KMK Cards Book 1

Question 1

Abnormal findings w/in NFL include:

Answer 1

• CWS (aka soft exudates), commonly d/t diabetes
• Splinter hemorrhages (aka Drance hemes), at or near the optic disc.
• Flame hemorrhages, associated w/ retinal vascular pathologies (diabetes, hypertensive retinopathy, retina vein occlusions)

**issues in the NFL are more superficial

Question 2

Pathology found in INL

Answer 2

Dot or blot hemorrhages (deep retinal vascular pathology).

Question 3

Astrocytes, define

Answer 3

Define: astrocytes are fibrous cells that provide structure to nerve fibers and retinal capillaries. Performing similar function as Muller cells.

Astrocytes replace the foot plates of Muller cells at the optic disc. This means that the internal limiting membrane (INL) is not present over the optic disc.

Question 4

Define Muller Cells

Answer 4

Most common glial cell present exclusively in retina. Extends from ELM to the ILM. Most muller cell bodies are located within the INL. Gives structural and nutritional support.

• Maintains alignment of retina.
• provides nutrients to retina and aids in glycogen metabolism (excess glucose is converted in glycogen and stored here for the photoreceptors to use).
• Absorbs and recycles metabolic waste products such as GABA and glutamate.

Question 5

Microglial cells, define

Answer 5

• phagocytosis cells
• responds to inflammation and/or injury
• found anywhere in retina

Question 6

Central retinal artery, CRA

Answer 6

There are 2 capillary networks from the CRA: superficial capillary network in the NFL and a deep capillary network in the INL (near OPL).

• central retinal vein will drain inner retinal layers while the outer retinal layers will be drained by the vortex veins

Question 7

Foveala, define

Answer 7

Last area of the retina to develop. It is completely avascular and contains only cones (no ganglion cells, bipolar or other cells).

• Retina is thickest just outside the fovea in the parafoveal region.
• Retinal layers present: RPE, photoreceptors layer, ELM, ONL, Henle’s fiber layer, and ILM.

Question 8

Peripheral retina; what happens at the periphery?

Answer 8

• terminates approximately 5 mm anterior to the equator of the eye at the Ora Serrata. Ora Serrata is a 2 mm band at the anterior-most portion of the retina and composed of dentate processes and oral bays.
• RPE becomes pigmented ciliary epithelium
• neural retina significantly thins and transitions into the NPCE.
• Vitreous base (strongest point of attachment) extends over and posterior to the Ora Serrata.
• thinning out of the retinal vasculature

Question 9

Dentate processes, define

Answer 9

Extensions of peripheral retina onto par plana of the ciliary body

Question 10

Oral bays, define

Answer 10

Extensions of pars plana into the peripheral retina

Question 11

which nerves carry out the gag reflex?

Answer 11

CN9 and CN10

Glossopharyngeal and Vagus

Question 12

CN-10 (Vagus) palsy

Answer 12

Uvula deviates away from the lesion; palate does not elevate; patient will report hoarse voice

Question 13

CN-12, hypoglossal palsy

Answer 13

Tongue deviates towards side of lesion

Question 14

Optic nerve, define

Answer 14

Composed of ganglion cell bodies w/in the GCL of retina
- axons converge at the optic disc, exit the sclera at lamina cribrosa, and leave orbit via optic foramen to travel through the optic canal.

Question 15

CN-2, optic nerve, destinations

Answer 15

1. LGN: relays to primary visual cortex (V1)
2. Protectal nucleus: pupil innervation
3. Superior colliculus: control of saccades; contra lateral and FEF

Question 16

Edinger-Westphal nucleus; define

Answer 16

Provides parasympathetic innervation to the ciliary and iris sphincter muscles through the ciliary ganglion.
- Edinger-Westphal is within the nucleus of CN-3 that is within the superior colliculus, which is ultimately within the midbrain.

Question 17

What nuclei are CN-3 connected to?

Answer 17

Connected to CN 4, 6, and 8 by the medial longitudinal fasciculus (MLF).
CN-3 nuclei also receives information from the superior colliculus and the visual cortex.

Question 18

How does CN-3 enter the orbit?

Answer 18

Through the superior orbital fissure.

Travels close to posterior communicating artery before piercing roof of the cavernous sinus. Within cavernous sinus, CN-3 receives sympathetic innervation from the internal carotid artery plexus. Then it finally goes through the superior orbital fissure after separating into superior and inferior divisions.

Question 19

CN-3 superior division

Answer 19

• Muller’s muscle (upper eyelid)
• superior levator
• SR (which is a contra-lateral muscle)

Question 20

CN-3 inferior division

Answer 20

• MR, IR, IO
• iris sphincter (parasympathetic, pupillary constriction)
• ciliary muscle (accommodation)

Question 21

CN-3 lesion/palsy

Answer 21

“Down and out” eye (exotropia and hypotropia)

Question 22

CN-3 palsy w/ pupil-involvement

Answer 22

• fixed and dilated pupil
• suspicion for aneurysm of the posterior communicating artery (most likely located at the junction between the posterior communicating artery and the internal carotid artery)

Question 23

CN-3 palsy w/ pupil sparing

Answer 23

• most likely d/t ischemia of the small blood vessels that nourish the inner fibers of CN-3
• most likely d/t systemic condition (diabetes or hypertension)
• low chance of compressive lesion

Question 24

CN-4, Trochlear nerve; connection

Answer 24

Connected to nuceli of CN 3, 6, and 8 via the MLF (medial longitudinal fasciculus). Also connected to superior colliculus via tectobulbar tract, which then connects to the visual cortex.

Question 25

Pt w/ superior oblique palsy, d/t right trochlear nerve lesion will cause...

Answer 25

- left superior oblique palsy | - pt tilt head towards right

Question 26

Superior oblique origin:

Answer 26

anatomical origin: lesser wing of sphenoid bone | Physiological origin: trochlea

Question 27

V2 - Maxillary division track

Answer 27

- V2 travels along inferior lateral portion of the cavernous sinus before entering the foramen rotundum of the greater wing of the sphenoid.

Question 28

What is the nerve supply to the lower eyelid?

Answer 28

Zygomaticofacial --> infraorbital --> infratrochlear nerve The infratrochlear nerve (branching from the nasociliary nerve) provides nerve supply to the medial portion of the lower eyelid (majority) and the upper eyelid.

Question 29

V2 (maxillary division): zygomatic nerve

Answer 29

Carries parasympathetic fibers from the pterygopalatine ganglion of CN-7 to the lacrimal nerve of V1 to stimulate lacrimation.

Question 30

Where is the abducens nucleus located?

Answer 30

Pons Fibers leave the nucleus between the pons and the medulla and then makes a tight bend over the petreous ridge of the temporal bone before entering the cavernous sinus.

Question 31

Where does the CN-6, abducens nerve, enter and exit?

Answer 31

CN6 enters the orbit through superior orbital fissure and passes through the common tendinous ring before innervating the lateral rectus.

Question 32

A CN-6 palsy will cause what type of deviation?

Answer 32

ESO deviation w/ horizontal diplopia that is most apparent at distance and may also present w/ a head turn toward the affected side.

Question 33

Course of CN-7, facial

Answer 33

Input in the CN7 begins int he pre-central motor cortex in the frontal lobe. The fibers then descend within the corticobulbar tract to the pons, where the facial motor nucleus and superior salivatory/lacrimal nuclei are located. - Fibers exit the nuclei of CN-7 as a main motor root and the nervous intermedium root (carries parasympathetic fibers of CN-7).

Question 34

What forms the vidian nerve? (part of CN-7)

Answer 34

Greater petrosal nerve w/ the deep petrosal nerve. - Greater petrosal nerve carries parasympathetic innervation to the lacrimal gland. - Deep petrosal nerve contains post-ganglionic sympathetic fibers.

Question 35

Which terminal branch of CN-7 carries taste fibers from the anterior 2/3 of the tongue and provides parasympathetic supply to the submandibular and sublingual glands?

Answer 35

chorda tympani nerve

Question 36

The main root of CN-7 passes through the stylomastoid foramen and enters the parotid gland where it divides into 5 branches (temporal, zygomatic, buccal, mandibular, and cervical branches) to supply the muscles of facial expression. What do the temporal and zygomatic branches innervate?

Answer 36

Temporal: procures, corrugated, occipital frontalis, and the orbicularis oculi. Zygomatic: orbicularis oculi

Question 37

Which nerve provides innervation to the parotid gland?

Answer 37

CN-9, glossopharyngeal nerve

Question 38

Your patient's right lower face is paralyzed with slight drooping of the mouth. He is still able to close his eyes and wrinkle his forehead. Where is the lesion?

Answer 38

Supranuclear lesion of the left side (contralateral muscles of the lower face affected).

Question 39

Parasympathetic innervation to the eye originates from the midbrain (CN-3) and the pons (CN-7). What are the three major functions parasympathetic innervation plays in the eye?

Answer 39

1. miosis (via iris sphincter, CN3) 2. accommodation (ciliary muscle, CN3) 3. lacrimation (lacrimal gland, CN7)

Question 40

Which nerve/ganglion ultimately takes in the sensory information from LPCNs and SPCNs?

Answer 40

trigeminal ganglion SPCNs: original from ciliary ganglion and carry post-ganglionic sympathetic and parasympathetic fibers to various anterior structures of the eye. They also carry sensory information from the eye back to the ciliary ganglion via the nasociliary nerve. LPCNs: branch from nasociliary nerve of V1. Caries post-ganglionic sympathetic fibers to the eye, as well as carry sensory information from eye back to the trigeminal ganglion.

Question 41

By 6 months, infants have been shown to demonstrate 20/20 visual acuity with what form of measurement?

Answer 41

Pattern VEP testing

Question 42

Examples of forced choice preferential looking.

Answer 42

Teller, cardiff, & broken wheel

Question 43

When is the spatial visual acuity with FCPL 20/20?

Answer 43

20/20 at 3-4 years 1 month: 20/600-20/1200 1 year: 20/50-20/60

Question 44

Which is vergence in infant equivalent to adult levels?

Answer 44

By six months of age.

Question 45

Temporal vision is measured by the critical flicker frequency. When does this reach adult levels in infants?

Answer 45

Three months of age

Question 46

Which acuity takes the longest to develop?

Answer 46

Vernier acuity, for finely distinguishing lines. Develops at 6-8 yrs.

Question 47

Define occlusional amblyopia. Examples include congential cataracts, ptosis, or corneal opacities

Answer 47

Aka form deprivation amblyopia. Occurs when deprivation of vision during critical period (7-9 years).

