Neda's typed out notes Flashcards
1
Q
What is the initial glaucomatous damage seen on VFT?
A
Paracentral scotoma
2
Q
What conditions are contraindicated for PG drugs for glaucoma?
A
- History of Uveitis
- CME
- HSK
- Complicated cataract surgery
3
Q
What is the known ocular complication of a topical beta blocker?
A
Narrow Angles.
Pt’s who have a low BPM (Bradycardia), which ultimately should be avoided.
4
Q
What are the 2 contraindications of CAI usage in glaucomatous pt’s?
A
Corneal endothelial compromise (Fuch’s dystrophy) and Sulfonamide allergy.
5
Q
What are the 2 systemic side effect relative contraindication in patient taking what certain medications?
A
MAO inhibitors and Bradycardia
6
Q
When should you assess the efficacy of a topical drop in a glaucomatous patients?
A
4 to 6 weeks
7
Q
When should be the follow up for a pt who has achieved their target IOP?
A
3 to 6 months
8
Q
Signs: Recurrent attacks of unilateral acute raised IOP (Usually 40 to 60mmHg) associated with mild anterior uveitis?
A
Posner Schlossman Syndrome
9
Q
What is the “speculated” cause of Posner Schlossman syndrome?
A
Acute Trabeculitis ; possibly by CMV or H. Pylori
10
Q
What is the treatment for Posner Schlossman syndrome?
A
- IOP controlling meds (Timolol 0.5% BID
- Short course (1 week) steroids (Prednisolone Acetate 1% QID)
- If significantly high, use Oral CAI
11
Q
True or False, synchiae are formed during Posner Schlossman syndrome?
A
False. Synechiae and optic nerve damage is not seen. However, corneal edema is.
12
Q
Which two layers of the angle will you see black pigment with a pt who has Pseudo-exfoliation syndrome?
A
Trabecular meshwork and Anterior to Schwalbe’s line (Sampaolesi line)
13
Q
When is IOP the highest?
A
Night time
14
Q
When is Aq humor production the lowest?
A
12am to 6 am
15
Q
When Aq humor production the greatest?
A
In the morning
16
Q
What is the fastest peak glaucoma drug?
A
Beta blocker
17
Q
When does a drance heme go away?
A
1 to 3 months
18
Q
What is the most common location for a drance heme?
A
Inferior Temporal
19
Q
Which condition likely occurs due to elevated IOP following retinal vascular conditions?
A
CRVO
20
Q
What is the IOP target when to treat for precautionary measure to avoid CRVO?
A
30 mmHg and above
21
Q
How long does it take for a “steroid” to cause an increase in IOP?
A
4 weeks
22
Q
How would you taper steroids?
A
Start by prescribing QID x 5 days, then tapers to BID x 5 days and then qd x 5 days.
Note: Longer the treatment period or frequent dosage, the longer the taper will be.
23
Q
What is the most commonly encountered form of infantile glaucoma?
A
Primary Congenital glaucoma
24
Q
What are the signs of Primary congenital glaucoma?
A
Male 75% Bilateral Before 1st birthday Sporadic orgin Abnormal angle (either flat iris insertion or a concave iris insertion) No systemic condition No inheritance pattern
25
What are the symptoms of Primary congenital glaucoma?
Photophobia, epiphora and blepharospasm
Note: Corneal appear cloudy due to corneal edema.
26
Which layer of the cornea will result in a tear when a pt has Primary congenital glaucoma?
Descemet's
27
If the glove enlarges and the structures stretch with a pt suffering from primary congenital glaucoma is called?
Buphthalmos
28
What are horizontal breaks called when associated with congenital glaucoma? Which layer does this occur?
Haab's striae and ruptures in Descemet's membrane
29
What is the preferred procdeure for Congenital glaucoma?
Goniotomy (TM is incised)
Note: Trabeculectomy is used as a last resort when the cornea is not transparent and Schlemm's canal cannot be located.
30
What occurs to the cupping observed earlier in congenital glaucoma?
Reverses back to normality due to increased elasticity of connective tissue
31
When should a pt return with POAG?
1 month
The reason is to get various IOP readings throughout the day's time frame and to establish a baseline and to re-measure IOP.
32
What test would aid in the diagnosis of OHTN?
VF Test; Should be within normal limits for OHTN pt's.
This was the criteria in the Ocular Hypertension Treatment study (OHTS)
33
What is the first line of drug for the treatment of open angle glaucoma and ocular hypertension?
PG's. It lowers the most amongst all classes of glaucoma medications.
34
What is the second line of choice for glaucomatous patients'?
Beta Blockers ; if no heart rate or asthma issues.
35
What is the typical clinical presentation of a pt with plateau iris?
Female
30 to 50's
Myopic Refractive error
36
What is the common sign seen with indentation gonioscopy is preformed on a plateau iris?
Double hump sign
Note: LPI should be considered as a first line of treatment to counter act pupillary block
37
What is the treatment for PDS?
Miotic agent is the first line of treatment (Pilocarpine 4% gel qhs)
38
What is stage 1 in neovascular glaucoma?
Rubeosis iridis
39
What is stage 2 in neovascular glaucoma?
Open angled neovascular glaucoma
40
What is stage 3 in neovascular glaucoma?
Angle closure neovascular glaucoma
41
Where does iris neovascularization occurs?
Pupillary margin
42
What is the firstline of treatment for neovascular glaucoma?
Panretinal photocoagulation
43
Where do the newly formed abnormal vessels from iris neovacularization originates from?
