ป บัณฑิต CMU Flashcards
1
Q
Pharmacology of Older Patients ?
A
less drug elimination > More effectvie drug .
2
Q
What to do when treat Fungal corneal ulcer with nata but not improved ?
A
Switch to other drug , change to subconj .
3
Q
S/P Craniotomy + Inf ED > Imp ?
A
Exposure keratopathy.
4
Q
Teenage c mucous discharge + dysuria
A
STD infection > Tx by using Cef 3 Im or Azythromycin .
5
Q
CT Brain Show Pituitaryt Tumor + Hg > What is the key point
A
1.Pituitary account for 10-15 % brain Tumor
2.CN II is most affected
3.Supervior Invasion affect vision because compress Optic chaism , Inferior affecrt Sphenoid sinus
4.Functioning tumor ex prolactinoma come with endocrine , non fx often comefirst after apoplexy
6
Q
Whatis Glaucomflecken ?
A
Ant len epithelium necrosis from high IOP related with AACG
Clinical Corneal Edema , Mild Dilated pupil , Conj injection
7
Q
Giant Papillae conjunctivitis c shield ulcers reated with ? and Mx
A
- VKC related
2.Key treatment :
- Control imflammation
- Prevent secondary infection
- Promote epithelial healing
8
Q
Most Common Conjunctival reaction of HSV
A
Foolicular Conjunctivitis.
9
Q
Papillae Conjunctivitis seen in ?
A
Allergic or bacterial conjunctivitis.
10
Q
Pyogenic granuloma seen in ?
A
Localized Vascular overgrowth.
11
Q
Pseudomembrane seen in ?
A
Severe adenoviral conjunctivits .
12
Q
Aqueous humor outflow is facilitated by?
A
Trabecular meshwork
13
Q
Ciliary body muscles main fx .
A
accommodation and aqueous humor production
14
Q
Trabecular meshwork drain pathway
A
anterior chamber → Schlemm’s canal → episcleral veins.
15
Q
Schlemm’s canal function
A
Drains aqueous after it passes through the trabecular meshwork.
16
Q
Episcleral vessels key important ?
A
Final drainage destination; not where outflow is facilitated.
17
Q
Conjunc part of what immunology tissue ?
A
mucosal-associated lymphoid tissue (MALT)
18
Q
Explain the cell in conjunctiva ? which is Numerous
A
NK Cell - Normally present in conjunctiva as part of immune surveillance.
Basophil - Rare in normal conjunctiva
Eosinophil - Typically absent in healthy conjunctiva; found in allergic conjunctivitis.
Plamacell - Found in chronic inflammation (e.g., trachoma), but not predominant in normal conjunctiva.
19
Q
Naming Pigmented fungi ? ( dematiaceous fungi )
A
Curvularia
Bipolaris
Alternaria
These are filamentous fungi with melanin > Brown Black appearance
20
Q
Naming non pigmented fungi . (hyaline fungi)
A
Fusarium
Aspergillus
21
Q
Treament of fungal keratitis ?
A
Topical antifungals:
Natamycin 5% (drug of choice for filamentous fungi, including pigmented species).
Amphotericin B 0.15% (better for yeasts like Candida).
Oral antifungals:
Voriconazole (especially if deep stromal involvement or scleritis).
22
Q
Drug of choice for filamentous fungi ?
A
Natamycin 5% (drug of choice for filamentous fungi, including pigmented species).
23
Q
Drug of choice yeast ?
A
Amphotericin B 0.15%
24
Q
UV scleral pathway antiglaucoma drug group ?
A
Pro-Alpha ROCKs the Uveoscleral Path
- Prostaglanding
- ALpha 2
- ROCKS
25
Function of Muller cells ?
Glial Cell support and Homeostasis
26
Function of Amacrine cells ?
Signal modulation (inner)
27
Function of Bipolar cells ?
Signal relay
28
Function of Horizontal Cells ?
Signal modulation (outer)
29
HCQ maculopathy OCT findings ?
Flying saucer sign > parafoveal thinning ( Esp EZ and RPE ) c central fovea preservation
30
Triad clinical presentation of Congenital Glaucoma ?
