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ABIM > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

RAPD

A

Relative afferent pupillary defect (RAPD) or Marcus Gunn pupil Light directed in the affected eye will cause only mild constriction of both pupils (due to decreased response to light from the afferent defect), while light in the unaffected eye will cause a normal constriction of both pupils (due to an intact efferent path, and an intact consensual pupillary reflex).

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2
Q

Swinging flashlight test

A
  1. Swing a light back and forth in front of the two pupils 2. When light reaches a pupil there should be a normal direct and consensual response. 3. An RAPD is diagnosed by observing paradoxical dilatation when light is directly shone in the affected pupil after being shown in the healthy pupil indicating disease in the optic nerve or severe retinal disease
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3
Q

Mechanism of RAPD

A

Damage to: 1. optic nerve 2. severe retinal disease.

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4
Q

Differentiate between decreased vision from an ocular problem such as cataract or from a defect of the optic nerve

A

Swinging flashlight test

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5
Q

The pathway for pupillary constriction begins at the _ nucleus near the occulomotor nerve nucleus. The fibers enter the orbit with CN _ nerve fibers and synapse at the _ ganglion.

A

The pathway for pupillary constriction begins at the Edinger-Westphal nucleus near the occulomotor nerve nucleus. The fibers enter the orbit with CN III nerve fibers and ultimately synapse at the cilliary ganglion.

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6
Q

_ innervation leads to pupillary constriction performed by sphincter pupillae. The pathway begins at the Edinger-Westphal nucleus near the occulomotor nerve nucleus. The fibers enter the orbit with CN III to synapse at the cilliary ganglion.

A

Parasympathetic innervation leads to pupillary constriction performed by sphincter pupillae. The pathway begins at the Edinger-Westphal nucleus near the occulomotor nerve nucleus. The fibers enter the orbit with CN III to synapse at the cilliary ganglion.

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7
Q

__ stimulation causes pupillary dilation, performed by dilator pupillae. Pathway begins at the cortex with the first synapse at the __ center. Post synaptic neurons travel through the brain stem and exit through the __ __ chain and the superior cervical ganglion. They synapse at the superior cervical ganglion where third-order neurons travel through the _ plexus and enter into the orbit through the first division of the _ nerve.

A

Sympathetic stimulation causes pupillary dilation, performed by dilator pupillae. Pathway begins at the cortex with the first synapse at the cilliospinal center. Post synaptic neurons travel through the brain stem and exit through the cervical sympathetic chain and the superior cervical ganglion. They synapse at the superior cervical ganglion where third-order neurons travel through the carotid plexus and enter into the orbit through the first division of the trigeminal nerve.

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8
Q

Innervation of the pupil

A

https://upload.wikimedia.org/wikipedia/commons/a/a5/Gray840.png

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9
Q

Most effective monotherapy for lowering IOP

A

latanoprost

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10
Q

Sympathetic connections of the ciliary and superior cervical ganglia.

A

https://upload.wikimedia.org/wikipedia/commons/a/a5/Gray840.png

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11
Q

The cause of uveitis is typically:

A

idiopathic

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12
Q

Causes of uveitis

A

Idiopathic Sarcoidosis B-27 associated spondyloarthropathies

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13
Q

Hazy cornea, fixed dilated pupil

A

Acute angle closure glaucoma

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14
Q

Uvea

A

iris, ciliary body, choroid

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15
Q

Floaters, flashing lights, shadow

A

Retinal detachment

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16
Q

is a type of distorted vision in which grid of straight lines appears wavy and parts of the grid may appear blank. People with this condition often first notice this when looking at mini-blinds in their home.

A

Metamorphopsia

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17
Q

Metamorphopsia: sign of

A

Age related macular degeneration

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18
Q

Rx: age related macular degeneration

A

Bevacizumab

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19
Q

Rx: tractional retinal detachment, persistent vitreous hemorrhage

A

Vitrectomy

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20
Q

Grid of horizontal and vertical lines used to monitor central visual field; visual disturbances caused by changes in the retina, particularly the macula (e.g. macular degeneration, Epiretinal membrane), as well as the optic nerve

A

Amsler grid

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21
Q

Non-invasive imaging test that uses light waves to take cross-section pictures of retina

A

Ocular coherence tomography

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22
Q

Humphrey visual field testing is used to:

A

Monitor glaucoma Peripheral vision testing

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23
Q

How can you stop bradycardia with timolol?

