Ophthamology

In infants, the eyes should move in parallel without deviation by the age of? 2 weeks 3 months 6 months 1 year

6 months

Which of the following is the most likely to be seen on a fundoscopic examination of a patient with central retinal artery occlusion? A diffusely pale or milky retina with a red spot on the fovea A localized area of pallor limited to the affected artery A blood and thunder appearance of the retina A bloody appearance limited to the affected vessel

A diffusely pale or milky retina with a red spot on the fovea

A 75-year old man presents with sudden unilateral vision loss. His history includes some prior episodes of visual loss that completely resolved spontaneously. In the past, to evaluate these episodes, he underwent a carotid ultrasound which confirmed a suspected diagnosis of bilateral carotid stenosis. Considering the patient's current painless sudden visual loss, which of the following findings would you expect to find with fundoscopic examination? -Retinal lines that have the appearance of a "ripple on a pond" or a "billowing sail" -A pale or milky retina with a cherry-red fovea -Enlarged physiologic cup, occupying more than half of the disc's diameter -A swollen disc with blurred margins; no visible physiologic cup -Yellowish-orange to creamy-pink disc with sharp margins and a centrally located physiologic cup

A pale or milky retina with a cherry-red fovea Diagnosis: Central Retinal Artery Occlusion

A 6-year-old girl with no significant past medical history presents 4 days after developing a red, irritated left eye. Her mother states that she has been wiping thick whitish-yellow discharge from her eye, and the eye is matted shut in the morning. She denies any exposure to a sick contact, upper respiratory symptoms, or contact lens use. She also denies any significant pain or light sensitivity. On examination, the patient's pupils are equal and reactive. She does not have a tender preauricular lymph node. Penlight examination does not reveal any corneal opacity, but thick, whitish discharge is seen.

Acute conjunctivitis

A 56 year-old female presents complaining of intense left eye pain associated with unilateral headache, nausea, and colored rings around lights. On examination you note decreased visual acuity, a pupil that is fixed and mid-dilated, and ciliary flushing. Which of the following is the most likely diagnosis? Acute glaucoma Migraine Episcleritiis Acute uveitis

Acute glaucoma Acute glaucoma is an ocular emergency that presents as an acutely painful eye and elevated intraocular pressure. Patients typically complain of acute eye pain associated with unilateral headache, nausea/vomiting, cloudy vision, and colored rings around lights. On exam the pupil is fixed and mid dilated with prominent ciliary flush.

A 64 year-old woman complains of headache and left eye pain for about a day. She says it started yesterday as a dull ache and now is throbbing. She also complains of nausea and vomiting, which she attributes to the popcorn she ate at the movie theater yesterday afternoon. On exam, the left pupil is mid-dilated and nonreactive. The cornea is hazy. A ciliary flush is noted. Which of the following is the most likely diagnosis? Migraine headache Temporal arteritis Acute glaucoma Retinal artery occlusion

Acute glaucoma Acute glaucoma often presents with abdominal complaints that may delay diagnosis. Findings of ciliary flush, mid-dilated and nonreactive pupil, and hazy cornea in a patient with severe eye pain are consistent with acute angle closure glaucoma

Which of the following would indicate an optic nerve lesion? Excessive conjunctival edema Ptosis Inability to gaze laterally Afferent pupillary defect

Afferent pupillary defect

A 75-year-old woman presents with new-onset distortion in one eye. Vision is 20/80 in the involved eye. She has a family history of AMD and has smoked 20 cigarettes a day for most of her adult life.

Age-related Macular Degeneration

Which of the following is the most common cause of permanent blindness in people greater than 65 years of age in the United States? Glaucoma Cataracts Diabetic retinopathy Age-related macular degeneration Retinal detachment

Age-related macular degeneration

A patient presents complaining of left eye discharge and eyes that were matted shut this morning. The patient denies changes in visual acuity, but states that he is afraid to put his contacts in. On physical examination you note erythematous conjunctivae and mucopurulent discharge of the left eye. The cornea is clear. Which of the following topical agents is the treatment of choice in this patient? Aminoglycoside(Tobrex) Olopatadine(Patanol) Cycloplegic Prednisolone acetate

Aminoglycose(Tobrex) Topical aminoglycoside or fluoroquinolones are indicated in contact lens wearers with conjunctivitis to cover for Pseudomonas infection.

A 50-year-old woman, who has no eye symptoms, is found during routine ophthalmic examination to have elevated intraocular pressure of 42 mmHg in both eyes. Funduscopy shows that the optic nerve head appears normal, with no evidence of glaucomatous neuropathy. Gonioscopy shows that the anterior chamber angles are closed for almost the full circumference.

