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Med > Ophthalmo and neurosurg1 > Flashcards

Ophthalmo and neurosurg1 Flashcards

1
Q

Visual acuity testing distance

A

20 ft (6m)

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2
Q

20/40 acuity means:

A

20/ smallest line pt can read

Or

What pt can see at 20, a nl person can see at denominator

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3
Q

Testing hierarchy for low vision

A

Snellen acuity

Counting fingers

Hand motion

Light perception with projection

Light perception

No light perception

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4
Q

When does a child gain normal visual aquity

A

2-4 yr

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5
Q

Definition of legal blindness

A

Best corrected visual acuity that is 20/200 or less

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6
Q

Minimum visual requirement to operate a non-commercial automobile

A

20/50, with both eyes open and examined together.

120° Continuous horizontal visual field.

15° continuous visual field above and below fixation.

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7
Q

Visual acuity testing in newborn

A

Cannot be tested conventionally

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8
Q

VA testinf in 3mo-3 yr

A

Can only access visual function, not acuity

Test each eye for fixation symmetry using an interesting object

Normal function= central, steady, maintained

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9
Q

VA testing from 3yr until alphabet known

A

Pictures or letter cards/charts

Tumbling E chart

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10
Q

Colour vision testing

A

Ishihara pseudoisochromatic plates

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11
Q

Indications for color vision testing

A

Testing for optic nerve function:
Optic neuritis
Chloroquine use
Thyroid ophthalmopathy

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12
Q

Visual field testing

A

Confrontation

Automated testing

Amsler grid (tests for central/paracentral scotoma in pts with AMD)

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13
Q

PERRLA

A

Pupil Equal
Round
Reactive to Light
Accommodation

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14
Q

Shallow anterior chamber

A

Light shown tangentially from temporal side

If > 2/3 of nasal side of iris in shadow= shallow chamber

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15
Q

Gold standard method for assessing anterior chamber depth

A

Gonioscopy

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16
Q

Stain for de-epithelialized cornea

A

Fluorescein dye

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17
Q

Stain for Devitalized corneal epithelium

A

Rose Bengal dye

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18
Q

Normal IOP

A

9-21 mmHg

Has diurnal variation

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19
Q

Gold-std for measurement of IOP

A

GAT, using slit lamp

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20
Q

Contraindications to pupillary dilation

A

Shallow anterior chamber

Iris-supported anterior chamber lens implant

Potential neurologic abnormality requiring pupil evaluation

Caution with cardiovascular disease

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21
Q

Nerve to superior oblique muscle

A

CN IV

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22
Q

If myopia started after the age 25 think of

A

DM

Cataract

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23
Q

Complications of myopia

A

Retinal tear/detachment

Macular hole

Open angle glaucoma

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24
Q

Accommodative esotropia may develop in

A

Hyperopia

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25
Q

Complications of hyperopia

A

Angle-closure glaucoma

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26
Q

Age of presbyopia

A

> 40 yr

Decreased accommodative ability of lens due to decreased deformability

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27
Q

Exophthalmus

A

Protrusion > 18 mm

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28
Q

Inv for exophthalmos

A

CT/MRI head/orbit

U/S orbit

TFT

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29
Q

Most common cause of exophthalmos in adults

A

Grave’s

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30
Q

Most common cause of exophthalmus in children

A

Orbital cellulitis

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31
Q

Inv for enophthalmus

A

CT/MRI

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32
Q

The systemic manifestations of infection in preceptal cellulitis

A

Fever: may be present

WBC: moderate elevation

ESR: Normal or elevated

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33
Q

Tx of preseptal cellulitis

A

Systemic ABx (HI, S. Aureus, Strep)

Amoxicillin-clavulanate

If severe: Treat as orbital cellulitis

If child < 1 yr: Treat as orbital cellulitis

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34
Q

Mx of orbital cellulitis

A

Admit

B/C x2

Orbital CT

IV AB (ceftriaxone, vanco) x 1wk

Surgical drainage of abcsess

Close F/U

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35
Q

Meds causing dry eye

A

Anticholinergics

Antihistamines

BB

Diuretics

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36
Q

Which nerve palsy causes dry eyes?

A

CN VII

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37
Q

Vitamin deficiency causing goblet cell dysgenesis

A

Vit A

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38
Q

Inv for dry eye

A

Rose Bengal/Fluorecein staining (punctate staining of cornea)

Schimmer test

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39
Q

Tx of dry eye

A

Preservative-free artificial tears

Ointment at bedtime

Short course of mild topical CS

Omega3 fatty acids orally

Eyelid hygiene

Ophthalmic cyclosporin for moderate cases

Surgical

Treat underlying

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40
Q

Inv for epiphora

A

Fluorescein dye

Jone’s dye test to detect lacrimal drainage obstruction

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41
Q

Dacryocystitis organism

A

S. Aureus

S.pneumoniae

Pseudomonas

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42
Q

Tx of dacryocystitis

A

Warm compress

Nasal decongestant

Systemic and topical AB

If chronic:
Obtain culture by aspiration

After resolution of infection:
Dacryocystorhinostomy

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43
Q

Dacryoadenitis organisms

A

S. Aureus

Mumps

EBV

VZV

N. Gonorrhea

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44
Q

Tx of dacryoadenitis

A

Warm compress

NSAIDs

Systemic AB if bacterial

If chronic: treat underlying

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45
Q

Most common type of ptosis

A

Aponeurotic ( disinsertion/dehiscence of levator aponeurosis)

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46
Q

Meds causing ptosis

A

Pregabalin

Opioids

Heroin

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47
Q

Tx of ptosis

A

Surgery

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48
Q

Underlying causes of trichiasis

A

Entropion

Involutional age change

Chronic inflammatory lid disease

Trauma

Burns

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49
Q

Tx of trichiasis

A

Topical lubricants

Eyelash epilation

Electrolysis

Cryotherapy

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50
Q

Causes of entropion

A

Aging

Cicatricial (trauma, surgery, burn, zoster)

Orbicularis oculi muscle spasm

Congenital

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51
Q

Tx of enteropion

A

Lubricant

Evert lid with tape

Surgery

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52
Q

Causes of ectropion

A 
Aging
Paralysis of CN VII
Cicatricial
Mechanical
Congenital
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53
Q

Tx of ectropion

A

Lubricant

Eyelid taping overnight

Surgery

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54
Q

Stye (hordeolum) micro-organism

A

S. Aureus

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55
Q

Stye Tx

A

Warm compresses

Lid care

Gentle massage

Resolves within 2 wk

+/- incision and drainage

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56
Q

Chalazion site of disease

A

Meibomian (chronic granulomatous inflammation)

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57
Q

Tx of chalazion

A

Warm compress

If no improvement after 1 mo:
Incision and curettage

If chronic recurrent lesion: Bx

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58
Q

Toothpaste sign

A

Blepharitis:

