Eyes

Question 1

Xanthelasma

Answer 1

Lesions d/t abnormal lipid metabolism

Question 2

Ectropion

Answer 2

Lower lid is turned away from the eye

Question 3

Entropion

Answer 3

Lid is turned inward toward the globe

Eyelashes cause corneal and conjunctival irritation

Question 4

Hordeolum

Answer 4

Stye
Commonly d/t staph infection
Erythematous, yellow lump

Question 5

Blepharitis

Answer 5

Crusting along eyelashes

D/t bacterial infection, seborrhea, psoriasis, manifestation of rosacea, allergic response

Question 6

Lagophthalmos

Answer 6

Closed lids do not completely cover the globe

Cornea may become dried, at risk of infection

Question 7

Palpation of the orbit

Answer 7

Assess intraocular pressure

Pain on palpation: scleritis, orbital cellulitis, cavernous sinus thrombosis

Question 8

Pterygium

Answer 8

Abnormal growth of conjunctiva that extends over the cornea from the limbus
Heavy exposure to UV light

Question 9

CN V

Answer 9

Corneal sensitivity
Blink = CN V, CN VII (facial)
Decreased corneal sensation associated with DM, HSV,, herpes zoster, trigeminal neuralgia

Question 10

Corneal arcus

Answer 10

Arcus seniors
Lipids deposited in the periphery of the cornea
Forms a complete circle
> 60 y/o
If < 40 y/o likely = lipid deposition d/o

Question 11

Mydriasis

Answer 11

Accompanies coma (eg. d/t DM, alcohol, uremia, epilepsy, brain trauma) some eye drops
Abnormal failure of pupils to constrict
>6 mm

Question 12

Marcus-Gunn pupil

Answer 12

Pupil continues to dilate instead of constrict (abnormal)

Question 13

Accommodation

Answer 13

Pupils restrict going from distant object to close

Question 14

Miosis

Answer 14

Pupillary constriction <2 mm
D/t drugs (morphine)
Glaucoma medications
Inflammation of iris and ciliary body - Iridocyclitis

Question 15

Failure to respond (constrict) with increased light stimulus

Answer 15

Iridocyclitis; retinal degeneration
Optic nerve destruction
Midbrain synapses involving afferent papillae fibers or oculomotor nerve
Impairment of efferent fibers (parasympathetic) that innervate sphincter papillae muscle
Mydriatics - drug induces pupil dilation

Question 16

Argyll Robertson pupil

Answer 16

Bilateral meiotic irregularly shaped pupils that fail to constrict with light but retain constriction with convergence
Neurosyphilis or lesions in the midbrain

Question 17

Anisocoria

Answer 17

Unequal size of pupils
Congenital (20% of population) but have normal reflexes
Unilateral SNS or PNS pupillary pathway destruction

Question 18

Iritis constrictive response

Answer 18

Acute uveitis (eye pain, blurred vision, sensitivity to light, a small pupil, and redness) is commonly unilateral
Constriction of pupil accompanied by pain, red eye, adjacent to the iris

Question 19

Oculomotor nerve damage

Answer 19

Pupil dilated and fixed
Eye deviated laterally and downward
Ptosis

Question 20

Adie pupil

Answer 20

Tonic pupil
Affected pupil dilated, reacts slowly or fails to react to light
Responds to convergence
D/t impairment of postganglionic PNS innervation to sphincter pupillae muscle or ciliary malfunction
Diminished tendon reflexes (as with diabetic neuropathy, alcoholism)

Question 21

Senile hyaline plaque

Answer 21

Dark, slate gray pigment just anterior to the insertion of the medial rectus muscle

Question 22

Strabismus

Answer 22

Crossed eyes

Question 23

Exotropic

Answer 23

Outward

Question 24

Esotropic

Answer 24

Inward (toward the nose)

Question 25

Myelinated retinal nerve fibers

Answer 25

White area with soft, ill-defined peripheral margins No significance, benign Myelinated nerve fibers obscure area of retinal blood vessels, esp. inferiorly

Question 26

Papilledema

Answer 26

Loss of definition of the optic disc margin Venous pulsations not visible Venous hemorrhage may occur Initially vision not altered Caused by: increased intracranial pressure transmitted along the optic nerve

Question 27

Glaucomatous optic nerve head cupping

Answer 27

Disc margins are raised with a lowered central area Impaired blood supply may lead to optic atrophy, disc appears whiter than usual Cup is usually not particularly enlarged in contrast to glaucomatous atrophy Peripheral vision constricted Result of intraocular pressure with loss of nerve fibers and death of ganglion cells

Question 28

Cotton wool spot

Answer 28

Ill-defined, yellow area caused by infarction of nerve layer of the retina Result of vascular disease secondary to HTN or DM

Question 29

Exophthalmos

Answer 29

Bulging of eye anteriorly out of orbit Graves disease - abnormal connective tissue deposition in orbit and extra ocular muscles Unilateral - retro-orbital tumor

