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OPHTHALMOLOGY BCSC > QUESTIONS > Flashcards

QUESTIONS Flashcards

1
Q

How do you treat post op pupillary block

A

cycloplegia, LPI

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2
Q

How do you treat post op ciliary block?

A

cycloplegia, LPI (to r/o pupillary block), aqueous suppression

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3
Q

patients with elevated IOP from ICE syndrome…what is best therapy?

A

tube shunt vs trabeculectomy. laser angle surgery doesn’t work due to angle abnl

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4
Q

What serologic markers are most associated with uveitis in JIA patients?

A

postive ANA with negative RF

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5
Q

First line treatment for fungal keratitis?

A

natamycin–only available topical anti fungal in US

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6
Q

When should you consider giving steroids in EKC?

A

SEIs or pseudomembranes

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7
Q

prostaglandin ocular side effects?

A

macular edema, uveitis

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8
Q

topical carbonic anhydrase ocular side effects?

A

K edema

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9
Q

laser trabeculoplasty is good for patients for what kind of angle structure?

A

open angles such as in pseudo exfoliation syndrome

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10
Q

what is Kasabach Merritt syndrome?

A

infantile hemangioma on organs leading to thrombocytopenia due to sequestration

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11
Q

anterioposterior width of lens at birth and in adult?

A

3.5 mm and 5 mm in adults

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12
Q

what’s the width of a phase tip?

A

1.6mm

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13
Q

what optic disc features are seen in NTG?

A

larger CDR, sloping, PPA, disc hemorrhage

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14
Q

what is scleromalacia perforans?

A

necrotizing scleritis WITHOUT inflammation. Associated with RA and is painless. High mortality–manage with a rheumatologist

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15
Q

redundant periumbilical fold is associated with what condition?

A

axenfeld rieger

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16
Q

interrupted PKP sutures are best for what kind of patients?

A

inflamed K, children, thin cornea, and vascularized corneas.

allows sutures to be removed individually if needed

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17
Q

rubella infection of second trimester is associated with what?

A

retinopathy

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18
Q

rubella of first trimester is associated with sequestration of virus in lens leading to cataracts… what other association is almost never seen at the same time with cataracts in these patients

A

congenital glaucoma

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19
Q

myasthenia gravis is also associated with what comorbid condition?

A

Graves and thymoma

Get TSH and CT chest/neck

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20
Q

salt pepper fundus

A

congenital rubella mostly associated with second trimester infection

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21
Q

describe Lisch Epithelial Corneal Dystrophy?

A

X link dominant condition with micro cysts in epithelium forming whirl like pattern. Similar to Meesman’s

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22
Q

definition and width of perifovea

A

1.5 mm, area of the very peripheral macula

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23
Q

width of parafovea

A

0.5mm, area surrounding fovea. It is where ganglion cells are the thickest

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24
Q

foveola definition. width of foveola?

A

area where there’s only cones.

250 microns

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25
Q

where is foveola in relations to optic nerve?

A

0.4mm temporal, and 0.8mm inferiorly

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26
Q

What is the width of fovea?

A

1.5mm–aka 1 disc diameter

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27
Q

thickness of K epithelium?

A

50 microns

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28
Q

thickness of Bowman’s layer?

A

8-14 microns

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29
Q

Thickness of decedent’s membrane?

A

3 microns at birth —increases to 10 microns in adulthood

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30
Q

nevus of Ota is associated with what condition?

A

glaucoma in 10% pts

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31
Q

Feldenstrucktur muscle is at what NMJs for what movements

A

at En grappe NMJs for smooth pursuits

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32
Q

Fibrillenstruktur muscle is at what NMJs for what movements

A

en plaque NMJs for saccades

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33
Q

Cidofovir ocular side effect?

A

uveitis, hypotony

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34
Q

what conditions are associated with enlarged K nerves/

A

neurofibromatosis 2
MENIIB
leprosy

MeN2 large k nerves

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35
Q

how many % of melanomas come from PAM (with atypic)? de novo? nvus?

A

70% from PAM. de novo 20% rest from nevus

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36
Q

dieffenbachia plant exposure causes what?

