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CSAO > Preparing > Samples (Judgement Component)
| CASE HISTORY:
Demographics:
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38 year old white male; computer programmer
Chief complaint:
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Hit in the face with baseball at company picnic yesterday. Broke glasses. Black eye OS since then, seeing double occasionally.
Ocular History:
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Last oculovisual assessment 3 months ago - results as follows:
- Corrected visual acuity at 6 m: OD 6/6 OS 6/6
- Spectacle Rx: OD -3.50 OS -4.00
- Von Graefe phorias:
- horizontal - ortho at 6m, 3 exo @40 cm
- vertical - ortho at 6m and 40cm, ±vergences 2/1
- Slit lamp examination - NAD OU
- Fundus - NAD OU
Medical History:
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levothyroxine (Eltroxin) 50 mg/day for 5 years
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Last medical exam 6 months ago; no significant problems
Clinical Data:
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Best correction: OD -3.50 6/6 OS -4.00 6/30
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OS restricted in upward gaze, pain on movement
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Pupil reflexes present OU (sluggish OS)
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Edema and ecchymosis of eyelid OS
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The correct responses for these items are identified by displaying them bold and red.
- What is the tentative diagnosis?
- Fourth cranial nerve palsy
- Orbital blow-out fracture
- Orbital hemorrhage and edema
- Third cranial nerve palsy
- What additional diagnostic procedure is CONTRAINDICATED at this time?
- Biomicroscopy with fundus lens
- Dilated fundus examination with scleral
depression
- Exophthalmometry
- Tonometry
- What is the most appropriate management of this patient?
- Advise patient everything will be back to normal once black eye clears
- Follow-up assessment in 2 days
- Follow-up assessment in 2 weeks
- Immediate referral to local hospital emergency
department
- All of the following are likely potential complications EXCEPT
- angle recession glaucoma.
- carotid-cavernous fistula.
- microhyphema.
- orbital cellulitis.
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