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Oral Boards > Differentials/Associations > Flashcards

Differentials/Associations Flashcards

1
Q

Cotton wool spot

A
  • ischemic (HTN, DM, RVO, radiation)
  • immune (SLE, GCA)
  • infectious (HIV, cat scratch, fungemia)
  • embolic (carotid, cardiac, Purtscher)
  • neoplastic (lymphoma, leukemia)
  • myelinated NFL
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2
Q

Retinal hemorrhage

A
  • CRVO/BRVO
  • HTN, DM
  • CNV
  • NVE
  • macroaneurysm
  • Valsalva
  • choroidal rupture
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3
Q

Ptosis

A
  • 3rd nerve palsy (GCA)
  • Horner syndrome
  • myasthenia gravis
  • CPEO
  • intracranial mass
  • intraorbital mass
  • aponeurotic
  • traumatic
  • mechanical
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4
Q

Proptosis

A
  • infectious (orbital cellulitis, mucor)
  • neoplasm
  • inflammatory (Tolosa-Hunt, IOIS)
  • thyroid eye disease
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5
Q

Adult orbital masses

A
  • cavernous hemangioma
  • meningioma (optic nerve sheath)
  • mesenchymal tumor (fibrous histio)
  • optic nerve glioma
  • neurofibroma
  • dermoid cyst
  • mucocele
  • lymphoma or lymphoid hyperplasia
  • metastasis
  • rhabdomyosarcoma
  • lacrimal masses
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6
Q

Leukocoria

A

Retinoblastoma
Toxocariasis
Coats disease
FEVR
Persistent fetal vasculature
Cataract
Retinal astrocytoma (tuberous sclerosis)
ROP
Coloboma

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7
Q

Esodeviations (peds)

A
  • pseudoesotropia
  • congenital (infantile)
  • acquired nonaccommodative
  • accommodative (refractive or non-refractive)
  • sensory deprivation
  • divergence insufficiency
  • CNS/cranial nerve palsy
  • Duane syndrome type 1
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8
Q

Exodeviations (peds)

A
  • pseudoexotropia (large angle K, macula dragging)
  • exophoria
  • intermittent exotropia
  • constant exotropia
  • Duane syndrome type 2
  • 3rd nerve palsy
  • myasthenia
  • INO
  • orbital disease, TED
  • convergence paralysis
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9
Q

Strabismus syndromes

A
  • Duane syndrome (type 1 abd, type 2 add, type 3 both)
  • Brown syndrome (limited elevation in adduction)
  • monocular elevation deficiency (restriction of inferior rectus or paresis of inferior oblique or superior rectus)
  • Mobius syndrome
  • congenital fibrosis syndrome (usually both eyes downward so chin-up)
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10
Q

Corectopia

A
  • ICE (unilateral)
  • Axenfeld Reiger (bilateral)
  • posterior polymorphous dystrophy
  • ectopic lentis et pupillae
  • aniridia
  • trauma
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11
Q

Secondary angle closure

A
  • PAS
  • neovascular membrane
  • ICE
  • lens-induced
  • drug induced (topiramate, sulfonamides) [no PI, use mydriatic and maybe steroids]
  • choroidal swelling
  • posterior tumor
  • aqueous misdirection
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12
Q

Elevated IOP with open angle

A
  • inflammatory glaucoma
  • traumatic (hemolytic)
  • pigmentary glaucoma
  • pseudoexfoliation
  • Posner-Schlossman
  • retrobulbar hemorrhage
  • carotid-cavernous fistula
  • phacolytic/phacoantigenic
  • Schwartz-Matsuo syndrome
  • steroid induced
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13
Q

Glaucoma optic neuropathy

A
  • POAG
  • physiologic cupping
  • low tension glaucoma
  • secondary open angle glaucoma
  • previous glaucomatous damage
  • optic nerve pit
  • optic nerve coloboma
  • optic disc drusen
  • optic atrophy
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14
Q

Glaucoma testing

A
  • RAPD assessment
  • color vision
  • IOP
  • gonioscopy
  • OCT NFL
  • visual fields
  • pachymetry
  • disc photos
  • heavy metal panel/B12/MRI if abnormal
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15
Q

Prostaglandin side effects

A
  • iris darkening
  • periorbital skin darkening
  • HSV
  • CME
  • hypertrichosis
  • contraindicated in pregnancy
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16
Q

Topical beta blocker side effects

A
  • asthma
  • COPD
  • heart block
  • bradyarrythmias
  • heart failure
  • depression
  • sexual dysfunction
  • reduced exercise tolerance
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17
Q

Carbonic anhydrase inhibitor side effects

A
  • sulfa allergy
  • metabolic acidosis
  • hypokalemia
  • paresthesias
  • aplastic anemia
  • corneal endothelial dysfunction
  • weight loss
  • sickle crisis in sickle cell
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18
Q