Question 48

3 forms of refractive amblyopia

Answer 48

Anisometropic amblyopia: eye with blurred retinal image develops less. Isometropic amblyopia: large symmetrical blurring, neither eye gets a clear image. Meridional amblyopia: uncorrected astigmatism during critical period.

Question 49

Define strabismic amblyopia

Answer 49

Constant, unilateral deviation of one eye compared to the other. Alternating strabismus will not result in amblyopia. Patients will have poor stereopsis.

Question 50

Common cause of a bitemporal hemianopsia?

Answer 50

Classically caused by a pituitary gland tumor that compresses the nasal fibers from each eye that cross at the optic chiasm.

Question 51

Which VF defects do lesions anterior to the chiasm and most commonly due to glaucoma cause?

Answer 51

- VF defects that respect horizontal midline

Question 52

Which VF defects do lesions post-chiasmal and commonly due to strokes cause?

Answer 52

- VF defects that respect the vertical midline

Question 53

Optic nerve lesions, define.

Answer 53

1. cause asymmetric visual field loss between the eyes 2. defects typically respect the horizontal midline 3. defects may be bilateral but they are NOT congruous 4. an APD can occur if asymmetrical damage between the optic nerves is greater enough 5. visual field defects will correspond to the location of the lesion within the retinal nerve fiber layer

Question 54

Retinal lesions, define.

Answer 54

1. causes asymmetric visual field loss between the eyes (common w/ optic nerve lesions) 2. defects do not respect the horizontal or vertical midlines 3. defects may be bilateral but they are not congruous

Question 55

When does foveal maturation occur?

Answer 55

at approximately 4 years of age

Question 56

The anterior lens epithelium attributes to the development of the remaining nuclei: (in the following order)

Answer 56

fetal nucleus, juvenile nucleus, adult nucleus, and lens cortex

Question 57

When does the adult nucleus form?

Answer 57

Contains lens fibers that are formed from birth to sexual maturation.

Question 58

When is the lens cortex formed?

Answer 58

Contains lens fibers formed after sexual maturation.

Question 59

define induction

Answer 59

Induction refers to how the development of one tissue influences the development of another tissue; an example during ocular development is how optic cup formation stimulates lens development.

Question 60

Which embryonic layer forms the corneal epithelium?

Answer 60

surface ectoderm (epithelium, lids, and glands) - also responsible for conjunctival/eyelid epithelium, lens, meibomian, Zeis, Moll, Krause, and Wolfing glands - also the lacrimal gland, lacrimal sac, canaliculi, nasolacrimal duct, and caruncle

Question 61

Which embryonic layer contributes to the formation of the corneal stroma and endothelium?

Answer 61

neural crest cells - also responsible for TM, iris and CB stroma - also sclera, choroid, and vitreous

Question 62

Haab's striae; define

Answer 62

folds in Descemet's membrane | - possibly d/t increase in IOP (congenital glaucoma)

Question 63

Buphthalmos; define

Answer 63

A character of congenital glaucoma (same/associated w/ staphyloma). It is an enlargement of the eye prior to the age of 3 secondary to elevated IOP.

Question 64

Which filter do you use when trying to visualize the retinal NFL better?

Answer 64

Green (red free) for retina. Enhances contrast.

Question 65

Which wavelength of light has an increased association with the development of macular degeneration?

Answer 65

485-510 nm. Blue violet light

Question 66

Define Salus sign

Answer 66

Indication of grade 2 hypertensive retinopathy. Deflection of retinal veins at arteriovenous crossings

Question 67

Which two signs are associated with grade 3 hypertensive retinopathy?

Answer 67

Bonnet sign | Gunn sign

Question 68

At which peaks do erythrolabe, chlorolabe, and cyanolabe absorb light?

Answer 68

Erythrolabe: 565nm Chlorolabe: 535nm Cyanolabe: 430nm

Question 69

Normal arden ratio?

Answer 69

(Light peak)/(dark trough) 1.85 is normal, less is abnormal

Question 70

Where is the rhodopsin molecule found in a rod photoreceptor?

Answer 70

Membrane of the outer segment

Question 71

What type of action potential do bipolar, photoreceptor, and horizontal cells do?

Answer 71

Graded potentials, not action potentials BPH

Question 72

What is the smooth endoplasmic reticulum responsible for?

Answer 72

- steroid production in the adrenal cortex - storage and breakdown of glycogen and detoxification of lipid soluble drugs - storage and release of calcium for muscle contractions in muscle cells.

Question 73

Describe direct cell to cell signaling via Gap Junctions

Answer 73

Gap junctions connect cytoplasm of adjacent cells and serve as a passageway for small hydrophilic molecules, ions, and metabolites to pass directly from one cell to another. Examples include the heart and intraocular lens

Question 74

Define rhodopsin

Answer 74

An example of a transmembrane protein that is stimulated by photons to produce a signal transduction cascade within photoreceptors. Secondary protein made of alpha helices.

Question 75

What's the strongest chemical bond?

Answer 75

Covalent bonds, involving the sharing of electrons between two molecules.

Question 76

List of essential amino acids.

Answer 76

Histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. Conditionally essential or semi-essential amino acids include: arginine, cysteine, glutamine, and tyrosine.

Question 77

Describe AA tryptophan

Answer 77

Precursor for serotonin, a NT

Question 78

Describe tyrosine

Answer 78

Amino acid derived from phenylalanine. Precursor for dopamine, epinephrine, and norepinephrine (catecholamine neurotransmitters). With tyrosinase (absent in albinism) becomes melanin.

Question 79

Which amino acids are precursor for nucleotide synthesis?

Answer 79

Glycine, glutamine, and aspartate.

Question 80

Define IgM

Answer 80

First antibody made in response to an antigen. Found primarily in blood and on the surface of immature b-cells.

Question 81

Describe IgG

Answer 81

Most plentiful Ab in the body. Able to cross placenta.

Question 82

Describe IgA

Answer 82

- primary antibody in excretions (tears, saliva, mucous, and breast milk)

Question 83

Describe IgD

Answer 83

Antigen receptor on surface of mature B-cells

Question 84

Describe IgE

Answer 84

- binds to allergens and triggers histamine release from mast cells, leading to allergy symptoms and type 1 hypersensitivity reactions - protection against parasites.

Question 85

Describe collagen

Answer 85

- begins with hydroxylation (cofactor Vit C) of lysine and proline residues within the polypeptide strands of procollagen. - golgi apparatus then modifies procollagen into tropocollagen - tropocollagen connected together through covalent bonds to form collagen fibrils

Question 86

Type 1 collagen

Answer 86

Found in cornea, sclera, and Bowmans membrane. Osteogenesis imperfecta is an AD defect in the production of type 1 collagen. Resulting in multiple fractures, poor wound healing, hearing loss, and blue sclera.

Question 87

Type 2 collagen

Answer 87

Found in vitreous.

Question 88

Type 4 collagen

Answer 88

Found in descemets membrane

Question 89

Type 5 collagen

Answer 89

Found in cornea, maintains uniformity

Question 90

Diseases effecting collagen

Answer 90

- systemic lupus erythematoses and rheumatoid arthritis: autoimmune disorders where body attacks healthy collagen fibers. - ehlers-danlos syndrome: abnormal type 1 & 3 collage. Resulting in loose and hyperextended joints, hyperelastic skin, aortic dissection, blue sclera and corneal thinning - osteoporosis: decreased levels with aging

Question 91

Vitamin B1 and deficiency

Answer 91

Thiamine Disorder d/t deficiency: beriberi, causing peripheral nerve damage (delirium, memory loss, oculomotor paralysis, and heart failure).

Question 92

Vitamin B2

Answer 92

Riboflavin

Question 93

Define angular cheilitis

Answer 93

Cracking of skin and corners of mouth, can be caused by riboflavin deficiency

Question 94

Vitamin B3

Answer 94

Niacin, can be derived from tryptophan

Question 95

Define pellagra

Answer 95

Can be caused by chronic niacin deficiency. Symptoms: diarrhea, dermatitis, and dementia

Question 96

Vitamin B6

Answer 96

Pyridoxine

Question 97

Vitamin B12

Answer 97

Cobalamin Most common deficiency worldwide, seen often with alcoholism.

Question 98

Pernicious anemia

Answer 98

An autoimmune disorder that destroys the parietal cells of the stomach, causing a loss of production of intrinsic factor necessary for vitamin B12 absorption.

Question 99

Deficiency of folic acid (folate)

