BCS Exam 1

Question 1

Myopia

Answer 1

Impaired far vision

Question 2

Presbyopia

Answer 2

Impaired near vision found in middle-aged and older people. A presbyopic person sees better when the card is farther away

Question 3

miosis

Answer 3

Constriction of the pupil

Question 4

mydriasis

Answer 4

Dilation of the pupil

Question 5

Anisocoria

Answer 5

Difference in pupillary size of 0.04 mm or greater.

Question 6

Nystagmus

Answer 6

Fine rhythmic oscillation of the eyes

Question 7

Ptosis

Answer 7

Drooping of the upper lid

Question 8

Entropion

Answer 8

Inward turning of the eyelid margin

Question 9

Ectropian

Answer 9

Lower eyelid margin turns outward

Question 10

Exopthalmos

Answer 10

Protrusion of the eyeball

Question 11

Hordeolum (Stye)

Answer 11

A painful, tender, red infection at the outer margin of the eyelid. Usually obstructed meibomian (inner margin) or tear gland (Outer margin)

Question 12

Chalazion

Answer 12

A subacute nontender, usually painless nodule caused by a blocked meibomian gland

Question 13

Blepharitis

Answer 13

A chronic inflammation of the eyelids at the base of the hair follicles. Often from S. aureus

Question 14

Xanthelasma

Answer 14

Slightly raised, yellowish, well circumscribed cholesterol filled plaques that appear along the nasal portions of the one or both eyelids. 50% affect have hyperlipidema

Question 15

Pterygium

Answer 15

A triangular thickening of the bulbar conjunctiva that
grows slowly across the outer surface of the cornea, usually from
the nasal side. Reddening may occur. May interfere with vision as it
encroaches on the pupil.

Question 16

Pinguecula

Answer 16

A harmless yellowish triangular nodule in the bulbar conjunctiva
on either side of the iris. Appears frequently with aging, first on
the nasal and then on the temporal side.

Question 17

Episcleritis

Answer 17

A localized ocular inflammation of the episcleral vessels. Vessels
appear movable over the scleral surface. May be nodular or show
only redness and dilated vessels. Seen in rheumatoid arthritis,
Sjögren’s syndrome, and herpes zoster.

Question 18

Cataracts

Answer 18

Opacities of the lenses visible through the pupil. Risk

factors are older age, smoking, diabetes, corticosteroid use.

Question 19

Kayser-Fleischer Ring

Answer 19

A golden to red brown ring,
sometimes shading to green or blue, from copper deposition in
the periphery of the cornea found in Wilson’s disease. Due to a
rare autosomal recessive mutation of the ATO7B gene on
chromosome 13 causing abnormal copper transport, reduced
biliary copper excretion, and abnormal accumulation of copper
in the liver and tissues throughout the body. Patients present
with liver disease, renal failure, and neurologic symptoms of
tremor, dystonia, and psychiatric disorders ranging from behavior
changes to depression and schizophrenia.65,66

Question 20

Tonic Pupil

Answer 20

Pupil is large, regular, and usually unilateral.
Reaction to light is severely reduced and slowed, or even absent. Near
reaction, although very slow, is present. Slow accommodation causes
blurred vision. Deep tendon reflexes are often decreased.

Question 21

Oculomoter Nerve Paralysis

Answer 21

The dilated pupil is fixed to
light and near effort. Ptosis of the upper eyelid and lateral deviation of
the eye are almost always present.

Question 22

Horner Syndrome

Answer 22

The affected pupil, though small, reacts briskly to
light and near effort. Ptosis of the eyelid is present, perhaps with loss of
sweating on the forehead. In congenital Horner’s syndrome, the involved
iris is lighter in color than its fellow (heterochromia).

Question 23

Argyll Robertson Pupils

Answer 23

Small, irregular pupils that accommodate but
do not react to light indicate Argyll Robertson pupils. Seen in central
nervous system syphilis.

