PANCE Blueprint EENT (7%)


Patient will present as → a 42-year-old white female complaining of a severely painful right eye. The pain is a constant, boring pain that worsens at night and in the early morning hours and radiates to the face and periorbital region. Additionally, she reports a headache, watering of the eye, and ocular redness.

Inflammation of the sclera (the white outer coating of the eye) associated with systemic immunologic disease, such as rheumatoid arthritis

  • It causes significant eye pain (severe, deep pain)

On examination, there is ocular redness and pain on palpation of the eyeball. It can cause visual impairment

  • Labs should include screening for systemic immunologic diseases - ANCAs, ANA, CRP, ESR, Lyme, RA, ACE, RPR, etc.

Refer the patient for prompt evaluation by an ophthalmologist

  • Treatment involves topical and sometimes systemic corticosteroids

Question 1
A 69-year-old female with scleritis and has been taking 600 mg of ibuprofen three times per day. She presents for a follow-up and stated she had not had any improvement in her symptoms after 7 days. What is the next best treatment option at this time?
Prescribe oral prednisone 1 mg/kg/day for one month
Prescribe topical prednisolone acetate 1% four times per day for one week
Topical steroids can be used as the first-line agent in addition to oral NSAID treatment.
Discontinue ibuprofen
The patient has not responded to first-line treatment but requires additional treatment to manage inflammation.
Prescribe topical artificial tears four times per day
Artificial tears do not manage inflammation. They may provide some relief to any ocular surface dryness present.
Question 1 Explanation: 
If there is no response with the first-line treatment of oral NSAIDs, then second-line treatment of oral steroids is indicated.
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Shaded items are complete.

References: Merck Manual · UpToDate

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