Capillaries of the Minor Arterial Circle of the Iris
44
What 2 ocular procedures increases the risk of developing neovascular glaucoma in an eye with iris neovascularization?
Cataract surgery and Vitrectomy
45
What are 2 side-effects are most frequently associated with Topamax?
Myopic shift and Angle closure
46
What is the angle closure treatment?
1 gtt timolol 0.5%
1 gtt pilocarpine 2%
1 gtt apraclonidine 1%
Acetazolamide 500mg PO
Measure IOP every 15 to 30 mins
If the IOP does not reduce in 1 hour; add hyperosmotic like glycerin or isosorbide for diabetic pts
47
Who are the most common individuals who get angle closure glaucoma?
South-East Asian, Eskimo or Chinese descent.
48
What common oral antihistamine can cause angle closure?
Benadryl
49
What is the term when it refers to the duty of an optometrist to avoid acts that could potentially harm a patient?
Non-maleficence
50
Who governs CTL's?
FDA
51
Which type of contact lens, hydrogel or silicon, has higher incidence of lipid deposit?
Silicon
Note: Hydrogen has protein deposit
52
Which was is the filter oriented in Polarized glasses?
Vertically
53
In which meridian does flexure cause OR cylinder?
Same meridian of the corneal toricity
54
How much center thickness should be increased for each prism diopter?
1.0mm for each PD
55
What happens when you increase the Dk in gas permeable lenses?
Increase oxygen and wettability decreases
56
What is the etiology of dimple veiling?
Poor tear exchange under the GP lens and CO2 gas from the cornea, when wearing a GP lens and causing the cornea to have indentations
57
How do you get rid of dimple veiling?
Removing the CTL for several hours will typically allow for resolution of dimple veiling.
Long term: Decrease the OVD and Flatten the base curve
58
What is the treatment of choice for getting rid of dimple veiling?
Decrease the diameter of the OZD.
59
Which types of CTL's are more prone to jelly bumps?
Hydrophillic
60
Which non silicone hydrogel soft lenses will have more protein deposits?
Group 4
LHLH -NNII
61
Which type of lenses tend to attract more proteins?
Ionic compounds
62
Which populations has the highest predilection for refractive error of myopia?
Japanese, Chinese, Jewish and Arab.
Rare in African Americans
63
You have an african american pt who has had there 3rd hypema in few years, what should you do next?
Screen for Sickle Cell
64
What is the treatment for Hyphema?
Atropine 1% BID to TID (Scopolamine)
65
What is the f/u for hyphema?
1 day ; do GONIO in 4 weeks.
66
What is the elevated element when a pt has Band Keratopathy?
Calcium
67
What is the treament for mild band keratopathy?
AT's 4 to 6 times a day w/wo bandage CTL
68
What is the treatment for severe band keratopathy?
EDTA, however if there is stromal haze, PTK can be used to improve vision.
69
Posterior embrytoxon is an anteriorly displaced Schwalbe's line, which type of inheritance is it?
Dominant trait
70
What is the difference between Axenfeld anomaly vs. Rieger anomaly?
Axenfeld anomaly (Posterior Embryotxon) is when the scwalbe's line is anteriorly displaced. Rieger anomaly is Axenfeld anomaly and correctopia as well.
71
What is Peter's Anomaly?
Rare but bilateral Axenfeld-Reiger anomaly and central corneal opacity.
72
What seasons does VKC generally occur?
Spring and Summer
73
What is the treatment for VKC?
Loteprednol etabonate 0.2% 1gtt OU QID
74
What is the follow up for VKC?
1 week --> Check IOP even though Alrex is a soft steroid
75
What is good for a 2yo who has allergic conjunctivitis?
Pataday
76
What is the treatment for Molluscum Contagiosum?
Excision of the lesion or removal via laser
77
What is a common associated sign with Molluscum Contagiosum?
Unilateral folliculitis located on the same side of the lesion
78
What are the 5 major findings when associated with Trachoma?
```
Mucopurulent discharge
Lymphadenopathy
Red eye
Superior tarsal follicles
Superior pannus
```
79
Treatment for Trachoma
Oral doxycycline, Tetracycline, Azithromycin or Erythromycin
80
What is the category for refractive surgery with CK?
+0.75 to +3.00 D and less than 0.75 D of astigmatism
81
How long does Epithelial ingrowth occur after lasik?
Several days to weeks
Monitor pt for 2 weeks.
82
What is another name for DLK?
Sands of Sahara
83
How long after does DLK occur after Lasik?
2 to 5 days.
84
Contrast sensitivity and visual acuity are decreased for how long status post Lasik?
3 months
85
Which staining agent is the best to use for HZV?
Rose Bengal
Some studies have shown that NaFl poorly stains
86
What is the treatment for HZV?
Acyclovir, Famciclovir or Valcyclovir should be initiated within 72 hours of the onset of skin lesions.
87
What is the follow up for HZV?
1 to 7 days of the initiation of treatment.
Follow up 1 to 4 weeks
then 3 to 6 months as relapse may occur
88
What are the signs of HSV?
a) Unilateral follicular reaction
b) Lymphadenopathy
c) Tearing
d) Ocular irritation
e) Photophobia
f) Blurry vision
g) Decreased corneal sensation
h) Crops of skin vesicles
89
What is the treatment for HSV?
Triflurdine (Viroptic), Vidaradine (Vira-A) and Ganciclovir (Zirgan) Ointment
q2h
90
F/U for HSV?
