A 5 years old child came to ER with his mother c/o sudden squint and double vision
A- Call neurosurgeon immediately
B- Refer to paediatric-ophthalmology
C- Brain MRI for occupying lesion
D- Referrer to paediatric ophthalmologist
Answer: C. Choice B/D would be correct if it was an emergency referral.
A medically free child with no history of trauma who is presenting with a sudden presentation of an esotropia/inward deviation of the eyes should alert to a sign of compression on cranial nerve 6 (tumor or increased ICP). A full ophthalmic and neurologic examination should be done, followed by imaging tests (mostly MRI).
Another recall:
Concerned father due to sudden squint of his child. He has NO history of trauma and presented with convergent squint. What you will do?
A. Neurologist refer now ( or Neurosurgery)
B. CT to detect any space occupying lesion
C. Refer to pediatric ophthalmologist after 24 hours (Next day)
D. Reassurance
Answer: C since the referral is next day.
CT is usually not preferred in children because of the risk of radiation. We also prefer MRIs in these cases because we want to assess for space occupying tumors. Keep in mind that retinoblastomas can present with strabismus, making CT scans not preferable due to risk of secondary malignancies related to radiation exposure.
A- Call neurosurgeon immediately
B- Refer to paediatric-ophthalmology
C- Brain MRI for occupying lesion
D- Referrer to paediatric ophthalmologist
Answer: C. Choice B/D would be correct if it was an emergency referral.
A medically free child with no history of trauma who is presenting with a sudden presentation of an esotropia/inward deviation of the eyes should alert to a sign of compression on cranial nerve 6 (tumor or increased ICP). A full ophthalmic and neurologic examination should be done, followed by imaging tests (mostly MRI).
Another recall:
Concerned father due to sudden squint of his child. He has NO history of trauma and presented with convergent squint. What you will do?
A. Neurologist refer now ( or Neurosurgery)
B. CT to detect any space occupying lesion
C. Refer to pediatric ophthalmologist after 24 hours (Next day)
D. Reassurance
Answer: C since the referral is next day.
CT is usually not preferred in children because of the risk of radiation. We also prefer MRIs in these cases because we want to assess for space occupying tumors. Keep in mind that retinoblastomas can present with strabismus, making CT scans not preferable due to risk of secondary malignancies related to radiation exposure.
Forwarded from Wafa OBGYN (Wafa)
Obstetrics and Gynecology- SMLE wafa 2023.pdf
14.9 MB
Q. About 11 years with red eye and yellow discharge on examination bilateral red conjunctiva and wet discharge
What is the most appropriate management:
A. Oral antibiotics
B. Reassure and normal saline drops
C. Steroid ointment for 7 days
D. Referral to ophthalmologist for ophthalmoscope
What is the most appropriate management:
A. Oral antibiotics
B. Reassure and normal saline drops
C. Steroid ointment for 7 days
D. Referral to ophthalmologist for ophthalmoscope
pediatric newborn with purulent eye discharge , Culture showed gram negative diplococci , How to treat ?
• A. Topical antibiotic
• B. Observation
• C. IV Cephalosporin
• D. IV Doxycycline
Answer is C. The description of the gram-negative diplococci is alluding to the diagnosis of Neisseria Gonnorhea causing ophthalmia neonatorum, which is treated by systemic (not topical) third generation cephalosporin (e.g., Ceftriaxone).
- Ceftriaxone in a single dose (25-50 mg/kg IM or IV, up to a maximum of 125 mg).
- Bacitracin or erythromycin ointment every 2 to 4 hours.
- Topical atropine if corneal involvement.
**If there is a systemic disease, treatment is required for 7 to 14 days.
**Hospitalization and evaluation for disseminated N. gonorrhea infection.
**Topical irrigation with normal saline to remove mucopurulent discharge.
• A. Topical antibiotic
• B. Observation
• C. IV Cephalosporin
• D. IV Doxycycline
Answer is C. The description of the gram-negative diplococci is alluding to the diagnosis of Neisseria Gonnorhea causing ophthalmia neonatorum, which is treated by systemic (not topical) third generation cephalosporin (e.g., Ceftriaxone).
- Ceftriaxone in a single dose (25-50 mg/kg IM or IV, up to a maximum of 125 mg).
- Bacitracin or erythromycin ointment every 2 to 4 hours.
- Topical atropine if corneal involvement.
**If there is a systemic disease, treatment is required for 7 to 14 days.
**Hospitalization and evaluation for disseminated N. gonorrhea infection.
**Topical irrigation with normal saline to remove mucopurulent discharge.
لاتترددون أبداً عن سؤالي عن أي شيء بالإمتياز أو بالأوفثا.
