Clinmed Test 6

Front 1

About ___% of all sensory receptors are in the eyes.

Back 1

70%

Front 2

The sclera, the outer supporting layer of the eye, is continuous anteriorly with the cornea and posteriorly with the ______ ______ _______ surrounding the optic nerve.

Back 2

cranial dural sheath

Front 3

Modified sebaceous glands in the tarsus of the eye with ducts that open onto the eyelid margins producing sebaceous secretions that enable airtight closure of the lids to prevent rapid evaporation of tears.

Back 3

Meibomian glands

Front 4

What muscle raises the eyelid and what nerve supplies it?

Back 4

Levator Palpebrae (CN III)

Front 5

What muscle closes the eyelid and what nerve supplies it?

Back 5

Orbicularis Oculi (CN VII)

Front 6

Drooping of the eyelid caused by weakness of the levator palpebrae superioris.

Back 6

ptosis

Front 7

Usually caused by scarring of the palpebral conjunctiva or degeneration of the facial attachments to the lower lid that occurs with aging this abnormality cuases the eyelashes to turn inward so that corneal irritation may occur.

Back 7

Entropion

Front 8

Caused by relaxation of the orbicularis oculi muscle due to CN VII weakness or aging
Causes tearing and ocular irritation
May lead to inflammation of the cornea

Back 8

Ectropion

Front 9

Patient complains of irritation, burning, redness and itching of the eyelid margins and has flaking of the scalp and brows. Dx? Tx?

Back 9

Suborrheic blepharitis
J&J Baby Shampoo and treat suborrheic scalp and brow with zinc pyrithione or selenium sulfide

Front 10

Patient has painful lesions on the margins of the eye lids with no signs of flaking on the scalp and brow. Dx? Tx?

Back 10

Suborrheic blepharitis secondary to bacterial infection
Bacitracin or erythromycin ophthalmic ointment

Front 11

Patient has Inflammation of the eyelids that you suspect involves the meibomian glands b/c tears are frothy and abnormally greasy. Dx? Tx?

Back 11

Posterior blepharitis
Tetracyclines or erythromycin and warm compress

Front 12

Patient with small bump on eyelid complains of pain and has redness, and swelling. You suspect an infection of the sebaceous glands of the eyelid. Dx? Tx?
May be internal or external
Main symptoms are

Back 12

Hordeolum (stye)
Bacitracin or erythromycin ophthalmic and warm compress

Front 13

Patient has a large, granulomatous inflammation of the eyelid and had a stye a week ago that got worse. The nodule is nontender but the conjunctiva around the nodule is red and elevated. Dx? Tx?

Back 13

Chalzion
Treatment consists of incision and curettage

Front 14

List the content of tears:

Back 14

Water 98%
NaCl 1.5%
potassium
glucose
albumin
IgA, IgG, IgE

Front 15

List the three layers of tears and describe the function of each layer.

Back 15

-The superficial lipid layer is secreted by the meibomian glands and retards evaporation
-The aqueous layer is secreted by the lacrimal glands
-The mucinous layer overlies the cornea and the epithelial cells and wets the surfaces of the hydrophobic cell membranes

Front 16

Another name for dry eyes?

Back 16

Keratoconjunctivitis Sicca

Front 17

48 year old woman with rheumatoid arthritis complains of keratoconjunctivitis sicca and has Telangiectases (purpuric spots) on her face with bilateral parotid enlargemen. Dx? Tx?

Back 17

Sjogrens Syndrome
Artificial tears and moist mouth (gum)
encourage good oral hygiene

Front 18

Why would you encourage patients with keratoconjuctivitis sicca to avoid antihistamine and anticholinergic eye drops?

Back 18

Rebound dryness

Front 19

Infant has unilateral tearing, discharge, pain and tenderness with swelling of the eyes. You culture S. aureus. Dx? Tx?