2 to 7 days, stain with FLC and Rose bengal
91
What is the prophylaxis treatment to prevent epithelial keratitis caused by HSV?
400 mg of Acyclovir BID for 1 year
92
What is an early sign of Acanthamoeba Keratitis?
Epithelial mottling (Psuedodendrite)
93
Where is the break in Polymorphous dystrophy?
Descemet's Membrane
94
What layer does PTK remove?
Epithelium and superficial stroma
95
What layer does DALK transplant?
Stromal
96
What layers are replaced in DMEK?
Descemet's and Endothelium, however host stroma is still used.
97
What layers are transplanted in DSEK?
Descemet's and Endothelium, while a donor stroma is also used.
98
What are the 2 major demographics Terrien's Marginal Degeneration are predisposed to?
Men
| 2nd to 4th decade
99
What is the F/U for a pt with Terrien's Marginal Degeneration?
6 to 12 months
100
What is the predilection for Salzmann's?
Females and >50 YO
101
What are the nodules in Salzmann made of and what layer do they impact?
Hyaline and Bowman's
102
What is the management of Salzmann's?
Lubricants, Steroids (if inflammed), Bandage CL.
103
What is the reason for refractive error to change during pregnancy?
Increase in central corneal thickness, possibly due to edema and fluid retention.
104
What type of refractive error occurs during pregnancy?
Myopic shift
105
What are two major decreases that occur during pregnancy, in regards to the eye?
Decrease in corneal sensitivity and decrase in IOP
106
What is Siderosis?
FB which dislayed intraocular involvment
Usually due to Iron will lead to enzymal toxicity
107
What is the agic number in endothelial loss in Fuch's endothelial dystophy?
1800 cells/mm2 (Normal is 2400 cells/mm2)
108
Fuch's is predominantly occurs more so in women, is there an inheritance pattern?
Yes, Autosomal Dominant
109
The same patien returns one year later with a further reduction in acuity and ishes to undergo cataract surgery. You notice that she has Fuch's dystrophy. This finding puts him most at risk for which post-operative complications?
Pseudophakic Bullous Keratopathy
110
What would you give a pt that has a corneal abrasion from vegetative matter?
Gatifloxacin (Zymar) QID
We are worried about Pseudomonas.
111
What is a pt with a corneal abrasion is in pain?
Rx Ketorolac Oph solution QID. A topical NSAID maybe prescribed.
112
What is the normal protocol for treating EKC?
AT's and Vasoconstrictor
113
What is the most common etiology of Filmentary Keratitis?
Keratoconjunctivitis Sicca
114
What is the treatment for Filamentary Keratitis?
Mechanical debridement and removal of corneal filaments.
Acetylsycteine (Mucomyst) when applied will help alleviate the attachment.
115
FDA requires soft CTL wearer to be out of contacts for how long prior to surgery?
2 weeks
RGP's are 1 month
116
When does Keratoconus generally start in an individuals life?
Starts at Puberty but stablizes in 3rd and 4th decades of life
117
Which layer does Fleischer's ring occur?
Bowman's layer and must be seen with a Cobalt Blue filter due to Iron deposition.
118
Which layer do Vogt's Striae occur in?
Stroma
119
What is the percentage of pts who develop corneal hydrops from Keratoconus?
5%; usually ocur in Descemet's membrane
120
What is the topography presentation in Keratoconus?
Inferior steeping or a "sagging bowtie"
121
What type of topography is noticed on forme fruste keratoconus?
Central or Paracentral irregular astigmatism
122
Should a pt be recommended for Lasik if they have Forme Fruste Keratoconus?
No, as this could progress into a serious ectasia such as Keratoconus.
123
What IOP measuring tool is best used for individuals with Fuch's Endothelial dystrophy?
ORA (Ocular Response Analyzer); eliminates corneal hysteresis
124
What is the treatment for arc welder's flash?
AT's (preservative free) every 2 hours and Vigamox QID
Prognosis is good due to good if treatment started, if not high chance for infectious keratitis to occur due to epithelial barrier has died.
125
What is the usage of Acular?
Decrease Conjunctival
Post Cataract inflammation
CME
Seasonal Allergic Conjunctivitis
126
What are the 3 major side effects of a Topical AH/Mast cell stabalizers?
Stinging upon instillation, Headaches and Adverse taste (Use punctual occlusion)
127
What is the immediate thought process of a unilateral arcus?
Contralateral Carotid Artery disease of potential occlusion.
The reason why this is due to the fact that the contralateral artery is blocked thus the lipid deposition is not making to the non-arcus eye.
128
Which topical steroid needs to be shaken?
FML, since its a suspension
129
What are the only 3 anti-histamine/mast cell stabilizer?
1. Lastacraft QD
2. Patanol BID
3. Zaditor BID
130
How often is Cromolyn Sodium (Mast cell stabilizer) should be used?
4 to 6 times/day
131
Which systemic anti-depressant is commonly associated with suicidal thoughts?
Wellbutrin
132
What is the MOA of Warfarin?
Inhibits the activation of clotting factors that depend on vitamin K for synthesis
133
What is the MOA of Heparing?
Inhibits the conversion of prothrombin to thrombin
134
What is the MOA of Aspiring?
Irreversible inhibition of platlet cycloxygenase
135
What is the function of Biguanides (Glyburide or Metformin)?
