Download COMPREHENSIVE IHUMAN CASE 2026 and more Exams Nursing in PDF only on Docsity!
COMPREHENSIVE IHUMAN
CASE 2026: CORNEAL
ABRASION IN A 20-YEAR-OLD
MALE PRESENTING WITH
ACUTE, EXAMS OF NURSING
ASSURED A+|PERFECT SCORE
A 65 year old Female with diabetes, a history of smoking, and history of UV exposure presents with progressive blurry vision over the past several years in both eyes. She also states difficulty with driving at night time. Upon physical exam you notice an absent red reflex and opaque lens.
- What is the diagnosis?
- What can cause this?
3. What is the tx? - ANSWERS -1. Cataracts
- UV light, age, diabetes, smoking, steroids, trauma, malnutrition
- Observation if mild. Cataract surgery is elective. Extracapsular incision (larger) or Phacoemulsification (more common, smaller)
A 50 year old African American M presents to the office today with slow, progressive painless bilateral peripheral vision loss. Upon physical exam you notice cupping of optic disc and notching of the disc rim.
- What is the diagnosis?
2. Possible treatments? - ANSWERS -1. Primary open angle
glaucoma
- LOWER THE IOP!
- 1st = Prostaglandin analog eyedrops (latanoprost)
- 2nd = Surgery such as Argon Laser Trabeculoplasty (ALT) or Trabeculectomy A 65 y/o Asian F presents to the ED with sudden onset of severe unilateral ocular pain. She states nausea and headache, blurry vision, and halos around lights. She has a history of hyperopia. Upon PE you notice cloudy swollen cornea, conjunctival injection and intraocular inflammation. Tonometry shows increased IOP and fundoscopy reveals optic disc cupping.
- What is the diagnosis?
- What can cause this?
3. Treatments? - ANSWERS -1. Closed angle Glaucoma
- Mydriasis (dilation) can be caused by dim lights, sympathomimetics, anticholinergics.
2. Treatment - ANSWERS -1. Hodeolum (Stye) - Staph aureus
- Treatment:
- Mostly warm compresses
- Topical antibiotic ointment
- I&D if no spontaneous drainage after 48 hrs. A 25 y/o F presents with a large, firm, tender, painless nodule on the conjunctival surface of the eyelid. She has also noticed some redness associated with that eyelid.
- What is the diagnosis?
2. Tx? - ANSWERS -1. Chalazion
- Treatment:
- warm compress
- Triamcinolone injection if no infection
- Incision and curettage A 10 year old boy was violently struck from the left side while playing a football game. After he removed his helmet his teammates noticed a bright red patch on the white of his eyeball. He saw his family PCP the next day and the red patch was painless and no vision loss was noted.
- Diagnosis?
2. Treatment? - ANSWERS -1. Subconjuctival hemorrhage
- No treatment will heal in about 1 week. Monitor BP just to be sure not elevated. A 65 y/o female presents with pain and swelling in the outer part of the upper lid with a S-shaped curve of its margin. Upon physical exam you notice a firm lobulated mobile mass felt under the upper rim of orbit and watery discharge.
- Diagnosis?
- Causes?
3. Treatment? - ANSWERS -1. Dacryoadenitis
- Acute - viral or bacterial, Chronic - inflammatory disease such as sarcoidosis, Grave's
- Treatment:
- Acute: warm compress + abx
- Chronic: treat underlying disease A 15 y/o F presents with red burning eyes with itchy eyelids and crusting and scaling of the eyelid and flaking on the lashes. The patient admits to wearing makeup to bed at night time and forgetting to remove it before.
- Diagnosis, what is most common cause?
2. Tx? - ANSWERS -1. Viral conjunctivitis - Adenovirus
- Treatment:
- OTC antihistamine
- warm/cool compress
- artificial tears A 10 y/o M presents to the office with a crusty eye that is stuck shut in the morning. There is conjunctival erythema and no visual changes noted. Upon PE you notice purulent discharge.
- Diagnosis?
- Most common cause?
