AOC Emergency Response Procedures 3 — Questions and Answers
Question 1: A patient with known myasthenia gravis presents to the orthoptic clinic in respiratory distress with worsening ptosis and dysphagia. This presentation suggests:
- Ocular myasthenia gravis relapse
- Myasthenic crisis requiring emergency transfer (Correct answer)
- Cholinergic crisis from overmedication
- Horner syndrome
Correct answer: Myasthenic crisis requiring emergency transfer
Myasthenic crisis involves life-threatening respiratory muscle weakness and requires immediate emergency transfer for potential intubation and plasmapheresis.
Question 2: During strabismus measurement with a cover test, a patient develops sudden onset severe headache described as 'the worst headache of their life.' What is the priority action?
- Complete the orthoptic exam and document findings
- Administer an OTC analgesic and recheck in 30 minutes
- Activate emergency services immediately for possible subarachnoid hemorrhage (Correct answer)
- Schedule urgent MRI within 24 hours
Correct answer: Activate emergency services immediately for possible subarachnoid hemorrhage
A 'thunderclap' headache—the worst headache of one's life—is a red flag for subarachnoid hemorrhage and requires immediate emergency activation regardless of other symptoms.
Question 3: Which ocular emergency requires ocular massage and anterior chamber paracentesis within 90-120 minutes to restore vision?
- Central retinal vein occlusion
- Central retinal artery occlusion (Correct answer)
- Anterior ischemic optic neuropathy
- Vitreous hemorrhage
Correct answer: Central retinal artery occlusion
Central retinal artery occlusion causes retinal ischemia with a narrow treatment window; ocular massage and paracentesis aim to dislodge the embolus and restore perfusion.
Question 4: A child presents with proptosis, restricted motility, fever, and eyelid erythema. What is the most dangerous complication of orbital cellulitis that necessitates emergent referral?
- Amblyopia development
- Cavernous sinus thrombosis (Correct answer)
- Exposure keratopathy
- Strabismus fixus
Correct answer: Cavernous sinus thrombosis
Cavernous sinus thrombosis is the most life-threatening complication of orbital cellulitis, as infection can spread intracranially via venous drainage.
Question 5: When a patient with a penetrating eye injury arrives at the clinic, what should the orthoptist do to protect the eye during transport?
- Apply a pressure patch to control bleeding
- Instill antibiotic drops immediately
- Shield the eye without applying pressure and restrict oral intake (Correct answer)
- Irrigate the eye to remove foreign material
Correct answer: Shield the eye without applying pressure and restrict oral intake
A rigid shield (not pressure patch) protects the globe without increasing intraocular pressure; NPO status is maintained in anticipation of emergency surgery.
Question 6: A patient on anticoagulation therapy develops a large spontaneous subconjunctival hemorrhage. After ruling out trauma, what is the most important next step?
- Irrigate eye with saline and patch
- Check blood pressure and systemic anticoagulation status (Correct answer)
- Prescribe topical steroids
- Schedule prism adaptation therapy
Correct answer: Check blood pressure and systemic anticoagulation status
In anticoagulated patients, spontaneous hemorrhage warrants blood pressure evaluation and review of anticoagulation levels to rule out dangerous over-anticoagulation.
Question 7: Which finding during a prism cover test warrants immediate medical referral rather than continued orthoptic management?
- Intermittent exotropia of 20 prism diopters
- Newly acquired esotropia with abduction deficit (Correct answer)
- Small-angle esophoria at near
- Vertical deviation from superior oblique overaction
Correct answer: Newly acquired esotropia with abduction deficit
A newly acquired esotropia with abduction deficit suggests a sixth nerve palsy, which can indicate increased intracranial pressure or a mass lesion requiring urgent neuroimaging.
AOC Emergency Response Procedures 3
A patient with known myasthenia gravis presents to the orthoptic clinic in respiratory distress with worsening ptosis and dysphagia.
This presentation suggests: