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2005-2006 Ophthalmology Questions

 

Question 1.

A 45 year-old female with a coagulation disorder presents to the emergency department with headache, nausea and vomiting. There is no history of trauma. Which of the following is the most likely cause of her symptoms?

 

  1. Increased intraocular pressure
  2. Subconjunctival hemorrhage
  3. Elliptical pupil
  4. Iritis

 

Correct answer: A.

 

Explanation: A spontaneous hyphema occurred in this woman.  A large clot in the area of the visual axis is seen. Blood in the area of the outflow tract is also seen.  A subconjunctival hemorrhage is also seen.  Complications of hyphema include corneal staining, rebleeding, typically 4-5 days after the initial bleed,  and increased intraocular pressure due to red blood cells blocking the outflow tract of aqueous humor. Subconjunctival hemorrhage typically does not cause pain. An elliptical pupil alone does not typically cause pain. Iritis is usually present in patients with a hyphema but should not cause headache, nausea, and vomiting.

 

Question 2.

A 23 year-old male presents to the emergency department at 2AM with severe left eye pain. He has myopia and wears extended wear contact lenses. He only takes them out for several hours every 2 weeks to clean them.  He has severe direct and consensual photophobia. He is otherwise healthy. His uncorrected visual acuity in the affected eye is 20/200.  Normally it is 20/100.  There is a circular, 2mm area of white infiltrate at 12 o’clock just above the visual axis. Fluorescein stain reveals an epithelial defect at the area of the infiltrate.

 

Organisms likely to cause this condition include all of the following except:

A. Staphylococcus species

B. Streptococcus species

C. Pseudomonas species

D. Eikenella corrodens

 

Correct answer: D

 

Explanation: Eye pain, corneal infiltrate, and an epithelial defect are the findings seen with a corneal ulcer. The most common bacteria causing a corneal ulcer include staphylococcus species, streptococcus species, and Pseudomonas. Corneal ulcer is ophthalmologic emergency and requires consultation. Scrapings of the ulcer for Gram stain, and application of fortified antibiotic drops ever hour are required for treatment of a corneal ulcer. Corneal scarring and perforation potential complications.

 

Question 3.

A 19 year-old male comes to the emergency department after a motor vehicle crash. His only apparent injury is his right eye. His uncorrected visual acuity is 20/30 in the affected eye. Management of this condition includes all of the following except:

 

  1. Protective eye shield
  2. Double eye patch
  3. Upright head position
  4. Antiemetics
  5. Pain medication

 

Correct answer: B

 

Explanation: An elliptical pupil with prolapsed uveal (iris) contents suggests an open globe. A CT scan of the orbits may be helpful to determining the extent of globe injury. Immediate consultation is necessary and measures to prevent increasing intraocular pressure and extrusion of orbital contents should be taken. These include protective eye shield, head in upright position, antiemetics, and narcotic pain control. Double patching should not be preformed as this will worsen the extrusion of orbital contents.

 

Question 4.

A 56 year-old male presents to the emergency department with bilateral eye discharge and discomfort for 3 days. His bulbar and Palpebral conjunctivae are markedly inject and his discharge is seen below. He denies trauma and he is otherwise healthy. His visual acuity is normal.

 

Management of this patient includes which of the following?

 

  1. Routine culture
  2. CT scan of the orbits
  3. Empiric treatment with topical antibiotics
  4. Double patch

 

Correct answer: C

 

Explanation: Acute bacterial conjunctivitis is typically unilateral. Discharge is mucopurulent and irritation is common. Photophobia is mild and a mild foreign body sensation is present. Routine culture is not necessary. CT scan of the orbits is not necessary unless there is proptosis, double vision or fever. It is unwise to patch any infectious condition of the eye. Empiric topical antibiotic treatment  includes Polytrim, gentamycin,  erythromycin, or ciprofloxin.

 

 

 

Question 5.

A 32- year old welder presents to the emergency department at 2AM because of bilateral eye pain. His visual acuity is 20/70 bilaterally.  The pain is moderately relieved with topical proparacaine.

 

Correct management includes all of the following except:

 

  1. Treat with antibiotic ointment such as erythromycin
  2. Treat with a cycloplegic agent such as homatropine
  3. Look for a foreign body under the upper and lower lids
  4. Immediate ophthalmology consultation

 

Correct answer: D.

 

Explanation: Welder’s or UV keritatis is manifest by bilateral eye pain after UV light exposure. Fluorescein staining reveals multiple punctate lesions which represent disruption of individual epithelial cells. Treatment includes antibiotic ointment, cycloplegic agent (which relieves ciliary spasm and pain), and looking for a foreign body under the lids. This condition can be easily managed with the above measures and ophthalmology consultation is usually not required.