Discharge with pressure on lids

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59
Q

Etiology of anterior blepharitis

A

Staph: (ulcer, dry scales)

Seborrheic: no ulcer, greasy scale

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60
Q

Etiology of posterior belpharitis

A

Meibomian glands dysfunction

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61
Q

Complications of blepharitis

A

Recurrent hordeola

Conjunctivitis

Keratitis

Corneal ulceration/neovascularization

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62
Q

Tx of blepharitis

A

Warm compress

Lid massage

Lid washing

Topical/systemic AB

+/- short course of topical steroids if severe

Omega 3

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63
Q

Pinguecula

A

Hyaline and elastin deposit

No involvement of cornea

Associations: sun and wind exposure,
Aging

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64
Q

Tx of piguecula

A

Lubricating drops

Surgery for cosmesis

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65
Q

Pterygium

A

Fibrovascular

Encroachment on cornea

Can induce: astigmatism, decreased vision

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66
Q

Tx

A

Lubricants for irritative symptoms

Excision for:
Chronic inflammation
Treat to visual axis
Cosmesis

One-third recur

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67
Q

When to suspect globe rupture in subconjunctival hemorrhage?

A

360° hemorrhage and Hx of trauma

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68
Q

Tx if subconjunctival hemorrhage

A

Resolves spontaneously in 2-3 wk

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69
Q

Inv for subconjunctival hemorrhage

A

Not needed if negative Hx

Medical/hematologic w/u if recurrent

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70
Q

Tx of allergic conjunctivitis

A

Avoidance

Cool compresses

Non-preserved artificial tears

Oral/topical antihistamines

Topical mast-cell stabilizers:
Cromolyn
Ketotifen
Olopatadine

Topical CS

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71
Q

Onset of atopic conjunctivitis

A

Late adolescence, early adulthood

Perennial

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72
Q

Papillae in atopic conjunctivitis

A

Tarsal papillary hypertrophy

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73
Q

Tx of atopic conjunctivitis

A

CNI oint

Topical CS

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74
Q

Conjunctivitis in contact lens wearers

A

Giant papillary conjunctivitis

Superior palpebral conjunctiva

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75
Q

Tx of giant papillary conjunctivitis

A

Clean, change or discontinue use of contact lens

Topical CS

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76
Q

Vernal conjunctivitis timing

A

Seasonal (warm weather)

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77
Q

Papilla of vernal conjunctivitis

A

Large papillae on superior palpebral conjunctiva

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78
Q

Conjunctivitis with corneal ulcer and keratitis

A

Vernal

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79
Q

Time course of vernal conjunctivitis

A

In children

Lasts for 5-10 y

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80
Q

Tx of vernal conjunctivitis

A

Non-preserved artificial tears

Topical CS

Topical cyclosporine

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81
Q

Main virus causing conjunctivitis

A

Adenovirus

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82
Q

How long is viral conjunctivitis contagious?

A

Up to 12 days

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83
Q

Tx of viral conjunctivitis

A

Cool compress

Topical lubricant

Proper hygiene to prevent transmission

Self-limiting

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84
Q

Organisms causing bacterial conjunctivitis

A

S. Aureus

S. Pneumoniae

H. Influenza

M. Catarrhalis

If neonate or sexually active:
N. Gonorrhoeae

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85
Q

Bacterial conjunctivitis which invades cornea

A

Gonorrhea

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86
Q

The most common cause of conjunctivitis in neonates

A

C. Trachomatis

Causing inclusion conjunctivitis

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87
Q

Tx of bacterial conjunctivitis

A

Topical broad spectrum ABs

Systemic AB of indicated (neonates, children)

Self-limited

Course of 10-14 d w/o treatment. 1-3 d with treatment

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88
Q

Follicles usually seen in

A

Viral and chlamydial conjunctivitis

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89
Q

Infective conjunctivitis with papilla

A

Bacterial

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90
Q

Conjunctivitis with LAP

A

Viral

Chlamydial

LAP: pre-auricular , submandibular

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91
Q

Onset of gono/chlamy conjunctivitis

A

Neonatal gono:
First 5 d

Neonatal chlamy:
3-14 d

Adults if sexually active

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92
Q

Chlamydia disease in the eye

A

Trachoma

Inclusion conjunctivitis

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93
Q

Leading infectious cause of blindness in the world

A

Trachoma caused by chlamydia

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94
Q

Tx of trachoma

A

Oral azithromycin

Topical tetracycline

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95
Q

Inclusion conjunctivitis

A

Chronic

Chlamydia

Follicles

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96
Q

Tx of inclusion conjunctivitis

A

Oral:
Azithro
Tetra
Doxy

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97
Q

The most common cause of conjunctivitis in newborns

A

Inclusion conjunctivitis caused by Chlamydia

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98
Q

Episcleritis

A

F>M

Mostly idiopathic

1/3 bilateral

Pain and discomfort

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99
Q

Associations of episcleritis

A

Collagen vascular disease

Infections (VZV, HSV, syphilis)

IBD

Rosacea

Atopy

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100
Q

Interpalpebral red eye

A

Episcleritis

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101
Q

Tx of episcleritis

A

Self-limited (recurrent in 2/3)

Topical CS

Oral NSAID

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102
Q

Differentiation of episcleritis vs scleritis

A

Phenylephrine blanches redness in episcleritis

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103
Q

Scleritis assiciations

A

Collagen vascular: SLE, RA, GPC, AS

TB, Sarcoidosis, Syphilis

Gout, thyrotoxicosis

Staph, pneumococcus, pseudomonas, HSV

Chemical/physical agents

Idiopathic

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104
Q

The best indicator of scleritis progression

A

Pain

Quality of pain: deep, boring

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105
Q

Scleritis symptoms

A

Pain

Photophobia

Decreased vision

Red eye

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106
Q

Topical erythromycin for prevention of ophthalmia neonatorum

A

Questionable efficacy

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107
Q

Effective means for preventing ophthalmia neonatorum

A

Screening all pregnant women for gonorrhea and chlamydia infection, Tx and F/U of those infected

Testing mothers who were not screened, during delivery

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108
Q

Infants of mothers with untreated gonococcal infection at delivery:

A

Receive ceftriaxone

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109
Q

Infants of mothers with untreated chlamydial infection at delivery:

A

Close F/U for signs of infection

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110
Q

Scleromalacia perforans

A

Strong association with RA

Asymptomatic

Anterior necrotizing scleritis

No inflammation

May cause scleral thinning

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111
Q

Types of scleritis

A

Anterior:
Pain radiating to face
Scleral thinning
Necrotizing

Posterior:
Rapidly progressive blindness
Exudative RD
more common in women and elderly