Alpha 2 receptor agonist side effects

A
  • contraindicated in patients taking monoamine oxidase inhibitors
  • children under 5 due to CNS and cardiorespiratory depression
  • local irritation/intolerance
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19
Q

Hyphema

A
  • trauma
  • NV (DM, RVO, OIS)
  • Fuch’s heterochromic iridocyclitis
  • blood dyscrasia or coagulopathy
  • anticoagulant medication
  • HSV
  • UGH syndrome
  • iris or ciliary body melanoma
  • retinoblastoma
  • juvenile xanthogranuloma
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20
Q

Corneal rings

A
  • Kayser-Fleischer ring (Wilson disease, hepatitis, primary biliary cirrhosis) [also sunflower cataract]
  • Fleischer ring (KCN)
  • arcus senilis
  • siderosis or chalcosis
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21
Q

Corneal iron lines

A
  • Hudson-Stahli line
  • Stocker Line (pterygium)
  • Ferry line (bleb)
  • Fleischer ring (KCN)
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22
Q

NF 1 associations

A
  • autosomal dominant; chromosome 17
  • Lisch nodules
  • cafe au lait spots
  • neurofibromas
  • glaucoma (esp w/ plexiform neurofibroma)
  • intertriginal freckling
  • optic nerve glioma
  • sphenoid dysplasia
  • encephalocele
  • prominent corneal nerves
  • intracranial astrocytoma
  • pheochromocytoma
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23
Q

Prominent corneal nerves

A
  • Riley-Day (familial dysautonomia)
  • Refsum syndrome (phytanic acid, RP, hearing loss)
  • NF1
  • leprosy
  • acanthamoeba
  • MEN 2 (medullary thyroid cancer, pheochromocytoma, mucosal neuromas, parathyroid tumors)
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24
Q

NF 2 associations

A
  • autosomal dominant; chromosome 22
  • bilateral acoustic nerve masses
  • juvenile PSC
  • neurofibroma
  • optic nerve sheath meningioma
  • glioma
  • Schwannoma
  • combined hamartoma of the retina and RPE
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25
Q

Sturge-Weber associations

A
  • spontaneous, not heritable
  • diffuse choroidal hemangioma
  • glaucoma (treat w/ aqueous suppressants, goniotomy/trab/tube)
  • iris heterochromia
  • blood in Schlemm canal
  • serous retinal detachment (photodynamic therapy, laser, radioactive plaque)
  • intellectual disability
  • leptomeningeal angiomatosis
  • incracerebral calcifications
  • seizures
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26
Q

Tuberous sclerosis associations

A
  • autosomal dominant
  • retinal astrocytic hamartoma (mulberry)
  • adenoma sebaceum
  • seizures
  • cerebral astrocytomas
  • intellectual disability
  • Shagreen patches, ash leaf spots
  • renal cell carcinoma
  • cardiac rhabdomyoma
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27
Q

Von Hippel-Lindau associations

A
  • autosomal dominant
  • retinal capillary hemangiomas
  • bilateral 50%
  • CNS hemangioblastoma
  • renal cell carcinoma
  • pheochromocytoma
  • laser, cryo, photodynamic therapy, or radiotherapy if therapy is indicated (serous detachment or exudation)
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28
Q

Wyburn-Mason associations

A
  • racemose hemangioma
  • spontaneous, not heritable
  • orbital racemose hemangioma
  • midbrain hemangiomas
  • seizures, neurologic deficits
  • maxillary/mandibular hemangiomas
  • no treatment, watch for hemorrhage and NVG
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29
Q

Conjunctival telangiectasia

A
  • autosomal recessive
  • Louis-Barr syndrome (ataxia-telangiectasia)
  • oculomotor apraxia
  • supranuclear gaze palsies
  • nystagmus
  • strabismus
  • progressive cerebellar ataxia
  • immunologic deficiency (frequent infections
  • increased risk of malignancy
  • intellectual disability
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30
Q

Retinal capillary hemangioma differential

A
  • Coats disease
  • racemose hemangioma
  • retinal cavernous hemangioma
  • FEVR
  • congenital retinal vascular tortuosity
  • retinal vasoproliferative tumor
  • retinal macrovessel
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31
Q

Contact fitting by Ks

A
  • 42.5-44.5 use 8.7 BC
  • 44.5-46.0 use 8.3 BC
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32
Q

LARS rule

A

Related to toric contact fitting. If inferior lines are left or right of 6 o’clock:

  • left = add 30 degrees to minus cyl axis, right = subtract 30 degrees minus cyl axis
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33
Q

Legal blindness in US

A
  • BCVA 20/200 or worse in better seeing eye
  • field of vision in better eye is 20 degrees or less
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34
Q

Monocular diplopia

A
  • refractive error
  • surface problem
  • iris defect
  • irregular astigmatism
  • lenticular irregularity (cataract, lenticonus, lens dislocation)
  • retinal problem
  • diagnose with cover one eye, pinhole testing
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35
Q