Act by increasing insulin sensitivity; molecular target is the AMP dependent protein kinase (AMPPK)
136
Biguanides are associated with lowering of serum lipis and decrease weight, however it is useful against what systemic condition aswell?
Polycycstic Ovarion Syndrome (PCOS)
137
What is the MOA of Thiazolidinediones (-glitazone)?
Enhance the action of insulin at target tissues
138
What is the MOA of Sulfonylureas (Glipizide, Glyburide and Glimepiride)?
Stimulate secretion of insulin from pancreatic cells increasing the level of circulating insulin
May cause Hypoglycemia
139
Which common medication causes tinnitus?
Aspirin
140
Phenlyephrine is what type of dilation medication?
Sympathomimetics
141
Cholinergic antagonist (ASHCT), inhibit which cholinergic receptors in the iris sphincter?
Muscarinic
142
Which 4 of the following medication have been linked to cataract formation?
1. Amiodarone (Anterior sub-capsular lens deposits)
2. Steroids (Posterior subcapsular opacification)
3. Allopurinol (longer than 3 years are at greatest risk)
4. Chlorpromazine, Phenothiazines, gold and busulfan (cataract formation)
143
Whats the treatment for syphilis?
3 to 4 million units of IV Penicillin G q4h 10 to 15 days
144
What are the two commonly used medications for gonorrhea?
Ceftriaxone and Azithromycin
145
What is the common medication for the treatment for Chlamydia?
Doxycycline
146
What is the best treatment for anterior uveitis?
Prednisolone Acetate 1% q1h and Cyclopentalate 1% BID with a follow up in 1 day.
147
Which of the following is an absolute contraindication of using 10% Topical Phenylephrine?
TCA's such as Amytriptyline
148
What is an ocular side effect of Dilantin?
Nystagmus
Phenytoin blocks voltage-sensitive Na+ channels in neurons, resulting in reduced repetitive firing and thereby helping to treat most seizure disorders.
149
What is the most common side effect of subcutaneous injection of Kenalog?
Depigmentation at the injection site
150
Which drugs can cause a myopic shift?
Isotretinoin, BCP's, Topamax and Diuretics
151
What is the MOA for Zoloft?
SSRI
152
Which NSAID is known to increase the risk of stroke, Myocardial Infarction and Thrombosis?
Indomethacin
153
Which drops are used with caution in pigment dispersion syndrome?
2.5% Phenylephrine and Pupil mydriasis
154
What is the treatment for an ulcer in the periphery that is 1mm in size and minimal anterior chamber reaction?
Ciproflocacin every 2 to 4 hours
155
Ulcer 1.5mm and higher should be treated with?
Fortified Tobramycin or Gentamycin, alternated with fortified cefazolin or vancomycin every 30 mins. If not available, then FLQ 1gtt every 5 minutes for 25 minutes, then every 15 minutes for 45 minutes , then every half hour for 1 day.
156
How long does it take Pseudomons Aeruginosa to liquify the cornea?
1 to 2 days.
157
What condition is associated with HLA-A29?
Birdshot Retinopathy
158
HLA DR4 is associaed with what condition?
Vogt-Koyanagi Harada syndrome
159
HLA B51 is commonly associated with what condition?
Behcet's disease
160
What is the offending agent in toxocaris?
Nematode
161
What is the offending agent in Toxoplasmosis?
Protozoan
162
Which condition is associated with "headlights in the fog"?
Toxoplasmosis ; Vitritis is associated with the overlying the chorioretinal lesions.
163
What is the treatment of an active lesion of Toxoplasmosis?
Oral Pyrimethamine 200 mg; then 25 mg 2x day for 3 to 6 weeks.Oral Folnic 10 mg acid and Oral sulfadiazine 2g followed by 1g 4x day for 3 to 6 weeks.
164
What is the offending agent in Histoplasmosis?
Fungus
165
Which condition is associated with Ohio-Missippi river valley region?
Histoplamosis
166
What is the triad for Histoplasmosis?
1. Histo spots; which appear small (1mm in size)
2. Peripapillary atrophy
3. CNVM
167
Which condition has vitiritis?
Toxoplasmosis; Histoplasmosis never does.
168
What is the inheritance pattern for FAP?
Dominant; will usually have atypical CHRPE's at birth
169
Which population is common with being impacted by Idiopathic polypoidal choroidal vasculopathy?
Asian. 50% of cases resolve spontaneously.
170
Which systemic condition is associated with IPPC?
HTN
171
What is the grading of Mild NPDR?
Either one of hard exudates, microaneurysms and/or dot/blot hemorrhages.
172
What is the grading of Moderate NPDR?
More hemes, venous beading or CWS with the possible presence of IRMA
173
What is the grading of Severe NPDR?
4-2-1 rule
174
In the early stages of DM2, what are of the retina was mostly likely to have been affected first?
Mid periphery
175
What are the 3 criteria for CSME?
1. Retinal thickening within 500 microns
2. Hard exudates within 500 microns of the center of the fovea, if associated with adjacent retinal thickening
3. Thickening of the retina with a size greater than 1 disc area, part of which is within 1 DD of the foveal center.
176
What is the criteria for High-Risk PDR?
1. NVD with a size greater 1/4 to 1/3 of the ONH
2. Any degree of NVD if an associated or vitreous hemorrhage is present
3. NVE associated with a preretinal or vitreous hemorrhage
177
What is the criteria for the diagnosis of diabetes?