Angle-closure glaucoma

A 64-year-old woman presents to the ER with severe pain around her right eye of 4-hour duration, accompanied by blurred vision in that eye. She is also nauseated. Examination shows a red right eye with edematous cornea and a wide pupil that is unresponsive to light. Intraocular pressure is extremely elevated (60 mmHg), only in the right eye. The anterior chamber angle is closed in both eyes.

Angle-closure glaucoma

A patient is seen in the ED following mild-moderate trauma to the eye. The patient states that his pain is 8/10. Exam is normal except for epiphora(tearing of the eye) and significant photophobia(light sensitivity). What is the most appropriate treatment for this patient? Antibiotic ointments or drops Emergent consultation w/ an ophthamologist Complete bed rest and avoidance of ASA/NSAIDs Oral or topical NSAIDs for pain relief

Antibiotic ointment or drops

A 16 year-old male involved in a fight sustained a laceration to his right upper eyelid. He is unable to open his eye, and a possible laceration of the globe is suspected. Which of the following is the next step? Use a slit lamp to determine the extent of the injury Use fluorescein strips to determine the extent of injury Apply a metal eye shield and refer to an ophthalmologist Apply antibiotic ointment to the lid and recheck in 24 hours

Apply a metal eye shield and refer to an ophthalmologist Protect the eye from any pressure with a rigid metal eye shield and refer for immediate ophthalmologic consultation. Avoid unnecessary actions that would delay treatment or cause further injury.

A 72-year-old male presents with progressive bilateral loss of central vision. This has made driving difficult, and often finds himself needing a bright light to look at objects. He reports that his peripheral vision is intact. When looking at a specific region at line grid, he reports a dark "spot" in the center, with bent lines. Dilated ophthalmic examination is shown here. What is the most likely diagnosis? Atrophic macular degeneration Cataracts Retinal vein occlusion Open angle-closure glaucoma

Atrophic macular degeneration

A 65-year-old man presents with bilateral ocular itching, burning, and foreign body sensation, as well as crusting of his eyelids in the morning for the past several months. He also notes that his eyes are often red and feel dry. Physical exam demonstrates facial pustules, facial redness, and telangiectasia. Slit lamp exam shows lid collarettes, telangiectasia, and capped meibomian glands.

Blepharitis

A 65-year-old man presents complaining of generally decreased vision and difficulty driving at night due to glare from oncoming headlights. He describes having trouble reading the small print on his television screen. He is healthy and has no history of any other eye problems. His best corrected visual acuity is noted to be 20/50 in the right eye and 20/40 in the left eye. On exam, a yellowish opacification of the lens in the left eye is noted. On ophthalmoscopy, the red reflex in the left eye is obscured centrally, and the details of the fundus are indistinct. No other abnormalities are found.

Cataract

A 66 year-old male presents complaining of 6 month history of progressive blurred vision without associated pain. On examination there is no erythema or injection of the sclera. On funduscopic examination there is an absent red reflex and a cloudy lens. Which of the following is the most likely diagnosis? Retinal detachment Chronic glaucoma Age related macular degeneration Cataract

Cataract

A 27-year-old man presents following an incident where he was struck in the left eye with a paint ball. He notices a sudden decrease in vision in the left eye, from 20/20 before the accident, to counting-fingers vision after the accident. On exam, the left pupil appears whitish, and visual acuity is greatly decreased. The patient does not have any history of other medical problems. On dilated eye exam, the lens in the left eye appears whitish anteriorly, with a spoke-like pattern. On direct ophthalmoscopy, the red reflex is diminished and retinal details are indistinct.

Cataracts

Which of the following is the most concerning complication of administration of topical corticosteroids to the eye? Conjunctivitis Corneal abrasions Cataracts Subconjunctival hemorrhage Pterygium

Cataracts

A 23 year-old sexually active female presents with a 4 day history of painless bilateral eye exudates which she describes as copious. Visual acuity is 20/20, generalized conjunctival inflammation with sparing of the cornea is noted on physical examination. Gram stain of the exudate reveals gram negative diplococci. Appropriate management of this case is Ceftriaxone (Rocephin) Polymyxin ophtalmic drops(Aerosporin) Ciprofloxacin (Cipro) Doxycycline (Doryx)

Ceftriaxone (Rocephin) With sparing of the cornea, as in this case, a single 1 gram IM dose of ceftriaxone is sufficient treatment for ophthalmic gonorrhea. If the cornea is involved, 5 days of IM ceftriaxone would be required.

