Part 2

Question 1

It is a drooping of the upper eyelid that causes from myasthenia gravis, damage to the oculomotor nerve (CN III), and damage to the sympathetic nerve supply (Horner syndrome).

Answer 1

Ptosis

Question 2

More common in the ederly, which is an inward turning of the lid margin. The lower lashes which often invisible when turned inward, irritate the conjunctiva and lower cornea.

Answer 2

Entropion

Question 3

The lower lid margin turns outward, exposing the palpebral conjuctiva.

Answer 3

Ectropion

Question 4

A wide-eyed stare suggests_____

Answer 4

Lid Retraction

Question 5

Decribes protrusion of the eyeball, a common feature of Graves ophthalmopathy, triggered by autoreactive T lymphocytes

Answer 5

Exophthalmos

Question 6

Swelling and Excessive tearing are seen in

Answer 6

• Conjunctival inflammation

* Corneal irritation

Question 7

Dryness of the lacrimal apparatus from impaired secretion

Answer 7

Sjogren Syndrome

Question 8

Impaired Drainage of Lacrimal Apparatus

Answer 8

• Ectropion

* Nasolacrimal duct obstruction

Question 9

A harmless yellowish triangular nodule in the bulbar conjunctiva on either side of the iris.

Answer 9

Pinguecula

Question 10

A localized ocular inflammation of the episcleral vessels. Seen in rheumatoid arthritis, Sjogren syndrome, and herpes zoster.

Answer 10

Episcleritis

Question 11

A painful, tender, red infection at the inner or outer margin of the eyelid, usually from Staph aureus.

Answer 11

Stye (Hordeolum)

Question 12

A subacute nontender, usually painless nodule caused by a blocked meibomian gland.

Answer 12

Chalazion

Question 13

Leakage of blood outside of the vessels, producing a homogenous, sharply demarcated, red area that resolves over 2 weeks; no pain; vision not affected; no ocular discharge; pupil not affected; clear cornea; may result from trauma, bleeding disorders, or sudden increase in venous pressure, as from cough

Answer 13

Subconjuctival Hemorrhage

Question 14

Diffuse dilation of conjunctival vessels with redness that tends to be maximal peripherally; mild discomfort rather than pain; vision not affected except for temporary mild blurring due to discharge; watery, mucoid or mucopurulent ocular discharge; pupil not affected; clear cornea; bacterial, viral, and other infections, highly contagious; allergy, irritation

Answer 14

Conjunctivitis

Question 15

Pain is moderate to severe, superficial, vision usually decreased, watery or purulent ocular discharge; pupil not afffected unless iritis develops; cornea changes depending on cause

Answer 15

Corneal Injury or Infection

Question 16

Severe, aching, deep pain; decreased vision; no ocular discharge; dilated, fixed pupil; steamy, cloudy cornea; acute increase in intraocular pressure constitutes an emergency

Answer 16

Acute Angle Closure Glaucoma

Question 17

Moderate, aching, deep pain, decreased; photophobia vision; no ocular discharge; small and irregular pupil; clear or slightly clouded; injection confined to corneal limbus cornea

Answer 17

Acute Iritis

Question 18

A thin grayish white arc or circle not quiet at the edge of the cornea. Usually benign.

Answer 18

Corneal arcus

Question 19

A golden to red ring, somtimes shading to green or blue, from copper desposition in the periphery of the cornea found in WIlson disease

Answer 19

Kayser-Fleischer RIng

Question 20

A superficial grayish white opacity in the cornea, secondary to an old injury or to inflammation. Visible on a deeper plane and only through the pupil.

Answer 20

Corneal scar

Question 21

A triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side.

Answer 21

Pterygium

Question 22

Opacity of the lenses visible through the pupil. Risk factors are old age, smoking, diabetes, corticosteriod use

Answer 22

Cataracts

Question 23

Produces spokelike shadow that point-gray against black, as seen with flashlight, or black against red with an ophthalmoscope.

Answer 23

Peripheral Cataract

Question 24

Increases the risk for acute narrow-angle glaucoma in iris

Answer 24

•Narrow angle

Question 25

The normal spatial relation between iris and cornea is preserved.

Answer 25

Open-angle glaucoma

Question 26

Considered benign if it is equal in dim and bright light, and there is brisk pupillary constriction to light.

Answer 26

Simple anisocoria

Question 27

When anisocoria is greater in bright light than in dim light. The larger pupil cannot constrict properly. It causes

Answer 27

* trauma to the eye. * open-angle glaucoma. * impaired parasympathetic innervation to the iris * tonic pupil and oculomotor nerve (CN III) paralysis.