1. HbA1c >6.5%
2. FBS >126 mg/dL (7.0mmol/L). Fasting is defined as no caloric intake for atleast 8 hours.
3. 2 hour plasma glucose >200mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT).
178
What is the etiology of Coat's disease?
Breakdown of the blood-retinal-barrier
179
What is the etiology of Choroideremia?
Progressive, and diffuse atrophy of the choroid, RPE and retinal photoreceptors.
180
What are the 5 stages of ROP?
Stage 1: Presence of myopia in addition to minimal peripheral retinal pigmentary disturbances
Stage 2: Appearance of temporal vitreoretinal fibrosis with dragging of the ON and posterior retinal
Stage 3: More severe peripheral fibrosis with contracture and the formation of falciform retinal fold
Stage 4: Partial ring of the retrolental fibrovascular tissue with the presence of a partial retinal detachment
Stage 5: Complete ring of retrolental fibrovascular tissue with total RD
181
Wis the gestational age and birth weight risk factor for ROP?
32 weeks and 1500g
182
What age does retinal vasculature reach the nasal and temporal periphery?
6 months for nasal and 1 month after birth for temporal
183
What are the 3 zones for describing ROP?
Zone 1: Posterior pole (2x the distance from the disc to the macula)
Zone 2: From zone 1 to nasal ora serrata, temporally equidistant to the disc
Zone 3: The remaining temporal periphery
184
What 2 conditions are children at a higher chance with a low birth weight and those treated with ROP?
Strabismus and Myopia
185
Which measurement is over-exagerated when dragging of the macula occurs temporally?
Angle Kappa, looks larger than it is.
186
Dilated tortuous retinal vessels in the posterior pole of children diagnosed with ROP, is called what condition?
Plus disease
187
What is the genetic predisposition of Choroidermia?
X-linked disorder
| Males in 2nd to 3rd decade of life
188
What is the early sign of Choroidermia?
Night blindness
189
What would be the ERG and EOG findings in Choroidermia?
Abnormal ERG and EOG
190
Treatment for Choroidermia?
Specific gene therapy
191
Which two layers of the retina are impacted by CME?
OPL and INL
192
When should YAG capsulotomy be preformed after cataract surgery?
6 months, to reduce the chances of CME
193
Chronic CME can leased to what condition?
Lamellar Macular Hole
194
What is the treament for CME?
Ketorolac 0.5% QID for 3 months
195
What is the peak period of Irvine Gass syndrome to occur?
following cataract surgery of 6 weeks to 3 months.
196
When does CSCR spotaneously resolve?
6 months.
197
What type of field loss is seen in BRAO?
Sectoral visual field loss
198
What is the follow up for a BRAO?
3 to 6 months
199
What will be the VA for a CRAO?
Counting fingers to Light preception
200
CRAO f/u time?
1 to 4 weeks; check for neo
201
What is the final VA for CRAO?
20/400; this will be permanent
202
What type of FA will be noticed with a BRVO?
Early phase hypofluorescence and during the late phase of FA.
203
What are the 5 stage of Best's disease?
1. Previtelliform - abnormal EOG, normal fundus and no symptoms
2. Vitelliform - egg yolk
3. Pseudohypopion - absorbed lesion, no effect on VA
4. Vitelliruptive - scrambled egg, mild visual loss
5. End stage - CNVM and macular scarring, mod to severe VA loss
204
What substance is being deposited into the retina/sub-retinal space in the above condition?
Lipofuscin-like material
205
What is the condition when the posterior pole becomes littered with white-yellow flecks?
Fundus Flavimaculatus
VA tends to be fairly good.
206
EOG measures which portion of the eye?
Bruch's membrane, RPE and cornea
207
What are the wave's that corresspond to their anatomy of the eye based on ERG?
A wave - PR
B wave - BP and Muller cells
C wave - RPE
D wave - off BP cell
208
What is the predilection genetic disorder based on Gyrate ATrophy?
AR
209
What is the amino acid that is deficient in Gyrate Atrophy?
Hyperornithinemia
210
What are the tests needed to diagnose Lyme Disease?
Elisa, Western Blot and PCR
211
What CN is impacted with Lyme disease?
CN 7
212
At around which week of gestation does incomplete closure of the embryonic fissure?
Week 6
213
Which part of the retina is impacted in a chorioretinal coloboma?
Inferior retina
214
What is the most common increase risk in development, when a pt has a chorioretinal coloboma?
Rhematogenous Retinal Detachment
215
Iris coloboma is impacted in what portion of the Iris?
Inferior nasal
216
Where is lattice degeneration the most common?
Superior temporal
217
What is the precentage of individuals who have lattice degeneration?
8%
218
In Reticular pigmentary changes are noted in which quadrant of the retina?
Nasal equator; no intervention is needed
219
Which gender is most likely to have Leber's Hereditary Optic Atrophy?
Male's due to malformation in maternal mitochondrial DNA
220
Which imaging technique allows for the BEST diagnostic evaluation of abnormal choroidal vasculature lesions?
ICG (Indocyanine green angiography)
221
Where is the most common area for white without pressure to occur?
Inferior temporal. Most common race is African American
222
What is the formula to gauge normal ESR for males?
age/2
223
What is the formula to gauge normal ESR for women?
age + 10 / 2
224
What is the immediate treatment for GCA?
IV Methylprednisolone for 3 days in addition to oral prednisolone. Usually they need to take steroids for 1 to 2 years. Fellow eye maybe affected even if treatment is successful
225
Best treatment for a RD?
