Part 2 Dr. Brittany Ears Eyes/HTN

A patient with long-standing hypertension has white fluffy retinal lesions on fundoscopic exam. What retinal finding is this and what is the underlying cause?

Cotton wool spots caused by hypertension or diabetes due to retinal nerve fiber ischemia.

What chronic diseases are most commonly associated with cotton wool spots?

Hypertension and diabetes mellitus.

A diabetic patient has retinal microaneurysms noted during fundoscopic examination. What is the diagnosis?

Diabetic retinopathy.

A patient has retinal neovascularization on fundoscopic examination. Which disease is most likely responsible?

Diabetes mellitus.

A patient has AV nicking on retinal examination. What chronic condition is the most likely cause?

Hypertension.

Copper wiring is noted during a fundoscopic exam. What disease should be suspected?

Hypertension.

Silver wiring of the retinal arteries is most commonly caused by what condition?

Long-standing hypertension.

A patient presents with papilledema during an eye examination. What serious condition must be ruled out immediately?

Increased intracranial pressure (ICP).

What is the priority treatment for papilledema?

Emergent evaluation and treatment of increased intracranial pressure.

A patient presents with a painless nodule on the eyelid. What is the diagnosis?

Chalazion.

What is the first-line treatment for a chalazion?

Warm compresses and observation because it usually resolves spontaneously.

A chalazion persists beyond 4 weeks despite conservative treatment. What is the next step?

Ophthalmology referral for surgical removal.

A patient presents with a painful swollen eyelid lesion. What is the diagnosis?

Hordeolum (stye).

What is the first-line treatment for a hordeolum?

Warm compresses.

A patient has a gray-white ring around the cornea. What is the diagnosis?

Arcus senilis.

Arcus senilis in a younger patient should prompt evaluation for what condition?

Hyperlipidemia.

What laboratory test should be ordered in a patient with arcus senilis?

Lipid panel.

A patient has a triangular fibrovascular growth extending onto the cornea. What is the diagnosis?

Pterygium.

What is the recommended conservative treatment for pterygium?

Reduce UV exposure and wear sunglasses.

When should surgery be considered for pterygium?

When vision is affected or symptoms become significant.

A patient has a yellow bump on the conjunctiva that does not cross onto the cornea. What is the diagnosis?

Pinguecula.

What is the treatment for pinguecula?

Avoid excessive UV exposure and wear sunglasses.

A patient has progressive painless vision loss with lens opacity. What is the diagnosis?

Cataract.

What is the definitive treatment for cataracts?

Surgical removal with lens replacement.

A patient develops gradual peripheral vision loss with elevated intraocular pressure. What type of glaucoma is most likely?

Open-angle glaucoma.

What is the first-line medication for open-angle glaucoma?

Timolol or other beta-blocker eye drops.

A patient develops sudden severe eye pain, halos around lights, nausea, and rapid vision loss. What is the diagnosis?

Angle-closure glaucoma.

What is the treatment for angle-closure glaucoma?

Emergent ophthalmology referral for surgery.

What Snellen visual acuity is considered normal?

20/20.

What Snellen visual acuity defines legal blindness?

20/200.

A 55-year-old patient complains of difficulty reading up close but distance vision is normal. What condition is present?

Presbyopia.

What is the treatment for presbyopia?

Reading glasses.

A patient complains of central vision loss while peripheral vision remains intact. What condition should be suspected?

Macular degeneration.

What office tool is used to screen for macular degeneration?

Amsler grid.

What is the appropriate management for macular degeneration?

Refer to ophthalmology.

A patient has vesicular facial lesions and eye pain. Fluorescein staining reveals a dendritic lesion. What is the diagnosis?

Herpes keratitis.

What diagnostic test confirms herpes keratitis?

Fluorescein stain showing a dendritic (fern-like) pattern.

What is the treatment for herpes keratitis?

Emergent ophthalmology referral.

A patient presents with red eye and purulent discharge. What is the diagnosis?

Bacterial conjunctivitis.

What is the first-line treatment for bacterial conjunctivitis?

Topical antibiotic eye drops such as levofloxacin.

Why are antibiotics used in bacterial conjunctivitis?

To eliminate bacteria, shorten illness, reduce transmission, and prevent complications.

A patient has watery eyes after a viral upper respiratory infection. What is the diagnosis?

Viral conjunctivitis.

What is the treatment for viral conjunctivitis?

Supportive care because it resolves on its own.

A patient has itchy watery bilateral eyes during allergy season. What is the diagnosis?

Allergic conjunctivitis.

What is the treatment for allergic conjunctivitis?

Antihistamine eye drops.

A swimmer develops ear pain that worsens when the tragus is touched. What is the diagnosis?

Otitis externa.

What hallmark physical finding is associated with otitis externa?

Tragal tenderness.

What is the treatment for otitis externa?

Ciprofloxacin or Cortisporin ear drops.

A child presents with ear pain and an erythematous bulging tympanic membrane. What is the diagnosis?

Acute otitis media.

What is the first-line antibiotic for acute otitis media?

Amoxicillin.

What is the second-line antibiotic if amoxicillin fails?

Augmentin.

What antibiotic should be used in a penicillin-allergic patient with acute otitis media?

Azithromycin.

In a normal Rinne test, what finding is expected?

Air conduction greater than bone conduction (AC > BC).

What Rinne test finding indicates conductive hearing loss?

Bone conduction greater than air conduction (BC > AC).

During Weber testing, conductive hearing loss causes sound to lateralize to which ear?

The affected ear.

Presbycusis causes what type of hearing loss?

Sensorineural hearing loss.

Meniere disease causes what type of hearing loss?

Sensorineural hearing loss.

A patient presents with an anterior nosebleed. Where should pressure be applied?

Kiesselbach plexus.

What is the first-line management of anterior epistaxis?

Pinch the soft part of the nose over Kiesselbach plexus.

A patient presents with facial pain, purulent nasal drainage, fever, and maxillary tenderness. What is the diagnosis?

Acute bacterial sinusitis.

What is the first-line antibiotic for acute bacterial sinusitis?

Amoxicillin-clavulanate (Augmentin).

What antibiotic should be used if the patient has a penicillin allergy?

Doxycycline.

A patient has sore throat without fever and viral symptoms. What is the most likely diagnosis?

Viral tonsillitis.

A patient presents with fever, tonsillar exudates, anterior cervical lymphadenopathy, and no cough. What is the diagnosis?

Streptococcal pharyngitis.

What rapid office test confirms streptococcal pharyngitis?

Rapid strep test.

What is the first-line treatment for streptococcal pharyngitis?

Penicillin.

What antibiotic should be used for streptococcal pharyngitis in a penicillin-allergic patient?

Macrolide.

A child develops a sandpaper-like rash after strep throat. What is the diagnosis?

Scarlet fever.

What serious complication can scarlet fever predispose patients to?

Rheumatic fever.

A teenager presents with sore throat, fever, fatigue, and posterior cervical lymphadenopathy. What diagnosis should be suspected?

Infectious mononucleosis.

What virus causes infectious mononucleosis?

Epstein-Barr virus.

What test confirms infectious mononucleosis?

Monospot test.

What is the treatment for infectious mononucleosis?

Supportive care only.

How long should patients with mononucleosis avoid contact sports?

3 to 4 weeks because of splenic rupture risk.