ICM - Eye and Head Abnormals

Question 1

Exotropia. NON-PARALYTIC STRABISMUS

Answer 1

eye moves outward. Not enough muscle tone from the medial rectus therefore think CN 3 deficit

Question 2

PERIORBITAL CELLULITIS

Answer 2

acute eyelid erythema and edema. Bacterial infection usually results from local spread of an adjacent sinusitis or dacryocystitis. Typically treated with oral antibiotics

Question 3

FETAL ALCOHOL SYNDROME

Answer 3

Microcephaly. Smooth philtrum, Thin upper lip, Intellectual disability. Growth deficiency

Question 3

Esotropia. NON-PARALYTIC STRABISMUS

Answer 3

eye moves inward. Not enough muscle tone from the lateral rectus therefore think CN 6 deficit (LR6)

Question 3

check near reaction. Have the patient focus on an object approximately 10-12 cm away then focus on an object >6 feet away. Watch for pupillary constriction with near effort, and dilatation with gazing in the distance

Answer 3

If reaction to light is impaired or questionable…

Question 3

CN V is responsible for sensing the touch on the cornea. CN VII is responsible for contracting the muscles around the eye, causing the eye to shut.

Answer 3

BLINK REFLEX

Question 4

RACCOON EYES

Answer 4

Bilateral ecchymosis in the periorbital area, resulting from bleeding from a basilar skull fracture. May also be caused by facial fractures

Question 4

TONIC (ADIE’S) PUPIL

Answer 4

Reduced reaction to light causing mydriasis. Slowed near reaction (accommodation)

Question 5

HORDEOLUM (STYE)

Answer 5

Tender, erythematous infection near hair follicle of eyelashes. Like a pimple or boil on the eyelid. May cause entire eyelid to be red. Almost always caused by Staph.

Question 6

Superior Oblique – CN 4

Answer 6

Responsible for moving the gaze down. Also moves eye toward the nose

Question 8

BELL’S PALSY

Answer 8

Idiopathic facial nerve paralysis, CN VII. Difficulty closing eye. Flattened nasolabial fold. Uneven smile. Consider course of oral steroids, lubrication for eye (especially at night), and possibly antivirals

Question 9

ANISOCORIA

Answer 9

Unequal pupil size (>0.5mm diff.). Visible in approximately 20% of population. Many don’t realize they have this. Causes include blunt trauma to eye, glaucoma, brain injury. Considered benign when the pupillary reactions are equal

Question 11

Down’s Syndrome

Answer 11

Facial features - Upslanting palpebral fissures. Protruding tongue. Heart defects. Intellectual disability

Question 12

CHALAZION

Answer 12

Swelling caused by blockage of sebaceous glands (meibomian) and formation of granulomas. Usually chronic. Usually non-tender. Treat. with warm compresses (4 X day)

Question 13

Lateral Rectus – CN 6

Answer 13

Responsible for moving the gaze laterally

Question 14

CUSHING’S SYNDROME

Answer 14

Excessive production of cortisol. Obesity, Rounded facies. “Moon” face. Red cheeks. Buffalo hump

Question 16

HYDROCEPHALUS

Answer 16

Defect of cerebrospinal fluid (CSF) flow, leading to enlarged ventricles and therefore enlarged head

Question 16

PINGUECULUM

Answer 16

Yellowish, slightly raised thickening of the conjunctiva on the white part of the eye (sclera). Common in the middle- aged who spend a lot of time in the sun.

Question 17

ACROMEGALY

Answer 17

Excessive growth hormone production which causes enlargement of both bone and soft tissues. Head is elongated. Bony prominence of the forehead, nose and lower jaw. Soft tissues of the nose, lips and ears also enlarge

Question 19

BATTLE’S SIGN

Answer 19

Unilateral or bilateral ecchymosis in the postauricular area develops when the fracture line (basilar skull) communicates with the mastoid air cells, resulting in blood accumulating in the cutaneous tissues.

Question 21

HORNER’S SYNDROME

Answer 21

1) Ptosis (drooping of the upper lid). 2) Miosis (constricted pupil). 3) Anhidrosis. “Anhidrosis”= absent sweating on affected side

Question 22

DACRYOCYSTITIS. (LACRIMAL SAC INFLAMMATION)

Answer 22

Bacterial infection of the lacrimal sac. Treated with antibiotics and possibly incision and drainage

Question 23

STRABISMUS

Answer 23

Deviation of the eyes from their normally conjugate position. May be either: Non-paralytic – due to an imbalance of extraocular muscle tone. One muscle is stronger than another and PULLS one eye away. Paralytic – due to a paralysis of one or more extraocular muscles

Question 24

PTERYGIUM

Answer 24

a non-cancerous growth that starts in the of the clear, thin tissue (conjunctiva) of the eye. This growth covers the white part of the eye (sclera) and extends onto the cornea. It is often slightly raised and contains visible blood vessels.