Focal laser photocoagulation
226
Once a CRVO has occurred, how long after for NVE or NVD occur?
3 years from incident but generally develop 6 to 12 months after acute phase of the CRVO.
227
When is the follow up for NVI and why should you be concerned about it when someone has suffered a CRVO?
90 Day Glaucoma. Usually 2 to 4 months period from the initial presentation.
228
Follow up for a pt with VA of 20/40 or better with a CRVO?
1 to 2 months for 6 months.
229
Folow up for a pt with a VA of 20/200 or worse with a CRVO?
Every month for 6 months.
230
What is the FA finding in a pt with a Commotio Retinae?
Early transmission defect corressponding to the lesion
231
What is the genetic predilection of Familial Drusen?
Autosomal Dominant
232
What would the OCT look like for a pt with Familial Drusen?
Thickening of the RPE-Bruch's Membrane but the Photoreceptor layer is intact
233
What would be the ERG and EOG findings in Familial Drusen?
Normal ERG but subnormal EOG
234
Which decade does Stargardt's disease is noticed?
1st to 2nd decade
235
What are the 3 major findings in Oculocutaneous Albinism?
Transillumination defect, Nystagmus and Reduced VA
236
What is the most likely cause of reduced VA in Oculocutaneous Albinism?
Foveal Hypoplasia
237
F/U for Fuch's Endotheial Dystrophy?
4 months (3 to 12 months is the variance) check for rise in IOP and evaluate corneal edema
238
What is the CD4 count when CMV is evident?
50 cells/mm3
239
What is the treatment for CMV?
Intravitreal Ganciclovir implant
240
What is the genetic disposition of Juvenile Retinoschisis?
X linked recessive
241
What is the treatment for Juvenile Retinoschisis?
Nothing
242
What is the follow up for a Choroidal Melanoma?
6 months
243
What causes Valsalve retinopathy?
Forcible exhalation that occurs against a closed glottis and creates a sudden increase in intrathoracic or intraabdominal pressure.
244
Which area does the hemorrhage occur in Valsalve Retinopathy?
ILM and Sub-hyaloid region
245
What type of ocular deviation is noted with Posterior Staphyloma?
Large Exophoria
246
What is the condition called when the fellow eye is involved, when the impeding eye had a NAION?
Pseudo-Foster Kennedy Syndrome (Optic atrophy in one eye and optic nerve edema in the other)
247
What is a good medication to prevent the fellow eye being involved in NAION?
81mg Aspirin
248
When does the disc swelling decrease in NAION?
4 to 8 weeks
249
What is the most common visual field defect in NAION?
Altitudinal
250
Buried drusen is what type of material?
Hyaline
251
What is the FU for buried drusen?
6 months
252
Which layer of the choroid is impacted by Lacquer cracks?
Bruch's membrane
253
What is the genetic deposition of Usher's syndrome?
Autosomal Recessive
254
What is the triad of Retinitis Pigmentosa?
1. Arteriolar Attenuation
2. Retinal Bone Spicule pigmentation
3. Waxy optic disc pallor
255
Pt with the age >45, has a SO palsy. What is the etiology?
Microvasculature Infarction
256
What is the most common etiology of a 3rd nerve palsy?
Aneurysm
257
Pupil sparing 3rd nerve palsy is usually caused by?
Ischemic Vascular Disease, usually diabetic in nature
258
What is the FU period of a CN palsy?
Observation daily for the first 7 days after the onset.
259
Once the first 7 days of observation has been completed, what is the next step for follow ups?
Every 4 to 6 weeks. Function should return within 3 months. If the pupil does not go to its normal state, an Urgent MRI/MRA should be done.
260
Which pupillary condition has a normal near response?
Adies Tonic
261
A dilated pupil is noticed and you place 0.125% pilocarpine and miosis occurs. What condition can you consider?
Adies Tonic.
If it does not become miotic, it will be CN 3 palsy.
262
What type of visual field defect is seen in tilted disc ?
Superior temporal
263
Formula for calculating magnifcation of your eye?
60D/4
264
What are 2 major findings associated with Oculoglandular syndrome?
Unilateral Follicular conjunctivitis and Lymphadenopathy
265
What are the signs of CPEO?
After the age of 20 and bilateral ptosis.
266
What is the FU with someone with CPEO?
6 months
267
What is the treatment for CPEO?
Nothing. Only treat the exposure keratopathy
268
What is the inheritance pattern of CPEO?
Mitochondrial
269
What is Kearns-Sayre Syndrome?
Similar to CPEO, degeneration of retinal pigment, heart block and sudden death
270
What is the most common visual field loss based on a stroke?
Homonymous Hemianopsia
271
If there is a congruous homonymous visual field defect, where would you suspect the etiology to be?
Occiptal lobe
272
Superior quadrant - congrous visual field defect would be suspected in which etiology?
Inferior calcarine cortex
273
What is the affect of cocaine drops on Horner's?
Nothing, won't dilate
274
Aproclonidine will have what affect on a horner's pupil?
Pupil will dilate with horners
275
What medication tells you if the horners is pre or post ganglionic?
1% hydroxyamphetamine; Pre-ganglionic lesion will dilate
276
What will occur if light is shining in a Argyl Robertson Pupil?
No response to light, pupil respond to near stimulus
277
How do you distinguish between the CN 3 and Adies Tonic?
0.125% Pilocarpine ; constriction will occur in Adies pupil
1% is too much
278
What is the criteria for Malignant HTN?
