Path 3

Question 1

dacryocystitis vs adenitis

Answer 1

obstruction lacrimal duct –> pooling of tears in lacrimal sac –> infxn of lacrimal drainage system vs unilat ascending infxn of lacrimal gland in young children –> s shaped lid w/ pain & d/c

Question 2

hordeolum vs chalazion

Answer 2

infxn of sebaceous glands by s aureus –> tx w/ warm compresses or I&D vs infxn of Meibomian gland –> chronic painless granulomatous nodule of macs/multinuc giant cells/plasma cells

Question 3

internal vs external hordeolum

Answer 3

infxn of meibomian gland –> red tender lump on eyelid toward skin/conjunctiva vs gland of Zeis –> painful postule outside of eyelid

Question 4

preseptal vs orbital cellulitis

Answer 4

infxn ant to orbital septum, ethmoid > maxillary sinus; s pneu, H flu; full EOM, CT shows opac ant to orbital septum w/o inflamm vs infxn post to orbital septum, rhinosinusitis; s pneu, H flu, s pyogenes, s aureus; paralyzed EOM, CT shows opac post to orbital septum w/ inflamm

Question 5

blepharitis

Answer 5

meibomian gland dysfxn –> hyperkeratinization –> altered lipid comp –> bacterial growth –> lipase –> monoglycerides = toxic to ocular surface –> dry eye, FB sens, removable scales

Question 6

IOID w/ sxs. CT shows? tx?

Answer 6

isolated uni orbital inflam –> exophthalmos, diplopia, ophthalmoplegia, compressive optic neuropathy. ill defined mass w/ hetero comp. high dose oral steroids

Question 7

corneal arcus vs kayser fleischer ring vs calcified band keratopathy

Answer 7

age related bil white LDL/chol-ester ring around cornea vs copper/brown, green-yellow ring Descemet mem vs Ca2+ salts in Bowman’s membrane in central cornea; dystrophic -> chronic uveitis, end stage glaucoma vs mets -> hyperparathyroid, renal fail

Question 8

keratoconus

Answer 8

sporadic or auto dom assoc w/ Down, Turner, Alport Marfan; bil noninflamm but asymm cornea becomes cone shaped d/t thinning + breaks in Bowman & Descemet mem

Question 9

FED. genes?

Answer 9

cornea endothel maintains health & transparency but d/o –> corneal clouding, guttae (type VIII collagen fibrils alpha1 chain), thick Descemet –> blurring vision that abates during day, dec evap. COL8A2, ZEB1, SLC4A11

Question 10

bacterial (risk factors, which bacteria, sxs, dx, tx) vs HSV keratitis (virus, sx, dx)

Answer 10

from ocular surface dz or trauma, contacts; from staph or pseudomonas. hyperemia, chemosis, purulent d/c, corneal ulcers. corneal scrape, stain, cx. topical abx drops vs HSV 1 dormant in trigeminal ganglion –> dendrites w/ end bulbs, nonlinear geographic ulcer –> corneal scar, neovasc, vision loss. stain basement mem w/ fluorescin

Question 11

nuclear vs cortical vs post subcapsular senile cataract. dx? tx?

Answer 11

fading of lens w/ eos staining vs accum eos fluid –> displace & degen bordering fibers vs post mig of lens d/t external stimulus. ophthalmoscope, slit lamp. lens extraction

Question 12

risk factors of primary vs secondary open angle glaucoma

Answer 12

age, IOP, black, fhx vs trauma, RBC clot/obstruction, pig dispersion syndrome, pseudoexfoliation syndrome

Question 13

open vs closed angle glaucoma w/ dx (& tx)

Answer 13

deposited extracell in trab mesh & schlemm –> degen
trab mesh –> impaired aq drain –> inc IOP –> optic n dmg + visio loss; optic disc change vs pupillary block –> impaired aq drain –> inc IOP; narrow angle on gonioscopy, optic n/visual changes. tx w/ laser iridotomy

Question 14

glaucomatous optic neuropathy

Answer 14

inc IOP –> nerve compression, reduced bloodflow –> axonal dmg –> cupping (enlarged cup > optic disc) –> VF loss

Question 15

infectious (mostly in post) vs noninfectious uveitis. granulomatous vs nongranulomatous uveitis. endophthalmitis vs panophthalmitis

Answer 15

hematogenous spread from HSV, VZV, TB, C albicans, toxo gondii vs from autoimmune or immune mediated. granulomas from TB, syphilis, sarcoidosis, toxo vs perivasc lymphatic cuff + infiltration of retinal vessels. purulent inflamm of intraocular tissue x/ sclera vs inflamm of entire globe w/ orbital extension

Question 16

sporadic vs inherited uveal melanoma mutations

Answer 16

GNAQ/GNA11 G protein mutations –> activates MAPK vs auto dom inactivating BAP1 –> deubiquitin

Question 17

spindle vs endothel cell uveal melanoma. risk factors? dx? tx?