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112
Q

Tx of scleritis

A

Systemic NSAID

Systemic steroid

Systemic immunomodulators

Treat underlying (indicator of poor control)

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113
Q

Tx of corneal foreign body

A

Remove with sterile needle under local anesthetic and magnification

Topical AB (pseudomonas coverage if abrasion from organic material)

Topical NSAID (risk of corneal melt with prolonged use)

Cycloplegic (relieves photophobia)

Patch

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114
Q

Tx of corneal abrasion

A

Topical AB (pseudomonas coverage if abrasion from organic material)

Topical NSAID (risk of corneal melt with prolonged use)

Cycloplegic (relieves photophobia)

Patch

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115
Q

DDx of recurrent corneal abrasions

A

Previous traumatic corneal abrasion

Corneal dystrophy

Idiopathic

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116
Q

Tx of recurrent corneal abrasion

A

Same as corneal abrasion

Topical hypertonic saline oint at bedtime for 6-12 mo

Topical lubrication

Bandage contact lens

Anterior stromal puncture

Phototherapeutic keratotomy

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117
Q

Etiology ofcorneal ulcer

A

Infection (bacterial > viral)

Exposure, abrasion, foreign body, contact lens

Conjunctivitis, blepharitis, keratitis

Vit A deficiency

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118
Q

Tx of corneal ulcer

A

Urgent referral

Culture

Topical AB/ h

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119
Q

Inv for corneal ulcer

A

Seidle test (fluorescein under cobalt blue filter)

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120
Q

Corneal hyposthesia in

A

Viral keratitis

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121
Q

HSV epithelial keratitis form

A

Dendritic lesion

Terminal end bulbs

Stain with fluorescein

Also:
Other forms of infectious epithelial keratitis
Stromal keratitis
Endotheliitis

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122
Q

Complications of HSV keratitis

A

Scarring
Chronic interstitial keratitis
Secondary iritis
Secondary glaucoma

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123
Q

Tx of HSV keratitis

A

Topical trifluridine
Or
Systemic acyclovir

Debridement of dendrite

NO STEROIDS INITIALLY (unless by ophthalmologist and with caution)

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124
Q

Herpes Zoster ophthalmicus P/E

A

Pseudodendrite

Superficial punctate keratitis

Corneal hyposthesia

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125
Q

Herpes Zoster ophthalmicus complications

A 
Keratitus
Ulceration
Perforation
Scarring
Secondary iritis
Secondary glaucoma
Cataract
Muscle palsy (CNS involvement)
Severe PNH
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126
Q

Tx of Herpes Zoster ophthalmicus

A

Immediate oral antivirals

If immune-mediated keratitis/iritis: topical CS/cycloplegics

Erythromycin oint if conjunctival involvement

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127
Q

Associations of keratoconus

A

Down

Atopy

Vigorous eye rubbing

Contact lens

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128
Q

Broken cornea kayers in keratoconus

A

Bowman

Descemet

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129
Q

Tx of keratoconus

A

Correction with spectacles

Or

Rigid gas-permeable contact lens

Corneal collagen cross-linking Tx (halts progression)

Intrastromal corneal ring segments (can flatten the cone)

Penetrating keratoplasty

Deep anterior lamellar keratoplasty

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130
Q

Reasons for decreased vision in keratoconus

A

Stromal edema

Scarring

Irregular astigmatism

(Bilateral)

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131
Q

Arcus senilis

A

Hazy white ring

<2 mm wide

Clearly separated from limbus

Bilateral

Benign

Corneal degeneration due to lipid deposition

No visual Sx

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132
Q

Significance of arcus senilis

A

<40 yr associated with hypercholestrolemia

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133
Q

Kayser-Fleischer ring

A

Brown-yellow-green

Peripheral cornea

Starts inferiorly

Deposits of copper in descmet’s membrane

Wilson

Tx: underlying

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134
Q

Munson’s sign

A

Detects keratoconus

Bulging of lower eyelid when pt looks downward

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135
Q

Associations of iritis/iridocyclitis

A

Usually idiopathic

CTD:
HLA-B27: reactive arthritis, AS, PsA, IBD

Non-HLA-B27: Juvenile idiopathic arthritis

Infectious:
Syphilis, lyme, toxo, TB, HSV, herpes zoster

Others:
Sarcoidosis, trauma, post-ocular surgery, large abrasion

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136
Q

Iritis effect on IOP

A

Decreases IOP

Exception:
If severe, HSV, VZV, can cause inflammatory glaucoma (trabeculitis)

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137
Q

Tx of iritis/iridocyclitis

A

Mydriatics

Steroids

Systemic analgesia

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138
Q

Indication of W/U in iritis/iridocyclitis

A

If recurrent

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139
Q

The major site of inflammation in intermediate uveitis

A

Vitreous

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140
Q

Causes of intermediate uveitis

A

Mostly idiopathic

Sarcoidosis

Lyme

MS

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141
Q

Snowballs, snowbank

A

Snowballs: vitrous aggregates of inflammatory cells

Snowbank: gray-white fibrovascular plaque at the pars plana

Both are signs of intermediate uveitis

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142
Q

Tx of intermediate uveitis

A

Steroids

Immunosuppressive agents

Vitrectomy

Cryotherapy/ laser photocoagulation to the snowbank

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143
Q

Posterior uveitis causes

A 
Syphilis
TB
HSV
CMV
Histoplasmosis
Candidiasis
Toxoplasmosis
Toxocara

Immunesuppression predisposes to above infections

Behcet

Malignancies

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144
Q

Pain and uveiitis

A

Anterior:
Ocular pain
Globe tenderness
Brow ache

Intermediate: -

Posterior: -

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145
Q

Uveitis with visual field loss

A

Posterior uveitis

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146
Q

Tx of posterior uveitis

A

CS

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147
Q

Most common cause of reversible blindness all over the world

A

Cataract

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148
Q

The most common cause of cataract

A

Age related

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149
Q

Underlying etiologies for cataract

A 
DM
Wilson
Galactosemia
Homocystinuria
Hypocalcemia
Traumatic
Intraocular inflammation
Steroids
Phenothiazines
Radiation
High myopia
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150
Q

Congenital cataracts presentation

A

Altered red reflex

Leukocoria

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151
Q

Second sight phenomenon is seen in

A

Cataract

Patient is more myopic than previously noted

Patient may read without previously needed reading glasses

152
Q

Cortical cataract seen in:

A

Aging

DM

153
Q

Cause of nuclear sclerosis cataract

A

Age-related

154
Q

Posterior subcapsular cataract causes

A

Steroids

Intraocular inflammation

DM

Trauma

Radiation

Aging

155
Q

Tx of cataract

A

Surgical:

Phacoemulsification

156
Q

Indications for cataract surgery

A

If vision loss leads to functional impairment

To aid management of other ocular diseases

Congenital cataract

Traumatic cataract

157
Q

Complications of cataract surgery

A

RD

Endophthalmitis

Dislocated IOL

macular edema

Glaucoma

Posterior capsular opacification

158
Q

Etiology of lens dislocation

A

Marfan

Homocystinuria

EDS

lens coloboma

Syphilis

Traumatic

159
Q

Complications of dislocated lens

A

Cataract

Glaucoma

Uveitis

160
Q

Tx of dislocated lens

A

Surgical replacement

161
Q

Etiology of posterior vitrous detachment

A

Syneresis due to age

162
Q

Complications of posterior vitreous detachment

A

Retinal tear

Retinal detachment

Bleeding

163
Q

Treatment of posterior vitreous detachment

A

R/O retinal tear/detachment

No specific treatment

164
Q

Vitreous hemorrhage etiologies

A

Proliferative diabetic retinopathy

Retinal tear/detachment

Posterior vitreous detachment

Retinal vein occlusion

Trauma

165
Q

Tx of vitreous hemorrhage

A

R/O RD by U/S B-scan

If non-urgent:
Expectant Mx. Blood resorbs in 3-6 mo

Surgical:
Vitrectomy
RD repair
Retinal endolaser to possible bleeding sites

166
Q

Vitreous/retinal hemorrhage in child

A

R/O child abuse

167
Q

Etiology of endophthalmitis

A

Most common: post operative

Penetrating injury

Endogenous spread

Intravitreal injection

Bacterial > fungal

168
Q

Tx of endophthalmitis/vitritis

A

Ocular emergency

If LP vision or worst:
Admit
Immediate vitrectomy
Intravitreal AB

If HM or better:
Vitreous tap fir culture
Intravitreal AB

Topical fortified AB

Tetanus Px if post-traumatic

169
Q

Fundoscopy of central/branch retinal artery occlusion

A

Cherry-red spot

Retinal pallor

Cotton wool spots

Cholesterol emboli at arteriole biforcations

170
Q

Tx of CRAO

A

Emergency

Restore blood flow within 2 h:

Massage the globe (10s compress, 10s release x5’)

Decrease IOP:
Topical BB
IV acetazolamide
IV mannitol
Anterior chamber paracentesis

Nd:YAG laser embolectomy

Intra-arterial or intravenous thrombolysis

171
Q

When does irreversible retinal damage happen in complete RCAO

A

> 90 min

172
Q

Central/brand retinal vein occlusion etiologies

A 
Arteriosclerotic vascular disease
HTN
DM
Glaucoma
Hyperviscosity
Drugs (OCP, diuretics)
173
Q

Fundoscopy of CRVO

A

Blood and thunder

Diffuse retinal hemorrhage

Cotton wool

Venous engorgement

Swollen optic disc

Macular edema

174
Q

Complications of CRVO

A

Neovascularization

Secondary glaucoma

Vitreous hemorrhage

Macular edema

175
Q

Tx of CRVO

A

Treatment available for complications:

Photocoagulation

Anti-VEGF

CS injection

Ranibizumab

176
Q

Curtain of blackness

A

Retinal detachment

177
Q

IOP in retinal detachment

A

Decreases

178
Q

Tx of retinal detachment

A

Emergency

Rhegmatogenous:
Scleral buckle
Pneumatic retinopexy
Vitregtomy+ gas injection

Tractional:
Vitrectomy
+/- membrane removal/ scleral buckling/ intraocular gas or silicon oil

Exudative:
Tx of underlying

179
Q

Px of RD

A

If symptomatic tears (flashes, floaters):

Seal off with laser/cryotherapy

180
Q

Retinotis pigmentosa

A

Mostly:AR

Rod > cone photoreceptor degeneration and retinal atrophy

181
Q

Sx of retinitis pigmentosa

A

Night blindness

Tunnel vision

Decreased central vision

Glare (posterior subcapsular cataract)

182
Q

Fundoscopy of retinitis pigmentosa

A

Bone-spicule pigment clumping in mid-periphery of retina

Pale disc

Narrowed arteriols

183
Q

Investigations for retinitis pigmentosa

A

Electroretinography

Electrooculography

184
Q

Tx of retinitis pigmentosa

A

No Tx

Vit A and Vi E

Cataract extraction

185
Q

Most common cause of irreversible blindness in west

A

AMD

186
Q

Types of AMD

A

Non-exudative (dry):

Slow progression
Drusen
Geographic RPE atrophy
Can progress to wet form

Exudative (wet):

Choroidal neovascularization.

Can result in detachment of RPE and retina.

Hemorrhage/lipid deposition into sub-retinal space.

Elevated subretinal mass (disciform scarring, severe central vision loss).

187
Q

RFs for AMD

A

Female

Age

FHx

Smoking

Caucasian

Blue irides

188
Q

Sx of AMD

A

Progressive central vision loss

Metamorphosis

189
Q

Inv for AMG

A

Amsler grid

Fluorescein angiography

OCT imaging

190
Q

Tx of AMD

A

Dry:

Monitor
Low vision aids
Anti-oxidants
Green leafy vegetables
Sunglasses/visors

Wet AMD:

Intravitreal anti-VEGF
Laser photocoagulation (for neovascularization)
PDT with verteporfin
No Tx for disciform scarring

191
Q

Substance increasing the risk of lung cancer and its substitute

A

Carotenoid

Substitute: lutein + zeaxanthin

192
Q

Normal cup/disc ration

A

0.4 or less

193
Q

Which cup/disc is suspicious of glaucoma?

A

C:D > 0.6

C:D difference between eyes > 0.2

Cup approaches disc margin

194
Q

Most common form of glaucoma

A

Primary open angle glaucoma

195
Q

minor RFs for Primary open angle glaucoma

A

Myopia

HTN

DM

Hyperthyroidism

Chronic topical CS

Previous ocular trauma

Anemia/hemodynamic crisis

196
Q

Eye surveillance in ophthalmic CS users

A

If > 4wk

Yearly exam

197
Q

Earliest sign of Primary open angle glaucoma

A

Optic disc changes

Increased C:D ratio

C:D asymmetry between eyes > 0.2

198
Q

Eye exam in Primary open angle glaucoma

A

Increased C:D ratio

Thinning, notching of neuroretinal rim

Flame-shaped disk hemorrhage

360° peripapillary atrophy

Nerve fiber layer defect

Large vessels nasally displaced

Visual field loss: 
Paracentral defect
Arcuate scotoma
Nasal step
Central vision (late)
199
Q

Major RFs for Primary open angle glaucoma

A

IOP > 21

Age

African ethnicity

Familial

Thin central cornea

200
Q

Tx of Primary open angle glaucoma

A

Increase aqueous outflow:
Topical cholinergics
Topical PG analogues
Topical a-adrenergics