Nonorganic factors causing poor vision

A
  • uncorrected ametropia (needs refraction)
  • pupil size (larger than 6, smaller than 2.5 due to diffraction principle)
  • decreased contrast (bad eye chart or lighting)
  • eccentric viewing
  • age (too young or too old)
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36
Q

Simple vs compound astigmatism

A

Write Rx in both plus and minus cylinder notation and if when looking at spherical power:

  • both positive = compound hyperopic
  • one positive, one plano = simple hyperopic
  • one positive, one negative = mixed
  • one negative, one plano = simple myopic
  • both negative = compound myopic
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37
Q

Prismatic effect of myopic spectacles when reading

A
  • act like base-in prisms which induce esotropia
  • this makes reading easier
  • just like adding base-in prism in high plus power readers for low vision
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38
Q

Is reading easier with RGPs or SCLs?

A

With RGPs. The mid-peripheral optic zone in RGP allows for more vault which enhances near vision due to the tear film

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39
Q

Types of visual acuity testing

A
  • minimum resolvable letter: 1-5 minutes of arc
  • minimum visible (spot on wall): 10 seconds of arc
  • Vernier acuity: 2-10 seconds of arc
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40
Q

Snellen chart pearls

A
  • each letter is 5 minutes of arc at 20 feet
  • to determine arcmin of each letter for larger lines: multiply the inverse of the acuity by 5 (if at 20 feet)
  • so 20/40 line = inverse 40/20=2, then 2x5=10 arcmin
  • for observer standing at number of feet for a particular line, the arcmin will always be 5 (so a 20/100 letter will subtend 5 arcmin at 100 feet)
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41
Q

ROP stages

A
  • stage 1: flat demarcation line
  • stage 2: ridged demarcation line
  • stage 3: ridged line with NV
  • stage 4a: extrafoveal partial RD
  • stage 4b: foveal partial RD
  • stage 5: total RD
  • don’t forget plus disease
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42
Q

ROP treatment thresholds

A
  • zone 1, any stage with plus disease
  • zone 1, stage 3 without plus disease
  • zone 2, stage 2 or 3 with plus disease
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43
Q

ROP timing of first exam

A

31 weeks post menstrual age or 4 weeks postnatal age, whichever is later.

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44
Q

Pediatric cataract

A
  • idiopathic
  • congenital
  • familial
  • galactosemia (galactokinase deficiency, oil-droplet cataract may be reversible with dietary change)
  • persistent fetal vascular
  • rubella
  • Lowe syndrome (oculocerebrorenal syndrome) [X-linked recessive]
  • aniridia
  • Alport syndrome
  • Peter’s anomaly
  • trauma
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45
Q

Congenital cataract systemic testing

A
  • galactokinase levels (tested at birth)
  • hematuria/proteinuria, hearing testing, renal biopsy (Alport syndrome)
  • amino acid content (Lowe syndrome)
  • antibody titers for rubella
  • TORCH titers
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46
Q

TORCH

A
  • toxoplasma
  • others (HIV, syphilis, parvovirus, varicella)
  • rubella
  • CMV
  • HSV
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47
Q

Axenfeld-Reiger associations

A
  • autosomal dominant
  • posterior embryotoxon (prominent anterior Schwalbe line)
  • bilateral polycoria/corectopia
  • PITX2 and FOXC1
  • microdontia
  • skeletal abnormalities
  • cardiac defects
  • growth hormone deficiency
  • intellectual disability
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48
Q

Alport syndrome associations

A
  • X-linked
  • kidney disease and hearing loss
  • type IV collagen problem
  • anterior or posterior lenticonus
  • corneal epithelium or endothelium changes/vesicles
  • retinopathy (predisposed to injury)
  • test for hematuria, hearing, renal biopsy
  • ACEi for hematuria/proteinuria
  • cataract surgery
  • renal transplant
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49
Q

Aniridia associations

A
  • autosomal dominant or sporadic
  • bilateral iris absence
  • glaucoma
  • foveal hypoplasia, nystagmus
  • PAX6 deletion = WAGR = Wilms tumor, aniridia, genital abnormalities, retardation)
  • 30% chance of Wilms tumor in aniridia requires screening
  • Gillespie syndrome (cerebellar ataxia, optic atrophy)
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50
Q

Albinism associations

A
  • oculocutaneous (autosomal recessive)
  • ocular only (X-linked recessive)
  • refractive error
  • strabismus
  • nystagmus
  • foveal hypoplasia
  • Hermansky-Pudlak (platelet dysfunction, Puerto Rican descent)
  • Chediak-Higashi (white blood cell dysfunction, predisposed to lymphoma)
  • benefit from FL-41 tint in glasses
  • refraction and amblyopia treatment
  • needs sun protection
  • discuss low vision aids
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51
Q

