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Self-Assessment Questions

Emergency Medicine

Eye Emergencies: Review Questions

Stuart Spitalnic, MD

Dr. Spilatnic is an assistant residency director, Brown University Emergency Medicine Residency Program, and an assistant professor of emergency medicine, Brown University, Providence, RI.

Choose the single best answer for each question.

1. A 35-year-old woman complains of 1 day of double vision. She has had no headache or recent illness and has no other complaints. General physical examination is normal. Her right eye appears normal and has a visual acuity of 20/20, and her left eye has a visual acuity of 20/40. The left pupil is dilated and minimally reactive. There is left-sided ptosis and disconjugate gaze, with the left eye tending to go down and out. Which of the following conditions must most urgently be excluded?
  1. Brain tumor
  2. Cavernous sinus thrombosis
  3. Cerebral aneurysm
  4. Horner’s syndrome
  5. Multiple sclerosis
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2. A 40-year-old man complains of pain and a foreign body sensation in his right eye. His visual acuity is normal bilaterally. After staining with fluorescein, Wood’s lamp examination reveals multiple, vertically oriented, nearly parallel, fine corneal abrasions. What is the most appropriate next step in this patient’s management?

  1. Apply an eye patch
  2. Apply antibiotic ointment
  3. Evert the eyelid
  4. Instill cycloplegic drops
  5. Irrigate with a Morgan lens
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3. A 50-year-old woman complains of a left-sided headache and left eye pain associated with nausea and vomiting. Her right eye has a visual acuity of 20/40 and appears normal. Her left eye has a visual acuity of 20/200, has a mid-fixed, nonreactive pupil, and is injected. You arrange for her transfer to an ophthalmologist. Which of the following medications would be most appropriate to instill into her eye before transfer?

  1. Acetazolamide
  2. Atropine
  3. Homatropine
  4. Mannitol
  5. Pilocarpine
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4. A 60-year-old man complains of left eye pain and photophobia. After staining the affected eye with fluorescein, Wood’s lamp examination reveals uptake in a fine branching pattern. His ipsilateral conjunctiva is injected, and there is erythema of the periorbital skin. You also note erythema and a small vesicle on the tip of the patient’s nose. What is the most appropriate therapy for this patient?
  1. Oral antibacterial agent
  2. Oral antifungal agent
  3. Oral antiviral agent
  4. Topical antibacterial agent
  5. Topical antiviral agent
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5. Following blunt facial trauma, a 35-year-old patient is noted to have marked proptosis, restricted ocular movement, and decreased visual acuity of the left eye. What is the recommended temporizing maneuver?

  1. Anterior chamber paracentesis
  2. Carbogen inhalation
  3. Globe massage
  4. Lateral canthotomy
  5. None of the above
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