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119 Cards in this Set

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what is amblyopia?
1. decreased vision secondary to failure of develpment of the pathway btw the retina and visual cortex before age 7
2. usually affects one eye, can be secondary to cataracts, severe refractive error or strabismus
what are the causes of amblyopia?
1. failure of development of the pathway bwt the retina and visual cortex before age 7
2. can be secondary to cataracts,
3. secondary to severe refractive error
4. secondary to strabismus
what are si/sx of amblyopia?
1. esotropia (inwardly rotated "crossed eyes")
2. exotropia (outwardly rotated "walled eyes")
3. diplopia
4. refractive error not correctable with lenses
what is tx for amblyopia?
early correction of cause of visual acity disturbance
what is bitemporal hemianopsia?
1. unable to see in b/l temporal fields
2. usually caused by a pituitary tumor
what is bitemporal hemianopsia usually caused by?
1. pituitary tumor
what is internuclear ophthalmoplegia?
1. classically found in multiple sclerosis
2. lesion of median longitudinal fasciculus
where do you classically find internuclear ophthalmoplegia?
1. multiple sclerosis
what are si/sz of internuclear ophthalmoplegia?
1. inability to adduct the ipsilateral eye past midline on lateral gaze (inability to perform conjugate gaze)
what is internuclear ophthalmoplegia caused by?
1. lack of communication btw contralateral CN VI nucleus and ipsilateral CN III nucleus
what is parinaud's syndrome?
1. midbrain tectum lesion
2. causes b/l paralysis of upward gaze
3. commonly a/c pineal tumor
what is a pineal tumor commonly a/c?
1. Parinaud's syndrome
what is a pituitary tumor commonly a/c?
bitemporal hemianopsia (unable to see in b/l temporal fields)
what is a Marcus-Gunn pupil?
1. pupil will not react to direct light but will react consensually when light is directed at the normal contralateral eye
2. b/c of afferent defect of CN II
3. characterized by post. swinging flashlight test
how do you characterized Marcus-Gunn pupil?
1. positive swinging flashlight test
2. swing penlight quickly back and forth btw eyes
3. denervated pupil will not constrict to direct stimulation
4. instead, denervated pupil will appear to actually dilate when light is shone in it b/c it is dilating back to baseline when consensual light is removed from other eye
what is optic neuritis?
1. inflammation of optic nerve within the eye
what are causes of optic neuritis?
1. viral infxn
2. multiple sclerosis
3. vasculitis
4. methanol
5. meningitis
6. syphilis
7. tumor metastases
what are si/sx of optic neuritis?
1. variable vision loss
2. decreased pupillary light reflex
what do you seen on funduscopic exam with optic neuritis?
(inflamm of optic nerve)
1. will see disk hyperemia
if pt is >60 yr old, what should you r/o when working up optic neuritis?
(inflamm of optic nerve)
1. bx the temporal artery to r/o temporal arteritis
how do you tx optic neuritis?
(inflamm of optic nerve)
1. tx with corticosteroids
what is a chalazion?
1. inflamm of internal meibomian sebaceous glands
2. presents c/ swelling on conjunctival surface of eyelid
what is the dz of inflamm of internal meibomian sebaceous glands?
1. chalazion
2. presents c/ swelling on conjunctival surgace of eyelid
3. tx is self-limiting
what is a hordeolum?
1. stye!
2. infxn of external sebaceous glands of Zeiss or Mol
3. presents c/ tender red swelling at lid margin
what do you call an infxn of ext. sebaceous glands of Zeiss or Mol?
1. hordeolum/stye
2. presents c/ tender red swelling at lid margin
3. tx c/ hot compresses, can add abx
what is blepharitis?
1. inflamm of eyelids and eyelashes resulting from infxn (S. aureus) or secondary to seborrhea
2. presents c/ red, swollen eyelid margins, c/ dry flakes noted on lashes
3. s/ tx, can extend along eyelid (cellulitis)
what do you can inflamm of eyelids and lashes resulting from (S. aureus) or secondary to seborrhea?
1. blepharitis
2. presents c/ red, swollen eylid margins c/ dry flakes noted on lashes
3. tx=wash lid margins daily c/ baby shampoo, control scalp seborrhea c/ shampoo
how do you tx blepharitis?
1. inflamm of eyelids and lashes resulting from infxn (S. aureus) or secondary to seborrhea
2. tx=wash lid margins daily c/ baby shampoo, control scalp seborrhea c/ shampoo
what is orbital cellulitis?