Question 28

•When anisocoria is greater in dim light, the smaller pupil cannot dilate properly is seen in which caused by an interruption of the sympathetic innervation

Answer 28

Horner syndrome

Question 29

* Direct reaction - | * Consensual reaction -

Answer 29

* Direct reaction - pupillary constriction in the same eye | * Consensual reaction - pupillary constriction in the opposite eye

Question 30

Pupil is dilated, regular, and usually unilateral. Reaction to light is severely reduced and slowed or even absent. Constriction during the near vision is present, although very slow.

Answer 30

Tonic PUpil (Adie Pupil)

Question 31

The pupil is large and fixed to light and near effort. Ptosis of the upper eyelid and lateral deviation of th eye downward and outward are almost always present.

Answer 31

Oculomotor Nerve (CN III) Paralysis

Question 32

The affected pupil is small, unilateral, reacts briskly to light and near effort, but dilates slowly, especially in dim light. Anisocoria is >1mm, with ipsilateral ptosis of the eyelid and often loss of sweating on the forehead. (miosis, ptosis and anhydrosis)

Answer 32

Horner Syndrome

Question 33

The pupils are small, irregular and usually bilateral. They constrict with near vision and dilate with far vision but do not react to light, seen in neurosyphilis and rarely in diabetes.

Answer 33

Small, Irregular Pupils (Argyll Robertson Pupils)

Question 34

Unilateral blindness does not cause anisocoria as long as the sympathetic and parasympathetic innervation to both irises is normal. A light directed into the seeing eye produces a direct reaction in that eyeand a consensual reaction in the blind eye.

Answer 34

Equal Pupils and One Blind Eye

Question 35

The normal conjugate movements of the eyes in each direction.

Answer 35

Extra Ocular Muscles

Question 36

•A fine rhythmic oscillation of the eyes. A few beats of nystagmus on extreme lateral gaze are normal. If you see this, bring your finger in to within the field of binocular vision and look again.

Answer 36

Nystagmus

Question 37

• Proptosis • Characteristic “stare” on frontal gaze. - Poor convergence

Answer 37

Hyperthyroidism

Question 38

Consider an orbital tumor or retrobulbar hemorrhage from trauma.

Answer 38

Unilateral Proptosis

Question 39

Consider an orbital tumor or retrobulbar hemorrhage from trauma.

Answer 39

Unilateral Proptosis

Question 40

Contraindications for mydriatic drops

Answer 40

- Head injury and coma | • Any suspicion of narrow-angle glaucoma.

Question 41

Swelling of the optic disc and anterior bulging of the physiologic cup suggest ___ which is associated with increased intracranial pressure

Answer 41

Papilledema

Question 42

Absence of a red reflex of the fundus suggests: | Less common ones

Answer 42

- opacity of the lens (cataract) • Opacity of the vitreous • Artificial eye Less commonly • Detached retina • Retinoblastoma in children

Question 43

They focus anterior to the retina and the retinal structures look larger than normal.

Answer 43

myopia

Question 44

They focus posterior to the retina.

Answer 44

hyperopia

Question 45

An enlarged cup suggests

Answer 45

Chronic open-angle glaucoma

Question 46

Occurs with high intracranial pressures above 190 mm H2O. Other causes include glaucoma and retinal vein occlusion

Answer 46

Loss of Spontaneous Venous Pulsation(SVPs)

Question 47

Is an important cause of poor central vision in older adults.

Answer 47

Macular degeneration

Question 48

Types of Macular degeneration

Answer 48

Dry atrophic - more common but less severe | Wet exudative, or neovascular.

Question 49

Elevated intracranial pressure causes intraaxonal edeman along the optic nerve, leading to engorgement and swelling of the optic disc; it has a color pink, hyperemic appearance; often with loss of venous pulsations; dics swollen with margins blurred, the physiologic cup is not visible; and seen in intracranial mass, lesion, or hemorrhage, meningitis

Answer 49

Papilledema

Question 50

- Tiny disc vessels give normal color to the disc - color yellowish orange to creamy pink - disc margins sharp - physiologic cup located centrally or temporally, maybe conpiscious or absent

Answer 50

Normal Optic Disc

Question 51

- Increased intraocular pressure within the eye leads to increased cupping (backward depression of the disc) and atrophy - the base of the enlarged cup is pale - death of optic nerve fibers leads to loss of the tiny disc vessels

Answer 51

Glaucomatous Cupping