Answer 99

``` Spina bifida Anencephaly Megaloblastic anemia Diarrhea Glositis ```

Question 100

Calciferol

Answer 100

Vitamin D Most toxic fat soluble vitamin

Question 101

Tocopherol

Answer 101

Vitamin E Least toxic fat soluble vitamin

Question 102

Wilsons disease (aka hepatolenticular degeneration)

Answer 102

Results from large accumulation of copper. Patients may have a Kayser-Fleischer ring on the cornea and sunflower cataracts.

Question 103

Fat soluble vitamin

Answer 103

ADEK

Question 104

Antioxidants

Answer 104

ACE

Question 105

What is the initiation codon for every mRNA strand?

Answer 105

AUG, standing for amino acid methionine

Question 106

Define introns

Answer 106

Part of DNA that does not code for proteins

Question 107

Define extrons

Answer 107

Part of DNA that does code for proteins and are intermixed with introns.

Question 108

What are the modifications made to mRNA prior to exportation from the cell nucleus?

Answer 108

Addition of a modified GTP 5' cap Addition of a 3' poly A tail (multiple As) Introns are spliced from the mRNA sequence.

Question 109

Define missense mutation

Answer 109

New codon specifies a different amino acid, leading to alterations in protein function (sickle cell disease)

Question 110

Define nonsense mutation

Answer 110

New codon is a stop codon.

Question 111

Define Frameshift mutations

Answer 111

Occurs when the addition or deletion of neucleotides causes a shift in the reading frame of codons during translation of RNA, resulting in the production of an incorrect amino acid sequence. These mutations are often nonsense mutations.

Question 112

Define trinucleotide mutations

Answer 112

Caused by errors in DNA replication that result in an abnormal number of repeated trinucleotides within a gene. Examples of diseases include Huntington's disease, fragile X syndrome, and myotonic dystrophy. There is an increase in severity of each successive generation due to increase of the trinucleotide repeat.

Question 113

Define southern, northern, and western blot techniques.

Answer 113

SunDay, No Rain, Why not Picnic These different techniques are used to detect either DNA, RNA, or proteins within tissues.

Question 114

Define vitravene

Answer 114

Vitravene is the first FDA approved anti-sense drug for the treatment of CMV retinitis in immunocompromised patients.

Question 115

Which drugs interfere with cell walls?

Answer 115

Bacitracin, penicillins, cephalosporins, and vancomycin.

Question 116

Define bacterial transformation

Answer 116

Transformation is when a segment of DNA is taken up by the cell and incorporated into the bacterial chromosome.

Question 117

Define bacterial transduction.

Answer 117

A segment of DNA within a phage particle is taken up by the cell and incorporated into the bacterial chromosome.

Question 118

Define bacterial conjugation

Answer 118

A segment of DNA is directly transferred from a donor male cell to a recipient female cell via a sex pilus. The male cells contain a F plasmid for the sex pilus.

Question 119

Define staphylococcus aureus

Answer 119

Gram positive Catalase positive Coagulase positive Causes approximately half of all ocular infections. Including conjunctivitis, blepharitis, bacterial keratitis, hordeola, abscesses, boils, and acute bacterial endocarditis. Staph hypersensitivity resulting from chronic staphylococcus blepharitis can include the formation of infiltrates near the corneal limbus. Toxic shock syndrome. Includes high fever, vomiting, and watery diarrhea.

Question 120

Define staphylococcus epidermidis

Answer 120

Gram positive cocci Catalase positive Coagulase negative

Question 121

Define streptococcus pneumonia

Answer 121

Gram positive cocci, facultative anaerobes Classically grow in pairs Catalase negative Can cause pediatric bacterial conjunctivitis and corneal ulcers. Most common cause of bacterial pneumonia, meningitis, and otitis media.

Question 122

Which medications would you use to treat blepharitis or a hordeola?

Answer 122

These are classically caused by gram positive bacteria and so can be treated with: - topical ointments (bacitracin, erythromycin, and polysporin) - oral agents (dicloxacillin and doxycycline)

Question 123

You discover a cocci bacteria that is gram positive, catalase negative, and grows in chains. Which streptococcus is this most likely?

Answer 123

Streptococcus pyogenes Common cause of bacterial pharyngitis (strep throat). Can also cause scarlet fever, rheumatic fever, impetigo, and toxic shock.

Question 124

List some gram positive rods.

Answer 124

- bacillus anthracis (anthrax) - clostridium (c. botulinum causes botulism) - corynebacterium diphtheria (can penetrate intact corneal epithelium)

Question 125

Define pseudomonas aeruginosa

Answer 125

Motile, oxidase positive, gram negative - grape juice odor and blue/green pigment. - common with corneal ulcers in contact lens wearers (must differentiate from amoeba), burn victims, and immunocompromised patients.

Question 126

Patient presents with painful red eye with thick mucopurulent discharge, often accompanied by hypopyon. What do you want to treat this with?

Answer 126

Should be concerned with pseudomonas. Need gram negative fighting rx (fluoroquinolones).

Question 127

Which bacteria should you culture with chocolate agar (Thayer Martin Agar)?

Answer 127

``` Haemophilus influenza (gram negative rod) Neisseria gonorrhea (gram negative cocci, can penetrate intact cornea) ```

Question 128

List gram negative cocci bacteria

Answer 128

- neisseria gonorrhea - neisseria meningitidis (meningitis, culture on blood agar) - moraxella catarrhalis (shared eye makeup) - bordatella pertussis (whooping cough)

Question 129

List gram negative enteric bacteria

Answer 129

- escherichia coli (e. coli, conjunctivitis, corneal ulcers, endophthalmitis) - klebsiella pneumonia (pneumonia, sinusitis, pharyngitis) - proteus mirabilus - serritia marcescens (red pigment)

Question 130

Two types of mycobacteria (slight gram stain positive, acid-fast)

Answer 130

``` Mycobacterium tuberculosis (fever, night sweats, weight loss) Mycobacterium leprae (leprosy) ```

Question 131

Define treponema pallidum

Answer 131

Sexually transmitted disease either congenital or acquired. Causes syphilis. Conjunctivitis is seen in either secondary or tertiary phase, not primary. Argyll-Robertson pupil and interstitial keratitis are two ocular findings. Treatment with penicillin.

Question 132

Define different types of chlamydia trachomatis

Answer 132

- chlamydial inclusion conjunctivitis is chronic STD caused by serotypes D to K. - trachoma conjunctivitis is caused by serotypes A to C. Leading cause of preventable blindness in the world (corneal ulceration).

Question 133

Patient presents with a chronic red eye and large inferior palpebral conjunctiva follicles.

Answer 133

Chlamydia most likely cause. STD test referral to PCP.

Question 134

Leading cause of ophthalmia neonatorum

Answer 134

Leading cause in US is chlamydia. | Treatment is erythromycin ointment.

Question 135

Define rickettsia (gram stain, triad, associated disease, treatment)

Answer 135

Gram negative stain, obligate intracellular parasites transmitted by insect vectors. - triad of headache, fever, and rash - causes Rocky Mountain Spotted Fever through tick bites. - treatment of doxycycline

Question 136

The bacteria Mycoplasma does not contain a cell wall. Therefore, its resistant to pencillin. What can you treat mycoplasma with instead?

Answer 136

Clindamycin, erythromycin, and azithromycin.

Question 137

Which cells are responsible for tissue transplant rejections?

Answer 137

T killer cells through type 4 hypersensitivity reactions

Question 138

Test to be ordered for patient with suspected giant cell arthritis

Answer 138

CBC, ESR, CRP ESR & CRP indicate 97% specificity.

Question 139

HLA-B27 tests for

Answer 139

Reactive arthritis | Ankylosis spondylitis

Question 140

HLA-B54 tests for

Answer 140

Glaucomatocyclic crisis

Question 141

List all granulomatous inflammation (marked with collections of large, activated macrophages with a squamous cell-like appearance)

Answer 141

- bacterial (tuberculosis, leprosy) - fungal (histoplasmosis, blastomycosis) - foreign body (suture, vascular graft) - unknown (sarcoid, syphilus)

Question 142

What does histamine cause?

Answer 142

``` Vasodilation Decreased BP Bronchoconstriction (inhibited by epinephrine) Tachycardia Increase in leukotrienes ```

Question 143

Which immunoglobulins are involved with type two hypersensitivity?

Answer 143

IgM and IgG

Question 144

What causes phlyctenulosis?

Answer 144

Result of type 4 delayed hypersensitivity reaction, usually from staphylococcal infection secondary to blepharitis

Question 145

Your pediatric patient has a negative RF and a positive ANA lab results. She has asymptomatic, chronic, bilateral, non granulomatous, anterior uveitis. What should be part of your ddx?

Answer 145

Juvenile idiopathic arthritis (juvenile rheumatoid arthritis)

Question 146

Sjogrens syndrome triad

Answer 146

Dry mouth, dry eyes, and arthritis. | Affecting females 40-60.

Question 147

Describe sarcoidosis (rheumatologic disease)

Answer 147

- non caseating granulomatous - 25% with ocular involvement, 75% of this with anterior granulomatous uveitis - increased levels of angiotensin converting enzyme, ACE - lung involvement (indicating chest xray) - sometimes asymptomatic with complaints of breathing difficulties, dry cough, and unusual rashes. Associated with Bells Palsy (cn 7, exposure keratitis) - vasculitis (candle wax drippings) and diffuse vitritis (cotton ball opacities in inferior vitreous)

Question 148

Define ankylosing spondylosis (rheumatologic disease)

Answer 148

Chronic inflammation of spine and large joints. Order a sacroiliac x-ray. Classic bamboo spine, sarcoilitis, uveitis, and aortic regurgitation. Young males, 10-30 years. 90% positive with HLA-B27 gene.

Question 149

Describe reactive arthritis (Reiters syndrome, rheumatologic disease)

Answer 149

Triad: uveitis, conjunctivitis and/or anterior uveitis and arthritis. (+) HLA-B27

Question 150

Common opportunistic infections in someone with AIDS

Answer 150

Pneumocystic pneumonia, PCP pneumonia caused by Pneumocystis joroveci - toxoplasmosis - mycobacterium tuberculosis - CMV, HSV, Kaposi's sarcoma (herpes virus HHV-8)

Question 151

Define impetigo (describe the skin lesion)

Answer 151

Gram positive infection with classic honey colored crusted lesions. Very common in children.

Question 152

Which HSV is most commonly associated with ocular manifestations?

Answer 152

HSV 1

Question 153

Patient with herpes presents with Hutchinsons sign, blepharoconjunctivitis with vesicles at the lid margin, and episcleritis. Which type of herpes is this most likely?

Answer 153

HZV, herpes zoster virus

Question 154

Which drugs can cause aplastic anemia (pancytopenia)?

Answer 154

- antibiotics: trimethoprim, pyrimethamine - acetazolamide (a CAI) - chemotherapy drugs: methotrexate

Question 155

Define pernicious anemia and which vitamin malabsorption it is most associated with.

Answer 155

Pernicious anemia is characterized by autoantibodies against the parietal cells of the stomach, resulting in decreased production of intrinsic factor. Affecting B12 absorption.

Question 156

Describe what a Roth spot looks like and which conditions it is characteristic of.

Answer 156

A retinal hemorrhage with a white spot in the middle (Roth spot). It is characteristic of leukemia and endocarditis.

Question 157

Define thromocytosis

Answer 157

Elevated platelet count. | Caused by inflammation, kidney disease or spleen removal.

Question 158

Define thrombocytopenia

Answer 158

Decrease in platelets | Causes include infection, liver failure, and bone marrow disorders.

Question 159

Describe pathophysiology of diabetic macular edema.

Answer 159

Caused by microaneurysms and dilations of capillary walls. Pericytes, endothelial foot plates that surround the vessels, are damaged, allowing leakage of blood and fluid with resulting edema.

Question 160

There are many different hemorrhages found within the body. Define the following hemorrhages: petechiae, purpura, ecchymoses, and hemothorax/hemopericardium/hemoperitoneum

Answer 160

Petechiae: 1-2mm hemes in the skin. Purpura: greater than 3mm hemes associated with trauma, local vascular inflammation, and low platelet counts. Ecchymoses: greater than 1-2cm and include subcutaneous hematomas or bruises. Hemothorax/hemopericardium/hemoperitoneum: large accumulations of blood in body cavities.

Question 161

What are the lab results for someone with atherosclerosis? And what are the normal values?

Answer 161

Increased total cholesterol, LDL, and CRP. Decreased HDL. Good values: Total 40 LDL:

Question 162

Describe findings for hypertensive choroidopathy, which is often seen in young patients with acute hypertension.

Answer 162

Elschnig spots and Siegrist streaks.

Question 163

What are common signs and symptoms of rheumatic fever?

