BCSC 8. External Disease and Cornea

Question 1

Cornea receives glucose from

Answer 1

Aqueous humor

Question 2

Increased matrix metalloproteinase-9

Answer 2

DES

Question 3

Initial treatment for neurotrophic ulcer

Answer 3

bandage contact lens

Question 4

Shown to reduce postherpetic neuralgia (PHN)

Answer 4

Prior VZ vaccine reduces PHN by 66%

Question 5

Broad activity against yeast and filamentous funghi

Answer 5

Topical amphotericin B 0.15%

Question 6

Better for filamentous molds

Answer 6

Natamycin 5%

Question 7

Treatment for repeated recurrence of HZ keratitis

Answer 7

maintenance dose of valacyclovir

Question 8

Most common fungal corneal pathogen

Answer 8

Candida (yeast)

Question 9

Radial perineuritis

Answer 9

Acanthamoebea keratitis

Question 10

27 yo F s/p LASIK 6 wks ago noted to have infiltrate at interface with no improvement after 3 days of q1hr fluoroquinolone eyedrops. Next step

Answer 10

Lift flap; cx on blood, chocolate agar, Sabourad’s agar. Start Fortified vancoycin and gentamicin q1hr.

Question 11

MC cause of late interface infections (after 2 weeks)

Answer 11

Slow-growing organisms - Candida or atypical mycobacteria. Require definitive identification of causative agent

Question 12

Condition a/w keratinized epithelial cells (metaplastic epithelial change)

Answer 12

MUCOUS MEMBRANE PEMPHIGOID - associated conditions. SJS, TEN, GVHD (severe ocular surface dx)

Question 13

Treatment for large corneal ulcer in nursing home patient

Answer 13

corneal scraping for culture and sensitivity testing, f/b fortified topical vancomycin and gentamicin

Question 14

Tx for vision rehabilitation for severe ocular surface dx with SJS and TEN

Answer 14

OSTEO-ODONTO-KERATOPROSTHESIS and boston type II keratoprosthesis

Question 15

Eosinophils in conjunctiva are less numerous and more often degranulated in ___ compared to ___.

Answer 15

Atopic keratoconjunctivitis c/t VKC

Question 16

Percentage of patients with necrotizing scleritis that have detectable systemic disorder

Answer 16

66%

Question 17

Percentage of patients with diffuse or nodular scleritis that have detectable systemic disorder

Answer 17

33%

Question 18

central opacity of cornea with underlying ENDOTHELIAL DEFECT and IRIS ADHESIONS

Answer 18

Peters anomoly

Question 19

Vertical ruptures in descemet membrane that can lead to corneal edema, permanent vertical striae in posterior cornea resulting in high astigmatism

Answer 19

Birth trauma injury

Question 20

Horizontal curvilinear breaks in the Descemet membrane associated with congenital glaucoma

Answer 20

Haab striae

Question 21

Opacities are accumulations of unesterified and esterified cholesterol and phospholipids

Answer 21

Schnyder corneal dystrophy

Question 22

X-linked recessive disorder of cornea

Answer 22

Hunter and Fabry

Question 23

Drug a/w cornea verticillata

Answer 23

Amiodarone

Question 24

Produces lysosomal deposits in basal corneal epithelium creating whorl-like pattern

Answer 24

Amiodarone (similar pattern found in Fabry’s disease)

Question 25

Inheritance of marfan syndrome

Answer 25

AD

Question 26

AD disorder a/w defect in fibrillin gene, lens subluxation, scleral thinning (blue) and CORNEAL FLATTENING

Answer 26

Marfan syndrome

Question 27

Corneal finding in Marfan

Answer 27

Corneal flattening

Question 28

Thinning of peripheral cornea that is quiet, noninflammatory, slowly progressive.

Answer 28

Terrien marginal degeneration

Question 29

Line of lipid deposits appears at leading edge of pannus

Answer 29

Terrien marginal degeneration

Question 30

Lucid interval occurs between limbus and peripheral edge of keratopathy

Answer 30

Calcific band keratopathy

Question 31

Fine, dustlike, basophilic deposits in bowman membrane

Answer 31

Band keratopathy

Question 32

Always treat traumatic hyphema with these medicines

Answer 32

TOPICAL CORTICOSTEROIDS and CYCLOPLEGIC drugs - reduce inflammation and put pupil at rest to reduce incidence of rebleeding. +/- oral corticosteroids if severe inflammation. Topical anti-hypertensives mainstay (beta-bloackers and alpha agonists)

Question 33

Clinical finding that best supports diagnosis of limbal stem cell failure

Answer 33

Absence of limbal palisades of Vogt, abnormal epithelium on cornea, vascularization

Question 34

Corneal epithelium is highly differentiated cell type that is entirely regenerated approximately

Answer 34

every 7 days

Question 35

Remove interrupted sutures s/p PK at this time interval

Answer 35

4 weeks

Question 36

Tx for Fuchs CED

Answer 36

Endothelial keratoplasty (DSEK or DMEK)

Question 37

POW3 s/p PKP p/w persistent epithelial defect

Answer 37

presume herpetic disease, trial of oral acyclovir 400 mg po QID. Giving topical corticosteroids is CONTRAINDICATED!!

Question 38

DDx enlarged Corneal Nerves

Answer 38

``` MARKING "L" Cornea M: MEN II B (med Ca thyroid, pheo, neuroma) A: Acanthamoeba R: Refsum's disease (phytanic acid/Riley Day) K: Keratoconus I: Icthyosis N: Neurofibromatosis G: Grafts (failed) Glaucoma (infantile) L: Leprosy ```

Question 39

D/Dx Ring infiltrate

Answer 39

``` the PATH to ring infiltrate P: Pseudomonas A: Acanthamoeba T: Topical anesthetic abuse H: Herpes simplex virus ```

Question 40

MPS does NOT heavily involve cornea

Answer 40

Sam the Hunter must see to shoot S: Sanfilippo H: Hunter

Question 41

MPS most heavily involves cornea

Answer 41

Hurler and Scheie's

Question 42

Cloudy Corneas

Answer 42

``` STUMPED S: Sclerocornea T: Tears in descemet's (infantile glaucoma, birth trauma) U: Ulcers (HSV, bacterial, neutotrophic) M: Metabolic (mucopolysaccaridosis) P: Peter's anomaly E: Endothelial dystrophies (CHED, PPMD, CHSD D: Dermoid ```

Question 43

Direct penetration of intact epithelium

Answer 43

``` "N & N Can Lyse Hole Skin" Neisseria gonorrhea N. meningidides Corynebacterium diptheriae Listeria Hemophilis Shigella ```

Question 44

Derived from neuroectoderm

Answer 44

``` ROVINZ R: RPE/Pig CB epi O: Optic nerve/axons V: Vit (all) I: Iris sphincter/dilator N: Neurosensory ret/nonpig CB epithelium Z: Zonules ```

Question 45

Derived from surface ectoderm

Answer 45

``` CCLLSZ C: Cilia C: Conj/Cornea epithelium L: Lids/Lacrimal gland and drainage L: Lens S: Skin Z: Zonules ```

Question 46

Derived from mesoderm

Answer 46

``` MEETS M: Mesoderm E: EOM E - Endotherlial blood vessels T: Temporal sclera S: Schlem's canal ```