Tasty Morsels of EM 100 – #FRCEM The red eye

1 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here

Most of this is really easy but the ones i struggle with are the drugs in glaucoma and the various associations with iritis

What is Iritis/Uveitis?

  • The uvea consists of iris, ciliary body and choroid.
  • features
    • red
    • sore
    • pain on movement occasionally and tender globe
    • pain with light (as the ciliary body has to constrict). Can be reproduced even with shining light in unaffected eye
    • blurred vision and floaters (probably because of the cells in the ant chamber)
    • pupil can become irregular with adhesions
    • look for a hypopyon (a hyphaema of white cells)
  • associations
    • lots of HLA B27 associations (like i know what that means…)
    • ank spond
    • ulcerative colitis, crohns
    • sarcoid
    • Bechets
    • Reactive arthrits (used to be Reiter’s)
    • kawawsaki
    • MS
    • lupus

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What is glaucoma and its management?

(Nice RCEM Learning Piece)

  • shallow anterior chamber at risk (in the long sighted older folk, these are the ones not to give pupillary dilation to)
  • bunch of drugs (not just drops can precipitate it)
    • sympathetics eg salbutamol
    • anticholinergics eg hyoscine or ipratropium
    • SSRIs
    • Antihistamines (with anticholinergic effect) eg chlorpheniramine
  • block in the canal of schlemm
  • increased intra ocular pressure in the ant chamber
  • features
    • pain
    • headache
    • vomiting
    • red eye
    • mid size fixed pupil
    • “halos”
    • reduced VA
    • hazy cornea
  • management
    • constrict the pupil -pilocarpine 4% ever 15mins
    • prophylact the other side
    • acetazolamide 500mg IV (diuretic)

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Name some bugs that cause conjunctivitis

  • Adenovirus
  • strep pneumo
  • haemophilus
  • gonorrhoea
  • chlamydia
  • mumps
  • measels
  • herpes

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2 Replies to “Tasty Morsels of EM 100 – #FRCEM The red eye

  1. Hi Andy

    Your work is great and easy to read. Probably a slight slip but under management it should read ‘constrict’ the pupil (muscarinic parasympathomimetic :-)).

    Thanks for all your hard work – it’s amazing!

    Anbin

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