Emergency Medicine Exam 4 Questions and Answers 100% pass.

Emergency Medicine Exam 4 Questions and Answers 100% pass. your 23yo male pt presents c/o a painful red bump on his eye, he stats it showed up over night. no associated sx. On Pe you note an edematous, erythematous bump with a visible pustule on the lid margin. dx/tx what is the pathogen - ANS- hordeolum warm compresses, erythromycin ophthalmic ointment bid for 7-10d s. aureus your 30yo pt c/o a painless red lump on her eyelid that has been growing over the last week, there is mild erythema and no associated symptoms. dx/tx pathogen? - ANS- chalazion warm compresses, may resolve on its own not a bacterial infection- its a blockage. your 16yo pt presents with an irritated, red left eye. On PE you note mucopurulent discharge and his eyelash is matted. Conjunctival inflammation is present. This pt does not wear contacts. dx/tx - ANS- bacterial conjunctivitis erythromycin ointment, trimethoprim-polymyxin drops your 12 yo male pt comes in c/o an irritated, red right eye. He states the eye has been tearing a lot. You note watery d/c, chemosis, and palpable periauricular lymph nodes dx/tx/ pathogen what needs to be ruled out - ANS- viral conjunctivitis cool compresses, artificial tears adenovirus r/o HSV w fluorosceine stain your 43yo female pt c/o a painful left eye with blurred vision. On PE you note chemosis, conjunctival inflammation. On flurosceine stain you see dendritic lesions. dx/tx - ANS- herpes simplex emergent ophthalmologist referral--> antiviral trifluorothymidine drops your 60yo male pt presents with a U/L rash and eye pain on the left side of his face. He c/o photophobia and states the rash tingles. On PE, you note blisters on the tip of his nose. dx/tx what is this sign called. - ANS- herpes zoster opthalmicus hutchinson's acyclovir PO + erythromycin ophth ointment refer all to ophth Your 13yo pt comes in c/o a red, itchy eyes bilaterally. He denies any pain, states he noticed it when his parents got him a new hamster. he has a pmhx of eczema. on PE you note papillae in the conjunctival fornix, watery d/c, and prominent chemosis. dx/tx - ANS- allergic conjunctivitis eliminate allergen, cool compresses, topical ahx- olopatadine, cromolyn 23yo male patient, Blake, presents with severe, purulent discharge from his left eye. He states the onset was over a day after coming home from the Bahamas and "has no idea what it could be" (I have an idea) sx/dx - ANS- gonococcal conjunctivitis emergent ophth consult + cx, rocephin IM 10yo female brought in by mom, she states she had some congestion and a cough a week ago and is now presenting with eyelid swelling, fever, eye pain and erythema. on PE you note no pain with eye movement. dx/tx - ANS- preseptal cellulitis amoxicillin/clav and 24hr f/u with ophth 7yo male brought in by dad, c/o chemosis, eyelid swelling, fever, and eye pain. He states his son had a sinus infection recently hes still getting over. You note proptosis on PE and pain with eye movement how do you dx/dx/tx - ANS- post septal cellulitis dx with CT immediate ophth consult, IV cefuroxime or ceftriaxone 40yo pt presenting with a red, painful eye, stating it feels like there is something stuck in her eye. She also reports photophobia and blurry vision. She currently wears contact lenses. on PE you note a round, irregular ulcer w a white hazy base dx/tx/pathogen - ANS- corneal ulcer emergent ophth referral -->fluoroquinolone drops pseudomonas 44yo pt who recently had eye surgery presents with pain and decreased VA. on exam you note hyperemia, chemosis and a hypopyon. dx/tx/pathogen what is the biggest concern - ANS- endopthalmitis emergent ophth consult, systemic abx, admit staph vision threatening 28yo pt presents with a painful, red, tearing, and photophobic left eye. On PE you note a miotic pupil and there is a large concentration of redness around the iris. when you shine your pen light in the unaffected eye, the affected eye hurts. dx/tx - ANS- iris/uveitis topical cyclplegic (tropic amide), ophth f/u in 24-48hrs 50yo pt presents stating her eyeball is bleeding because she sneezed too hard. on examination, you note bright red blood that is sharply circumscribed and stops at the limbus. Pt denies pain, photophobia, change in VA, or discharge. what is your dx/tx - ANS- subjunctival hemorrhage nothing, tell her to gtfo of the ER 22yo female c/o eye pain that began after she tried to take her contacts out. Now her left eye is in severe pain, it is red, photophobic and tearing. She believes something might still be in there. you give her some eye numbing drops (tetracaine) that happen to ease the pain. Your fluorosceine stain w woods lamp shows a linear