NBME Shelf Review (Part 5) – Ophthalmology and Toxicology

Corneal Abrasion

* Stain the eye with fluorescein and use woods lamp* Look for fixed staining (“uptake”) on the cornea

Acute Angle Closure Glaucoma

* Symptoms* Eye Pain* Headache* Check for intraocular pressure greater than 20* Commonly precipitants* OTC cough/cold medicine (anticholinergic effect)* Dark environment (such as movie theater)* Treatment* Timolol* Pilocarpine* Acetazolamide* Apraclonidine

Giant Cell Arteritis

* Common features* Severe headache* Tenderness of the Temporal Arteries * Jaw claudication* Elevated ESR (“sed rate”)* Treat with steroids

Anterior Uveitis

* Painful red eye* Cell and flair on slit lamp examination

UV Keratitis (“snow blindness”)

* Common in skiers/snowboarders* Diagnose with fluorescein and use woods lamp* Punctate lesions on the cornea

Common Poisons/Antidotes

* Digoxin toxicity* Digibind* Acetaminophen toxicity* N-Acetylcysteine (NAC)* Ethylene glycol or methanol toxicity* Fomepizole* Jimson weed (anticholinergic toxicity)* Physostigmine* Organophosphate toxicity* Atropine* Treat until airway secretions have stopped* Pralidoxime * Opiate toxicity* Naloxone* Benzodiazepine * Flumazenil (falling out of favor)* Cocaine toxicity* DON’T give beta blockers* Unopposed alpha effect* Very little data to support this but commonly believed* Iron toxicity* Deferoxamine* Salicylate overdose* Sodium bicarbonate* Dialysis* Tricyclic antidepressent* Sodium bicarbonate* Beta blocker overdose* Glucagon* Calcium channel blocker overdose* Glucagon* IV Calcium* High dose euglycemic insulin therapy* Sulfonylurea overdose* Octreotide* Dextrose* Heparin reversal* Protamine sulfate* Cyanide toxicity (common in house fires)* Hydroxocobalamin * Sodium Nitrite* Carbon monoxide toxicity* Oxygen oxygen oxygen* Hyperbaric oxygen* BEWARE: pulse oximetry will be normal* Valproic acid toxicity* L-carnitine

Additional Reading

* Approach to Eye Complaints (EM Clerkship)* Acetaminophen Overdose (EM Clerkship)* Salicylate Overdose (EM Clerkship)