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Part 1 > EPT5 > Flashcards

EPT5 Flashcards

1
Q

Which of the following statements regarding tear drainage is correct?

a. Horner’s muscle encircles the nasolacrimal duct
b. The valve of Hasner prevents retrograde movement from the nasal cavity
c. Riolan’s muscle encircles the canaliculi
d. The nasolacrimal duct empties into the lacrimal sac

A

b. The valve of Hasner prevents retrograde movement from the nasal cavity

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2
Q

A 6m old infant demonstrates 20/20 VA with which test?

A

VEP

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3
Q

All of the following are characteristic of the retinal vasculature EXCEPT:
a. Lack of anastomoses

b. Autonomic innervation
c. Autoregulation of BF
d. Non-fenestrated capillary beds

A

b. Autonomic innervation

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4
Q

A facial nerve palsy is MOST likely to affect which of the following 2 actions?

a. Opening eyelid
b. Accommodation
c. Reflex tearing in response to bright light
d. Ciliary touch sensation
e. Eyelid closure
f. Vergence eye movement

A

a. Opening eyelid
c. Reflex tearing in response to bright light

NOTE: CN7 –> facial expressions, ant 2/3 taste, lacrimation, salivation (submaxillary, submandibular)… Course of CN7 is Greater Petrosal Nerve (lacrimal gland parasymp), Chorda Tympani Nerve (ant 2/3 tongue), and Facial expression (closing eye). This nerve also DAMPENS sound

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5
Q

A 62 yo pt presents w sudden onset diplopia & a notable strab of the right eye. When testing W4D w the red lens over OD, he reports seeing 5 dots, with the 3 green dots to his left. In what head position would you expect his strab to have the highest magnitude?

A

Head turn to the LEFT!!

Uncrossed diplopia = RIGHT ESOTROPIA

Therefore the Right LR UA

So turning head to the left is hardest!

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6
Q

What are the 3 potential ADE associated with the use of orally administered sulfonamides?

a. Vestibular toxicity
b. Tendonitis
c. Blood dyscrasias
d. SJS
e. Myopic shift

A

c. Blood dyscrasias
d. SJS
e. Myopic shift

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7
Q

Which of the following oral antibiotics does NOT interfere with bacterial ribosomes?

a. Chloramphenicol
b. Ciprofloxacin
c. Gentamicin
d. Tetracycline

A

b. Ciprofloxacin

NOTE: chloramphenicol is 50S

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8
Q

A pt presents with 4pd CLXT and 2pd TEF OS. What is the magnitude of deviation measured w ACT?

A

4pd XT = D measured

D true is different though

Dt=Dm+EF

NOTE: XT/TEF = (-)
ET/NEF=(+)

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9
Q

Which of the following coincide when a thick lens is completely surrounded by air?
a. Principal and focal points

b. Principal and nodal points
c. Nodal points and vertices
d. Nodal and focal points

A

b. Principal and nodal points

PN=f + f’

PN is the displacement of each nodal point (both equidistant from p)

If n1=n3 then f=f’ and P co-incides with N

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10
Q

Which of the following events occurs during the PR interval on an EKG?

a. Slow depolarization of the AV nodes
b. Repolarization of the SA nodes
c. Depolarizatino of the His Purkinje Fibers
d. Contraction of the ventricles

A

a. Slow depolarization of the AV nodes

P-wave=Atrial depolarization

PR segment=Delay in AV node (Atrial Systole)

QRS complex=Ventricular depolarization

T wave= Ventricular repolarization

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11
Q

Excess production of parathyroid hormone is MOST likely to result in which of the following clinical findings?

a. Fleischer ring
b. INC IOP
c. Corneal Edema
d. Cataracts

A

d. Cataracts

NOTE: an INC in intracellular Ca2+, DEC glutathione, and DEC in crystallins are factors that sig contribute to cataracts

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12
Q

Which of the following ganglia does NOT directly innervate the ciliary body?

a. Semilunar
b. Oculomotor
c. Ciliary
d. Superior cervical

A

a. Semilunar ??