Answer 163

In 75-80% of cases the mitral valve is attacked, often requiring valve replacement later in life. Common signs and symptoms include fever, elevated ESR, red hot joints, and endocarditis

Question 164

Describe the Circle of Willis. Which arteries are involved?

Answer 164

The Circle of Willis is a meeting loop for the BASILAR artery, the INTERNAL CAROTIDS, and the ANTERIOR and POSTERIOR COMMUNICATING arteries (small arteries bridging the basilar and internal carotids). The Circle of Willis forms an arterial circle beneath the brain and allows for a system of redundancy for the flow of the blood to the intracranial tissue. Basilar artery goes to POSTERIOR CEREBRAL, which supplies temporal and occipital lobes. Internal carotid artery supplies ANTERIOR CEREBRAL and MIDDLE CEREBRAL. Anterior cerebral supplies frontal lobe while middle cerebral (last and largest branch of ICA) supplies frontal lobe, lateral surfaces of the temporal and parietal lobes, and the occipital lobe.

Question 165

List some antiepileptics

Answer 165

- phenytoin - phenobarbital - carbamazepine - valproic acid

Question 166

________ is substituted for ___________ in sickle cell anemia.

Answer 166

Valine is substituted for glutamic acid due to single base pair mutation in the Beta globin gene.

Question 167

Patient has the following list of symptoms. Which headache is this most likely? - Male, 40 years old - unilateral headache 2 times a day, lasting less than 1 hour. Occurs either middle of the night or in the morning.

Answer 167

Cluster Headache - Often present with red eyes and/or nasal stuffiness and can cause a transient or permanent ipsilateral Horner's syndrome. - Occurring in smokers and alcohol drinkers.

Question 168

- Female, has been occurring all her life (55 yo now). - Headache is from mild to intense and is worse when she is stressed out. Sometimes occurs before a migraine. - Feels like headache is wrapped around her head.

Answer 168

Pt has Tension Headache | - Band-like distribution w/ varying intensities. (Frontalis muscle)

Question 169

Pt used to experience headaches since she was 25 yo, stopped since her 50th birthday. - photosensitivity & slight nausea - Lasts for hours (minimum of 4hrs and a max of 72hrs) and it's worse when she has exercised. Which headache did your patient used to experience?

Answer 169

Migraine headache | Triggers include dehydration.

Question 170

Pt experiences a headache that wakes him up in the middle of the night. - He has experienced nausea, vomiting, and visual changes that have all increased with time. - Headaches are throughout the day, but worse in the morning. What does your patient have?

Answer 170

Interrupting sleep? You should consider a brain tumor. But remember that less than 1% of patients with brain tumors have headaches as their only symptom.

Question 171

Pt comes in for CEE. But mentioned having had an upper respiratory tract infection. Upon further questioning he gives you the list of symptoms. - fever - headache - neck stiffness - Occasional nausea, vomiting, sweats, weakness, myalgias, and photophobia. After your DFE, you noticed papilledema. What does your patient have? And is your procedure?

Answer 171

- Meningitis (likely viral, but can also be caused by bacteria, tuberculosis, fungi, or chemical agents). Order CT-scan followed by lumbar puncture to check for increased CSF.

Question 172

What is the most common primary malignant brain tumor?

Answer 172

glioblastoma multiforme - can cross corpus callosum - prognosis of less than one year life expectancy

Question 173

Most common benign brain tumor?

Answer 173

Meningioma (but could be malignant as well) - usually found in middle aged women - arise from arachnoid cells and extend to brain

Question 174

Noticed that your patient of 10 years has had a progression of proptosis over the years. He reports no symptoms. Dx?

Answer 174

Schwannoma (tumor of Schwann cells). Often localized in CN-8 (vestibulocochlear). Can be referred to as acoustic schwannoma. Rare, most common in young to middle-aged adults.

Question 175

Your pt's chart documents two separate central nervous system lesions on at least two occasions. The lesions both involved white matter. She now is diagnosed with multiple sclerosis. What is the most common presenting symptom of MS?

Answer 175

- optic neuritis (25% of patients). Pt will show decreased VA/color, (+) APD. Classically presents as sudden, non-progressive onset of monocular vision loss. - other ocular findings include pain on eye movement (90%), internuclear ophthalmoplegia (INO), and diplopia. - Can experience Uhthoff's phenomenon: increased in body temperature, which could be followed by a decrease in acuity.

Question 176

Causes of papilledema

Answer 176

- Guillain-Barre Syndrome - Meningitis - pheochromocytoma - stage 4 hypertensive retinopathy (malignant retinopathy)

Question 177

Guillain-Barre Syndrome is characterized by inflammation and demyelination of peripheral nerves and motor fibers of the ventral roots. It will classically present w/ symmetric ascending muscle weakness that begins in the distal lower extremities. What are some ocular findings?

Answer 177

- Adie's tonic pupil (d/t ciliary ganglion lesion, dx w/ 0.125% pilocarpine) - diplopia (multiple CN palsies) - facial diplegia - papilledema (d/t elevated protein levels in CSF)

Question 178

Myasthenia gravis is an autoimmune disease d/t blockade of neuromuscular signals d/t autoantibodies binding to ACH (acetylcholine) receptors. Affecting all ages, but mostly younger women and older men. Associated w/ thymic tumor (thymoma), rheumatoid arthritis, and lupus. Systemic symptoms include respiratory weakness and weakness of the jaw muscles. What are some ocular findings?

Answer 178

- ptosis and diplopia (secondary to external ocular muscle weakness, worse w/ beta-blockers) - Symptoms worse at end of the day.

Question 179

The following neurodegenerative diseases are associated w/ deposits or lack of specific substances in the brain. Fill in the blanks. - Alzheimer's disease: __________ - Vascular dementia: ___________ - Parkinson's disease: __________

Answer 179

- Alzheimer's disease: develop deposits (plaques) of a protein called BETA AMYLOID and disorganized masses of protein fibers known as neurofibrillary tangles. - Vascular dementia: blood clots or fatty deposits (cerebral microinfarcts) w/in vessels - Parkinson's disease: deficiency in dopamine in striatum d/t degeneration of neurons in substantia nigra

Question 180

Parkinson's symptoms go by TRAP (tremor at rest, akinesia, postural instability). What are some medications?

Answer 180

- Levodopa, Bromocriptine, Carbidopa, and Sinemet®

Question 181

Horner's syndrome causes sympathectomy of the face, d/t a lesion above T-1. Signs and symptoms include what triad?

Answer 181

- Triad: ptosis, miosis, anhydrosis | - associated w/ cluster headache and Pancoast tumor (which affects preganglionic sympathetic fibers)

Question 182

Patient has extreme thirst and polyuria resulting from a lack of ADH (anti-diuretic hormone) or a deficiency in renal response to ADH. Which diabetes does this patient have and what are treatment optiosn?

Answer 182

Diabetes Insipidus | Tx: increased fluid intake, intranasal desmopression (ADH analog), indomethacin, or HCTZ for nephrogenic causes.

Question 183

Pt has increased TSH and decrease free T4 and T3. | Dx?

Answer 183

Hypothyroidism (cold intolerance, hypoactivity, weight gain, fatigue, lethargy, decreased appetite, constipation, weakness, myxedema, dry cool skin, and coarse hair. Most common cause of hypothyroidism in iodine-sufficient areas in the worse is Hashimoto's Thyroiditis (autoimmune attack of thyroid gland). Females, 45-65 year old.

Question 184

Pt has elevated T4 and decreased TSH. Which condition is this, and what is the most likely underlying cause?

Answer 184

Hyperthyroidism, caused by Grave's disease (autoimmune condition caused by TSH autoantibodies). Causes excessive production of T3 and T4. Females, 40-50 yo. 1% of patients developing myasthenia gravis. Symptoms include heart palpitations, weight loss, heat intolerance and/or hair loss. Graves' Ophthalmopathy: proptosis and upper lid retraction are common signs. Superior limbic keratoconjunctivitis is an uncommon, bilateral, inflammatory reaction associated w/ thyroid disease.

Question 185

Pt has hypercalcemia w/ bone pain, pathologic fractures, renal stone, constipation, mental changes, and fatigue. Dx and possible Tx.

Answer 185

Dx: primary hyperparathyroidism Tx: parathryoidectomy

Question 186

Your hyperparathyroidism patient undergoes a (para)thyroidectomy, what's the most common side effect?

Answer 186

Hypoparathyroidism Symptoms include tetancy, muscle cramps, irritability, carpopedal spasms, convulsions, and mental retardation. - Decreased serum calcium. - Ocular: cataracts, uveitis, blurry vision

Question 187

Pt has chronic adrenocortical deficiency that is result of autoimmune atrophy of adrenal glands. Symptoms include weakness, fatigue, anorexia, weight loss, nausea, and vomiting, diarrhea, abdominal pain, muscle and joint pains, and amenorrhea. What is the name of this disease?

Answer 187

Addison's disease

Question 188

Pt has excessive corticosteroids on the body. Usually this is d/t chronic, prescribed corticosteroid medications. Pt presents w/ central obesity, a moon face, and a buffalo hump. May also have osteoporosis, hypertension, poor wound healing, hyperglycemia, and elevated serum cortisol levels. What is the name of this disease?

Answer 188

Cushing's Syndrome (hypercortisolism)

Question 189

Pt has a rare condition caused by a tumor secreting excessive amounts of norepinephrine and epinephrine. What is this condition called?

Answer 189

Pheochromocytoma - can affect any age (commonly 40-60 yo). - symptoms include elevated BP, papilledema, severe h/a, perspiration, heart palpitations, and anxiety w/ a sense of impending doom. (Quick Dx: Pain via h/a, Palpitations, Pallor, and Perspiration)

Question 190

Glomerular disease that is associated w/ hypertension, edema, and active urine sediment w/ hematuria, blood casts, and protein-uria. What is this condition?

Answer 190

Nephritic syndrome

Question 191

Which glomerular disease is associated w/ greater than 3.5 g of protein in urine that is accompanied by hypoalbuminemia, hyperlipidemia, and edema?

Answer 191

Nephrotic syndrome

Question 192

What is the classic triad of renal cell carcinoma?

Answer 192

Triad: flank pain, hematuria, and abdominal renal mass - Patients usually asymptomatic. - first diagnostic test is abdominal ultrasound

Question 193

Glomerular disease that is associated w/ hypertension, edema, and active urine sediment w/ hematuria, blood casts, and protein-uria. What is this condition?

Answer 193

Nephritic syndrome

Question 194

Which glomerular disease is associated w/ greater than 3.5 g of protein in urine that is accompanied by hypoalbuminemia, hyperlipidemia, and edema?

