CDM Final Exam questions and answers(latest update)

Do corneal abrasions require an antibiotic? Depends on size (large yes, small no) What would you use for a CL wearer with a large corneal abrasion? Ciloxin (ciprofloxacin) For the CL wearer with a large corneal abrasion, what can you add to the antibiotic for treatment? (2) 1. Homatropine for comfort 2. Tobramycin ung for antibiotic coverage and lubrication at night If your patient has a large corneal abrasion, when should you see them back? 1 day If your patient has a small abrasion only treated with lubrication, when should you see them back? 1 week Initial treatment for corneal abrasion OS. VA: 20/50 sc PHNI. Staining shows no pooling under epithelium. 1. Ocuflox oph soln 1gtt q 2 hours x 2 days --> QID x 5 days 2. Homatropine 2% q morning 3. Tobramycin ung QHS Would you use a bandage CL? Yes Causes of infectious corneal ulcers (4) 1. Bacterial 2. Fungal 3. Acanthamoeba 4. Herpes Simplex Which is the most common cause of corneal ulcers? Bacterial When should you consider a corneal ulcer has been caused by a fungus? Traumatic injury from vegetable matter and CL wearers What are the hallmarks of Acanthamoeba ulcers? - Extremely painful - CL wearer with history of poor lens hygiene Patient enters with red eye and reduced vision OD from 1 week ago. Eye is a little scratchy but not painful. VA: 20/50 PHNI. Noted skin rash at lateral canthus with elevated white nodules. What questions should you ask yoru patient? 1. Do you have a history of cold sores? 2. Does this wispy q-tip feel different on this eye vs. your unaffected eye? What should you do next for this patient? Instill FL Upon installation of FL you see a large dendritic ulcer. What is this indicative of? Herpes Simplex What other structures should we check? - Infiltration into stroma - Anterior chamber reaction (cells and flare) - IOP - Posterior segment What is our initial diagnosis for this patient? HSV epithelial keratitis What are options for treatment of HSV epithelial keratitis? - Viroptic - Zirgan - Oral Acyclovir Which needs to be dosed more often, Viroptic or Zirgan? Viroptic What are the pros and cons of oral Acyclovir? (+) : less expensive, better for people who don't like drops (-) : therapeutic levels need to be reached in tear film, 500 mg 5x per day x 1 week Is it OK to use a topical and oral antiviral together? Yes. It can be useful in severe or recalcirant cases Should you treat the lids if they're affected in HSV, and what should you use? Yes. Use Bacitracin ung because lesions of lids are not viral, but they will be susceptible to Gram (+) bacteria If a HSV patient returns in a few with with patchy anterior stromal inflammation that is fluffy looking, what should you assume? Early immune stromal HSV keratitis How do you treat early immune stromal HSV keratitis? Predforte 1% + continued antiviral coverage How do you keep HSV from recurring according to HEDS II? Low dose oral Acyclovir What percentage of adults is estimated to carry HSV? 90% How many new cases of HSV are reported in the US each year? 20,000 The presence of which clinical sign can help you differentiate between primary HSV and adenoviral infection? Skin lesions Primary HSV infection clinically manifests in which percentage of the American population? 6% A recurrence of ocular HSV is most likely to occur in ______. Males What is the classic presentation of HSK? A dendritic pattern, with terminal end bulbs Typically what is the earliest clinical sign of HSK? Raised epithelial vesicles In comparison to pseudo-dendrites caused by varicella zoster virus, herpes simplex dendritic ulcers are Likely to extend through the basemen