A 65-year-old man with a history of hypertension and hypercholesterolemia notices sudden, painless vision loss in his right eye. The vision loss is limited to the superonasal quadrant of his visual field. He first noticed the visual field loss approximately 6 weeks ago. For the past 2 weeks, however, he has started to have blurred vision centrally, making reading difficult.

Central retinal vein occlusion(CRVO)

A 40-year old female presents with a foreign-body sensation to the right eye. Over the last 3 weeks, she has had gradually increasing painless swelling around the right lower eyelid. Your examination shows a nontender discrete nodule on the right lower eyelid. There is no evidence of injection or discharge and her visual acuity is normal. The most likely diagnosis is? Blepharitis Pterygium Chalazion Dacryocystitis Hordeolum

Chalazion

A patient presents with a nontender, painless, nodule involving a meibomian gland. Which of the following is the most likely diagnosis? Chalazion Dacryocystitis Entropiion Hordeolum

Chalazion

A 22-year-old woman presents to the ER with acute bilateral eye pain after removing her contact lenses 1 hour ago. She reports forgetting to remove her daily wear lenses at bedtime and awakening in the morning with bilateral mild eye pain. On removal of both lenses she reports markedly increased pain, photophobia, and foreign body sensation. With glasses, her visual acuity is 20/30 bilaterally. On slit lamp exam, she has no ulceration but diffuse fluorescein uptake in a contact lens distribution bilaterally.

Corneal abrasion

A 32-year-old man is struck in the face with a branch while hiking through dense bush. He is not wearing any eye protection and feels immediate pain, discomfort, and watering on opening his right eye. He does not wear contact lenses. He has photophobia in the right eye, and there is marked conjunctival injection but normal visual acuity. After instillation of a topical anesthetic his symptoms resolve, facilitating a complete slit lamp exam, which reveals a 3 mm corneal defect with fluorescein uptake without ulceration or any foreign body.

Corneal abrasion

A patient develops acute eye pain and photophobia after mild trauma to the eye. Examination of the eye is grossly normal except for photophobia and tearing. This patient is most likely suffering from which of the following conditions? Subconjunctival hemorrhage Hyphema or blood in anterior chamber Conjunctival abrasion Corneal abrasion Ophthalmoplegia

Corneal abrasion

When seeing a 64 year old gentleman for a routine follow up of HTN and HLD, exam of the retina shows white lesions with irregular borders. They are moderate in size. What are these lesions called? Hard exudates Cotton-wool patches Drusen Intraluminal plaques Retinal infiltrates *Drusen are tiny to small yellowish round spots with hard or soft edges that are often seen in age-related macular degeneration.

Cotton-wool patches Cotton-wool patches are fluffy white or grayish ovoid lesions with irregular borders. They are typically moderate in size and seen in patients with hypertension.

Closure of the eyelids is mediated by which cranial nerve? Cranial nerve III Cranial nerve V Cranial nerve VII Cranial nerve IX

Cranial nerve VII

Which of the following is the most common cause of adult blindness in the USA? HTN DM Macular degeneration Retinal artery occlusion

DM- Diabetes Mellitus Diabetes is the leading cause of blindness in the US, and is usually due to diabetic retinopathy. Up to 15% of type 1 diabetics and up to 7% of type 2 diabetics become legally blind.

A 70-year old woman with a history of glaucoma and diabetic retinopathy represents to the ED stating that she fell down and bumped her head earlier in the evening. She is now experiencing a sensation of flashing lights and floaters in her right eye. She has decreased visual acuity and feels there is a curtain over her visual field. Fundoscopic examination is difficult and therefore nondiagnostic. What is the next step that you should take? Emergency ophthalmology referral Fasting blood glucose CT scan of the head Neurological examination Admission to the hospital for head injury observation

Emergency ophthamology referral Diagnosis: Retinal Detachment

A 75 year-old woman presents to the office with complaint of vision loss. Examination reveals a palpable cord in the temporal region. Which of the following is the most helpful initial test to order on this patient? Erthrocyte sedimentation rate Carotid US Chest x-ray Complete blood count

Erythrocyte sedimentation rate The patient is suspected of having temporal arteritis. This disease is most commonly noted in patients over age 50 and should be suspected in patients with sudden vision loss and a palpable cord in the temporal region. Erythrocyte sedimentation rate is almost always increased in this disease.

