Path 3 Flashcards
dacryocystitis vs adenitis
obstruction lacrimal duct –> pooling of tears in lacrimal sac –> infxn of lacrimal drainage system vs unilat ascending infxn of lacrimal gland in young children –> s shaped lid w/ pain & d/c
hordeolum vs chalazion
infxn of sebaceous glands by s aureus –> tx w/ warm compresses or I&D vs infxn of Meibomian gland –> chronic painless granulomatous nodule of macs/multinuc giant cells/plasma cells
internal vs external hordeolum
infxn of meibomian gland –> red tender lump on eyelid toward skin/conjunctiva vs gland of Zeis –> painful postule outside of eyelid
preseptal vs orbital cellulitis
infxn ant to orbital septum, ethmoid > maxillary sinus; s pneu, H flu; full EOM, CT shows opac ant to orbital septum w/o inflamm vs infxn post to orbital septum, rhinosinusitis; s pneu, H flu, s pyogenes, s aureus; paralyzed EOM, CT shows opac post to orbital septum w/ inflamm
blepharitis
meibomian gland dysfxn –> hyperkeratinization –> altered lipid comp –> bacterial growth –> lipase –> monoglycerides = toxic to ocular surface –> dry eye, FB sens, removable scales
IOID w/ sxs. CT shows? tx?
isolated uni orbital inflam –> exophthalmos, diplopia, ophthalmoplegia, compressive optic neuropathy. ill defined mass w/ hetero comp. high dose oral steroids
corneal arcus vs kayser fleischer ring vs calcified band keratopathy
age related bil white LDL/chol-ester ring around cornea vs copper/brown, green-yellow ring Descemet mem vs Ca2+ salts in Bowman’s membrane in central cornea; dystrophic -> chronic uveitis, end stage glaucoma vs mets -> hyperparathyroid, renal fail
keratoconus
sporadic or auto dom assoc w/ Down, Turner, Alport Marfan; bil noninflamm but asymm cornea becomes cone shaped d/t thinning + breaks in Bowman & Descemet mem
FED. genes?
cornea endothel maintains health & transparency but d/o –> corneal clouding, guttae (type VIII collagen fibrils alpha1 chain), thick Descemet –> blurring vision that abates during day, dec evap. COL8A2, ZEB1, SLC4A11
bacterial (risk factors, which bacteria, sxs, dx, tx) vs HSV keratitis (virus, sx, dx)
from ocular surface dz or trauma, contacts; from staph or pseudomonas. hyperemia, chemosis, purulent d/c, corneal ulcers. corneal scrape, stain, cx. topical abx drops vs HSV 1 dormant in trigeminal ganglion –> dendrites w/ end bulbs, nonlinear geographic ulcer –> corneal scar, neovasc, vision loss. stain basement mem w/ fluorescin
nuclear vs cortical vs post subcapsular senile cataract. dx? tx?
fading of lens w/ eos staining vs accum eos fluid –> displace & degen bordering fibers vs post mig of lens d/t external stimulus. ophthalmoscope, slit lamp. lens extraction
risk factors of primary vs secondary open angle glaucoma
age, IOP, black, fhx vs trauma, RBC clot/obstruction, pig dispersion syndrome, pseudoexfoliation syndrome
open vs closed angle glaucoma w/ dx (& tx)
deposited extracell in trab mesh & schlemm –> degen
trab mesh –> impaired aq drain –> inc IOP –> optic n dmg + visio loss; optic disc change vs pupillary block –> impaired aq drain –> inc IOP; narrow angle on gonioscopy, optic n/visual changes. tx w/ laser iridotomy
glaucomatous optic neuropathy
inc IOP –> nerve compression, reduced bloodflow –> axonal dmg –> cupping (enlarged cup > optic disc) –> VF loss
infectious (mostly in post) vs noninfectious uveitis. granulomatous vs nongranulomatous uveitis. endophthalmitis vs panophthalmitis
hematogenous spread from HSV, VZV, TB, C albicans, toxo gondii vs from autoimmune or immune mediated. granulomas from TB, syphilis, sarcoidosis, toxo vs perivasc lymphatic cuff + infiltration of retinal vessels. purulent inflamm of intraocular tissue x/ sclera vs inflamm of entire globe w/ orbital extension
sporadic vs inherited uveal melanoma mutations
GNAQ/GNA11 G protein mutations –> activates MAPK vs auto dom inactivating BAP1 –> deubiquitin
spindle vs endothel cell uveal melanoma. risk factors? dx? tx?