200/140
279
Which vasculature in the eye have autoregulation?
Retinal Arterioles and Capillaries
280
How long does it take a CWS disappear?
3 to 6 weeks
281
When do intraretinal periarteriolar transudates resolve?
2 to 3 weeks
282
What is the most common etiology of isolated 3rd nerve palsy?
Damage of the nerve fibers in the area of the subarachnoid space
283
What is the etiology of a cortical blindness?
Ischemia of the occipital lobe
284
What type of VF loss is associated with Alcholism?
Temporal Disc Pallor
285
What is the age for doing DEM?
6 to 13
286
Which parts of the DEM test, works on Automaticity?
A and B test
287
What part of the test of DEM works on oculomotor?
Test C
288
How do you adjust the horizontal time?
(Raw score x 80)/(80-Additions + Omissions)
289
How do you calculate the Ratio score?
Horizontal time / Vertical time
290
How do you distinguish to diagnosis a oculomotor dysfunction?
Low Ratio score and High Error ; Therefore high horizontal portion and the vertical portion is normal. Ratio will be high
291
How do you diagnose Poor automaticity?
Horizontal and Vertical components are high. Ratio will be normal
292
What are the findings with both an oculomotor dysfunction and poor automaticity?
High ratio = High error
| High test times for both horizontal and vertical components in addition to an increaed ratio
293
What is the normal percentile in DEM?
31% and above
294
What would a 16% to 31% percentile in DEM score mean?
Suspect; anything below would be highly suspect
295
What is the best way to notice subtle receeded NPC?
Use R/G glasses; control binocularity
296
What is the training vergence program?
SILO (Small In and Large Out)
297
Findings for DI
Esophoria at distance>near,
Low AC/A Ratio
Decreased NFV at distance
298
Treatment for DI?
BO Prism
299
Findings for DE
High exophoria at distance,
| High AC/A ratio, decreased DFV
300
What VT training is good for DE?
Brewster stereoscope
301
Findings in CE
High Esophoria at near, reduced NFV, High AC/A, Lowe PRA and failes -2.00 Binocular accommodative facility testing
302
What is the most common binocular problems seen in clinical practice?
CE ; approx 6%
303
Formula to calculate AC/A?
PD(cm) + near distance (m) x (near phoria - distance phoria)
Exo = - and Eso = +
304
If a pt has poor vergence, how will the disparity curve look?
Narrow curve
305
Sheard's criterion
2/3phoria - 1/3compensating fusional vergence
306
What is the amount for normal values of phenol red test?
9 to 20 mm
307
What is the treatment for Phthirasis?
Mechanical removal of all nits and lice with jeweler's forceps and placing into alcohol.
Rx. Bacitracin TID
308
How often do are the eggs laid in Phthirasis?
7 to 10 days
309
What are the follow up for pt with Phthirasis?
Everyday.
310
What will you communicate to the PCP with Phthirasis?
Check for STD and treat sexual partner too.
311
What is the etiology of Interstitia Keratitis?
Secondary to an immune reaction caused by exposure to infectious agents triggering the deployment of T cells to the stroma.
312
What is the most common cause of Interstitial Keratitis?
Congenital Syphilis
313
What is the treatment for Interstitial Keratitis?
Topical Steroids 1 to 6 hours.
Prednisolone Acetate 1% q2h, Homatropine 2% TID and Valtrex 1 gram PO BID.
314
What is the FU for Interstitial Keratitis?
3 to 7 days
315
What are the 3 major meds that can cause Contact Dermatitis?
Neomycin, Dorzolamide and Chloramphenicol
316
What is the treatment of Contact Dermatitis?
Cool compresses 4 to 6 /days. Preservative free AT's 6 to 8 times/day. If skin is scaly and crusty, Dexamethasone 0.05% BID to TID for 5 days. Oral Histamine such as Benadryl can be added.
317
What is the FU for Contact Dermatitis?
1 week
318
How long does acute angioedema last for?
7 to 21 days
319
What condition is Kaposi sarcoma associated with ?
AIDS
320
What is blephamide consist of?
Sulfacetamide and Prednisolone
321
Chronic Blepharitis is usually what etiology?
Staphylococcus
322
Mucopurulent discharge, that seals the eyelids shut by the morning. Crusting of eyelashes and conjunctival injection which is unlateral and corneal SPK. Which condition?
Bacterial Conjunctivitis
323
Follow up for conjunctival nevi?
6 to 12 months
324
What is the description with a pt has Primary Aquired Melanosis?
Middle aged (usually after 45), Caucasian
325
Which layer of the conjunctiva is impacted by PAM?
Basal layer
326
A brown lesion that is immobile and slow growing, would indicate which condition?
Melanocytoma
327
What is the condition called when there is an absence of the punctal opening?
Punctal Artesia
328
What is the treatment for Punctal Artesia?
Cannulation with silicone tubes
329
What is punctal stenosis?
Narrowing
330
HTN retinopathy FU
2 to 3 months
331
Which condition is associated with Epiblepharon ?
Grave's disease
332
What is the treatment for Epiblepharon?
Lower lid Blepharoplasty
333
Treatment for Dacryocystitis
Augmentin or Keflec PO. Warm compresses.
If febrile give IV antibiotics
334
FU for Dacryocystitis?
1 day
335
When is there a FU for Hordeolum?
Not nessecary unless it becomes enlarged
336
What is the treatment for a Chalazia?
Hot soaks are always mandatory and digital massage.