Your patient, who is a 39 year old truck driver presents stating that he has had a growth for at least 8 years on his eyes. Your examination shows a fleshy triangular area of conjunctivae encroaching onto the nasal aspect of the cornea bilaterally. It has begun affecting his vision. What is the best intervention at this time? Artificial tears Excision Iridotomy Topical NSAIDs Reassurance, this is a benign condition

Excision The patient stated that the lesion was affecting his vision. Therefore, and especially as the patient is a truck driver, he requires excision of this lesion. Dx: pterygium

A patient presents with acute eye pain and photophobia after putting in his contact lens. The patient states he removed his contact which he noted to be torn. Which of the following is the diagnostic study of choice in this patient? Fundoscopic exam Applanation tonometry Fluroescein staining Schirmer Test

Fluorescein staining

A 39-year-old male states that he was holding his baby daughter and she put her fingers in his right eye. He now presents to the ED with acute eye pain and photophobia. His right eye appears grossly normal except for increased tearing. Which of the following is the diagnostic study choice in this patient? Fundoscopic examination and refraction Fluorescein staining Schirmer test Visual acuity testing

Fluorescein staining Diagnosis: Corneal abrasion

A patient presents with the complaint of irritation of the left eye one day after gardening. He states "I think there is something in my eye." Which of the following findings is consistent with your suspected diagnosis? Increased IOP Rust ring Hazy cornea Fluorescein uptake

Fluorescein uptake Fluorescein dye uptake is diagnostic for corneal abrasion

An 18 year-old college student took her goggles off in the chemistry lab while she was washing her glassware from an experiment she had just completed. She thinks the beaker had contained sodium hydroxide, and it splashed into her right eye. She rinsed her eye out for about five minutes in the lab. Which of the following is the most appropriate first step? Check visual acuity Flush the eye with two liters saline Check for corneal damage with fluorescein Instill a topical anesthetic to facilitate examination

Flush the eye with two liters saline Any chemical injury to the eye may result in severe injury and loss of sight, and is a true emergency. The eye should be irrigated copiously with at least two liters of saline, and pH checked to determine when the chemical has been cleared.

Use of systemic corticosteroids can cause which of the following adverse effects in the eye? Cortical blindness Optic atrophy Glaucoma Papilledema

Glaucoma

Which of the following is a potential complication of a traumatic hyphema? Retinal detachment Glaucoma Cataract formation Chronic conjunctivitis

Glaucoma

While working in the ER you are triaging a patient who experiences facial trauma. You note blood in the anterior chamber of the patients left eye. What is a possible complication for this patient? Retinal detachment* Cataract formation Glaucoma Chronic conjunctivitis Complications are extremely rare and most patients return to normal vision

Glaucoma Acute angle closure glaucoma may be brought on by hemorrhage causing excessive RBC in the anterior chamber damaging the trabecular meshwork.

During a baseball game, a 22 year-old college student is hit in the right eye by a baseball. He complains of blurry vision in that eye. On physical exam, the physician assistant notes proptosis of the right eye, and limitation of movement in all directions. On CT scan, which of the following is most likely to be seen? Fracture of the medial orbital wall Prolapse of orbital soft tissue Hematoma of the orbit Orbital emphysema

Hematoma of the orbit Orbital hemorrhage into the space surrounding the globe following blunt trauma and rupture of the orbital vessels results in increased ocular pressure, proptosis, visual loss, and limitation of movement in all directions. CT reveals a hematoma.

You are evaluating a patient with eye pain and after taking a history, measuring visual acuity, extraocular movement and grossly examining the eye, you apply fluorescein stain and examine with a Wood's lamp. You see what looks like a "tree branch" pattern. What is the most likely diagnosis? Glaucoma Hypopyon Hyphema Herpetic keratitis Iritis

Herpetic keratitis

A 19 year old female presents with pain, redness and swelling of the upper eyelid for the last 3 days. There are no visual changes or photophobia. Examination reveals a tender, erythematous and outward-pointing edema of the right eyelid. The most likely diagnosis is which of the following? Hordeolum Chalazion Subconjunctival hemorrhage Entropion Blepharitis

Hordeolum

A 30-year-old man presents with a painful, swollen right eye for the past day. He reports minor pain on palpation of the eyelid and denies any history of trauma, crusting, or change in vision. He has no history of allergies or any eye conditions and denies the use of any new soaps, lotions, or creams. On exam, he has localized tenderness to palpation and erythema on the midline of the lower eyelid near the lid margin. The remainder of the physical exam, including the globe, is normal.

