves on its own
Term
Berlin's edema
Definition
commotio retinae located in the macula
Term
commotior retinae
Pathophysiology
Definition
due to photoreceptor outer segment discruption
Term
Hyphema
Sx and Signs
Definition
Sx: pain, blurred vision

Signs:
- can be red or black (can be seen by naked eye)
- microhyphemas: only red (need SL for observation)
- angle recession 60%
- significant IOP increase can occur
Term
Hyphema
Pathophysiology/Dx
Definition
- results from trauma to iris and/or CB
- B-scan (to R/O RD)
- 60% of pts will have angle recession
- rebleeds can occur and tend to be worse than the orignal presentation
Term
What is a condraindicated procedure in a pt with hyphema?
Definition
GONIOSCOPY or SCLERAL DEPRESSION
(although you want to look at angle recession, do NOT because you do not want to disrupt and scatter the blood in the AC)
Term
8-ball hyphema
Definition
a black hyphema that emcompasses 100% of AC

- idiopathic
- common in AA and Mediterranean pts
- screen for sickle-cell and/or clotting disease!
- Order: CBS and Prothrombin time (PT/PTT)
Term
What qurstion must you always ask in Case hx on a idiopathic hyphema such as a 8-ball hyphema?
Definition
AlWAYS inquire about NSAID or ASA use (of high doses)

because these medicines thins blood and interferes with clotting
Term
Orbital Floor Fracture
Epidemiology
Definition
due to trauma by a LARGE object such as a fist or tennis ball
Term
Orbital Floor Fracture
Sx and Signs
Definition
Sx: Pain, binocular DIPL, CREPITUS after nose blowing
Signs: MANY. Varies according to which wall is fractured. Most commonly:
- dipl
- angle recession
- enopthalmos
- hyphema
- subconj heme
- RD
- etc
Term
Orbital Wall Fractures
4 things you should look for:
Definition
1. limiting upgaze (due to trapped inferior rectus)
2. forehead hypesthesia 9due to damge to infraorbial nerve)
3. postive forced ductions
4. periorbital crepitus
Term
Why are obital floor fractures most common? What bone is affected?
Definition
It is most cmmon because the maxillary bone in the posterior medial floor is the weakest bone in the orbit. it is also most susceptible to IOP increase during trauma
Term
What tests should you NOT perform in orbital floor fractures?
Definition
gonio or scleral depression
Term
What should you advise your pt not to do within 48 hours of a orbital floor fracture?
Definition
Blow their nose because that can induce orbital infection
Term
What is the clinical signs that are different between preseptal cellulitis vs orbital cellulitis?
Definition
PC will NOT have
- proptosis
- fever
- pain on eye movement
- EOM restrictions
Term
Thyroid Eye Disease
Epidemiology
Definition
F:M ratio = 8:1
Most commonly presents 4th-5th decade of life
Term
Thyroid Eye Disease
Signs
Definition
- ptosis
- Kocher's sign (stare appearance)
- Von Graefe's sign (lid lag during downgaze)
- corneal exposure signs (punctate keratitis, SLK
- EOM swelling
Term
Thyroid Eye Disease
List the EOMs affected from most common to least common
Definition
IR > MR > SR > LR
Term
True or False: Thryoid eye disease can cause APD, reduce CV, and VF loss
Definition
true. If EOMS are swollen at the orbital apex, it can compress the ON can cause the aforementioned Sx
Term
Phlctenulosis
Definition
Hx: TB history?
Sx: Photophobia, lacrimation, blepharospasm
Signs: small, white (LYMPHOCYTIC) nodule with dilated vessels surrounding. Can be on CORNEA or CONJ

Pathophysiology:
- a result of a delayed hypersensitivity Rxn caused by blepharitis (staphylococcus), TB, acnea rosacea
Term
Parinaud's OculoGLANDULAR Syndrome
Definition
Epid/Hx: rare
Sx: Red eye, FBS, MUCOPURULENT DISCHARGE
Signs: unilateral, granulomatous palpebral conjunctivitis, visibly swollen preauricular/submandibular lymphadenopathy. May have fever and rash
Pathophysiology: Occurs secondary to:
- cat-scratch fever (most common)
- tularemia (rabbit fever)
- TB
- Syphillis
Term
Pediculosis
Definition

Sx: itching burning

 

Signs: lice, nits, blood-tinged debris on lids and lashes. - - Mild to severe chronic follicular conjunctivitis

- swollen preauricular nodes

 

Patho/Dx: 

- caused by Phtirus Pubis

- most commonly sexually transmitted but can result from direct contact

- is NOT demodicosis (associated with bleph)

Term
Most plentiful Ab in circulation and ONLY Ab to cross placenta and protect the fetus
Definition
IgG
Term
IgM
Definition
- made first in response to an antigen
- found primarily in the blood and on the surface of immature B-cells
Term
IgM
Definition
- made first in response to an antigen
- found primarily in the blood and on the surface of immature B-cells
Term
IgA
Definition
- excretions such as mucous, saliva, TEARS, and breast milk
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