Question 24

Acute Angle Closure Glaucoma

Answer 24

Acute increase in intraocular pressure constitutes an emergency

PE:
Severe pain, decreased vision, dilated or fixed pupil, and steamy/cloudy cornea

Question 25

Papilledema

Answer 25

Elevated intracranial pressure causes
intraaxonal edema along the optic
nerve, leading to engorgement and
swelling of the optic disc.

Question 26

Superficial Retinal Hemorrhages

Answer 26

Small, linear, flame-shaped, red streaks in the fundi, shaped by the superficial bundles of nerve
fibers that radiate from the optic disc in the pattern illustrated (O = optic disc; F = fovea). Sometimes the hemorrhages occur in clusters
and look like a larger hemorrhage but can be identified by the linear streaking at the edges. These hemorrhages are seen in severe
hypertension, papilledema, and occlusion of the retinal vein, among other conditions. An occasional superficial hemorrhage has a white
center consisting of fibrin. White-centered retinal hemorrhages have many causes.

Question 27

Deep retinal hemorrhages

Answer 27

Small, rounded, slightly irregular red
spots that are sometimes called dot or blot hemorrhages. They occur in
a deeper layer of the retina than flame-shaped hemorrhages. Diabetes is
a common cause.

Question 28

Microaneurysms

Answer 28

Tiny, round, red spots commonly
seen in and around the macular area. They are minute
dilatations of very small retinal vessels; the vascular
connections are too small to be seen with an
ophthalmoscope. A hallmark of diabetic retinopathy.

Question 29

Neovascularization

Answer 29

Refers to the formation of new blood vessels.
They are more numerous, more tortuous, and narrower than other
blood vessels in the area and form disorderly looking red arcades. A
common feature of the proliferative stage of diabetic retinopathy. The
vessels may grow into the vitreous, where retinal detachment or
hemorrhage may cause loss of vision.

Question 30

Cotton-Wool Patches

Answer 30

Cotton-wool patches are white or grayish, ovoid lesions with
irregular “soft” borders. They are moderate in size but usually
smaller than the disc. They result from infarcted nerve fibers.
Seen in hypertension and many other conditions.

Question 31

Hard Exudates

Answer 31

Hard exudates are creamy or yellowish, often bright, lesions with
well-defined “hard” borders. They are small and round but may
coalesce into larger irregular spots. They often occur in clusters or
in circular, linear, or star-shaped patterns. Causes include diabetes
and hypertension.

Question 32

Drusen

Answer 32

Drusen are yellowish round spots that vary from tiny to small.
The edges may be soft, as here, or hard (p. 232). They are
haphazardly distributed but may concentrate at the posterior
pole between the optic disc and the macula. Drusen appear in
normal aging but may also accompany various conditions,
including age-related macular degeneration.

Question 33

Hypertensive Rentinopathy

Answer 33

Marked arteriolar-venous crossing changes are seen, especially
along the inferior vessels. Copper wiring of the arterioles is present.
A cotton-wool spot is seen just superior to the disc. Incidental disc
drusen are also present but are unrelated to hypertension.

Question 34

Serous Effusion

Answer 34

Serous effusions are usually caused by viral upper respiratory infections (otitis media with
serous effusion) or by sudden changes in atmospheric pressure as from flying or diving
(otitic barotrauma). The eustachian tube cannot equalize the air pressure in the middle
ear and outside air. Air is absorbed from the middle ear into the bloodstream, and serous
fluid accumulates there instead. Symptoms include fullness and popping sensations in the
ear, mild conduction hearing loss, and, sometimes, pain.

Question 35

Acute Otitis Media with Purulent Effusion

Answer 35

Acute otitis media with purulent effusion is commonly caused by bacterial infection from
S. pneumoniae and H. influenzae. Symptoms include earache, fever, and hearing loss. The
eardrum reddens, loses its landmarks, and bulges laterally, toward the examiner’s eye.