Hordeolum (Stye) & chalazion

Which of the following is a staphylococcal infection characterized by a localized red swollen and acutely tender abscess of the upper or lower eyelid? Hordeolum Uveitis Chalazion Dacrocystitis

Hordeolum(Stye)

Which of the following is the most appropriate initial treatment for suspected orbital cellulitis? Topical antibiotics Oral antibiotics IV antibiotics Outpatient ophthalmology referral Surgical drainage

IV antibiotics

A 17 year-old male is accidentally struck in the right eye while playing football and is immediately transported to the hospital. In the emergency room, he complains of severe pain behind the eye as well as double vision. On examination, he has exophthalmos, cannot move his right eye upward and blood is noted in the anterior chamber. Which of the following is the most appropriate course of action at this time? Apply ice packs and cold compresses Immediately refer pt to ophthalmologist Attempt to keep patient calm and order a skull x-ray Administer a dose of IM broad-spectrum abx

Immediately refer to ophthamologist This scenario describes a "blow-out" fracture of the orbit with hyphema and, because of the signs and symptoms presented, warrants an immediate consult by an ophthalmologist.

A 10 year-old boy was playing with sparklers (magnesium sulfate) and got some of the "sparkle" in his right eye. Which of the following is the most appropriate initial treatment? irrigate the eye for at least 20 minutes Apply bacitracin ointment and patch the eye Remove the sparkle with a moisitened cotton swab Protect the eye with a metal shielf and refer to ophthamologist

Irrigate the eye for at least 20 minutes Dx: chemical injury

Which of the following is the best initial treatment for a patient with suspected blepharitis? Topical antibiotics Oral antibiotics Incision and drainage Lid washing and massage Outpatient referral to ophthalmology

Lid washing and massage

Which of the following is the leading cause of permanent visual loss in a patient over the age of 75? Blepharitis Cataracts CRAO Macular degeneration

Macular degeneration

Which of the following may precipitate acute angle-closure glaucoma? Metoclopramide Timolol Glyburide Acetazolamide

Metoclopramide Metoclopramide and other drugs with high anticholinergic effects may precipitate acute angle-closure glaucoma from pupillary dilation.

A 12 year-old presents with complaint of both eyes "watering." He also complains of sinus congestion and sneezing for two weeks. On exam vital signs are T-38°C, P-80/minute, and RR-20/minute. The eyes reveal mild conjunctival injection bilaterally, clear watery discharge, and no matting. Pupils are equal, round, and reactive to light and accommodation. The extraocular movements are intact. The funduscopic exam shows normal disc and vessels. The TMs are normal and the canals are clear. The nasal mucosa is boggy, with clear rhinorrhea. Which of the following is the most helpful pharmacologic agent? Artificial tears Tobramycin drops Erythromycin ointment Naphazoline (Naphcon-A) drops

Naphazoline (Naphcon-A) drops

The best course of action for a patient with a bothersome inflamed pinguecula (pingueculitis) is? Antibiotic drops Excision Visine drops No treatment

No treatment With pingueculitis, no treatment is necessary; a short course of NSAID drops or steroids may help.

In a patient with suspected open globe, which of the following is the most appropriate next step? Palpate the lids and lacrimal apparatus for tenderness Measure intraocular pressure Perform an MRI of the affected eye Obtain urgent ophthalmology follow up Perform plain films of the affected eye

Obtain urgent ophthalmology follow up

A 50-year-old man presents for a routine eye examination with no symptoms. He has elevated intraocular pressure of 25 mmHg in the right eye and 30 mmHg in the left eye. On dilated examination, the cup-to-disk ratio is 0.5 in the right eye and 0.8 in the left eye. Corneal thickness and gonioscopy are normal. Subsequent automated testing of visual fields demonstrates peripheral visual field loss greater in the left eye than in the right. Repeated automated visual field testing shows that the visual field defects are reproducible.

Open-angle glaucoma

Bitemporal hemianopia is noted on physical examination in a patient with visual changes over the past 2 years. The central field of vision is spared. The lesion is located in the? Optic nerve Optic chiasm Temporal optic radiation Optic tract

Optic chiasm

In the setting of orbital trauma, a patient presenting with limited eye movement, sunken appearance of the eye, and painful range of motion may be most suspicious for which of the following diagnosis? Hyphema Orbital cellulitis Global rupture Orbital blow out fracture Retinal detachment

Orbital blow out fracture

In patients with diabetic retinopathy, what clinical intervention is most successful in preserving vision? Panretinal laser photocoagulation Iridectomy Radial keratotomy Vitrectomy