Answer 194

Nephrotic syndrome

Question 195

What is the classic triad of renal cell carcinoma?

Answer 195

Triad: flank pain, hematuria, and abdominal renal mass - Patients usually asymptomatic. - first diagnostic test is abdominal ultrasound

Question 196

Patient has chlamydia, the most common bacterial sexually transmitted disease in the US. Caused by Chlamydia trachomatis. He has inclusion conjunctivitis (chronic infection w/ large inferior, palpebral conjunctival follicles). What is the Tx plan?

Answer 196

Tx of chlamydia include Azithromycin or Doxycycline "C" for Chronic conjunctivitis

Question 197

Female pt infected with Neisseria Gonorrhea. Pt experiences common symptoms of gonorrhea which include severe, hyperacute, purulent discharge. How should you treat this patient?

Answer 197

Treatment of gonorrhea consists of a single dose of Ceftriaxone 125 mg IM plus Doxycycline 100 mg p.o. bid x 7 days. - Doxycycline will be given w/ ceftriaxone to cover for chlamydia (most common STD in US) because chalmydia trachomatis often cohabitates with N. Gonorrhea.

Question 198

Which stain do you confirm the dx of HSV with?

Answer 198

Wright-Giemsa stain

Question 199

Which spirochete bacteria causes Syphilis?

Answer 199

Treponema pallidum Primary/early phase = cancre (painless ulcer in genital region) Secondary lesions = eye, kidney, mucous membranes, skin, CNS or liver Tertiary phase = nerve system and ophthalmic lesions including an Argyll Robertson pupil

Question 200

Describe an Argyll Robertson pupil (found in tertiary phase of syphilis)

Answer 200

(-) APD (-) direct light response (+) nerve accommodative response

Question 201

List ocular manifestations of syphilis (Treponema pallidum).

Answer 201

- interstitial keratitis, retinitis, and retinal vasculitis - salt and pepper fundus and flame-shaped retinal hemorrhages - Uveitis (less than 1% of uveitis patients, can be granulomatous or non-granulomatous) - cranial nerve and optic neuropathies (diplopia) - acute multifocal chorioretinitis and vitritis (panuveitis) (similar to toxo)

Question 202

What are the screening tests (active infection) for syphilis?

Answer 202

- RPR: rapid plasma reagin test - VDRL: veneral disease research laboratory test - EIA: enzyme immunoassay test

Question 203

What are the diagnostic tests (lifetime infection) for syphilis (treponema pallidum)?

Answer 203

- FTA-ABS (fluorescent treponemal antibody absorption test - TPPA: treponema pallidum particle agglutination assay dark field microscopy - MHA-TP: microhemagglutination assay

Question 204

What is a common tx for BPH (benign prostate hypertrophy)?

Answer 204

Terazosin (Flomax®), which relaxes prostate muscles. Alpha-1-blocker. Side effect of floppy eye syndrome

Question 205

Describe pre-eclampsia which can occur from 20 wks of gestation to 6 wks post-partum. Occurring d/t pregnancy.

Answer 205

Pre-eclampsia is characterized by triad of blood pressure greater than 140mmHg, protein in urine, and swelling in the lower extremities. - Best tx is delivery. Eclampsia occurs w/ above symptoms AND mother experiencing SEIZURES.

Question 206

Breast feeding occurs because oxytocin (from __________ ________) allows milk ejection and prolactin (from the __________ _________) allows for milk production.

Answer 206

Oxytocin is from the posterior pituitary = milk ejection Prolactin is from the anterior pituitary = milk production (PROlactin = PROduction)

Question 207

What are the most common INCIDENCES of cancers in women and men in the US?

Answer 207

Women: breast > lung > colon cancer Men: prostate > lung > colon cancer

Question 208

What are the most common causes of CANCER DEATH in women and men in the US?

Answer 208

Women: lung > breast > colon cancer Men: lung > prostate > colon cancer

Question 209

Describe the most severe (100% fatal) neural-tube defect disorder in neonates - anencephaly.

Answer 209

Anencephaly is when the orbital bones are nearly normal in size, but there is an absence of normal brain and cranial bone tissue.

Question 210

What is the number one cause of congenital malformation?

Answer 210

Fetal alcohol syndrome

Question 211

What is the generic term that includes non-progressive varied infections, toxins, and congenital malformations in infants?

Answer 211

Cerebral palsy

Question 212

List side effect of Rubella (German Measles?)

Answer 212

- microphthalmia - glaucoma - infant cataracts - heart defects

Question 213

When you see infant cataracts, what should be included in your ddx?

Answer 213

- galactosemia (diabetes?) | - rubella

Question 214

Which bacteria and medication (not necessarily in combination) can result in peptic ulcer disease (generally duodenal or gastric ulcer)?

Answer 214

- Helicobacter Pylori | - chronic NSAID use

Question 215

What is the treatment for peptic ulcer disease?

Answer 215

- H2 bocker - Proton pump inhibitor (PPI) - Combination therapy (either the H2 blocker or PPI with 2 antibiotics for H. Pylori)

Question 216

How can you tell if the peptic ulcer is duodenal or gastric?

Answer 216

Gastric ulcer's main symptom would be pain soon after eating.

Question 217

What is the name of the condition where normal esophageal lining is replaced by metaplastic columnar cells; occurs as a result of squamous changing to columnar cells?

Answer 217

Barrett's Esophagus, which can lead to esophageal adenocarcinoma, which requires surgical resection of the esophagus. Treatment would include long-term PPI (proton pump inhibitors).

Question 218

Which conditions are HLA-B27 positive again? U-CRAP

Answer 218

U-CRAP - ulcerative colitis - Crohn's disease - reactive arthritis - ankylosing spondylitis - psoriatic arthritis

Question 219

Copper needs to enter the circulation in the form of ceruloplasmin. When this fails to occur, you get copper accumulation that is most concentrated in the liver, brain, and cornea (Kayser-Fleischer Ring). What is the name of this condition?

Answer 219

Wilson's disease. Some manifestations include a sunflower cataract, cirrhosis of the liver, basal ganglia degeneration, and dementia. Tx includes pencillamine (Cuprimine®) that is a chelating agent (binds copper). Ocular side effects of pencillamine include ocular myasthenia (diplopia, ptosis), ocular pemphigoid, and optic neuritis.

Question 220

Which 2 enzymes that are contained within liver cells will always be released into the blood in increased concentrations d/t hepatitis (regardless of the etiology)?

Answer 220

AST and ALT liver enzymes

Question 221

There are 5 types of Hepatitis (viral inflammatory condition of the liver parenchyma that leads to necrosis) which types have a vaccine or medication readily available?

Answer 221

- Hep A: vaccine available (0, 6-12 months), spread via fecal oral route, limited infection. - Hep B: vaccine available (0, 6-12 months), spread via blood, IV drugs, and sex. Active infection w/ brief course. - Hep C: No vaccine available. Spreads like Hep B. Chronic hepatitis will develop in approximately 80% of pts. Tx available (ribovirin with interferon) - Hep D: carried only w/ Hep B as a superinfection. Increased morbidity and mortality. - Hep E: no vaccine available, spread fecal oral route.

Question 222

Which type of hepatitis has vaccines readily available?

Answer 222

Hep A (fecal oral rout) and Hep B (blood, IV drugs, and sex)

Question 223

What is the name for yellowing of the skin and conjunctiva caused by a build-up of urobilinogen (converted from conjugated bilirubin by bacteria and directly from heme metabolism) and bilirubin? This commonly occurs in cirrhosis, hemolytic disorders, and obstructive gallbladder disorders.

Answer 223

Jaundice

Question 224

Common bacteria responsible for otitis media (pain in ear) and treatment (hint, gram + bacteria are responsible)?

Answer 224

- Strep. Pneumoniae and H. Influenza responsible. - Tx: amoxicillin or other gram positive agents Otitis media common in infants and children.

Question 225

What is the name of the condition that includes episodic and often severe vertigo, hearing loss, and tinnitus (ringing of ears)?

Answer 225

Meniere's disease (disorder of the inner ear)

Question 226

What is the disease that is marked by an enlargement of air spaces and a decrease in recoiling because of destruction of the alveolar walls. Symptoms will include shortness of breath (dyspnea), decreased breath sounds, and tachycardia.

Answer 226

Emphysema (pink puffers) | - narrowing of small airways and break down of lung tissues

Question 227

What is the disease marked by productive cough for 3 consecutive months in 2 or more years d/t hypertrophy of mucous-secreting glands in the bronchioles. Common symptoms will include cyanosis of the fingers and toes and wheezing/crackling of lungs.

Answer 227

Chronic bronchitis (blue bloaters)

Question 228

Pt is treated with an inhaled steroid for his asthma, what is the most likely pathophysiology of his asthma?

Answer 228

Chronic inflammation of the airways. Pt most likely does not have an acute reversible bronchoconstriction -- otherwise he would have just been on beta-2 agonist inhaler for bronchodilation (albuterol, isoproterenol, and metaproterenol)

Question 229

Which ocular medication would be contraindicated in patient's with asthma?

Answer 229

Beta-blockers for glaucoma (timolol, betaxolol)

Question 230

What is the treatment for TB, tuberculosis (mycobacterium tuberculosis)?

Answer 230

- RIPES | Rifampin, isoiazid, pyrazinamide (not on NBEO outline), ethambutol

Question 231

What are the 2 most common etiologies for someone with chronic, bilateral, anterior, granulomatous uveitis?

Answer 231

TB and sarcoid

Question 232

Influenza is an acute respiratory illness caused by what?

Answer 232

Influenza A or B viruses. Symptoms include fever, cough, rhinitis, headache, and myalgias

Question 233

What are neoplasms with an epithelial embryologic origin?

Answer 233

Adenocarcinoma, squamous cell carcinoma

Question 234

What are neoplasms with a lymphoproliferative embryologic origin?

Answer 234

Leukemia, lymphoma

Question 235

What is a neoplasm with a mesenchymal embryologic origin?

Answer 235

Sarcoma

Question 236

What is the most common primary ORBITAL MALIGNANCY (neoplasm)?

Answer 236

Rhabdomyosarcoma is a connective tissue cancer that causes bone destruction. Arises from mesenchymal (connective) tissue.

Question 237

What is the SECOND MOST COMMON form of skin cancer and results from metaplasia?

Answer 237

Squamous cell carcinoma (no telangectasia present)

Question 238

Which genes (when activated) turn cancer "on" by allowing mutated cells, which normally die secondary to apoptosis, to survive and proliferate into a cancer?