Corneal haze
Buphthalmos (enlarged eyeball)
High IOP in both eyes
31
Congenital Glaucoma inherit pattern ?
Sporadic
32
Traid for Incontinentia Pigmenti ?
N: Neonatal vesicular skin lesions (blistering rash)
A: Avascular retina with neovascularization (risk of tractional retinal detachment)
R.F.: Whorled pigmentary changes in later skin stages
33
Childen present c Erythematous vesicle papule on leg
Retinal findings: peripheral avascular retina and neovascularization at the avascular/vascular junction what is diagnosis and inherit pattern ?
Incontinentia pigmenti , XD
34
Surface Ectoderm Develop to ?
L ens
E pithelium of Lens
V itreous
E yelid
L acrimal gland
35
Mesoderm develop to ?
ROMES
Retina
Optic stalk
Muscle of iris and CB
Epithelium of Iris and CB
Sclera
36
RPE function ?
PLAN VIP"
P → Phagocytosis of photoreceptor outer segments
L → Light absorption (via melanin)
A → Active transport (nutrient supply, waste removal)
N → Nourishment of photoreceptors
V → Visual cycle (retinoid recycling)
I → Immune modulation (maintains immune privilege)
P → Produces growth factors (VEGF, PEDF)
37
Patter Laser Advantages ?
"Faster, Finer, Friendlier"
Faster → Multiple spots at once.
Finer → Less thermal damage.
Friendlier → Less painful for the patient.
38
What Pattern laser use for ?
Panretinal photocoagulation (PRP) in diabetic retinopathy.
Macular grid treatment for macular edema.
39
What conventional Laser use for ?
Focal treatments, like sealing microaneurysms.
40
Laser Mechanism ? 4 types ?
Photocoagulation
Photodisruption
Photoablation
Photodynamic
41
What is Photocoagulation Laser use for ?
Seal blood vessels and created adhesion
ex PRP
Argon Diode Krypton
42
What is Photodisruptive Laser use for ?
Break tissue
ex ND-Yag Femto
43
What is Photoablative Laser use for ?
Tissue ablation ex Excimer laser
44
What is PhotodynamicLaser use for ?
Activate photosensitizing agents (e.g., Verteporfin)
ex CNV in AMD , Diode
45
How Verteporfin work ?
It is PDT drug > IV inject then accumulate in CNV > then use PDT > Generate ROS and Destroy abnormal vessels
46
Ordering Laser from short wavelength to long ?
BGYR
47
Formula of Galleon Telescope Length
Legnth = Focal object - |F eye piece |
48
Calculate Galleon , Eye piece = -10 , object = +4
100/4- |-100/10 | = 25 -10 = 15 cm
49
Pt present c Chronic irritation + Superior ED + Conjunctival injection . Dx ?
TED
50
TED investigation ?
TSH
51
Pt with high FBs relate with what type of cataract
Snow flake
52
Type of Entropion ?
Involutional - Agin horizontal lid laxity c orbicularis overrid
Cicatrial - Scarring
Congenital - Maldevelopment of tarsus
Spastic - Orbicularis muscle spasm
Mechanical - Mass effects
53
Involutional Entropion surgery choices ?
Horizontal laxity - LTS
preseptal Orbicularis override - Orbicularis muscle suspension or Jones retractor
Combine - LTS + Everting sutures
54
Cicatrial l Entropion surgery choices ?
Posterior lamella shortening - Mucous membrane graft
Horizontal laxity present
55
Congenital Entropion surgery choices ?
retractor reinsertion
56
Spastic Entropion surgery choices ?
Botox injection
57
Mechanical Entropion surgery choices ?
Remove mass or cause
58
What is typical symtom of Lacrimal gland tumor that is Lymphoma ?
Painelss progressive with no bone destruction
59
What is the consider of Anterior Orbitotomy ?
For biopsy of superficial orbital/lacrimal lesions without bone destruction
60
What is the consider of Lateral Orbitotomy ?
large mass, deep lesion, or excisional biopsy
61
What is the complication of TED ? and what is symptoms ?