Back 19

Acute dacryocystitis (infection of the lacrimal sac secondary to obstruction of the nasolacrimal system)
ABx and warm compress

Front 20

The thin layer of mucous membrane that lines the anterior surface of the optic globe that produces lubricating mucus that baths the eye.

Back 20

Bulbar conjunctiva

Front 21

Patient has red eyes with conjunctival injection, discharge and complains of a foreign body sensation. She does not complain of itching and has no signs of preauricular adenopathy. She has normal visual acuity and pupillary reactivity. Dx? Tx?

Back 21

Allergic conjunctivitis
Avoid allergen, cold compress, oral antihistamines, vasoconstictor eyedrops (short term), topical mast cell stabilizer, H1 receptor antagonist, topical NSAIDS. Refer for allergy testing.

Front 22

Patient describes rapid onset and has copious yellow discharge with chemosis (conjuctival edema) and preauricular edema. Dx? Tx?

Back 22

Hyperacute Bacterial Conjunctivitis
suspect Neisseria gonorrheae
culture, 5-day course ceftriaxone 1-2g qd (Rocefin) with topical erythromycin or bacitracin.

Front 23

Patient woke up this morning with her eyes stuck together. She was fine last night. She has mild pruritis and a mucoprurulent discharge but no preauricular adenopathy. Dx? Tx?

Back 23

Bacterial Conjuctivitis
Sulfacetamide 10% solution TID x 3 days

Front 24

Patient has watery mucous discharge, inferior palpebral conjunctival follicles and preauricular lymphadenopathy. She had a UTI a week ago and still has fever. Dx? Tx?

Back 24

Viral conjunctivitis
Symptom relief (7-14 days)

Front 25

Flouricien drops show epithelial lesions on the cornea. Patient complains of photophobia and has a unilateral burning sensation and a mucoid discharge. Preauricular lymph nodes are swollen. Dx? Tx?

Back 25

Herpes Simplex Virus Conjunctivitis
Refer to opthalmologist

Front 26

What is a major cause of blindness world wide that can be easily treated with 20mg/kg of Azithromycin?

Back 26

Chlamydial conjunctivitis secondary to C. trachomatis (serotypes A-C) infection

Front 27

5 day old infant has severe conjunctivitis and mother states she had premature rupture of membranes (PROM) at birth. Dx? Tx?

Back 27

Ophthalmia Neonatorum

Front 28

1 week old infant presents with dendritic keratitis? Dx? Tx?

Back 28

Considered Ophthamolic emergency
Herpetic keratoconjunctivitis until proven otherwise
Refer to ophthamologist

Front 29

Patient describes acute onset of redness in left eye onlyone eye. She has injection of a section of the episcleral and overlying conjunctival vessels with diffuse redness and a translucent white nodule centrally within the inflamed area. Dx? Tx?

Back 29

Episcleritis
Prednisolone acetate 1% or Dexamethasone 0.1%
One drop q 1-2 hours until redness disappears, then 3-4 times daily for 4-5 days

Front 30

Patient presents describes gradual onset of pain and redness with associated photophobia, tearing, and decreased vision. She now has severe, boring ocular pain and her whole face hurts. Her scleral vessels are significantly dilated. Dx? Tx?

Back 30

Scleritis
Refer to ophthalmologist

Front 31

Name the three layers of the cornea.

Back 31

Bowmans' membrane (outer)
Stroma
Descemet's membrane (inner)

Front 32

Cornea appears dull, uneven and hazy. Dx?

Back 32

Corneal edema

Front 33

Patient was using a string trimmer yesterday and now complains of pain and foreign body sensation in his eye. What will you do before testing and treating?

Back 33

Check and DOCUMENT visual acuity as a base line for treatment effectiveness. Then corneal fluorescein stain.

Front 34

Treatements for corneal abrasion.

Back 34

Proparacaine ophthalmic solution (do not prescribe topical analgesic)
Oral analgesic
Topical Abx
Urgent consultation for suspected corneal ulceration or to remove foreign body

Front 35

All layers of the cornea are inflamed but the epithelium is intact. Dx?

