TREATMENT AND MANAGEMENT OF OCULAR DISEASE REVIEW QUESTIONS Volumn V
Note: Reference pages from Clinical Ocular Pharmacology-3rd edition, Bartlett/Jaanus, are given at the end of some questions. Reference pages from The Wills Eye Manual, Office and Emergency Room Diagnosis and Treatment of Eye Disease-2nd edition, Cullom and Chang are given at the end of some quesitons and indicated by the word, Wills. 1. Which single treatment would be most effective in the management of chronic staphylococcal blepharitis? (568) A. B. C. D. 2. Blephamide - one drop every four hours. Polysporin ointment at bedtime. Lid scrubs twice a day. Tetracycline 250 mg orally four times a day.
A 21 year old male presents with a right eye with marked conjunctival injection, +3 follicles in the lower lid, positive preauricular adenopathy, +3 diffuse punctate keratitis, and a watery discharge. Which of the following would be the most effective treatment? A. B. C. D. Gentamicin ointment three times a day OD. Neosporin one drop four times a day OD. Erythromycin ointment three times a day OD. None of the above would be appropriate.
A 30 year old male soft contact lens wearer presents with contact lens intolerance. You note +3 sludging of the meibomian secretion, but no other significant ocular findings. Which of the following would be least beneficial in the management of this patient's condition? (571-573) A. B. C. D. Warm compresses four times a day. Tetracycline 250 mg orally four times a day. Polysporin ointment to the lids at bedtime. Digital massage of the lids four times a day.
A 9 year old boy presents with an acute red eye of six days duration. The nurse at his pediatricians office has prescribed NeoDecadron drops four times a day, but the condition is worsening. Your examination reveals +2 mucopurulent discharge, +3 inferior palpebral conjunctival hyperemia, punctate keratitis, and faint marginal infiltrates. What would you do to treat this patient? (638-639) A. B. C. D. Discontinue the NeoDecadron, prescribe gentamicin drops qid x 14 days. Reassure improvement and continue the current medication. Discontinue the NeoDecadron, prescribe sulfacetamide drops qid. Discontinue the NeoDecadron, prescribe trimethoprim-polymyxin B drops
qid x 7 days.
A 50 year old male is referred to you by your local co-management center to follow. He presents with a previous diagnosis of chronic open angle glaucoma. He was prescribed Timoptic .5% twice a day in both eyes, but admits to very poor compliance, usually using the drop only once a day. His optic nerve findings and threshold fields show minimal changes from expected norms and his intraocular pressure measures 15 mmHg in both eyes. What would you do? (187, 897) A. B. C. D. Discontinue the medication and see what his pressure does. Change his medication to Timoptic-XE .5% - once a day. Change his medication to Propine .1% - twice a day. Change nothing, lecture the patient about going blind from glaucoma.
A 28 year old female presents with an acutely red, painful left eye. She wears disposable soft contact lenses on an extended wear basis and has worn her current lenses for the last 12 days. You note significant mucous and protein build up on the lenses. The left cornea shows a 1.5 mm round marginal infiltrate with faint staining of the overlying epithelium. How would you treat this condition?
A. B. day. C. D. 7.
Discontinue lens wear and see the patient in 24 hours. Discontinue lens wear, prescribe Blephamide drops every three hours OS and Discontinue lens wear, prescribe gentamicin drops every two hours OS and Discontinue lens wear, prescribe Polytrim drops every three hours and see
see the patient the next
see the patient in 3 days. the patient the next day.
A 27 year old female, soft extended wear contact lens patient presents with an intermittent red eye (mainly the left) over the past six months. Her medical history includes an active peptic ulcer. She is taking Metrodin, orally, twice a day. Examination reveals large, relatively clear elevations on the upper tarsal plate (OD +2 and OS +3), +1 superior corneal pannus, and a trace, stringy mucopurulent discharge. What would be the best treatment plan? (649-650) A. B. C. D. E. Erythromycin 250 mg orally four times a day for 21 days. Discontinue lens wear and prescribe Naphcon A drops three times a day. Tetracycline 250 mg orally four times a day for 21 days. Discard the present lenses and refit the patient in disposable, daily wear Doxycycline 100 mg orally bid x 7 days then 100 mg qd x 14 days.
You see a young male patient who was hit in the right eye with a handball approximately two hours earlier. You note +2 perilimbal injection, but a clear anterior chamber. The right pupil is slightly smaller than the left. What is your initial treatment plan? (Wills-31-32) A. B. C. D. E. Inflamase Forte susp. one drop q3h OD. HMS one drop q3h OD, Tropicamide one drop qid OD. Inflamase Forte susp. one drop q2h, Homatropine one drop qid OD. FML one drop every two hours, Tropicamide one drop four times a day OD. Cyclogel 2% one drop qid OD.
A patient presents with an acute, mildly red eye with +1 mucopurulent discharge. You note trace injection and crusty build-up to the lid margins of both eyes. You decide to treat the patient with an antibiotic. What is your best choice? A. B. C. D. Gentamicin ointment OU hs. Bacitracin ointment OU hs. Polysporin ointment OU hs. Erythromycin ointment OU hs.
You are examining a patient 36 hours after cataract surgery on the right eye. The patient says the eye feels fine, but the vision is very blurry. You measure uncorrected vision at 20/100 and it does not improve with pinhole. The conjunctiva is mildly injected and there is a trace of flare in the anterior chamber. The wound is secure and the implant is centered. The pupil is round and free. Intraocular pressure is 21 mmHg. The cornea shows +3 striae and +2 stromal edema. What single treatment choice would be most effective in improving this patient's vision? A. B. C. D. E. Do nothing - nothing will help so just wait it out. Prescribe Muro 128 drops four times a day. Prescribe Muro 128 ointment at bedtime. Prescribe Timoptic .5% bid. Increase their steroid use.
The best initial choice of treatment for postoperative cataract sx CME is: (821) A. B. C. D. Indomethacin. Oral steroids. Laser photocoagulation. Steroid injections.
The initial choice of treatment for a CRA occlusion is: (819) A. B. C. D. Digital massage of the globe. CO2 administration. Retrobulbar injections of acetylcholine. Breathing into a paper sack.
Ocular side effects of corticosteroids therapy: (312) A. Cataracts.
B. C. D. 14.
Glaucoma. Ocular infection. All of the above.
Best initial choice of treatment on a 10 year old patient with vernal conjunctivitis is: (759) A. B. C. D. HMS. Pred Forte. Cold compresses and topical antihistamines. Cromolyn sodium.
The best initial treatment for viral conjunctivitis is: (645) A. B. C. D. Cold compresses, decongestants, and lubricants. FML. Topical antibiotics. 1% Pred Forte.
The most effective initial treatment for primary meibomianitis is: (572) A. B. C. D. Digital massage and gland expression. Topical antibiotics. Oral antibiotics. 1% silver nitrate.
Initial tx of a mild preseptal cellulitis in an adult: (575) A. B. C. D. FML ung. FML susp. Dicloxacillin orally. Vidarabine ung.
A 28 year old white female presents at your office on an emergency basis and reports she has accidentally cut the white of her eye on a piece of typing paper. Upon slit lamp examination you discover that there is indeed a shallow clean cut that is approximately 8 mm in length and temporal to the limbus. The cut does not penetrate or perforate the sclera, but the edges appear slightly separated when the patient moves her eye away from the side of the injury. What is the best treatment plan? (672) A. Prednisolone acetate 1%, q2h on a tapering dose. B. Topical steroids and surgical resection. c. Artificial tears and .5% silver nitrate. d. Cool compresses q4h for 2 days followed by warm compresses. e. Bacitracin-polymyxin B ointment prophylactically, pressure patch, warm analgesics.
Treatment of exposure keratopathy can include all of the following except: (696) A. B. C. D. Topical steroids. Lubricating drops. Lubricating ointment. Taping eyelids shut.
Treatment of bullous keratopathy can include all of the following except: (733-734,) A. B. C. D. E. Topical hyperosmotics. Hydrophilic contact lenses. Conjunctival flap over the cornea. EDTA 3%. Blow dryer on the cornea.
Management of Fuch's Dystrophy can include all of the following except: (Wills-102-103)
A. B. C. D. 22.
5% sodium chloride ung or gtts. Topical beta-blockers. Hair dryer held at arm's length 2-3 times per day. Topical antibiotics.
A patient presents with a red, painful photophobic right eye. Biomicroscopy reveals a miotic pupil with 2+ cells and flare in the anterior chamber, IOP OD is 28 mmHg and OS 24 mmHg. The treatment of this condition might include the following except: (780-781) A. B. C. D. Cyclopentolate 1%. Homatropine 5%. 1% prednisolone acetate. Pilocarpine.
Usual dosage for diamox in angle closure glaucoma upon being discharged after the initial attack has been broken is: (Wills-228) A. B. C. D. 250 mg qid po. 500 mg bid po. 500 mg tid po. 250 mg qid po.
A patient complains of a foreign body sensation in both eyes. Examination shows superior bulbar conjunctival hyperemia and rose bengal staining of the superior cornea and limbus. The initial treatment plan includes: (669) A. B. C. D. Silver nitrate 5% sol. Surgical resection of superior conjunctiva. Cautery of superior conjunctiva. Artificial tears.
The least effective treatment of episcleritis is: (765) A. B. C. D. FML .1%. Prednisolone 1%. Tobramycin. Topical decongestants.
The least indicated treatment for mild anterior uveitis is: (780-781) A. B. C. D. Atropine 1%. FML .1%. Homatropine 5%. Prednisolone acetate 1%.
An 18 year old male presents for a routine eye exam. Best corrected acuity is 20/30. Indirect ophthalmoscopy with scleral depression shows "snowbanks" in the retinal periphery. Initial treatment would be: (787) A. B. C. D. Oral steroids. Topical steroids. Ophthalmoscopy and vision check in 3 months. Refer immediately for immune system work-up.
A 66 year old female with diabetes and asthma has intraocular pressures of 32 mmHg and paracentral visual field losses O.U. Gonioscopy shows open angles. The best initial treatment would be: (894-895) A. B. C. D. Pilocarpine. Diamox. Timoptic. Betagan.
A patient presents with a closed angle glaucoma episode. Intraocular pressures are 59 mm. O.U. The drug to LEAST likely initially lower intraocular pressure would be: (910) A. B. C. D. Timoptic. Pilocarpine. Osmoglyn. Diamox.
A patient presents with a closed angle glaucoma episode. Intraocular pressures are 40 mmHg O.U The patient is diabetic and asthmatic. The best initial treatment is: (895, 910) A. B. C. D. Timoptic. Pilocarpine. Osmoglyn. Betagan.
A 30 year old female presents with complaints of headaches, decreased vision, fever and general malaise. She has recently returned from a camping trip and has follicular conjunctivitis and a circular red area on her arm. Best oral treatment for this condition would be: (649, Wills-399) A. B. C. D. Oral penicillin and topical gentamicin. TobraDex. Aspirin and trifluridine. Oral doxycycline and topical tetracycline.
A 12 year old male reports itchy burning eyes. Examination reveals hard, brittle scales surrounding the lashes and on the lid margin. There are no other ocular abnormalities. The LEAST recommended treatment would be: (568569)
A. B. C. D. 33.
Bacitracin ointment. Mercuric oxide ointment. Lid scrubs. Naphcon-A.
A 72 year old male complains of burning and gritty eyes. In addition to a moderate keratitis and blepharitis, you observe multiple facial telangiectasia and rhinophyma. Treatment would include all but: (657-659) A. B. C. D. Oral Tetracycline 250 mg qid. Oral steroids. Lid scrubs. Topical antibiotic-steroid combination.
A seven year old white female presents to you with complaints of photophobia in the right eye. Upon examination, the right eye appears minimally injected. Examination of the anterior chamber reveals marked flare with the absence of cells. A posterior synechia is present at the 7:00 position of the right eye. Examination of the left eye reveals a quite conjunctiva, cornea and anterior chamber. The presence of past synechia is noticeable on the anterior lens capsule. Further questioning reveals soreness of the ankles and knees. (155) A. B. C. D. tid. This patient should be treated with Pred Forte q1h. This patient should be treated with 5% Homatropine tid. Treatment should consist of Maxitrol drops qid. This patient should be administered 10% phenylephrine in the office and
treated with 5% Homatropine
A twenty-nine year old white male presents to you with a red photophobic left eye. Previous history reveals treatment for Herpes Simplex in the left eye approximately two months prior to seeing you. Your examination reveals a moderately dense stromal haze in the left eye with some associated pannus. The epithelium is intact and does not stain with fluorescein or rose bengal. The most appropriate treatment for this patient is: (717) A. B. C. D. Viroptic q6h OS. Pred Forte q3h OS. Viroptic q3h and Pred Forte q3h both OS. Acyclovir po.
A patient presents with angle closure glaucoma. His pressure is 42 mmHg by applanation. What is your first treatment of choice? (909) A. B. C. D. Timoptic. 2% pilo. Diamox. Glycerin.