Answer 238

Oncogenes | Example: "Ras" oncogene which has been found to play a role in specific cancers

Question 239

Which genes have a repressive effect on the regulation of the cell cycle and/or promote apoptosis when turned "on," thus preventing DNA damage and regulates cellular activities?

Answer 239

Tumor Suppressor genes. | The loss of tumor suppressor genes, such as the BRCA gene in breast cancer, can lead to cancer.

Question 240

What is the name of the condition that involves protein malnutrition resulting in skin lesions, anemia, edema, and liver malfunctions? The clinical presentation will include a very swollen belly on a malnourished appearing patient.

Answer 240

Kwashiorkor

Question 241

What is the name of a protein calorie malnutrition resulting in tissue wasting? Clinical appearance will be an overall wasting and weight loss in affected individuals.

Answer 241

Marasmus

Question 242

Wernicke-Korsakoff syndrome is a deficiency of which vitamin? It is associated with alcoholism and can lead to a toxic optic neuropathy that leads to bilateral temporal optic nerve pallor.

Answer 242

Deficiency in vitamin B1 (thiamine)

Question 243

Benzodiazepines are given to which patient? (The one with depression or the one with anxiety).

Answer 243

Benzos are given to the patients with anxiety, not depression.

Question 244

Schizophrenia is due to increased levels of ___________ in the mesolimbic region. Patients are treated with antipsyhotic medications.

Answer 244

Increased levels of dopamine in the mesolimbic region.

Question 245

When the cobalt blue filter is used without fluorescein, you observe black rings on the cornea. What is this deposit most likely and which disease is it associated with?

Answer 245

You are seeing iron rings (appearance of black w/ cobalt blue filter) that are present in Fleischer rings (keratoconus).

Question 246

When you have commotio retinae in the macula, where trauma causes disruption of RPE from the photoreceptor outer segments, it is given the name of _____________. Also includes gray white discoloration in area.

Answer 246

Berlins edema

Question 247

Vossius ring is pigment imprint made on the anterior lens surface from contact with......

Answer 247

Posterior pigmented iris epithelium during trauma | This can develop into a traumatic cataract.

Question 248

Which bacteria most likely affect adults and children, including in orbital cellulitis?

Answer 248

Adult: staphylococcus aurea (strep as well) Children: haemophilus influenza

Question 249

Sign caused by upper eyelid lag on down gaze.

Answer 249

Von Graefe's sign

Question 250

Sign when there is globe lab compared to lid movement when looking up.

Answer 250

Kocher's sign

Question 251

Sign when lid retraction occurs resulting in a stare appearance.

Answer 251

Dalrymple's sign

Question 252

There is a clinical triad of chemosis, pulsatile proptosis, and ocular bruit. What condition would this patient have?

Answer 252

Carotid cavernous fistula | Results from an abnormal communication between the arterial and venous systems.

Question 253

What goes through the carotid cavernous?

Answer 253

CN 3, 4, 6, V1, V2; 5 and 7 dont go through.

Question 254

True or False. | In thyroid eye disease, there is widespread inflammation throughout the orbit including the tendons of the EOMs.

Answer 254

FALSE Tendons of EOMs are not inflamed in TED. Here we are talking about a possible orbital pseudotumor (rare) and you would order a CT/MRI to aid in diagnosis because this will show enlargement of EOMs and TENDONS.

Question 255

Orbital pseudotumor is an idiopathic inflammatory process that can impact any soft tissue component of the orbit. What is the name of another rare idiopathic orbital inflammation, but this time affecting the cavernous sinus and superior orbital fissure?

Answer 255

Tolosa-Hunt syndrome

Question 256

What procedure involves removal of the globe?

Answer 256

Enucleation

Question 257

Which procedure involves removal of the inner contents of the eyes? The sclera and other orbital contents remain.

Answer 257

Evisceration

Question 258

Which procedure involves removal of ALL contents of the orbit, including EOMs and orbital fat?

Answer 258

Exenteratiom

Question 259

Where do internal and external hordeolums affect?

Answer 259

Internal affects meibomian glands. | External affects the glands of Zeis or Moll. Also know as a stye.

Question 260

What is an eversion of the lid away from the globe of the eye called? The most common cause is age related (involutional) loss of muscle tone of the orbicularis oculi.

Answer 260

Ectropion

Question 261

What is an inversion of the eyelid against the globe called? Causes include age related, cicatricial (trachoma, OCP, Stevens Johnson syndrome, chemical burns, previous lid surgeries, trichiasis, distichiasis), and congenital (rare).

Answer 261

Entropion Trichiasis: eyelashes grow posteriorly from their site of origin Distichiasis: a second row of eyelashes arises from the meibomian gland openings

Question 262

Benign essential bleharospasm (BEB) involves which ocular muscles?

Answer 262

- orbicularis oculi - procerus - corrugator

Question 263

Which syndrome is characterized by BEB and lower facial abnormalities (i.e. Difficulty chewing and opening the mouth, jaw spasms, jaw pain, etc.)?

Answer 263

Meige's syndrome; approximately 50% of patients with BEB have Meige's.

Question 264

Which muscle is involved in myokymia?

Answer 264

- orbicularis ocular ONLY

Question 265

Which eyelid cancer is the most common (90% of all eyelid malignancies), associated w/ UV exposure (especially UV-B), and usually consists of a chronic shiny, firm, pearly nodule with superficial telangiectasia that can eventually develop central ulceration (into a "rodent ulcer")

Answer 265

Basal Cell Carcinoma

Question 266

Which layer does squamous cell carcinoma affect?

Answer 266

Stratus spinosum layer of the epidermis. Will appear similar to BCC, but without surface telangiectasia.

Question 267

Your patient in Phoenix, AZ has a central plaque located on their eyelid. The tumor grows very quickly to a large size (1-2cm) and then suddenly started shrinking. At their next annual eye exam, the plaque is gone! Which maligancy is this?

Answer 267

Keratoacanthoma - has a similar appearance to BCCs and SCCs.

Question 268

Pt has a recurrent chalazia. You later realize it is a neoplasm of the sebacious glands of the eyelids (meibomian and Zeis glands) that may be associated with prior radiation therapy. Which malignancy is this?

Answer 268

Sebaceous gland carcinoma

Question 269

What are the ABCDE characteristics of suspicious skin lesions for malignant melanoma? Remember that the depth of invasion and lesion size are the two most important pronostic factors for malignant melanoma.

Answer 269

``` A: asymmetry B: border irregularity C: Color difference (uneven pigmentation) D: Diameter (large) E: Enlargement of the lesion ```

Question 270

Define punctal stenosis.

Answer 270

Defined as a narrowing or occlusion of the puncta of the upper and/or lower lids. Commonly defined as a punctal diameter less than 0.3mm or as the inability to intubate the puncta with a 26 gauge cannula.

Question 271

Which valve is blocked in the 5-30% of newborns with nasolacrimal duct obstruction?

Answer 271

Valve of Hasner | Spontaneous opening of the valve of Hasner will frequently occur 1-2 months after birth.

Question 272

Jones 1 and 2 testing is used to evaluate the ability of the tears to pass through the lacrimal drainage system. When you have reflex of fluid through the same punctum, this indicates an obstruction where?

Answer 272

Obstruction w/in upper or lower canaliculus = reflex of fluid through same punctum. Nasolacrimal blockage: retrograde flow through the opposite canaliculus and punctum If the Jones 2 test failes, a dacryocystorhinostomy (DCR) should be performed.

Question 273

What's another name of conjunctival concretions?

Answer 273

Ocular lithiasis

Question 274

You notice a pigmented patch with indistinct margins located somewhere on the conjunctiva of the right eye. What do you write in the chart?

Answer 274

Primary Acquired Melanosis, PAM Though can be benign, it has premalignant potential. 30% of cases progress to malignant melanoma. You should be more suspicious of nodular lesions with increased vascularity and/or increased growth.

Question 275

What do you call a pigmented or non-pigmented lesion (previously from PAM) on the conjunctiva?

Answer 275

Conjunctival melanomas: commonly arise from PAM (50-75% of cases), less commonly from a pre-existing nevus (33% of cases) and rarely de novo. Most important prognostic indicator for progression to malignancy is the thickness of lesion. Most common site of metastasis is the liver.

Question 276

Conjunctival intraepithelial neoplasia, CIN, is the MOST COMMON conjunctival malignancy in the US. It is also known as Bowen's disease or conjunctival squamous dysplasia. Which malignancy is CIN able to progress to?

Answer 276

Squamous cell carcinoma

Question 277

You see a pedunculated, benign, red, vascular lesion of the palpebral conjunctiva on your patient; what is this called?

Answer 277

Pyogenic granuloma (results from trauma, surgery, chalazion, or other sources of chronic irritation).

Question 278

Pt experiences acute (within an hour) onset of redness that began in one eye and then to the other. He has foreign body sensation, mucopurulent discharge, and his eyelids are stuck together when he wakes up. What is this? And what is the treatment?

Answer 278

Simple bacterial conjunctivitis. H. Influenza in children. S. Epidermidis or S. Aureus in adults. Symptoms subside 10-14 days without treatment.

Question 279

Pt experiences a hyperacute (know the minute) onset of severe purulent discharge. Additional symptoms include redness, foreign body sensation, and eyelids stuck together upon waking up. It started in one eye, now both eyes are affected. Which bacterial conjunctivitis is responsible for this?

Answer 279

``` Gonococcal conjunctivitis (Neisseria gonorrhea) Important Signs: severe purulent discharge (often w/ pseudomembranes), marked preauricular lymphadenopathy. ``` N. Gonorrhea can invade an intact cornea!! (CNHL)

Question 280

Preauricular lymphadenopathy and pseudomembranes are typically associated with viral conjunctivitis. What is the only bacterial conjunctivitis that can commonly cause both these signs?

Answer 280

Neisseria gonorrhea

Question 281

Xerophthalmia can cause excessive evaporation leading to ocular surface disease. What is another name for xerophthalmia and what finding is it associated with on the conjunctiva?

Answer 281

Vitamin A deficiency (decreasing amount of goblet cells). Associated with Bitot's spots on the conjunctiva. http://webeye.ophth.uiowa.edu/eyeforum/atlas/photos/Bitots-spot.jpg

Question 282

What are the associated conditions of keratoconus? T-DOME

Answer 282

Turner syndrome, Down's syndrome. Osteogenesis imperfecta, Marfan's syndrome, Ehlers-Dalos syndrome. Also associated with atopic dermatitis and mitral valve prolapse.

Question 283

Which ring made of iron deposits at the base of the cone (best seen w/ cobalt blue filter, appearing dark) is seen Keratoconus? And when does this sign occur?

Answer 283

Fleischer's Ring, which is an EARLY sign.