fusiform shaped atypical melanocytes -> favorable prog vs spherical shaped atypical melanocytes -> poor prog. fair skin, freckles, prone to sunburn, UV. iris –> slit lamp, ciliary body –> US, choroid –> dil indirect ophthalmoscope or US. rad, enucleation
retinitis pigmentosa. genes?
auto dom/rec, X linked mutations –> RPE degen –> rod degen –> cone degen –> bone spicule pig in fundus –> tunnel vision, retinal atrophy, photophobia. RHO for rhodopsin, UsH2A for usherin, RPGR for RPGR
dry vs wet AMD
drusen, geographic atrophy –> lost RPE, greater choroid vessel visibility –> vision loss vs neovasc –> detached RPE –> dome shaped elevation on exam –> loss photoreceptors, accum of lipofuschin –> lost central vision
passive vs active retinal detach. rhegmatogenous vs traction vs exudative retinal detach. sxs of retinal detach?
d/t fluid accum vs d/t vit traction on retina in DM. lacunae filled w/ vit, frag of collagen, proteoglycan accum vs fibrotic adhesions b/w vit & retina –> separate retina from RPE vs fluid accum under retina. floaters w/ fleeting photopsia, permanent vision loss after 24h
sporadic vs hereditary retinoblastoma. gene? gross vs microscopic. endo vs exophytic growth. sxs?
uni vs auto dom, bil. Rb1 tumor suppressor b/w G1 + S phase. yellow/white vs blue cells w/ hyperchromatic nuclei & scant cyto and high mitosis. inner retinal layer growing centrally into vit cavity vs outer retinal layer detaching retina & invade choroidal stroma; hematogenous spread. leukocoria, strab, inflam -> red eye, pain, orbital cellulitis
Trilateral retinoblastoma
vs Nonocular malig tumors in retinoblastoma survivors
uni/bil hereditary retinoblastoma (Rb1 mutation) w/ intracran midline pineoblastoma vs Rb1 mutation –> inc risk of nonoc malig tumors in soft head tissue, bone, skin, brain
ant ischemic optic neuropathy. arteritic vs nonarteritic
ischemia of optic n –> optic n dmg –> monocular vision loss, afferent pupillary defect. d/t giant cell/temporal arteritis vs isolated stroke of optic n assoc w/ HTN, HLD, DM
papilledema
from ICP –> bil optic disc swelling –> inc CSF –> optic n sheath stops axonal transport –> nerve head swelling seen on ophthalmoscope –> graying out vision, blurry
leber hereditary optic neuropathy
mito inherited MT ND6 encoding ND6 protein –> loss retinal ganglion + diffuse axonal depletion of optic n –> optic atrophy, optic hyperemia, vision loss both eyes, no pain. RPE & photoreceptors = unaffected
genetic vs environ etio of otosclerosis. modeling vs remodeling
auto dom w/ dec penetrance vs similar to Paget’s, paramyxovirus, measles. from skel develop in fetus to 2nd decade vs initiated by osteocyte apop –> occurs throughout life by osteob/clasts & doesn’t change shape of bone
osteoprotegerin (OPG). how does this affect pts w/ otosclerosis?
anti-resorptive cytok produced 1000x more in inner ear secreted in perilymph –> no clasts. dec OPG prod –> bone remodeling –> conductive hearing loss
Stapes endplate also has what cytok?
increased TNF-alpha + IL-1beta = pro-inflammatory cytokines w/ anti-apoptotic effect –> inc inflow of immature forms of osteoclasts –> more resorption & remodeling
Otosclerotic foci have predilection for what window?
ant/post oval > round > basal/apical cochlear –> sensorineural hearing loss
Otospongiotic vs Otosclerotic phase w/ CT
inc clast –> resorption of bony otic capsule –> replace nml bone w/ enlarged marrow spaces + enlarged
vasc channels w/ capillary proliferation –> blue staining porous + spongy bone. demineralized lesions w/ lower density vs remodeling –> replacement w/ osteoid –> new cellular “woven” bone but poorly organized. remineralization –> indistinguishable findings from nml otic capsule
otosclerosis sxs vs dx vs tx
bil/asymm hearing, tinnitus, vestibular complaints vs rinne (pos if nml AC>BC, neg if conductive BC>AC) & weber (nml if hear both ears; conductive in affected ear, sensorineural in unaffected ear) tuning fork test. air conduxn audiometry (pts raise hand if hear sound but sound drops 10dB q time) & bone conduxn audiometry (bone vibrating device on mastoid; sound bypass outer/middle ear –> to inner ear). CT of mid ear & bony labryinth vs hearing aids to amplify sound & transmit energy to stiff ossicles; stapedectomy & stapotomy to restore middle ear
conductive vs sensorineural vs mixed hearing loss
BC>AC b/c problems conducting sound waves in out/mid ear and TM vs poor AC & BC b/c problems w/ inner ear, CN8, or central processing brain centers vs BC>AC but both air & bone thresholds low
describe ext ac meatus. ceruminous glands?
