First Aid

Question 1

3 substances that decrease aqueous humor

Answer 1

Beta-blockers
Alpha2-agonists
Carbonic anhydrase inhibitors

Question 2

2 substances that increase aqueous humor drainage

Answer 2

Trabecular outflow: M3 agonist

Uveoscleral outflow: prostaglandin agonists

Question 3

4 refractive errors

Answer 3

Hyperopia: eye too short for refraction, light behind retina
Myopia: eye too long for refraction, light in front of retina
Astigmatism: abNl curvature of cornea, diff refractive power at diff axes
Presbyopia: age, impaired accomodation (near objects), low lens elasticity

Question 4

8 acquired + 8 congenital risk factors of Cataract

Answer 4

Age, smoking, excessive alcohol, excessive sunlight, prolonged corticosteroid, diabetes, trauma, infection

Classic galactosemia, galactokinase deficiency, trisomies (13,18,21), ToRCHeS infections, Marfan sd, Alport sd, myotonic dystrophy, neurofibromatosis 2

Question 5

4 findings in Glaucoma

Answer 5

Optic disc atrophy w/ cupping
High IOP
Progressive peripheral visual field loss
Ttt: lower IOP (pharmacological or surgical)

Question 6

3 findings in Open-angle glaucoma

Answer 6

Painless
Primary (bilateral vision loss, progressive, cupping)
Secondary (blocked trabecular meshwork from WBCs, RBCs, retinal elements)

Question 7

Closed-angle glaucoma

Answer 7

Primary (enlargement/forward lens against central iris then against cornea)
Secondary (hypoxia from retinal ds then vasoproliferation in iris)
Chronic (asymptomatic)
Acute (emergency, red eye, very painful, vision loss)

Question 8

5 findings in Uveitis

Answer 8

Anterior: iritis
Intermediate: pars planitis
Posterior: choroiditis and/or retinitis
Hypopyon or conjunctival redness
Ass w/ systemic inflammatory disorders

Question 9

2 symptoms + 2 types of Age-related macular degeneration

Answer 9

Metamorphopsia + central scotoma
Dry (>80%, yellowish deposits, drusen, gradual vision loss, prevent progression w/ multivitamins+antioxidants+stop smoking)
Wet (choroidal neovasc then bleeding then rapid vision loss, gray-green subretinal disc, ttt w/ anti-VEGF injection)

Question 10

2 types of Diabetic retinopathy

Answer 10

Nonproliferative: damage capillaries, hge+macular edema, ttt w/ glycemic control

Proliferative: chronic hypoxia, neovasc tracting retina, ttt w/ photocoag, surgery, anti-VEGF

Question 11

4 findings in Retinal vein occlusion

Answer 11

Compression from arterial atherosclerosis
Venous engorgement
Edema in affected area
Retinal hge

Question 12

5 findings in Retinal detachment

Answer 12

Separation of neurosensory from pigmented epithelium
Degeneration of photoreceptors
Preceded by posterior vitreous detachment
Monocular vision loss
Surgical emergency

Question 13

4 findings in Retinoblastoma

Answer 13

1 ocular tumor of childhood

White pupillary reflex in <5yo
40% familial (bilateral, w/ other tumors)
60% sporadic (unilateral)

Question 14

5 findings in Central retinal artery occlusion

Answer 14

Acute monocular vision loss
Painless
Retinal whitening + attenuated vessels
Cherry-red spot at fovea
Search for embolic source

Question 15

5 findings in Retinitis pigmentosa

Answer 15

Inherited retinal degeneration
Painless
Night blindness first
Progressive vision loss
Spicule-shaped deposits around macula

Question 16

3 causes of Conjunctivitis

Answer 16

Viral +++ (esp. adenovirus, mucous discharge, preauricular node)
Allergic (itchy, bilateral)
Bacterial (pus)

Question 17

3 causes of Retinitis

Answer 17

Retinal edema + necrosis
Viral +++ (CMV, HSV, VZV)
Bacterial
Parasitic

Question 18

4 findings in Papilledema

Answer 18

Optic disk swelling (~ bilateral)
Due to high ICP
Enlarged blind spot
Blurred margins of optic disc

Question 19

2 causes + 2 findings in Marcus Gunn pupil

Answer 19

Optic nerve damage
Severe retinal injury

Diminished bilateral pupillary constriction when light in affected eye
Swinging flashlight test

Question 20

3 symptoms + 2 findings in Horner syndrome

Answer 20

Ptosis
Myosis
Anhidrosis

Sympathetic denervation of face
Ass w/ lesion of spinal cord above T1

Question 21

CN III damage

Answer 21

Somatic (extraocular muscles) central - affected 1st in vascular ds (diabetes): down+out position, ptosis, acute onset diplopia

Autonomic, parasymp. (constriction + accomodation) peripheral - normal in db, affected 1st by compression: low/absent pupillary light reflex

Question 22

Difference between CN III, IV and VI damage

Answer 22

CN III: diagonal diplopia
CN IV: vertical + torsional diplopia
CN VI: horizontal diplopia

Question 23

CN IV damage

Answer 23

Eye moves upward w/ contralateral gaze
Head tilts toward side of lesion
Problem going down stairs (tild head in opposite direction)

Question 24

CN VI damage

Answer 24

Eye cannot abduct

Directed medially

Question 25

6 findings in Internuclear ophthalmoplegia

Answer 25

``` Lesion in MLF Horizontal gaze palsy CN VI nucleus activates ipsilat LR but contralat CN III nucleus does not stimulate MR Abducting eye gets nystagmus Normal convergence Directional term: paralyzed eye ```

Question 26

5 families of Glaucoma drugs

Answer 26

Alpha-agonists: epinephrine (a1), brimonidine (a2) Beta-blockers: timolol, betaxolol, carteolol Diuretics: acetazolamide Cholinomimetics (M3): direct (pilocarpine, carbachol), indirect (physostigmine, echothiophate) Prostaglandin: bimatoprost, latanoprost (PGF2a)