A 5 year old child presents to your office with flushing of the face, hyperthermia, irritability, and delirium. You determine the childs blood pressure, pulse, and respiration are all normal. The mother reports that the child ingested the contents of an almost empty bottle of eye drops with a red top. What is your treatment of choice? (173) A. Rev-eyes. B. Pilocarpine. C. Referral to medical doctor. D. Monitor condition in your office. If extreme toxicity occurs, initiate overcoming anticholinergic effects.
A 55 year old patient presents with a sudden onset of ptosis in the left eye. Upon lifting the eye lid the eye is in a down and out position. The pupil is reactive to light. The most probable systemic diagnosis could be? A. B. C. D. Hypertension. Tumor of pons. Diabetes. Aortic Aneurysm.
A dry eye patient presents with strands of proliferative hyperplastic epithelial cells protruding anterior to the corneal surface. Your most likely treatment is? (Wills-55) A. B. E. D. Pred Forte. Bacitracin ointment. Opticrom. Mucomyst.
A patient presents with ecchymosis of the left eyelid, ptosis and crepitus. What is your diagnosis? (Wills-40) A. B. C. D. E. Fracture of the orbital apex. Fracture of the lateral wall. Fracture of the roof. Fracture of the medial wall. Fracture of the floor.
A patient presents with a hyphema. All of the following may be appropriately used in the initial medical management except: (783) A. B C. D. Cycloplegics. Aspirin. Topical Steroids. Antifibrinolytic agents.
A young man presenting with recurrent nongranulomatous anterior uveitis and low back pain should be suspect of having what disease? (784) A. B. C. D. Sarcoid. Crohn's. Whipple's. Ankylosing spondylitis.
A 65 year old presents with a carotid bruit. The patient is asymptomatic and no other clinical signs are present. Your recommendations are:
A. B. C. D. 44.
Referral for non invasive testing and aspirin therapy if indicated. Referral for non invasive testing and surgery if indicated. Referral for invasive testing and surgery if indicated. Diagnose total occlusion of carotid artery and assume impending stroke.
A patient has had a recurrent pterygium removed from the right eye on two occasions. He has just returned back to your care following another pterygium removal. You should consider prescribing: (670) A. B. C. D. Tobrex. Pred-Forte. Thiotepa. Naphcon-A.
An extended wear soft contact lens patient presents with a central corneal ulcer. Which antibiotic is most appropriate? (707) A. B. C. D. Ciloxan. Gentamicin. Bacitracin. Sulfa.
A patient presents with a corneal abrasion secondary to a tree limb. Your treatment consists of: (682-683) A. B. C. D Tobramycin ointment and pressure patch. Tobramycin drops qid. Tobramycin, cycloplegia and pressure patch. Multiple stroma puncture with 18 gauge, cycloplegia, erythromycin
ointment and pressure patch.
A 51 year old white male presents with IOPs of 28 mmHg OU. His angles are open. He has .6 glaucomatous cupping and early arcuate field defects. His medical history is normal except for emphysema. Your initial drug choice would be: (192) A. B. C. D. Timoptic 0.25%. Betagan. Betaxolol. Pilo 2%.
A patient presents with what appears to be a non specific keratitis in one eye. She is mildly photophobic. Her acuities are 20/25 and she has no anterior chamber reaction. She has a history of recurrent fever blisters. Your initial treatment may consist of: A. B. C. D. Suspect adenovirus and start Pred Mild qid. Suspect bacterial keratitis and start Tobrex qid. Diagnose Herpes simplex and start Viroptic. Suspect Herpes simplex, prescribe artificial tears and ask the patient to
return in 24 hours.
A patient presents with redness and erythema of the medial and lateral canthi which produces a red cracking of the skin. Your treatment would most likely be: (573) A. B. C. D. FML ointment. Vira-A ointment. Zinc sulfate .5%. Tobrex ointment.
A patient presents with a slowly growing, umbilicated nodule, with an elevated irregular pearly border. The lesion is located on the bottom lid. It most likely is: A. B. C. D. H. simplex vesicle. Squamous cell. Basal cell. Molluscum contagiosum.
A patient presents with a hyperacute profuse mucopurulent discharge from both eyes. You should suspect what type of infection? (641)
A. B. C. D. 52.
Staph. Viral. Neisseria. S. pneumoniae.
A patient presents with red watery eyes and follicles. He also has subepithelial infiltrates and preauricular lymph nodes. Your treatment consists of: (710) A. B. C. D. FML. Tobrex. Artificial tears and decongestants. Pred Forte.
A patient presents with upper tarsal follicles, superior corneal pannus and limbal follicles. Your most likely diagnosis is: (651) A. B. C. D. Adenovirus. Follicular conjunctivitis secondary to molluscum contagiosum. Chemical conjunctivitis. Trachoma.
A patient presents with clustered vesicles on the right forehead and also to the tip of the nose. The patient is 70 years old and appears to be in a weakened condition. The patient has a non specific keratitis and mild anterior chamber flare. Your treatment should be: (647) A. B. C. D. E. Cold compresses and artificial tears. Chloroptic. Tetracycline 250 mg PO qid. Viroptic. Oral acyclovir and topical steroids.
A 16 year old patient presents with itchy, red eyes. The patient's bulbar conjunctiva is edematous. He is hauling hay to earn money for school and relates a history of eye itchiness and redness when in the hay field. Your most likely combination treatment is: (755) A. B. C. D. Cold compresses and benadryl (25 mg qid). Vasocon -A and cold compresses. Opticrom 4% q6h and seldane. Pred Forte qid and chlorpheniramine maleate tablets.
You are practicing in Dallas in the month of January. A 7 year old patient presents with an acute bacterial conjunctivitis. The mother reports that "the pink eye" has been going around at school. The child has a concomitant upper respiratory track infection. There are some petechial hemorrhages, especially in the upper fornix. You suspect: (639) A. B. C. D. S. aureus. Haemophilus. Chlamydia. S. pneumoniae.
A patient presents with shallow anterior chamber, narrow angles, and intact irides. The drug of choice for dilation is: (490) A. B. C. D. Homatropine 2%. Cyclopentolate 1%. Phenylephrine 2.5%. Tropicamide 1%.
A 35 year old black male presents with a tennis ball injury. His visual acuity is 20/200 and slit lamp examination reveals a 35% hyphema. His I.O.P. is 25 mmHG. His sickle cell prep is positive. Which drug is contraindicated? (217) A. Amicar.
B. C. D. 59.
Mild analgesics. Atropine 1%. Acetazolamide.
A patient presents with eye irritation which has been unrelieved with ocular lubricants. She complains about decreased vision, foreign body sensation and "white spots" on the cornea. Your slit lamp evaluation reveals anterior corneal plaque of calcium in the palpebral fissure area, separated from the limbus by clear cornea. The plaque has a "swiss cheese" appearance. It begins at the 3 and 9 o'clock positions adjacent to the limbus, and extends across the cornea. Your most probable treatment: (736) A. B. C. D. E. Pred Forte. Disodium EDTA. NACI ointment. Bandage contact lens. Corneal transplant.
A 20 year old presents with severe ocular pain, redness and photophobia over a period of several weeks. The patient is a daily wear soft contact lens patient and uses Miraflow daily cleaner and homemade saline. The slit lamp examination showed a corneal stromal infiltrate the shape of a ring. The most likely infectious agent is: (731) A. B. C. D. E. E. coli. Acanthamoeba. Candida. Fusarium. Aspergillus.
A 12 year old white male presents with headaches, episodes of blurred vision, nausea and vomiting. These symptoms began about two weeks ago and seem to be getting worse. He saw his family physician two days ago and was prescribed medication for a stomach virus. Your ophthalmoscopy reveals bilaterally swollen, hyperemic disc. Your major concern and treatment is: A. B. C. D. Undiagnosed type I diabetics - order fasting blood sugar. Giant cell arteritis - order ESR. Ischemic optic neuropathy - order CT scan. Intracranial tumors - order CT scan as soon as possible.
A patient presents with a small hypopigmented defect in the nerve tissue of the optic disc. A potential complication could be: A. B. C. D. E. Glaucoma. Optic neuritis. Choroidal tumor. Serous macular detachment. Macular degeneration.
A 22 year old female presents with symptoms of extreme itching and swelling of the left eyelid. The left eye also waters excessively. She reports the problem started about a week ago and has increased in intensity with the itching becoming unbearable. What would you prescribe for this lady to give the fastest, most effective relief from her symptoms? A. B. C. D. E. Cromolyn sodium 4% solution four times a day. Naphcon A solution every four hours. Diphenhydramine 25 mg by mouth every four hours. Inflamase Forte l% solution every three hours. Cold compresses every three hours
A 65 year old female presents with a prior diagnosis of chronic open angle glaucoma. She is using Timoptic .5% solution twice a day in both eyes. Her medical history includes asthma and diabetes. Her surgical history includes a liver transplant in l986 and bilateral cataract surgery in l988. Pressures by applanation are 12 mmHg in both eyes. You are concerned over the use of a beta blocker with her pulmonary history and decide to change her medication. What would be the most appropriate medication for this patient? (894-895) A. Pilocarpine 2% solution four times a day in both eyes.
B. C. D. 65.
Propine .1% solution twice a day in both eyes. Neptazane 50mg by mouth twice a day. Phospholine iodide .12% suspension twice a day in both eyes.
A 49 year old black male presents with a red, asymptomatic left eye and pinhole acuity of 20/50. You note +1 diffuse conjunctival injection, +3 cells with focal areas of plasmoid aqueous, +1 corneal endothelial pigment, a 4.5 mm fixed pupil, applanation pressure of 27 mmHg, and a 2 mm hypopyon. He states his eye has become red like this four or five times in the past ten years, but is very vague in his history. He says that before it has always resolved in a week or two with drops given him ten years ago. What is the most appropriate treatment plan? A. B. C. D. Inflamase Forte 1% every two hours, Cyclogel 1% solution every four hours. Homatropine 5% solution every four hours, refer to an internist for systemic evaluation. Pred Forte 1% suspension every four hours, Tropicamide 1% every four hours. FML .1% every three hours, Cyclogel 1% every four hours.
You are treating a 49 year old white male for glaucoma. He is currently using Betoptic .25% S twice a day and Propine .1% and claims complete compliance. His medical history includes chronic pulmonary edema, kidney stones and bilateral posterior subcapsular cataracts. At his most recent examination you note an increase in pressure of 8 mmHg in both eyes. He already has significant field loss in both eyes, but has no insurance and cannot afford surgery. What would you suggest next? A. B. C. D. Recheck his fields in four months for any possible change. Pilocarpine 1% drops four times a day in both eyes. Acetazolamide 500 mg sequels by mouth twice a day. Methazolamide 50 mg by mouth twice a day.
A 49 year old diabetic female presents with a red, painful right eye. She reports extreme nausea. You note a 2 mm, minimally reactive pupil and a cloudy cornea. Intraocular pressure measure 59 mmHg in the right eye and 19 mmHg in the left. What would you do next? (225) A. Give the patient Glycerol at 1.5 g/kg body weight and recheck the pressure in 30 minutes. B. Give the patient one drop Timoptic .5% and one drop Pilocarpine 4% and recheck the pressure in 30 minutes. C. Give the patient a 500 mg Diamox sequel and recheck the pressure in 30 minutes. D. Refer to the patient for a peripheral iridectomy. E. Give the patient Isosorbide 1.5 g/kg body weight and recheck the pressure in 30 minutes.
A 21 year old male presents with an acutely painful lower lid. You note a swollen, inflamed area below the inferior puncta. The erythema and pain extends down into the cheek area. A pus-like 3mm mass appears under the superficial external eyelid in the area of the inflammation. What would be the most appropriate treatment plan? A. Gentamicin ointment four times a day, hot compresses every three hours. B. Refer the patient to a lid specialist. C. Dicloxacillin 500 mg by mouth stat then 250 mg by mouth four times a day for seven days, hot compresses every three hours. D. Hot compresses every three hours, Minocycline 200 mg by mouth stat then 100 mg by mouth twice a day for seven days.
Your patient calls frantic having just splashed bleach in their eye. You tell them to rinse the eye continuously with water for thirty minutes and then come into the office. Which of the following would you most likely not consider treating this patient with once they arrive at your office? (698) A. B. C. D. Bacitracin-polymyxin B ointment at bedtime. Pred Forte. Cyclogel 1% drops every four hours. Polytrim drops every four hours.
A 34 year old male patient presents with a chronically red right eye. He states the condition has persisted for over six months; you are the fourth doctor he has seen. He shows you six different eye drops he has been prescribed and states he has also taken tetracycline for the past thirty days. He is currently using Polytrim drops three times a day. Other than some mild conjunctival injection the only other significant clinical sign is a +2 follicular response on the upper and lower tarsal lid. What would you recommend for this patient? A. B. Referral to a local internist. Discontinue the Polytrim, prescribe Refresh drops four times a day.
C. Discontinue the Polytrim, prescribe HMS 1% drops four times a day. D. Discontinue the Polytrim, prescribe Doxycycline 100 mg by mouth every Acromycin ointment at bedtime for 30 days. 71.