Purtscher retinopathy associations

A
  • compression injury to head, chest, lower extremity
  • pseudo-Purtscher
  • acute pancreatitis
  • malignant hypertension
  • collagen vascular disease
  • thrombotic thrombocytopenic purpura
  • chronic renal failure
  • retrobulbar injection
  • amniotic fluid embolism
  • long bone fracture
  • supportive therapy (risk of permanent vision loss)
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52
Q

Acanthamoeba keratitis testing

A
  • routine cultures
  • Gram, Giemsa, clacofluor white may show cysts
  • nonutrient agar with E. coli overlay
  • corneal biopsy
  • confocal microscopy
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53
Q

Fungal keratitis associations

A
  • injury with vegetable matter
  • satellite lesions
  • filamentous fungi, Fusarium or Aspergillus (previously healthy, vegetable matter, contacts)
  • non-filamentous, Candida (previously diseased or hospitalized)
  • routine cultures
  • Gram, Giemsa, calcofluor white, KOH
  • corneal biopsy
  • topical natamycin, voriconazole, or amphoteracin
  • may add oral voriconazole
  • NO steroids
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54
Q

Corneal ulcer differential

A
  • bacterial
  • fungal
  • HSV/VZV
  • acanthamoeba
  • atypical mycobacteria
  • Staph hypersensitivity
  • ocular rosacea
  • PUK/Mooren
  • topical anesthetic abuse
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55
Q

Corneal cultures

A
  • blood (most bacteria)
  • Sabouraud dextrose (fungi)
  • thioglycolate broth (aerobic and anaerobic)
  • chocolate (Haemophilus, Neisseria)
  • Lowenstein-Jensen (mycobacteria, Nocardia) [esp in LASIK pts]
  • nonnutrient agar with E. coli overlay (acanthamoeba)
  • acid-fast stain (mycobacteria, Nocardia)
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56
Q

Crystalline keratopathy differential

A
  • infectious crystalline keratopathy (Strep viridans, Corynebacterium, pseudomonas)
  • lattice corneal dystrophy
  • amyloidosis
  • lymphoproliferative (multiple myeloma)
  • Schnyder corneal dystrophy
  • Bietti corneoretinal dystrophy
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57
Q

Interstitial keratitis differential

A
  • congenital syphilis (bilateral whereas other causes are often unilateral)
  • acquired syphilis
  • HSV/VZV
  • TB
  • Cogan syndrome (associated hearing loss
  • Lyme disease
  • EBV
  • leprosy
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58
Q

Congenital syphilis stigmata

A
  • saddle nose deformity
  • Hutchinson teeth
  • saber shins
  • frontal bossing
  • salt and pepper chorioretinitis or optic atrophy
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59
Q

Relevant connective tissue diseases

A
  • rheumatoid arthritis
  • SLE
  • HLA-B27
  • granulomatosis with polyangiitis
  • relapsing polychondritis
  • polyarteritis nodosa
60
Q

Marginal ulcer differential

A
  • PUK
  • Mooren ulcer
  • sclerokeratitis
  • infectious keratitis
  • Terrien marginal degeneration
  • Staph marginal keratitis
  • exposure keratitis
  • phlyctenuosis (Staph, TB)
  • pellucid marginal degeneration
  • furrow degeneration
61
Q

Dry eye testing

A
  • Schirmer testing
  • MMP9 (elevated in DES)
  • tear osmolarity (elevated in DES)
  • lactoferrin (low in DES)
  • Sjogren antibodies
  • history of radiation?
62
Q

Epithelial and Bowman corneal dystrophies

A
  • epithelial basement membrane dystrophy (shadowing/monocular diplopia)
  • Meesman
  • Reis-Buckler/Thiel-Behnke (recurs in graft after PKP)
  • painful erosions in all
63
Q

Corneal stromal dystrophies

A
  • lattice (erosions common)
  • granular (intervening spaces, spares periphery, erosions uncommon)
  • macular (no intervening spaces, involves periphery, erosions common, autosomal recessive)
  • Schnyder (work up systemic cholesterol, rarely requires PK or PTK)
64
Q

Corneal endothelial dystrophies

A
  • Fuch’s
  • posterior polymorphous corneal dystrophy
  • CHED (autosomal recessive)
  • KP differential
65
Q

Posterior polymorphous corneal dystrophy associations

A
  • autosomal dominant
  • bilateral
  • glaucoma
  • corectopia, iridocorneal adhesions
  • keratoconus
  • Alport syndrome
  • treat glaucoma, edema with Muro
  • consider DMEK or PKP
66
Q

CHED associations

A
  • autosomal recessive
  • can be associated with deafness (Harboyan syndrome)
  • nystagmus
  • beaten copper endothelium
  • treat with Muro
  • PKP, DSAEK, DMEK
67
Q