Back 35

Nonulcerative keratitis

Front 36

Parts of the stroma and epithelium of the cornea are destroyed by inflammation. Dx?

Back 36

Ulcerative keratitis

Front 37

The most common cause of ulcerative keratitis and the most common cause of corneal blindness in the US?

Back 37

Herpes Simplex Virus keratinitis

Front 38

Patient has had fever and a headache with burning and itching of his eye. A pustular rash is now starting to crust and has moved to the tip of his nose. Dx? Tx?

Back 38

Ophthalmic emergency
Varicella Zoster Ophthalmicus
Ophthalmology referal

Front 39

Name an abnormal golden/greenish copper ring around the limbus of the iris.

Back 39

Kayser-Fleischer ring
Wilson's disease?

Front 40

Name the thick grayish with ring aourng the limbus of the iris.

Back 40

Arcus senillis
Hyperlipidemia

Front 41

What is the main problem with a corneal transplant?

Back 41

Scar tissue

Front 42

Blood in the anterior chamber of the eye.

Back 42

Hyphema

Front 43

If hyphema is present with > 27 mmHg interocular pressure, Tx?

Back 43

Atropine
Topical steroids
Beta blocker
Bed rest with head at 30 degree angle
Acetaminophen for pain (No ASA due to bleeding risk)

Front 44

Patient has a yellowish, slightly raised deposit of abnormal collagen on her temporal limbal conjunctiva. Dx?

Back 44

Pinguecula
Pinguins have pingueculas

Front 45

If a pinguecula extends into the cornea, Dx?

Back 45

Pterygium

Front 46

Patient has had a severe cough for several days and now has a bloody eye. Dx? Tx?

Back 46

Subconjunctival hemorrhage
resolves spontaneously in 1-3 weeks

Front 47

Name the layers of the vascular uveal tract

Back 47

Choroid - highly vascular
Ciliary body - aqueous humor
Iris (radial or dilator muscles and sphincter or constrictor muscles)

Front 48

Patient complains of not being able to see coming out of no where. He has deep eye pain and photophobia. On examination you se perilimbal dilation of the episcleral and scleral vessels, a small pupil and posterior synechiae. Dx? Tx?

Back 48

Anterior uveitis
Refer to ophthalmologist

Front 49

Pupillary constriction. Name and NS?

Back 49

miosis (parasympathetic)

Front 50

Pupillary dilation. Name and NS?

Back 50

mydriasis (sympathetic)

Front 51

Name the region of the brain that controls the pupillary reflex.

Back 51

pretectum

Front 52

Patient has permanent pupillary dilation. What nerve do you suspect may be damaged?

Back 52

CN III

Front 53

Atropine and other medications can cause pupillary dilation due to ____________ blockade of this cranial nerve.

Back 53

parasympathetic CN III

Front 54

A treatment for narrow angle glaucoma is pilocarpine which activates the parasympathetic pupillary reflex. What will happen to the pupil?

Back 54

Miosis (constriction)

Front 55

Patient has unequal pupil sizes but they react normally. Dx? Tx?

Back 55

Anisocoria
normal

Front 56

Patient has left sided ptosis, miosis, anhidrosis and his left pupil is slow to dilate in dim light. Dx?

Back 56

Horner Syndrome possibly secondary to lung cancer

Front 57

Patient has miosis, irregular shape and loss of direct and consensual pupillary reflex to light. Dx?

Back 57

Argyll Robertson pupils possible secondary to neurosyphilis

Front 58

Aqueous humor filters through the trabecular meshwork and enters the _____ __ ______ for return to the venous circulation.

Back 58

Canal of Schlemm

Front 59

70 year old female patient of Asian descent with hyperopia complains of ocular pain, blurred vision and halos around lights. She has a steamy cornea and IOP of 50mmHg. Dx? Tx?