3. Treatment? - ANSWERS -1. Bacterial conjunctivitis "pink eye"
- Causes:
- S. aureus in adults
- S. pneumonia, H. influenzas, M. catarrhalis in kiddos
- Treatment:
- Topical abx: erythromycin or polymyxin/trimethoprim drops
- If wears contacts: cover pseudomonas (cipro, Gentamycin)
A 2 y/o male presents with R eye ocular pain, eyelid erythema, and edema. The patients mother stated that the pt was bitten by a bug on the R side of the face recently.
- Diagnosis and next step?
- Causes?
3. Treatment? - ANSWERS -1. Periorbital cellulitis, get CT scan to
r/o orbital cellulitis
- MC is H. influenzae in kiddos, MC is staph and strep in elderly
- Abx for Gram+ and warm compresses A 25 y/o M presents today with blurry vision, photophobia, and erythema of the eyeball. When working up his chief complaint, the MA informs you that he was out surfing in the 95 degree sunny weather yesterday.
- Dx?
2. Treatment? - ANSWERS -1. Eye burn
- Treatment:
- Eye burns are an emergency
- UV exposure: topical NSAIDs, cold compress
A 91 y/o M presents with an inward turning of the R and L lower eyelid. He occasionally feels like there is something "stuck" in his eye, tearing, and redness.
- Diagnosis?
2. Treatment? - ANSWERS -1. Entropion "Inside"
- Artificial tears and surgery to tighten muscles A construction worker comes to the ED after a nail penetrated his eye complaining of altered vision and eye pain. Upon physical exam you notice 360 degree bulbous subconjunctival bleeding, tear dropped pupil, hyphema and a + Seidel sign.
- Diagnosis?
- Any other tests?
3. Treatment? - ANSWERS -1. Globe rupture
- Fundus exam, CT of facial bones and orbit, ultrasound. DO NOT DO IOP TESTING OR MRI.
- Bed rest, protective eye shield, avoid eye solutions. IV therapy for pain and nausea, IV broad spectrum abx and tetanus booster. A 5 year old male child who previously had a paperclip stuck in his eye and treated 2 months ago presents to the ED complaining of progressing blindness in both eyes.
- Diagnosis?
- Patho?
3. Treatment? - ANSWERS -1. Sympathetic opthalmia
- a presumed autoimmune T-cell mediated response to a retinal antigen 3 weeks to 3 months after trauma.
- Prophylaxis by treating ocular injury with excision or abx and steroids before. Tx after is topical atropine surface drops in affected eye + steroids. After a bar fight at Mcfadden's a 32 y/o male was punched in the left face and presented to the ED. He complains of diplopia and cannot gaze superiorly in the left eye. CT of the orbit shows an inferior fracture. PE reveals a subconjunctival hemorrhage and facial asymmetry.
- Diagnosis?
2. Treatments? - ANSWERS -1. Orbital floor "blowout" fracture
- Oral antibiotics, oral steroids, and avoid blowing nose or sneezing A 50 y/o Female presents to the ED after spending a day at the beach. The patient complains of tearing, photophobia, and a gritty sensation in her R eye. Upon PE you notice chemosis. Slit lamp
reports foreign-body sensation in his left eye. He denies any flashing lights or floaters or mucous discharge from the eye. Upon PE his visual acuity is normal and penlight examination reveals a corneal abrasion.
- Diagnosis?
2. Treatment? - ANSWERS -1. Corneal abrasion
- Antibiotics - esp. antipseudomonas, oral NSAIDs. Patch for large abrasions. A 70 y/o made was mowing his lawn when he ran over a stone and it hit him in the L eye. He presented to the ED shortly after complaining of photophobia, blurry vision, and nausea a vomiting. He denies flashes/floaters. Upon PE you notice blood filling the anterior chamber.
- Diagnosis?
2. Treatment? - ANSWERS -1. Hyphema
- Treat with eye shield. Monitor IOP daily - if high give beta blockers, CAI. Steroid eye drops. Some may surgical require clot evacuation. A 42 y/o F was playing soccer with her 2 kids when one of them kicked the ball and it hit her in the eye. Upon physical exam you notice multiple brown granules of iris pigment in a circular
arrangement within the pupil. You also notice an opacified structures and partial rupture of the zones.
- Diagnosis?
- S/S?