A young female presents with a moderately inflamed eye. She reports mild to moderate pain in the eye and there is hyperemia that will blanch with 2.5% neosynephrine. She also has a slight foreign body sensation with a small amount of lacrimation. She states that these symptoms have occurred before and has usually lasted 2-3 weeks. There is no corneal involvement. She is best initially treated with: (765) A. B. C. D. E. Polysporin ointment. Tobrex solution qid. Opticrom. Pred mild. Benign neglect
A patient presents with a significant anisocoria and no light response in the involved (OD = large pupil) eye. Instillation of one drop pilocarpine 0.5% into each eye has no effect on the right eye, but the left eye constricts. Instillation of 1% pilo also has no effect on the right eye. What is the most likely cause of the pupillary anomaly? (529-530)
A. B. C. D. E. 73.
Adie's tonic pupil. Episodic pupillary dysfunction. Pharmacological blockade. IIIrd nerve palsy. Physiologic anisocoria.
A 25 year old white male presented to your office with a corneal abrasion secondary to a foreign body of unknown origin. The foreign body involvement occurred approximately 24 hours previous. The depth of the foreign body (which was located inferior and about one half way between the visual axis and the limbus) was to Bowman's membrane or the very anterior stroma. Associated with the foreign body was a significant anterior chamber reaction: 2+ cells and 3+ flare. There was no nodule formation but a diffuse nongranulomatous KP throughout the inferior aspect of the cornea. The pupil was miotic and the intraocular pressure was 4 mmHg less in the involved eye. The patient was very symptomatic and photophobic. After removal of the foreign body, you: (689) A. Cycloplege the eye using Homatropine 5% stat. and Rx Homatropine 5% to be used BID and return for a progress in 24 hours. B. Administer Pred Forte 1% stat. and Rx Pred Forte 1% q2h during waking hour. Also Rx a steroid ointment at bedtime and return for a progress in 24 hours. C. Treat the corneal abrasion with a broad spectrum antibiotic ointment(i.e., Polysporin) lightly pressure patch and return for progress in 24 hours. D. All of the above. E. A and C.
The use of topical chloramphenicol has fallen into disuse mainly because: (273, 995-996) A. B. C. D. It is poorly tolerated by the corneal epi.thelium. It is not effective against S. pneumoniae It has been associated with aplastic anemia. It has a narrow spectrum of activity with many resistant organisms.
A 23 year old white emmetropic male presents with a history of photophobia, foreign body sensation and tearing in both eyes. Case history reveals that the condition has been "coming and going" for the last couple of years. Biomicroscopy reveals a course punctate epithelial keratitis that is centrally located and appears about equal in each eye. The conjunctiva and anterior chambers are quiet. Your initial treatment should be: (712-714) A. B. C. D. Frequent installations of .12% prednisolone acetate for 7 days and then .12 prednisolone acetate qid x 14 days. Gentamicin qid x 14 days. Bacitracin ointment at bed time. tapered slowly.
A 17 year old contact lens patient presents with a central corneal ulcer in her right eye. A Gram stain shows the presence of gram-negative rods. Which of the following antibiotics would be the least effective in the treatment of this patient's condition? (253,260) A. B. C. D. Bacitracin. Erythromycin. Polymyxin B. Trimethoprim.
A 65 year old male presents for a routine examination. Case history reveals the patient to have cardiac disease and arteriosclerosis. The patient's visual acuity is correctable to 20/20 with minor changes in the lens powers. The O.U. intraocular pressures are 19 mm Hg and angles are grade 4 by the van Herick technique. What would be the theoretically safest regimen for pupil dilation of this patient? (156-158, 179-180) A. B. C. D. E. Phenylephrine 2.5%. Phenylephrine 2.5% and 0.5%-1.0% tropicamide. Tropicamide 0.5%-1.0%. Phenylephrine 2.5% and cyclopentolate O.5%-1.0% This patient should not be dilated.
A 22 year old very intelligent female presents with a mild bilateral bacterial conjunctivitis. Upon questioning about drug allergies, the patient reported that she once was diagnosed as having something called Stevens-Johnson syndrome, but she could not remember what triggered the reaction. What drug must be avoided during the treatment of this patient's conjunctivitis? (277) A. B. C. D. Bacitracin. Gentamicin. Erythromycin. Sulfonamide.
A 33 year old female presents with hyperemic lids. She reports mimimal discharge, but says there is some mattering upon awakening. Biomicroscopy reveals the presence of numerous concretions in the palpebral conjunctiva and maceration of the lateral canthus. The treatment of choice is: (642) A. B. C. D. Blephamide qid x 7 days. Rigorous lid hygiene and bacitracin bid HS x 14-21 days. Garamyacin drops qid x 7 days. Warm soaks and lid scrubs bid x 14 days.
The most likely pathogen in question 79 is: (642) A. B. C. D. K pneumoniae. S. aureus. E. coli. Haemophilus.
A 65 year old female undergoing chemotherapy complains of deep pain with a sensation of heat and tingling on the right side of the face and including her eye and forehead. It started about 24 hours ago. A gross examination is unremarkable. The best management of this patient's problem would be to: (718-720)
A. B. C. D. 82.
Prescribe aspirin for pain in the appropriate dosage and see the patient again in 48 hours. Prescribe cold compresses, Vasocon-A, and an oral OTC for pain and see patient again in 48 hours. Consult her internist and recommend he prescribe acyclovir. Prescribe Pred-G QID X 1 week.
A 11 year old female presents in your office with a chief complaint of her left eye being red and burning for four weeks. She says that a bump appeared on her left upper lid about six weeks ago and has gotten larger. You find the tumor-like umbilicated nodule located at her lash line and to be 1 mm in size. Biomicroscopy also reveals diffuse keratitis and follicular conjunctivitis. What is the most successful treatment plan for this patient? (647-648) A. B. C. Prescribe 3% acyclovir ung HS x 3 weeks. Surgical excision of the nodule. Polysporin ung HS x 3 weeks.
Bacitracin ung HS x 2 weeks.
A patient presents with interstitial keratitis, "salt and pepper" chorioretinitis and a positive FTA-ABS test. This patient should be treated with: (Wills-398) A. B. C. D. Oral tetracycline 250 mg po qid x 21 days. Oral erythromycin 500 mg po qid x 21 days. IM penicillin G x 10-14 days. Trifluridine.
A 23 year old pregnant female presents with moderate to severe swelling, inflammation and tenderness of the midtarsus of the right upper lid. The condition has been present for 5 days and she thinks it is getting worse. The appropiate treatment would be: (650) A. B. C. D. Hot compresses. Erythromycin 250 mg po qid x 21 days. Puncture and drainage with a sterile needle. Tetracycline 250 mg po qid x 14 days.
A 30 year old male presents with chronic hyperemia, desquamation and ulceration of the outer canthus of the left eye. The lateral aspect of the conjunctiva of the eye is mildly injected and tender. The condition was first noticed two weeks ago while vacationing and another doctor prescribed zinc sulfate 0.25% sol QID, but there has not been significant improvement. The treatment should be changed to: (573) A. B. C. D. Decadron ung tid. Maxitrol ung qid. Erythromycin ung. Viroptic.
A 35 year old black female patient presents complaining of a deep, dull pain and photophobia in her OD. Slit lamp examination shows mutton-fat KP's. Binocular indirect ophthalmoscopy shows candle-wax drippings. Which of the laboratory tests below would be the most useful in making her diagnosis? (785) A. B. C. D. ELISA. ACE. HLA-B27. ANA.
An oriental patient presents with what you determine to be hypopyon uveitis. He complains of mouth ulcers and genital lesions. A general practitioner recently diagnosed phlebitis in his right leg. The best treatment for this patient's eye condition would be? (785) A. B. C. D. Steroids and cyclosporine. Cyclosporine and penicillin. Cyclosporine only. Penicillin only.
A 3 year old black male is brought to your office by his mother who reports his eyes have been "oozing" puss for the past two days and it appears to be getting worse today. You suspect Neisseria. Which type of culture media would you NOT use to confirm your diagnosis? (635) A. B. C. D. Blood agar. Chocolate agar. Sabouraud's agar. Thayer-Martin medium.
A 33 year old female presents to your office with bilateral moderate inflammation and tremendous eye pain. You look for nodules of the scleral tissue but find none. You wish to differentiate between scleritis and episcleritis. Your drug of choice for diagnosis is: (763) A. B. C. D. Azathioprine. Prednisolone. Pilocarpine. Phenylephrine.
A 72 year old patient presents complaining of an acute vision loss in his left eye and left temporal headaches, both of which started within the last couple of weeks. Ophthalmoscopically, you see disc pallor and edema in the left eye. What is the best treatment regimen for this patient? (545) A. B. C. D. Anticoagulants (Coumarin drugs and Heparin). Analgesics and supportative therapy. NSAIAs. Prednisone.
You measure intraocular pressures of 34 mm Hg in the right eye and 36 mm Hg in the left eye of a 58 year old black pseudophakic patient with kidney stones. You start your treatment regimen with timolol and add pilocarpine. Later, you still feel you need a further reduction in pressure. What should your next step be? (894-895) A. B. C. D. Dipivefrin. Acetazolamide. Methazolamide. Echothiophate.
A 12 year old white male presents with mild pharyngitis, submaxillary adenopathy, follicular conjunctivitis and complaints of chills and fever. He claims these symptoms started approximately one week following a picnic and swim party he attended. The best treatment for his ocular condition is: (643-645,711-712) A. B. C. D. Prednisolone and sulfa. Prednisolone. Bacitracin. Topical vasoconstrictors, lubricants and cool compresses.
A 30 year old white female presents in your office with an acute red left eye. There is a mucopurulent discharge. The antibiotic least appropiate for this condition would be: (639) A. B. C. D. Bacitracin. Gentamicin. Sodium sulfacetamide. Tobramycin.
A 30 year old female presents with an anisocoria, which is greater in light than in dark. There is no pain in the involved eye. The pupil is very sluggish and reacts poorly to an accommodative stimulus. When observed with the slit lamp, the iris demonstrates subtle and irregular movement of its sphincter. Before instilling any diagnostic drugs, your initial diagnosis, based on the above information would be: (526) A. B. C. D. Horner's syndrome. Adies tonic pupil. Angle closure glaucoma. Essential anisochoria.
A 9 year old boy presents with itchy and irritated lid margins. Slit lamp examination reveals a dark crusty discoloration of the lid margins, caused by parasitic debris matted to the base of the lashes. The best treatment for the lid margins would be: (579) A. B. C. D. 1% yellow mecuric oxide ointment. Polysporin ointment. Kwell. Warm compresses.
A 56 year old man presents with a "red eye." Upon external inspection, you find superficial punctate corneal erosions, conjunctival hyperemia and several clogged Meibomian glands. You also notice several pustular lesions on his cheek and forehead as well as rhinophyma of the nose. Which is the most effective treatment for his condition? (657-658)
Erythromycin 250 mg po qid.
B. C. D. 97.
Penicillin G 100 mg po bid. Amoxicillin 250 mg po bid. Tetracycline 250 mg po qid.
A 60 year old patient presents with the complaint that she notices her vision is worse than it use to be. During ophthalmoscopy, you note the macular areas of both eyes have a fine pigmentary mottling and foveal reflexes are absent. She is taking several medications which were prescribed by her family practitioner. When you call and consult with him concerning this patient, which one of the following should you recommend that he either discontinue or reduce the dosage? (982) A. B. C. D. Amytriptyline. Dexamethasone. Propranolol. Chloroquine.
A 25 year old sexually active female presents with a unilateral follicular conjuctivitis and mucopurulent discharge. In case history, she reports that her "red eye" has been coming and going for about three months and when it gets red, she treats it with some drops she received from another doctor and it will get better for a while. With the exception of surgery to repair torn cartlage in her right knee when she was 18 and a tubal ligation when she was 21, the medical history was unremarkable. What would be the best treatment plan? (650) A. B. C. D. Erythromycin 250 mg po qid x 21 days. Erythromycin 500 mg po qid x 21 days. Tetracycline 500 mg po qid x 21 days. Tetracycline 250 mg po qid x 21 days.
A 25 year old sexually active female presents with a unilateral follicular conjuctivitis and mucopurulent discharge. In case history, she reports that her "red eye" has been coming and going for about three months and when it gets red, she treats it with some drops she received from another doctor and it will get better for a while. With the exception of her being 2 months pregnant and surgery to repair torn cartlage in her right knee when she was 18, the medical history was unremarkable. What would be the best treatment plan? (269-270, 650) A. B. C. D. Erythromycin 250 mg po qid x 21 days. Erythromycin 500 mg po qid x 21 days. Tetracycline 500 mg po qid x 21 days. Tetracycline 250 mg qid x 21 days.
A 25 year old sexually active female presents with a unilateral follicular conjuctivitis and mucopurulent discharge. In case history, she reports that her "red eye" has been coming and going for about three months and when it gets red, she treats it with some drops she received from another doctor and it will get better for a while. With the exception of surgery to repair torn cartlage in her right knee when she was 18 and a tubal ligation when she was 21, the medical history was unremarkable. During ophthalmoscopy, it was noted that the patient had bilateral swollen, hyperemic discs with blurring of the margins. What would be the best treatment plan for the red eye? (269-270, 650) A. B. C. D. Erythromycin 250 mg po qid x 21 days. Erythromycin 500 mg po qid x 21 days. Tetracycline 500 mg po qid x 21 days. Tetracycline 250 mg po qid x 21 days.
