AOC Emergency Response Procedures 2 — Questions and Answers
Question 1: A patient in the orthoptic clinic develops sudden onset diplopia with ptosis and a dilated pupil. What is the most critical diagnosis to rule out first?
- Myasthenia gravis exacerbation
- Posterior communicating artery aneurysm (Correct answer)
- Thyroid eye disease flare
- Decompensated phoria
Correct answer: Posterior communicating artery aneurysm
A dilated pupil with ptosis and diplopia is the classic triad for a posterior communicating artery aneurysm, a life-threatening emergency requiring immediate neurosurgical evaluation.
Question 2: During a pediatric vision exam, a child suddenly becomes unresponsive and begins convulsing. After calling for help, what is the orthoptist's immediate priority?
- Restrain the child to prevent injury
- Time the seizure and protect the airway (Correct answer)
- Administer oral glucose immediately
- Insert a tongue depressor between the teeth
Correct answer: Time the seizure and protect the airway
Timing the seizure and protecting the airway by positioning the child safely are the immediate priorities; restraining or inserting objects in the mouth are contraindicated.
Question 3: A patient reports sudden painless monocular vision loss described as a 'curtain coming down' from above. Which emergency condition is most likely?
- Central retinal artery occlusion
- Rhegmatogenous retinal detachment (Correct answer)
- Acute angle-closure glaucoma
- Optic neuritis
Correct answer: Rhegmatogenous retinal detachment
A descending curtain of visual loss is the hallmark symptom of a superior rhegmatogenous retinal detachment involving the macula, requiring urgent surgical referral.
Question 4: When a patient experiences anaphylaxis after topical eye drop administration, what is the first-line emergency medication?
- Oral diphenhydramine
- Intramuscular epinephrine (Correct answer)
- Intravenous corticosteroids
- Inhaled albuterol
Correct answer: Intramuscular epinephrine
Intramuscular epinephrine (typically to the lateral thigh) is the first-line treatment for anaphylaxis and must be administered before antihistamines or steroids.
Question 5: A patient receiving cycloplegic drops suddenly complains of severe eye pain, nausea, and sees halos around lights. What emergency is occurring?
- Allergic conjunctivitis
- Acute angle-closure glaucoma (Correct answer)
- Corneal abrasion from drop instillation
- Sympathetic ophthalmia
Correct answer: Acute angle-closure glaucoma
Cycloplegic agents can precipitate acute angle-closure glaucoma in anatomically predisposed eyes by dilating the pupil and blocking the trabecular meshwork.
Question 6: In an ophthalmic emergency involving chemical splash to both eyes, how long should irrigation continue before checking pH?
- 5 minutes
- 10 minutes
- At least 20-30 minutes (Correct answer)
- Until pain resolves
Correct answer: At least 20-30 minutes
Continuous irrigation for at least 20-30 minutes is recommended before checking pH to adequately dilute and neutralize the chemical agent.
Question 7: A staff member collapses in the clinic with no pulse. The AED is available. After calling 911, what action takes priority before AED use?
- Obtain IV access
- Begin high-quality CPR immediately (Correct answer)
- Check blood glucose level
- Place patient in recovery position
Correct answer: Begin high-quality CPR immediately
High-quality CPR should begin immediately and continue until the AED is ready to analyze; minimizing interruptions to chest compressions is critical for survival.
AOC Emergency Response Procedures 2
A patient in the orthoptic clinic develops sudden onset diplopia with ptosis and a dilated pupil.
What is the most critical diagnosis to rule out first?