2. Treatment? - ANSWERS -1. Lens Injury
- S/S - vossius ring, traumatic cataract, sublaxation of lens, dislocation of lens
- R/o other ocular injuries and consult ophthalmology A 78 y/o male presents to his ophthalmologist complaining of vision loss within his central vision. He smokes 1 ppd and has had previous cataract surgery. Upon PE you notice Drusen deposits, atrophy of the terminal pigment epithelium, subretinal hemorrhages, and subretinal pigment epithelial clumping. When he looks at an Amsler grid the lines are distorted.
- Diagnosis?
2. Treatments? - ANSWERS -1. Dry Macular degeneration - d/t
atrophy of the outer retina and retinal pigment epithelium.
- Smoking cessation. No proven effective treatment. Could try Areds, zinc vitamins.
- Control BP - Beta blockers, ACEI, Diuretics and lifestyle modifications A 60 y/o F was at work on the computer when she began to notice flashing lights, floaters, and a "falling curtain" in her L eye. She immediately presented to the ED because she never experienced this before.
- Diagnosis?
2. Treatment? - ANSWERS -1. Retinal detachment
- Treatment:
- Asymptomatic detachments--> laser photocoagulation or cryoretinopexy barrier, creates a chrioretinal scar, holding the detachment in place and preventing spread
- Significant detachments --> pneumatic retinopexy, scleral buckling, vitrectomy
- Retinal Hole/tear: Laser retinopexy or cryoretinopexy A 50 y/o male with a history of carotid artery atherosclerosis presents to the ED after experiencing painless vision loss in his R eye. Upon PE you notice a cherry red spot in his R eye and "Box- carring".
- Diagnosis?
2. Treatments? - ANSWERS -1. Central Retinal Artery Occlusion
- Push CRA occlusion into branch of retinal artery - digital massage, IOP lowering drugs, vasodilation techniques. aka ocular massage, beta blockers, breathe in a paper bag, acetazolamide. A 40 y/o male with a hx of HTN presents to the ED complaining of moderate, sudden, painless, vision loss in his L eye. Upon PE you notice retinal hemorrhages and "blood and thunder" appearance of the retina.
- Diagnosis?
2. Treatment? - ANSWERS -1. Central Retinal Vein Occlusion
- No specific treatments, aspirin.
- BRVO/CRVO without macular edema --> observation
- if macular edema 1st: intravitrela anti-VEGF, 2nd: steroids
- BRVO with neovascularization: - Peripheral scatter photocoagulation
- CVRO with neovascularization: Panretinal photocoagulatin
A 5 y/o presents to the ED complaining of right nostril discomfort, his mom has also noticed a malodorous discharge from that nostril x 3 days.
- Diagnosis?
2. Treatment? - ANSWERS -1. most likely nasal foreign body
- attempt removal or refer to ENT A 15 y/o F complains of sneezing, nasal congestion, and clear watery nasal discharge. Upon PE you notice nasal discharge, mucosal thickening, and enlarged erythematous turbinates.
- Diagnosis?
2. Treatment? - ANSWERS -1. Infectious rhinitis
- decongestants, antihistamines, steroid nasal sprays. A 50 y/o male moved to Florida 3 weeks ago and complains of stuffiness and rhinorrhea.
- Diagnosis?
2. Treatment? - ANSWERS -1. Vasomotor rhinitis d/t temperature
change
- Avoid the irritant?
A 25 y/o F presents to her PCP complaining of sinus pain, congestion, and minimal nasal discharge x 1 month. She stated that she does frequently use nasal decongestants.
- Diagnosis?
2. Treatments? - ANSWERS -1. Rhinitis medicamentosa
- d/c decongestant overuse, topical steroids A 30 y/o F with a history of eczema presents to her PCP c/o sneezing, nasal decongestion, watery eyes every spring. Upon PE you notice allergic shiners and pale, buggy nasal turbinates with cobblestone mucosa of the conjunctiva.
- Diagnosis?
2. Treatment? - ANSWERS -1. Allergic rhinitis
- intranasal steroids (Fluticasone) are first line for allergic, antihistamines, avoidance of the allergen. A 40 y/o M presents with a decreased smell and nasal congestion in both nares. His history is significant for asthma. He also tells you he has severe reaction to aspirin and can not take it. Upon PE of the nasal mucosa you notice gray glistening masses.
- Diagnosis?