LASIK complications

A
  • infection
  • free flap (flat corneas)
  • buttonhole flap (steep corneas)
  • epithelial defect
  • epithelial downgrowth
  • flap striae
  • diffuse lamellar keratitis
  • corneal haze/scarring
  • HOAs
  • dry eye
  • pressure-induced stromal keratitis
68
Q

Acute conjunctivitis differential

A
  • viral/EKC (watch for membranes)
  • HSV
  • allergic
  • vernal/atopic (giant papillae)
  • bacterial
  • gonococcal
  • pediculosis
  • molluscum
  • medicamentosa
69
Q

Vernal conjunctivitis associations

A
  • seasonal
  • giant papillae
  • Horner-Trantas dots (limbal eosinophils)
  • shield ulcer (add steroid, topical abx, scrape it)
70
Q

Special consideration for bacterial conjunctivitis in kids

A
  • look out for Haemophilus influenzae otitis media
  • treat with Augmentin
71
Q

Gonococcal conjunctivitis

A
  • Gram stain will show Gram-negative intracellular diplococci
  • watch for corneal involvement
  • treat with IM ceftriaxone and PO azithromycin
  • IV ceftriaxone if corneal involvement; watch for perforation, use topical fluoroquinolone ointment
72
Q

Chronic conjunctivitis differential

A
  • chlamydial inclusion conjunctivitis
  • Parinaud’s oculoglandular
  • contact lens related
  • conjunctival tumor
  • molluscum contagiosum
73
Q

Chlamydial inclusion conjunctivitis

A
  • serotypes D-K
  • young people with urethritis, vaginitis,or cervicitis
  • tarsal or bulbar follicles
  • corneal pannus
  • palpable preauricular node
  • peripheral SEIs
  • test for immunofluorescence or PCR
  • Giemsa will show basophilic intracytoplasmic inclusion bodies
  • PO azithromycin
  • topical erythromycin ointment
  • longer course of doxy if does not resolve
74
Q

Trachoma associations

A
  • serotypes A-C
  • follicular conjunctivitis
  • tender preauricular node
  • superior corneal SEIs, pannus, limbal follicles
  • extensive conjunctival scarring
  • Arlt line
  • trichiasis
  • corneal scarring
  • azithromycin, erythromycin, or doxycycline PO and ointment
75
Q

Parinaud’s oculoglandular conjunctivitis

A
  • Bartonella henselae (azithromycin or Bactrim and topical gentamicin)
  • tularemia (treat with gentamicin, sometimes critically ill)
  • tuberculosis
  • syphilis
76
Q

Superior limbic keratoconjunctivitis associations

A
  • thyroid disease
  • sectoral thickening, inflammation, and radial injection of the superior conj
  • superior corneal micropannus and filaments
  • same differential as episcleritis and phlyctenule
  • treat with DES/blepharitis measures
  • topical tacrilolimus and acetylcystein
  • low potency steroid
  • low concentration silver nitrate
  • doxycycline
  • conjunctival resection/recession
77
Q

Ocular cicatricial pemphigoid differential

A
  • Stevens-Johnson or toxic epidermal necrolysis
  • history of membranous conjunctivitis
  • severe chemical burn
  • chronic topical medication
  • previous radiation or surgery
78
Q

OCP treatment

A
  • aggressive lubrication
  • serum tears
  • punctual plugs
  • moisture goggles
  • treat blepharitis
  • cautious topical steroids (corneal melting)
  • systemic steroids
  • immunosuppressants
  • dapsone (watch out for G6PD deficiency due to hemolysis)
  • cautious surgery for ectropion, entropion, trichiasis
  • mucous membrane grafts
79
Q

Lacrimal mass differential

A
  • sarcoidosis
  • IOIS
  • IgG4-related
  • infectious
  • pleomorphic adenoma
  • adenoid cystic carcinoma
  • malignant mixed epithelial tumor
  • lymphoproliferative
  • TB
  • other orbital mass
80
Q

ABCD for drug induced cataract

A
  • Amiodarone
  • Busulfan
  • Chlorpromazine
  • Dexamethasone
81
Q

STUMPED pediatric corneal clouding

A
  • Sclerocornea
  • Tears in Descemet (trauma)
  • Ulcer
  • Mucopolysaccharidosis
  • Peter’s anomaly
  • Edema (CHED)
  • Dermoid
82
Q

Nonorganic vision loss differential

A
  • ambylopia
  • cortical blindness
  • retrobulbar optic neuritis
  • cone-rod dystrophy
  • chiasmal tumor
  • cancer associated retinopathy
83
Q

Tests for nonorganic vision loss

A
  • pupillary exam (lack of RAPD suggests anterior pathways normal but doesn’t rule out cortical blindness)
  • mirror test
  • optokintetic test (20/200 or better)
  • base out prism test (look for inward movement of eye)
  • vertical prism dissociation test
  • Worth four dot test
  • start with smallest lines and work way up chart
  • fog the normal seeing eye
  • retest visual acuity at near or closer than 20 feet
  • look for tunneling of visual field
84
Q

