Eyes

Question 1

What most often causes central retinal artery occlusion (CRAO)?

Answer 1

Emolized plaque from ipsilateral carotid artery

Pale retina - due to ischemia and edema
Macular cherry-red spot (fovea thinnest here)

Question 2

Flame-shaped hemorrhages

Answer 2

Hypertensive retinopathy

Question 3

Obscured optic disc margins

Answer 3

Papilledema - increased ICP
Headache, nausea/vomiting

Visual function often normal

Question 4

Glaucoma treatments

Answer 4

Bimatoprost - prostaglandin F2a analog increases uveoscleral outflow

Timolol - reduces aqueous production
Acetazolamide - rapidly reduce further production of aqueous humor

Apraclonidine - decreases aqueous production and increases outflow

If unresolved, use laser trabeculostomy, trabeculectomy, or trabecular shunt

Acute angle definitive treatment:
Laser iridotomy - facilitate aqueous outflow and provide definitive management
Use others and pilocarpine to manage until laser performed
Pilocarpine - cholinergic M3 agonist causes ciliary muscle contraction to open trabecular meshwork

Question 5

Sympathetic ophthalmia - treatment

Answer 5

Corticosteroids, monoclonal biologics

Can try to prevent by removing damaged eye if no chance of recovery

Question 6

Cause of fluffy, yellow-white exudates immediately adjacent to fovea and retinal vessels

Answer 6

CMV retinitis

Valganciclovir - both IV and intravitreal needed if lesions near fovea or optic nerve to prevent retinal scarring, blindness, and retinal detachment

Question 7

Cause of branched linear lesions/keratitis under slit lamp examination

Answer 7

HSV keratitis

Also has clear, watery eye drainage

Question 8

How is herpes simplex keratitis diagnosed?

Answer 8

Slit lamp

Question 9

CMV vs HSV keratitis

Answer 9

CMV is painless; fluffy or granular retinal lesions near vasculature, as well as retinal hemorrhage

HSV has pain, dendritic ulcerations, normal fundoscopic exam

Question 10

Central round infiltrate lesion of eye

Answer 10

Bacterial keratitis (e.g. Pseudomonas, S aureus) - typically due to contact lenses

Question 11

Multiple ulcers with feathery margins

Answer 11

Candida keratitis - typically in immunocompromised after corneal trauma, particularly soil

More indolent than bacterial keratitis, but both have mucopurulent discharge

Question 12

HIV retinopathy - appearance

Answer 12

Cotton-wool retinal lesions that are rarely hemorrhagic, without floaters or blurred vision

Question 13

Vitreous hemorrhage requires what for diagnosis?

Answer 13

Dilated eye exam + slit lamp

Question 14

What should be used in treatment of diabetic retinopathy but not wet age-related macular degeneration?

Answer 14

Laser photocoagulation - it would damage the retina
Instead, use intravitreal injections of VEGF inhibitors

Question 15

Uveitis - signs

Answer 15

Moderate pain, blurred vision
Anterior chamber shows flare and cells on slit lamp exam
Pupil constricted with poor light response

Question 16

Discharge/crusting of eyelashes, burning/itching of lids, foreign body sensation

Answer 16

Blepharitis - inflammation of the eyelid margin at opening of meibomian glands

Question 17

Common causes of blepharitis

Answer 17

Seborrheic dermatitis
Rosacea
Allergic disorders
Bacterial infection (especially S aureus)
Viral (e.g. HSV)
Demodex mites

Question 18

Wavy lines

Answer 18

Macular degeneration, more likely wet (exudative/neovascular)

Question 19

Features of diabetic retinopathy

Answer 19

Microaneurysms (dot and blot hemorrhages when ruptured)
Macular edema (capillary leakage)
Hard exudates (insoluble lipids)
Cotton-wool spots (capillary leakage)

Question 20

Macular cherry red spot (not congenital cause)

Answer 20

Central retinal artery occlusion
Would also have painless monocular vision loss

Question 21

Nonspherical cornea

Answer 21

Astigmatism - blurry at any distance

Question 22

CN V, X, XI, XII lesions - which side?

Answer 22

CN V: Jaw towards side of lesion (due to unopposed opposite pterygoid muscle)
CN X: Uvula away from lesion
CN XI: Weakness turning head away from lesion (SCM muscle); drooped shoulder (trapezius)
CN XII: Tongue towards side of lesion

Question 23

Blown pupil suggests…

Answer 23

CN III compression ipsilaterally

1. If due to uncal herniation - would also see contralateral hemiparesis that can progress to ipsilateral hemiparesis due to contralateral compression against Kernohan notch (Kernohan phenomenon)
2. Could be due to posterior communicating artery aneurysm