Ophthalmology Symptoms and Signs Quiz

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Questions and Answers

Which symptom is NOT typically associated with corneal ulcers?

Swelling of the eyelid (correct)

Photophobia

Pain

Decreased vision

What does a gray or dirty white infiltrate with feathery borders indicate in corneal ulcers?

A bacterial infection

A fungal infection (correct)

A viral infection

Herpes simplex keratitis

Which treatment should NOT be used for corneal ulcers caused by Candida?

Natamycin 5%

Amphotericin B prepared 0.15%

Fluconazole 0.5% topically

Scopolamine 0.25% TID (correct)

Which sign could be indicated if a smear shows hyphae fragments?

Presence of filamentous fungi Signup and view all the answers

What would be the first choice for treating Candida when smear shows oval buds?

Amphotericin B prepared 0.15% Signup and view all the answers

Which corticosteroid is contraindicated in the management of corneal ulcers?

Topical steroids Signup and view all the answers

When a corneal ulcer is treated as bacterial until proven otherwise, which stain is often used?

Giemsa stain Signup and view all the answers

If an infection involves deeper stroma and is worsening, which treatment is likely to be added?

Miconazole topical Signup and view all the answers

What characterizes the discharge associated with Pseudomonas aeruginosa infections?

Yellow-green mucopurulent Signup and view all the answers

What is a common consequence of a ring ulcer caused by an infectious corneal ulcer?

Corneal perforation Signup and view all the answers

Which type of ulcer is characterized by peripheral location and minimal pain?

Sterile ulcer Signup and view all the answers

What is the recommended initial treatment for a moderate risk of bacterial keratitis?

Fluoroquinolone eye drops Signup and view all the answers

Which statement is true regarding the treatment of fungal keratitis?

Filamentous fungi often enter the eye following trauma with vegetative matter. Signup and view all the answers

What is the primary use of ACV 400 mg 5 times a day?

As a substitute for Ganciclovir in keratouveitis Signup and view all the answers

What condition may lead to an increased intraocular pressure (IOP) that requires glaucoma medications?

Trabeculitis Signup and view all the answers

What is a key characteristic of a neutrophic ulcer?

Smooth and rolled borders Signup and view all the answers

When should antiviral therapy be discontinued in the treatment of a small epithelial defect?

When the ulcer size decreases Signup and view all the answers

What is the recommended initial treatment for a large neutrophic ulcer?

Topical antibiotics QID and cycloplegic Signup and view all the answers

What distinguishes a horizontal ovoid size neutrophic ulcer?

Size range of 2-8 mm Signup and view all the answers

What should be considered if there is no response to initial treatment of a large ulcer?

Implementation of an amniotic membrane Signup and view all the answers

What differentiates a geographical ulcer from a neutrophic ulcer?

Visual presentation and borders Signup and view all the answers

What is included in the management for a neutrophic ulcer persisting despite therapy?

Amniotic membrane application Signup and view all the answers

Which medication is commonly suggested for glaucoma secondary to trabeculitis?

Beta-blockers Signup and view all the answers

What is the initial appearance of lesions in HSV keratitis?

Small, clear, raised vesicles Signup and view all the answers

Which treatment is recommended for epithelial lesions in HSV keratitis?

Ganciclovir 0.15% ophthalmic solution Signup and view all the answers

What visible characteristic differentiates a true dendrite from other lesions?

Stains with NaFl in the middle Signup and view all the answers

Which symptom is typically associated with preauricular lymphadenopathy in herpes patients?

Increased sensitivity when pressed Signup and view all the answers

What happens to dendritic ulcers in HSV keratitis over time?

They merge into larger geographical lesions Signup and view all the answers

What sign is indicative of healing dendrites in HSV keratitis?

Footprint scars Signup and view all the answers

What features characterize geographical lesions in HSV keratitis?

Possibly extending into the anterior stroma Signup and view all the answers

What is a common misconception regarding the signs of HSV keratitis?

All lesions are painful Signup and view all the answers

What is an essential part of the treatment and management of ulcers in HSV keratitis?

