Special Senses

Question 1

Central Retinal Artery Occlusion

presentation? funduscopy? risks/causes?

(anatomy?)

Answer 1

ACUTE, PAINLESS MONOCULAR vision loss; entire visual field + may be permanent

fundoscope shows PALE + OPAQUE FUNDUS (ischemia) with CHERRY RED MACULA (supplied by choroid artery)

athero-/thromboemboli via A.FIB or CAROTID STENOSIS or GIANT CELL ARTERITIS

(CRA is a branch of ophthalmic a. which is a branch of ICA)

Question 2

Amaurosis fugax

presentation? cause?

Answer 2

TRANSIENT, monocular vision loss via SMALL EMBOLUS to ophthalmic a. (few seconds)

can occur in GIANT CELL ARTERITIS

Question 3

Diabetic retinopathy

presentation? acute or progressive? funduscopy?

Answer 3

blurry vision, black spots, floaters and decreased PERIPHERAL vision; usually progressive

acute loss may occur with vitreous hemorrhage

funduscopy will show NEOVASCULARIZATION

Question 4

Anosmia

MCCs (3)

less common cause

Answer 4

1. infection/inflammation of nasal cavity
2. neurodegenerative disease (Alzheimer’s, etc.)
3. head trauma - accel/decel forces can cause OLFACTORY NERVE ROOTLET AVULSION > long-term anosmia

Temporal lobe seizure - transient smell/taste issues

Question 5

Lingual nerve

branch of? does what?

Answer 5

branch of V/3 mandibular n.

somatic sensation and taste (via chorda tympani, CN VII) to ANTERIOR 2/3 tongue

Question 6

Ocular side effects of neonatal oxygen supplementation in premature newborn

Answer 6

“Retinopathy of prematurity” or “Retrolental fibroplasia”

retinal neovascularization (into vitreous body)
possible retinal detachment + blindness

temporary local hyperoxia via O2 supplement > return to room air ventilation > upregulation of VEGF

Question 7

What patient populations are at higher risk of ACUTE ANGLE CLOSURE GLAUCOMA?

Answer 7

Inuit and Asian descent

Question 8

What is the pathophysiological mechanism of papilledema?

Answer 8

IMPAIRED AXOPLASMIC FLOW in the optic nerve

high ICP compresses optic nerve sheath within subarachnoid space > impaired axoplasmic flow causes bilateral optic disc edema

Question 9

Posterior uveitis

inflammation of what? associations?

Answer 9

CHOROIDAL inflammation

assoc. with IBD and ank. spon.

Question 10

Posterior Uveitis

presentation?
ophthalmic exam findings?

Answer 10

PAINLESS vision loss with FLOATERS

WBCs in vitreous humor

Question 11

ANGLE CLOSURE glaucoma

presentation (3 eye-related sx, 2 general)

Answer 11

PAINFUL MONOCULAR vision loss
HA
vomit
conjunctival injection
poorly reactive MID-DILATED pupil

Question 12

OPEN ANGLE glaucoma

presentation (character of vision loss + funduscopy)

Answer 12

progressive PAINLESS BILATERAL vision loss

CUPPING of optic disc (disc atrophy)

Question 13

Optic neuritis

characteristics of vision loss
other ocular change
funduscopy

Answer 13

assoc. with MS
- progressive MONOCULAR loss over SEVERAL WEEKS with PAINFUL MOVEMENT of eye
- AFFERENT PUPILLARY DEFECT w/ hyperemia
- OPTIC DISC SWELLING

Question 14

Differential

central retinal artery occlusion vs. amaurosis fugax

Answer 14

Amaurosis fugax - is a PAINLESS MONOCULAR vision loss but is transient, for a few seconds, via small ophthalmic a. embolus

CRAO - is also painless and monocular but lasts longer, may be permanent without fixing occlusion