A 35 year old patient presents with a membranous conjunctivitis. You collect a smear and the Gram stain shows gram-positive rods. Which of the following antibiotics would be the best choice to prescribe for this patient? A. B. C. D. Polymyxin B. Gentamicin. Amikacin. Vancomycin.
A 48 year old white male presents for a routine examination. In response to a case history question concerning history of ocular trauma, the patient reports that he had a fight about ten years ago and received a hard left jab to his right eye that caused bleeding inside the eye and resulted in a 3 day hospital stay. The visual acuities are correctable to 20/20 OU at both distance and near. Ophthalmoscopy reveals a cup/disc ratio of .5/.5 in the right eye and .3/.3 in the left. Gonioscopy shows a wide ciliary body band and a deep anterior-chamber angle in the right eye. Automated perimetry shows small paracentral scotomas in the right eye. Which of the following drugs would most likely be ineffective in treating this patient's condition? (923)
A. B. C. D. 103.
Timolol .5%. Levobunolol .5%. Pilocarpine 2%. Acetazolamide.
A 48 year old white male presents for a routine examination. Case history reveals he had a physical examination 2 weeks ago and it was determined that he had early congestive heart disease. The visual acuities are correctable to 20/20 OU at both distance and near. The intraocular pressures are OD 28 mm Hg and OS 30 mm Hg. Ophthalmoscopy shows cup/disc ratios of OD .5/.5 and OS .5/.6. Visual field testing with automated perimetry shows small paracentral scotomas located in the superior nasal fields of each eye. What would be the best initial choice drug for the beginning treatment of this patient? (894-895) A. B. C. D. Timolol .5%. Pilocarpine 2.0%. Acetazolamide. Dipivefrin.
A 48 year old white male presents for a routine examination. Case history reveals he had a physical examination 2 weeks ago and was determined to be in excellent health. The visual acuities are correctable to 20/20 OU at both distance and near. The intraocular pressures are OD 28 mm Hg and OS 30 mm Hg. Ophthalmoscopy shows cup/disc ratios of OD .5/.5 and OS .5/.6. Visual field testing with automated perimetry shows small paracentral scotomas located in the superior nasal fields of each eye. You initially prescribe Timolol .5% bid and after two weeks determine that a further reduction in pressures is needed. What would be the next step? (894-895) A. B. C. D. Change to Timolol .5% qid. Add Pilocarpine 2.0% qid. Add Acetazolamide 250 mg. qid. Add Dipivefrin .1% bid.
A 48 year old pseudophakic white male presents for a routine examination. Case history reveals he had a physical examination 2 weeks ago and was determined to be in excellent health. The visual acuities are correctable to 20/20 OU at both distance and near. The intraocular pressures are OD 28 mm Hg and OS 30 mm Hg. Ophthalmoscopy shows cup/disc ratios of OD .5/.5 and OS .5/.6. Visual field testing with automated perimetry shows small paracentral scotomas located in the superior nasal fields of each eye. You initially prescribe Timolol .5% bid and after two weeks determine that a further reduction in pressures is needed. What would be the next step? (894-895) A. B. C. D. Change to Timolol .5% qid. Add Pilocarpine 1.0% qid. Add Acetazolamide 250 mg. qid. Add Dipivefrin .1% bid.
A 48 year old white male presents for a routine examination. Case history reveals he had a physical examination 2 weeks ago and was determined to be in excellent physical health. Case history also reveals the patient had retinal detachments in both eyes about 1 year ago and he is taking a tricyclic antidepressant for emotional problems. The visual acuities are correctable to 20/20 OU at both distance and near. The intraocular pressures are OD 28 mm Hg and OS 30 mm Hg. Ophthalmoscopy shows cup/disc ratios of OD .5/.5 and OS .5/.6. Visual field testing with automated perimetry shows small paracentral scotomas located in the superior nasal fields of each eye. You initially prescribe Timolol .5% bid and after two weeks determine that a further reduction in pressures is needed. What would be the next step? (894-895) A. B. C. D. Change to Timolol .5% qid. Add Pilocarpine 2.0% qid. Add Acetazolamide 250 mg. qid. Add Dipivefrin .1% bid.
A patient presents for a routine examination and you diagnose primary open-angle glaucoma. During the case history, the patient reports he had an allergic reaction to sulfa drugs prescribed by another physician. Which of the following drugs is contraindicated in this patient's treatment plan? (216) A. B. C. D. Timolol .5%. Pilocarpine 2.0%. Acetazolamide 250 mg. Dipivefrin .1%.
A 68 year old patient presents for a routine examination and you diagnose primary open-angle glaucoma. During the case history, the patient reports he has hypertension and emphysema. Which of the following drugs is would be the best initial choice for this patient's treatment plan? (894-895)
A. B. C. D. 109.
Timolol .5%. Pilocarpine 2.0%. Betaxolol .5%. Dipivefrin .1%.
A 28 year old black male presents after being involved in an automobile accident several hours previously and complains of pain and blurred vision in his left eye. Case history reveals that the patient is sickle trait positive. Distance visual acuities are: OD 20/20 and OS 20/80 with best correction. Biomicroscopy of the right eye is unremarkable, however a reddish haze in the anterior chamber makes evaluation of the left eye impossible. Intraocular pressures are: OD 17 mm Hg and OS 53 mm Hg. Which of the following treatments is not contraindicated? A. B. C. D. Acetazolamide. Acetylsalicylic acid. Aminocaproic acid. Pilocarpine.
A 28 year old female patient presents for a routine examination. She wears a myopic correction and you find no need for a change. The patient wants new glasses because she is tired of her present glasses. All the pupil reactions are normal, however you notice the right pupil is larger than the left. When asked, she says that no one has ever mentioned the difference in pupil size before. You proceed in testing to determine a cause of the anisocoria. You note that the right pupil remains larger in both bright light and darkness. The drug of choice to determine the abnormality would be: (532) A. B. C. D. E. 2% Cocaine. 1% Hydroxyamphetamine. .1% Pilocarpine. All of the above. None of the above.
A 46 year old female patient presents for a routine examination with the chief complaint being a "jumping" or "quivering" of her left eyelid for the last three months. She reports using drops bought at the drugstore, but they did not help. She admits to being under a lot of stress lately and volunteers that she has smoking and drinking more than usual. She thinks everyone can see her eye "jump". With slit lamp examination, you notice a very small quiver of the lower lid of the left eye. The treatment of choice would be: (583) A. B. C. D. Vit-A-Drops qid. Retinoic acid tid. Promethazine (Phenergan) 25 mg tid. Hydroxycobalamin - intramuscular injections.
A chronic bacterial conjunctivitis patient presents with mild conjunctival hyperemia, minimal discharge, recurrent hordeola and an associated mild blepharitis. Initial treatment should consist of the following? (643)
A. B. C. D. E. 113.
Gentamycin 1 gtt qid and systemic tetracycline. Lid margin hygiene with either bacitracin or Polysporin ung qhs. Hygienic lid scrubs and artificial tears prn. Hygienic lid scrubs until culture results are available. None of the above.
A patient complains of a sudden loss of vision in the right eye and pain on eye movement. The presenting visual acuities are: OD 20/200 and OS 20/20 with no improvement of right eye acuity with pinhole. The patient has a positive right Marcus Gunn pupil. Intraocular pressures are: OU 15 mm Hg. The internal examination is unremarkable with no sighs of pathology present. The likely diagnosis would be: (540)
A. B. C. D. E. 114.
Central retinal artery occlusion. Central retinal vein occlusion. Retinal detachment. Retrobulbar neuritis. Vitreous detachment.
You diagnose a 28 year old white female with a 22 mm proptosis on the left eye. The patient has lid retraction with no symptoms of ocular problems. The normal treatment would include all of the following except: (852-853) A. B. C. D. Ocular lubricants. Periocular steroids. Tinted lenses. Topical guanethidine.
A 45 year old chronic open angle glaucoma patient is taking Timoptic 0.5% bid OU, pilocarpine 2% qid OU, and propine 0.1% bid OU. The pressures are still high. Given the patient's history of kidney stones, which carbonic anhydrase inhibitor would be the next form of medical treatment? (218, 894-895) A. B. C. D. E. Acetazolamide 500 sequell bid po. Dichlorphenamide 50 mg bid po. Ethoxzolamide 125 mg bid po. Glycerol 50% po since anhydrase inhibitors cannot be used. Methazolamide 50 mg bid po.
When treating a closed angle glaucoma attack, the use of pilocarpine concentrations greater than 2% or anticholinestrase agents is contraindicated because: (910) A. Pilocarpine concentrations greater than 2% are no more effective than 2%. B. The use of strong miotics causes further narrowing of the angle and can lead to increased pupillary block, permanent synechiae, and angle-closure. C. Topical anticholinesterase agents can cause a toxic corneal reaction. D. All of the above. E. A and B are correct.
A 60 year old female has had peripheral iridectomies for acute angle closure glaucoma. Since anticholinergic agents such as cyclopentolate may cause angle closure by crowding of the iris against the trabeculum. Which agent would be the least likely to cause angle closure? (491) A. Tropicamide. B. Phenylephrine. C. Homatropine. D. Hydroxyamphetamine. You see a 14 year old female in your office and you detect an infection and decide to prescribe an aminoglycoside. The most likely systemic side effect would probably be: (267) A. B. C. D. E. Ototoxicity and nephrotoxicity. Nausea. Hyperactivity of central nervous system. Vasovagal syncope. Respiratory arrest.
The drug of first choice to dilate a pupil with shallow anterior chamber or narrow angle is: (490) A. B. C. D. Homatropine. Cyclopentolate. Tropicamide. Phenylephrine.
You see a 45 year old diabetic patient with pain in his right eye. He says he has been nauseated. You note redness and when questioned, he remembers the lights look funny because of the circles around them. Intraocular pressures are: OD 58 mm Hg. and OS 16 mm Hg. Which medication would be most indicated? (225, 910) A. B. C. .5% Timoptic. 2% pilocarpine. Isosorbide.
You are delivering the postoperative care for a 64 year old white male patient after cataract surgery to his right eye. The patient's progress is going well until approximately seven weeks after the surgery, when he presents and reports a decrease in vision in that eye. The right eye acuity has dropped from 20/25+ to 20/50 and there is metamorphopsia as revealed by the Amsler grid. Intraocular pressures are: OD 18 mm Hg. and OS 15 mm Hg. Which of the follow drugs should be prescribed for this patient? (820-821) A. B. C. D. Pred Mild 1 gt qh for 24 hours followed by 1 gt qid until acuity Indomethacin 1% qid for 1 to 4 months. Timolol .25% bid. Dipiverfin .1% bid. returns to normal.
A 25 year old female with no Rx presents to your office with unilateral ptosis, ipsilateral miosis and complaints of dry skin. She reports these signs are of recent origin and that she has had no head trauma. Which of the following drugs may be used in your diagnosis? (581) A. B. C. D. E. .125% Pilocarpine. 2.5 % Phenylephrine. 1% Cyclogyl. .5% Mydriacyl. 5% Homatropine.
A 7 year old male presents to your office with an inflammed right eye. On closer observation you find raised whitish nodular areas slightly nasal to the limbus of each eye. The child's mother reports that he has been treated for this condition several times in the past and shows you a list of drugs which have been prescribed at one time or another. These drugs include 1% Econopred, .3% Garamycin, Thiotepa, Vasacon-A and tetracycline. The mother states that some of the medicines either cured or made the problem better, but it seems to keep coming back. What should be one of your first rule outs? (702-703) A. B. C. D. E. Adenovirus. Chlamydia. Dry eyes. Staph epidermis. Tuberculosis.
A 42 year old male gas permeable contact lens patient complains of moderate foreign body sensation. His wearing time is down to four hours per day. There is a filamentary keratitis involving the superior one-third of his corneas and the superior bulbar and palpebral conjunctiva are very hyperemic. You recheck his case history from three years ago and notice that he reported a concern for his thyroid activity by his general practitioner. Your diagnostic process should include: A. B. C. D. A Schirmer test. Fluorescein staining. Corneal scraping. Rose Bengal staining.
A 78 year old male patient phones your office at 4:50 PM and says he has a bad problem and should be there in about 15 minutes. He is very concerned about a large "blood red" area that is located superior and temporal on the "white" of his left eye. He reports that his wife just noticed it and she says it was not there two hours ago. There is no history or trauma. He says he just had a complete physical a couple of days ago and was declared "fit as a fiddle" except for his hayfever which has really been bothering him lately. You wait for the patient and perform biomicroscopy. What would be the initial treatment for this patient? A. B. C. D. An antifibrinolytic agent. An acetylsalicylic acid product. Cool compresses qid for two days followed by warm compresses qid. Hot compresses qid and digital massage bid.
Which of the following can be used to prevent recurrence of pterygia after surgical resection? (669-670) A. B. C. D. Dichloroacetic acid. EDTA. Kenalog-10. Thiotepa.
