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OPHTHALMOLOGY BCSC > Questions 2 > Flashcards

Questions 2 Flashcards

1
Q

lincoff’s rules (4)

A
  1. ST or SN RDs primary breaks are within 1:30 clock hours of highest border
  2. total or superior RDs crossing 12 oclock. break is at 12 oclock or in a triangle
  3. inferior RDs higher side of RD indicates side of optic disc primary break is one
  4. inferior bullous RDs. break is superior.
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2
Q

Alstrom syndrome. ocular manifestation and systemic

A

dilated cardiomyopathy

cone rod dystrophy

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3
Q

congenital ectropion uveae is associated with what condition

A

NF, Rieger syndrome

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4
Q

what is harada ito procedure?

A

advancement of superior oblique tendon’s anterior fibers to strengthen it. increases torsion without significant ipsilateral hypertropia.

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5
Q

monocular oscillopsia. cause. treatment.

A

caused by superior oblique myokymia. terat with phenytoin, topical timolol, carbamazepine.

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6
Q

ophthalmodynamometry. what is it?

A

used to measure retinal artery pressure. can distinguish CRVO from ocular ischemic syndrome.

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7
Q

fluorophotometry. what is it

A

measures aqueous humor formation.

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8
Q

I:S ratio in keratocnus

A

> 1.4

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9
Q

treatment for hydrops

A

hypertonic saline, patching, cycloplegia, aq suppressants

gas in AC (pneumatic decemetopexy)

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10
Q

CMV response to antivirals is gauged by what

A

how big the size is and how much activity there is at the edge of the lesion

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11
Q

three most likely broad etiologies for color loss?

A

macular dz, parietal lobe dz, optic neuropathy

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12
Q

RPE abnormalities in AMD?

A

geographic atrophy, non geographic atrophy, and focal hyperpigmentation

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13
Q

causes of leukocoria?

A

Rb, congenital cataract, coat’s disease, retinal detachment, PHPV, coloboma, ROP, toxocariasis

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14
Q

what are three ways of measuring corneal power on topography?

A
  1. axial curvature: takse a Sagitta cut through line of site. better at estimation of central K
  2. instantaneous radius of curvature- takes just one point. better at peripheral estimation
  3. mean curvature-this uses best fit sphere method. also better for peripheral K

SAC TIP (sagittal axial central; tangential instantaneous peripheral)

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15
Q

according to ONTT, what appearance of the optic nerve is associated with least likelihood of MS?

A

very edematous with hemorrhages.

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16
Q

what gauge needles do you use for AC tap vs vitreous tap?

A

30 gauge for AC

25 gauge for vitreous

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17
Q

What medicine can you use to cause miosis in scotopic conditions? why is this useful

A

brimonidine can be used to cause miosis in apodized multifocal IOLs or s/p LASIK to decrease scotopic glare

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18
Q

endogenous fungal Endophthalmitis. risk factors without overt known fungemia??

A

recent GI surgery, prolonged indwelling catheters

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19
Q

How do you treat endogenous fungal endophthalmitis without systemic infection?

A

oral fluconazole or voriconazole if retinal alone.

vitrectomy with intravitreoal vori or ampho

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20
Q

what is the 5 year risk of contralateral involvement in GCA?

A

54-95%

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21
Q

what’s the 5 year risk of contralateral involvement of NAION?

A

15%

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22
Q

what’s the indication for phakic IOLs?

A

young patients who cannot undergo corneal refractive surgery and desire to be spectacle free

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23
Q

posterior chamber depth for phakic IOLs?

A

250-750 microns. 1.0 +/- 1.00 corneal thickness.

this allows the lens to be vaulted to prevent pupillary block, iris chaffing, and anterior capsular cataract.

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24
Q

most common cause of endogenous endophthalmitis in Asia?

A

klebsiella liver abscess

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25
Q

most common cause of endogenous endophthalmitis in IV drug users?