A

corneal calcium oxalate crystals called raphides

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37
Q

treatment for toxo?

A

oral: pyrimethamine, sulfadiazine, folic acid…(triple therapy)… then later on prednisone

or IV of clindamycin and dexamethasone

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38
Q

LASIK. what organisms are common infections in <10 days post op? what about >10 days post op?

A

Gram + <10 days

Fungal or atypical mycobacteria >10 days

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39
Q

Lens capsule is thickest where?

A

posterior pre equatorial 23 microns

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40
Q

anterior lens capsule thickness?

A

14microns

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41
Q

direct eye lid closure is used for what size of eye lid defects?

A

<33%

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42
Q

how do you close lid defect 33-50%?

A

lateral canthotomy then rotate flap (Tenzel flap)

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43
Q

what is Cutler-Beard procedure?

A

for UPPER lid defects of >50% by using lower lid as flap

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44
Q

What is the modified Hughes procedure?

A

to fix lower lid defects >50% with upper eyelid flap to construct posterior lamella

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45
Q

what is echothiophate?

A

indirect Miotics. Do NOT give succinylcholine with it as it may prolong paralysis

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46
Q

What is central cloudy dystrophy of Francois?

A

exactly the same appearance as crocodile shagreen. Except for crocodile shagreen develops over time and central cloudy dystrophy of Francois is from birth (it’s a dystrophy)

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47
Q

what are the two flattest quadrants of the cornea?

A

superior and nasal

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48
Q

fovea size

A

1.5mm same as ON

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49
Q

microscopic breaks in bowman’s layer is associated with early stages of what condition?

A

Keratoconus

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50
Q

What is the difference between CHED and CHSD?

A

CHSD is extremely rare –there is no corneal edema, but there’s thickening with flaky stromal lesions.

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51
Q

what is astigmatism keratotomy?

A

parallel corneal incisions about 1mm from apex in order to flatten steep meridian and steepen the flat meridian (coupling)

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52
Q

what effect do radial incisions on the cornea have on the curvature?

A

radial incisions flatten both the meridian at hand as well as 90 degrees from it

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53
Q

Cidofovir is used for CMV retinitis. what are its side effects?

A

anterior uveitis.
hypotony
renal toxicity

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54
Q

what is the only medicine proven to reduce rebleed s/p traumatic hyphema?

A

aminocaproic acid

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55
Q

christmas tree cataract are associate with what two conditions?

A

myotonic dystrophy

hypoparathyroidism

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56
Q

what kind of collagen is associated with decemet’s membrane

A

type IV

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57
Q

corneal power total? anterior? posterior?

A

total is 43. anterior is 48, posterior is -6

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58
Q

sudden vision loss with disc edema/peripapillary telangiectasia. waht condition? pattern of inheritance?

A

Leber hereditary optic neuropathy. mitochondrial

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59
Q

symptomatic patients and what % of carotid occlusive disease should get CEA? what’s the periop risk of stroke in CEA? how does stenting compare?

A

70-99%. Periop risk of stroke for CEA is 6%. vs higher with stenting

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60
Q

ONTT. how many % of patients with optic neuritis had pain with EOM?

A

92%

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61
Q

square wave jerks. associated with what condition? it’s nystamoid movement but not nystagmus because?

A

parkinson’s and cerebellar/pontine disease.

It is saccdic intrusion and does not have fast/slow phase.

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62
Q

How many posterior short ciliary arteries enter the globe around the optic nerve? how many posterior short ciliary nerves?

A

20 arteries

10 nerves

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63
Q

what’s the length of intraorbital portion of optic nerve?
what’s the length of intrascleral portion of optic nerve?
what’s the length of intra canal portion of optic nerve?

A

24mm
1mm
10mm

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64
Q

whats the difference between prolapsed orbital fat and lipodermoid

A

lipodermoid is choristoma present at birth vs prolapse happen with age

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65
Q

rate of aqueous production

A

2 microliters/min

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66
Q

what substances are at increased concentration in Aqueous than blood

A

vit C, hydrogen, chloride

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67
Q

type 2 parafoveal telangiectasia is associated with what lab test finding?

