eye

Question 1

epithelial layer surrounding sclera that produces mucous to lubricate eye

Answer 1

conjuctiva

Question 2

lens attached to

Answer 2

ciliary body/ciliary muscles:

allows for accomodation (focus far/near objects)

Question 3

uvea contents (behind sclera)

Answer 3

iris
cilliary apparatus
choroid (vascular layer posterior to retina)

Question 4

fluid posterior to lens

Answer 4

vitreous humor (body)

Question 5

fluid in anterior chamber + posterior chamber

Answer 5

aqueous humor

Question 6

anterior to iris

Answer 6

anterior chamber

Question 7

posterior to iris, anterior to lens

Answer 7

posterior chamber

Question 8

abrupt onset of eye pain, headache (eyebrow→temporal), nausea, colored halos, rainbows around light
red, teary eye with hazy cornea and fixed, mid-dilated pupil (not reactive to light)
eye firm to palpation

Answer 8

acute angle-closure glaucoma (closed-angle, narrow-angle)

EMERGENCY!

Question 9

insdidious (yrs) - usually bilateral

early: asymptomatic, elevated intraocular pressure
late: ↑ IOP → damages optic nerve → gradual loss of PERIPHERAL vision, permanent blindness if untreated

Answer 9

open-angle glaucoma (wide-angle)

more common

Question 10

treatment of acute angle-closure glaucoma: inhibit aqueous humor production, improve outflow of aqueous humor

Answer 10

laser iridotomy (holes in iris, allow fluid to flow from posterior to anterior chamber→ TM)
if >1 hr before iridotomy:
↓ aqueous humor production: eye drop timolol (DOC - B blocker) or oral acetazolamide (carbonic anhydrase inhibitor diuretic)
↑ outflow of aqueous humor:
PG-F2α (DOC) or apraclonidine (α agonist) or pilocarpine (cholinergic agonist)
↓ IOP rapidly: mannitol
laser trabeculoplasty: holes into TM to improve outflow

Question 11

risk factors for open-angle glaucoma

Answer 11

>40 yo
african american
family hx of glaucoma
myopia
diabetes

Question 12

screening for glaucoma

Answer 12

fundic exam: optic cup:disc ratio

enlarged optic cup: >50% diameter of optic disc

Question 13

fundoscopic exam

Answer 13

yellow circle = optic disc = optic nerve
bright white circle inside optic disc = optic cup
Normal: optic cup

Question 14

loss of CENTRAL vision

peripheral vision intact

Answer 14

age-related macular degeneration

Question 15

drusen accumulates between retina and choroid → gradual loss of vision

Answer 15

dry age-related macular degeneration

Question 16

rapid onset and progression

neovascularization of choroid → vessels bleed and damage photoreceptors

Answer 16

wet age-related macular degeneration

Question 17

risk factors for macular degeneration

Answer 17

smoking

Question 18

treatment of macular degeneration

Answer 18

stop smoking
antioxidant: B carotene, vitamin C, lutein, selenium, zinc
Wet: injection of anti-vascular endothelial growth factor (anti-VEGF) into vitreous humor OR laser therapy

Question 19

cotton wool spots

Answer 19

focal areas of retinal ischemia possibly caused by:
diabetes
HTN

Question 20

well-defined, bright yellow exudates
flame hemorrhages
cotton wool spots

Answer 20

diabetic retinopathy

Question 21

neovascularization (proliferation of new blood vessels) → can rupture, bleed, scar

Answer 21

proliferative diabetic retinopathy

Question 22

causes of retinal detachment

Answer 22

trauma

diabetes

Question 23

sudden onset of flashing lights, floaters → ↓ vision

wrinkled retina

Answer 23

retinal detachment

must surgically reattach

Question 24

loss of red reflex (white reflex instead) in one eye of child or infant

Answer 24

retinoblastoma

Question 25

swelling of optic disc blurry margins physical exam finding that suggests ↑ICP from brain tumor or pseudotumor cerebri

Answer 25

papilledema

Question 26

painless vision loss → pale retina (ischemic retina) with "cherry red spot" on macula (retina is thin at macula, able to see choroid behind retina)

Answer 26

central retinal artery (+ vein run through optic nerve) occlusion: ischemia of eye

Question 27

cherry red spot on retina

Answer 27

central artery occlusion Tay Sachs disease Niemann Pick other lysosomal storage disorders: accumulation in ganglia of macula (gives red color)

Question 28

opacification of lens - usually bilateral slowly progressive, painless ↓ in vision first sign: near-sightedness (don't need reading glasses any more) difficulty driving at night, reading road signs, reading fine print sun or oncoming headlights at night cause disabling glare

Answer 28

cataracts

Question 29

risk factors for cataracts

Answer 29

``` age long-term GC use tobacco alcohol diabetes ```

Question 30

diabetic complications of eye

Answer 30

retinopathy glaucoma retinal detachment cataracts

Question 31

refractive structures that help to focus light on retina

Answer 31

cornea | lens

Question 32

accumulation of lipid | white/blue ring in periphery of cornea

Answer 32

arcus senillis (in elderly)

Question 33

clouding of cornea

Answer 33

mucopolysaccharidoses (lysosomal storage disease - accumulation in cell of cornea)

Question 34

iris pain and redness photophobia pus in anterior chamber (cornea)

Answer 34

anterior uveitis (iritis)

Question 35

seronegative spondyloarthropathies: reactive arthritis or ankylosing spondylitis (HLA-B27) sarcoidosis juvenile idiopathic artheritis

Answer 35

anterior uveitis (iritis)

Question 36

associated with CMV, toxoplasma, cat scratch disease (bartonella), psoriatic arthritis, IBD arthritis (HLA-B27)

Answer 36

``` posterior uveitis (chorioretinitis if retina involved too) behind retina ```

Question 37

allergies/infection → inflammation → capillaries of conjuctiva dilate → pink eye

Answer 37

conjunctivitis

Question 38

adenovirus (viral infection usually) bacterial (unilateral, pus around eye) allergic (+ allergic rhinitis in spring/fall)

Answer 38

conjunctivitis