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Divine Intervention Episode 36

USMLE Ophthalmology
Some PGY1
1
71 yo M with central scotomas. Straight lines appear
wavy and blurred when he tries to read. Diagnosis?
Types of disease? Which is more rapid in
progression? HY exam risk factors? Differentiating
this disorder from glaucoma. Treatment strategies
by type of disease? Most common cause of vision
loss in the “developed” world?
2
35 yo M was punched in the eye 2 hrs ago. He is
brought to the ED by a friend with complaints of
visual difficulty in his left eye. He has a sensation of
items “floating” in his visual fields along with bright
streaks of light. Diagnosis? Classic presentation? HY
exam risk factors? Treatment strategies.
3
Newborn with a white reflex in his right eye. An
intraocular mass is suspected. Diagnosis? What is a
potential “future” connective tissue malignancy?
4
Differentiating between amblyopia and strabismus.
Other causes of amblyopia. Diagnostic testing in
patients with strabismus. Treatment strategies.
5
A 45 yo Asian male has the sudden onset of severe
pain in his right eye along with nausea and
vomiting. He took a nasal decongestant an hour ago
for some annoying nasal symptoms. Diagnosis?
Treatment strategies? Other type of this disorder.
Classic presentation/demographic/risk factors?
Diagnostic testing? Findings on diagnostic testing?
The pharmacology of this disorder.
6
23 yo M presents with a 2 day history of severe R
eye pain and blurry vision. He has been taking
Benadryl for a “sinus problem” that began 5 days
ago. HEENT exam is notable for pain with R eye
movement and 20/200 vision. Diagnosis? Diagnostic
testing? Differentiating this disorder from its close
cousin. Common bug causes. Treatment.
7
23 yo F presents with a 2 day history of severe left
eye pain. She can barely see anything out of the left
eye. The patient mentions that the visual difficulty
gets worse after she takes a hot shower. Diagnosis?
Diagnostic testing? Classic disease association?
Pathophysiology? Unique treatment? Most likely
sequel of disease?
8
76 yo F comes to her PCP for a routine annual
exam. She complains of a 6 month history of
difficulty driving at night and reading road signs.
Diagnosis? Pathophysiology? Metabolic risk factor?
Drug associated risk factor? Infectious risk factors?
Newborn with a bilateral presentation? Most
common cause of death in these newborns?
9A
Most common cause of conjunctivitis in the first 24
hrs of life? 5 day old newborn with “super” purulent
conjunctivitis (bug, tx, prophylaxis)? 12 day old
newborn with “watery” discharge conjunctivitis and
eyelid swelling (bug, tx, prophylactic relationship to
presentation 2, pneumonia presentation, “down the
line” nonbilious vomiting after tx)? Of the top 3
above, which is the most dangerous?
9B-What is the most likely cause of conjunctivitis?
#1-Glued eyes in the morning (unilateral) + watery
discharge + rhinorrhea (Dx, Tx, HY bug, HY bug
associations, relevant epidemiology).
#2-Glued eyes in the morning (unilateral) + purulent
discharge + no rhinorrhea (Dx, MCC in adults, Tx, Tx
in contact lens wearers).
#3-Hx of asthma + bilateral “itchy red eye”
10
Eye pain + pain worsened with light in a 23 yo M
with a history of chronic low back pain and
morning stiffness. Diagnosis? Pulmonary disease
association? Pediatric rheumatology association?
Diagnostic testing? Treatment strategies (+ if caused
by HSV, + if caused by an autoimmune
phenomenon, + if caused by some kind of
bacterium)?
11
70 yo F with difficulty reading books. She often has
to move the book away from her eyes to make out
words on the page. Diagnosis? Pathophysiology?
12
Differentiating a central retinal artery occlusion
from a central retinal venous occlusion. Some Step 1
throwback with lysosomal storage diseases.
Funduscopic findings in diabetic retinopathy (+
diagnostic testing, + diagnostic frequency, + tx
strategies)
13
19 yo F presents with pain and a “foreign body
sensation” in the eye. She wears contact lenses.
Diagnosis? Diagnostic testing? Tx strategies?