Eye and ear

Question 1

What does the Medial Longitudinal Fasciculus do?

Answer 1

Maintains conjugate gaze

Question 2

Patient has upper quadrantanopia. Where is the lesion?

Answer 2

Temporal lobe

Question 3

Patient has lower quadrantanopia. Where is the lesion?

Answer 3

Parietal lobe

Question 4

What causes uveitis?

Answer 4

Infection (viral, syphilis)
Autoimmune (ankylosing spondylitis, JIA)
Inflammatory (IBD)

Question 5

Patient has pain and photophobia. What would be seen on slit lamp exam if this were anterior uveitis?

Answer 5

Inflammation of eye and keratin deposits on cornea

Question 6

Patient has mild vision abnormalities. What would be seen on slit lamp exam if this were posterior uveitis?

Answer 6

Eye inflammation and retinal lesions

Question 7

A patient has frequent changes of lens prescription. What should done?

Answer 7

Check ocular pressure…could have glaucoma

Question 8

How is vision lost with open-angle glaucoma? What is seen on funduscopic exam?

Answer 8

Peripheral to central

Cupping of optic disc

Question 9

What are treatment options for open angle glaucoma?

Answer 9

Topical beta-blockers (timolol) and alpha-adrenergic agonists decrease aqueous humor production
alpha-adrenergic agonists and cholinergic agonist (pilocarpine) increase aqueous removal

Question 10

What shouldn’t you do to someone with closed angle glaucoma?

Answer 10

Dilate their eyes…further closes angle

Question 11

How is closed angle glaucoma treated?

Answer 11

Acetazolamide decreases pressure
Pilocarpine (after pressure reduction) reduces obstruction
Laser iridotomy to prevent recurrence (done on both sides)

Question 12

What is the most common cause of bilateral vision loss in old people?

Answer 12

Macular degeneration

Question 13

How is vision lost with macular degeneration?

Answer 13

Central to peripheral

Question 14

What is seen on funduscopic exam with macular degeneration?

Answer 14

Retinal pigmentation (atrophic type...slow)
Retinal hemorrhage (exudative type...fast)

Possibly a detachment

Question 15

What are treatment options for macular degeneration?

Answer 15

Supplements: vit C and E, beta-carotene, copper, zinc
Intravitreal ranibizumab may help with exudative lesions near fovea
Laser photocoagulation may delay progression

Question 16

A patient has painless acute vision loss…“window shade pulled over eye” or “numerous floaters.” What likely happened? What would be seen on funduscopic exam?

Answer 16

Retinal detachment

Pigmented fragments or gray retina floating in vitreous humor

Question 17

How is retinal detachment treated?

Answer 17

Laser photocoagulation or cryotherapy to halt progression and reattach…may not fully restore vision

Question 18

Patient comes in with sudden, painless vision loss with a cherry red spot in fovea and poor arterial filling on funduscopic exam. What is going on? How is it treated?

Answer 18

Retinal artery occlusion…signs due to no blood

Thrombolysis w/in 8hrs
Acetazolamide and O2 to decrease congestion and increase perfusion

Question 19

Patient comes in with gradual, painless vision loss and cotton wool spots, edema, retinal hemorrhages and dilated veins are seen on funduscopic exam. What is going on? How is it treated?

Answer 19

Retinal vein occlusion…signs due to increased pressure

Laser photocoagulation can help

Question 20

How is otitis externa

(swimmer’s ear) treated?

Answer 20

Topical polymyxin, neomycin, and hydrocortisone
Oral cephalosporin or ciprofloxacin for Pseudomans infection…or if infection spreads to the skull
Topical drying agents to prevent recurrence

Question 21

What is another name for Meniere disease? Besides the awful vertigo, what else happens with this disease?

Answer 21

Endolymphatic hydrops

Low-frequency hearing loss

Question 22

How is miner disease treated?

Answer 22

Anticholinergics, antiemetics, and antihistamines improve exacerbations
Salt restriction and thiazides can reduce frequency of exacerbations
Surgical decompression is necessary in refractory cases

Question 23

Patient comes in with hearing loss, dizziness, tinnitus, and unilateral facial palsy. On exam, he has decreased sensation of his face. What should be done?

Answer 23

MRI to localize acoustic neuroma (acoustic schwannoma…benign tumor)