Panretinal laser photocoagulation

A 36-year-old female presents to the occupational health clinic with a history of a fleck of metal in the right eye obtained while working in a fabrication plant. You note a large area of subconjunctival hemorrhage and a central abrasion of the sclera. How would you rule out perforation of the globe? Apply gentle pressure to the globe to see if there is an extrusion Perform a magnetic resonance imaging test Perform a test using fluorescein dye Do nothing until cleared by an ophthalmologist

Perform a test using fluorescein dye

Which of the following is considered a risk factor for retinopathy of prematurity? Maternal rubella infection Maternal alcohol abuse Perinatal oxygen therapy Family hx of retinal detachment

Perinatal oxygen therapy Risk factors for retinopathy of prematurity include perinatal oxygen therapy, low birth weight, prematurity, and sepsis.

Which of the following is a fleshy growth on the nasal side of the conjunctiva that is raised, yellow and respect the corneal border? Pinguecula Pterygium Entropion Chalazion Hordeolum

Pinguecula

Which of the following is described as a harmless triangular nodule in the bulbar conjunctiva on either side of the iris? Corneal arcus Hordeolum Pinguecula Xanthelasma

Pinguecula Pinguecula is a yellow elevated conjunctival nodule, more commonly on the nasal side, in the area of the palpebral fissure.

Which of the following findings is most consistent with cataracts? Conjunctival injection Poorly visualized optic disc Central visual field loss Arcus senilis

Poorly visualized optic disc

A 57 year-old male was working on his farm, when some manure was slung hitting his left eye. He presents several days after with a red, tearing, painful eye. Fluorescein stain reveals uptake over the cornea looking like a shallow crater. Which of the following interventions would be harmful? Ophthalmic antibiotics Pressure patch Examination for visual acuity Copious irrigation

Pressure patch Patching of the eye after abrasion associated with organic material contamination is contraindicated due to increased risk of fungal infection.

A 45 y/o woman suddenly experiences pain in the right eye along with blurred vision, nausea, and vomiting. IOP is 58 mmHg and there is moderately dilated right pupil, decreased visual acuity, shallow anterior chamber, and steamy cornea noted during physical exam. Based on this information, what is the most likely diagnosis? Retinal detachment Retinal artery occlusion Uveitis Primary open angle glaucoma Primary acute angle closure glaucoma

Primary acute angle closure glaucoma

A 45-year-old woman suddenly experiences severe pain in the right eye along with blurred vision, nausea, and vomiting. Intraocular pressure is 58 mm Hg and there is a moderately dilated right pupil, decreased visual acuity, shallow anterior chamber, and steamy cornea noted during physical examination. Based on this information, what is the most likely diagnosis? Retinal detachment Retinal artery occlusion Uveitis Primary open angle glaucoma Primary acute angle closure glaucoma

Primary acute angle closure glaucoma

After a recent bout of gastroenteritis characterized by vomiting and diarrhea, a 60 year old male patient presents with bright red blood visible on the lateral right sclera. Blood pressure is normal as is his visual acuity. What is your treatment plan? Emergency consultation with an ophthalmologist Computed tomography (CT) scan to rule out intracranial hemorrhage Provide reassurance to the patient; no treatment is needed Complete intraocular examination with dilation Complete blood cell count and bleeding studies

Provide reassurance to the patient; no treatment is needed Dx: subconjunctival hemorrhage

Presence of which of the following would suggest allergic etiology for a patient with conjunctivitis? Yellow discharge Pruritus and rhinorrhea Recent sick exposure Pain with eye movement

Pruritus and rhinorrhea

A 35-year-old woman of Middle-Eastern origin presents with a lesion at the corner of her eye by her nose. This has been present for several years. She occasionally gets ocular irritation but is worried about the cosmetic appearance. A raised fleshy lump can be seen at the nasal aspect of her cornea, which encroaches about 2 mm onto the cornea. The eye otherwise looks normal with vision recorded at 20/16.

Pterygium

A 45-year-old man presents with ocular irritation, burning, and tearing with the presence of a white/red lesion on the side of his eye by his nose, which he reports has been growing toward the pupil for at least 5 to 10 years. He has been residing in the US for the past 5 years but previously lived in West Africa. He reports slight blurring of his vision. He has a triangular-shaped piece of fleshy, fibrovascular tissue encroaching onto the nasal aspect of his cornea by about 3 to 4 mm. At its apex it has a whitish head, and it is continuous with the conjunctiva at its base, which is about 6 mm in length. The eye otherwise looks normal with a best spectacle-corrected vision of 20/20.