Question 36

Bullous Myringitis

Answer 36

In bullous myringitis, painful hemorrhagic vesicles appear on the tympanic membrane,
the ear canal, or both. Symptoms include earache, blood-tinged discharge from the ear,
and conductive hearing loss.
In this right ear, at least two large vesicles (bullae) are discernible on the drum. The
drum is reddened, and its landmarks are obscured.
This condition is caused by mycoplasma, viral, and bacterial otitis media.

Question 37

Conductive Hearing Loss

Answer 37

External or middle ear disorder impairs sound
conduction to inner ear. Causes include foreign body,
otitis media, perforated eardrum, and otosclerosis of
ossicles.

Question 38

Sensorineural Hearing Loss

Answer 38

Inner ear disorder involves cochlear nerve and
neuronal impulse transmission to the brain. Causes
include loud noise exposure, inner ear infections,
trauma, acoustic neuroma, congenital and familial
disorders, and aging.

Question 39

Angular Chelitis

Answer 39

Angular cheilitis starts with softening of the skin at the angles of the mouth,
followed by fissuring. It may be due to nutritional deficiency or, more commonly,
to overclosure of the mouth, seen in people with no teeth or with ill-fitting
dentures. Saliva wets and macerates the infolded skin, often leading to secondary
infection with Candida, as seen here.

Question 40

Otitis Externa vs Otitis Media

Answer 40

Pain occurs in the external canal in otitis externa (inflammation of the external ear canal) and, deeper within the ear in otitis media (infection of the middle ear). Pain in the ear may also be referred from other structures in the mouth, throat, or neck.

Acute otitis externa and acute or chronic otitis media with perforation usually
present with yellow-green discharge.

Movement of the auricle and tragus (the “tug test”) is painful in acute otitis externa (inflammation of the ear canal), but not in otitis media (inflammation of the middle ear). Tenderness behind the ear occurs in otitis media.

In chronic otitis externa, the skin of the canal is often thickened, red, and itchy.
Look for the red bulging drum of acute purulent otitis media30 and for the amber drum of a serous effusion.

In acute otitis externa (Fig. 7-43), the canal is often swollen, narrowed, moist,
pale, and tender. It may be reddened.

Question 41

Pharyngitis

Answer 41

These two photos show reddened throats without exudate.
In A, redness and vascularity of the pillars and uvula are mild to moderate.
B
In B, redness is diffuse and intense. Each patient would probably complain of a
sore throat, or at least a scratchy one. Causes are both viral and bacterial. If the
patient has no fever, exudate, or enlargement of cervical lymph nodes, the
chances of infection by either of two common causes—group A streptococci and
Epstein-Barr virus (infectious mononucleosis)—are small.

Question 42

Thrush

Answer 42

Thrush is a yeast infection from Candida species. Shown here on the palate,
it may appear elsewhere in the mouth (see p. 289). Thick, white plaques are
somewhat adherent to the underlying mucosa. Predisposing factors include
(1) prolonged treatment with antibiotics or corticosteroids and (2) AIDS.

Question 43

Allergic Rhinitis vs Viral Rhinitis

Answer 43

In viral rhinitis, the mucosa is reddened
and swollen; in allergic rhinitis,
it may be pale, bluish, or red.

Question 44

Nasal Polyps

Answer 44

Nasal polyps are pale saclike
growths of inflamed tissue that can
obstruct the air passage or sinuses.
Conditions conducive to polyps
include allergic rhinitis, aspirin
sensitivity, asthma, chronic sinus
infections, and cystic fibrosis.

Question 45

Acute Bacterial Rhinosinusitis

Answer 45

Local tenderness, together with
symptoms such as pain, fever, and
nasal discharge, suggest acute
sinusitis involving the frontal or
maxillary sinuses.