Answer 17

fusiform shaped atypical melanocytes -> favorable prog vs spherical shaped atypical melanocytes -> poor prog. fair skin, freckles, prone to sunburn, UV. iris –> slit lamp, ciliary body –> US, choroid –> dil indirect ophthalmoscope or US. rad, enucleation

Question 18

retinitis pigmentosa. genes?

Answer 18

auto dom/rec, X linked mutations –> RPE degen –> rod degen –> cone degen –> bone spicule pig in fundus –> tunnel vision, retinal atrophy, photophobia. RHO for rhodopsin, UsH2A for usherin, RPGR for RPGR

Question 19

dry vs wet AMD

Answer 19

drusen, geographic atrophy –> lost RPE, greater choroid vessel visibility –> vision loss vs neovasc –> detached RPE –> dome shaped elevation on exam –> loss photoreceptors, accum of lipofuschin –> lost central vision

Question 20

passive vs active retinal detach. rhegmatogenous vs traction vs exudative retinal detach. sxs of retinal detach?

Answer 20

d/t fluid accum vs d/t vit traction on retina in DM. lacunae filled w/ vit, frag of collagen, proteoglycan accum vs fibrotic adhesions b/w vit & retina –> separate retina from RPE vs fluid accum under retina. floaters w/ fleeting photopsia, permanent vision loss after 24h

Question 21

sporadic vs hereditary retinoblastoma. gene? gross vs microscopic. endo vs exophytic growth. sxs?

Answer 21

uni vs auto dom, bil. Rb1 tumor suppressor b/w G1 + S phase. yellow/white vs blue cells w/ hyperchromatic nuclei & scant cyto and high mitosis. inner retinal layer growing centrally into vit cavity vs outer retinal layer detaching retina & invade choroidal stroma; hematogenous spread. leukocoria, strab, inflam -> red eye, pain, orbital cellulitis

Question 22

Trilateral retinoblastoma
vs Nonocular malig tumors in retinoblastoma survivors

Answer 22

uni/bil hereditary retinoblastoma (Rb1 mutation) w/ intracran midline pineoblastoma vs Rb1 mutation –> inc risk of nonoc malig tumors in soft head tissue, bone, skin, brain

Question 23

ant ischemic optic neuropathy. arteritic vs nonarteritic

Answer 23

ischemia of optic n –> optic n dmg –> monocular vision loss, afferent pupillary defect. d/t giant cell/temporal arteritis vs isolated stroke of optic n assoc w/ HTN, HLD, DM

Question 24

papilledema

Answer 24

from ICP –> bil optic disc swelling –> inc CSF –> optic n sheath stops axonal transport –> nerve head swelling seen on ophthalmoscope –> graying out vision, blurry

Question 25

leber hereditary optic neuropathy

Answer 25

mito inherited MT ND6 encoding ND6 protein –> loss retinal ganglion + diffuse axonal depletion of optic n –> optic atrophy, optic hyperemia, vision loss both eyes, no pain. RPE & photoreceptors = unaffected

Question 26

genetic vs environ etio of otosclerosis. modeling vs remodeling

Answer 26

auto dom w/ dec penetrance vs similar to Paget’s, paramyxovirus, measles. from skel develop in fetus to 2nd decade vs initiated by osteocyte apop –> occurs throughout life by osteob/clasts & doesn’t change shape of bone

Question 27

osteoprotegerin (OPG). how does this affect pts w/ otosclerosis?

Answer 27

anti-resorptive cytok produced 1000x more in inner ear secreted in perilymph –> no clasts. dec OPG prod –> bone remodeling –> conductive hearing loss

Question 28

Stapes endplate also has what cytok?

Answer 28

increased TNF-alpha + IL-1beta = pro-inflammatory cytokines w/ anti-apoptotic effect –> inc inflow of immature forms of osteoclasts –> more resorption & remodeling

Question 29

Otosclerotic foci have predilection for what window?

Answer 29

ant/post oval > round > basal/apical cochlear –> sensorineural hearing loss

Question 30

Otospongiotic vs Otosclerotic phase w/ CT

Answer 30

inc clast –> resorption of bony otic capsule –> replace nml bone w/ enlarged marrow spaces + enlarged
vasc channels w/ capillary proliferation –> blue staining porous + spongy bone. demineralized lesions w/ lower density vs remodeling –> replacement w/ osteoid –> new cellular “woven” bone but poorly organized. remineralization –> indistinguishable findings from nml otic capsule