A

Punctal occlusion

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24
Q

Brimonidine

A

topical alpha agonist increases outflow decreases production of aqueous humor rx glaucoma

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25
Q

Latanoprost

A

rx glaucoma topical prostaglanding analog increases outflow

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26
Q

Dorzolamide

A

rx glaucoma decreases production topical carbonic anhydrase inhibitor

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27
Q

Pilocarpine

A

rx glaucoma Topical parasympathomimetic increases outflow Side-effects: retinal detachment, brow ache

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28
Q

Gradual decrease in visual acuity + problems with glare

A

Cataracts Blurred vision, glare difficulty with night driving Myopic shift in prescription

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29
Q

Small yellow areas of localized extra-cellular deposits on fundoscopy

A

Drusen

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30
Q

Associated with macular degeneration

A

Drusen

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31
Q

Rx: blepharitis

A

Warm compresses, baby shampoo cleansing of eye-lashes

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32
Q

Blepharitis: complications

A

Chalazion

Stye

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33
Q

Rx: WPW + irregularly irregular stable WCAT

A

Procainamide

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34
Q

Why are nodal blocking agents (verapamil, adenosine, beta blockers, digoxin) contra-indicated in WPW+atrial fibrillation with RVR (a rare condition)?

A

They can cause preferential conduction through the accessory pathway causing death.

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35
Q

Indication for cataract surgery

A
  1. Functional impairment
  2. ADL impairment

Snellen’s alone is not helpful predictor of dysfunction

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36
Q

Commonest anesthesia in cataract surgery

A

Topical + intra-ocular

GA is rare

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37
Q

Cataract surgery pre-op

A
  1. Surgery performed through peripheral clear cornea using topical or intraocular (intracameral) anesthesia allows patients to remain on warfarin or aspirin through cataract surgery
  2. IV sedation usually required for surgery, but
  3. Preoperative testing in otherwise healthy patients is NOT needed
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38
Q
A
39
Q

The optic disk is __ to the fovea.

A

The optic disk is nasal to the fovea.

40
Q

Cx: Gradual visual loss

A
  1. Cataract
  2. Primary open angle glaucoma
  3. Age related macular degeneration
  4. Narrow angle glaucoma
  5. Diabetic retinopathy
41
Q

Cx: Classification parameter acute visual loss

A

Time course: <transient></transient>

  1. Transient (Amaurosis Fugax)
    1. Emboli (cholesterol plaques, cardiac myxoma, clot)
    2. Vasospasm (migraine, subarachnoid hemorrhage, hypertensive crisis)
  2. Sustained
    1. Optic neuritis (MS, lupus, sarcoidosis)
      1. Anterior ischemic optic neuropathy
      2. Arteritic: GCA
    2. Nonarteritic—associated with advancing age, hypertension
    3. Hemorrhage (neovascular AMD, vitreous hemorrhage in diabetes)
    4. Occipital infarct
    5. AMD, MS
42
Q

Leading cause of legal blindness in patients age 55 years and older in the United States

A

AMD

43
Q

Deposits of material in the macula that probably represent deposition by-products of photoreceptor metabolism. On ophthalmoscopy, they appear as small, bright yellow objects.

A

Drusen

Signify: dry AMD

44
Q

Describe abnormalities

A

Dry yellow bodies: Drusen

Non-neovascular age-related macular degeneration.

45
Q

Forms of AMD, frequency

A
  1. Dry: 90%
  2. Wet: 10%
46
Q

Thin, highly vascularized and pigmented tissue under the sensory retina that forms the posterior portion of the uveal tract (the iris, ciliary body, and _.

A

Choroid

47
Q

The inner boundary of the choroid is Bruch’s membrane (BrM) on which the retinal pigment epithelium (RPE) lies. This vasculature has three layers: the anterior choriocapillaris; Sattler’s layer of intermediate vessels in the middle; and the outermost Haller’s layer with large vessels.