Dysthyroid Optic Neuropathy
- Optic nerve compression and orbital apex > Orbital congestion + Inflammation
- Colorvision loss + VF defects
CT : Apical Crowding
62
Tx of DON ?
High-dose IV steroids - Methylprednisolone 500-1000 mg IV daily for 3 days
63
Pt come with Epiphora + Probing Hard stop + Mucous Reflux Dx + Mx ?
NLDO - DCR
64
What is Acute Dacryocystitis and how to Mx ?
Infection of Lacrimal sac
Mx . Systemic ATB > Amoxiclav or Clindamycin
65
What is Pouting Punctum and why it important ?
Eversion or protusion of punctal > meaning Chronic inflam or infection of Canaliculi if Concretion is present > high yield
66
how to mx Canaliculitis ?
Canalicular irrigation with ATB ( Penicillin or Fluoroquinolones )
67
Most common Malignant eyeid tumor ?
Basal cell carcinoma
68
BCC Key features ?
Rolled edegd c central ulceration ( Rodent ulcer )
Slow growing at Lower eyelid ( low risk ) , Medial canthal ( high risk )
PEARL >
Pearly nodule
Eyelid
Arborizing vessels
Rolled edges
Locally invasive
69
Mx of BCC ?
1. Srugical Excision
2.Radiation therapy
3.Topical Treatments
70
Worst Prognosis Of Retinoblastoma Pathological
Optic nerve & choroidal invasion
71
What is Ghost cell glaucoma ? and Pathophysiology
Secondary Glaucoma caused by degenerated RBC
1. VH
2. RBC degenerate
3.Ghost cell Block Trabecular mesh work
72
Mx of Ghost cell glaucoma
Aqueos suppressant drug
73
Aqueous Suppressants (Anti-Glaucoma Drugs)
A2BC
74
Congenital Glaucoma pathopysiology ?
AC angle abnormality
75
Mx of Congenital Glaucoma ?
Tx
76
What is Malignant Glaucoma ?
Aqueous Misdirection to posterior of Lens > Anterior displacement > High IOP
77
Mx of Malignant Glaucoma ?
Atropine > Paralyze CB , Pulling Back Lens > deepen AC
78
Clinical Presentation of Malignant Glaucoma ?
Shallow AC , High IOP no SCH
79
Naming Direct gonioscopy ?
Swan Jacob
80
Naming Indirect gonioscopy ?
Schossmann Trabeculoplasty
81
Plateau Iris Finding ?
Flat iris , Deep AC , Steep iris insertion
82
UBM finding of Plateau Iris ?
Ant CB position
Ant CB process
Absent CB sulcus
83
Naming 3 Order of Horner syndrome location ?
1st order : Central ( Brainstem )
2nd order : Preganglionic
3rd order : Post ganglionic
84
Cause of 1 st order Horners
Stroke , MS
85
Cause of 2nd order Horners
Pancoast tumor , Thyroid or neck surgery
86
Cause of 3rd order Horners
Carotid dissection , Cluster Headache
87
What is Adies Pupils ?
Tonic, dilated pupil caused by damage to the postganglionic parasympathetic fibers
88
Adies pupiles Key features ?
ADIES
A : Accomodatiob preserve
D : Dilated Pupiles
I : Ineffective light responsce
E : Enhance pilocarpine response
89
Prominent Corneal Nerve condition ?
"MEN See Large Nerves Clearly" + Keratoconus
MEN → MEN 2B
S → Sjögren / Systemic causes
L → Leprosy
N → Neurofibromatosis
C → Congenital ichthyosis
Keratoconus > Thinning of cornea
90
Epiphora in 1 mo impression ?
Congetinal NLDO .
91
Congenital NLDO Mx key ?
Massage before probe
< 12 mo : massage + ATB
> 12 mo : Probing
92
Tract of Posterior Visual Pathway ?
Optic tract > LGN > Optic radiations > Occipital Cortex
93
Anterior visual Pathway sign ?
RAPD , Pallor , Light near
94
Posterior visual Pathway sign ?
Nystagmus or bilateral vision loss
95
What structure is associated with RAPD ?
Optic nerve and retina
96
What is by mean optic dis pallor ?