A

bacillus species

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26
Q

what is heavy eye syndrome in high myopia?

A

elongation of globe herniates between superior and lateral rectus. eye deviates infra nasally.

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27
Q

at what age do children peak in terms of hyperopia?

A

age 6-8

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28
Q

what’s the pathophys of dellen?

A

raised conj…leading to drying of adjacent cornea… leading to thinning of epithelium and stroma. Rehydration would lead to reformation of area.

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29
Q

siderosis on ERG?

A

A wave initially is more negative with nl B wave. then B wave disappears with time.

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30
Q

what’s the power of a Hruby lens

A

55D. attached to slit lamp to give a upright image that is very restricted in field of view.

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31
Q

tonic pupil pathophys

A

disruption of post-ganglionic parasympathetic pupillomotor fibers.

idiopathic is most common.
orbital tumors, VZV, orbital trauma, giant cell arteritis, DM, amyloidosis, syphilis.

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32
Q

which study established tight glycemic control is effective to reduce microvascular damage?

A

UK prospective Diabetes study (UKPDS)

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33
Q

Macular Dystrophy MARKS the cornea limbus to limbus

A

Macular
AR auto recessive
KS keratan sulfate
limbus to limbus

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34
Q

how many percent of people with symptomatic PVD will have a hole/tear?

A

15%

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35
Q

how many percent of people with hemorrhagic PVD will have a hole/tear?

A

50-70%

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36
Q

how many % of patients with ankylosing spondylitis have HLAB27 positivity?

A

90%. preferred treatment is TNFa inhibitors such as infliximab

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37
Q

monocular elevator deficiency with chin up position and hypotropia…how can you correct

A

if there’s restriction–release it.

if not knapp procedure by borrowing medial or lateral rectus portions to superior rectus

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38
Q

what is the Hummelsheim-type procedure?

A

similar to knapp procedure for elevator defect. it’s for CN VI palsy by borrowing fibers from superior/inferior rectus

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39
Q

common features of congenital esotropia?

A 
<6 months of age
cross fixation
DVD
latent nystagmus
angle is usually large
possible V pattern
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40
Q

three types of glycosminaglycans in the corneal stroma

A

dermatan, keratan, chondroitin sulfate

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41
Q

what distance should be in between the two lenses of telescopes?

A

the addition of the two focal lengths

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42
Q

Ishihara plates tests for what kind of color deficiency?

A

red-green deficiency only!
use Anthony tritan plates for blue yellow. Farnsworth panel D-15, lathery desaturated 15 hue test, or farnsworth-munsell 100-hue test for detailed testing

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43
Q

Best disease gene?

A

VMD2 gene for bestrophin

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44
Q

what does EOG measure

A

TransRPE potential

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45
Q

what are paraxial rays?

A

rays coming in near the center of the optical center of the lens and is not refracted very much

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46
Q

features of hemangiopericytomas?

A

well circumscribed tumors with or without pain.

pericytes with “stag horn” blood channels. reticulin deposits surround each cell

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47
Q

what are neutral density filters?

A

put it over the good eye to quantify APD

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48
Q

in a DCR…what is 8 mm medial to the medial canthus?

A

angular artery and vein

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49
Q

what is angle alpha and angle kappa and angle gamma?

A

alpha is: optical center, and visual center (AOV)
Kappa: is pupillary center and visual center (KPV)
Gamma: is optical and fixation axis (GOF)

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50
Q

what is angle alpha most important in ?

A

alpha is important for multifocal IOL placements. if too large then they’re not a good candidate

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51
Q

what is angle kappa most important in?

A

kappa is important for corneal refractive surgery

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52
Q

refractive index of cornea?

A

1.376

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53
Q

exudative retinal detachments can occur with PRP. how do you treat this?

A

treat by steroids and observation. will spontaneously resolve.

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54
Q

hypo pigmented iris spots seen in Down syndrome are called what

A

Brushfield spots (similar Wofflin nodules can occur with normal individuals)

due to stromal hyperplasia

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55
Q

polypoidal choroidal vasculopathy characteristics

A

mostly older F blacks/asians.
present with serous or hemorrhagic RD.
Tend to be around peripapillary areas
ICG is most helpful

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56
Q

other than central retinal artery…what other artery is seen in 15-30% of people in the retina?

A

cilioretinal artery (from posterior ciliary arteries)

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57
Q

GCA patient who is on steroids….how long do you have until temporal artery biopsy is no longer valid

A

1-2 weeks

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58
Q

Bardet-Biedl syndrome

A

intellectual disability, hypogonadism, renal failure, poly dactyl, obese, nyctalopia, macular mottling, pigmentary retinopathy

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59
Q

Alsotrome syndrome

A

autosomal recessive, retinal degeneration, obesity, DM, hearing loss, renal failure, dilated CM.

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60
Q

which are the septet fungi?

A

FACtSeptate

fusarium, aspergilis, curvularia

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61
Q

pigment dispersion syndrome. other than glaucoma and zonular instability… what other complications do they have

A

RD

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62
Q

unilateral optic neuropathy with disc swelling and APD. do FA and there’s no leakage…what’s the diagnosis

A

Leber’s hereditary optic neuropathy.

other findings include peripapillary telangiectasia

63
Q

most commonly used isotope for treating choroidal melanoma in the US

A

iodine 125

64
Q

which wall of the orbit has the shortest length (anterior posterior length)

A

floor. it does not extend to apex and stops at the pterygopalatine fossa

65
Q

treatments for acanthomoeba keratitis?

A

biguanide, PHMB/propamidine, chlorhexidine,

66
Q

corneal power estimation s/p refractive surgery…

A

Kestimated=Kpre+Rpre-Rpost

67
Q

What corneal thickness/endothelial count is at risk for poor outcome after cataract surgery

A

thickness >600 and endo count <1000

68
Q

what are optociliary shunt vessels?

A

retinochoroidal collaterals due to chronic poor central retinal vein drainage. These are from the arachnoid.

causes: optic sheath meningioma, gliomas, chronic Papilledema, glaucoma, old CRVO/BRVO

69
Q

retinal hemorrhage in a few day old baby..what should you do

A

observe…can be due to birth trauma.

70
Q

how many milliliters is the avg eye

A

7 ml (5ml is vitreous)

71
Q

Risk factors for AMD

A

Female, age, light iris, caucasian, HTN, CAD, HLD, FMHx

Smoking and hyperopia

72
Q

Alagile syndrome?

A

JAG1 mutation
broaden forehead, pointed chin, betterfly hemivertebrae, developmental delay, jaundice, cardiac defects, POSTIOER EMBRYOTOXON

73
Q

don’t give doxycycline to which patients?

A
  • women of reproductive age
  • breast cancer hx
  • liver disease
  • on AC
  • children
74
Q

epithelial dystrophies in order of increasing recurrence s/p graft

A

Let’s Graft More

lattice, granular, macular

75
Q

progression of epithelial dystrophies in increasing order?

A

May like to grow

Mac, lattice, granular

76
Q

chalmydia trachoma…classic findings

A

Herbet pits (from gimbal follicles), tarsal conj scarring, panus at superior limbus, follicles/arlts line at superior limbus

77
Q

AREDS are beneficial to

A

eyes with intermediate AMD, advance unilateral AMD, non subfoveal geographic atrophy

78
Q

uveitis and facial paralysis ddx?

A

sarcoid vs lyme

79
Q

neurosarcoid usually involves what nerve

A

CN VII and II

80
Q

hemifacial spasm that doesn’t go away when sleeping

A

facial nerve compression via ecstatic vertebral or AICA arteries.
sx control with botox OR Janetta procedure done by neurosurg (place sponge between nerve and vessel.

81
Q

squamous cell carcinomas should be excised with what margin?

A

4mm

82
Q

iron filings on lens capsule?

A

pseudoexfoliation

83
Q

dominant optic atrophy AKA Kjer optic atrophy

A

temporal pallor with area of triangle excavation

  • slow loss of vision
  • no nystagmus
  • ble yellow (titan) dyschromatopsia
  • OPA1 gene
  • generally will progress to 20/200 vision and stop
84
Q

Behr optic atrophy

A

childhood on set of visual loss, ataxia, intellectual disability, urinary incontinence.

85
Q

how is macular edema in CRVO treated

A

antiVEGF or IV steroids

laser doesn’t improve VA according to CVOS

86
Q

Type 1 unilateral parafoveal telangiectasia (Leber Miliary Aneurysms)

A

macular Coats-like exudates
usually in males
edema responds to PRP.

Type II parafoveal telangiectasia does not work with laser.

87
Q

Enhanced S-Cone syndrome

A

apparent macular edema on OCT but more truly represents macular schisis.

88
Q

oculomasticatory myorhythmia

A

whipples disease

89
Q

What’s absolute hyperopia?
manifest hyperopia?
facultative hyperopia
latent hyperopia?

A

-absolute hyperopia: (noncycloplegic) minim plus correction needed for clear distance vision
-Manifest hyperopia: max noncycloplegic plus the eye can accept without blurring vision
-Facultative hyperopia: manifest hyperopia-absolute hyperopia
latent hyperopia: cycloplegia hyperopia-manifest hyperopia

90
Q

the two antibodies for myasthenia?

A

anti ACH R and anti MuSK

91
Q

cogan’s lid twitch?

A

lid retraction s/p lateral gaze and returning to primary gaze. Associated with myasthenia

92
Q

what is Q value?

A

the asphericity of the cornea.
Q value 0= spherical K
Q value < 0 is prolate
Q value > 0 is oblate

93
Q

what are the three layers of the sclera?

A

episclera, stroma, lamina fusca (uveal is attached at lamina fusca)

94
Q

Melkerson Rosenthal syndrome

A

recurrent facial paralysis
orofacial edema
lingual plicate/ fissured tongue

-granulomatous infiltration. Treat with cortical steroids/immunomodulatory agents

95
Q

which type of UV ray tend to reach the lens to cause oxidative damage?

A

UVA.

UVB is generally filtered out by the cornea and aqueous.

96
Q

non pigmented epithelium of the ciliary body. characteristics?

A

lens zones originate from basal laminae of these cells

  • aqeous is produced here
  • tight junctions make up blood aqueous barrier
  • apart of neuroectoderm and continues to be connected to posterior pigmented epithelial layer of the iris
97
Q

spiral of tillaux

A

5.5,6.5, 6.9, 7.7

98
Q

bitot spot

A

seen in vitamin A deficiency–> loss of goblet cells. Bitot spot are foamy lesions made of keratinized epithelium, debris, inflammatory cells, and corynebacterium xerosis

99
Q

congenital glaucoma

A

M>F, 2/3 are bilateral

100
Q

what makes up primary vitreous

A

hyaloid artery, vasa haloidea propria, mesenchymal cells, tunic vasculosa lentos

101
Q

what does tertiary vitreous consist of?

A

zone fibers

102
Q

features of atopic keratoconjunctivitis

A

small papillae, K vascularization, year round disease, PSC, anterior sub capsular cataract

-depressed cell mediated immunity and Increased risk of HSV keratitis

103
Q

optic nerve passes through optic canal–which is located in which part of the sphenoid?

A

lesser wing

104
Q

corneal transplant graft…which type of rejection is worst in prognosis

A

endothelial cell rejection as endothelial cells cannot be replaced.

105
Q

is there any difference in graft donors <66 y/o vs >66 y/o for PKs?

A

no they both had the same failure rate in the Cornea Donor Study

106
Q

whats % of patients develop visually significant cataracts 2 years after vitrectomy?

A

90%

107
Q

Pyogenic granuloma

A

actually reactive hemangioma–fibroblasts and proliferating capillaries. Histologically has “spoke wheel” vascular pattern. 3-4 weeks s/p surgery. treat with intralesional steroid , cautery

108
Q

Jones I
Jones II
JOnes III

A

Jones I is testing the nose after a fluorescent disapeance test.
Jones II is using irrigation after a jones 1 with saline to flush out any potential blockage

Jones III s/p DCR. dye disappearance test then swab middle meatus

109
Q

cholesterolosis (aka synthesis scintillatingans)

A

yellow crystals in the inferior vitreous space in eyes that have under gone trauma

110
Q

retinoscopy is done at what distance for a working distance subtract of 1.50 for final refraction

A

66cm; 2/3 of a meter

111
Q

retinoscopy – you want to make all meridians to what motion first?

A

add minus so all meridians are with motion

112
Q

Sildenafil gives blue vision due to cross reactivity between PDE5 and PDE6. What is another ocular side effect of sildenafil

A

NAION

113
Q

hidrocystomas include fluid from what structure

A

apocrine glands of moll

114
Q

promethazine (antiemetic) should not be used in what group of patients

A

Peds under age of 2. can cause severe respiratory depression

115
Q

Scheie syndrome. mucopolysaccharidosis.. what’s the enzyme not broken down?

A

lysosomal alphaL iduronidase
(mildler Hurler’s syndrome)
both are type 1 MPS

116
Q

major ocular finding in Hunter’s syndrome

A

retinal degeneration

MPS2

117
Q

indication of enucleation in Rb

A

tumor occupying >50% of globe
optic nerve involvement
anterior segment involvement

118
Q

What is type 1 choroidal neovascularization

A

vessels from choroiocapillais grow through a defect in Bruch’s membrane in to sub RPE space.

  • poorly delineated with late staining on FA
  • “Occult” CNV
119
Q

what is type II choroidal neovascularization

A

Abnl vessels from choriocapillaris penetrate through RPE–between RPE and outer segments of retina.

  • FA shows well demarcated vascular pattern on early phase.
  • lacy gray-green appearance on funds exam
  • “classic” CNV
120
Q

what is type 3 CNV?

A

originates from blood vessels of the deep capillary plexus of retina and grow downward to RPE
“retinal angiomatous proliferation.”

121
Q

CN V1 divides in to frontal, nasociliary, and lacrimal.

What are the two subdivisions of frontal nerve
what are the two subdivisions of nasociliary

A

frontal: supratrochlear and supraorbital
nasociliary: ethmoidal and long ciliary nerve (to iris, cornea, and ciliary body, and nose skin)–thus Hutchinson’s sign

122
Q

What percentage of PAM with atypic will progress to melanoma?

A

47%;

if there’s PAM with atypic with pagetoid spread or full thickness epithelial involvement then it’s 75-90%

123
Q

causes of crystalline retinopathy

A

tamoxifen, antifreeze (ethylene glycol), talc, Bietti crystalline dystrophy, nitrofurantoin, methoxyfurane

124
Q

what kind of cells are rhabdomyosarcoma derived from

A

undifferentiated mesenchymal cells. NOT muscle

125
Q

echothiophate. should not be given together with what. what are other side effects and how to prevent?

A

do not give with succinylcholine

SE: iris cyst, ectopia uvea–prevent with phenylephrine

126
Q

two types of degenerative schisis

A

Typical and reticular (splitting at RNFL)-ppx treatment is not recommended if asymptomatic

127
Q

choroidal melanoma…which cell type has worse pox

A

epitheliod

128
Q

sx of hyperparathyroidism

A

bones, stones, psych overtones

129
Q

Bowmans is what collagen type

A

I and V

130
Q

when is AC wash out indicated in hyphemas?