Question 31

otosclerosis sxs vs dx vs tx

Answer 31

bil/asymm hearing, tinnitus, vestibular complaints vs rinne (pos if nml AC>BC, neg if conductive BC>AC) & weber (nml if hear both ears; conductive in affected ear, sensorineural in unaffected ear) tuning fork test. air conduxn audiometry (pts raise hand if hear sound but sound drops 10dB q time) & bone conduxn audiometry (bone vibrating device on mastoid; sound bypass outer/middle ear –> to inner ear). CT of mid ear & bony labryinth vs hearing aids to amplify sound & transmit energy to stiff ossicles; stapedectomy & stapotomy to restore middle ear

Question 32

conductive vs sensorineural vs mixed hearing loss

Answer 32

BC>AC b/c problems conducting sound waves in out/mid ear and TM vs poor AC & BC b/c problems w/ inner ear, CN8, or central processing brain centers vs BC>AC but both air & bone thresholds low

Question 33

describe ext ac meatus. ceruminous glands?

Answer 33

tube from auricle to TM lined by strat sq w/ wall reinforced by elastic cartilage (superficial 1/3) or bone (deep 2/3). modified apocrine sweat glands secreting cerumen into hair follicles or surface

Question 34

describe TM. it has 2 regions pars flaccida vs pars tensa

Answer 34

fibrous mem separating ext ac meatus from mid ear. sup small nontense area vs tense area attached to annulus fibrocartilaginous

Question 35

TM has 3 layers: cuticular vs intermediate fibrous vs inner mucous layer

Answer 35

thin hairless skin vs outer layer = fibers radially, inner layer = fibers circular vs simple cub epith w/ thin underlying lamina propria

Question 36

describe ossicles

Answer 36

endochrondial bone lined w/ simple cub or pseudostrat epith w/ thin underlying lamina propria

Question 37

describe cochlea. 3 canal cmpts: scala vestibuli vs media vs tympani. what does spiral ganglion contain?

Answer 37

tri-cmpt tube spiraling around modiolus containing auditory sense organ. at oval window w/ perilymph vs contains organ of Corti w/ endolymph maintained by stria vascularis -> strat sq w/ highly vascularized lamina propria vs w/ perilymph, separated from media by basilar mem. cell bodies of bipolar neurons to CN8

Question 38

describe organ of Corti

Answer 38

on basilar mem; tect mem on top of its hair cells –> waves in endolymph make tect mem depress cilia of hair cells. contains supporting cells: pillar cells for foundation, inner/outer phalangeal cells for support

Question 39

otoliths vs semicirc canals

Answer 39

utricle (closer to semicirc canal) & saccule. 3 layers: columnar (type 2), goblet (type 1), supporting cells. cilia in glycoprotein. ca carbonate crystals on top of glycoprotein layer for linear acc vs contains crista ampullaris receptor organ for rot acc (XYZ planes). type 1&2 hair cells surrounded by supporting cells, cilia in glycoprotein cupula. rotation -> endolymph pushes cupula in opposite direction -> detected by hair cells

Question 40

eye has 3 tunicas: tunica fibrosa vs vasculosa vs interna. know characteristics of each

Answer 40

cornea ant 1/6, limbus, sclera 5/6 vs uvea: iris (ant), ciliary body, choroid (post) vs retina. Eye lecture notes pgs 1-4

Question 41

intraocular structures: vit body vs lens

Answer 41

water & hyaluronic acid, periph fibril capsule, macs & fibrocytes, hyaloid canal (remnant of hyaloid a from optic disk to vit to lens) vs elastic avasc biconvex structure focusing light on retina, nourished by aq humor; lens capsule = elastic & transport basal lamina covering entire lens to prevent penetration of cells, subcapsular epith = low cub to columnar near lens equator, lens fibers = long/narrow/hexagon/anuclear/epith cells making up bulk of lens filled w/ crystallin proteins

Question 42

extraocular accessory structures: conjunctiva vs eyelids/palpebrae vs lacrimal gland

Answer 42

covers exposed part of sclera => bulbar conjunctiva; covers inside of lid => palpebral; strat sq to strat cub epith w/ goblet cells & underlying connective tissue vs covers skin ant & conjuctiva post; tarsus; tarsal/Meibomian glands = mod sebac glands for lub; voluntary skel muscle; Zeis (eyelash) & Moll (mod apocrine sweat) glands for oily layer to cover tear layer -> slow evap vs tubuloalveolar glands making tears, basophilic secretory acini makes lysozyme in tears

Question 43

where is canal of schlemm? what does RPE contain? what is Bruch’s mem? ganglion cells in retina are what kind of neurons; where do their axons converge? photoreceptors have what 3 parts? optic n = outgrowth of what?

Answer 43

b/w iris & cornea. melanin, apical microvilli. separates RPE & choroid. unipolar; optic disc. outer seg -> light sensitive visual pig, microvilli; inner seg -> Muller cells; cell body. small yellow disc of fovea. forebrain enveloped by meninges