Question 30

Episcleritis

Answer 30

Inflammation of the superficial layers of the sclera anterior to the insertion of the rectus muscle Simple - intermittent episodes of moderate to severe inflammation, recurs Nodular - prolonged attacks of inflammation that are typically more painful than simple Idiopathic - may have autoimmune disorders, RA, Chron's. SLE, psoriatic arthritis, gout, atopy, foreign bodies, infection

Question 31

Band Keratopathy

Answer 31

Deposition of calcium in the superficial cornea Chronic corneal disease Hypercalcemia, hyperparathyroid, trauma, sarcoidosis, syphilis Horizontal grayish bands interspersed with dark area Passes over pupil (not around like arcus senilis)

Question 32

Corneal Ulcer

Answer 32

Disruption of the corneal epithelium and storm Rheumatologic disorder Connective tissue disease (RA, Sjogren syndrome, systematic vasculitic d/o (SLE, Wegener granulomatosis, polyarteritis nodes) Infection - viral, bacterial Extreme dryness Pain, photophobia, contacts, blurry

Question 33

Horner Syndrome

Answer 33

Interruption of the SNS to the ye Congenital, acquired, hereditary (autosomal dominant) May result from lesion of the primary neuron, stroke, trauma to the brachial plexus, tumors Triad of ipsilateral mitosis, mild ptosis, loss of hemifacial sweating

Question 34

Cataracts

Answer 34

Opacity in lens Denaturation of lens protein caused by aging Steroids Infections - maternal rubella, fetal insults Cloudy/blurry/halo Cloudiness of the lens

Question 35

Diabetic Retinopathy (Background, non-proliferative)

Answer 35

Hard and soft exudates are the result of lipid transudation through incompetent capillaries Soft exudates (cotton wool spots) caused by infarction of the nerve layer Patients asymptomatic early Blurred vision, distortion Blood vessels with balloon like sacs (microaneurysms) Tiny yellow patches of hard exudates Flames shaped and dot-blot hemorrhages, cotton-wool spots, microaneurysms

Question 36

Diabetic Retinopathy (Proliferative)

Answer 36

Vessels grow out of the retina toward the vitreous humor May occur in peripheral retina or on optic nerve itself New vessels lack supporting structure of healthy vessels Bleeding causes blindnesss

Question 37

Lipemia Retinalis

Answer 37

Creamy white appearance of retinal vessels that occurs with excessively high serum TGL Peripheral fundus changes in early stages Salmon pink -> whitish

Question 38

Retinitis Pigmentosa

Answer 38

Autosomal recessive d/o when genetic defects cause cell death, predominately in the rod photoreceptors Optic atrophy with a waxy pallor, narrow arterioles, peripheral bone spicule pigmentation

Question 39

Glaucoma

Answer 39

Disease of the optic nerve wherein the nerve cells die, usually d/t excessively high intraocular pressure Acute glaucoma = accompanied by intense ocular pain, blurred vision, halos around eyes, red eye, dilated pupil Occasionally N/V See optic nerve damage clearly during dilated eye exam Characteristic increase cupping of the optic nerve

Question 40

Chorioretinitis

Answer 40

Chrorioretinal Inflammation Inflammatory process involving both the choroid and the retina Caused by laser therapy for diabetic retinopathy, histoplasmosis, cytomegalovirus, toxoplasmosis, rubella Hx cleaning cat litter, laser surgery floaters, photophobia Sharply defined lesion, whitish yellow, becomes stippled with dark pigment in later stages ending with a chorioretinal scar

Question 41

Retinoblastoma

Answer 41

Embryonic malignant tumor arising from the retina First 2 years of life Autosomal dominant trait or by chromosomal mutation Family hx of retinoblastoma White reflex on photos Sign is leukocoria, white reflex (cat's eye reflex) rather than red reflex

Question 42

Retinopathy of prematurity

Answer 42

Disrupt normal progression of retinal vascular development in preterm infant Proliferation of blood vessels May progress to retinal detachment and blindness

Question 43

Retinal Hemorrhages in Infancy

Answer 43

Abnormal bleeding of the blood vessels in the retina Shaken baby syndrome Usually bilateral Or: HTN, leukemia, sepsis, vasculitis, retinal dz, anemia, hypoxia

Question 44

Macular degeneration

Answer 44

Are related macular degeneration Dry (atrophic) from gradual breakdown of cells in the macula Gradual blurring of central vision Drusen = multiple spots in the macular region Thinning and loss of the retina and the choroid Wet (exudative, neovascular) - new abnormal blood vessels grow under the center of the retina Blood vessels leak, bleed, scar retina, distorted/destroy central vision Blurred vision Blind spots, stomas Metamorphosia = straight lines look irregular Micropsia = objects appear smaller in one eye