Decreased aqueous production:
Topical BB
Topical/oral carbonic anhydrase inhibitor
Topical a-adrenergics

Laser trabeculoplasty

Cyclophtocoagulation

Trabeculotomy

Minimally invasive glaucoma surgery

201
Q

Follow up of primary open angle glaucoma

A

Serial optic nerve head examination

Serial IOP measurement

Serial visual field testing

202
Q

The only modifiable risk factor that has been proven to prevent progression of glaucoma

A

Elevated IOP

203
Q

Normal tension glaucoma

A

Normal IOP

Primary open-angle glaucoma

Women > 60

Associations:
Migraine
Peripheral vasospasm
Systemic nocturnal hypotension
Sleep apnea

Tx: underlying

204
Q

Secondary open angle glaucoma

A

Steroid
Trauma
Pigmentary dispersion syndrome
Pseudoexfoliation syndrome

Causing meshwork obstruction

205
Q

RFs for primary angle-closure glaucoma

A 
Hyperopia
Age > 70
F
FHx
Asian and inuit
Mature cataract
Shallow anterior chamber
Pupil dilation (stress, darkness, anticholinergics)
206
Q

Cornea and pupil in open angle vs angle-closure glaucoma

A

Open: nl

Angle-closure:
Corneal edema
Fixed, mid-dilated pupils

207
Q

Tx of primary angle-closure glaucoma

A

Emergency

Miotic drops (pilocarpine)

Multiple topical IOP lowering agents (BB, AA, Choli)

Hyperosmotic agents (oral glycerine, IV mannitol)

208
Q

Secondary angle-closure glaucoma

A

Uveitis

Neovascularization (proliferative diabetic retinopathy, CRVO)

209
Q

Test for loss of sympathetic innervation

A

4-10% cocaine

Will cause dilation of normal pupil (prevents re-uptake of NE)

No dilation if loss of sympathetic fibers

210
Q

Eye receptors

A

a1:
Mydriasis

B2:
Ciliary muscle relaxation
Increased aqueous humour production

M3:
Miosis
Accommodation (ciliary contraction)

211
Q

Differentiating pre- vs post-ganglionic sympathetic lesions

A

0.125 % epinephrine:

If dilated : postganglionic (increased receptors)

Normal pupil: no dilation

212
Q

Pre- vs post-ganglionic parasympathetic lesion differentiation

A

0.125% pilocarpine

If constriction: pupil constricts

Normal pupil: no constriction

213
Q

Idiopathic/physiologic anisocoria

A

20% of population

Round

Regular

<1 mm difference

Reactive to light/accommodation

Responds to miotic/mydriatics

Post eye surgery

214
Q

Argyll-Robertson pupil

A

Abn miotic pupils (<3mm)

Poor light response, better accommodation

Irregular

Usually bilateral

215
Q

Site of lesion in Argyll-Robertson pupil

A

Midbrain

216
Q

Horner’s syndrome

A

Unilateral

Abn miotic + Ptosis + anhydrosis + pseudoenophthalmus

Round

Brisk light and accommodation response

217
Q

Anisocoria in Horner

A

Worse in the dark

218
Q

Site of lesion in Horner

A

Sympathetic system

219
Q

Adie’s tonic pupil

A

Abn mydriatic pupil (impaired constriction)

Irregular

F>M

Poor light response

Better accommodation

Hypersensitivity to dilute pilocarpine

220
Q

Anisocoria in Adie’s tonic pupil

A

Worse in light

221
Q

Site of lesion in Adie

A

Ciliary ganglion

222
Q

Pupil in CN III palsy

A

Mydriatic

Fixed in acute phase at 7-9 mm

Round

Constricts with pilocarpine

223
Q

Anisocoria in CN III palsy

A

Worse in light

224
Q

If no pupil response to mydriatic/miotics

A

Problem at iris sphincter level

225
Q

If Horner pupil dilated with hydroxyamphetamine,

A

Central or preganglionic lesion

226
Q

Etiologies of Argyll-Robertson pupils

A

Syphilis

DM

MS

Encephalitis

Chronic alcoholism

CNS degenerative diseases

227
Q

Marcus Gunn pupil

A

RAPD

Lesion in visual afferent pathway anterior to optic chiasm

Does not occur with media opacity

Pupil reacts poorly to light/ better to accommodation

228
Q

Most common intra-ocular malignancy in adults

A

Mets

Breast, lung

229
Q

Most common primary intra-ocular malignancy in adults

A

Melanoma

230
Q

Most common intra-ocular malignancy in children

A

Neuroblastoma mets

231
Q

DDx of RAPD

A 
Large RD
BRAO
CRAO
CRVO
Advanced glaucoma
Optic nerve compression
Optic neuritis (most common)

CATARACT NEVER PRODUCES RAPD

232
Q

HIV retinopathy

A

Most common retinopathy in HIV

Cotton wool

Intraretinal hemorrhage

233
Q

CMV retinitis

A

CD4 < 50

Necrotizing
Hemorrhage
Vasculitus
Brushfire
Pizza pie

Progression to other eye in 4-6 wk

234
Q

Tx of CMV retinitis

A

Gancyclovir

Foscarnet

(IV, intravitreal)

235
Q

Necrotizing retinitis of HIV

A 
HSV
VZV
Toxo
Disseminated choroiditis
Pneumocystis carinii
Mycobacterium avium intracellulare
Candida
236
Q

Candidal endophthalmitis

A

Fluffy
White-yellow
Superficial retinal infiltrate.

May eventually result in vitritis

Tx: systemic amphoB, oral fluconazole

237
Q

Toxoplasmosis retinitis

A

Focal

Gray-yellow-white

Chorioretinal

Surrounding vasculitis

Vitreous infiltration

Visual impairment more with congenital form

238
Q

Tx of toxo retinitis

A

Pyrimethamine

Sulfonamide

Folinic acid

Clindamycin

+/- steroid

239
Q

Most common cause of blindness in young people in north America

A

DM

240
Q

Loss of vision in DM due to:

A

Progessive microangiopathy:
Macular edema

Progressive retinopathy:
Neovascularization, retinal detachment, vitreous hemorrhage

Rubeosis iridis:
Neovascularization of iris, glaucoma

241
Q

Non-proliferative diabetic retinopathy findings

A

Microaneurysms

Dot and blot hemorrhage

Hard exudate (lipid deposits)

Macular edema

242
Q

Advanced non-proliferative diabetic retinopathy

A

Microaneurysms
Dot and blot hemorrhage
Hard exudate (lipid deposits)
Macular edema

Plus:

Venous beading in at least 2 of 4 quadrants

IRMA (intraretinal microvascular anomalies) in at least 1 quadrant. Dilated leaky vessels