127. Your patient has a mild problem with dry eyes and you suggest that they use an over-the-counter ocular lubricant each night before they go to bed. You suggest Refresh PM which comes in a 3.5 g tube. Your instructions to the patient are: apply a 2 cm ribbon of the ointment into the lower lid of each eye, immediately before bed each night. Your patient's job will require that they spend the next 6 months in Shanghai and they want to be sure they take an adequate supply of Refresh PM for that period of time. How should you advise the patient? A. B. C. D. E. 128. Take a supply of 4 tubes. Take a supply of 9 tubes. Take a supply of 14 tubes. Take a supply of 19 tubes. Say, "Damned if I know, ask the pharmacist how many tubes you should take
A young diabetic 170 lb female presents in your office with an acute angle closure attack. Which of the following is the most appropiate treatment? (225) A. B. C. D. Isosorbide 4-6 oz. Isosorbide 8-12 oz. Osmoglyn 4-6 oz. Osmoglyn 8-12 oz.
A 28 year old male who works of off-shore oil rigs presents with a mucopurulent discharge and follicles in the inferior fornix of the right eye. The ipsilateral preauricular node is swollen. He reports that for several weeks he has been bothered by redness, tearing and a foreign body sensation in the eye. After making you diagnosis and questioning the patient further, you are concerned that the his work and irregular eating schedule will prevent proper compliance in taking the needed medication. Which of the following would be the best choice to prescribe for this patient? (268) A. B. C. D. Demeclocycline. Doxycycline. Oxytetracycline. Tetracycline.
Which of the following condition is not a contraindication for the use of Timoptic? (189) A. B. C. D. History of asthma. Being a child. History of heart disease. History of kidney disease.
A 56 year old man presents with red and thickened eyelids. With the slit lamp you see scaly flakes along the eyelashes and +1 superficial punctate keratitis affecting the inferior 1/3 of the cornea. Which of the following antibiotics is the treatment of choice? (569) A. B. C. D. Erythromycin ung. Sulfacetamide ung. Tetracycline ung. Tobramycin ung.
A patient presents and you make an initial diagnosis of Horner's syndrome. Which of the following tests would be selected if you only wanted to confirm the initial diagnosis? (521-522) A. B. C. D. Cocaine test. Epinephrine test. Hydroxyamphetamine test. Phenylephrine test.
A 45 year old patient presents for an examination with the chief complaint of both upper eyelids drooping toward the end of each day. She reports she has noticed this for the last three months and that overall, she feels run down and
weak. You want to perform a diagnostic test to confirm or rule out your initial suspicion. What drug would you use? (533-534) A. B. C. D. 134. Edrophonium. Neostigmine. Promethazine. Pyridostigmine.
A 13 year old female is scheduled for a routine annual examination. Past examinations have been unremarkable except for the presence of a round sharp, "punched out" lesion one disc diameter in size and surrounded by black pigment clumps. The lesion is located one disc diameter temporal to the macula. You have photographed and followed the lesion since the patient was 5 years old and it has not changed. When performing biomicroscopy, you note an indistinct yellow-white lesion with an overlying vitritis at the nasal margin of the old inactive lesion. Which of the following drugs would not be considered in the management of this patient? (823) A. B. C. D. Diethylcarbamazine. Oral prednisone. Pyrimethamine Triple sulfonamides.
The best treatment for phakolytic glaucoma is: (789) A. B. C. D. Document intraocular pressure, C/D, field and recheck in 1 month. Pilocarpine 2% bid. Removal of the lens. Timolol 0.5% bid.
A 15 year old female presents with a pea-sized bump on her upper lid. She first noticed it about a week ago and feels that it is growing in size. There is pain when the area is touched and it appears inflamed. Which of the following is not a recommended treatment? (565-566) A. B. C. D. Erythromycin. Hot compresses. Tetracycline. Triamcinolone injection.
A patient presents complaining of irritation, injection and blurred vision. Biomicroscopy reveals a grayish horizontal area of deposits within the interpalpebral area. You note that the deposits do not extend all the way to the limbus and leave a small clear area of cornea at both the nasal and temporal limbus. Which of the following would be appropiate in the management of this patient? (736) A. B. C. D. Dichloroacetic acid. EDTA. Kenalog-10. Thiotepa.
A soft contact lens patients presents with complaints of severe ocular pain in the right eye. There are also complaints of blurred vision, photophobia, tearing and foreign body sensation. Biomicroscopy reveals a very mild keratitis which seems disproportionate to the level of pain being reported. What should be your first concern? (731) A. B. C. D. Acanthamoeba. Chlamydia. Herpes simplex virus keratitis. Varicella zoster virus.
A 16 year old male is scheduled by his parents for a second opinion. Three weeks ago while on vacation, the patient was horseback riding and abraded the cornea of his left eye when the horse got off the trail and ran through some bushes. At that time, the patient was prescribed bacitracin-polymyxin B by an emergency room physician. The patient is still using the medication and the eye seems to be getting worse. Your biomicroscopy of the eye reveals a dull gray central ulcer with fine lines extending peripherally from it to several gray-yellow fluffy lesions with blurred borders. You collect a smear for culture, but elect to begin treatment immediately. Which of the following should be prescribed? (708-709) A. Acyclovir.
B. C. D. 140.
Natamycin Tobramycin. Trifluridine.
The treatment of moderate-to large-sized corneal abrasions consists of: (683) A. B. C. D. A cycloplegic and a pressure-patch. An antibiotic and a pressure-patch. A cycloplegic, an antibiotic and a pressure-patch. A cycloplegic, an antibiotic and heat.
Which drug is the preferred drug for treatment of gram-negative bacillary infections in which resistance to both gentamicin and tobramycin is encountered? (266) A. B. C. D. E. Natamycin. Erythromycin. Carbenicillin. Flurbiprofen. Amikacin.
A 22 year old male reports to your office with bilateral red eyes that itch and tear and are getting worse. He states that this has happened 4-5 months per year for the past 3 years. He takes Theo-Dur regularly and shows you a tube of Tobrex his family doctor prescribed for his eyes 2 weeks ago. Significant findings include: grade III papillary hypertrophy, 2+ bulbar injection OU; and slight ptosis OU. What is the superior long term continous treatment for this problem? (759) A. B. C. D. E. Aspirin 250 mg q12h. Vasocon A q4h. Terfenadine 60 mg q12h. Cromolyn sodium 4% tid. Pred Forte q6h.
A 60 year old female comes to you complaining of severe pain, foreign body sensation and photophobia. You find patches of coalesced stain over 30% of the cornea and strands of tissue attached to the cornea which stain with fluorescein. How do you treat this condition? (362) A. B. C. D. E. Polysporin ung q6h. Copious irrigation to loosen filaments, Maxitrol ung q12h. Debride filaments, Mucomyst 10% q6h. Debride filaments, Ilotycin ung q6h. Debride filaments, FML drops q12h.
One of your star contact lens patients is driving down the freeway and reaches for a bottle of artificial tears in her purse to wet her contacts. She accidently grabs a bottle of Krazy Glue (Cyanoacrylate Tarsorraphy) and doses her left eye. What is the suggested form of management? (563-564) A. B. C. D. 5% Solution acetone drops or 5% Krazy Glue Solvent q10 min or until adhesion is broken. Surgical lysis of adhered lids. Rubbing with cotton-tipped applicator soaked in EDTA until adhesion is broken. Application of mineral oil-soaked eyepads until the adhesion is broken.
A 38 year old female television news anchor presents with a red left eye that started 3 days ago. She has experienced no pain, but is quite concerned with appearance in her high-profile position. Your findings include interpalpebral injection temporally on the left eye. On closer inspection, you see that the vessels are beaded and slightly tortuous. All other structures are intact and clear. What would be the most effective, yet prudent, form of initial treatment to serve this patient's needs? (765) A. B. C. Tobrex drops qid. Maxitrol drops qid. Pred Mild drops q2h.
D. E. 146.
Viroptic drops q2h. Artificial tears q4h.
A 65 year old female pseudophakic patient presents at 3 days following cataract surgery complaining of intense pain and increased loss of vision in the operative eye over the last 24 hours. Visual acuity in the eye is 20/400 with pinhole. Upon slit lamp examination, 4+ cells are present in the anterior chamber and vitreous with a small hypopyon formation inferiorly. The lids are swollen, there is marked injection of the conjunctiva and the eye is extremely sensitive to light and to touch. The most appropiate management is: (800) A. B. C. D. Homatropine 5% bid with 1% Pred Forte q2h. Cyclogyl 1% bid with 1% Pred Forte q2h. Atropine 1% bid with Maxidex qh. Hospitalization, anterior chamber tap with culture and intense
Patients allergic to sulfonamides should not be given which of the following? (216) A. B. C. D. Tobrex. Ancef. Diamox. Opthalgan.
Which of the following is most likely to release pigment cells from the iris pigment epithelium into the anterior chamber and possibly impair accurate assessment of cells in the anterior chamber? (156) A. B. C. D. Pilocarpine 1%. Pilocarpine 2%. Atropine 1%. Phenylephrine 2.5%.
A patient presents with a punctate epithelial keratitis and decreased corneal sensitivity. Which of the following would least likely be considered in your initial treatment plan? (717) A. B. C. D. Artificial tears. Oral acyclovir. Tobrex q2h. Viroptic 1% q2h.
The reduction of vision function associated with an increase in body temperature is known as: A. B. C. D. L'Hermitte's Symptom. Anton's Symptom. Uhthoff's Symptom. Liebreich's Symptom.
In which of the following conditions would you most likely need an oral antibiotic? (565) A. B. C. D. E. Acute external hordeolum. Acute internal hordeolum. Adenoviral conjunctivitis. Blepharitis. Chalazion.
A 14 year old white male presents complaining of tender red eyelids that are crusty. Biomicroscopy reveals inflamed eyelid margins with the presence of hard, brittle, yellowish scales surrounding the lashes. A superficial punctate keratitis is present in the lower portion of each cornea. Which of the would be least effective in the management of this patient? (568-570) A. B. C. D. Bacitracin ointment. Erythromycin ointment. Gamma benzene hexachloride (Kwell shampoo). Hot compresses and lid scrubs.
You examine a 3 year old patient that presents with severe itching and irritation of the lids. Biomicroscopy reveals the lid margins to have a dark discolored crusty appearance due to the presence of a reddish black material matted
to the lids and lashes. The use of which following management option requires the most caution in this young patient? (579-580) A. B. C. D. 154. Bland petrolatum ointment bid to lids and lashes. Kwell shampoo to wash hair. RID liquid shampoo to wash hair. Yellow mercuric oxide 1% bid to lids and lashes.
A 22 year old college student presents to your office after having an acid solution splashed in his left eye about one hour earlier. The laboratory instructor had taken first aid measures and irrigated the eye with distilled water for approximately 45 minutes. You examine the eye and find three small focal epithelial losses, but no areas of perilimbal ischemia. Which of the following would not be part of the usual treatment regimen for this patient? (696697) A. B. C. D. E. Acetaminophen for pain. Cycloplegia with 1% cyclopentolate or 5% homatropine. Steroid solution such as Pred Forte. Topical antibiotic ointment such as erythromycin. Pressure patching.
A 35 year old male patient presents with complaints of bilateral burning, foreign-body sensation and scratchiness which increased in severity during each day. History reveals that mattering is a problem throughout the day. A reduced TBUT and mild corneal staining was noted during biomicroscopy. Which of the following is not a usual treatment for this condition? (612-613) A. B. C. D. E. Lubrication with gtts and ung. Punctal occlusion. Soft contact lenses with artificial tears. Mucomyst. Vitamin C oral.
Which of the following is not considered to be of major concern when treating an anterior uveitis? (780) A. B. C. D. Reducing the severity of the attack. Preventing anterior synechiae. Preventing the development of secondary cataracts. Preventing phthisis bulbi.
Which of the following is not considered to be of major concern when treating a posterior uveitis? (782) A. B. C. D E. Protecting the macula. Protecting the optic nerve. Protecting the vitreous. Preventing posterior synechiae. Preventing cataract formation.
A 32 year old female product liability-malpractice attorney who is four months pregnant and with a history of liver problems comes to see you for treatment of a localized area of tenderness, inflammation, and swelling within the tarsus of her left upper eyelid. You determine that she has an internal hordeolum. She tells you that she needs it resolved as quickly as possible for an upcoming court appearance in which she is the plaintiff's attorney representing a client who is suing an optometrist for two million dollars for allegedly missing a one-half diopter cylinder by 2 degrees. The best treatment for this patient is: (565-566) A. B. C. D. Rx hot compresses. Rx oral penicillin and hot compresses. Rx oral erythromycin 250 mg qid x 14 days and hot compresses. Rx oral tetracycline 250 mg qid x 14 days and hot compresses.
A 25 year old male presents at your office with anisocoria. He is a flower arranger and first noticed a difference in pupil size the previous day as he was leaving work. Upon examination, the anisocoria is greater in the light than in the dark. You instill 0.1% pilocarpine and there is no change in the larger pupil. You then instill 1.0% pilocarpine and again there is no change in the larger pupil. What is the most likely diagnosis? (529-530) A. Third-nerve palsy.
B. "Atropinic" mydriasis. C. Preganglionic Horner's syndrome. D. Adie's tonic pupil. A 52 year old woman weighing 130 pounds needs Osmoglyn treatment for an acute angle closure glaucoma. What approximate amount should be given? (224) A. B. C. D. 3 oz. 5 oz. 7 oz. 9 oz.