Back 59

Angle-Closure Glaucoma
Ophthalmologist will order IV acetazolamide (diuretic) and when pressure falls will apply pilocarpine 4% constrict the pupil by shrinking the iris which will open the angle

Front 60

68 year old African American man with asthma and DM and myopia is found to have a cup-to-disk ration of 0.8 and IOP of 35mmHg. Dx? Tx?

Back 60

Open-Angle Glaucoma
Prostaglandin analogs and beta blockers and oral carbonic anhydrase inhibitors

Front 61

Changing the shape of the lens to adjust for differing focal differences

Back 61

Accommodation

Front 62

Farsightedness. Dx? Tx?

Back 62

Hyperopia
Convex lenses

Front 63

Nearsightedness. Dx? Tx?

Back 63

Myopia
Concave lenses

Front 64

Nonuniform curvature of the refractive medium of the eye usually due to a defect in the cornea.

Back 64

Astigmatism

Front 65

Paralysis of the ciliary muscle with loss of accommodation.

Back 65

Cycloplegia

Front 66

Changes in vision due to aging.

Back 66

Presbyopia

Front 67

Patient complains of 'ghosting' of images and just can't see at night anymore because of the glare. He has fallen several times. On exam you see lens opacity. Dx?

Back 67

Cataracts

Front 68

The most common cause of age related visual loss in the world.

Back 68

Cataracts

Front 69

List three components of the neural retina.

Back 69

Photoreceptors
Bipolar cells
Ganglion cell layer

Front 70

Patient complains of a reduced sensitivity to light. What vitamin might you suggest?

Back 70

Vitamin A

Front 71

Vision at low light levels, primarily as a function of the rods in the neural layer of the retina.

Back 71

Scotopic vision

Front 72

What are the three visual pigments in the cones of the retina?

Back 72

blue, green and red

Front 73

A 'yellow spot' near the center of the retina that is primarily cones and facilitates acute and detailed vision.

Back 73

Macula lutea

Front 74

Located within the macula lutea this feature of the retina allows light to pass through to cone alone allowing for high acuity vision. At what age is this feature fully developed.

Back 74

fovea centralis (4 years old)

Front 75

T/F color blindness is autosomal dominant and found more often in females.

Back 75

False: sex linked and > in males

Front 76

Patient complains of a slow loss of peripheral vision in both eyes that is starting to appear as tunnel vision. She really can't see at night. Dx?

Back 76

Retinitis pigmentosa

Front 77

On fundoscopic exam you not atrophic, waxy pallor on the optic disk, marked attenuation of retinal arteries and bony spicule-shaped disruption of the pigmentation. Dx?

Back 77

Retinitis pigmentosa

Front 78

List two sources of blood supply to the retina.

Back 78

Choriocapillaries
Central renal artery

Front 79

T/F retinal vessels provide a 'snapshot' of blood vessels in the brain.

Back 79

True

Front 80

Patient complains of vision loss in one eye that happens 2-3 times a day and lasts about 15 minutes. She describes the vision loss as curtain coming down over her eye. Dx?

Back 80

Amaurosis fugax that might be secondary to internal carotid stenosis

Front 81

On fundoscopic exam you see a 'choked disk' protruding into the interior of the eye, blurred margins of the optic disk and few vessels. Dx? and Ddx?

Back 81

Papilledema secondary to:
cerebral tumor
subdural hematoma
hydrocephalus
malignant hypertension
lead poisoning

Front 82

Patient complains of a painless rapid deterioration of visual acuity. Dx and Ddx?

Back 82

Central retinal vein occlusion:
Hypertension
Diabeties mellitus
Sickle cell anemia

Front 83

Rings of yellow exudate compaosed of lipid and lipoprotein blood breakdown products associated with retinal trauma, severe anemia, papilledema and diabetic retinopathy.

Back 83

Cotton wool spots

Front 84

What is the 3rd leading cause of blindness in the United States regardless of age.