tube from auricle to TM lined by strat sq w/ wall reinforced by elastic cartilage (superficial 1/3) or bone (deep 2/3). modified apocrine sweat glands secreting cerumen into hair follicles or surface
describe TM. it has 2 regions pars flaccida vs pars tensa
fibrous mem separating ext ac meatus from mid ear. sup small nontense area vs tense area attached to annulus fibrocartilaginous
TM has 3 layers: cuticular vs intermediate fibrous vs inner mucous layer
thin hairless skin vs outer layer = fibers radially, inner layer = fibers circular vs simple cub epith w/ thin underlying lamina propria
describe ossicles
endochrondial bone lined w/ simple cub or pseudostrat epith w/ thin underlying lamina propria
describe cochlea. 3 canal cmpts: scala vestibuli vs media vs tympani. what does spiral ganglion contain?
tri-cmpt tube spiraling around modiolus containing auditory sense organ. at oval window w/ perilymph vs contains organ of Corti w/ endolymph maintained by stria vascularis -> strat sq w/ highly vascularized lamina propria vs w/ perilymph, separated from media by basilar mem. cell bodies of bipolar neurons to CN8
describe organ of Corti
on basilar mem; tect mem on top of its hair cells –> waves in endolymph make tect mem depress cilia of hair cells. contains supporting cells: pillar cells for foundation, inner/outer phalangeal cells for support
otoliths vs semicirc canals
utricle (closer to semicirc canal) & saccule. 3 layers: columnar (type 2), goblet (type 1), supporting cells. cilia in glycoprotein. ca carbonate crystals on top of glycoprotein layer for linear acc vs contains crista ampullaris receptor organ for rot acc (XYZ planes). type 1&2 hair cells surrounded by supporting cells, cilia in glycoprotein cupula. rotation -> endolymph pushes cupula in opposite direction -> detected by hair cells
eye has 3 tunicas: tunica fibrosa vs vasculosa vs interna. know characteristics of each
cornea ant 1/6, limbus, sclera 5/6 vs uvea: iris (ant), ciliary body, choroid (post) vs retina. Eye lecture notes pgs 1-4
intraocular structures: vit body vs lens
water & hyaluronic acid, periph fibril capsule, macs & fibrocytes, hyaloid canal (remnant of hyaloid a from optic disk to vit to lens) vs elastic avasc biconvex structure focusing light on retina, nourished by aq humor; lens capsule = elastic & transport basal lamina covering entire lens to prevent penetration of cells, subcapsular epith = low cub to columnar near lens equator, lens fibers = long/narrow/hexagon/anuclear/epith cells making up bulk of lens filled w/ crystallin proteins
extraocular accessory structures: conjunctiva vs eyelids/palpebrae vs lacrimal gland
covers exposed part of sclera => bulbar conjunctiva; covers inside of lid => palpebral; strat sq to strat cub epith w/ goblet cells & underlying connective tissue vs covers skin ant & conjuctiva post; tarsus; tarsal/Meibomian glands = mod sebac glands for lub; voluntary skel muscle; Zeis (eyelash) & Moll (mod apocrine sweat) glands for oily layer to cover tear layer -> slow evap vs tubuloalveolar glands making tears, basophilic secretory acini makes lysozyme in tears
where is canal of schlemm? what does RPE contain? what is Bruch’s mem? ganglion cells in retina are what kind of neurons; where do their axons converge? photoreceptors have what 3 parts? optic n = outgrowth of what?
b/w iris & cornea. melanin, apical microvilli. separates RPE & choroid. unipolar; optic disc. outer seg -> light sensitive visual pig, microvilli; inner seg -> Muller cells; cell body. small yellow disc of fovea. forebrain enveloped by meninges