A

choriocapillaris

48
Q

Differences between wet and dry AMD

A

Frequency Progression

Wet 10% Rapid

Dry 90% Slow

49
Q

Distortion of straight lines may be an early presenting complaint

A

AMD

(Amsler grid)

50
Q

Rx: reduce the risk of progression from moderate to severe AMD,

A

zinc + vitamins C and E + beta-carotene

51
Q

Anti–vascular endothelial growth factor (VEGF) agents (__, _) injected intraocularly (usually monthly) can stabilize neovascular AMD and often improve vision.

A

bevacizumab, ranibizumab

52
Q

Rx: neovascular AMD

A
  1. Anti-VEGF (bevacizumab, ranibizumab)
  2. Laser (photocoagulation, photodynamic)
53
Q

Second leading cause of blindness in Americans

A

Primary Open angle glaucoma

54
Q

Leading cause of blindness in African Americans

A

Primary open angle glaucoma

55
Q

Pathogenesis: open angle glaucoma

A

Trabecular meshwork is blocked by excess glycosaminoglycan production, decreasing aqueous outflow, but not clinically visible.

56
Q

Why is POAG hard to diagnose?

A

Asymptomatic till much later: measurement of visual acuity alone not adequate.

Dx: tonometry, automated visual field, imaging study of optic nerve

57
Q

Is headache common in POAG?

A

Rarely causes headache unless IOP is extremely high

58
Q

Screening age for POAG in African Americans

A

40

59
Q

Rx: POAG

A
  1. Drugs: Prostaglanding analog, beta blocker, alpha agonist, cholinergic agonist.
  2. Laser trabeculoplasty: may be temporary
  3. Surgery
60
Q

Differentiate POAG and narrow angle glaucoma

A

Narrow angle: acute, headache, nausea, painful red eye

61
Q

Why is glcyemic control important in diabetic retinopathy?

A

Degree of glucose control is a better predictor of progression than duration of disease.

62
Q

Among diabetics older than 40 years of age, prevalence of:

diabetic retinopathy: _ %

sight-threatening retinopathy: _ %

A

40, 8

63
Q

_ dilated funduscopic examination.

A

Yearly

64
Q

Types or stages

A
  1. Non-proliferative (background or pre-proliferative)
  2. Proliferative
65
Q

the retina, optic disc, macula, fovea, and posterior pole.

A

Fundus

66
Q

Cotton-wool spots, microaneurysms, intraretinal hemorrhages, lipid (“hard”) exudates, retinal edema, venous beading, and intraretinal microvascular abnormalities

A

Non-proliferative diabetic retinopathy

67
Q

Differences between non-proliferative and proliferative

A

Proliferative = Non-proliferative + neovascularization

68
Q

Locate macula, fovea, disc, cup

A

disk is pale pink, approximately 1.5 mm in diameter, with sharp, flat margins.

The physiologic cup is located within the disk and usually measures less than six-tenths the disk diameter.

69
Q

Describe features

A

Hemorrhage

subretinal neovascularization

Age-Related Macular Degeneration: Hemorrhage seen beneath the retina + subretinal neovascularization.

70
Q

Describe abnormalities

A

Linear collection of yellow lipid deposits with sharp margins in macula.

Hard Exudates

71
Q

Describe what you see

A

Multiple white centred haemorrhages

Roth’s spots: retinal hemorrhages with white or pale centers, composed of clot, inflammatory infiltrate, infectious organisms, or neoplastic cells.

In this case: Multiple retinal haemorrhages (decompression retinopathy) following paracentesis for macular branch artery occlusion

72
Q

Grid _ _ more effective than intraocular corticosteroids for leaking vessels causing macular edema.

A

Grid laser photocoagulation more effective than intraocular corticosteroids for leaking vessels causing macular edema

73
Q

Treatment overview

A
  1. Laser photocoagulation: grid and pan-retinal
  2. Intravitreal injections of VEGF antagonists
  3. Surgery
74
Q

Causes

A
  1. Conjunctivitis (allergic, bacterial, viral)
  2. Corneal ulcer
  3. Anterior uveitis
  4. Acute glaucoma
  5. Anterior scleritis
75
Q

Aetiological types

A
  1. Allergic
  2. Bacterial
  3. Viral
76
Q

Red eye differential diagnosis parameters

A
  1. Vision: <normal></normal>
  2. Pruiritus: <+, ->
  3. Photophobia: <+, ->
  4. Discharge: <watery></watery>
  5. Pain:
  6. Pupillary size
  7. Pupillary response
  8. Redness distribution
77
Q