Back 84

Diabetic retinopathy

Front 85

Patient with a history of DM complains of a sensation of glare. On exam you see microinfarcts and microaneurysms. Dx?

Back 85

Non-proliferative diabetic retinopathy

Front 86

Using an Amsler grid you note patient with history of DM has increasing blurring, darkening and distorted images. Dx?

Back 86

Macular edema
Non-proliferative diabetic retinopathy

Front 87

On fundoscopic exam of a patient with history of DM you note the formation of fragile looking blood vessels around the optic disk and retina. Dx? Whys is this disease a threat to vision?

Back 87

Proliferative diabetic retionopathy
Bleeding into the vitreous humor
Retinal detachment

Front 88

What is the best treatment for diabetic retinopathy?

Back 88

Tight glucose control

Front 89

On fundoscopic exam you note edema, intraretinal hemorrhages and cotton wool spots. The retinal blood vessels are transparent and the veins look like a 'string of boxcars' while the arteries look like 'copper wire'. You also see AV nicking. Dx?

Back 89

Hypertensive retinopathy

Front 90

List four signs of hypertensive retinopathy.

Back 90

Vessel ration artery to vein 1:2 (vs 2:3)
AV nicking (artery/vein crossing)
Copper wire arteries
Box car veins
Cotton wool spots
Microaneurysms
Retinal hemorrhages

Front 91

Patient complains of flashing lights, sparks, floaters and spots in her field of vision. She describes a 'dark curtain' coming down over her eyes for the past several months. Dx? Tx?

Back 91

Retinal detachment
Surgical reattachment
Scleral buckling (silicone)

Front 92

The most common cause of reduced vision in the US

Back 92

Age related macular degeneration

Front 93

List five risk factors of age related macular degeneration.

Back 93

age > 65 years
female gender
white
cigarette smoke
lack of dietary carotenoids

Front 94

On fundoscopic exam you note bruch's membran and choriocapillaries and drusen spots in this 70 year old, white female that is a 50 pack year smoker. Dx? Tx?

Back 94

Dry macular degeneration
No tx.

Front 95

Patient has had trouble seeing for the past 5 years. Now she sees a big black spot in the middle of her field of vision. On fundoscopic exam you note blood underneath her macula. Dx? Tx?

Back 95

Wet macular degeneration
Supplemental antioxidants to slow progression
Argon laser photocoagulation
Photodynamic therapy

Front 96

Rare hereditary macular dystrophy that manifests in the first and second decades of life.

Back 96

Stargardt's disease

Front 97

blind spot

Back 97

scotoma

Front 98

A glassy membrane of the uvea of the eye, lying between the choroid membrane and the pigmented epithelium of the retina.

Back 98

Bruch's membrane

Front 99

The highly vascular middle layer of the eyeball, immediately beneath the sclera consisting of the iris, ciliary body and choroid forming the pigmented layer of the eye.

Back 99

Uvea

Front 100

3 year old patient has leukocoria (loss of red reflex). Dx? Tx?

Back 100

Retinoblastoma
chemotherapy
cryotherapy
radiotherapy

Front 101

Name that cranial nerve:
Lateral rectus

Back 101

VI abducens

Front 102

Name that cranial nerve:
Superior oblique

Back 102

IV trochlear

Front 103

Name that strabismus:
medial deviation

Back 103

Esotropia

Front 104

Name that strabismus:
lateral deviation

Back 104

Exotropia

Front 105

Name that strabismus:
upward deviation

Back 105

hypertropia

Front 106

Name that strabismus:
downward deviation

Back 106

hypotropia

Front 107

List three Txs for starbismus.

Back 107

-surgically adjusting the tension of the eye muscles
-botox injections
-prism glasses

Front 108

A condition of diminished vision that cannot be corrected by lenses this disorder leads to inadequately developed CNS circuitry because of visual deprivation.

Back 108

Amblyopia