A 21 year old college student complains of a persistent lid twitch for the past 3 months. Which of the following treatments would be appropriate for this condition? (582-583) A. B. C. D. Neostigmine bromide 15 mg 3 to 5 times daily. Topical antazoline every 4 hours as needed. Lacri-lube ointment at night time. Oral tetracycline 250 mg 4 times per day for 3 weeks.
A 27 year old female presents to your office with complaints of a red and irritated left eye. This has been present off and on for almost a year. She has seen four other eye doctors during that time and has been prescribed Tobrex, Blephamide, and Viroptic. None of the medicines helped. Biomicroscopy of the left eye revealed a superficial punctate keratitis, pannus at the 12 o'clock position, and a follicular response of the lids. The right eye is clear with no unusual findings. The patient is on no medication other than birth control pills. The best treatment would be: (650-651) A. B. C. D. Tetracycline 250 mg qid x 21 days. Gentamicin qtt qid x 10 days. Gentamicin qtt qid x 14 days. Viroptic gtt qid x 14 days.
A 27 year old female presents to your office with complaints of a red and irritated left eye. This has been present off and on for almost a year. She has seen four other eye doctors during that time and has been prescribed Tobrex, Viroptic, and oral tetracycline. None of the medicines helped. Biomicroscopy of the left eye revealed a keratitis, pannus at the 6 o'clock position, and a follicular response in the lower cul-de-sac. A very small round umbilicated lesion is present on the left lower lid at the lash line. The right eye appears clear and normal. The patient is on no medication other than birth control pills. The best treatment would be: (647-648) A. B. C. D. Erythromycin ointment applied to the eyelid. Erythromycin p.o. 250 mg qid x 10 days. Surgical removal of the lesion. Naphcon-A qid.
A 27 year old female presents to your office with complaints of a red and irritated left eye. This has been present off and on for almost a year. She has seen four other eye doctors during that time and has been prescribed Tobrex, oral tetracycline, and blephamide. None of the medicines helped. Biomicroscopy of the left eye revealed a keratitis, a watery discharge, and a follicular response. The right eye is clear with no unusual findings. The patient is on no medications other than birth control pills. The best treatment would be: (646) A. B. C. D. Erythromycin po 250 mg qid x 10 days. Viroptic qid. Naphcon-A qid. Non-preserved artificial tears.
You are treating a 32 year old male for a severe corneal abrasion. You have just instilled homatropine 2%. The patient reports that he feels dizzy, uncomfortable, and that his chest feels tight. You observe that he begins to develop hives on his face,neck, and arms. He seems very anxious and appears to have difficulty breathing. The next step in management of this patient should be to: (1008-1009) A. B. C. D. E. Observe the patient in the office until symptoms subside. Notify the Emergency Medical System or call 911. Wave an ammonia tablet under the patient's nose. Instill pilocarpine. Call your attorney.
You notice a small lesion (approximately one disc diameter in size) in the posterior pole of a 46 year old female. You suspect a choroidal melanoma by its appearance. The least useful procedure would be: (Wills-177-179) A. B. C. D. Visual fields. Baseline fundus photography and repeat in 3 months. Fluorescein angiography. Ultrasonography.
A 55 year old black male with a fifteen year history of diabetes presents to your office. During the course of your examination you find pressures of 30 mmHg in each eye. After gonioscopy, you conclude the high pressures are secondary to vessel growth in the anterior chamber angle. Which of the following medications is not recommended in the treatment of this patient? (924-927) A. B. C. D. Timoptic. Pilocarpine. Propine. Betoptic.
A 21 year old male has been treated for four weeks for meibomianitis with hot compresses, lid massage, and gland expression. Upon examination you note that a cheesy excretion is still present when you express the glands. The next step in your treatment plan may include: (571-573) A. B. C. D. Bacitracin ung qid. Tetracycline ung qid. Tetracycline 250 mg po qid. Doxycycline 100 mg po qid.
A 21 year old female presents with a red, watery, painful right eye which she reports she has had for two days. Upon slit-lamp examination you note dendrites on the right cornea which stain with fluorescein. You also note 2+ cells and 1+ flare in the anterior chamber. Pressures at this time are OD 25 mm Hg and OS 27 mm Hg. Which of the following is not appropriate in the initial management of this patient? (717) A. Viroptic q2h. B. Vira-A ung qhs. C. Inflamase Forte q2h. D. Homatropine 5% qid. E. Timoptic bid. A patient with systemic lupus erythematosus presents with whorl-like discoloration of the corneas. This would be due to treatment with which of the following drugs? (960) A. B. C. D. Oxytetracycline. Prednisolone. Chloroquine. Prednisolone.
An open angle glaucoma patient who is being treated with pilocarpine may be best dilated with which of the following? (488) A. B. C. D. 2.5% Phenylephrine. 1% Cyclopentolate. 1% Atropine. 5% Homatropine.
After treatment for an ischemic central retinal vein occlusion, a patient is instructed to return to your office every 2-3 three weeks for the first 6 months to check for: ( 816-818, Wills-297-299) A. B. C. D. Central macular edema. Corneal changes. Hypotony. Neovascularization of the iris
The leading infectious cause of ophthalmia neonatorum is: (652-655) A. B. Chlamydia trachomatis. Neisseria gonorrhea.
C. D. E. 174.
Staphylococcus aureus. Streptococcus viridans. Pseudomonas aeruginosa
A 10 year old male patient complains of a small (4 mm dia), hard immobile lump in the upper lid of his right eye. Palpation of the lesion produces no pain or tenderness. The patient and his parents report the condition has been present for about a month. The most appropriate therapy is: (566-567) A. B. C. D. E. 0.05 ml triamcinolone diluted to 5mg/ml injection into the lesion. Hot compresses several times daily. Surgical incision and curettage. Erythromycin 250 mg qid x 14 days. Hot compresses followed by vigorous digital massage.
The patient in question 174 returns to you after one month. He and his parents report he has complied with the treatment plan you prescribed, but the condition is unchanged. What would be next appropriate step in the care of this patient? (566-567) A. B. C. D. E. 0.05 ml triamcinolone diluted to 5mg/ml injection into the lesion. Hot compresses several times daily. Surgical incision and curettage. Erythromycin 250 mg qid x 14 days. Hot compresses followed by vigorous digital massage.
A 30 year old white male reports he is experiencing a burning, stinging, and tearing of his eyes and that sometimes it feels as though there is something in the eyes. Upon questioning, he can only report that the condition has been present for a fairly long time. Biomicroscopy examination reveals a mild conjunctival hyperemia and thickened, rounded eyelid margins with inspissated plugs at the meibomian gland openings. A markedly reduced tear breakup time is evident. The most effective treatment for this patient is: (571-573) A. B. C. D. 1% Silver nitrate application to the lid margins tid. Topical steroids to the conjunctival sac qid. Hot compresses followed by lid massage and gland expression tid. Gentamicin sol. tid and ung hs.
The most frequently encountered cause of non-contact lens related corneal ulcers and chronic conjunctivitis in adults is: (704-705) A. B. C. D. E. Bacillus. Pseudomonas. Serratia. Staph. Strep.
The best short-term management of a simple allergic conjunctivitis would be to administer: (755) A. B. C. D. Topical antihistamine-vasoconstrictor combinations. Pulsed topical steroids. Topical antibiotics for 2-3 weeks. Lid scrub hygiene.
A 36 year old myopic (-5.00) male patient, in excellent health, has a collection of discrete pigment deposits positioned vertically on the center of the corneal endothelium. There are iris transillumination defects and gonioscopy reveals 3+ pigment deposits of the trabecular meshwork. Applanation tonometry is: OD 19 mm Hg and OS 20 mm Hg. What would be the best management plan for this patient? (915-918) A. B. C. D. E. Perform provocative testing using phenylephrine. Obtain post exercise IOPs and baseline visual fields, progress in 6 mos. Refer patient to internist to rule out systemic condition. Begin 0.25% Timoptic bid OU, progress in 6 weeks. Begin 0.50% Timoptic bid OD, progress in 6 weeks.
Which of the following is not a side effect of oral tetracycline? (269-270)
A. B. C. D. E. 181.
Photo-sensitivity. Lymphadenopathy. Gastrointestinal irritation. Tooth discoloration. Pseudomembraneous colitis.
A 29 year old black female, in excellent health (had physical for a new job 8 months ago) presents with a complaint of moderate photosensitivity and some periorbital pain in the right eye. Biomicroscopy shows: OD, 2+ cells and flare, clumped grayish-white pigment deposits on the corneal endothelium; OS, anterior chamber is quiet with no cells or flare, but you note multiple adhesions of the iris to the lens at the 2:00-3:00, 7:00-8:00 and 11:00 o'clock positions. The IOP's are: OD, 18 mm HG; OS, 21 mm Hg. A dilated fundus examination reveals cup/disc ratios which are .5 horizontal and vertical in both eyes. Which one clinical test would be the best to confirm your expected diagnosis of the underlying disease process in this patient? (778-780, 785) A. B. C. D. Sedimentation rate (ESR). Chest X-ray (CXR). Rheumatoid factor (RA). Angiotensin-I-converting enzyme (ACE).
An alcoholic patient has reduced visual acuity and optic disc edema. Which of the following do you prescribe? (549550) A. B. C. D. Thiamine. Vitamin A. Vitamin D. Ascorbic acid.
If you examine a patient on the first day postoperative after routine cataract surgery. The eye looks good with everything as expected. When do you schedule the patient for his next appointment? (779) A. B. C. D. 3 days. 7 days. 14 days. 21 days.
A 22 year old male contact lens wearer presents late in the day with a very red, irritated right eye. He reported that the right eye had been slightly irritated for about one week and he had quit wearing his lenses three days ago. The severe symptoms had occurred after he put the lenses in early this morning. Biomicroscopy reveals 3+ conjunctival hyperemia, photophobia, blepharospasm and a profuse watery, slightly yellow discharge. The cornea stains slightly over a localized area of white subepithelial infiltrate at 1-2 o'clock. Which of the following represents an appropriate initial treatment plan? (707) A. B. C. D. E. Prednisolone acetate 1% qid and RTC the next day. Bacitracin ung qhs and RTC in 1 week. Blephamide ung bid and RTC in 2 weeks. Ciprofloxacin 0.3% q1h and RTC the next day. Ciprofloxacin 0.3% q2h and RTC in 4 days.
A 7 year old male presents complaining of irritated, sensitive eyes of 2 weeks duration. He mother states that he is always picking "matter" out of the corner of his eyes. Your examination reveals 2+ conjunctival hyperemia and a mild ptosis OD. There is also papillary hypertrophy (3+ OD, 2+ OS) of the superior palpebral conjunctiva. Your diagnosis is: (758) A. B. C. D. Trachoma. Giant papillary conjunctivitis. Vernal conjunctivitis. Superior limbic conjunctivitis.
An overweight 55 year old female presents for routine examination. Her medical history is significant for angina for which she takes digitalis. She denies any history of asthma or emphysema, but her breathing seems labored and ragged. The examination reveals H/V C/D ratios of .4/.6 OD and .5/.7 OS. The intraocular tensions are 27 mm Hg OD and 29 mm Hg OS. You decide to treat this patient. Which of the following medications is least contraindicated? (201, 208-209, 895) A. Timoptic 0.5% bid.
B. C. D. 187.
Pilocarpine 4% qid. Acetazolamide 250 mg qid. Propine 0.1% bid.
A 24 year old male presents complaining of hazy vision in his right eye which has been getting worse the last 2 days. He reports being punched in that eye during a friendly fight at a local pool hall over the weekend. Best corrected visual acuities are 20/40 OD and 20/20 OS. A slit lamp exam reveals 2+ conjunctival hyperemia and 2+ cells and flare in the anterior chamber OD. The left eye appears normal. Intraocular tensions are 19 mm Hg OD and 13 mm Hg OS. Which of the following represents the most appropriate treatment plan? A. B. C. D. E. Pilocarpine 1% qid, dexamethasone 0.1% qid OD and RTC in 2 days. Dexamethasone 0.1% q2h, cyclopentolate 2% q4h OD and RTC in 1 day. Prednisolone acetate 1% q2h, atropine 1% qid OD and RTC in 1 day. Prednisolone acetate 1% q2h, Betoptic 0.25% bid OD and RTC in 2 days. Prednisolone acetate 1% q2h, Betoptic 0.25% bid, homatropine 5% qid
OD and RTC in 1 day.
A 70 year old pseudophakic male presents for routine examination. His medical history is remarkable for borderline diabetes which is controlled by diet. He is not taking any medications. A dilated fundus examination reveals C/D ratios of .4/.4 OD and OS. Intraocular tensions measure 27 mm Hg OD and 30 mm Hg OS. A 30-2 visual field examination reveals what appears to be an early nasal step OD and a paracentral scotoma OS. Which of the following represents an appropriate treatment plan? (894-895) A. B. C. D. No treatment, but have the patient return for a DFE and visual fields in 9-12 Propine 0.1% bid OU and RTC in 2 weeks. Timoptic 0.5% bid OS and RTC in 2 weeks. Pilocarpine 4% qid OU and RTC in 1 month. months.