NOTE: sensory nerve fibers from the trigeminal ganglion of V1 travel w LPCNs to CB; Sympathetic nerve fibers from the superior cervical ganglion of the sympathetic ganglion chain travel w the LPCNs and SPCNs to innervate arteries within the CB; CN3 parasympathetic nerve fibers travel w SPCNs from ciliary ganglion to supply the ciliary muscle

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13
Q

Which malignant eyelid cancer is least likely to be casued by exposure to UV light?

A

Sebaceous cell carcinoma

NOTE: Hx of recurrent bleph/chalazia, skin cancer. Neoplasm of MG and Zeiss assoc w prior radiation therapy

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14
Q

What is Rochon-Duvigneaud’s Syndrome?

A

Damage to SOF

CN3,4,6,nasociliary nerve, frontal nerve, lacrimal nerve, S/I divisions of the ophthalmic vein

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15
Q

A 25-year old pt presents with bilateral hyperacute mucopurulent conjunctivitis w pseudomembranes and pre-auricular lymphadenopathy. Gram staining reveals Gram (-) diplococci that grow on a chocolate agar. Which of the following microbes is the MOST likely etiology?

A

Neisseria gonorrhoeae

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16
Q

All of the following oral medications are contraindicated in pts with angle closure glaucoma EXCEPT:

a. Imipramine
b. Fluoxetine
c. Amitriptyline
d. Phenytoin

A

d. Phenytoin

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17
Q

Which of the following are 4 potential causes of scleritis (SELECT 4)?

a. Systemic vasculitis
b. Uveitis
c. Episcleritis
d. Surgical trauma
e. Bisphophonate medications
f. Idiopathic

A

a. Systemic vasculitis
b. Uveitis
e. Bisphophonate medications
f. Idiopathic

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18
Q

Which of the following characteristics is NOT ideal for fitting a segmented, translating bifocal GP contact lens?

a. High add requirement
b. Lower lid positioned at the lower limbus
c. Large pupil size
d. Critical distance vision requirement
e. Loose lid tension

A

b. Lower lid positioned at the lower limbus

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19
Q

A pt’s near VA is measured as 0.25m/3.0M. Which telemicroscope will allow this pt to read 1.0M print at a distance of 25 cm.

a. 3X telescope; +4.00D reading cap
b. 3X telescope; +3.00D reading cap
c. 4X telescope; +4.00D reading cap
d. 4X telescope; +3.00D reading cap

A

a. 3X telescope; +4.00D reading cap

Deq=(power telescope)*(reading cap) –> note: WD is from the reading cap :)

3.0M/1.0M=3X telescope

Deq=3X*(+4.00)=+12.00D

They want to read at 25 cm so 1/0.25=+4.00 reading cap

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20
Q

You wish to experimentally determine a dark adaptation curve for a normal pt under different conditions. Which of the following will produce the earliest rod-cone break?

a. Spot size covering central 10 deg of retina, wavelength of 610 nm
b. Spot size covering central 10 deg of retina, wavelength of 465 nm
c. Spot size limited to central 0.5 deg of fovea, wavelength of 500 nm
d. Spot size covering central 10 deg of retina, wavelength of 650 nm

A

d. Spot size covering central 10 deg of retina, wavelength of 650 nm

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21
Q

Which of the following ganglia causes vasodilation of the choroidal vessels?

a. Ciliary
b. Superior cervical
c. Trigeminal
d. Pterygopalatine

A

d. Pterygopalatine

NOTE:
CN7 parasympathetic fibers from the pterygopalatine ganglion cause vasodilation of the choroidal vessesl

CN3 parasymp fibers originate from the ciliary ganglion & have an unknown function w/in the choroid

CNV1 provides sensory innervation of the choroid

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22
Q

Which of the following topical ophthalmic medications has the GREATEST coverage of gram (-) and gram (+) bacteria?

a. Levofloxacin
b. Ciprofloxacin
c. Besifloxacin
d. Ofloxacin

A

c. Besifloxacin

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23
Q

All of the following will result in a myopic refractive error after cataract extraction and PCIOL implantation EXCEPT:

a. Posterior displacement of the PCIOL
b. Anterior displacement of the PCIOL
c. Overestimation of the central corneal radius of curvature by keratometry
d. Underestimation of the axial length by A-scan

A

d. Underestimation of the axial length by A-scan ??
??
??
??