1. can occur if blepharitis is left untreated
2. also seen as complication of paranasal sinus infxn
3. can spread to cavernous sinus, leading to deadly thrombosis and meningitis
what can spread to cavernous sinus, leading to deadly thrombosis and meningitis?
orbital cellulitis!
*tx emergently c/ IV vancomycin and cefotaxime
how do you tx orbital cellulitis?
1. emergently!
2. with IV vancomycin and cefotaxime
what is Argyll-Robertson pupil?
1. Pupils constrict c/ accommodation
2. but do NOT constrict to direct light stimulation
3. pupils accommodate but do not react
4. pathognomonic for 3' syphilis (neurosyphilis)
if neonatal conjuctivitis occurs in the first 24 hours of life, what is m/c cause?
1. chemical conjuctivitis
2. silver nitrate (or erythromycin) drops are given prophylactically to all newborns to prevent gonorrheal conjunctivitis
3. may cause a chemical conjunctivits c/ no purulent discharge
4. develops w/in 12 hours of instilling the drops and resolves within 48 hours
if extremely purulent discharge occurs at 2-5 days of a neonate (conjuctivitis), what is m/c cause?
gonorrheal conjunctivitis
1. tx is topical (erythromycin ointment)
2. prophylactic drops should prevent gonorrheal conjunctivitis
neonatal conjunctivitis occuring at 5-14 days of age is?
chlamydial conjunctivitis
1. tx c/ topical and system abx to prevent chlamydial pneumonia (oral erythromycin)
2. prophylactic eyedrops do NOT effectively prevent chlamydial conjunctivitis
neonatal conjunctivitis occuring at 2-5 days of age is?
gonorrheal conjunctivitis
neonatal conjunctivitis occuring at in the first 24 hours of age is?
chemical conjunctivitis
characterize open-angle glaucoma
1. 90% of cases of glaucoma
2. PainLESS
3. no acute attacks
4. elevated intraocular pressure (20-30 mmHg)
5. gradually progressive visual field loss
6. optic nerve changes (increased cup-to-disc ratio)
characterize closed-angle glaucoma
1. sudden ocular PAIN
2. haloes around lights
3. red eye
4. high intraocular pressure
>30)
5. n/v
6. sudden decreased vision
7. fixed, mid-dilated pupil!!
8. tx immediately c/ pilocarpine drops
what are the indications for topical ocular steroids?
NEVER!!
*never give topical ocular steroids
1. topical steroids can worsen ocular herpes and fungal infxns
2. esp. do not give if the pt has a dendritic corneal ulcer stained green by fluorescein!!)
what are retinal and fundus changes seen in diabetes?
1. dot-blot hemorrhages (edema)
2. microaneurysms
3. neovascularization
what are retinal and fundus changes seen in hypertension?
1. arteriolar narrowing
2. copper/sliver wiring
3. cotton wool spots
4. papilledema c/ severe hypertension
what eye condition is pathognomonic for 3' syhpilis (neurosyphilis)?
Argyll-robertson pupil
what conditions does lens dislocation more commonly occur?
1. homocystinuria (inferior dislocation)
2. Marfan's (superior)
3. Alport's syndromes (variably)
which direction does the lens dislocate in Maran's syndrome?
1. superiorly
2. Marfan's pts are tall, their lenses dislocate upward
what direction does the lens dislocate in homocysinuria?
inferiorly
What are Kayer-Fleischer rings pathognomonic for?
1. Wilson's disease
2. finding is a ring of golden pigment (copper) around the iris
what eye condition do you find in Wilson's disease?
Kayer-Fleischer rings--ring of copper around the iris
what is a pterygium?
1. fleshy growth from conjunctiva onto nasal side of cornea
2. a/c exposure to wind, sand, sun and dust
how do you tx a pterygium?
(fleshy growth from conjunctiva onto nasl side of cornea)
1. tx=cosmetic removal unless impairing vision;
wear sunglasses and avoid dry eyes
what is a pinguecula?
1. benign yellowish nodules on either side of the cornea
2. commonly seen in pt >35
3. rarely grows and requires no tx
what is subconjunctival hemorrhage?
1. spontaneous onset of a painless, bright-red patch on sclera
2. bening self-limited condition usually seen after overexertion
what is retrobulbar neuritis?
