NUPY2_Eye Pathology

Question 1

Mechanism of cataract in the aging individual

Answer 1

Oxidative damage

Question 2

Diagnosis?
improved near vision without glasses
colored halos
difficulty driving at night
See image

Answer 2

Cataract

Question 3

Mechanism of cataract formation in diabetes mellitus

Answer 3

Accumulation of sorbitol

Question 4

Mechanism of visual loss in glaucoma

Answer 4

retinal ganglion cell apoptosis

Question 5

funduscopy findings in glaucoma

Answer 5

enlargement of cup of optic disc and pallor in area of cupping

Question 6

majopr risk factors for primary angle closure glaucoma

Answer 6

• hyperopia
• shallow anterior chamber

Question 7

Diagnosis?

sudden onset of visual loss excruciating pain, halos, photophobia.
intraocular pressure >40mmHg
a hazy cornea
a fixed, moderately dilated pupil
ciliary injection.

Answer 7

acute angle closure glaucoma

Question 8

bilateral swelling of optic disc secondary to increased intracranial hypertension

Answer 8

papilledema

Question 9

How does increased ICP cause swelling of the optic disc?

Answer 9

Increased intracranial pressure–> concentric increase in pressure encircling the optic nerve–>** axoplasmic flow stasis at the optic nerve head–> edema of the nerve.

Question 10

Funduscopy findings in papilledema

Answer 10

• Blurring of the margins of the optic disc
• Hyperemia of the optic disk with
• Obliteration of the physiologic optic cup

Question 11

Causes of optic neuritis

Answer 11

• Multiple sclerosis
• Adverse effect of sulfonamides, ethambutol, isoniazid

Question 12

Most common cause

• – acute painful monocular visual loss
• periocular pain exacerbated by eye movements

Answer 12

Diagnosis- optic neuritis
Most common cause- Multiple sclerosis

Question 13

Diagnosis?

Answer 13

Hypertensive retinopathy

Question 14

Basis of the following changes seen on funduscopy in hypertensive retinopathy:
arteriolar narrowing
Arteriovenous nicking
Arteriolar wall opacity (“silver wiring”)

Answer 14

Hypertension–> arteriolosclerosis

Question 15

the earliest clinically detectable sign of diabetic retinopathy on funduscopy

Answer 15

microaneurysms

Question 16

Cause for macular edema in non-proliferative diabetic retinopathy

Answer 16

breakdown of the inner blood–retinal barrier at the level of the retinal capillary endothelium –>allows leakage of fluid and plasma constituents into the surrounding retina

Question 17

funduscopy findings in non proliferative diabetic retinopathy

Answer 17

Microaneurysms
Hemorrhages- superficial flame-shaped, deep dot & blot
Cotton-wool spots
Macular edema

purple circle-macular edema, red arrows- cotton wool spots

Question 18

2 potential causes of blindness in proliferative diabetic retinopathy

Answer 18

vitreous hemorrhage
retinal detachment

Question 19

funduscopy finding in proliferative diabetic retinopathy

Answer 19

new vessel formation at the disc and elsewhere in the retina

Question 20

• Fragments of atherosclerotic plaques that lodge within the retinal circulation

Answer 20

Hollenhorst plaque

Question 21

3 causes for cherry red spot in the retina

Answer 21

Central retinal artery occlusion
Tay Sachs disease
Niemann Pick disease

Question 22

mechanism of this finding (see image) in Tay Sachs disease

Answer 22

The storage material accumulates in retinal ganglion cells: the ganglion cell layer of the macula surrounding the fovea is thick, but there are no ganglion cells in the center of the macula, the fovea. Thus, the fovea is relatively transparent to the underlying choroidal vasculature but is rimmed by relatively opaque retina, the result of storage material accumulating in the perifoveal macular ganglion cells

image=cherry red spot

Question 23

mechanism of this finding (see image) in central retinal artery occlusion

Answer 23

Ischemia–> retinal swelling–> opaque retina–> normal orange-red of the choroid highlighted by surrounding opaque retina and physiologically thin fovea–>cherry red spot

Question 24

most likely causes for central retinal artery occlusion

Answer 24

1. Thrombosis due to atherosclerosis
2. Embolization of thrombi in the heart or from ulcerated atheromatous plaques in the carotid arteries to the central retinal artery
3. Giant cell arteritis

Question 25

**Most likely cause of this finding:** Complete monocular visual loss with full recovery after 5–10 minutes, described as a curtain passing vertically across the vision.

Answer 25

****Finding: Amaurosis fugax Most likely cause: embolus from an atherosclerotic plaque in the carotid bifurcation.

Question 26

# Diagnosis? * Sudden painless loss of vision in a 56 year old * Hyperlipidemia, hypertension * Funduscopy shows - dilated tortuous veins with retinal and macular edema, hemorrhages in all four quadrants of the retina

Answer 26

central retinal vein occlusion | Funduscopy: blood and thunder fundus

Question 27

**Dry ARMD/ wet ARMD?** * 72 year old , gradual vision loss * difficulty driving at night, need for brighter light while reading * loss of a portion of central visual field * Funduscopy shows granular, yellow, lipid-rich material

Answer 27

Dry age related macular degeneration (ARMD) | Drusen=granular, yellow, lipid-rich material

Question 28

**Dry ARMD/ wet ARMD?** * 72 year old , rapid vision loss * straight, linear objects appear wavy or distorted * loss of a portion of central visual field * Funduscopy image attached

Answer 28

Wet age related macular degeneration (ARMD) | Image = subretinal hemorrhage due to rupture of new choroidal vessels

Question 29

Treatment of choroidal neovascular lesions in wet ARMD

Answer 29

VEGF inhibitors

Question 30

Prevention of progression of both types of ARMD

Answer 30

* vitamin C and vitamin E, antioxidants (beta-carotene), zinc , and copper * smoking cessation

Question 31

Underlying mechanism of this condition: * night blindness (nyctalopia) * gradually progressive peripheral visual field loss * Fundoscopic findings: waxy optic disk pallor, attenuation of retinal arterioles, peripheral retinal pigment clumping

Answer 31

progressive hereditary degeneration of photoreceptors | Diagnosis= Retinitis pigmentosa

Question 32

Diagnosis? * night blindness (nyctalopia) * gradually progressive peripheral visual field loss * Fundoscopic findings: see image

Answer 32

Retinitis pigmentosa

Question 33

Diagnosis? * Cherry red spot in the retina * Ashkenazi Jew * hepatosplenomegaly.  *  hypotonia, failure to progress developmentally, loss of milestones *  deficiency of sphingomyelin 

Answer 33

Niemann Pick disease

Question 34

Microscopic morphology of excised ocular mass with following features: 3 year old leukocoria (white pupil)

Answer 34

* Sheets of small, round tumor cells with hyperchromatic nuclei * Clusters of tumor cells arranged around a central lumen (Flexner-Wintersteiner rosettes) | Diagnosis= retinoblastoma

Question 35

Familial retinoblastoma is associated with increased risk of which secondary malignancies?

Answer 35

**osteosarcoma,** soft tissue sarcoma, malignant melanoma

Question 36

Cause for white pupil in retinoblastoma

Answer 36

due to external light reflecting off the white intraocular tumor

Question 37

Most common primary intraocular neoplasm in children

Answer 37

retinoblastoma

Question 38

most common intraocular malignancy of adults

Answer 38

metastasis to the uvea

Question 39

most common primary intraocular neoplasm in adults

Answer 39

melanoma