A

IOP >60 for 2 days, IOP >35 for 7 days, IOP >25 for 1 day with sickle cell

also corneal endothelial staining

131
Q

CD45

A

immature lymphocyte marker

132
Q

extra ocular muscle blood supply?

A

ophthalmic artery–> lateral muscular branch and medial muscular branch.

lateral musc branch: lateral R, superior R, superior oblique, levator palpeerde.
Medial muscular branch: inferior rectus, medial rectus, inferior oblique muscles.

133
Q

Riley Day syndrome

A

familial dysautonomia.
-ashkenazi family hx, skin blotching, neurotropic keratopathy with decreased tearing.
enlarged corneal nerves

134
Q

what are angioid streaks?

A

breaks in Bruch’s membrane–can lead to spontaneous sub retinal hemorrhage and sometime CNV (which then causes permanent vision loss)

135
Q

what are associations of angioid streaks

A

B PEPSI: beta that, pseudoxanthoma elastic, ehler danlos, paget bone disease, sickle cell, idiopathic

136
Q

megalocornea definition? inheritance?

A

X linked.

>/=13mm in diameter

137
Q

associated disorders with megalocornea?

A

marfan’s
Down syndrome
alport
osteogenesis imperfecta

138
Q

most common condition leading to corneal transplant in children?

A

Peters anomaly

139
Q

FEVR

A

genetic disorder of retinal blood vessel development–results in vitreous traction, peripheral exudation, peripheral breaks, incomplete retinal vascularization. similar to ROP

autosomal dominant

140
Q

incontinenential pigmenti (IP)

A

AKA Block-Sulzberger syndrome (x linked dominant; lethal in homozygous male) skin bull on extremities, hyper pigmented bascules on trunk. microcephaly, seizures. ROP-like funds with incomplete peripheral vascularization. leading to CNVM and detachment,

141
Q

DUSN. what are the the organisms? what’s the clinical presentation? treatment?

A

organisms: Baylisascarias procyonis, ancylostoma, toxocara

PresentatioN: multifocal choroiditis, mild optic nerve swelling, mild vitirits. retinal arterial narrowing, RPE changes.

treatment is PRP the nematode that can be seen under the retina

142
Q

peripheral retinal findings with increased risk of tear and RD?

A
  • cystic retinal tufts
  • zonular traction retinal tufts
  • lattice degernation
  • meridional folds
  • encoded ora bays
  • peripheral retinal excavations
143
Q

peripheral findings NOT predisposed to tears/and RD?

A

-noncystic retinal tufts
-cobble stone degernation
RPE hyperplasia
RPE hypertrophy
peripheral cystoid degernation

144
Q

what is the fasanella-servat procedure?

A

tasoconjunctival mullerectomy

  • generally not the choice of therapy due to the fact it removes tarsus
  • good only for mild ptosis with good amount of elevator function
145
Q

blue light forms what phytotoxic compound leading to oxidative RPE damage?

A

A2E

146
Q

Stargardt

A 
AR, ABCA4
beaten bronze Mac atrophy
funds flamimaculuatus
dark choroid on FA
lipofuscin

Avoid vit A due to increased lipofuscin accumulation

147
Q

holes of V1,2,3

A

Standing Room Only

sup orbital fissure
foramen rotundum
foramen ovale

148
Q

gyrate atrophy

A

OAT mutation

elevated plasma ornithine

149
Q

choroideremia

A

x linked
CHM gene–geranylgeranyl transferase

–scalloped RPE and choriocapillaris loss–> tunnel vision

retinal vessels remain normal

150
Q

homer wright rosettes

A

neuroblastoma
retinoblastoma
medulloblastoma

151
Q

psammoma bodies

A

meningioma

152
Q

Rosenthal fibers

A

optic gliomas, pilocytic astrocytomas

153
Q

post orbital Surg pain… think what?

A

retrobulbar hematoma. due to perforating arteries (from infraorbital artery) in the infra temporal quadrant

OPHTHALMOLOGY BCSC (8 decks)

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