Pterygium

A blacksmith presents to your clinic after feeling like something went in his eye while he was grinding on a piece of metal. You stain the eye with Fluorescein and can visualize uptake with what appears like a deep abrasion. You are unable to visualize any foreign body with your indirect ophthalmoscope. Although he makes an attempt, he complains of some visual loss in that eye. His last Tetanus booster was 4 years ago. What is the most appropriate next step in the management of this patient? Administer tetanus Prescrive tetracaine ophthalmic Provide reassurance only Refer to ophthalmologist

Refer to ophthalmologist Intraoccular foreign body requires emergency treatment by an ophthalmologist.

After being involved in an altercation the night before a 24 y/o male presents to the ER with persistent double vision. His left periorbital area displays significant ecchymosis and edema. Based on the hx, what other findings do you expect on PE and what diagnostic test will confirm the diagnosis? Hyphema; schiotz tonometer Hyphema; plain radiograph Restricted ocular movement; CT scan Restricted ocular movement; plain radiography Ruptured globe; retinal angiography

Restricted ocular movement; CT scan

59 year-old male complains of "flashing lights behind my eye" followed by sudden loss of vision, stating that it was "like a curtain across my eye." He denies trauma. He takes Glucophage for his diabetes mellitus and atenolol for his hypertension. He has no other complaints. On funduscopic exam, the retina appears to be out of focus. Which of the following is the most likely diagnosis? Central retinal vein occlusion Retinal artery occlusion Retinal detachment Hyphema

Retinal detachment

A 67-year-old man presents with a 2-day history of sudden visual loss in his right eye. He is slightly myopic and had successful cataract extraction with intraocular lens implantation 3 years earlier. He does not remember this eye ever having been injured. No pain was associated with the vision loss, and his blood pressure is normal with medication. The patient describes the loss of vision as a veil covering the visual field.

Retinal detachment

You are counseling a newly diagnosed type 2 diabetic about the need for referral to ophthalmology for a dilated funduscopic exam. Which of the following best describes the rationale for referral? He can wait until next year when he goes to get his refraction He does not need to see an ophthalmologist if his Hemoglobin A1C is < 6.0 Retinopathy is present in 20% of patient with type 2 Diabetes Mellitus at time of diagnosis Your non-dilated exam can substitute for this referral

Retinopathy is present in 20% of patient with type 2 Diabetes Mellitus at time of diagnosis

A 62 year-old male chronic smoker is examined for slowly progressive non-painful vision loss. Visual acuity showed 20/150 in both eyes. Extra-ocular muscles are intact. Pupils are responsive to direct and consensual stimuli however appear hazy. During funduscopic exam you are unable to visualize the optic cup, disk or the vessels. What is the most appropriate diagnosis? Anterior uveitis Narrow angle glaucoma Retinal detachment Senile cataract

Senile cataract

A 75 year-old patient with history of macular degeneration and hypertension presents with complaint of sudden onset of visual loss in the left eye. The patient denies pain. On examination you note a dome-shaped retina and subretinal fluid that shifts with position changes. Which of the following is the most likely diagnosis in this patient? CRVO Acute angle-closure glaucoma Acute nongranulomatous anterior uveitis, Serous retinal detachment

Serous retinal detachment Serous retinal detachment is characterized by a dome shaped retina and subretinal fluid that shifts position with posture changes. Serous retinal detachment results from subretinal fluid accumulation which can occur in exudative age-related macular degeneration.

What pathogen is most likely associated with acute onset pain, redness, and outward-pointing edema of the eyelids? Aspergillus species Staphylococcus aureus Haemophilus influenzae Candida albicans Streptococcus aureus

Staphylococcus aureus Dx: hordeolum

Which of the following is diagnosed by use of the cover/uncover test? Adies pupil Strabismus Glaucoma Myopia

Strabismus

In a patient with suspected corneal injury, which of the following layers would be the most superficial layer required to classify the injury as a corneal ulcer? Epithelium Bowman's layer Stroma Descemet's Layer Endothelium

Stroma

A 9 year-old patient presents with conjunctivitis after swimming at the local pool. On examination, there is visible lid edema with redness of the palpebral conjunctiva, copious watery discharge, and scanty exudate. The sanitation system of the public pool is through the use of a salt water system; therefore, the possibility of a chemical induced conjunctivitis is almost non-existent. Which of the following should be instituted to prevent the sequalae of the condition? Ketorolac tromethamine (Acular) Dexamethasone ophthalmic Naphazoline HCL (Naphcon A) Sulfacetamide ophthalmic

Sulfacetamide ophthalmic One of the most common causes of viral conjunctivitis is adenovirus type 3. Contaminated swimming pools can be source of infection. Topical sulfonamides prevent secondary bacterial infection.