A 20 year old female presents with an acute onset of a very red, irritated right eye. She reports that the eye is extremely uncomfortable. Your examination shows 3+ conjunctival hyperemia in the temporal sector. The anterior chamber is deep and quiet. There is no corneal staining. Intraocular pressures measure 19 mm Hg in both the right and left eye. Medical history is unremarkable. An appropriate treatment plan for this condition would be: (770771) A. B. C. D. Prednisolone acetate 1% q2h and RTC in 2 days. Idoxuridine 0.1% qid and RTC in 1 week. Artificial tears PRN and RTC in 2 weeks. Bacitracin ung bid and RTC in 1 week.
A 30 year old male presents complaining of red irritated eyes. He reports that the eyes became irritated about 6 weeks ago and have been getting steadily worse over the last 2 weeks. He has been medicating himself with over the counter Visine drops since the condition began. He reports the drops helped the condition initially, but lately they are having little effect despite frequent application. A slit-lamp reveals 2+ conjunctival hyperemia and heavy punctate staining over the entire cornea. The anterior chamber is deep and quiet. An appropriate initial treatment would be: A. B. C. D. E. Increase Visine to q1h and add cold compresses qid. Discontinue Visine and prescribe erythromycin ung bid. Discontinue Visine and prescribe Naphcon A qid and cold compresses qid. Continue Visine qid and add FML q4h and warm compresses qid. Discontinue Visine and fit a bandage soft contact lens.
A 46 year old male present complaining of a red right eye in which the vision has become "hazy" in the last couple of days. Best corrected visual acuities are 20/100 OD and 20/20 OS. A slit lamp examination reveals 2+ conjunctival hyperemia and a disc shaped area of stromal edema of the central cornea. The anterior chamber exhibits a 1+ reaction with cells and flare and there are a few keratic precipitates on the posterior corneal surface. The epithelium is noted to be intact. Which of the following is an appropriate treatment plan? A. B. C. D. Scopolamine 0.25% tid, trifluorothymidine 1% tid, and prednisolone acetate 1% qid. Scopolamine 0.25% tid and dexamethasone .1% q4h. Pilocarpine 1% and Timoptic 0.5% alternately every 5 minutes for 20 minutes. Zovirax 800 mg po 5X/day, prednisolone acetate 1% qid, and homatropine 5% tid.
A patient presents with a pain in the right eye. Examination reveals a dilation of the limbal vessels, a steamy cornea, and a mid-dilated pupil that is unreactive to light. You wish to perform gonioscopy, but the corneal edema
makes it impossible to get a clear view. Which of the following might be used to reduce the edema so that gonioscopy can be performed? (909) A. 0.5% Betoptic. B. 1% Pred Forte. C. Hypo tears. D. Topical glycerin. 193. An 18 year old female patient presents with complaints of blurred vision with her left eye. She also reports that she sees spots in front of the same eye. She reports that her last eye exam was about a year ago and the doctor told her she could see 20/20 with both her right and left eye. When you check her acuities, you find: 20/20 OD and 20/80 OS. When you perform a dilated fundus examination with scleral depression, you note "snowbanks" in the far inferior periphery of the left eye. After baseline fluorescein angiography, what would be the appropriate treatment plan for this patient? (787) A. Monitor acuities and fluorescein angiography on a regular basis. B. Inform patient that the condition is almost always self limiting and have her examination. C. Oral or periocular steroid treatment. D. Inform patient that the condition is almost always self limiting and give her a instructions to contact you if the condition appears to worsen. 194. return in 12 months for a routine home Amsler grid with
A 70 year old healthy patient presents complaining of very intense pain to the left half of his face and forehead that has been present for approximately 24 hours. Examination reveals small blister-like lesions in the area of the pain with several located on the lids. What would be the best treatment plan for this patient? (719-720) A. Supportive: cold compresses, vasoconstrictors, and lubricants. B. Acyclovir 800 mg 5x daily x 7 days, prednisolone 60 mg po x 3 days, then 40 mg po x 3 days, then 20 mg po x 4 days and then discontinue, bacitracin ointment to the skin lesions bid. C. Cold compresses qid, Vasocon-A 1 gt q2h, trifluridine (Viroptic) 1 gt q1h during the day and vidarabine (ViraA) ung q3h after bedtime. D. Supportive: cold compresses, vasoconstrictors, lubricants, and acetaminophen 1000 mg q6h.
A 15 year old female presents because of several small flat, round lesions on and around the left eyelid. Biomicroscopy reveals that the lesions are slightly raised and a yellow pink color. The patient reports that she first noticed the lesions about three months ago and they haven't increased in size or number, however, she wants them removed for cosmetic reasons. What would be the best treatment plan for this patient? (589-592) A. B. C. D. Counsel the patient that the lesions are benign and should disappear spontaneously within 2 years or less. Irradiation. Antiviral therapy: Idoxuridine O.50% ung tid to each lesion. Dichloroacetic acid cauterization.
A 16 year old male presents because of swelling in the right medial canthus area that is accompanied by pain and redness. The condition has been present since yesterday and seems to be getting worse. What would be the best treatment plan? A. B. C. D. Dilation and irrigation or right lacrimal system followed by hot compresses qid. Penicillin 250 mg po qid and hot compresses qid. Cloxacillin 250 mg po qid and hot compresses qid. Amoxicillin 30 mg/kg/day po in three divided doses and hot compresses qid.
A 22 year old male college student presents as a walk-in between classes because of "pink eye" in his left eye. He reports that the condition has been present since yesterday and he awoke this morning with his eyelids stuck together. He also says that there is a lot of yellow "gunk" collecting in the affected eye. Biomicroscopy reveals a moderate conjunctival injection and a moderate degree of mucopurulent discharge. Which of the following treatment plans would be most appropriate? (638-639) A. Polytrim 0.1% sol 1 gt qid x 7 days.
B. C. D. 198.
Chloramphenicol 0.5% sol 1 gt qid x 7 days. Lid Scrubs and bacitracin-polymyxin B ung 1/2 inch ribbon qid x 7 days. Sodium sulfacetamide 10% sol 1 gt qid x 7 days.
If a patient reports a prior allergic reaction to procaine, which anesthetic can be used safely? (127) A. B. C. D. Benoxinate. Tetracaine. Proparacaine. Chloropracaine.
Primary open-angle glaucoma is most prevalent in which of the following racial groups? (878-879) A. B. C. D. Asians. Blacks. Hispanics. Whites.
The use of which of the following medications often results in color vision disturbances? (989) A. B. C. D. Diazepam. Digatalis. Ampicillin. Ibuprofen.
A very alarmed patient is waiting when you first arrive at your office. He reports that when he first looked in the mirror this morning, he noticed that the entire "white" part of his left eye was blood red. He says that it feels a little bit uncomfortable, but there is no pain involved. The patient reports that he has been having some problems with hay fever and sneezing a great deal, but is otherwise in great health. Which of the following would not be an acceptable treatment for this condition? A. Artificial-tear drops such as Refresh qid to alleviate discomfort. B. Cool compresses to reduce the typically mild inflammation. C. Warm compresses to speed reabsorption. D. Aspirin to alleviate discomfort. E. Reassurance to calm patient. A 4 year old patient presents with very swollen purplish lids and conjuctivitis. On the gram stain from the eye you would expect to see: (253, 638-639) A. B. C. D. Gram positive cocci in clusters. Gram negative rods. Gram negative cocci in pairs. Gram positive cocci in long chains.
Your 30 year old soft contact lens patient has developed a corneal ulcer. The most likely organism responsible is: A. B. C. D. E. Pseudomonas. Serratia. Staphylococcus. Moraxella. Streptococcus.
Use the following information to answer the next nine (204 to 212) questions. A male presents for a routine examination. The vision is correctable to 20/20 at both distance and near. Intraocular pressures by Goldmann tonometry are: OD 29 mm Hg and OS 33 mm Hg. Posterior pole evaluation with the biomicroscope and the +90D lens determine the cup/disc ratios to be: OD .6/.6 and OS .6/.7. Visual field evaluation with automated perimetry shows 3 small scotomas within the central 30 degrees of the right eye and 4 within the left. 204. If the patient is 50 years old and your case history reveals he is in excellent physical health, which of the following would be the best choice for initial treatment of this gentleman? (894-895) A. B. Acetazolamide. Dipivefrin.
C. D. 205.
Pilocarpine 2.0%. Timolol .5%.
If the patient is a 60 year old pseudophake and your case history reveals he is in excellent physical health, which of the following would be contraindicated? (894-895) A. B. C. D. Acetazolamide. Dipivefrin. Pilocarpine 2.0%. Timolol .5%.
If the patient is a 50 year old and your case history reveals a history of kidney disease, which of the following would be contraindicated? (894-895) A. B. C. D. Acetazolamide. Dipivefrin. Pilocarpine 2.0%. Timolol .5%.
If the patient is a 50 year old and your case history reveals a history of cardiovascular disease, which of the following would be contraindicated? (894-895) A. B. C. D. Acetazolamide. Dipivefrin. Pilocarpine 2.0%. Timolol .5%.
If the patient is a 50 year old and your case history reveals a history of pulmonary disease, which of the following would be contraindicated? (894-895) A. B. C. D. Acetazolamide. Dipivefrin. Pilocarpine 2.0%. Timolol .5%.
If the patient is a 50 year old in excellent health and your examination determined the presence of bilateral posterior subcapsular cataracts, which of the following would be contraindicated? (894-895) A. B. C. D. Acetazolamide. Dipivefrin. Pilocarpine 2.0%. Timolol .5%.
If the patient is an 18 year old in excellent health, which of the following would be contraindicated? (894-895) A. B. C. D. Acetazolamide. Dipivefrin. Pilocarpine 2.0%. Timolol .5%.
If the patient is a 23 year old in excellent health and case history reveals a childhood history of blunt trauma to each eye which resulted in bilateral angle recessions, which of the following would be contraindicated? (922-923) A. B. C. D. Acetazolamide. Dipivefrin. Pilocarpine 2.0%. Timolol .5%.
If the patient is a 60 year old in excellent health and case history reveals that he is allergic to the penicillins and sulfonamides, which of the following would be contraindicated? (216-217)
A. B. C. D. 213.
Acetazolamide. Dipivefrin. Pilocarpine 2.0%. Timolol .5%.
A 17 year old white female presents with complaints of moderate pain and blurred vision after being hit in the right eye with a tennis ball. Biomicroscopy reveals blood in the anterior chamber. Which of the following is prescribed to decrease the chances of a rebleed? (783) A. B. C. D. E. Triamcinolone acetonide (Kenalog-10). N-acetylcysteine (Mucomyst). Phenylephrine 2.5% (Neo-synephrine). Triethylenethiophosphoramide (Thiotepa). Aminocaproic acid (Amicar).
A 48 year old white female presents with complaints of glare and blurred vision. Questioning reveals that the condition is most noticeable when she first wakes up in the morning and on wet, humid days. Vision is correctable to 20/20 OD and OS. Biomicroscopy reveals bilateral corneal stromal edema and a "ground glass" appearance of the endothelium. Which of the following treatment plans is not appropriate? (Wills 101-102) A. B. C. D. Topical sodium chloride 5% sol qid and 5% ung hs. Warm air from hair dryer held at arm's length for 5-10 minutes in the morning. Timolol 0.25% bid. Refresh qid and Refresh PM hs.
A 22 year old female patient presents late in the afternoon with complaints of acute ocular pain in the right eye when she wakes up in the morning. This has been going on for about a week to ten days and she didn't come in sooner because it gets so much better as the day progresses. She also complains of photophobia, tearing, and foreign body sensation. Her last complete eye examination had been about ten months ago, but you had sucessfully treated her for a corneal abrasion 2 months prior to the present visit. Biomicroscopy reveals a localized roughening of the corneal epithelium of the right eye that fluorescein dye outlines lightly. You have the patient return early the next morning and biomicroscopy shows a small area of epithelial loss that stains with fluorescein. You have her return a few hours later, and the area of staining has improved greatly. Which of the following is not a recommended treatment for this condition? (693-695, Wills 59-61) A. B. C. D. E. Sodium chloride 5% sol tid and 5% ung hs. Epithelial debridement. Chelation with EDTA 0.37% sol. Bandage contact lens. Anterior stromal punctures, 20 to 50 with 25 gauge needle.
A 32 year old male presents with a painful and photophobic right eye. The eye is moderately red, especially in the limbal area. Biomicroscopy reveals the presence of 3+ cells and 3+ flare in the anterior chamber. Goldmann tonometry pressures are: OD 15 mm Hg and OS 21 mm Hg. Which of the following is the best treatment plan for this patient? (780-782) A. B. C. D. E. Tropicamide 1%, prednisolone 0.12%, and Ibuprophen. Tropicamide 1% and prednisolone 0.12% for right eye and timolol 0.25% for the left eye. Homatropine 5% and prednisolone 0.12%. Homatropine 5% and prednisolone 1% and Ibuprophen. Homatropine 5% and prednisolone 1% for the right eye and timolol 0.5% for the left eye and Ibuprophen.
