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Friedman's Ophthalmology > Cornea > Flashcards

Cornea Flashcards

1
Q

Name 3 stains for amyloid?

A

Congo red, thioflavin T, crystal violet

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2
Q
A
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3
Q

Name of Iron line at head of pterygium?

A

Stocker’s line

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5
Q

Does pterygium usually cause ATR or WTR? Astigmatism?

A

Usually WTR (flattens in meridian of pterygium/horizontal)

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7
Q

What causes adenochrome deposits?

A

topical epinephrine is metabolized to melanin

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9
Q

How large is a giant papillae?

A

>1.0mm

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11
Q

What type of hypersensitivity is AKC? What age?

A

Type IV > Type I, onset 30-50yo

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13
Q

What type of cataract is associated with AKC?

A

Subcapsular Maltese Cross

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15
Q

What systemic disease is associated with SLK?

A

Thyroid disease

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17
Q

Imagine patient with SLK, What are typical exam findings of SLK?

A

Velvety papillary hypertrophy, with superior cornela and conjunctival punctate staining, micropannus, redundant superior conj, +/- filamentary keratitis

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19
Q

What is treatment for SLK?

A

Steroids of little use; usually requires conj scarring (cautery or silver nitrate) or recession/resection of superior conj; can try large diameter CL

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21
Q

Is parinaud’s oculoglandular syndrome papillary or follicular conjunctivitis?

A

Follicular

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23
Q

Most common eye finding in Reactive arthritis?

A

COnjunctivitis (30%)

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25
Q

Common bugs for Reactive Arthritis?

A

Chlamydia, Shigella, Salmonella

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27
Q

What is the lining of inclusion cyst?

A

normal epithelium (non-keratinized stratified squamous)

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29
Q

Treatment for squamous conj papilloma?

A

Excisional biopsy with cryotherapy

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31
Q

Most common malignant epithelial tumor of conj?

A

SCC

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33
Q

Width of margin for conj SCC?

A

4mm

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35
Q

Path buzzword for SCC?

A

Keratin pearls

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37
Q

% of conj nevi that are amelanotic?

A

20-30%

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39
Q

Location of junctional nevus?

A

confined to epithelial/subepithelial junction (anterior to basement membrane)

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41
Q

Location of compound nevus?

A

cells in epithelial and subjepithelial locations

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43
Q

Which nevus type is most common?

A

Compound nevus

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45
Q

Cause of PAM (cellular level)?

A

Proliferation of intraepithelial melanocytes

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47
Q

Causes of secondary acquired conj melanosis (4)?

A

Addision’s, radiation, pregnancy, topical epinephrine

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48
Q

Stains for conj melanoma (2)?

A

S-100 and HMB-45

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50
Q

SCC or melanoma more likely to invade sclera?

A

melanoma

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52
Q

melanoma thickness with increased risk of mets?

A

2mm

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54
Q

Better prognosis with cutaneous or conj melanoma?

A

Conj melanoma

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56
Q

What is path for cavernous hemangioma?

A

endothelial lined canals with RBCs

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58
Q

Most common conj location for lymphoid tumors?

A

Fornix

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60
Q

What percent of conj lymphoid tumor associated with systemic disease?

A

20%

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62
Q

which medium is used for Immunofluorescent stain?

A

Michel’s medium

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64
Q

Pathology for fibrous histiocytoma?

A

Storiform pattern?

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66
Q

What does BHID stand for?

A

Benign hereditary intraepithelial Dyskeratosis

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68
Q

What is BHID inheritance>

A

AD

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70
Q

Where is BHID found?

A

Halifax County, NC with Haliwa Indians

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72
Q

What is BHID presentation

A

Itching, burning, photophobia in 1st decade of life with bilateral dyskeratotoic lesions (plaques with gelatinous base and keratinized surface) on bulbar conj

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74
Q

where is oncotytoma commonly found?

A

Caruncle

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76
Q

why do alkali burns penetrate deeply?

A

Alkalis saponifies fat

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78
Q

which alkali is associated with Firework injuries?

A

MgOH

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80
Q

normal tear meniscus in mm?

A

0.5mm

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82
Q

normal TBUT?

A

10sec

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84
Q

normal Tear Osmolality?

A

<311mosm

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86
Q

Normal Phenol red thread test?

A

>9mm in 15 seconds

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88
Q

What is Mikulicz syndrome?

A

Lacrimal and parotid gland swelling and dry eye from sarcoid, TB, lymphoma or leukemia

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90
Q

What is Heerfordt syndrome?

A

CN7 palsy, parotid gland enlargment, fever and uveitis from sarcoid

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92
Q

How do you measure the number of goblet cells?

