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State University of New York at BuffaloPediatric Emergency Medicine FellowshipF&L 7th Edition Chapter Review: 10-12-16Chapter 25: Eye: Visual DisturbancesQ: A parent brings their toddler to the ED saying, “I checked his vision on a chart and it’s only 20/40!” What should you do and then what advice should you give?A: Confirm with your own exam; Reassure—normal toddler visual acuity is 20/40 and improves to 20/20 by 5-6 years of ageQ: Child presents with fever, decreased visual acuity, proptosis, ophthalmoplegia, and pain with eye movements—what is the workup and diagnosis?A: Orbital CT with contrast to rule out Orbital cellulitis/abscessQ: A child is kicked in the face in gym class and has a blowout fracture of his orbit. What portion of the orbit is most likely broken?A: The floor—which may entrap the extraocular musclesQ: An adolescent with contact lenses has a chronic conjunctivitis. What is the most likely pathogen?A: Pseudomonas speciesQ: In the U.S., what is the most common acquired corneal infection causing blindness?A: HSVQ: A child sustains a splash injury to her eye and when you look up the substance, it says it is an alkali—what is the management?A: Topical anesthetic drops and immediate copious irrigation with NS until pH < 7.5Q: A child has a hyphema. What is the management and what are some potential complications and instructions you’d give the parents?A: Eye protection and rest, avoid NSAIDs; ophtho to rx omphthalmoplegic and corticosteroid drops; if it is to worsen, it will ususally happen within the first 5 days post injuryQ: What can be some signs that your hyphema patient is developing acute glaucoma?A: worsening pain around eye, blurred vision, nausea and vomiting—immediate ophtho consult is indicated.Q: A teenager with sickle cell disease has a sudden painless total loss of vision in one eye. You suspect what?A: Central retinal artery occlusionQ: Your patient with head trauma complains of flashing lights and has a visual field defect—you suspect…A: retinal detachmentQ: A toddler presents with sudden bilateral blindness, you suspect what toxin?A: Methyl alcoholQ: Your next patient has ptosis, pupillary dilation, exotropia, and diplopia, and blurred vision as his headache is ending. You suspect…A: Ophthalmoplegic migraineQ: A child has an occipital headache, tunnel vision, dizziness, ataxia, diplopia, and vomiting. You suspect…A: basilar migraineQ: A child has a headache with a sudden loss of vision followed by nausea; you suspect…A: Retinal migraineQ: A child has hypertension, altered mental status and a seizure followed by visual disturbances. You suspect…A: Posterior reversible encephalopathy syndrome (PRES) Q: You patient has severe bilateral vision loss associated with head trauma. You suspect…A: Cortical blindness (usually reversible within a few hours)Q: Your patient has severe bilateral vision loss not associated with head trauma. You need to suspect…A: Toxins ................
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