NBEO PART 3 STUDY EXAMS GUIDE ALL
QUESTIONS AND ANSWERS SURE A+
✔✔AAION - Testing - ✔✔RNFL OCT, VF (altitudinal or central), Pupils (APD), Red cap
(reduced), Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
✔✔AAION - Treatment - ✔✔Refer to ER for blood work and IV methylprednisolone,
Switch to oral steroids if (+) TA biopsy and cont for 6-12 months
✔✔AAION - FU - ✔✔3-4 wks
✔✔AAION - Education - ✔✔You have AAION/GCA. This condition leads to
inflammation of the medium and large blood vessels in the body, leading to your fever,
headaches, and jaw pain. This inflammation is also affecting the blood supply to your
optic nerve, leading to vision loss. Unfortunately, there is only a small chance the vision
loss you are experiencing will return. The primary goal is to prevent this from happening
in the other eye. I am referring you for urgent blood work, as well as steroids at the
hospital. They will likely keep you on steroids for 6-12 months after this to keep
inflammation in your body low. I'd like to see you back in about a month.
✔✔Optic Neuritis - Testing - ✔✔RNFL OCT, VF (central or arcuate), Pupils (APD), Red
cap (reduced), EOM (pain), Urgent MRI and LP
,✔✔Optic Neuritis - Treatment - ✔✔Refer for imaging, and oral steroids if within the first
1 -2 weeks of onset. Refer to neurology for MS management.
✔✔Optic Neuritis - FU - ✔✔3-4 weeks. After that, q 3-6 mo
✔✔Optic Neuritis - Education - ✔✔You have a condition called optic neuritis. This
means that the optic nerve connecting your eye to your brain is swollen, leading to your
blurry vision. Your vision will return after the swelling has gone down. However, this kind
of swelling is often associated with MS. MS is an autoimmune disease in which your
body's own immune system attacks your tissues and nervous system. It's important that
we refer you for an MRI and to a neurologist to help make that diagnosis. I'd like to see
you back in 1 month, and we'll check your vision every 3-6 months from here on out.
✔✔ONH Drusen - Testing - ✔✔FAF (+), B-scan (hyper-reflective), VF (generalized
depression), RNFL OCT
✔✔ONH Drusen - Treatment - ✔✔Observation
✔✔ONH Drusen - FU - ✔✔q 6-12 mo
✔✔ONH Drusen - Education - ✔✔You have ONH drusen, which are calcified deposits
within the optic nerve. Usually these are benign and will have no effect on your vision.
Rarely, they can start to compress the nerve tissue and lead to loss of vision. I'd like to
see you every 6-12 months to check on your visual field to make sure that they are not
impacting your vision. There is no treatment for this condition.
✔✔Horner Syndrome - Testing - ✔✔Pupil sizing, Near testing (no LND/ normal), MRD 1
(2mm ptosis), Old photos, 1% Apraclonidine testing (dilates Horner pupil), RTC 1 day
for 1% Hydroxyamphetamine testing (dilates if pre-ganglionic), Order chest CT
(Pancoast tumor), MRI/MRA of brain/neck (carotid artery dissection [esp if neck pain]),
CBC w/ diff
✔✔Horner Syndrome - Treatment - ✔✔Refer for neuroimaging
✔✔Horner Syndrome - FU - ✔✔FU after imaging
✔✔Horner Syndrome - Education - ✔✔You have a condition called Horner syndrome
that leads to the lid droop and smaller pupil that you are experiencing. This can be
caused by several things, but there is likely inflammation or compression of the nerve
that connects parts of your eye to the brain. It may be due to headaches or migraines,
or something more serious like a mass. I need to refer you for imaging to rule out that
possibility. I will follow up with you after the imaging results.
✔✔Adie Tonic Pupil - Testing - ✔✔Pupil sizes, Near testing (LND), Old photos, 0.125%
Pilocarpine (constriction)
, ✔✔Adie Tonic Pupil - Treatment - ✔✔0.125% Pilocarpine bid-qid to help with
accommodation and cosmesis, Cosmetic CL, sunglasses
✔✔Adie Tonic Pupil - FU - ✔✔1 year
✔✔Adie Tonic Pupil - Education - ✔✔You have a condition called Adie tonic pupil. This
is a benign condition in which one of your pupils is bigger than the other, and it does not
focus as well up close. You may also be more light sensitive on that side since that pupil
is bigger. I recommend wearing sunglasses when outside and I can prescribe you a
drop that helps to constrict the pupil to make reading easier. This condition may occur in
both eyes with time. We can monitor you annually.