A

impression cytology

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94
Q

What topical drops are associated with OCP?

A

Pilocarpine, Phospholine iodide, timolol, epinephrine, idoxuridine

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97
Q

What is pathology of OCP?

A

IgA in conj basement membrane zone with antigen-antibodies below epidemis; occurs at level of BM

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99
Q

Most common cause of bilateral interstitial keratitis?

A

syphilis (congenital)

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101
Q

WHat is Cogan syndrome?

A

vertigo, tinnitus, hearing loss, interstitial keratitis (also conjunctivitis, iritis, scleritis, episcleritis

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103
Q

Differential for Cornea and vestibuloauditory symptoms?

A

Cogan, Syphilis, PAN, Wegeners, Sarcoid, VKH, Sympathetic ophthalmiaa, cerebellopontine angle tumore

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105
Q

Treatment of Cogan syndrome?

A

Systemic steroids

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107
Q

Thygeson’s HLA type?

A

DR3

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109
Q

Natural course ofThygeson without treatment?

A

1-2months then with recurrences in as little as 2 months

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111
Q

What are filaments made of?

A

Mucus and desquamated epithelial cells adherent to cornea at one in

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113
Q

Treatment of filaments?

A

Mucomyst, lubricatione, removal, BCL

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115
Q

what is limbal girdle of vogt?

A

small, white, fleck and needle deposits at temporal and nasal limbus

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117
Q

What causes salzmann’s nodules?

A

chronic inflammation (old phlyctenulosis, trachoma, staph hypersensitivity, IK)

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119
Q

What is pathology of Salzmann’s nodules?

A

replacement of Bowman’s membrane by hyaline and fibrillar material

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121
Q

Spheroidal degeneration types?

A

1- peripheral cornea/horizonal meridian, 2- other cornea pathology/involves center, 3- Involve conj also

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123
Q

What are Cornea Farinata?

A

Tiny, dot- and comma shaped flour like” deep stromal opacities with lipofuscin (an AD involutional change)

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125
Q

What is Hassall-Henle Body?

A

Gutatta in Periphery, normal with age

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127
Q

When does Coat’s white ring occur?

A

Following metallic foreign body

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129
Q

Dyslipoproteinemias are associated with which chromosome?

A

16

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131
Q

What is Tangier’s disease?

A

AR, HDL deficiency, relapsing polyneuropathy, small deep stromal opacities

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133
Q

Alkaptonuria Chromosome/inheritance pattern?

A

AR, Chr 3

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135
Q

Tyrosinemia enzyme deficit/inheritance/chromosome?

A

Tyrosine aminotransferase, Chr 16, AR;

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137
Q

Tyrosenemia findings?

A

corneal dendrites, retardation, skin lesions

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139
Q

Which quadrant does Kayser-Fleischer ring start?

A

Superior

141
Q

In wilson Dz, increase or decrease in ceruloplasmin?

A

Decrease

143
Q

Does Kayser Fleischer ring resolve or not?

A

Resolves with treatment

145
Q

What is chalcosis?

A

Deposition of CU in descemets from FB

147
Q

What is siderosis?

A

Accumulation of iron in stroma

149
Q

What is iron ring in keratokonus?

A

Fleischer ring

151
Q

What is iron line at head of pterygium?

A

Stocker line

153
Q

What is iron line at filtering bleb?

A

Ferrys line

155
Q

What is iron line at lower 1/3 of cornea?

A

Hudson-Stahli line

157
Q

What is argyrosis?

A

Silver in deep stroma

159
Q

What is Chrysiasis?

A

Gold in deep stroma

161
Q

What is Krukenberg spindle made of?

A

Melanin

163
Q

Corneal crstals can come from which plant?

A

Dieffenbachia

165
Q

What type of hypersensitivity is moorens?

A

Type 2

167
Q

Is moorens painful?

A

Yes

169
Q

Is sclera involved in Moorens?

A

No, but can have adjacent conj injection

171
Q

Which type of astigmatism is caused by Terriens?

A

Against the rule

173
Q

is Terriens painful?

A

No

175
Q

What demographic is Terriens most common?

A

Young middle age men (75%)

177
Q

What are common findings in Terriens?

A

Leading edge of lipid, steep centrally/sloping peripheally with no epi defect

179
Q

What enzyme is elevated in PUK to cause melting?

A

Collagenase

181
Q

What is Fuch’s superficial marginal keratitis?

A

marginal infiltrates initially then pseudopterygium with severe corneal thinning underneath; like kids version of terriens

183
Q

Bugs that can penetrate intact epithelium?