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24
Q

Which of the following oral medications is MOST commonly associated w oculogyric crisis?

a. Phenothiazine
b. Salicylate acid
c. Phenobarbital
d. Phenytoin

A

a. Phenothiazine

NOTE: phenothiazine is a dopamine receptor antagonist which is used as an anti-psychotic. Anti-psychotics cause changes in pigmentation, cause anti-cholinergic effects, OCULOGYRIC CRISIS, and Parkinson-like effects if too much.

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25
Q

Which of the following limit the maximum amount of measurable (+) and (-) power of spectacle lenses with lensometry?

a. Power of Badal lens; power of the Badal lens
b. Length of lensometer; power of Badal lens
c. Length of lensometer; Length of the lensometer
d. Power of Badal lens; Length of Lensometer

A

???? a. Power of Badal lens; power of the Badal lens

????

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26
Q

What are limitations to the Badal Optometry?

A
  1. Restriction of negative (myopic) ocular vergence range
  2. The need for targets to be small
  3. The problem of “proximal” accommodation.

NOTE: The simple Badal Optometer consists of a movable target and a fixed positive power lens placed at its focal distance away from the eye. The perceived angular size of the target is independent of target position and the power scale is linear.

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27
Q

A 30 year old female complains of BLUR only when reading. Best corrected VA is 20/20 OD/OS. Confrontations and EOMs WNL. Pupil size 6mm/7mm OD/OS in the dark. 3mm/6mm OD/OS under bright illumination. What is the MOST likely Dx?

A

Adies

28
Q

Which of the following will inactivate HIV reverse transciptase?

a. AZT
b. Fluorouracil
c. ATP
d. Methotrexate

A

a. AZT

NOTE: Zidovudine (Retrovir or AZT) is used to Tx HIV. It is a nucleoside analog of thymidine that acts as a potential inhibitor of viral RNA-dependent DNA polymerase (reverse transcriptase). ADEs: bone marrow suppression, lactic acidosis, myopathy, amblyopia & macular edema!

29
Q

Cycloablation results in a significant DEC in IOP due to changes in which of the following structures?

A

Ciliary muscle specifically the ciliary processes

NOTE: All 3 techniques share the common goal of decreased aqueous production, and all share the possible side effects of inflammation (including possible sympathetic ophthalmia), ineffective treatment, and over-treatment with resultant hypotony or even phthisis. Although there is not uniform agreement, most surgeons reserve cycloablation procedures for those cases refractory to, or not amenable to, procedures that improve aqueous outflow such as angle surgery, glaucoma drainage implant surgery, and trabeculectomy Nonetheless, for especially refractory pediatric glaucoma (as with adult cases), cyclodestruction represents a valid method of attempting control of glaucoma that otherwise threatens residual vision or causes ongoing damage to the structure of the child’s eye.

30
Q

Which of the following 3 statements are TRUE regarding the use of prism thinning and PAL?

a. Prism thinning is equal to 2/3 the add power
b. Prism thinning is equal to 1/2 the add power
c. Prism thinning bases are opposing btwn the lenses
d. Prism thinning results in a more uniform lens profile
e. Prism thinning bases are yoked btwn the lenses

A

a, d, e

Prism-thinning (also called equi-thinning) is the process of grinding vertical prism into a progressive lens blank in order to minimize the thickness difference between the top and bottom edges of the lens as well as to reduce the overall thickness of the lens.

31
Q

A pt presents with 6 XP’ w BI 10/15/12 and BO 20/25/15. What is the magnitude of the relative compensating vergence?

A

20pd BO

32
Q

Which of the following systemic adverse reactions is NOT associated with acetazolamide?

a. Depression
b. Metabolic alkalemia
c. Metallic taste
d. Weight loss

A

b. Metabolic alkalemia

Common ADE: metallic taste, tingling hands/feet, metabolic acidosis, fatigue, weight loss, anorexia, depression

Serious ADE: thrombocytopenia, agranulocytosis, aplastic anemia

Fatal: Bone marrow suppression & Aplastic anemia

MYOPIC SHIFT

33
Q

What drugs cause myopic shift?