Cotton wool spots

243
Q

Proliferative diabetic retinopathy

A

Neovascularization of iris, disc, retina

=>

Neovascular glaucoma
Vitreous hemorrhage
Retinal detachment

244
Q

Screening for diabetic retinopathy in DM 1

A

5 yr after Dx, annually

All pts >12 y, annually

All pts entering puberty, annually

245
Q

Screening for diabetic retinopathy in DM 2

A

Start examination at time of Dx, annually

246
Q

Screening for diabetic retinopathy in Pregnancy

A

Gestational diabetes:
No need for screening

DM1/2:
Ocular exam in T1 and close F/U throughout

247
Q

Effect of pregnancy on diabetic retinopathy

A

Can exacerbate

248
Q

Tx of diabetic retinopathy

A

Tight control of blood sugar

BP control

If clinically significant macular edema:
Focal laser
Intravitreal CS
Intravitreal anti-VEGF

If proliferative DR:
Pan-retinal laser photocoagulation

If non-clearing vitreous hemorrhage:
vitrectomy

If tractional retinal detachment in PDR:
Vitrectomy

249
Q

Lens changes in DM

A

Earlier senile cataract

Hyperglycemic cataract due to sorbitol accumulation

Sudden refractive changes by changes in blood glucose level

250
Q

DM and extraacular muscle palsy

A

CN III infarct

CN IV and VI

Course:
Usually recover within few month

251
Q

Optic nerve and DM

A

Optic neuropathy due to infarction of optic disc/nerve

252
Q

Most common manifestation of HTN in the eye

A

Retinopathy

253
Q

Acute HTN retinopathy

A

Retinal arteriolar spasm

Superficial retinal hemorrhage

Cotton wool

Optic disc edema

254
Q

Chronic HTN retinopathy

A

AV nicking

Flame/blot retinal hemorrhages

Microaneurisms

Cotton wool

255
Q

Effect of medical therapy on DR

A

Reduction in DR rate by:

Intensive glycemic control

Intensive combination treatment of dyslipidemia

(But not HTN)

256
Q

MS optic neuritis treatment

A

IV steroid, taper to oral form

DO NOT TREAT WITH ORAL CS IN ISOLATION, this increases likelihood of eventual MS

257
Q

Most common source of Amaurosis Fugax

A

Ipsilateral carotid

258
Q

Amaurosis Fugax sign/symptoms

A

< 5-10 min

Hollenhorst plaques

259
Q

Effect of thyroid gland treatment in Grave’s on ophthalmopathy

A

None!

260
Q

Pathophysiology of Grave’s ophthalmopathy

A

Sympathetic overdrive

Inflammatory infiltrate of orbital tissue

261
Q

Course of Grave’s ophthalmopathy

A

Initially: inflammatory

Followed by: quiescent cicatricial phase

262
Q

Tx of Grave’s ophthalmopathy

A

Tx of hyperparathyroidism

Corneal exposure:
Hydration

Diplopia/ proptosis/ compressive optic neuropathy:
CS (acute phase)
Orbital bony decompression
RT of orbit

Strabismus/ eyelid problem:
Surgery once inflammation subsides

263
Q

Most common eye manifestation of collagen vascular diseases

A

Keratoconjunctivitis sicca

264
Q

Negative Bx for GCA, next step?

A

Bx the other side

265
Q

Mutton fat keratitic precipitates

A

Sarcoidosis

266
Q

Sarcoidosis eye Sx

A

Granulomatous uveitis

Optic neuropathy

Oculomotor abnormalities

Visual field loss

267
Q

Strabismus in children < 4mo

A

Sometimes resolves

Esp if:
Intermittent deviation
Variable
Measures < 40 prism diopters

268
Q

Incomitant (paralytic strabismus)

A

Most often acquired

Neural, muscular, structural causes

Diplopia: common

Amblyopia: uncommon

269
Q

Concomitant strabismus (nonparalytic)

A

Gradual or shortly after birth

Infancy

No restriction in ROM of eye

Monocular, alternating, intermittent

Diplopia: uncommon

Risk of amblyopia (unless alternating or intermittent)

270
Q

Accommodative esotropia seen in

A

Hyperopes (constantly accommodating)

Reversible with correction of refractive error

271
Q

Average age of onset of accommodative esotropia

A

2.5 yr

272
Q

Non accommodative esotropia

A

50% of childhood strabismus

Mostly idiopathic

Maybe due to monocular visual impairment or divergence insufficiency

273
Q

The most common cause of amblyopia

A

Strabismus (esp esotropia)

274
Q

Detection of amblyopia

A

Holler test:
Young child upset if good eye is covered

Quantitative visual acuity by age 3-4 yr, using picture charts, matching game

275
Q

Amblyopia Tx less successful if not treated by age:

A

8-10yr

A trial should be given no matter what age

276
Q

Prognosis of amblyopia

A

Good if treated < 4yr

277
Q

Mx of amblyopia

A

Strabismus:
Restore ocular alignment + patching until 8 yr

Anisometropia:
Glasses
Patching if visual acuity difference persist after 4-8 wk

Deprivation amblyopia:
Treat underlying
Patching

278
Q

In anisotropia, amblyopia happens in which eye?

A

The more hyperopic eye

279
Q

Indications for safety glasses or poly carbonate lenses in amblyopia

A

If visual equity in worse eye < 20/50

280
Q

Mx of leukocoria

A

Urgent referral

281
Q

DDx of leukocoria

A 
Cataract
Retinoblastoma
Retinal coloboma
ROP
persistent hyperplastic primary vitreous
Persistent fetal vasculature
Toxocariasis
RD
282
Q

Most common primary intraocular malignancy in children

A

Retinoblastoma

283
Q

Retinoblastoma

A

1/3 bilateral

Malignant

Leukocoria/strabismus

284
Q

Mx of retinoblastoma

A

Screening of siblings/offspring

U/S or CT: calcified mass

RT

Chemo

Laser

Cryopexy

Enucleation

285
Q

RFs for retinopathy of prematurity

A

Non-black race

Low GA

Birth weight < 1500g

High O2 exposure after birth

286
Q

Tx of ROP

A

If fibrovascular tissue:

Laser: standard treatment
Cryo
Anti-VEGF (off-lable)

If retinal detachment:
Watch carefully
Vitrectomy
Scleral buckle

287
Q

Prognosis of ROP

A

High rate of myopia

288
Q

Nasolacrimal defect presentation

A

At 1-2 mo of age

289
Q

Sx of nasolacrimal system defects

A 
Epiphora
Crusting
Discharge
Recurrent conjunctivitis
Mucopurulent discharge with pressure
290
Q