Question 284

Vogt's striae (vertical lines in deep stroma), Munson's sign (lower lid protrusion on downsize), Rizzuti's sign (conical reflection on the nasal cornea when a light is shown from the temporal side) and hydrous (tears in Descemet's membrane that result in edema and rupture of the epithelium) are all signs of Keratoconus. During which stage of the disease progression do these signs occur?

Answer 284

Late stage.

Question 285

Patients coming in with corneas measuring 48-54D should be diagnosed with which form of Keratoconus? a. mild b. moderate c. severe

Answer 285

Answer: B, moderate mild 54D

Question 286

Autosomal recessive ocular diseases:

Answer 286

- keratoglobus - Macular Dystrophy - Usher's syndrome (w/ congenital hearing loss) - Stargardt's disease (most common hereditary macular dystrophy). - gyrate atrophy

Question 287

Which corneal dystrophy results in abnormal development and replacement of Bowman's layer with collagen? a. Meesman's Dystrophy b. Reis-Buckler Dystrophy c. EMBD: epithelial basement membrane dystrophy d. Cogan's microcytic dystrophy

Answer 287

Answer: B, Reis-Buckler Dystrophy - The amount of recurrent corneal erosions are common in early life and decrease with age. Logan's microcytic dystrophy is the same as EMBD. (aka Map-Dot Fingerprint, ABMD)

Question 288

Which stromal corneal dystrophy is (relatively) common after LASIK and is a rare variant of granular dystrophy? It is characterized by granular AND lattice-like deposits within the central stroma. It is also known as granular-lattice dystrophy.

Answer 288

Avellino dystrophy

Question 289

Which mutation is responsible for granular, lattice, and avellino dystrophies? (Macular stromal dystrophy is NOT associated with this gene mutation).

Answer 289

TGFB1, transforming growth factor beta 1

Question 290

Which stromal corneal dystrophy is associated with current or past high cholesterol?

Answer 290

Schnyder's Dystrophy ("Schnyder eats too many buttery pretzels")

Question 291

What are the types of deposits for the stromal dystrophies? Marilyn Monroe Got High in LA

Answer 291

``` Macular = Mucopolysaccharide deposits Granular = Hyaline deposits Lattice = Amyloid deposits ```

Question 292

In Fuchs' Endothelial Dystrophy when the endothelial cell counts are less than 500 cells/mm2 edema can occur in which layer of the cornea?

Answer 292

stromal edema

Question 293

Describe the DSEK treatment for Fuchs' Endothelial Dystrophy.

Answer 293

Takes out the endothelial, Descemet's membrane and the posterior stroma.

Question 294

You find bilateral subtle patches of vesicles (hallmark sign), band lesions (linear "train track lesions") and diffuse opacities at the level of Descemet's membrane and the endothelium. What posterior corneal dystrophy do you think you're seeing?

Answer 294

Posterior polymorphous dystrophy | Bilateral, autosomal dominant occurring 2nd or 3rd decade (can be a "cloudy corneal" at birth)

Question 295

Pt has congenital glaucoma. You see horizontal cracks (clear parallel lines) in Descemet's membrane from increased IOP. What are these cracks called?

Answer 295

Haab's striae

Question 296

What is an anteriorly displaced Schwalbe's line called? And what disease is this a hallmark for?

Answer 296

Posterior embryotoxin, a hallmark for Axenfeld-Rieger Syndrome.

Question 297

What has posterior embryotoxin + angle abnormalities + increased glaucoma risk?

Answer 297

Axenfeld anomaly

Question 298

What has posterior embryotoxin + increased glaucoma risk + iris stromal abnormalities?

Answer 298

Rieger ANOMALY

Question 299

What has posterior embryotoxin + increased glaucoma risk + iris stromal abnormalities + systemic abnormalities?

Answer 299

Rieger SYNDROME

Question 300

Gram (-) pathogens:

Answer 300

- Pseudomonas aeruginosa: most common gram (-) found in severe bacterial keratitis.

Question 301

Which bacteria can invade an intact corneal epithelium? CNHL

Answer 301

Corynebacterium diphtheria, Neisseria gonorrhea and meningitides, Haemophilus, and Listeria

Question 302

Define corneal ulcer.

Answer 302

(+) infiltrate | (+) corneal epithelial defect

Question 303

Do infiltrates stain?

Answer 303

NO (to very mild

Question 304

What type of agar should suspected Aspergillus or Fusarium species be cultured on?

Answer 304

Sabouraud's agar

Question 305

What is the name of a condition found in HSV keratitis that is characterized by an infiltrate with diffuse neovascularization, an immune ring (Wessley ring), stromal thinning and subsequent scarring?

Answer 305

Interstitial keratitis; the epithelium and endothelium are NOT INVOLVED. - Most patients are born with IK as a result of congenital syphilis (90%). In the US, IK is typically a result of herpetic disease.

Question 306

Endotheliitis is a secondary stromal edema due to an immune reaction against a viral antigen or live virus within the corneal endothelium. What is another name of endotheliitis?

Answer 306

disciform keratitis - Unlike interstitial keratitis, stromal infiltrates and neovascularization are NOT PRESENT in disciform endothelilitis (keratitis)

Question 307

Post herpetic neuralgia and depression is present in which herpetic infection?

Answer 307

Varicella zoster virus, HZV

Question 308

An older patient presents with a unilateral peripheral crescent-shaped gray infiltrate on their cornea. The ulcer continues to enlarge concentric to the limbus with an overhanging edge. After 3 weeks it appears the ulcer has self-limited. Pt reports severe pain, redness, tearing and photophobia. What kind of peripheral ulcerative keratitis is this called?

Answer 308

Mooren's ulcer

Question 309

Staphylococcal marginal keratitis results from what type of hypersensitivity response (typically to chronic staphylococcal blepharitis)?

Answer 309

Type 3 hypersensitivity response

Question 310

Rheumatoid arthritis, systemic lupus erythrematosus (SLE), polyarteritis nodosa, and Wegener's granulomatosis can cause peripheral corneal thinning and/or ulcer because they are all what type of system vascular disorder?

Answer 310

systemic collagen vascular disorders (there are other disorders not mentioned here)

Question 311

Systemic conditions that cause increased serum calcium or phosphorus levels, including gout (check uric acid levels), hypercalcemia, sarcoidosis, and renal failure (check blood urea nitrogen and creatine levels) can result in this condition? (calcium deposits found in Bowman's membrane or in the sub-epithelial space that appear as white spots w/ a swiss-cheese pattern)

Answer 311

Band keratopathy; calcium deposits located 3 and 9 o'clock in the periphery so patients are usually asymptomatic.

Question 312

Where does lipid deposition occur in Arcus senilis?

Answer 312

Peripheral cornea beginning on Descemet's membrane and is subsequently deposited on Bowman's layer before extending into the stroma. If you have unilateral arcus, you should consider carotid disease on the side WITHOUT the arcus. Arcus in patients younger than 50 is associated with an increased risk of coronary artery disease; lipid profile should be completed.

Question 313

Corneal farinata is known as bilateral "flour dust." Where are corneal farinata located?

Answer 313

most commonly in the central deep stroma

Question 314

Corneal graft rejection is a type 4 hypersensitivity response. When it is a stromal rejection it is associated with subepithelial infiltrates and is known as what?

Answer 314

Krachmer's spots (stromal rejection w/ SEI) - Endothelial rejection line is characterized by WBCs on the endothelium that form a Khodadoust line.

Question 315

Are the following absolute or relative contraindications for refractive surgery? - younger than 18 years old, w/ unstable refractive findings within the last year - unrealistic expectations - keratoconus, active herpes simplex keratitis, contact lens warpage - connective tissue disease (i.e. keloid formers), collagen vascular disease, immunocompromised disease (i.e. chronic steroid use)

Answer 315

absolute contraindications for refractive surgery

Question 316

Are the following absolute or relative contraindications for refractive surgery? - blepharitis, dry eye syndrome, chronic eye rubbing, ocular surface disease, large pupils - diabetes mellitus - primary open angle-glaucoma - pregnancy - retinal thinning/lattice degeneration

Answer 316

relative contraindications for refractive surgery

Question 317

Which part of the cornea is removed in LASIK (laser-assisted in situ keratomileusis)?

Answer 317

anterior stromal bed

Question 318

Your patient presents with a fine, granular, sand-like infiltrate approx 2-3 days after their LASIK surgery. They sometimes experience photophobia, blurry vision, foreign body sensation and pain... and sometimes they don't notice it. What is this condition known as? Sands of the Sahara (but what's another name for it?)

Answer 318

Diffuse lamellar keratitis (DLK). Rare, inflammatory, non-infectious reaction that occurs at the lamellar interface between the corneal flap and the stroma. Most likely caused by toxins (i.e. blade debris, microkeratome oil). DLK is less common w/ disposable microkeratomes.

Question 319

You notice either a faint gray line or white, milky deposits within 2 mm of the flap edge interface 1 month after your patient's LASIK procedure. What is this complication known as?

Answer 319

Epithelial ingrowth Pt usually asymptomatic and condition is not treated unless progression documented, the visual axis obstructed, greater than 2 mm ingrowth occurs from flap edge, or results in corneal astigmatism. Epithelial ingrowth is the most common complication associated w/ a LASIK enhancement!!! (DED is the most common w/ the first LASIK procedure).

Question 320

What are the small, star-shaped, pigmented deposits on the anterior capsule of the lens called? They are the residual remnant of the tunica vasculosa lentis.

Answer 320

Epicapsular stars

Question 321

Lens to examine the optic disc, macula, posterior pole and central vitreous. Non-contact. Provides a stereoscopic, erect, and magnified image.

Answer 321

Hruby lens

Question 322

The three-mirror lens provides a stereoscopic, reversed (anterior-posterior direction), and magnified image of the retina 180 degrees away from the position of the mirror. What does each mirror view? 1. Trapezoidal mirror (angled at 73º from corneal plane) 2. Square mirror (67º from the corneal plane) 3. Bullet mirror (59º from the corneal plane)

Answer 322

1. Trapezoidal mirror: equator region & vortex views; this is your most peripheral 2. Square mirror: used to evaluate the area between anterior equator and ora serrata 3. Bullet mirror: used to evaluate the anterior chamber angle and the ora serrata. (least peripheral)

Question 323

What is the sign associated when retinal pigment epithelium is released into the anterior vitreous after a retinal tear? What is another name this sign goes by?

Answer 323

Share's sign, aka "tobacco dust"

Question 324

Which type of hemorrhage is located between the retina and an intact posterior vitreous face; appearing very red and often has a keel shape?

Answer 324

pre-retinal vitreal hemorrhage

Question 325

Which type of hemorrhage is located within the vitreous (anterior to the posterior vitreous face)? Chronic cases will appear yellow.

Answer 325

Vitreous Hemorrhage; diabetic retinopathy is the most common cause of a spontaneous vitreous hemorrhage (31-54% of cases)

Question 326

What is the ocular disease most commonly associated with CRVOs?

Answer 326

Glaucoma; up to 40-60% of patients w/ CRVO have POAG.

Question 327

Neovascular glaucoma is a major concern in patients with CRVOs and is most likely to develop within the first 3 months of diagnosis; what is a nickname for this glaucoma?

Answer 327

90 day glaucoma - 33% of ischemic cases develop NG - 6% of non-ischemic develop rubeosis or angle neovascularization

Question 328

Ischemic CRVO is worse than non-ischemic. Which test is necessary to identify ischemic CRVO?

Answer 328

10 DD or more of non perfusion on fluorescein angiography. | 90% of cases present with 20/200 vision or worse, and the prognosis is poor (final VA CF or worse)

Question 329

Which tests should be ordered for a suspected GCA, giant cell arthritis?

Answer 329

ESR: erythrocyte sed rate CRP:

Question 330

In order to meet the diagnosis for severe NPDR the pt has the meet one of the three criteria of the 4-2-1 rule. What are the three rules?

Answer 330

1. severe retinal hemorrhage in 4 quadrants 2. venous beading in 2 quadrants 3. IRMA in 1 quadrant

Question 331

Proliferative diabetic retinopathy occurs in 5% of patients with DR and is dx'd based on the presence of neovascularization. The risk of vision loss is characterized by High Risk Characteristics, what are these HRCs?

Answer 331

1. NVD greater than 1/4 DD w/in 1 DD of the ONH. | 2. Any NVD or NVE w/ an associated vitreous or pre-retinal hemorrhage.

Question 332

To be dx'd with macular edema you need to have one of three criteria. List criteria for CSME.

Answer 332

Clinically significant macular edema: 1. retinal thickening w/in 500µm (1/3 DD) of the foveal center 2. hard exudates w/in 500µm of the foveal center w/ adjacent retinal thickening 3. retinal thickening of at least 1DD w/in 1DD of the foveal center

Question 333

Which HTN retinopathy scale is this? (name) Stage 1: mild to moderate diffuse narrowing of the retinal arteries (w/o focal constriction) Stage 2: stage 1 plus focal constriction of the retinal vasculature (arteriovenous nicking) and exaggeration of the arterial light reflex. Stage 3: stage 2 plus retinal hemorrhages, CWS, hard exudates (likely in star configuration w/in the OPL radiating away from fovea) and retinal edema Stage 4: stage 3 plus papilledema (malignant HTN). Patients w/ malignant hypertension must be hospitalized immediately due to a high risk of stroke! BP at this stage is usually >220/120.

Answer 333

Keith-Wagener-Barker classification

Question 334

What are choroidal infarcts that occur in severe HTN retinopathy known as?

Answer 334

Elschnig spots

Question 335

Pt presents with unilateral dot/blot hemorrhages of the mid peripheral funds, dilated non-tortuous retinal veins, narrowed retinal arteries, and possible NVD and/or anterior segment (NVI/NVA). What are your ddx? List reasoning.

Answer 335

Ddx: giant cell arteritis, ocular ischemic syndrome (OIS), venous stasis retinopathy Venous stasis and OIS can be secondary to atherosclerosis or GCA. Venous stasis: no anterior segment involvement OIS: anterior segment signs and symptoms. Commonly associated with systemic HTN, DM, and cardiac disease. Cardiac disease is the most common cause of a 40% 5-year mortality rate in these patients.

Question 336

What is the condition found in Waldenstrom's macroglobinemia, multiple myeloma, serum positive rheumatoid arthritis, systemic lupus erythematous, and HIV infection that is the most common cause of hyperviscosity retinopathy?

Answer 336

hyperglobulinemia In hyperviscosity retinopathy there is an increase in resistance of blood flow secondary to elevated levels of plasma proteins, red blood cells, and/or WBCs, resulting in impaired circulation of blood and oxygen through the microvasculature.

Question 337

What is the epidemiology of retinopathy of prematurity (retrolental fibroplasia)?

Answer 337

- premature infants (

Question 338

Give differential list of ocular conditions commonly associated with leukocoria (white pupillary reflex resulting from fibrovascular scarring secondary to a tractional RD in cases of ROP)?

Answer 338

1. Coat's (20% leukocoria) 2. ROP 3. Retinoblastoma (50% leukocoria) 4. toxocariasis

Question 339

What is the most common intraocular malignancy in children?

Answer 339

retinoblastoma

Question 340

What is the most common primary intraocular malignancy?

Answer 340

choroidal melanoma

Question 341

What study established the four main risk factors that increase the risk of progression from dry to wet ARMD? What are the risk factors?

Answer 341

Macular Photocoagulation Study Group 1. Multiple soft drusen (especially if confluent) 2. focal hyper pigmentation 3. HTN 4. smoking

Question 342

Define classic versus occult CNVMs?

Answer 342

Classic CNVMs: well-defined membrane that fills with dye during the early phase of FA Occult CNVMs: poorly-defined membrane w/ late appearing and less intense leakage during FA.

Question 343

At what stage of a macular hole is a positive Watzk-Allen sign reported

Answer 343

Stage 3; large, full-thickness hole w/ an operculum

Question 344

Define nictalopia.

Answer 344

Night blindness

Question 345

Symptoms of retinitis pigmentosa and the classical triad of signs

Answer 345

Symptoms: - night blindness (most common symptom) - peripheral vision loss - associated w/ Usher's syndrome = (+) hearing loss Signs: retinal bone-spicule pigmentation (pigment clumping in the mid-periphery), arteriolar attenuation, and waxy optic disc pallor - ERG used for diagnosis: in the early stages of RP the scotopic ERG is reduced while the photopic ERG is relatively normal.

Question 346

Which dystrophy is the most common hereditary macular dystrophy and has a normal ERG in early stages of the disease?

Answer 346

Stargardt's disease | - ERG will be normal in early stages of the disease, becoming abnormal as the condition progresses.

Question 347

Which retinal/choroid disease is x-linked recessive (all males affects and daughters are carriers) and due to a deficiency in rap gerangyl-geranyl transferase, an enzyme utilized in membrane metabolism?

Answer 347

choroideremia

Question 348

What are the differential diagnosis for night blindness?

Answer 348

- RP (retinitis pigmentosa) - choroidermia - gyrate atrophy

Question 349

What are the differential diagnosis for bull's eye maculopathy?

Answer 349

- Stargardt's disease - progressive cone dystrophy - chloroquine and hydroxychloroquine toxicity - thioridazine toxicity

Question 350

Pt presents with a normal ERG but an abnormal EOG, which condition is this indicative of?

Answer 350

Best's disease

Question 351

Pt presents to clinic with bilateral chorioretinal degeneration due to a deficiency in the mitochondrial enzyme ornithine aminotransferase.

Answer 351

Gyrate atrophy. Ornithine blood plasma levels will be high and can help in the diagnosis if the clinical picture is unclear.

Question 352

Where is the retinal break expected if your patient reports a field defect in the inferior nasal quadrant and flashes of light in their temporal quadrant?

Answer 352

Flashes of light is of no value!!! Inferior nasal quadrant defect = superior temporal retinal break

Question 353

What causes an angioid streak?

Answer 353

Large breaks in Bruch's membrane that result from damage to the elastic core of Bruch's membrane. 50% of cases are idiopathic; remaining cases are due to systemic disease.

Question 354

What are the common causes of angioid streaks? PEPSI

Answer 354