A

CHANLS-> Corynebacterium diphtheriae, Haemophilus aegyptus, Neisseria, listeria, Shigella

185
Q

What is bug most commonly associated with ICK (infectious crystalline keratopathy) ?

A

Strep Viridans

187
Q

What does ICK look like?

A

Branching, Cracked-glass appearance without epi defect

189
Q

Can HSV have granulomatous AC reaction?

A

Yes

191
Q

Can HSV have hypopyon?

A

Yes

193
Q

What type of inclusions are seen with HSV

A

Lipshutz and Cowdry A

195
Q

HEDS findings for stromal disease?

A

Steroids(8x/d)+ Viroptic (QID then 10 week taper) better than just Viroptic by 68%; no beenfit to adding oral acyclovir

197
Q

Heds fidnings for HSV Iritis?

A

Acyclovir (400 5x/d) + viroptic + steroid si better than viroptic + steroids alone

199
Q

HEDS findings for prophy?

A

Acyclovir BID for 1 year decreases recurrent HSV keratitis by 50%

201
Q

In HEDS, did oral acyclovir reduce risk of stromal keratitis in patheients with epithelial disease?

A

No

203
Q

Did oral Acyclovir reduces risk of recurrent ocular disease in HEDS?

A

Yes 19% vs 32%

205
Q

Describes VZV dendrites?

A

Blunt ends, no terminal bulbs, no ulceration, minimal staining, self limited (4-6 days);

207
Q

Describe iris atrophy in HSV

A

Patchy near pupillary border

209
Q

Describe iris atrophy in VZV

A

Segmental due to vasculitis and ischemia

211
Q

does chickenpox cause papillary or follicular conjunctivitis?

A

Papillary

213
Q

What type of fungi are fusarium and aspergillus

A

Septate filamentous (molds) form hyphae

215
Q

What type of fungi is Candida

A

Yeast/non-filatmentous

217
Q

Best treatment for filamentous?

A

Natmycin

219
Q

Best treatment for yeast/non-filamentous?

A

Amphotericin 0.15%

221
Q

What are common findings in acanthamoeba?

A

PSeduodendrite, ring ulcer, perineural infiltrate, hypopyon, scleritis, epithelial cysts

223
Q

Ways to culture acanthamoeba?

A

Calcocluor white, giemsa, non-nutrient agar with ecoli overlay, confocal microscopy

225
Q

Acanthamoeba treatments?

A

neomycin, paromycin 1%, oral keotconazole or itraconazole, propamidine (brolene) 0.1%, hexamidine 0.1%, Pentamidine, PHMB/pool cleaner 0.02%, chlorhexidine 0.02%

227
Q

Common cause of keratitis in HIV+ patient?

A

Microsporidia

229
Q

Treatment for microsporidia

A

Fumagillin

231
Q

Findings in EBV keratitis

A

Multifocal stromal keratitis, lymphocytosis, elevated liver enzymes;

233
Q

What are vogt striae?

A

Fine deep stria anterior to descemets that dissapear with pressure in keratoconus

235
Q

Pathology of KCN

A

breaks in bowmans membrane, stromal thinning

237
Q

What type of astigmatism is seen with pellucid?

A

Irregular ATR

239
Q

Name 3 corneal dystrophies that are Autosomal recessive?

A

Macular, Type 3 lattice, gelatinous

241
Q

Path buzzword for Meesmann’s

A

Peculiar substance “ PAs posivite material in epithelial cells;

243
Q

Chromosome/Gene/Inheritance for Gelatinous

A

Chr 1 , TACT2/AR

245
Q

Path buzzword for Thiel Behnke

A

Honey Comb pattern

247
Q

BEst stain for Reis Buckler

A

Masson trichrome

249
Q

most common stromal dystrophy

A

granular

251
Q

most severe/least common stromal dystrophy

A

Macular

253
Q

macular gene/inheritance/chromosome

A

CHST6 for keratan sulfate, AR, 16

255
Q

Most common recurrence?

A

Reis-buckler then lattice

257
Q

Meretoja is seen in people of what descent?

A

FInnish

259
Q

Type 3 lattice associated with people of what descent?

A

Japanese

261
Q

Schnyder Chromosome/inheritance/gene?

A

1/AD/UBIAD1

263
Q

Systemic findings in Schnyder?

A

Hyperlipdemia, short forearm, genu valgum

265
Q

Does fleck dystrophy extend to periphery?

A

Yes

267
Q

IS Fleck Congenital? Progressive?

A

Yes and No

269
Q

WHat is central cloudy dystrophy of Francois?