A

Topomax

Pilocarpine

NSC

Oral CAI

34
Q

What drugs cause aplastic anemia?

A

Diamox

Chloramphenicol

CAI

Methotrexate

Trimethoprim

“Meds That Can Cause Death”

35
Q

Which drug can be utilized to prevent systemic side effects experienced during edrophonium testing for myasthenia gravis?

a. Physostigmine
b. Atropine
c. Acetylcysteine
d. Phenylephrine

A

??? b. Atropine
???

Edrophonium is an indirect cholinergic agonist

Atrophine is a cholinergic antagonist

36
Q

What is limbal relaxingt incisions (LRI)?

A

Limbal Relaxing Incisions (LRI for short) are partial thickness incisions made at the outer (non-seeing) edge of the cornea called the limbus, in folks with astigmatism, in order to reduce or even eliminate their need for distance glasses or contacts

37
Q

A plus cylinder lens Rx of +2.00 DS +3.25 DC x 090 is made with a 6.00 D BC. The F1 surface should be what?

A

+6.00D @ 090
+9.25D @ 180

BC is flatter of front curves

Steeper of front curves = CROSS CURVE

Back = SPHERE CURVE

38
Q

All of the following may occur as a result of a dissecting internal carotid artery aneurysm EXCEPT:

a. Anhidrosis
b. Miosis
c. Limited adduction
d. Ptosis

A

c. Limited adduction
????

ICA –> OPAM
O –> CL MS LSE

39
Q

What result do you expect on Jones I and II testing in a pt w a nasolacrimal duct obstruction?

A

????

40
Q

Your pt takes the DEM test and has a normal vertical time, an abnormally high horizontal score, and an abnormally high ratio. What is the MOST appropriate Dx?

A

Type II Behavior

NOTE:
a) Type I Behavior:
Essentially normal performance in Horizontal Time, Vertical Time, and Ratio.
b) Type II Behavior:
Characterized as abnormally increased time to complete the Horizontal Test in the
presence of normal performance on the Vertical Test. The Ratio would be abnormally
high in this case. Type II behavior is characteristic of oculomotor dysfunction.
c) Type III Behavior:
Typified as an abnormal increase in both the Horizontal Test and Vertical Test times, but
with a normal Ratio. In the presence of a normal Ratio, the Horizontal Test time is
influenced and increased because of an abnormal baseline. This represents a case of
difficulty in automaticity in number calling skills, not an ocular motility deficit.
d) Type IV Behavior:
Increased Horizontal and Vertical Test times, and an abnormally high Ratio. This case is
a combination of Type II and Type III behavior patterns. There are deficiencies in
automaticity/oculomotor skills.

41
Q

A 26 yo pt who recently suffered head trauma in a motor vehicle accident demonstrates a lack of self-discipline and anti-social behavior. He is unable to plan for the future and organize his behavior into logical sequences. A lesion in which of the following lobes is MOST likely?

A

Frontal Lobe

The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior.

42
Q

Which of the following 3 arteries provide blood supply to the eyelids?

a. Branches of the facial arteries
b. Medial palpebral arteries
c. Short Posterior Ciliary Arteries
d. Muscular arteries
e. Ethmoid arteries
f. Lateral palpebral arteries

A

a. Branches of the facial arteries
b. Medial palpebral arteries
f. Lateral palpebral arteries

NOTE: others include superficial temporal artery, lacrimal artery, zygomaticofacial artery, transverse facial artery, medial palpebral artery, supratrochlear artery, dorsal nasal artery, angular artery, lateral nasal artery, and inferior palpebral artery

43
Q

Which is characteristic of the early symptoms associated w systemic toxicity secondary to local (injectable) anesthetic overdose?