``` Pseudoxanthoma elasticum (most common cause) Ehlers-Dalos syndrome Paget's disease Sickle-cell disease idiopathic ```

Question 355

What is the name given to increased pigmentation anterior to Schwalbe's line?

Answer 355

Sampaolesi's line, which is associated w/ pseudoexfoliation syndrome and pigment dispersion syndrome.

Question 356

During your examination you notice vertically oriented pigment lines on the corneal endothelium, pigment on the anterior capsule of the lens and iris surface and trabecular meshwork hyper pigmentation. What major dx are you thinking of and what's another part of the eye you should check?

Answer 356

pigment dispersion syndrome (glaucoma) Transillumination defects The risk for glaucoma at 5 years is 10%; the risk at 15 years is 15%.

Question 357

Normal tension glaucoma puts females at higher risk. Additional risk factors include vascular disorders such as Raynaud's phenomenon or migraines, low blood pressure, sleep apnea, hyper coagulation, and taking BP medications before bedtime (may decrease ocular perfusion pressure). Which ethnicity is most at risk for NTG?

Answer 357

highest prevalence among Japanese patients

Question 358

What are anterior sub capsular opacities that result from lens epithelial cell ischemia and necrosis secondary to high IOP?

Answer 358

glaucomflecken

Question 359

What is Topamax a treatment for and a glaucoma related side effect?

Answer 359

Tx: migraines, weight loss, and epilepsy | Side effect: acute secondary angle closure

Question 360

What is the difference between peripheral anterior synechiae (PAS) and posterior synechiase (PS)?

Answer 360

PAS: iris (pigments) sticky on trabecular meshwork PS: iris pigments stick to the lens; ultimate cause of iris bombe and pupillary block when there is 360 degrees of attachment between iris and lens, moving the iris anteriorly into contact w/ the TM.

Question 361

Pt comes in with the corneal endothelium having a "beaten metal" appearance with corneal edema and corectopia. What syndrome is this?

Answer 361

Chandler's Syndrome (part of iridocorneal endothelial, ICE, syndromes)

Question 362

Nodules are seen on the anterior iris surface, which ICE syndrome is this?

Answer 362

Cogan-Reese syndrome (iris-nevus syndrome)

Question 363

Pt presents with acute trabeculitis that results an acute elevation of IOP (40-60mmHg). There are a few cells in the anterior chamber and gonioscopy reveals an open angle. This is known as Posner-Schlossman syndrome, a type of inflammatory glaucoma. What is another name for this?

Answer 363

Glaucomatocyclitic crisis

Question 364

Which imaging instrument uses a scanning laser polarimetry to detect thinning of the RNFL?

Answer 364

GDR (Laser Diagnostics Technology)

Question 365

Which imaging instrument uses optic coherence tomography?

Answer 365

OCT

Question 366

Which imaging instrument uses a confocal scanning laser ophthalmoscopy for a topographical evaluation of the ONH and peripapillary retina?

Answer 366

HRT (Heidelberg Engineering)