337
Treatment for Dacryocystitis?
Augmentin or Keflex
338
What is the treatment for Canaliculitis?
Canaliclotomy
339
When evaluating the function of the leavtor muscle, it is important to negate the action of which facial muscle?
Frontalis
340
Increasing pantoscoptic tilt will result what type of astigmatism?
At the 180 degree meridian
341
Abbe value of Polycarbonate?
30
342
Abbe value of Trivex?
43 to 45
343
What is the abbe value of CR39?
58
344
What is the abbe value for Crown Glass?
58
345
Which type of lens material possess the most amount of reflection?
Polycarbonate
346
What product on lenses will decrease glare and halos?
Anti-reflective coating
347
Pt reports that when she first picked up her glasses, everything appeared to be stretched vertically. What is the most likely etiology of this observation?
Her Rx contains a correction for Against-the-rule astigatism (minus cylinder with an axis of 090)
348
CNS cells that coats axons in a myelin sheath?
Oligodendrocytes
349
Stages of Proliferative retinopathy associated with Sickle cell disease
Stage 1: Occlusion of the peripheral arterioles
Stage 2: Peripheral Arteriovenous Anastomoses
Stage 3: Neovascularization of the anastomoses resulting in a "sea fan" appearance
Stage 4: Vitreous Hemorrhage
Stage 5: Proliferation of fibrovascular tissue and RDD
350
Signs of a cluster headache
Extreme intense and severe unilateral pain, Most intense they have ever endured, feels like behind one eye, lasts from 15 to 18 minutes and several times per day
351
What is the most common type of headache?
Tension
352
How long do common headaches last?
4 to 6 hours
353
How long does a migraine last for?
2 to 72 hours
354
What are the signs and symptoms associated with a Migraine headache?
Unilateral pain, pulsating, nausea, vomitting, photophobia and phonophobia
355
Which type of headache is associated with a visual aura?
Classical migraine
356
What type of VF defect would you notice when a pt complains of visual disturbances?
Homonymous Hemianopia
357
What are the signs of a sinus headache?
Constant pain in the location of the cheek bones
358
What is the treatment for cluster HA?
Oxygen therapy
359
What test do you order for Talc retinopathy?
Chest X-Ray
360
What is the biggest risk factor for COPD?
Smoking Cigarettes
361
What levels are decreased in COPD?
Alpha-1 Antitrypsin levels
362
What is the most common ocular presentation associated with Behcet's disease?
Bilateral, non-granulomatous panuveitis
363
Which test determines if the pt has or has not had systemic syphilis?
FTA-ABS
364
What test determines if Syphillis is currently active?
RPR-VDRL
365
What is the causative organism of syphilis?
Spirochete - Treponema Pallidum
366
What is the treatment for Syphilis?
3 to 4 million units of IV Penicillin G q4h for 10 to 15 days
367
What is the triad for congenital syphilis?
Interstitial Keratitis, Widely spaced incisors and deafness
368
What is the most common ocular complication related to Psoriatic Arthritis?
Anterior Uveitis
369
What is a pathognomonic sign for psoriasis?
Nail pitting
370
What is the most prevalent form of color discrimination deficiency amount males and females?
Deuteranomaly
371
What did the COMET study find?
Slowing down of juvenile onset of myopia with the use of PAL's
372
What type of visual defect is seen with Retinoschisis?
Absolute VF defect
373
What type of visual defect is seen with retinal deteachment?
Relative defect
374
What is the age of emmetropization?
9 to 18 months
375
You have latent hyperopia, and would like to prescribe based on cycloplegic refraction. Will you give the full rx or cut it, what would you do?
Cut the Rx by -1.00D to -1.50D, however keeping the anisometropia the same difference is needed.
376
What is the FU after prescribing glasses?
6 to 8 weeks
377
What type of degree of fusion is Worth 4 Dot?
Second degree (Biocular)
378
What are the Amblyogenic refractive error with Anisometropia?
M - 3.00D
H - 1.00D
A - 1.50D
379
What are the Amblyogenic refractive error with Isometropia?
M - 8.00D
H - 5.00D
A - 2.50D
380
BO Vergence ranges
Distance 9/19/10
| Near 17/21/11
381
BI Vergence ranges
Distance -/7/4
| Near 13/21/13
382
What type opacification is associated with Elscnig pearls?
Posterior opacification of the IOL
383
What is the term when you have bilateral subluxation of the lenses?
Ectopia Lentis
384
Pt's with Marfan's syndrome have what common development?
Aortic aneurysms and Aortic dissection
385
What is the most common ocular issue with marfan's syndrome?
Retinal Detachment
386
What type of subluxation occurs due to homocystinuria?
Inferior nasal
387
Which layers are impacted in Lamellar Cataract?
Between Nucleus and the Cortex
388
What layers are impacted in a NSC?
Fetal or Embryonic nucleus
389
What is the most common cause of acute post-operative endophthalmitis?
S. Epidermidis
390
What is the most common delayed post operative endophthalmitis?
Propionibacterium acnes
391
What systemic condition is associated with Episcleritis?
Rheumatoid Arthritis
392
Treatment for Episcleritis?
Topial steroids (FML QID)
393
How to treat Diffuse Scleritis?
Oral NSAID's (Indomethacin 25mg TID)
394
FU for Diffuse Scleritis?
1 week or less
395
US legal blindness?
20/200 or worse in the better seeing eye with glasses on.
Peripheral vision worse than 20 degrees OU