Optic atrophy = anterior visual pathway damage
97
What structure is associated with Light - near dissocation >
Midbrain lesion
98
VKH Findings ?
* Bilat ocular
> Early phase
- SRF + Choroidal thickening + Hyperemia of disc
> Late phase
- Sunset glow fundus
- Dalen-Fuchs nodules
* Neurological + Auditory
- Meningismus
- Tinnitus + Hearing Loss
* Skin findings
- Vitiligo poliosis alopecia
99
VKH imaging ?
Fluorescein Angiography (FA) ✅> Multiple pinpoint leaks at RPE → pooling of dye in subretinal space (SRF)
100
What is Granulomatous KP ?
Large, greasy, mutton-fat deposits of inflammatory cells on the corneal endothelium.
101
What is component of immune cell in Granulomatous KP ?
macrophages and epithelioid cells.
102
Granulomatous KP cause ?
STaRS HeVe
S → Sarcoidosis
T → Tuberculosis
R → Syphilis
S → Sympathetic ophthalmia
He → Herpes (HSV/VZV)
Ve → VKH
103
Work Up for Granulomatous KP ?
CXR (Chest X-ray) – First-line for sarcoidosis/TB
Tuberculin test (TT test) or IGRA (TB screening)
Syphilis serology (VDRL, FTA-ABS)
ACE levels (supportive for sarcoidosis)
OCT/FA – For retinal/choroidal involvement
104
How to treat progression of Myopia ?
Low-Dose Atropine
105
NAION findings ?
Acute painless visual loss
Hyperemic disc
Disc hemorrhage
Inferior altitudinal VF defect
disc atrophy without cupping (vs glaucoma)
106
AAION Findings ?
Chalky white disc edema
GCA features: fever, headache, malaise
BRAO co-existing Suggests arteritic ischemia due to vasculitis
Age + acute PL vision
107
AAION treatments ?
High-dose IV steroids must be started immediately .
108
What is Hard Exudate mean in Funduis ?
ipid/protein deposits in the retina from leaky microvasculature
related diabetic retinopathy, hypertensive retinopathy, and dyslipidemia
109
Hypertensive Retinopathy findings ?
CWS + Disc hemorrhage + Elevated BP
110
Etiology of Band K
calcium deposition in Bowman’s layer of the cornea, often forming a horizontal band
111
What is DALK ?
DALK replaces anterior corneal stroma while preserving the host Descemet's membrane (DM) and endothelium.
112
Contraindication to DALK ?
Endothelial Disease > HIP
Hydrops
ICE Syndrome
PPMD
113
PPV Complication ?
CAGE
C → Cataract ✅ (most common)
A → Aphakia/IOL issues
G → Glaucoma (less common)
E → Endophthalmitis (rare but serious)
114
CMVR Fundus Findings ?
CHEESE
C → Cottage cheese (fluffy necrosis)
H → Hemorrhages (ketchup)
E → Edges sharp (advancing margins)
E → Early periphery involvement
S → Sheathing of vessels (vasculitis)
E → End-stage atrophy
115
IRU Fundus Findings ?
GRAVES
G → Granular retina (healed CMVR)
R → Retinal perivasculitis (sheathing)
A → Absence of necrosis (vs CMVR)
V → Vitritis (2+ or more)
E → Epiretinal membrane, edema (CME)
116
IRU Management ?
T → Topical steroids (mild cases)
I → Intraocular steroids (periocular/IVT for severe cases)
P → Preserve ART (continue antiretroviral therapy)
117
CMVR Mx ?
G → Ganciclovir ✅
I → Intravitreal injection for sight-threatening lesions
V → Valganciclovir for oral maintenance
E → Eye monitoring (OCT, fundus)
FIGHT → Foscarnet if resistant
118
What is Pyogenic Granuloma ?
benign vascular proliferative lesion oftest post operative > steroid will make it worse > Easy vascular growth
119
Congenital Cataract surgery period ?
Bilateral dense > 6-8 wks
Unilateral dens > 4-6 wks
120
What is Behcet ?
Chronic, relapsing, multisystem inflammatory disorder
121
Behcet ocular findings ?