A

Posterior stromal mosaic opacities, vision usually not affected

271
Q

What inheritance is Fuchs endothelial dystrophy most commonly?

A

AD; early onset is Chr 1

273
Q

Most common inheritance of PPMD?

A

AD

275
Q

What is a delle?

A

focal thinning from dehydration due to adjacent area of elevation

277
Q

What is brown-mclean syndrome?

A

Peripheral corneal decompensation in aphakic patiens, central cornea remains clear;

279
Q

What is a Khodadoust line?

A

Sign of endothelial graft rejection

281
Q

Treatment of graft rejection?

A

Epithelial and stromal can be treated with increased topical steroids and enodthelial can use oral or IV steroids.

283
Q

Diagnosis of epithelial downgrowth?

A

Argon laser to surface of iris turns white

285
Q

How to diagnosis limbal stem cell deficiency?

A

Impression cytology (presence of goblet cells on cornea); slow wave like uptake of fluorescein by epithelium

287
Q

What are the eye findings possible in MEN2

A

prominent corneal nerves, cojunctival neuroma, eyelid neuroma, dry eye prominent perilimbal blood vessels

289
Q

What is differential diagnosis of prominent corneal nerves:

A

leprosy, acanthamoeba, downs, NF< KCN, congenital glaucoma, Refsum, Fuchs, ichthyosis, PPMD, trauma, advanced age

291
Q

is episcleritis more often sectoral or diffuse?

A

sectoral 70%

293
Q

When to perform systemic work-up in episcleritis?

A

if is persists for >3 weeks

295
Q

Most common cause of scleritits?

A

RA (20% of cases)

297
Q

what are the findings in posterior scleritis?

A

chorioretinal folds, amelanotic fundus mass, ON edema, vitritis, macular edema, limited motility, ptosis/proptosis, exudative RD, choroidal detachment

299
Q

Systemic sign in Takayasu?

A

Diminished pulse in upper xtremity; low BP but high in lower extremity

301
Q

Wegeners and PAN more common in male or female?

A

Male

303
Q

Recurrent episodes of inflammation i cartilaginous tissues seen in what disorder? treatment?

A

Relapsing polychondritis; steroids/dapsone

305
Q

What enzyme is deficient in alkaptonuria?

A

homogentisic acid oxidase deficient

307
Q

For PKP is HLA matching useful?

A

No, not cost effective or advantageous

309
Q

PK donor contraindications:

A

Septicemia, lymphoma/leukemia, ocular metastasis, anterior segment tumor, Creutzfeldt Jakob disease, rabies, subacute sclerosis panencephalitis, PML, HIV, hep , Hep C

311
Q

What is keratophakia?

A

Donor lenticule place between cornea after microkeratome has been used to make lamellar section

313
Q

What is keratomileusis?

A

Lamellar stromal section is removed, frozed and shaped on cryolathe then replaced into stromal be to correctrefractive error

315
Q

What is epikeratophakia?

A

epithelium is removed and a lather donor lenticule is placed on top to correct refractive error. Reversible

317
Q

What is optical zone for AK?

A

7-8mm

319
Q

What is optical zone for LRI?

A

10-12mm

321
Q

what factors increase effect in RK?

A

Longer incision, deeper incision, smaller optical zone, male sex

323
Q

Risk of hyperopic shift in PERK study at 10 years?

A

43 had at lead 1D of hyperopia

325
Q

wavelength of eximer for PRK

A

193nm

327
Q

what is munnerlyn equation?

A

depth = OZxOZ x (D of refractive error/3)

329
Q

Does haze after PRK cause myopic or hyperopic shift?

A

hyperopic

331
Q

Buttonhole more common with steep or flat cornea?

A

steep

333
Q

Free cap more common with steep or flat cornea?

A

flat

335
Q

What is DLK?

A

Inflammation within the flap interface

337
Q

What is treatment for DLK?

A

Topical steroids in stage I and II; Lift the flap in III & IV

339
Q

What is central toxic keratpathy?

A

Non-inflammatory central corneal opacity after LASIK with hyperopic shift; post op day 3-5; usually preceded by DLK; no treatment, spontaneously resolves in 2-18 months

341
Q

Which hinge location has worse dry eye after lasik?

A

superior is worse than nasal

343
Q

Most common infectious keratitis after lasik?

A

Gram positive cocci and atypical mycobacterium

345
Q

what type of refractive error are Intacs used for?

A

low to moderte myopia

347
Q

What type of refractive error is conductive keratoplasty used for ?

A

Low to moderate hyperopia

Friedman's Ophthalmology (12 decks)

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