A 62 year old female presents with pain and blurred vision in her left eye after being involved in a car accident in which her head hit the steering wheel. Biomicroscopy reveals the presence of suspended red blood in the anterior chamber of the problem eye. Which of the following would be the most contraindicated in the care of this patient? (782-784) A. B. C. D. E. Hospitalization, bilateral patches, and sedation. Periodic bedrest with head at 30 to 45 degrees and protective shield at Cycloplegic and mydriatic. Salicylates. Aminocaproic acid. bedtime.
Which of the following is ineffective in the management of acute angle-closure glaucoma when the intraocular pressure is greater than 50 to 55 mm Hg? (909-912) A. B. C. D. Oral acetazolamide. Oral glycerol. Pilocarpine. Timolol
A 48 year old male presents bilateral chronic ocular irritation, redness, and burning. Biomicroscopy revealed a mild blepharitis, associated with marked plugging of the meibomian glands and inferior, superficial corneal vascularization. The patient's cheeks, nose, and forehead are erythematous. What is the most effective treatment for this patient? (658-660) A. B. C. D. Careful lid hygiene including warm compresses. Topical antibiotics such as bacitracin or erythromycin. Prednisolone acetate. Oral tetracycline.
According to Bartlett and Jaanus, the recommended drug schema for treating primary open-angle glaucoma is: (894) A. B. C. D. E. Dipivefrin > methazolamide > ß blocker > pilocarpine Methazolamide > pilocarpine > dipivefrin > ß blocker ß blocker > pilocarpine > dipivefrin > dorzolamide Dipivefrin > pilocarpine > ß blocker > methazolamide ß blocker > dipivefrin > dorzolamide > pilocarpine > methazolamide
A 60 year old white male presents for a routine examination with a chief complaint of slightly blurred vision at near. Case history reveals open heart bypass surgery at age 40 and again at age 56. his only medications are Coumadin and Zocor, a blood thinner and a cholesterol-lowering drug respectively. The patient reports he is in excellent physical condition and runs four miles each day. Distant and near refractive findings correct the patient to 20/20. Goldmann pressures are: OD 30 mmHg and OS 33 mm Hg. Direct and indirect ophthalmoscopy, biomicroscopy, and +78 D lens findings are unremarkable with the ciliary body being visible in all quadrants during gonioscopy. Visual fields are suspicious. What is the best initial management plan for this patient? A. B. C. D. E. Timolol 0.25% bid. Pilocarpine 2.0% qid. Dipivefrin 0.1% bid. Dorqolamide 2.0% tid. Latanoprost .005% qd
One of your patients is a 43 year old Hispanic male. Approximately one year ago you diagnosed pigmentary glaucoma when the patient presented for a routine examination with: intraocular pressures of 28 and 30 mmHg, cup/disc ratios of .6/.7 and .6/.8, small paracentral scotomas, and pigmentary dispersion syndrome. You prescribed Timoptic 0.5% bid and the pressures stabilized at 18 mmHg OU and remained there for each progress check. However, when the patient presents for his latest examination, he reports that his oil well fire fighting business has really taken off and he is finding it very difficult to comply with his treatment regimen. He says he often has to leave town at a moment's notice and sometimes is away in the field for days under primative conditions. Assuming compliance will continue to be a problem, what is the best new management plan for this patient? A. B. C. D. E. Change Rx to: Timoptic-XE 0.5% qd. Change Rx to: Betagan 0.5% qd. Change Rx to: Betopic 0.5% qd. Change Rx to: Ocupress 1% qd. Argon laser trabeculoplasty.
223. You are prescribing Inflamase Forte 1%, an ophthalmic solution that come in 3, prescription has the following label: Place one drop in each eye: 5 times a day for 10 days, ( 7A, 10A, 1P, 4P, 7P) then 3 times a day for 7 days, (7A, 1P, 7P) then 2 times a day for 5 days, (7A, 7P) then 1 time a day for 5 days, (7A) then 1 time a day every other day for 10 days, (7A) then stop. What should be the subscription on the prescription? A. Dispense 1 5ml bottle. B. Dispense 1 10ml bottle. C. Dispense 1 15ml bottle. D. Dispense 1 2.5ml bottle and 1 5ml bottle. E. Dispense 1 2.5ml bottle and 1 10ml bottle.
5, 10, and 15 ml bottles. Your
224. A somewhat "laid-back" 42 year old white male presents in your office with a chief complaint of irritated red eyes, tearing, and photophobia. He reports that the condition has been coming and going for months........getting better for a while and then recurring. He says that he has not seen a doctor before because he has been traveling. He said he had used one of his lady traveling companion's prescription eye drops and it had helped, but he had used it all. Your examination reveals a follicular reaction, especially in the lower tarsal conjuntiva and fornix. There is a superior located keratitis with peripheral subepithelial infiltrates and corneal vascularization. When you tell the patient that you are going to prescribe oral antibiotics and will see him again in two weeks, he says that he is leaving town in a couple of days and probably wouldn't be back this way until the Grateful Dead play here again. At that point you decide the best treatment for this patient would be: A. B. C. D. E. Azithromycin. Dicloxacillin. Doxycycline. Erythromycin. Tetracycline.
225. You are providing the post-operative care of a cataract surgery patient. When this same patient had his first eye operated on a few months ago, he proved to be a steroid responder and the intraocular pressures elevated significantly and were difficult to control. Because of this past experience with the first eye, what would be a prudent anti inflammatory drug choice following surgery to the fellow eye? A. B. C. D. Dexamethasone Prednisolone acetate Prednisolone sodium phosphate Rimexolone
COMMON ABBREVIATIONS USED IN PRESCRIPTION ORDERS Word or phrase Ad libitum Agita Alternis horis Bene Bis in die Capsula Collyrium Abbreviaton Ad lib Agit Alt h bid cap collyr Meaning As desired Shake/stir Every other hour Well Twice a day Capsule An eye wash
Da, detur, dentur Dispense Ex modo prescipto Gutta Guttae Hora Hora somni Liquor Non repetatur Nocte Numerus Oculo utro Oculus dexter Oculus laevus Oculus sinister Per os Pro re nata Quaque Quaque diem Quaque hora Quater in die Recipe Signa Solutio Tabella Ter in die Unguentum Ut dictum Unus Duo Tres
d disp emp gtt gtt h hs liq non rep noct no OU OD OL OS po prn q qd qh q2h q3h qid Rx sig sol susp tab tid ung ut dict i, I ii, II iii, III
Give, let be given Dispense As directed A drop Drops An hour At bedtime Solution Do not repeat At night Number Each eye Right eye Left eye Left eye By mouth As needed Each, every Everyday Every hour Every two hours Every three hours Four times a day Take Write, label (Mark thou) Solution Suspension Tablet Three times a day Ointment As directed One Two Three
For all practical purposes, the following conversion factors are close enough when calculating glycerin and Isosorbide dosage : 1 gm (gram) = 1 ml (milliliter) = 1 cc (cubic centimeter) 1 oz (ounce) = 30 ml (milliliters) Since 1 kg (kilogram) = 2.2 lb (pounds) Then, 1.5 gm/kg = 1.5 ml/kg = 1.5 ml/2.2 lb
YOUR NAME EYE ASSOCIATES Your Name, O.D. Street Address Anytown, USA Telephone Number 713-999-2020 State Reg. No. TX 1947T ______________________________________________________ Name_______________(A)________________ Age______(A)_______ Address ____________(A)_________________ Date______(B)______ R (C) Superscription-the R symbol (D) Inscription-the drug, its form, and size or volumn
(E) Subscription-number or volumn to dispense (F) Signa-directions for patient to be placed on label
___________________________O.D ____________________________O.D PRODUCT SELECTION PERMITTED DISPENSE AS WRITTEN
(A) John Doe, 45 years old Houston, TX (B) April 1, 1997 (C) R (D) Tobradex Ophthalmic Solution 5 ml (E) Dispense 1 bottle (F) Place 1 drop in the left eye four times each day (8 AM, Noon, 4 PM, and 8 PM) for 10 days and stop. For eye irritation (G) 0, √
UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY ALUMNI ASSOCIATION THERAPEUTIC PEARLS AND HINTS
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
Never put a fluorinated steroid on a cornea with open epithelium. You can never under treat an iritis - don't be fooled by an acute presentation that doesn't look that bad....it can look dramatically different in 24 hours. You can rarely under treat an infectious keratitis. You can easily over treat an infectious conjunctivitis. Never underestimate the effects a cataract may have on aqueous flow and drainage. When in total doubt, non-preserved artificial tears or saline rinses and 24 hours will rarely cause any harm and may shed additional light on the problem. DOCUMENT EVERYTHING - what you saw, what you said, medication instructions, etc. Always put complete prescription instructions on the chart - patients forget, lose prescriptions, and pharmacists get confused. Assume non-compliance by the patient until proven otherwise. Form a tentative diagnosis based on an extensive case history with special emphasis on patient symptoms. Don't overlook the obvious (if it looks like a duck, walks like a duck, and quacks like a duck, it very often is a duck). Look at the patient first and the eye second. Study facial features and the ocular adnexa before you put the patient behind a slit lamp.
13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26.
Look at the uninvolved eye first - some supposed uninvolved eyes actually are involved. The uninvolved eye will also give you a baseline comparison for that individual patient. Don't insist that allergies and other systemic etiologies of ocular disease give a bilateral presentation - sounds reasonable, but just doesn't work that way all the time. When in doubt, assume staph - when you doubt staph, assume viral. All potentially infectious lesions of the cornea should be assumed as pseudomonas until proven otherwise. Gentamicin and tobramycin are not the panacea of all that ails the eye. Topical medications on glandular based diseases (meibomianitis, hordeola, etc.) are much akin to spitting in the ocean - you won't have much impact on the whole picture. The most important thing to remember in examining a cornea/conjunctival foreign body is to rule out the possibility of penetration. Listen to the patient - they are the person with the most valuable and pertinent information you need. When pain is a potential complication it is better to treat it up front than to see the patient again at midnight. Immediate sensitivity reactions usually respond best to anti-histamines while delayed or chronic reactions respond best to steroids. Whether the etiology is friction (mechanical) or immunological, no amount of Opticrom will resolve GPC unless the underlying etiology is eliminated. Photokeratoscopy is the best way to evaluate the astigmatic distortions induced by a pterygium. Chronic blepharitis is more immunological (toxic) than infectious - treatment plans must address the toxic problem (steroids, lid scrubs) more than the bacterial component. Never use a steroid in herpes simplex keratitis, during the first 24 hours of a bacterial keratitis, in fungal infections, or when equally effective therapeutic intervention is available. Anything else is fair game! DISCLAIMER: This is a clinical commentary....ignore this comment when taking board examinations. Avoid ointment preparations in seborrheic disease. In a non-complicated chalazion, antibiotics are rarely of value - they are only an additional expense for the patient. Whatever your treatment plan is, if it does not conform to the accepted standard of care it is rarely defensible in court. In a chronic follicular presentation, think chlamydia until proven otherwise. The two best ways to avoid malpractice are to provide patient education and to maintain patient control. The best way to lose patient control is by not being accessible - 24 hours a day, 7 days a week. Inform patients of potential side effects of medications before they start using them. Tell the patient what you expect the disease process to do over defined time period - the next 24 hours, 72 hours, week, etc. At a minimum let them know when you expect their condition to start improving and be resolved. Tell the patient to call if things do not happen the way you expect. When using a needle to remove a foreign body, bend the tip slightly into a hook by dragging the tip of the needle across the inside of the plastic casing. Flare and/or cells are best seen in a totally darken room. Use low slit lamp illumination intensity when evaluating the fundus with a 90D or 78D lens. Erythromycin ointment is bland and very non-toxic to the eye - a good choice in chronically traumatized corneas and as a cover antibiotic in viral infections that may cause a toxic keratitis (EKC).
27. 28. 29. 30. 31. 32. 33. 34.
35. 36. 37. 38.
39. 40. 41. 42. 43. 44. 45. 46.
Laboratories are your slave, not your master. They should be used to support your examination decisions and not dictate what you should do. Have confidence in your examination and diagnostic abilities. If you don't know what it is, don't put a steroid on it. Always take a complete case history on each patient. Record pertinent positives and pertinent negatives. Get consults before the patient requests a second opinion. If you did not write it in the chart, you did not do it. Even turkeys get sick. The conditions that present to your office never had the opportunity to read the books about themselves and therefore, don't always look like the pictures or descriptions in those books. happened. However, in all of this
47. This is all exciting and I couldn't be any happier about everything that has excitement and elation, lets don't forget who brought us to the dance.
DOSAGE OF EYE MEDICATIONS
A 2.5 ml bottle will dispense 50+ drops A 5 ml bottle will dispense 100+ drops A 10 ml bottle will dispense 200+ drops A 15 ml bottle will dispense 300+ drops A 5 ml bottle fortified with 2 ml will dispense 120+ drops A standard 3.5 gm tube of ointment will give you one week of application for one eye if used 4 times a day and the dose is a 2 cm ribbon. If treating one eye (QID), four times/day, one tube will last for one week. If treating both eyes (QID), four times/day, two tubes will last for one week. It is sometimes easier for the patient to understand if you tailor your doses and give the instructions based upon the number of tubes to be used instead of the number of days.