Tx of nasolacrimal obstruction

A

Massage over lacrimal sac

Spontaneous resolution within 9-12 mo

If no resolution, referral for duct probing

291
Q

Dx of ophthalmia neonatorum

A

Stains, cultures

292
Q

Epiphora in infant

A

R/O congenital glaucoma

Nasolacrimal obstruction

293
Q

First thing to check when ocular trauma

A

Visual acuity

294
Q

Referral of eye trauma if:

A 
Decreased VA
Shallow anterior chamber
Hyphema
Abnormal pupil
Ocular misalignment
Retinal damage
295
Q

Mx of penetrating eye trauma

A

Initial Mx: refer immediately

ABC

Don’t press on eye globe

Don’t check IOP if possibility of glob rupture

Check VA/ EOM

Rigid eye shield

Keep head 30-45° elevated

NPO

Tetanus status

IV AB (depending on trauma mechanism):
Mostly gram positives
If foreign body: bacillus
If organic matter: fungal

Usually: AG+ Cefazolin

R/O foreign body

CT orbit

296
Q

Post traumatic infectious endophthalmitis

A

Increased risk if delayed repair (>24h)

If intra-ocular foreign body:
Early vitrectomy and foreign body removal (within 24h)

Extreme pain+ hypopyon + vitritis

Obtain samples

AB (IV, intravitreous)

297
Q

Shaken baby syndrome

A

No external signs

Respiratory arrest
Seizures
Coms

Extensive retinal/intravitreal hemorrhage

298
Q

Inv for blow-out fx

A

Plane film (Water’s, lateral)

CT: AP, coronal

299
Q

Tx of blow-out fx

A

Refrain from coughing, blowing nose

+/- Systemic AB

Surgery if:
Fx > 50% orbital floor
Diplopia not improving
Enophthalmus > 2mm

300
Q

Indicative of poor prognosis in eye chemical burn

A

Opaque cornea

Alkali burn

301
Q

Tx of chemical burn

A

Immediate irrigation with water or buffered solution

ED:
Irrigate with IV drip and eyelid retracted until pH physiologic

Swab upper/lower fornices

DO NOT ATTEMPT TO NEUTRALIZE

Cycloplegic drops

Topical AB and patching

Topical CS (<2wk if persistent epithelial defect)

302
Q

Drops for red itchy eyes

A

Anti-histamines:
Sodium cromoglycate

Decongestants:
Nephazoline
Phenylephrine
(Rebound vasodilation with overuse)

303
Q

Abulia in damage to

A

Frontal lobe

304
Q

Disinhibition in damage to

A

Frontal lobe

305
Q

Apathy

A

in damage to

306
Q

Executive function impairment in damage to

A

Frontal

307
Q

Defect in orientation and judgment in damage to

A

Frontal

308
Q

Primitive reflex re-emergence in damage to

A

Frontal

309
Q

Upgoing babinski in damage to

A

Contralateral frontal

310
Q

Pronator drift in damage to

A

Contralateral frontal

311
Q

Lesion in frontal eye fieldcauses

A

Gaze towards destructive lesion

Gaze away from seizure focus

312
Q

Lesion in occipital lobe

A

Contralateral homonymous hemianopsia

313
Q

Dressing apraxia in damage to

A

Parietal, either side

314
Q

Cortical sensory loss in lesion of

A

Parietal, either side

315
Q

Lower homonymous hemianopsia in lesion of

A

Parietal, either side

316
Q

Damage to dominant parietal lobe

A

In attention or extinction of non-dominant side

Aphasia

Gertsmann syndrome

317
Q

Non-dominant parietal lesion

A

Hemispatial neglect

Apraxias

Agnosias

318
Q

Antegrade amnesia in damage to

A

Hippocampus (temporal lobe)

319
Q

Upper homonymous hemianopia

A

Temporal lobe

320
Q

Hemiballismus in damage to

A

Subthalamic nucleus

321
Q

Parinaud syndrome

A

Supranuclear upward gaze palsy

Damage to pineal gland/ dorsal midbrain

322
Q

Decerebrate/decorticate posture in damage to

A

Decorticate: above red nucleus

Decerebrate: below red nucleus

323
Q

Damage to cerebellar vermis

A

Truncal ataxia

Dysarthria

324
Q

Damage to cerebellar hemisphere

A

Intention tremor

Ipsilateral limb ataxia

Fall towards side of lesion

325
Q

Compensatory reserve of ICP Volume

A

Young: 60-80

Elderly: 100-140

326
Q

Cerebral perfusion pressure

A

MAP-ICP

Almost constant cerebral blood flow in CPP 60-150

327
Q

Circumstances under which cerebral autoregulation mechanism is not able to keep constant CBF

A 
High ICP (Cerebral perfusion pressure < 40)
MAP > 150
MAP < 50
Increased CO2
O2< 50
Brain injury
328
Q

Normal ICP

A

Adults: 10-15 mmHg

Children: 3-7 mmHg

Infant: 1.5-6 mmHg

> 20: moderate elevation
40: severe elevation

329
Q

Gold std for ICP measurement

A

Intraventicular cath

330
Q

MAP target in TBI

A

> 80

331
Q

Sx of acutely elevated Icp

A 
H/A
N/V
Lethargy
Significant decline in GCS
Subtle optic disc changes
Visual changes uncommon
CN VI palsy
Sunset eyes, esp in children with obstructive hydrocephalus
Often herniation syndromes occure
Focal deficits present
332
Q

Sx of chronic ICP elevation

A 
H/A
N/V
Irritability
Inattentiveness
LOC: Nl or modestly decreased
Obvious papilledema
Optic atrophy/blindness/enlarged blond spot
Full EOM
Herniation if acute on chronic
FND can be present
333
Q

Inv fir suspected ICP rise

A

CT/MRI

+/- ICP monitoring

334
Q

Mx of elevated ICP

A

Head elevation: 30°

Fever Mx

Prevent hypotension

Ventilate to pCO2: 35-40

pO2: >60 mmHg

20% IV mannitol

Maintain sBP > 90

Dexa (if tumor, abscess)

Sedation

Paralysis

Barbiturate induced coma

Drain CSF

Decompressive craniectomy

335
Q

Goals in ICP rise Tx

A

Tx when ICP > 20

Goal: ICP < 20

MAP > 90

CPP>65

Goals in trauma:
MAP > 80 in traumatic brain injury

MAP 85-90 in spinal cord injury

336
Q

Effect of barbiturate coma Tx on ICP rise outcome

A

Decreased mortality

No effect on neurologic outcome

337
Q

Associations of pseudotumor cerebri

A

Dural sinus thrombosis

Obesity

Hypervitaminosis A

Reproductive age

Mense irregularity

Addison/Cushing

IDA

Polycythemia vera

Steroid withdrawal

Tetracycline

Amiodarone

Lithium

Nalidixic acid

OCP

338
Q

Neurologic deficit in pseudotumor cerebri

A

CN VI palsy

339
Q

Visual Sx in pseudotumor cerebri

A

VA deficit

Field deficit

Papilledema

Optic atrophy

Blindness

340
Q

Course of pseudotumor cerebri

A

Self limited

341
Q

Inv for pseudotumor cerebri

A

MRI (+/- contrast):
Slit-like ventricles
Distended perioptic sub-arachnoid space

LP:
Opening pressure > 20
Normal CSF

Ophthalmologic exam:
VA/Field defect
Papilledema

342
Q

Tx of pseudotumor cerebri

A

Wt loss

Fluid/salt restriction

Acetazolamide :(decreased CSF production)