Non-granulomatous uveitis
Hypopyon (layered white cells in anterior chamber)
Retinal vasculitis (often veins, “frosted branch” appearance)
Vitritis, optic disc edema
122
Behcet Labatory investigation
HLAB 51
Pathergy test
123
Behcet Treatment ?
Systemic steroids + immunosuppressants (e.g., azathioprine, cyclosporine, infliximab) ✅
124
Behcet key features ?
B → Bleeding ulcers (oral/genital)
E → Eye involvement (uveitis, vasculitis)
H → Hypopyon
C → CNS involvement
E → Erythema nodosum
T → Thrombosis (vascular issues)
125
HLAB27 Associated ?
Mnemonic for HLA-B27 Diseases: "PAIR"
P → Psoriatic arthritis
A → Ankylosing spondylitis
I → IBD-associated arthritis (enteropathic)
R → Reactive arthritis
126
HLAB27 Symptoms
Acute, unilateral, recurrent, non-granulomatous anterior uveitis
Sudden onset pain, redness, photophobia
127
Describe PXS ?
Systemic disorder characterized by the accumulation of fibrillar extracellular material (pseudoexfoliative material) in various ocular and systemic tissues.
128
PXS Finddings
Pseudoexfoliative material
- Seen on the anterior lens capsule (target pattern), pupillary margin, corneal endothelium, trabecular meshwork
Pigment dispersion
- Trabecular meshwork pigmentation, iris transillumination defects
Phacodonesis/zonal instability
- Weak zonules → risk of lens subluxation/dislocation
Angle
- Open-angle appearance, but debris may clog trabecular meshwork
129
what is PXG ?
PXS + Glaucoma
130
PXG cause ?
Debris block TM > High IOP > Glaucoma
131
PXG mx ?
1st Line - Topical Low IOP
2. AST SLT
3. Trabeculectomy or GDD
132
Coin lesion at peripheral retina dx ?
CMV retinitis
133
Young male present c unilateral telangiectesia + exudative ?
COAT disease
134
Key features of coat disease ?
T → Telangiectasia
E → Exudation
L → Light bulb aneurysms
EXUDE → Exudative retinal detachment
135
Stage and Treatment of Coat disease ?
Stage 1 Retinal telangiectasia only > Laser or Cryo
Stage 2 Telangiectasia + exudation > Laser + Anti vegf
Stage 3 Exudative retinal detachment > Vitrectomy
(3A partial, 3B total)
Stage 4 Total detachment + glaucoma > Virectomy
Stage 5 Phthisis bulbi (shrunken eye) > Enucleation
136
MH Classification GASS
Stage 1a Impending hole – foveal cyst, loss of foveal depression (yellow spot)
Stage 1b Foveal pseudocyst (yellow ring)
Stage 2 Small full-thickness hole (<400 μm), partial vitreous attachment
Stage 3 Larger hole (>400 μm), vitreous attached at optic disc (no PVD)
Stage 4 Full-thickness hole + complete posterior vitreous detachment (PVD)
137
Mx of MH by classification
Stage 1a/1b Observation (can resolve spontaneously) or early vitrectomy if progressing
Stage 2-4 Pars plana vitrectomy (PPV) + ILM peeling + gas tamponade
138
Group of Antimicrobial
1.Cell wall
2.Plasma Membrane
3.Ribosome
4.DNA
5.Metabolic Pathway
139
Cell wall inhibit drug group ?
B Lactam - Bactericidal
Penicillin
Ceohalosporin
Carbapenem
Non B Lactam - Bactericidal
Vancomycin
Bacitracin
Inhibit bacterial transpeptidase
140
ATB drug group inhibit plasma membrane ?
Polymyxin - Bactericidal
141
ATB drug group target bacterial DNA ?
Bactericidal
Fluoroquinolone
Rifamycins
142
ATB drug group inhibit Metabolic Pathway ?
Sulfonamide - Bacteriostatic
143
ATB drug group target ribosome ?
- Aminoglycoside : Bactericidal
- Tetracycline : Bacteristatic
- Macrolide - Bacteristatic