Question 46

Risk Factors & PE for Cancers of the Tongue & Oral Cavity

Answer 46

Tongue cancer is a common oral
cancer, especially in men older than
50 years, smokers, tobacco chewers,
and alcohol drinkers, and usually
appears on the side or base of the
tongue.50 Any persistent nodule or
ulcer, red or white, is suspect, especially
if indurated. These discolored
lesions represent erythroplakia and
leukoplakia and should be biopsied.

Question 47

Apthous Ulcers

Answer 47

A painful, round or oval ulcer
that is white or yellowish gray and surrounded by a halo of
reddened mucosa. It may be single or multiple. It heals in 7–10
days, but may recur.

Question 48

Black, Hairy Tongue

Answer 48

Note the “hairy” yellowish to brown and black
elongated papillae on the tongue’s dorsum. This benign condition
is associated with antibiotic therapy, Candida infection, and poor
dental hygiene. It also may occur spontaneously.

Question 49

Erythroplakia (Carcinoma)

Answer 49

Reddened area of mucosa that is suspcious for malignancy

Question 50

Clinical Sig: Diffuse Thyroid Enlargement

Answer 50

Includes the isthmus and lateral lobes;
there are no discretely palpable nodules. Causes include Graves’
disease, Hashimoto’s thyroiditis, and endemic goiter.

Question 51

Clinical Sig: Multinodular Goiter

Answer 51

An enlarged thyroid gland with two or more nodules suggests a
metabolic rather than a neoplastic process. Positive family history and continuing nodular
enlargement are additional risk factors for malignancy.

Question 52

Clinical Sig: Single Nodule

Answer 52

May be a cyst, a benign tumor, or one nodule
within a multinodular gland. It raises the question of malignancy.
Risk factors are prior irradiation, hardness, rapid growth, fixation to
surrounding tissues, enlarged cervical nodes, and occurrence in men.

Question 53

Conjunctivitis

Answer 53

Conjunctival injection: diffuse dilatation of
conjunctival vessels with redness that tends
to be maximal peripherally

Question 54

Subconjunctival Hemorrhage

Answer 54

Leakage of blood outside of the vessels, producing a

homogeneous, sharply demarcated, red area that resolves over 2 weeks

Question 55

Corneal Injury

or Infection

Answer 55

Occurs from abrasions and other injuries; viral and bacterial infections too.

Physical Exam:
Ciliary injection, moderate to severe pain, decreased vision occasional, watery or purulent discharge.

Question 56

Acute Iritis

Answer 56

Associated with systemic infection, Herpes zoster, TB, refer promptly

PE:
Moderate pain, decreased vision, possible photophobia, small and irregular pupil, ciliary injection confined to corneal limbus

Question 57

Acute Angle Closure Glaucoma

Answer 57

Acute increase in intraocular pressure constitutes an emergency

PE:
Severe pain, decreased vision, dilated or fixed pupil, and steamy/cloudy cornea

Question 58

6 characteristics/descriptions of Lymph Nodes

Answer 58

Note their size, shape, delimitation (discrete or matted together), mobility,
consistency, and any tenderness. Small, mobile, discrete, nontender
nodes, sometimes termed “shotty,” are frequently found in normal
people.

Question 59

Clinical Sig: Enlargement of supraclavicular lymph nodes

Answer 59

Enlargement of a supraclavicular
node, especially on the left, suggests
possible metastasis from a
thoracic or an abdominal malignancy.

Question 60

Clinical Sig: Hard or Fixed (immobile) nodes

Answer 60

hard or fixed nodes suggest

malignancy.

Question 61

Clinical Sig: Generalized Lymphadenopathy

Answer 61

Generalized lymphadenopathy
is seen in HIV or AIDS, infectious
mononucleosis, lymphoma,
leukemia, and sarcoidosis.

Question 62

Clinical Sig: Anterior Neck Masses with Tracheal Deviation

Answer 62

Masses in the neck may push the
trachea to one side. Tracheal deviation
may also signify important
problems in the thorax, such as a
mediastinal mass, atelectasis, or
a large pneumothorax