Choroidal melanoma testing

A
  • low internal reflectivity on A-scan
  • double circulation on IVFA
  • check for mets to liver or lung
  • continued surveillance for mets or recurrence
85
Q

COMS treatment guide

A
  • small (2.5 mm): observation
  • medium (10 mm): plaque brachytherapy
  • large (>10 mm): enucleation without radiation
86
Q

Clinically significant macular edema

A
  • retinal thickening within 500 um of the foveal center
  • hard exudates within 500 um of the foveal center
  • retinal thickening > 1 DD, part of which is within 1 DD of the foveal center
87
Q

High risk PDR

A
  • NVD greater than 1/4 size of disc
  • NVD with VH
  • NVE > 1/2 DD with VH
  • any NVI or NVA
88
Q

Maternal diabetes follow-up schedule

A
  • gestational: none
  • no NPDR: 1st and 3rd trimester
  • mild/moderate NPDR: every trimester
  • severe NPDR: monthly
  • PDR: monthly (treat with PRP if needed)
89
Q

Gillespie syndrome

A
  • aniridia
  • cerebellar ataxia
  • intellectual disability
  • optic nerve hypoplasia
90
Q

Morning glory disc associations

A
  • basal encephalocele
  • callosal agenesis
  • Moyamoya or other cerebrovascular anomalies
  • PHACE syndrome
91
Q

PHACES syndrome

A
  • posterior fossa abnormalities
  • HEMANGIOMA of the face
  • arterial anomalies
  • cardiac anomalies
  • ocular anomalies (morning glory)
  • sternal or abdominal clefting
92
Q

CHARGE syndrome

A
  • Colobomas of the eye (typically not lid)
  • Heart defects
  • Atresia of the nasal choanae
  • Retardation of growth/development
  • Genitiurinary malformations
  • Ear malformations
93
Q

CT/CTA finding in carotid-cavernous fistula

A
  • enlarged superior ophthalmic vein
94
Q

Double Maddox rod testing in CN4 palsy

A
  • unilateral: less than 10 degrees of excyclotorsion
  • bilateral: greater than 10-15 degrees
95
Q

Vertical fusional amplitudes in CN4 palsy

A
  • congenital: 8-12 prism diopters
  • acquired: 2-3 prism diopters
96
Q

Rheumatologic work up

A
  • ESR/CRP/CBC
  • HLA-B27
  • ACE/lysozyme
  • RPR/FTA-ABS
  • chest xray
  • ANCA
  • ANA
  • RF
  • Lyme
  • EBV
97
Q

Light-near dissociation

A
  • bilateral optic neuropathy or retinopathy
  • Adie tonic pupil
  • dorsal midbrain (Parinaud) syndrome
  • syphilis (Argyl-Robinson)
  • third nerve palsy (aberrant regeneration)
  • diabetes, alcohol
98
Q

X-linked retinoschisis treatment

A
  • PO carbonic anhydrase inhibitors if foveal schisis
  • PPV if nonclearing VH
  • surgical repair of RD
  • amblyopia treatment
99
Q

Tay-Sachs associations

A
  • autosomal recessive, Jewish heritage
  • cherry red spot
  • hexosaminadase A deficiency
  • gangliosides accumulate
  • progressive neurodegeneration
  • seizures
  • no cure, treat associated symptoms
100
Q

Niemann-Pick associations

A
  • autosomal recessive
  • cherry red spot
  • sphingomyelin accumulates
  • progressive neurodegeneration
  • no cure, treat symptoms such as seizures
101
Q

CRVO etiologies

A
  • HTN
  • optic disc edema
  • glaucoma
  • hypercoagulable state (protein C and S deficiency, factor V Leiden, polycythemia, multiple myeloma)
  • abnormal platelet function
  • medications (OCPs, diuretics)
  • vasculitis
  • migraine
102
Q

Eleschnig spots

A
  • previous choroidal infarcts from malignant HTN
103
Q

Unilateral hypertensive retinopathy changes

A
  • suspect carotid occlusive disease sparing the uninvolved eye
104
Q

Severe diabetic retinopathy requirements

A
  • diffuse DBH in all quadrants
  • two quadrants of venous beading
  • one quadrant of prominent IRMA
105
Q

Bilateral multilayered retinal hemorrhages in an adult

A
  • Terson syndrome
  • subarachnoid hemorrhage, intracranial hemorrhage, or TBI
  • IVFA shows leakage around the disc
  • watch for ghost cell glaucoma, RD, and ERM after
  • PPV if nonclearing VH
106
Q

Peripheral retinal ischemia and NV in young male with unknown etiology

A
  • Eales disease
  • peripheral retinal periphlebitis
  • anterior uveitis
  • late optic atrophy, neovascular glaucoma, or retinal detachment
  • treat acute disease with steroids
  • possibly some benefit from anti-tuberculosis therapy
  • PRP of avascular retina
  • PPV if nonclearing VH
107
Q

