Eye (Mehrhoff)

Question 1

Hordeolum

Answer 1

an acute purulent soft mass in the periorbital region; if does heal properly can become a chalazion

Question 2

If a hordeolum doesn’t heal properly, what can it turn into?

Answer 2

chalazion

Question 3

Chalazion

Answer 3

chronic lipogranuloma from an obstructed meibomiam gland; roundish, firm lesion painLESS lesion within the tarsal plate.

Question 4

Sebaceous Adenocarcinoma of the eyelid

Answer 4

small, rubbery/firm nodule on upper eyelid (can mimic chalazion); slow-growing tumor with atypical epithelial cells; tends to metastasize; elderly and female predominate; yellowish appearance is a suspicious sign

Question 5

What is a sign that can help you distinguish a Sebaceous Adenocarcinoma of the eyelid from a Chalazion?

Answer 5

yellowish appearance - more towards Sebaceous Adenocarcinoma of the eyelid (also look for macaronis - loss of eyelashes)

Question 6

Basal cell carcinoma

Answer 6

most common malignant lesion of the eyelid (90%); flesh-colored to pearly raised nodule with “rolled edges”; rarely metastases; peak age of 70 yrs

Question 7

What is the most common malignant lesion of the eyelid?

Answer 7

Basal cell carcinoma

Question 8

A description of a flesh-colored to pearly raised nodule with “rolled edges”on the eyelid should make you suspect what?

Answer 8

Basal cell carcinoma

Question 9

Squamous cell carcinoma

Answer 9

most common skin cancer; predominately amongst dark-skinned individuals; erythematous pink nodules with overlying scale or crust; may find “horn pearls”

Question 10

What is the most common skin cancer?

Answer 10

Squamous cell carcinoma

Question 11

A description of erythematous pink nodules with overlying scale or crust and some “horn pearls” around the eyelid should make you suspect what?

Answer 11

Squamous cell carcinoma

Question 12

Melanoma of the eyelids

Answer 12

ABCDE’s of melanoma (asymmetry, border irregularities, color with black and blue hues, diameter >6mm and change in the lesion over time); looks for loss of eyelashes; associated with high mortality

Question 13

When light passes through the cornea and the lens, what is the orientation of the image?

Answer 13

Inverted and reversed (refracted)

Question 14

Hyperopia

Answer 14

farsightedness; corrected with convex lens

Question 15

Myopia

Answer 15

nearsightedness; corrected with concave lens

Question 16

Astigmatism

Answer 16

abnormal curvature of cornea; corrected with cylindrical lens

Question 17

Cataracts

Answer 17

painless opacification of the lens; nuclear is most common type - nuclear sclerosis increases the lens refraction and leads to increased myopia and decreased hyperopia

Question 18

What is the most common type of cataracts?

Answer 18

nuclear cataracts

Question 19

Explain the flow aqueous humor?

Answer 19

posterior chamber to pupil and then can go down one of two routes:
1. trabecular route - trabecular meshwork at angle of anterior chamber to scheme’s canal
2. uveoscleral route - uveal meshwork at ciliary muscles to the suprachoroidal space

both routes lead to the episcleral veins

Question 20

What are two structures that are compressed due to increased intraocular pressure (IOP) seen in glaucoma?

Answer 20

1. optic nerve - leads to cupping
2. vessels - ischemia of the optic nerve

Question 21

Glaucoma

Answer 21

group of optic neuropathies with cupping that lead to visual field defects due to obstruction of aqueous humor drainage; most cases lead to increased intraocular pressure (IOP)

Question 22

Open-angle glaucoma

Answer 22

“silent thief of sight” - no pain unless IOP is very high; resistance of AH flow in the trabecular meshwork (obstruction)

Question 23

What is a major risk factor to neovascular glaucoma?

Answer 23

type II diabetes with proliferative stage of diabetic retinopathy

Question 24

Retinal detachment

Answer 24

separation of the neurosensory retina from the RPE; check for “floaters and flashes” in the patient history; can be a description of “curtain drawn down”; there is no pain and fundoscopy can show crinkling of retina; is a surgical emergency

Question 25

“curtain drawn down” visual description should make you suspect which pathology?

Answer 25

Retinal detachment

Question 26

What are some irreversible markers of hypertension in the eye?

Answer 26

narrow arterioles, arteriovenous nicking and arteriolar thickening (silver wiring)

Question 27

Central retinal vein occlusion

Answer 27

dilation and retinal hemorrhages described as “blood and thunder” veins; patient can present with painless vision loss or blurry vision

Question 28

A description of blood and thunder” veins in the eye, should make you suspect what?

Answer 28

Central retinal vein occlusion

Question 29

Central retinal artery occlusion

Answer 29

will see a cherry-red center of the macula; boards will typically say patient had sudden and painless vision loss (greater degree compared to the central retinal vein occlusion)

Question 30

If you suspect diabetic retinopathy in a patient, what is something you should check/monitor?

Answer 30

intraocular pressure (IOP)

Question 31

Retrobulbar neuritis

Answer 31

inflammation of the posterior part of the optic nerve due to demyelination; typically monocular presents with subacute vision loss, color blindness** and moderate eye pain; attacks resolves spontaneously; associated with MS (get MRI)

Question 32

Retrobulbar neuritis is associated with what neurological disorder?

Answer 32

Multiple sclerosis (MS); get a MRI of brain and cervical and thoracic spine

Question 33

Retinopathy of Prematurity (ROP)

Answer 33

immature retinal tissue that leads to tractional retinal detachment causing vision loss or blindness in an infant

Question 34

Risk factors for retinopathy of prematurity?

Answer 34

extremely low birth weight infants
prematurity (<32 weeks)
respiratory distress infants
exposure to hyperoxia

Question 35

How does exposure to hyperemia contribute to retinopathy of prematurity in infants?

Answer 35

premature infants are given supplemental oxygen and exposed to hyperemia and this tells the eye we are oxygen sufficient and stops peripheral retinal vessel growth, leads to retinal hypoxia and neovascularization of incompetent vessels that leak and cause elevation and detachment of the retina

Question 36

Retinoblastoma (RB)

Answer 36

most common intraocular tumor in children (under 5 yrs); germinal mut on chromosome 13q14; patient presents with leukocoria and strabismus

Question 37

If you suspect that a patient has conjunctival melanoma, why shouldn’t you get a biopsy?

Answer 37

it may shed malignant cells; refer to a specialist

Question 38

Uveal melanoma commonly spreads to which organ?

Answer 38

liver

Question 39

Uveal melanoma

Answer 39

malignancy of the uveal; asymptomatic; can see a gray-brown lesion of the choroid with irregular fuzzy margins “classic mushroom-shape”; common hematogenous metastases to the liver

Question 40

A “classic mushroom-shape” on the eye, should make you suspect which malignancy?

Answer 40

Uveal (choroidal) melanoma

Question 41

Answer 41

Question 42

Answer 42

D is the correct answer

Question 43

Answer 43

Question 44

Answer 44

MS is a disease characterized by demyelination of CNS nerves; cranial nerves I and II are the only cranial nerves that are direct extensions of the brain (CNS with oligodendrocytes all other transition to schwann cells)

Question 45

Answer 45

D is the correct answer