A

Respiratory depression

44
Q

Which of the following 4 clinical findings are MOST consistent with a direct carotid-cavernous fistula? (SELECT 4)

a. Contralateral APD
b. Unilateral INC IOP
c. Opthalmoplegia
d. Lid retraction
e. Marked episcleral injection and hemorrhagic chemosis
f. Pulsatile proptosis
g. Pulsatile enophthalmos

A

b. Unilateral INC IOP
c. Opthalmoplegia
e. Marked episcleral injection and hemorrhagic chemosis
f. Pulsatile proptosis

NOTE: most commonly caused by HEAD Trauma (77%) but may be spontaneous (classically from a ruptured ICA aneurysm) or CS pathology. TRIAD: chemosis, pulsatile proptosis, and ocular bruit. Signs include - episcleral venous congestion, periorbital tissue swelling, elevated IOP, diplopia secondary to CN3,4,6 palsies, loss of lid/face sensation on affected side due to CN5 palsy

45
Q

Which of the following is NOT a complication of juvenile retinoschisis?

a. RD
b. Choroidal folds
c. Vitreous hemorrhage
d. RPE atrophy

A

b. Choroidal folds

46
Q

All of the following are characteristics of a tight SCL fit EXCEPT:

a. Greater than 2 mm inferior drop on upgaze
b. Conj vessel dragging
c. Mucin balls
d. Poor comfort after prolonged wearing time

A

a. Greater than 2 mm inferior drop on upgaze

47
Q

A pt presents w a sudden INC in BP, heart palpitations, and sweating. These symptoms are MOST likely caused by excessive secretion of products from which of the following?

a. Anterior pituitary
b. Adrenal medulla
c. Posterior pituitary
d. Adrenal cortex

A

b. Adrenal medulla

Catecholamine release from “fight or flight” response –> stress or hypoglycemia (DM1)

NEp, Ep

INC live/muscle glycogenolysis, INC lactate production in muscle for hepatic gluconeogenesis, (-) insulin release and glucose uptake, (+) of glucagon release and gluconeogenesis, enhanced lipolysis and FA oxidation, INC cardiac contractility & HR, dilated pupil, sweating

48
Q

An orbital blow-out fracture may cause hypoesthesia of the lower eyelid, cheek, and upper lid due to damage to which of the following nerves?

A

Damage to the INFRAORBITAL NERVE

49
Q

A biopsy of a squamous cell carcinoma of the left lower eyelid will MOST likely show a high concentration of which of the following cell types?

a. Macrophages
b. Natural killer cells
c. B lymphocytes
d. T lymphocytes

A

a. Macrophages

50
Q

A 27 year old male presents with a sluggish pupil response, mild corneal edema, trace keratic precipitates, and mild cells and flare in the AC OS. His IOP are 18 mmHg OD and 43 mmHg OS, and his angles are open on gonio OD, OS. What is the MOST likley Dx?

A

Glaucomatocyclitic crisis

51
Q

Which of the following agents would NOT exacerbate fatigue and depression in an 82 year old white female?

a. Topical ophthalmic latanoprost for Tx of pseudoexfoliative glaucoma
b. Topical ophthalmic brimonidine for Tx of pigmentary glaucoma
c. Topical ophthalmic timolol for tx of ocular HTN
d. Oral acetazolamide for Tx of POAG

A

a. Topical ophthalmic latanoprost for Tx of pseudoexfoliative glaucoma

52
Q

How would you label a telescope w an objective lens diameter of 25 mm and an exit pupil diameter of 5 mm?

A

5x25!

25/5=5X

markings: Mag x Obj Lens size

Mag=-Doc/Dobj = diameter obj/diameter XP

53
Q

Which of the following statements regarding the iris is INCORRECT:

a. The anterior iris stromal leaf contains the anterior border layer and a small portion of the iris stroma in the ciliary zone
b. Schwalbe’s contraction furrows are located at the iris pupillary margin and represent variations in the thickness of the posterior pigmented iris epithelium
c. Posterior iris stromal leaf contains most of the iris stroma in the ciliary zone and all of the iris stroma and the anterior border layer in the pupillary zone
d. Radial streaks are located in the ciliary and pupillary zones and are remnants of the fetal pupillary membrane during embryological development

A

d. Radial streaks are located in the ciliary and pupillary zones and are remnants of the fetal pupillary membrane during embryological development

54
Q

An infection of the superficial skin near the nose is capable of spreading to the brain because:

a. The angular vein communicates with the cavernous sinus via the inferior ophthalmic vein
b. The superficial temporal vein communicates w the cavernous sinus via the maxillary vein
c. The supraorbital vein communicates w the cavernous sinus via the inferior ophthalmic vein
d. The facial vein communicates w the cavernous sinus via the pterygoid plexus and inferior ophthalmic vein

A

???

a. The angular vein communicates with the cavernous sinus via the inferior ophthalmic vein

55
Q

Which of the following statements regarding the orbital fascia is INCORRECT?

a. It is continuous w the periosteum of the bones of the face and skull
b. It covers the blood vessels, EOMs, and adipose tissue within the orbit
c. It is composed of dense CT and covers the bones of the orbit
d. It prevents prolapse of orbital fat and orbital infections by forming the orbital septum within the eyelids
e. It is continuous with the dura mater surrounding the optic nerve at the optic canal

A

a. It is continuous w the periosteum of the bones of the face and skull

56
Q

A pt presents w new onset vertical diplopia and a right hypertropia in primary gaze after having a stroke that affected the superior division of CN3. in what 2 head positions would you expect the hypertropia to be worse?

a. Left head tilt
b. Left head turn
c. Right head turn
d. Right head tilt

A

a. Left head tilt
c. Right head turn

??

57
Q

All of the following are commonly associated w CHF EXCEPT:

a. Portal hypotension
b. Pulmonary edema
c. Dyspnea
d. Angle edema

A

a. Portal hypotension
??

More so HTN

58
Q

A 30 year old pt presents w new onset miosis and mild ptosis OD. Which of the following tests is MOST appropriate?

a. Orbital CT
b. MRI
c. Chest X-ray
d. Carotid ultrasound

A

d. Carotid ultrasound ???

New horner’s with neck or facial pain warrants r/o carotid dissection

or chest x-ray

59
Q

Which of the following topical ophthalmic solutions does NOT cause miosis in a physiological normal iris?

a. Pilocarpine 4%
b. Brimonidine 0.1%
c. Brimonidine 0.2%
d. Apraclonidine 0.5%

A

d. Apraclonidine 0.5%!!!!!

Brimonidine causes miosis and can be used to reduce glare, halos, and other night vision symptoms

NOTE: apraclonidine is used to control IOP spikes before and after Sx, laser iridotomy, trabeculoplasty, posterior capsulotomy

60
Q

Long term use of systemic steroids can cause what?

A
  1. INC blood sugar –> DM &/or insulin resistance
  2. Weight gain, peptic ulcers
  3. Immune suppression
  4. Poor wound healing
  5. HTN
  6. Fat redistribution
  7. Osteoporosis, collagen
  8. DEC corneoscleral outflow
  9. PSC cataracts/glaucoma/2nd ocular infection
61
Q

The major circle of the iris is the primary blood supply to the iris and is:

A

Formed by anastomoses (connections) btwn the LPCAs and Anterior ciliary arteries (ACA)

62
Q

Orbital emphysema due to an orbital fracture is the result of:

a. contact btwn orbital fascia and fractured bone
b. CSF w/in the subcutaneous tissue
c. Bone fragments rubbing together
d. Air from the paranasal sinuses in the subcutaneous tissue

A

d. Air from the paranasal sinuses in the subcutaneous tissue

63
Q

A posterior sclerostomy is indicated for the Tx of choroidal effusion bc it drains excess fluid from the:

a. scleral stroma
b. suprachoroid lamina
c. supraciliaris
d. choriocapillaris

A

???

64
Q

Clinical findings in ocular ischemic syndrome may include all EXCEPT:

a. Dilated retinal arteries
b. Cherry red spot at the fovea
c. retinal hemorrhage
d. anterior uveitis
e. iris neo

A

e. iris neo

65
Q

You note corneal haze OD in a 2 week old infant due to a forceps injury at birth. Which of the 3 conditions is the pt at risk for developing

a. Increased hyperopia
b. Amblyopia
c. Irregular corneal astig
d. Corneal stromal thinning
e. Bullous keratopathy

A

e. Bullous keratopathy
c. Irregular corneal astig
d. Corneal stromal thinning

??????

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