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+--- Thread: rh 2 - sami2004 (/showthread.php?tid=539285)
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rh 2 - sami2004 - ArchivalUser - 10-08-2010
A 62-year-old woman comes to clinic complaining of right eye pain and redness. It has been present for several weeks and is getting worse. She has a history of rheumatoid arthritis and has been on hydroxychloroquine, 400 mg/day, and prednisone, 5 mg/day, for several years. On examination, the eye is very red, with a violaceous hue to the sclera. Gentle finger pressure over the eyelid onto the globe is painful.
Which of the following should be the next step in the care of this patient?
A. Add an ocular lubricant to her regimen
B. Prescribe corticosteroid ocular drops
C. Stop the hydroxychloroquine immediately
D. Increase the prednisone to 20 mg/day
E. Call for an ophthalmology appointment
0 - ArchivalUser - 10-08-2010
Ans: C
0 - ArchivalUser - 10-08-2010
C....
0 - ArchivalUser - 10-08-2010
IT IS C..
0 - ArchivalUser - 10-08-2010
evryone pls reconsider, c isnt the right answer, i knew that u will pick c, this is why i selected this ques....
0 - ArchivalUser - 10-08-2010
the patient has been on hydroxychloroquine and prednisone for many years now. Even though hydroxychloroquine causes retinopathy, this looks like an inflammation of the sclera and hence needs to be seen by the expert---i would go and see the opthalmologist
I think the answer is EEEEE
0 - ArchivalUser - 10-08-2010
Patients with rheumatoid arthritis may have a variety of eye problems, including dry eye,
episcleritis, and scleritis. Dry eye is rarely serious and is treated with eyedrops and lubricants. Episcleritis is inflammation of superficial vessels and is generally not a threat to
vision; scleritis is caused by inflammation of the deeper vessels and can lead to loss of
vision. Differentiation of the two is based on the more violaceous hue of the sclera in scleritis— caused by inflammation around the sclera vessels—and pain on pressure over the
closed lid onto the globe, which is not seen in episcleritis. Confirmation can be done by
slit-lamp examination. Scleritis comes in different forms, and treatment decisions are best
made in conjunction with an ophthalmologist. The most serious form of scleritis can lead
to scleromalacia perforans, which usually leads to blindness in the affected eye.
Hydroxychloroquine can cause eye disease, notably retinopathy, but there are no superficial
manifestations. (Answer: E—Call for an ophthalmology appointment
0 - ArchivalUser - 10-08-2010
EEE..
0 - ArchivalUser - 10-08-2010
Thanks for the explanation
0 - ArchivalUser - 10-08-2010
thanks sami2004