✔✔Myasthenia Gravis - Testing - ✔✔MRD1, MRD1 after 2 min sustained upgaze, Ice
pack test or Tensilon test, pupils (normal), Bloodwork (T3, T4, TSH), Neck CT (r/o
thymoma)
✔✔Myasthenia Gravis - Treatment - ✔✔Refer to neurology for treatment (steroids may
help if early in the disease course, pyridostigmine if trouble breathing), Prism for
diplopia
✔✔Myasthenia Gravis - FU - ✔✔4-6 mo
✔✔Myasthenia Gravis - Education - ✔✔You have a condition called MG. This is an
autoimmune condition in which your body's own immune system attacks your tissues,
leading to a droopy eyelid and double vision towards the end of the day. It may also
lead to difficulty breathing. We are referring you to a neurologist who can treat you. We
also are ordering blood work, as this condition is often associated with thyroid and
thymus issues. If the double vision is consistent and bothersome to you, we can also
prescribe prism in your glasses to help. I'd like to see you back in 4-6 months.
✔✔Bell palsy - Testing - ✔✔NaFL, TBUT, Urgent referral to ER for stroke workup
✔✔Bell palsy - Treatment - ✔✔Perform stroke workup to R/O stroke, Refer to
neurology, PFATs, Ointment at bed time, Lid taping or eye mask at night, Turn off fans
while sleeping
✔✔Bell palsy - FU - ✔✔1-3 months
✔✔Bell palsy - Education - ✔✔You have a condition called Bell palsy. This is a
condition where inflammation of an unknown cause, or due to a previous viral infection,
leads to drooping on the whole side of your face. As this can often mimic a stroke, we
need to refer you to the ER for a stroke workup. We are also referring you to neurology
for further care. This condition is usually temporary and resolves in a few months. Since
your eye can not close properly, it's important to make sure your eyes do not dry out. I
QUESTIONS AND ANSWERS SURE A+
✔✔AAION - Testing - ✔✔RNFL OCT, VF (altitudinal or central), Pupils (APD), Red cap
(reduced), Palpation of temporal artery, TA biopsy, ESR/CRP/CBC with diff
✔✔AAION - Treatment - ✔✔Refer to ER for blood work and IV methylprednisolone,
Switch to oral steroids if (+) TA biopsy and cont for 6-12 months
✔✔AAION - FU - ✔✔3-4 wks
✔✔AAION - Education - ✔✔You have AAION/GCA. This condition leads to
inflammation of the medium and large blood vessels in the body, leading to your fever,
headaches, and jaw pain. This inflammation is also affecting the blood supply to your
optic nerve, leading to vision loss. Unfortunately, there is only a small chance the vision
loss you are experiencing will return. The primary goal is to prevent this from happening
in the other eye. I am referring you for urgent blood work, as well as steroids at the
hospital. They will likely keep you on steroids for 6-12 months after this to keep
inflammation in your body low. I'd like to see you back in about a month.
✔✔Optic Neuritis - Testing - ✔✔RNFL OCT, VF (central or arcuate), Pupils (APD), Red
cap (reduced), EOM (pain), Urgent MRI and LP
,✔✔Optic Neuritis - Treatment - ✔✔Refer for imaging, and oral steroids if within the first
1 -2 weeks of onset. Refer to neurology for MS management.
✔✔Optic Neuritis - FU - ✔✔3-4 weeks. After that, q 3-6 mo
✔✔Optic Neuritis - Education - ✔✔You have a condition called optic neuritis. This
means that the optic nerve connecting your eye to your brain is swollen, leading to your
blurry vision. Your vision will return after the swelling has gone down. However, this kind
of swelling is often associated with MS. MS is an autoimmune disease in which your
body's own immune system attacks your tissues and nervous system. It's important that
we refer you for an MRI and to a neurologist to help make that diagnosis. I'd like to see
you back in 1 month, and we'll check your vision every 3-6 months from here on out.
✔✔ONH Drusen - Testing - ✔✔FAF (+), B-scan (hyper-reflective), VF (generalized
depression), RNFL OCT
✔✔ONH Drusen - Treatment - ✔✔Observation
✔✔ONH Drusen - FU - ✔✔q 6-12 mo
✔✔ONH Drusen - Education - ✔✔You have ONH drusen, which are calcified deposits
within the optic nerve. Usually these are benign and will have no effect on your vision.
Rarely, they can start to compress the nerve tissue and lead to loss of vision. I'd like to
see you every 6-12 months to check on your visual field to make sure that they are not
impacting your vision. There is no treatment for this condition.
✔✔Horner Syndrome - Testing - ✔✔Pupil sizing, Near testing (no LND/ normal), MRD 1
(2mm ptosis), Old photos, 1% Apraclonidine testing (dilates Horner pupil), RTC 1 day
for 1% Hydroxyamphetamine testing (dilates if pre-ganglionic), Order chest CT
(Pancoast tumor), MRI/MRA of brain/neck (carotid artery dissection [esp if neck pain]),
CBC w/ diff
✔✔Horner Syndrome - Treatment - ✔✔Refer for neuroimaging
✔✔Horner Syndrome - FU - ✔✔FU after imaging
✔✔Horner Syndrome - Education - ✔✔You have a condition called Horner syndrome
that leads to the lid droop and smaller pupil that you are experiencing. This can be
caused by several things, but there is likely inflammation or compression of the nerve
that connects parts of your eye to the brain. It may be due to headaches or migraines,
or something more serious like a mass. I need to refer you for imaging to rule out that
possibility. I will follow up with you after the imaging results.
✔✔Adie Tonic Pupil - Testing - ✔✔Pupil sizes, Near testing (LND), Old photos, 0.125%
Pilocarpine (constriction)
, ✔✔Adie Tonic Pupil - Treatment - ✔✔0.125% Pilocarpine bid-qid to help with
accommodation and cosmesis, Cosmetic CL, sunglasses
✔✔Adie Tonic Pupil - FU - ✔✔1 year
✔✔Adie Tonic Pupil - Education - ✔✔You have a condition called Adie tonic pupil. This
is a benign condition in which one of your pupils is bigger than the other, and it does not
focus as well up close. You may also be more light sensitive on that side since that pupil
is bigger. I recommend wearing sunglasses when outside and I can prescribe you a
drop that helps to constrict the pupil to make reading easier. This condition may occur in
both eyes with time. We can monitor you annually.
✔✔Myasthenia Gravis - Testing - ✔✔MRD1, MRD1 after 2 min sustained upgaze, Ice
pack test or Tensilon test, pupils (normal), Bloodwork (T3, T4, TSH), Neck CT (r/o
thymoma)
✔✔Myasthenia Gravis - Treatment - ✔✔Refer to neurology for treatment (steroids may
help if early in the disease course, pyridostigmine if trouble breathing), Prism for
diplopia
✔✔Myasthenia Gravis - FU - ✔✔4-6 mo
✔✔Myasthenia Gravis - Education - ✔✔You have a condition called MG. This is an
autoimmune condition in which your body's own immune system attacks your tissues,
leading to a droopy eyelid and double vision towards the end of the day. It may also
lead to difficulty breathing. We are referring you to a neurologist who can treat you. We
also are ordering blood work, as this condition is often associated with thyroid and
thymus issues. If the double vision is consistent and bothersome to you, we can also
prescribe prism in your glasses to help. I'd like to see you back in 4-6 months.
✔✔Bell palsy - Testing - ✔✔NaFL, TBUT, Urgent referral to ER for stroke workup
✔✔Bell palsy - Treatment - ✔✔Perform stroke workup to R/O stroke, Refer to
neurology, PFATs, Ointment at bed time, Lid taping or eye mask at night, Turn off fans
while sleeping
✔✔Bell palsy - FU - ✔✔1-3 months
✔✔Bell palsy - Education - ✔✔You have a condition called Bell palsy. This is a
condition where inflammation of an unknown cause, or due to a previous viral infection,
leads to drooping on the whole side of your face. As this can often mimic a stroke, we
need to refer you to the ER for a stroke workup. We are also referring you to neurology
for further care. This condition is usually temporary and resolves in a few months. Since
your eye can not close properly, it's important to make sure your eyes do not dry out. I