أعتذر عن استقبال أي سؤال SMLE غير متعلق بالأوفثا
Telegram: @AbdulrahmanAlgwaiz
E-Mail: Abdulrahman.Algwaiz@hotmail.com
Twitter: https://x.com/gweizer
الله يوفقكم يارب وييسر أمركم دنيا وآخرة وعقبال ماتبشروننا بقبولكم ❤️
أعتذر عن استقبال أي سؤال SMLE غير متعلق بالأوفثا
Telegram: @AbdulrahmanAlgwaiz
E-Mail: Abdulrahman.Algwaiz@hotmail.com
Twitter: https://x.com/gweizer
الله يوفقكم يارب وييسر أمركم دنيا وآخرة وعقبال ماتبشروننا بقبولكم ❤️
X (formerly Twitter)
عبدالرحمن (@Gweizer) on X
Ophthalmology Resident @KKESHKSA / #IMSIU Graduate
5 y/o child came in pre school clinic just to check for pre school, you found the right eye misaligned what to do NEXT / initial ?
A- Refer to pediatric optha next day
B- Urgent glasses
C-HIRSCHBERG corneal reflex test
D-detailed history that point out for possible perinatal trauma
Answer: C (I asked a pediatric ophthalmology fellow about it also). The possibility of an undetected perinatal trauma causing an isolated undetected 6th cranial nerve palsy by forceps injury in a 5 year old child is low. Stick with the Hirschberg light reflex test, since this question is most likely structured in a way that they want you to know that this quick test exists to differentiate between a true vs pseudostrabismus (wide nasal bridge or epicanthal folds) before referring the child to an ophthalmologist for strabismus management. You can check the corneal light reflex with a direct ophthalmoscope easily and see if the light reflex is deviated from the center of the pupil (true strabismus) or in the center (pseudostrabismus).
A- Refer to pediatric optha next day
B- Urgent glasses
C-HIRSCHBERG corneal reflex test
D-detailed history that point out for possible perinatal trauma
Answer: C (I asked a pediatric ophthalmology fellow about it also). The possibility of an undetected perinatal trauma causing an isolated undetected 6th cranial nerve palsy by forceps injury in a 5 year old child is low. Stick with the Hirschberg light reflex test, since this question is most likely structured in a way that they want you to know that this quick test exists to differentiate between a true vs pseudostrabismus (wide nasal bridge or epicanthal folds) before referring the child to an ophthalmologist for strabismus management. You can check the corneal light reflex with a direct ophthalmoscope easily and see if the light reflex is deviated from the center of the pupil (true strabismus) or in the center (pseudostrabismus).
زميلنا عبدالمجيد الخثعمي جاب ٩٥٪ في الإختبار وجزاه الله خير حاب إنه يشارككم مصادره وطريقة مذاكرته:
https://t.me/MajeedSMLE
الله يوفقه ويوفقكم يارب ❤️
https://t.me/MajeedSMLE
الله يوفقه ويوفقكم يارب ❤️
Forwarded from Ophthalmology - Abdulmajeed Al Khathami
الزملاء اللي سألوا عن تصحيحي ..
هذا تصحيحي أنا وقروبي لشهر ٦،٧،٨
حتحصلون بعض الأخطاء طبيعي لكثرة الأسئلة لكن أي سؤال خطأ وأحد منكم انتبه له يرسله لي ونرسل تعديله خصوصا لشهر ٨
🛑 ما انصح احد يعتمدها بشكل نهائي لكن بإذن الله تفيدكم ولو بالشيء القليل،
الله يوفقكم وييسر أموركم ويرزقكم بالدرجات اللي تتمنون يارب يا كريم ..
طبعاً شهر سبتمبر ذاكرته من قناة سايلنت علطول فما عندي أي تصحيح له 😄..
هذا تصحيحي أنا وقروبي لشهر ٦،٧،٨
حتحصلون بعض الأخطاء طبيعي لكثرة الأسئلة لكن أي سؤال خطأ وأحد منكم انتبه له يرسله لي ونرسل تعديله خصوصا لشهر ٨
🛑 ما انصح احد يعتمدها بشكل نهائي لكن بإذن الله تفيدكم ولو بالشيء القليل،
الله يوفقكم وييسر أموركم ويرزقكم بالدرجات اللي تتمنون يارب يا كريم ..
طبعاً شهر سبتمبر ذاكرته من قناة سايلنت علطول فما عندي أي تصحيح له 😄..
Forwarded from Ophthalmology - Abdulmajeed Al Khathami