Part 3

Question 1

Small, linear, flmae-shaped, red streaks in the fundi, shaped by the superficial bundles of nerve fibers that radiate from the optic disc. Sometimes the hemorrhages occur in clusters and look like a larger hemorrhage but can be identified by the linear streaking at the edges.

Answer 1

Superficial Retinal Hemorrhage

Question 2

Small, rounded, slightly irregular red spots that are sometimes called dot or blot hemorrhage. They occur in a deeper lyer of the retina than flame-shaped hemorrhages. Diabetes is a common cause.

Answer 2

Deep Retinal Hemorrhage

Question 3

Develops when blood escapes into the potential space between the retina and vitreous. This hemorrhage is typically larger than retinal hemorrhages because it is anterior to the retina, it obscures any underlying retinal vessels.

Answer 3

Preretinal Hemorrhage

Question 4

Tiny, round, red spots commonly seen in and around the macular area. They are minute dilatations of very small retinal vessels; the vascular connections are too small to be seen with ophthalmoscope. A hallmark of diabetic retinopathy.

Answer 4

Microaneurysms

Question 5

Refers to the formation of new blood vessels. They are more numerous, more tortuous, and narrower than neighboring blood vessels in the area and form disorderly looking red arcades. A common feature of the proliferative stage of diabetic retinopathy

Answer 5

Neovascularization

Question 6

Are white or grayish, ovoid lesions with irregular soft borders. They are moderate in size but usually smaller than the disc. They result from extruded axoplasm.

Answer 6

Soft Exudates: Cotton-Wool Patches

Question 7

Are creamy or yellowish, often bright, lesions with well-defined hard borders. They are small and round but may coalesce into larger irregular spots.

Answer 7

Hard Exudates

Question 8

Inflammation has destroyed the superficial tissues to reveal a well-defined, irregular patch of white sclera marked with dark pigment.

Answer 8

Healed Chorioretinitis

Question 9

Are yellowish round spots that vary from tiny to small. The edges may be soft or hard. They are haphazardly distributed but may concentrare at the posterior pole between the optic disc and the macula

Answer 9

Drusen

Question 10

Movement of the auricle up and down. Painful in acute otitis externa.

Answer 10

Tug test

Question 11

Tenderness by pressing firmly just behind the ear

Answer 11

Occurs in otitis media

Question 12

A firm, nodular, hypertrophic mass of scar tissue extending beyond the area of injury. It may develop in any scarred area but is most common on the shoulders and upper chest.

Answer 12

Keloid

Question 13

This chronic inflammatory lesion starts as a painful, tender papule on the helix
or antihelix. Here the upper lesion is at a later stage of ulceration and crusting.

Answer 13

Chondrodermatitis Helicis

Question 14

This raised nodule shows the lustrous surface and telangiectatic vessels of basal cell carcinoma, a common slow-growing malignancy that rarely metastasizes.

Answer 14

Basal Cell Carcinoma

Question 15

A deposit of uric acid crystals characteristic of chronic tophaceous gout. It appears as hard nodules in the helix or antihelix and may discharge chalky white crystals through the skin.

Answer 15

Tophi

Question 16

Formerly called a sebaceous cyst,a dome-shaped lump in the dermis forms a benign closed firm sac attached to the epidermis.

Answer 16

Cutaneous Cyst

Question 17

In chronic rheumatoid arthritis, look for small lumps on the helix or antihelix and additional nodules elsewhere on the hands and along the sur-face of the ulna distal to the elbow, and on the knees and heels.

Answer 17

Rheumatoid Nodules

Question 18

Skin of the ear canal is thickened, red, and itchy

Answer 18

Chronic otitis externa

Question 18

• Red bulging drum
• Amber drum of a serous effusion.
• Decreased mobility

Answer 18

Acute purulent otitis media

Question 19

Unusual prominent short process and a prominent handle that looks more horizontal.

Answer 19

Retracted drum

Question 20

No mobility of the ear drum

Answer 20

Ear drum perforation

Question 21

The tympanic membrane, is pinkish gray. Note the malleus lying behind the upper part of the drum. Above the short process lies the pars flaccida. The remainder of the drum is the pars tensa

Answer 21

Normal Eardrum (Right)

Question 22

Are holes in the eardrum, usually from purulent infections of the middle ear. They may be central, if not involving the margin of the drum, or marginal, when the margin is involved.