1. caused by inflamm of the optic nerve, usually unilat
2. seen in multiple sclerosis, often is the initial sign
what are si/sx of retrobulbar neuritis?
1. rapid loss of vision and pain upon moving eye
2. spontaneously remitting within 2-8 wk, each relapse damages the nerve more, until eventally blindness results
what is dx/tx of retrobulbar neuritis?
1. dx--funduscopic exam is nonrevealing
2. tx--corticosteroids
3. if b/l in 20-40 y/o female, think multiple sclerosis
what is the pathway of the visual system?
1. optic nerve
2. optic chiasm
3. optic tract
4. Lateral geniculate body
5. Meyer's loop
6. Upper bank of calcarine sulcus
7. Lower bank of calcarine sulcus
where do you see macular drusen bodies?
1. macular degeneration
2. drusen are the byproduct of retinal metabolism and manifest as focal yellow-white deposits deep to the retinal pigment epithelium
what is papilledema?
1. characterized by optic disc swelling and
2. blurring of the disc margins
what are causes of papilledema?
1. hypertension
2. increased intracrainal pressure (brain tumor, pseudotumro cerebri)
3. cryptococcal meningitis
what is presbyobia?
1. occurs btw ages 40-50
2. the lens loses its ability to acoommodate and people need bifocals or reading glasses for near vision
3. nml part of aging and not a disease
which is a med. emergency: orbital cellulitis or preorbital celulitis?
1. orbital cellulitis!!!
2. si/sx=ophthalmoplegia, proptosis, severe eye pain, decreased visual acuity
3. m/c bugs are Strep pneumo, H. flu type B, stap/strep c/ trauma
what is dacryocystitis?
1. tear duct inflamm
2. infxn of lacrimal sac
3. usually caused by Staph aureus, Strep pneumo, H. flu, or strep pyogenes
what are the common causes of dacryocystitis?
(infx of lacrimal sac)
1. staph aureus
2. strep pneumo
3. h. flu
4. strep pyogenes
what are si/sx of dacryocystitis?
1. inflammation and tenderness of nasal aspect of lower lid
2. purulent discharge may be noted or expressed
(inflamm of lacrimal sac)
what is tx for dacryocystitis?
1. keflex (
what is a yellow eye caused from?
1. yellow eye=icterus
2. from bilirubin staining of sclera (jaundice)
what might cause yellow vision?
1. digoxin toxicity!!!
what can digoxin toxicity cause?
yellow vision!!
what is classically found in osteogenesis imperfecta and Marfan's dz?
Blue sclera!
what might cause blue sclera in a pt?
1. osteopgenesis imperfecta
2. Marfan's dz
what causes an opaque eye?
1. cataracts
2. opacity of lens severe enough to interfere c/ vision
where do you see macular drusen bodies?
1. macular degeneration
2. drusen are the byproduct of retinal metabolism and manifest as focal yellow-white deposits deep to the retinal pigment epithelium
what is papilledema?
1. characterized by optic disc swelling and
2. blurring of the disc margins
what are causes of papilledema?
1. hypertension
2. increased intracrainal pressure (brain tumor, pseudotumro cerebri)
3. cryptococcal meningitis
what is presbyobia?
1. occurs btw ages 40-50
2. the lens loses its ability to acoommodate and people need bifocals or reading glasses for near vision
3. nml part of aging and not a disease
which is a med. emergency: orbital cellulitis or preorbital celulitis?
1. orbital cellulitis!!!
2. si/sx=ophthalmoplegia, proptosis, severe eye pain, decreased visual acuity
3. m/c bugs are Strep pneumo, H. flu type B, stap/strep c/ trauma
what is dacryocystitis?
1. tear duct inflamm
2. infxn of lacrimal sac
3. usually caused by Staph aureus, Strep pneumo, H. flu, or strep pyogenes
what are the common causes of dacryocystitis?
(infx of lacrimal sac)
1. staph aureus
2. strep pneumo
3. h. flu
4. strep pyogenes
what are si/sx of dacryocystitis?
1. inflammation and tenderness of nasal aspect of lower lid
2. purulent discharge may be noted or expressed
(inflamm of lacrimal sac)
what is tx for dacryocystitis?
1. keflex (
what is a yellow eye caused from?
1. yellow eye=icterus
2. from bilirubin staining of sclera (jaundice)
what might cause yellow vision?
1. digoxin toxicity!!!
what can digoxin toxicity cause?
yellow vision!!
what is classically found in osteogenesis imperfecta and Marfan's dz?
