CMN 568 Final Modules 1-3 Questions
And Answers Download To
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KERATOCONJUNCTIVITIS SICCA (DRY EYE) - correct answer...✔✔older adults;
more prevalent in women
Etiology: hypofunction of lacrimal glands as we age; environmental factors (hot, dry
windy conditions), blepharitis (inflammation of eyelid from bacteria), systemic drugs
(antihistamines), and autoimmune disorders (Sjogren syndrome)
Clinical Findings: dry, red eyes, foreign body sensation, excessive mucous secretion;
decreased tear formation and photophobia (severe cases)
Treatment: artificial tears PRN or petroleum ointment may be used Refer to
ophthalmologist if no improvement
HORDEOLUM (STYE) Adult - correct answer...✔✔Etiology: localized infection in the
glands of Zeis of eyelid
Pathogens: Staphylococcus
Clinical Findings: tender, red, warm papule on eyelid Treatment: warm compress (may
help lesion to "point" and drain)
Medications: topical antibiotics (optional) with Polysporin or Sulamyd ointment **Treat
blepharitis if present
ACUTE CLOSED-ANGLE GLAUCOMA - correct answer...✔✔Rare, optho
EMERGENCY associated with elevated IOP Middle-aged or older patients with small
anterior chambers or altered iris structure;
Hx of topical/oral mydriatic use or eye surgery; + family hx of glaucoma; shallow anterior
chamber (associated with farsightedness or short stature or both); enlargement of the
crystalline lens with age; inheritance (Inuits and Asians)
PRIMARY ACUTE CLOSED-ANGLE GLAUCOMA (PACG) - correct answer...✔✔
Acute, sudden and severe closure of the angle with very high IOP (often 5-80 mm Hg),
decreased visual acuity, corneal edema, pain, nausea and vomiting
Usually occurs spontaneously in evening or dark setting
Secondary Acute closed-angle glaucoma (SACG) - correct answer...✔✔Etiology:
underlying identifiable pathologic (neovascularization, inflammation, developmental
abnormalities, uveal effusion syndrome, or mass lesions pushing the peripheral iris into
the angle)
AGRADESOLUTIONS
,s/s of acute closed-angle glaucoma - correct answer...✔✔UNILATERAL. Severe pain
and rapidly progressive loss of vision (blurred vision, halos around lights), acute
photophobia; diffuse, scleral redness, and corneal haziness
Involved Pupil: moderately dilated, unreactive to light (other pupil remains normal);
elevated IOP of affected eye - tested by digitally palpating for a hardened globe Severe
Cases: frontal headache, nausea, vomiting
Diagnosis Acute closed-angle glaucoma - correct answer...✔✔Slit lamp examination
and gonioscopy = preferred diagnostic methods Hallmark Findings: IOP (50-100 mm
Hg), shallow anterior chamber, corneal edema
Treatment Acute closed-angle glaucoma - correct answer...✔✔EMERGENT
REFERRAL TO OPTHO! optic nerve atrophy and irreversible loss of vision can occur
within hours after onset
Goal: lower intraocular pressure Initial treatment is reduction of intraocular pressure
A single 500-mg intravenous dose of acetazolamide - 250 mg orally four times a day +
topical medications Osmotic diuretics (oral glycerin and intravenous urea or mannitol) -
may be necessary if there is no response to acetazolamide
Definitive tx: laser peripheral iridotomy or surgical peripheral iridectomy
Keratitis - correct answer...✔✔inflammation of the cornea
Risk Factors: contact lens wear (especially overnight), corneal trauma (including
surgery)
Bacterial Keratitis - correct answer...✔✔Pathogens: pseudomonas aeruginosa,
Moraxella, gram-neg bacilli, staphylococci (including MRSA), streptococci
Causes: aggressive course; contacts (esp. overnight), corneal trauma (refractive sx)
Clinical Findings: hazy cornea and adjacent stromal abscess; hypopyon (pus in anterior
chamber)
Viral Keratitis - correct answer...✔✔Herpes simplex virus
Clinical Findings: lid, conjunctival, corneal ulceration (most easily visualized with
fluorescein exam); recurrences precipitated by fever, excessive exposure to sunlight,
immunodeficiency
Keratitis s/s - correct answer...✔✔Hazy cornea, central ulcer, hypopyon (pus in anterior
chamber), diffuse erythema, usually painful eye, photophobia, grittiness or foreign body
sensation, blurred vision
Keratitis treatment Adults - correct answer...✔✔BACTERIAL: 1st line Agents:
Fluoroquinolones (levofloxacin 0.5%, ofloxacin 0.3%, norfloxacin 0.3%, or ciprofloxacin
0.3%)
VIRAL: Responds well to simple debridement and patching Rapid healing: -Addition of
topical antivirals (trifluridine drops, ganciclovir gel, or acyclovir ointment) OR Oral
antivirals - reduces the rate of recurrent epithelial disease)
AGRADESOLUTIONS
, ACUTE ANTERIOR UVEITIS (iritis) - correct answer...✔✔Inflammation of the uvea
(layer between the retina and sclera)
Primarily immunologic; infection may be cause (immunocompromised patients) or
neoplastic
HLA-B27 related conditions (ankylosing spondylitis, reactive arthritis, psoriasis,
ulcerative colitis, Crohn disease) Bechet syndrome Herpes Simplex / Herpes Zoster
Uveitis (Iritis) s/s - correct answer...✔✔Unilateral eye pain, photophobia, may have
blurred vision Ciliary Flush (redness concentrated at border of cornea and sclera)
Cornea may be cloudy, pupil usually small, but reactive
Treatment of uveitis (Iritis) - correct answer...✔✔EMERGENT REFERRAL TO OPTHO!
Usually responds to topical corticosteroids Relieve Discomfort / Prevent Posterior
Synechiae (iris adhering to lens): dilation of the pupil Infectious Cause: specific
antimicrobial therapy
Retinal Detachment - correct answer...✔✔Degenerative changes in vitreous (persons >
50yr age) one or more peripheral retinal tears/holes, spontaneous retinal detachment
RISK FACTORS Nearsightedness; cataract extraction (most common) Penetrating or
blunt ocular trauma
Retinal Detachment s/s - correct answer...✔✔floaters and flashes of light; Sudden
onset of monocular painless vision loss - begins inferiorly and rapidly spreads upward;
"curtain" effect of vision loss Central vision -may remain intact (if macula is not
detached) No eye redness
Optho Exam: retina is seen "hanging" in vitreous - like a gray cloud
Treatment retinal detachment - correct answer...✔✔EMERGENT REFERRAL TO
OPTHO! During transportation, the patient's head is positioned so that the detached
portion of the retina will fall back with the aid of gravity (patient lying flat on side with
face opposite the vision loss to the pillow)
Affected side up
Prognosis Retinal Detachment - correct answer...✔✔About 90% of uncomplicated
rhegmatogenous retinal detachments can be cured with one operation. The visual
prognosis is worse if the macula is detached or if the detachment is of long duration
Conductive hearing loss - correct answer...✔✔-dysfunction of the external or middle
ear
-Mechanisms: obstruction (cerumen), mass loading (middle ear effusion), stiffness
effect (otosclerosis), discontinuity (ossicular disruption) Common Causes: URI, chronic
ear infection, trauma, or otosclerosis
cerumen impaction - correct answer...✔✔Cause: usually self-induced
AGRADESOLUTIONS