5 y/o with 2 day history of fever, sore throat, tearing and mild erythema of both eyes. She has been swimming in a public pool. There is scant exudate present bilaterally and large amount of watery discharge. Conjunctival and pharyngeal mucosa follicles present. Nontender preauricular adenopathy is present. What is the most appropriate treatment for this patient? Oral abx Topical or systemic antiviral medications Symptomatic treatment only Ocular antihistamines for tx of allergies

Symptomatic treatment only Dx: Viral conjuntivitis

A 14-year-old boy with no significant past medical history presents 3 days after developing a red, irritated right eye that spread to the left eye today. He has watery discharge from both eyes and they are stuck shut in the morning. He reports recent upper respiratory symptoms and that several children at his day camp recently had pink eye. He denies significant pain or light sensitivity and does not wear contact lenses. On examination, his pupils are equal and reactive and he has a right-sided, tender preauricular lymph node. Penlight examination does not reveal any corneal opacity.

Viral conjunctivitis

A patient is evaluated in the office with a red eye. The patient awoke with redness and a watery discharge from the eye. The eyelids were not matted together. Examination reveals a palpable preauricular node. Which of the following is the most likely diagnosis? Bacterial conjunctivitis Viral conjunctivitis Allergic conjunctivitis Gonococcoal conjunctivitis

Viral conjunctivitis

A 5-year-old child presents to your pediatric practice with her parents complaining of a 2-day history of fever (101F), sore throat, and tearing, and mild erythema of both eyes. Since it is summer, she has been taking swimming lessons in a public pool. There is no cough, nasal congestion, pain or photophobia. Your examination shows a small amount of exudate in the eyes bilaterally along with a large amount of clear discharge. There are conjunctival follicles present in both the preauricular area. What is the most likely diagnosis for this patient? Viral conjunctivitis Bacterial conjunctivitis Allergic conjunctivitis Bacterial pharyngitis Blepharitis

Viral conjunctivitis *Secondary systemic symptoms: fever, sore throat. *Clear discharge, erythema *Common in children swimming

A patient presents with eye pain and blurred vision. Snellen testing reveals vision of 20/200 in the affected eye and 20/20 in the unaffected eye. Fluorescein staining reveals the presence of a dendritic ulcer. Which of the following is the most likely diagnosis? Viral keratitis Fungal corneal ulcer Acanthamoeba keratitis Bacterial corneal ulcer

Viral keratitis Herpes Simplex virus is a common cause of dendritic ulceration noted on fluorescein staining.

Which of the following is the best next step in the evaluation of patient with suspected corneal foreign body? Application of topical anesthetic Removal with moist cotton applicator MRI of the affected eye Fluorescein staining of the affected eye, Visual acuity testing

Visual acuity testing

You are evaluating a 67 year-old Asian male in the emergency room for acute onset right eye pain. He states he was at the evening premier of a newly released movie when the pain started. He had acute, profound visual loss in the affected eye. The pain was intense enough for him to leave the theatre before the movie's conclusion, and present to your location. On examination, the eye appears injected (red) and the cornea appears hazy. His pupils are 6 mm on the affected side and 3 mm on the unaffected side. They respond to light on the unaffected side but not on the affected side. On palpation, the globe feels tense. What history question is most relevant to support the diagnosis? Contact lens use Past sexual contacts Recent URI symptoms Visualizing halos around street lights

Visualizing halos around street lights Primary acute angle-closure glaucoma occurs only with closure of a preexisting narrow anterior chamber angle found in older age groups, hyperopes, inuites, and Asians.

A patient with type 2 diabetes mellitus presents for a yearly eye exam. Ophthalmoscopic exam reveals neovascularization. Which of the following is the most likely complication related to this finding? Glaucoma Cataracts Vitreous hemorrhage Optic neuritis

Vitreous hemorrhage

A 32 year-old carpenter complains of right eye irritation all day after driving a metal stake into the ground with his hammer. He states that "something flew into my eye." Visual acuity is 20/20. Pupils are equal, round, reactive to light and accommodation. Extraocular movements are intact. There is minimal right corneal injection. No foreign body is noted with lid eversion. Fluorescein stain reveals a tiny pinpoint uptake in the area of the corneal injection. Which of the following is the most appropriate diagnostic test at this stage? MRI Xray orbit Applanation tonometry Fluorescein angiography

Xray orbit