dx/tx - ANS- corneal abrasion NSAIDs for pain control erythromycin ointment re-examine in 24-48hrs ophth if central location or large 18yo pt presents follow motorcycle accident with a cut on his eyelid from a piece of helmet. The cut is superficial, does not go through the lid margin, does not involve inner eyelid, resides on the lateral upper lid, and does not involve the lacrimal sac. are we allowed to suture? if so, what do we use - ANS- yes use 6-0 suture 9yo pt comes in with lid laceration after being dared to ride her bike down the road with her eyes closed and hit a mail box. The laceration exposes some adipose tissue, goes through the lid margin, and involves the lateral portion of the eyelid. can we suture? if so what do we use - ANS- no we do not- thats a job for plastics 29yo pt presents with eye pain, photophobia, blurred vision, and N/V. on PE you note a collection of blood in the anterior of the eye. pt has a pmhx of von willebrand dz. dx/tx what should this eval involve - ANS- hyphema emergent ophth consultation in the ED protective eye shield elevate HOB tx pain and N/V prevent rebleeding (3-5d later) *check IOP 26yo presenting with a fish hook in his eye after trying to fly fish. c/o eye pain. what do you expect to see on PE, how do you dx, tx - ANS- ruptured globe hyphen, teardrop pupil, limited eye movement positive seidel test on fluorosceine stain dx with CT of orbit tx= immediate ophth consult protective eye shield upright position tetanus 1st gen cephalosporin (cefazolin) I took you in a fight in the parking lot and punch you right in the orbit. Now your eyes don't track the same when you look up and you have double vision, you look stupid. dx? how do you dx/tx - ANS- inferior wall orbital blow out fxr dx: CT tx: abx prophylaxis w 3rd gen ceph (cefdinir) refer to ophth 36yo rushed to ER after getting " a chemical" in his eye while cleaning. He is experiencing pain, tearing, redness, and blurred vision. dx/tx whats your main concern - ANS- ocular chemical burn flush eyes immediately with NSS for 30min-- instill topical anesthetic use Morgan lens check pH w litmus after 2L irrigation identify substance consult ophth alkali injuries-- more serious= liquid necrosis 25yo pt presents with abrupt onset of severe right eye pain, blurred vision, HA, and sees halos around lights. He states it began after he turned off his lights to Netflix and chill. on PE you note a cloudy cornea and a nonreactive mid-dilated pupil his IOP is 22mmHg dx/tx - ANS- acute angle closure glaucoma emergent ophth consult FIRST THEN--> timolol 1 drop aproclonidine 1 drop pilocarpine 1 drop acetazolamide PO or IV (carbonic anhydrase inhibitor) osmotic agent- IV mannitol if IOP doesn't drop in 1 hour w above tx 60yo male pt presents with acute monocular vision loss, pain with eye movement, and washed out color vision. On PE you note pendular Nystagmus and a decreased direct light reflex dx/tx what condition might this me an initial presentation for - ANS- optic neuritis ophthal consult to direct consult and tx IV steroids followed by PO steroids (help visual recovery) MS-- both pendular nystag and optic neuritis 49yo female with a hx of smoking and T2DM presents with abrupt painless, monocular vision loss. She states shes had episodes of vision loss before lasting a couple seconds with complete recovery. on fundoscopic exam you note a cherry red spot dx/tx what the MCC - ANS- central retinal artery occlusion emergent ophth/neuro consult determine embolic source (carotid, cardiac, vasculitis) MCC is embolism 55yo male presents with sudden, monocular painless vision blurring lasting a couple seconds. On fundoscopic exam you note a blood and thunder fungus and cotton wool spots. dx/tx - ANS- central retinal vein occlusion no effective tx, tx underlying 70yo male c/o flashing lights and floaters in his visual field. He states it seemed like a dark veil was being pulled over his eyes dx/tx - ANS- retinal detachment urgent ophth consultation potential laser surgery 12yo pt presents after 2 weeks of abx therapy for persistent otitis externa, on exam there is noted exposed bone, ulceration of the external auditory canal, and facial nerve weakness how do you dx dx/tx MC pathogen - ANS- malignant otitis externa dx with CT to determine extent of dz emergent ENT consultation ciprofloxacin IV and admit pseudomonas 14yo pt presents after an OM infection with post auricular erythema/edema/tenderness and a fever how do you dx dx/tx? - ANS- mastoiditis dx with CT scan tx with emergent ENT consult for admission, IV ceftriaxone 10yo pt presents following OM infection with headache, papilledema, sixth nerve palsy and vertigo. dx/tx - ANS- lateral sinus thrombosis