VH differential

A
  • PVD
  • retinal tear/detachment
  • DM
  • RVO
  • ARMD
  • sickle cell
  • RAM
  • Valsalva
  • tumor
  • Eales
  • Terson
108
Q

Band keratopathy differential

A
  • JIA
  • silicone oil
  • chronic retinal detachment
  • metabolic disease (hyperoarathyroidism, hypercalcemia)
  • renal failure
  • gout, saroicdosis
  • trauma
  • end stage glaucoma
109
Q

Band keratopathy testing

A
  • ESR/CRP
  • RF
  • ANA
  • CMP
  • phosphorus/calcium
  • ACE
  • uric acid
110
Q

Anterior uveitis differential

A
  • idiopathic
  • HLA-B27
  • infection (TB, Lyme, syphilis, HSV)
  • trauma
  • autoimmune (sarcoid, RA, Wegener)
  • drug induced (rifabutin, cidofovir, sulfonamides)
  • tumor
  • Fuch’s heterochromic
  • posterior uveitis with anterior spillover
111
Q

Corneal crystals differential

A
  • Schyder dystrophy
  • cystinosis (kidney disease)
  • Bietti corneoretinal dystrophy (night blindness)
  • lymphoproliferative disorder (B symptoms)
  • fluoroquinolone use
  • infectious crystalline keratopathy
112
Q

Stargardt associations

A
  • autosomal recessive
  • ABCA4 gene
  • progressive vision loss, photophobia, loss of color vision
  • bull’s eye maculopathy
  • pisciform flecks
  • central scotoma on HVF
  • “dark choroid” on IVFA
  • mix hypoAF and hyperAF flecks on FAF
  • decreased photopic and scotopic response on ERG in advanced cases
  • no real therapy, VA typically stabilizes at better than 20/400
  • tinted glasses and low vision aids
113
Q

RP syndromes and differential

A
  • past trauma or inflammation
  • Refsum (avoid phytanic acid milk/fats)
  • Usher (hearing loss)
  • Bassen-Kornzweig (supplement vit AEK)
  • Kearns-Sayre (EKG, cardiology, CPEO)
  • syphilis
  • thioridazine toxicity
  • gyrate atrophy, choroideremia
  • Leber congenital amaurosis
114
Q

RP testing

A
  • ERG: prolonged dark adaptation and increased absolute rod threshold
  • HVF: ring scotoma
  • OCT: retinal thinning, ERM, CME, VMT
  • IVFA: CME
115
Q

RP treatment

A
  • vitamin A supplementation
  • smoking cessation
  • oral or topical CAI for CME
  • UV blocking glasses
  • CE/IOL if PSC
  • low vision counseling
  • potential gene therapy in the future
  • retinal implant for end stage RP
116
Q

Leber congenital amaurosis associations

A
  • autosomal recessive
  • often shows pigmentary retinopathy
  • moderate to severe vision loss
  • nystagmus
  • photophobia
  • oculodigital sign
  • sluggish or non-responsive pupils
  • markedly reduced or flat ERG
  • associated with keratoconus
  • gene therapy shows promise
117
Q

ROP differential

A
  • FEVR
  • Coats disease
  • persistent fetal vasculature
  • toxocara
  • Norrie disease (micropthalmia, developmental delays, deafness)
  • incontenentia pigments (X-linked dominant, skin findings, developmental delay and seizures)
118
Q

Gyrate atrophy associations

A
  • nyctalopia and loss of peripheral vision in first decade of life
  • scalloped progressive RPE atrophy
  • PSC cataracts
  • high myopia
  • CME on OCT and IVFA
  • flat ERG
  • FAF shows areas of hypoAF corresponding to RPE atrophy
  • high ornithine levels
  • intravitreal steroid for CME
  • low protein diet, supplement B6
119
Q

Choroideremia associations

A
  • X-linked recessive: men primarily affected
  • diffuse, progressive degeneration of the RPE
  • nyctalopia and peripheral vision loss
  • no optic atrophy
  • PSC and CME
  • decreased photopic and scotopic ERG early, eventually extinguished
  • IVFA shows scalloped areas of missing choriocapillaris
  • FAF shows areas of hypoAF corresponding to areas of RPE atrophy
120
Q

Bullseye maculopathy differential

A
  • chloroquine/hydroxy toxicity
  • cone-rod dystrophy
  • Stargardt disease
  • solar retinopathy
  • ARMD
  • macular hole
121
Q

Multifocal ERG in hydroxychloroquine toxicity

A
  • depression of signals in the perifoveal region
122
Q

Reason for closer f/u with hydroxychloroquine

A
  • dose > 5 mg/kg
  • renal or liver disease
  • taking medication > 10 years
123
Q