Gentle debridement of ulcer Signup and view all the answers

What type of uveitis can occur as a result of HSV keratitis?

Anterior uveitis Signup and view all the answers

What is the primary method by which Trifluridine (Viroptic) works on viral infections?

It invades viral DNA and creates fragile DNA. Signup and view all the answers

What is the recommended follow-up schedule after starting treatment with antiviral drops?

Every 2 days initially, then every 3-5 days upon improvement. Signup and view all the answers

What is a significant concern related to the use of Trifluridine (Viroptic)?

It can induce cytotoxicity, affecting good cells. Signup and view all the answers

Which of the following is an appropriate treatment for stromal immune keratitis?

Cycloplegia and topical steroids. Signup and view all the answers

Which medication is used for prophylaxis against secondary infections in eye treatments?

Erythromycin ung. Signup and view all the answers

What is the result of not tapering off treatment after complete healing?

Potential immune response making treatment harder. Signup and view all the answers

What does 'Pannus' indicate in the context of eye infections?

Neovascularization with surrounding opacification. Signup and view all the answers

Which cycloplegic agent is recommended for treating eye conditions?

Scopolamine. Signup and view all the answers

Study Notes

Symptoms of Corneal Ulcers

Pain, photophobia, decreased vision, and "white dot in my eye" as common complaints.
Early ulcer may mimic dendritic ulcers with slight inflammation signs.
Presence of gray or dirty white infiltrate with feathered borders and satellite lesions indicating severe corneal involvement.

Signs of Corneal Ulcers

Satellite lesions and hypopyon observed in infected eyes.
Immune ring (Wessely Ring) appears raised, often with hyphae at the edge.
Candida ulcers are multilobulated and appear "wet," while Fusarium infections result in large, dry epithelial defects.

Management of Corneal Ulcers

All unknown ulcers initially treated as bacterial; stains include Giemsa and Calcofluor white.
Natamycin 5% effective for Fusarium and Aspergillus, with a treatment regimen involving frequent drops.
Scopolamine 0.25% administered to manage uveitis; consider adding Miconazole or Clotrimazole based on severity.

Treatment for Fungal Infections

If Candida is indicated (oval buds on smear), treat with Amphotericin B 0.15% followed by Fluconazole if necessary.
Topical steroids contraindicated in infectious keratitis; can exacerbate conditions.

Herpes Simplex Virus (HSV) Keratitis

Epithelial type causes dendritic ulcers due to epithelial cell death; early signs include small, clear vesicles.
Healing dendrites may leave characteristic "footprint" scars.
Treatment involves gentle debridement, Ganciclovir 0.15% ophthalmic gel, and frequent follow-up.

Stromal Keratitis

Caused by immune reactions to viral antigens; presents as limbitis and iritis with possible high IOP.
Treatment includes cycloplegics, topical steroids, and regular follow-up.

Neurotrophic Ulcer

Occurs due to structural damage, often leads to corneal melting; presents with smooth rolled borders.
Treatment involves artificial tears and possibly antibiotics for larger ulcers.

Bacterial Keratitis

Characterized by yellow-green discharge and rapidly progressing corneal destruction.
Can lead to ring ulcers and perforation within 24-48 hours.
Requires identification and treatment based on risk level; management may include fortified antibiotics and potential hospitalization.

Fungal Keratitis

Commonly caused by Candida (non-filamentous) in diseased corneas or filamentous fungi like Fusarium post-trauma.
Difficult to manage and requires prompt referral to specialists.

General Treatment Guidelines

Document ulcer characteristics and initiate cultures promptly.
Administer fluoroquinolones for bacterial infections; adjust dosages based on severity and follow up frequently.
Severe presentations may necessitate corticosteroids post-48-72 hours of controlled infection.

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Description

Test your knowledge on the symptoms and signs related to various ophthalmic conditions. This quiz covers key indicators like pain, photophobia, and specific lesions observed in the eye. Perfect for medical students and professionals in ophthalmology.