Answer 22

Perforation of the Eardrum

Question 23

Is a scarring process of the middle ear from otitis media that involves deposition of hyaline and calcium and phosphate crystals in the eardrum and middle ear. When severe it may entrap the ossicles and cause conductive hearing loss.

Answer 23

Tympanosclerosis

Question 24

Are usually caused by viral upper respiratory infections (otitis media with serous effusion) or by sudden changes in atmospheric pressure as from flying or diving (otitic barotrauma)

Answer 24

Serous Effusion

Question 25

Is commonly caused by bacterial infection from S. pneumoniae or H. influenzae. Symptoms include earache, fever, and hearing loss. The eardrum reddens, loses its landmarks, and bulges laterally, toward the examiner’s eye.

Answer 25

Acute Otitis Media with Purulent Effusion

Question 26

Painful hemorrhagic vesicles appear on the tympanic membrane, the ear canal, or both. Symptoms include earache, blood-tinged discharge from the ear, and conductive hearing loss.

Answer 26

Bullous Myringitis

Question 27

Testing for Conductive Versus Neurosensory Hearing Loss

Answer 27

Tuning Fork Test

Question 28

Test for lateralization (Weber test).
•Normal
• the vibration is_____.

• Unilateral hearing loss
• Bilateral conductive or sensorineural deficits

Answer 28

Normal
• the vibration is heard in the midline or equally in both ears.

Unilateral hearing loss
• Lateralize to the ear with normal hearing

Bilateral conductive or sensorineural deficits
• No lateralization

Question 29

Describes the normal first phase in the hearing pathway.

Answer 29

Air conduction (AC)

Question 30

• Alternative pathway
• Bypasses the external and middle ear
• Used for testing purposes.

Answer 30

Bone conduction (BC)

Question 31

A vibrating tuning fork placed on the head stimulates

Answer 31

stimulates the cochlea directly

Question 32

AC is more sensitive than BC (AC > BC).

Answer 32

Normal hearing

Question 33

• External or middle ear disorder impairs sound conduction to inner ear. Causes include foreign body, otitis media, perforated eardrum, and otosclerosis of ossicles
• Childhood and young adulthood, up to age 40 years
• Abnormality usually visible, except in otosclerosis
• Little effect on sound
  Hearing seems to improve in noisy environment
  Voice remains soft because inner ear and cochlear
  nerve are intact
• Tuning fork at vertex
  Sound lateralizes to impaired ear—room noise not well heard, so detection of vibrations improves
• Tuning fork at external auditory meatus; then on mastoid bone
  BC longer than or equal to AC (BC ≥ AC).

Answer 33

Conductive Loss

Question 34

• Inner ear disorder involves cochlear nerve and neuronal impulse transmission tothe brain. Causes include loud noise exposure, inner ear infections, trauma, acoustic neuroma, congenital and familial disorders, and aging.
• onset: Middle or later years
• Problem not visible in the ear canal and drum
• Higher registers are lost, so sound may be distorted
  Hearing worsens in noisy environment
  Voice may be loud because hearing is difficult
• Tuning fork at vertex
  Sound lateralizes to good ear—inner ear or cochlear nerve damage impairs transmission to affected ear.
• Tuning fork at external auditory meatus; then on mastoid bone
  AC longer than BC (AC > BC).

Answer 34

Sensorineural Loss

Question 35

Measures the distance between the lateral angle of the orbit and an imaginary line across the most anterior point of the cornea.

Answer 35

Exophthalmometer

Question 36

Present in 60% of patients with Graves ophthalmopathy

Common symptoms 
• diplopia and tearing.
• Grittiness 
• Pain from corneal exposure. 
• Eyelid retraction (91%), 
• Extraocular muscle dysfunction (43%), 
• Ocular pain (30%)
• Lacrimation (23%)

Answer 36

Exophthalmos

Question 37

Discharge of mucopurulent fluid from the puncta

Answer 37

Nasolacrimal Duct Obstruction

Question 38

Reaction when the left-sided optic nerve is damaged in swinging flashlight test

Answer 38

Light reaction

Question 39

Defect on the afferent pupil

Answer 39

Marcus Gunn pupil