+ pain worse at night

A

Anterior scleritis

78
Q

Red eye + ciliary flush

A
  1. anterior uveitis
  2. Acute glaucoma
79
Q

Anterior uveitis: mx

A
  1. Topical corticosteroids
  2. Cycloplegic
  3. Systemic workup
80
Q

Corneal abnormality shown

A

Dendritic pattern after fluorescein staining

81
Q
  1. CD4 count < 50 cells/mm3
  2. Floaters, flashing lights, blind spots
  3. no pain, discharge, or redness
A

CMV retinitis

82
Q

Rx

A

Oral valganciclovir (IV foscarnet if resistance or intolerance)

83
Q

CMV retinitis: local rx

A

Systemic: Oral valganciclovir

Local:

  1. Ganciclovir implant + oral valganciclovir
  2. ntravitreous ganciclovir or foscarnet injections
84
Q

Syndrome of uveitis, vitreitis, macular edema, and epiretinal membrane formation in HIV+ on HAART

A

“Immune recovery uveitis” (IRU)

Exp: occurs in minority of eyes with CMV retinitis in patients responsive to HAART

85
Q

Reactivation of _ _ virus residing within the ophthalmic nerve; subtype of shingles.

A

Herpes zoster ophthalmicus (HZO) : reactivation of varicella zoster virus residing within the ophthalmic nerve; subtype of shingles.

86
Q

Bacterial conjunctivitis: bugs

A

S. aureus, S. pneumoniae, H. influenzae

87
Q

Internal _ : Infection of meibomian gland

A

hordeolum

Internal hordeolum: Infection of meibomian gland on the conjunctival side of the eyelid

External hordeolum (stye): Infection of gland and eyelash follicle on skin side of the lid

88
Q

Focal, noninfectious blockage of meibomian gland

A

Chalazion

89
Q

Chalazion: Rx

A

Warm compresses; incision and drainage

90
Q

Ring of injection around limbus

A

Ciliary flush

Exp: feature of uveitis, others Pain
Redness
Photophobia

91
Q

A 36-year-old woman is referred back to you by her ophthalmologist, who states that she has evidence of uveitis. She was begun on topical corticosteroids with some improvement. She says that her ophthalmologist wanted you to do a systemic evaluation. She has no complaints and no abnormalities on physical examination. Which of the following tests is an appropriate component of her evaluation?

Chest x-ray

Magnetic resonance imaging (MRI) of the head

Purified protein derivative (PPD) test

Herpes simplex virus (HSV) serology

A

CXR

The most common disorders associated with uveitis include JRA, seronegative spondyloarthropathies, Behçet syndrome, and sarcoidosis. Therefore, a chest x-ray to assess for lymphadenopathy from sarcoidosis would be the best answer.

92
Q

Which of the following medications increases the risk of open-angle glaucoma?

Anticholinergics

α-Adrenergic agents

β-Blockers

Corticosteroids

A

Corticosteroids

Explanation: Corticosteroids in any form can cause elevations in intraocular pressure without any visible changes

93
Q

A 44-year-old woman with rheumatoid arthritis complains of severe right-sided ocular pain for 3 days that radiates into “the back of my head.” She denies decreased vision, halos, or tearing. External examination shows normally reactive pupils. There is a localized area of intense redness over the temporal sclera that is very sensitive to touch. Superiorly, there is an area of bluish discoloration to the sclera. The cornea appears normal. She has no other medical problems. The most reasonable treatment at this point would be which of the following?

Topical corticosteroids

Oral corticosteroids

Oral hydroxychloroquine

Oral nonsteroidal anti-inflammatory drugs (NSAIDs)

A

NSAIDs

The patient has classic features of anterior scleritis. The area of bluish discoloration suggests previous scleritis that has resolved. RA is the most common underlying disease associated with scleritis.

Scleritis does not usually respond to topical therapy. Oral NSAIDs are the first line of therapy; prescription NSAIDs such as flurbiprofen or indomethacin are preferred

Oral corticosteroids are second-line therapy.

DMARDs are not effective in the treatment of scleritis.

94
Q
A

ABIM (36 decks)

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