Usmle Step 2: Ophthalmology Qbank

Front 1

complication of neurofibromatosis, type 1?

Back 1

optic glioma (15%)

clinical presentation?

Hint 1

usually children younger than 6, hx of slowly progressive unilateral visual loss and dyschromatopsia, exophthalmos, optic disk may be normal, swollen, or atrophic

Front 2

episcleritis

Back 2

infection of episcleral tissue between conjunctiva and sclera

clinical presentation?

Hint 2

mild to moderate discomfort, photophobia, watery discharge

exam: diffuse or localized bulbar conjunctival injection

Front 3

orbital cellulitis

Back 3

infection posterior to the orbital septum

unilateral, more common in children, abrupt onset of fever, proptosis, restriction of extraocular movements and swollen, red eyelids

Front 4

dacryocystitis

Back 4

infection of lacrimal sac

presents with inflammatory changes in the medial canthal region of the eye

Staph a. and Strep B are the usual infecting organisms

Front 5

macular degeneration

Back 5

age-related - usually in pts above 50

present with progressive and bilateral loss of central vision

peripheral and navigational vision always maintained, but may become impaired by development of cataracts

pathophys?

Hint 5

degeneration and atrophy of outer retina, retinal pigment epithelium, Bruch's membrane and choriocapillaries

Front 6

Acute ocular conditions p/w complete vision loss

Back 6

central retinal artery occlusion (usually noted upon waking in morning- see disc swelling, venous dilation and tortosity, retinal hemorrhages and CWS) -> "blood and thunder" appearance

tx?

retinal detachment (retina hanging in the vitreous)

Hint 6

high flow oxygen and ocular massage (which dislodges the embolus to a point further down the arterial circulation and improves retinal perfusion

(medical mgmt and and anterior chamber paracentesis to lower the IOP may be used as well, but ocular massage has most rapid action)

treat atherosclerotic risk factors

Front 7

sudden loss of vision in one eye that resolved in 15 min. "curtain falling down on one eye"

fundoscopy: zones of whitened, edematous retina following distribution of the retinal arterioles

dx?

Back 7

retinal emboli -> amaurosis fugax, characterized by visual loss commonly monocular and transient

retinal emboli from ipsilateral carotid artery -> noninvasive evaluation of the carotids is useful in providing info regarding the degree of carotid artery stenosis

(curtain description may also be indicative of retinal detachment)

Front 8

diabetic retinopathy: discuss different types

Back 8

simple: microaneurysms, hemorrhages, exudates, and retinal edema

pre-proliferative: cotton wool spots

proliferative: newly formed vessels

Front 9

presbyopia

Back 9

common age-related disorder that results from loss of elasticity of the lens

prohibits accommodation of the lens, which is required in order to focus on near objects

clinical presentation: pts have to hold reading material at a further distance. onset in 40s, sx peaking in 60s

tx with reading glasses

Front 10

astigmatism

Back 10

nonspherical cornea, typically p/w blurry vision both at a distance and up close

Front 11

glaucoma

Back 11

p/w peripheral visual field defects followed by central vision loss

Front 12

florescein exam

Back 12

to detect foreign bodies or corneal pathology

Front 13

external hordeolum

Back 13

aka stye

common staphylococcal abscess of eyelid that usually responds to WARM COMPRESSES

if lesion does not resolve in 48 hrs, incision and drainage

Front 14

non-ketotic hyperosmolar state -> ocular manifestations?

Back 14

Type 2 diabetics are prone to the development of a hyperosmolar hyperglycemic state without ketoacidosis.

Decreased consciousness is the most common sx

other reversible neurologic abnormalities, such as blurred vision, can also be caused by hyperglycemic hyperosmolarity

Front 15

Herpes simplex keratitis

Back 15

corneal vesicles and dendritic ulcers

also pain, photophobia, blurred vision, tearing, and redness

antiviral therapy

Front 16

bacterial keratitis - when to suspect

Back 16

contact lens wearers following corneal trauma or entry of foreign body - cornea appears hazy with a central ulcer and adjacent stromal abscess. hypopyon may be present

Front 17

vitreous hemorrhage vs detachment

Back 17

hemorrhage: typically with sudden LOV and onset of floaters (most commonly with diabetes), often fundus is hard to visualize

detachment: LOV, photopsia with showers of floaters. but fundus is CLEAR and demonstrates ELEVATED RETINA with folds and/or a tear

Front 18

tx for acute glaucoma

what to avoid?

Back 18

emergently with mannitol, acetazolamide, pilocarpine or timolol

avoid mydriatic agents like atropine (which can actually precipitate glaucoma alone)

Front 19

optic neuritis

Back 19

rapid impaired vision in one eye (or rarely both) and pain on eye movement

marked changes in color perception

APD and field loss occur, usually with central scotoma

Front 20

one of earliest signs of macular degeneration

Back 20

activities requiring fine visual acuity are usually the first affected, and pts with this condition may report that straight lines appear wavy . also driving and reading more difficult

primary risk factor: increasing age, although smoking can increase risk as well

either monocular or binocular

fundus exam: Drusen deposits in macula

Front 21

endophthalmitis

Back 21

most commonly after surgery

infection within eye, particularly the vitreous

present with pain and decreased visual acuity

swollen eyelids and conjunctiva, hypopyon, corneal edema and infection

vitreous can be sent for gram stain and culture and based on severity, intravitreal antibiotic injection or vitrectomy can be done

Front 22

conjunctivitis presentation

Back 22

excessive tearing, burning sensation, mild pain, conjunctival, and eyelid edema

vision not affected

Front 23

corneal ulceration presentation

Back 23

foreign body sensation, blurred vision, photophobia, pain

hx of contact lens use, recent trauma or ocular dz

eye is erythematous, and ciliary injection is present. purulent exudates in conjunctival sac and on the ulcer surface

Front 24

sx of acute angle closure glaucoma

Back 24

acute onset of severe eye pain and blurred vision a/w N/V

exam reveals red eye with steamy cornea (hazy) and moderately dilated pupil that is nonreactive to light

Front 25

CMV retinitis - fundoscopic analysis

Back 25

occurs when CD4 count less than 50/ul. may be asymptomatic

characteristic fundoscopic findings of yellow-white patches of retinal opacification and hemorrhages are diagnostic