Thiazide/furosemide

If failure:
Serial LP
Shunt
Optic nerve sheath decompression

F/U + repeat imaging + ophthalmo F/U

343
Q

Most common cause of non-communicating hydrocephalus

A

Post-infectious CSF absorption block

344
Q

Magnetic gait seen in

A

Normal pressure hydrocephalus

345
Q

Triad of Hakim

A

Ataxia(magnetic gait)
Incontinence
Dementia

NPH

346
Q

Inv for hydrocephalus

A

CT/MRI

U/S through anterior fontanelle in infants

ICP monitoring

347
Q

Tx of hydrocephalus

A

External ventricular drain

Intermittent LP

Surgery for underlying

348
Q

Shunt infection organisms

A

S. Epidermidis

S. Aureus

P. Acnes

Gram-negative becilli

349
Q

Inv for suspected shunt infection

A

Shunt tap

B/C

CBC

350
Q

Headache which is relieved by lying down in pts with shunt:

A

Over shunting

351
Q

Overshunting investigations

A

CT: slit ventricles, subdural hematoma

352
Q

DDx for ring enhancing lesion on CT with contrast

A

Mets

Abscess

Glioblastoma

Infarct

Contusion

Toxo

Lymphoma

Demyelination

Resolving hematoma

Radiation necrosis

353
Q

Inv for brain cancer

A 
CT
MRI
stereotactic Bx (tissue, molecular markers)
Mets w/u
Tumor markers
354
Q

Tx of brain tumors

A

If slow growing/benign:
Conservative (serial Hx, PE, imaging)

CS (reduce ICP, cytotoxic edema)

Pharmacologic treatment for pituitary adenoma

Surgical excision

Shunt

RT

Chemo

355
Q

New onset communicating hydrocephalus in cancer pts

A

Suspicion of leptomeningeal carcinomatosis

356
Q

Most common brain tumor in <15yr

A

Supratentorial:
Astrocytoma

Infratentorial:
Meduloblastoma

357
Q

Most common brain tumor > 15 yr

A

Supratentorial:
Adtrocytoma (GBM)
Mets (most common overally)

Infratentorial:
Mets

358
Q

Brain mets

A

Most common intracranial tumor in adults

Often at:
Gray-white matter junction
Temporal-parietal-occipital lobe junction

359
Q

Inv for mets

A 
Find source:
CXR
CT abdomen/chest
U/S abd
Mammo
Nuclear scan/PET

CT+ contrast for brain

+/- MRI

360
Q

Tx of brain mets

A

Phenytoin/levotiracetam

Dexa + ranitidine

Chemo
RT (if discrete, deep seated, inoperable): 
Stereotactic RT if < 3 lesions
WBRT if multiple lesions
Post-operative adjuvant RT

Surgical:
If single/solitary

361
Q

Most common cancers metastasizing to brain

A

Lung > breast

362
Q

Astrocytoma

A

Cerebral hemispheres&raquo_space; other sites

CT: hypodense
MRI T1: hypointense
MRI T2: hyperintense

Low grade:
Calcification
No enhancement

High grade:
Enhancement
Central necrosis

363
Q

Tx of astrocytoma

A

Low grade diffuse:
Surgery (better outcome)
RT (prolongs survival)
Chemo (for progression)

High grade (anaplastic, GBM)
Goal: prolong quality survival
Surgery 
\+RT
\+Temozolomide

Multiple gliomas:
WBRT +/- chemo

364
Q

Meningioma

A

Arises from arachnoid membrane

Calcified

Hyperostosis of adjacent bone

Bx: psammoma bodies

F> M

Increase in size with pregnancy (progesterone receptor)

Middle age

Association with NF2

365
Q

Inv for meningioma

A 
CT with contrast: 
Homogeneous, dense enhancement
Dural tail
Well circumscribed
Usually solitary

MRI with contrast

Angiography (arterial supply, venous involvement)

366
Q

Tx of meningioma

A

Conservative if:
Asymptomatic and non-progressive

Surgery(1st std therapy)
If symptomatic or documented growth

Endovascular embolization:
If highly vascularized, to facilitate surgery

Radiation:
If <3cm, partially occluding superior sagittal sinus

367
Q

Vestibular Schwannoma

A

Slow-growing

If bilateral: NF2

Middle age

<2cm: hearing loss, disequilibrium, tinnitus

Compression on CN VIII, CN VII, CN V (>2cm)

> 4cm: cerebellar signs, BS signs, hydrocephalus…

368
Q

Inv for acoustic neuroma

A

MRI with contrast

2nd choice: CT contrast

Audiogram

Brainstem auditory evoked potentials

Caloric test

369
Q

Tx of acoustic neuroma

A

Expectant:
If small, hearing preserved, high perioperative risk, elderly

RT

Surgery if:
>3cm
BS compression
Edema
Hydrocephalus

Testing family members for NF2 mutation

370
Q

CN palsies in pituitary adenoma

A

CN III
CN IV
CN V1, V2
CN VI

371
Q

Order of function impairment in pituitary adenoma

A 
GH
LH
FSH
TSH
ACTH
PRL
372
Q

Pituitary apopexy

A

Sudden expansion of mass due to hemorrhage or necrosis

Abrupt:
H/A
Visual disturbance
Ophthalmoplegia
Reduced mental status
Panhypopituitarism
DI
373
Q

Inv for pituitary adenoma

A

Formal visual fields

CN testin

Endocrine tests:
PRL level, TSH, 8 AM cortisol, fasting glucose, FSH/LH, IGF-1

Lytes, urine lytesand osmolality

MRI +/- contrast

374
Q

Tx of pituitary adenoma

A

Apoplexy:
Rapid CS
Surgical decompression

Prolactinoma:
Dopamine agonist

Cushing:
Cyproheptadine (serotonin antagonist)
Ketoconazole

Acromegaly:
Octreotide +/- bromocriptine

Endocrine replacement

Surgcal

375
Q

Nerves in cavernous sinus

A

CN II, III, IV, V2, VI

Med (25 decks)

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