Blue sclera!
what might cause blue sclera in a pt?
1. osteopgenesis imperfecta
2. Marfan's dz
what causes an opaque eye?
1. cataracts
2. opacity of lens severe enough to interfere c/ vision
what are causes of opaque eye (corneal clouding)?
1. congenital
2. diabetes (sorbitol precipitation in lens)
3. galactosemia (galactitol precipitation in lens)
4. Hurler's dz
characterize diabetic retinopathy
1. occurs after approx 10 yrs of diabetes
2. flame hemorrhages
3. microaneurysms
4. soft exudates (cotton-wool spots)
5. signs of retinal vascular dz
what are signs of retinal vascular dz?
1. flame hemorrhages
2. soft exudates (cotton-wool spots) on retina
what is tx for diabetes/rential vascular dz?
1. strict glucose control
2. strict HTN control
what is seen with proliferative type diabetes?
(more advanced dz)=
1. neovascularization easily visible around fundus (hyperemia)
2. hard exudates
what is tx for proliferative type (advanced dz DM)?
1. photocoagulation (laser ablation of blood vessels in the retina)
2. slows dz progression, but is not curative
what is m/c cause of blindness in adults older than 55?
macular degeneration
1. causes painless loss of visual acuity
2. see drusen bodies
how do you dx macular degeneration?
1. by altered pigmentation in macula--drusen bodies
2. drusen=byproduct of retinal metabolism and manifests as focal yellow-white deposits deep to the retinal pigment epithelium
how do you tx macular degeneration?
1. antioxidants and laser therapy
2. pts often retain adequate peripheral vision
how does retinal detachment present?
1. painless
2. dark vitreous floaters
3. lashes of light (photopsias)
4. blurry vision
5. progressing to a curtain of blindness as detachment worsens
how do you tx retinal detachment?
1. urgent surgical reattachment!!
what are signs of retianl vascular dz?
1. new vessels arising at the disk
2. perhaps a yellowish nature and distinct margin to exudates
3. or less distinct and white appearance of cotton-wool spots
what is retinits pigmentosa?
1. slowly progressive defect in night vision (often starts in young children)
2. with ring-shaped scotoma (blind spot)
3. that gradually increases in size to obscure more vision
what should you think of in children with slowly progressing defective night vision with ring-shaped scotoma?
retinitis (may be part of the Laurence-Moon-Biedl syndrome)
*no Tx
what syndrome might retinitis pigmentosa be a part of ?
1. Laurence-Moon-Biedl syndrome
2. dz is hereditary c/ unclear transmission mode
3. no Tx
what is leukocoria?
1. absent red reflex (actually appears white)
2. seen in retinoblastoma
what physical finding of the retina is found in retinoblastoma?
(absent red reflex)=leukocoria
what are roth spots?
1. small hemorrhagic spots
2. with central clearing in retina a/c endocarditis
what physical finding of the retina is a/c endocarditis?
1. roth spots=small hemorrhagic spots with central clearing in retina
what is seen in subacture HTN and/or atherosclerosis?
1. copper wiring
2. flame hemorrhages
3. A-V nicking
where do you find copper wiring, flame hemorrhages and A-V nicking?
1. HTN
2. atherosclerosis
where do you see cotton-wool spots (soft exudates)?
chronic HTN
what physical finding of the retina are seen in chronic HTN?
cotton-wool spots (soft exudates)
what is a/c an increase in intracranial pressure?
1. papilledema
2. appears as disk hyperemia, blurring and elevation
what physical retinal finding is seen in sickle cell anemia?
"sea fan" neovascularization
where do you find "sea fan" neovascularization?
sickle cell anemia
where do you find "wrinkles on the retina"?
seen in retinal detachment
where do you see a "cherry-red spot on macula"?
1. Tay-Sachs
2. Niemann-Pick dz
3. central retinal artery occlusion
what is commonly seen in:
1. Tay-Sachs
2. Niemann-Pick dz
3. central retinal artery occlusion
cherry-red spot on macula!
what is a Hollenhorst plaque?
yellow cholesterol emboli in the retinal artery
where do you find a brown macule on the retina?
1. malignant melanoma (m/c intraocular tumor in adults)
what is the m/c intraocular tumor in adults?
1. malignant melanoma
2. seen brown macule on retina
what do you see in malignant (choroidal) melanoma?
brown macules on the retina