Hypercoagulable work up

A
  • ANA
  • RPR
  • PT/INR
  • homocysteine
  • lupus anticoagulant
  • SPEP/UPEP
  • protein C/S
  • factor V Leiden
  • antithrombin III
124
Q

ERG findings in CRAO

A
  • normal A-wave
  • diminished B-wave
125
Q

Toxo differential

A
  • syphilis
  • CMV retinitis
  • fungal chorioretinitis
  • histoplasmosis
  • TB
  • toxocariasis
126
Q

Crouzon syndrome differential

A
  • Apert syndrome
  • Goldenhar syndrome
127
Q

Stargardt differential

A
  • fundus albipunctatus (CHNB variant, no macular degeneration or pigment changes, prolonged dark adaptation time but normal ERG)
  • retinitis punctata albescens (more marked VA, fields, and night blindness deterioration)
  • cone-rod dystrophy (more color vision deficit)
  • chloroquine/hydroxychloroquine toxicity
  • drusen
128
Q

Treatment for choroidal effusion due to hypotony

A
  • check for wound leak
  • gonio to look for cyclodialysis cleft
  • topical steroids, cycloplegics
  • if severe with iridocorneal or lens touch: reform AC with viscoelastic
  • surgical drainage if persists or if kissing choroidals
129
Q

RP inheritance

A
  • autosomal dominant best prognosis
  • X-linked has worst prognosis
130
Q

Serous retinal detachment differential

A
  • VKH
  • sympathetic ophthalmia
  • malignant hypertension
  • CSCR
  • choroidal tumor
  • optic pit
  • uveal effusion syndrome
  • posterior scleritis
  • APMPPE
131
Q

Birdshot associations

A
  • bilateral
  • middle aged female
  • HLA-A29
  • VITRITIS
  • postequatorial creamy white, yellow lesions, from disc, somewhat spares macula
  • CME, chronic, progressive
  • standard autoimmune therapy
132
Q

APMPPE associations

A
  • bilateral
  • young, M=F
  • viral prodrome
  • early hypofluorescence, later hyperfluorescence on IVFA
  • CEREBRAL VASCULITIS
  • spontaneous resolution
133
Q

MEWDS associations

A
  • unilateral
  • young female
  • mild vitritis and anterior uveitis
  • foveal granularity with surrounding hyperfluorescence in wreath pattern on IVFA
  • spontaneous resolution
134
Q

Serpiginous associations

A
  • bilateral
  • middle age M=F
  • IVFA similar to APMPPE: hypo early, hyper late
  • chronic, progressive, central scarring
  • CNV
  • standard autoimmune treatment
135
Q

PIC associations

A
  • bilateral
  • young, myopic female
  • no vitritis
  • small, yellow, round lesions in the macula
  • self-limited
  • late CNV
136
Q

Multifocal choroiditis associations

A
  • bilateral
  • young, myopic female
  • vitritis, anterior uveitis
  • white-yellow lesions evolve into punched-out scars
  • vision loss due to scarring and CNV
  • IVFA may show disc leakage, subretinal pooling, CME, or CNV
  • standard autoimmune therapy
137
Q

Neuro testing

A
  • pupils, color plates
  • Hertel
  • HVF
  • OCT nerve and macula
  • B-scan
138
Q

7th nerve palsy differential

A
  • Bell palsy
  • central lesion
  • CPA mass (acoustic neuroma)
  • trauma
  • infection (otitis media, Guillain-Barre, HZV, Lyme, syphilis)
  • infiltration
  • neoplasm (parotid)
139
Q

Bell palsy treatment

A
  • corneal exposure
  • oral steroids
  • consider oral antivirals
140
Q

Proptosis in children

A
  • orbital cellulitis
  • rhabdomyosarcoma
  • metastatic nueroblastoma
  • lymphangioma
  • capillary hemangioma
  • leukemia
  • optic nerve glioma
  • ONSM
  • dermoid cyst
  • carotid cavernous fistula
  • mucocele
141
Q

Horner syndrome in a child

A
  • metastatic neuroblastoma
142
Q

3rd nerve palsy in immunocomprimised

A

Cavernous sinus syndrome
- AV fistula
- cavernous sinus thrombosis
- mucor
- Tolosa-Hunt

143
Q

Methods for assessing visual potential in white cataract

A
  • check for RAPD
  • potential acuity meter
  • lighter perception and direction of orientation
  • projecting color
  • ERG
  • Haidinger’s brush
144
Q

Goldenhar exam

A
  • facial asymmetry
  • microphthalmia
  • epibulbar dermoids, lipodermoids
  • coloboma, commonly upper eyelid
  • aural tags
  • Duane syndrome
145
Q

Goldenhar therapy

A
  • eyelid reconstruction if exposure from coloboma
  • resection of limbal dermoid if astigmatism or amblyopia
  • facial reconstruction
  • ear reconstruction

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