Eye and Ear Disorders

Question 1

Arcus senilis/lipoides

Answer 1

• Elderly or HLD+smoking pts
• Gray-opaque ring at corneal margin
• Cholesterol deposits in corneal stroma

Question 2

Ophthalmia neonatorum

Answer 2

• Conj in newborn

* Neisseria gonorrhoeae or Chlamydia trachomatis

Question 3

Bacterial conjunctivitis

Answer 3

• Purulent conjunctivitis WITHOUT blurry vision

* Staph aureus, Strep pneumoniae, H. influenzae

Question 4

Viral conjunctivitis

Answer 4

• Watery exudates
• Adenovirus: pinkeye
• HSV1: keratoconjunctivitis w/ dendritic ulcers

Question 5

Acanthamoeba infection

Answer 5

Severe keratoconjunctivitis in pts who don’t clean contacts

Question 6

Chalazion

Answer 6

Granulomatous inflammation of meibomian gland

Question 7

Pterygium

Answer 7

• Exposure to wind, sun, sand

* Raised, triangular encroachment of thickened conjunctiva on nasal side

Question 8

Pinguecula

Answer 8

Yellow-white conj degeneration at jxn of cornea and sclera on temporal side; sun-damaged tissue

Question 9

Optic neuritis

Answer 9

• Blurry or lost vision, may cause optic atrophy

* MS, methanol poisoning

Question 10

Central retinal artery occlusion

Answer 10

• Embolization from carotid or ophthalmic artery; giant cell temporal arteritis
• Sudden, painless, unilateral loss of vision
• Pallor or optic disk, “boxcar” segmentation of blood in retinal veins, cherry-red macula

Question 11

Central retinal vein occlusion

Answer 11

• Caused by hypercoagulable state
• Sudden, painless, unilateral loss of vision
• Swollen optic disk, engorged retinal veins, “blood and thunder” appeareance

Question 12

Glaucoma

Answer 12

• Increased IOP
• Chronic open-angle: decreased rate of aqueous outflow in severely myopic people; cupping of optic disks; night blindness, tunnel vision
• Acute angle-closure: precipitated by mydriatic agent, uveitis, lens dislocation; red eye w/ steamy cornea; pupil fixed, nonreactive

Question 13

Uveitis

Answer 13

• Inflammation of iris, ciliary body, choroid
• Sarcoidosis, ulcerative colitis, ankylosing spondylitis
• Pain w/ vlurry vision, miotic pupil, normal IOP, adhesions b/w iris and anterior lens capsule
• When chronic: may cause calcific band keratopathy

Question 14

Macular degeneration

Answer 14

• Elderly
• Disruption of Bruch membrane in retina
• Dry type: thinning of retina, deposits called drusen
• Wet type: vessels under retina hemorrhage, cells die —> blind spots or distorted central vision

Question 15

CMV retinitis

Answer 15

• Usually painless, unlike VZV retinitis
• AIDS pts
• Cotton-woll exudates, retinal hemorrhages

Question 16

Cataracts

Answer 16

• Lens opacity

* Advanced age, DM, congenital infection, corticosteroids, intraocular disease

Question 17

Meniere disease

Answer 17

• 40-60 y/o
• Inner ear: increased endolymph, loss of cochlear hairs
• Dizziness, tinnitis, hearing loss

Question 18

Weber test

Answer 18

• Sensorineural: contralateral ear affected

* Conduction: lateral ear affected

Question 19

Otosclerosis

Answer 19

• Elderly

* Fusion of middle ear ossicles

Question 20

Malignant external otitis

Answer 20

• DM patients
• Mastoiditis, oteomyelitis, meningitis, etc.
• MCC: Pseudomonas aeruginosa

Question 21

Relapsing polychondritis

Answer 21

• Autoimmune disease, Abs to connective tissue

* Inflammation that destroys cartilage, including ear

Question 22

Chronic serous otitis media

Answer 22

• Goblet cell metaplasia in middle ear

* Hemorrhage, with erythrocyte destruction and cholesterol liberation —> cholesterol granuloma

Question 23

Cholesteatoma

Answer 23

• Mass of accumulated keratin and squamous mucosa in middle ear
• Growth of squamous epithelium from external ear thru perforated TM

Question 24

Jugulotympanic paraganglioma

Answer 24

• MC benign tumor of middle ear
• Lobules of richly vascular connective tissue
• Neural crest origin; contain catecholamines

Question 25

Chlamydia-associated eye disease

Answer 25

* Upper conjunctiva: trachoma | * Lower conjunctiva: inclusion conjunctivitis

Question 26

Onchoceriasis

Answer 26

* Helminth of Africa and Central America | * Corneal opacification and visual impairment ("river blindness")

Question 27

Phacoanaphylactic endophthalmitis

Answer 27

* Traumatized or cataractous lens | * Autoimmune rxn to lens proteins

Question 28

Sympathetic ophthalmitis

Answer 28

* Arrestin acts as antigen * Granulomatous inflammation of other eye 4-8 weeks after uveitis * Dalen-Fuchs nodules b/w Bruch membrane and retinal pigment epithelium

Question 29

Retinal hemorrhage

Answer 29

* HTN, DM, trauma, bleeding disorders * Flame-shamed: nerve fiber layer * Round: deeper

Question 30

Retinal detachment

Answer 30

* Sensory retina separates from retinal pigment epithelium | * Happens after eye trauma/surgery

Question 31

Retinitis pigmentosa

Answer 31

* May have RHO or PDE mutation * Destruction of rods, then cones; attenuation of vessels * Night blindness, peripheral vision defects

Question 32

Retinopathy of prematurity (retrolental fibroplasia)

Answer 32

* Results from high levels of inspired O2 in premature infants * Developing retinal vessels are obliterated * Deluge of angiogenesis when returned to ambient air may cause blindness

Question 33

Phthisis bulbi

Answer 33

Intraocular ossification after trauma or inflammation

Question 34

Retinoblastoma

Answer 34

* Young children * Malignant tumor of immature neurons * May have densely packed cells, rosettes, or fleurettes * Disseminate via optic nerve to brain or via choroid to blood * White pupil, strabismus, spontaneous hyphema, painful eye, cat's eye reflex, glaucoma