A

impaired glucose tolerance

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68
Q

Duane type 1. preferred surgical procedure?

A

medial rectus recession

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69
Q

Duane type 2. preferred surgical procedure?

A

lateral rectus resection

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70
Q

the orbits are separated by how many mm?

A

25

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71
Q

light induced scotoma that improves with laying down. dx? diagnostic studies?

A

ocular ischemic syndrome. also could present as hypotony and mid-peripheral DBH

can do FA, CTA, MRA, carotid doppler–carotid endarterectomy

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72
Q

volume of vitreous cavity

A

5ml

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73
Q

volume of AC

A

200 microliters

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74
Q

which immunemodulator is associated with drug induced lupus?

A

infliximab

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75
Q

vitrectomy induces what kind of cataract?

A

nuclear

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76
Q

silicon oil induces what kind of cataract

A

PSC

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77
Q

average power of the lens is how many diopters?

A

20

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78
Q

ectopia lentis et pupilae. mode of inheritance

A

autosomal recessive

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79
Q

what is the most common cause of congenital unilateral cataract?

A

persisting fetal vasculature (PFV)

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80
Q

how often is Rb bilateral

A

1/3 of the time

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81
Q

beer belly cornea, crab claw on keratometry. Dx?

A

pellucid marginal degeneration

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82
Q

what is snowflake degeneration?

A

degenerative changes to PMMA IOLs.

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83
Q

IOL calcifications happen with what kind of IOL material?

A

hydrogel

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84
Q

glistening occur with what kind of IOL material

A

hydrophobic

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85
Q

encephaloceles are associated with what two optic nerve abnormalities?

A

morning glory nerve

optic nerve hypoplasia

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86
Q

what is Heerford syndrome?

A

It’s uveitis, parotidis, and fever (uveoparotid fever)

can be a presentation of sarcoid

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87
Q

What is Lofgren’s syndrome?

A

erythema nodosum, hilarious LAD, and arthritis

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88
Q

what are the signs of intraoperative suprachoroidal hemorrhage?

A

tense eye, shallowing AC, loss of red reflex.

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89
Q

What do you do in the case of intraoperative suprachoroidal hemorrhage.

A

close wound with suture

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90
Q

the two oblique muscles are at how many degrees from visual axis?

A

51 degrees

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91
Q

the superior and inferior rectus muscles are at how many degrees from visual axis?

A

23 degrees

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92
Q

What is spherical aberration?

A

4th order aberration. Due to stronger focusing at peripheral corneal vs central. Risk factors: young, large pupil, myopic corneal ablation
night myopia is a side effect

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93
Q

What is coma?

A

coma and trefoil are 3rd order aberrations.

Coma is due to eccentric light focusing causing light to look like a comet

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94
Q

what are second order aberrations?

A

myopia (positive defocus) and hyperopia (negative defocus)

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95
Q

What are first order aberrations?

A

prisms.

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96
Q

What are ophthalmoplegic migraines?

A

intermittent 3rd nerve palsy. Almost always in Peds.

Always a diagnosis of exclusion (lymphomas, sarcoid..etc). enhancement on MRI is seen

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97
Q

what are the three FA patterns seen with central serous chorioretinopathy— in order of most common to least common?

A

expansile dot pattern, smoke stack (10%), diffuse

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98
Q

CN with the longest intracranial course?

A

CN 4

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99
Q

which sub nuclei of CN III are fused (and thus supplies both eyes)?

A

levator palpebrae

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100
Q

which EO muscle receives innervation from both ipsilateral and contralateral nerve fibers?

A

Superior rectus… from both CNIII fibers

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101
Q

Saltzmann’s nodules are in what layer of the K?

A

Bowman’s.

Middle age women–trachoma/interstitial keratitis/phlyctenules

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102
Q

most common hormone deficiency in de Morsier syndrome?

A

growth hormone

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103
Q

what is a contraindication to azathioprine?

A

hx of treatment with alkylating drug or hx of allergy

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104
Q

What is Foster-Kennedy Syndrome vs Pseudo Foster-Kennedy Syndrome? How do you distinguish?

A

Foster Kennedy syndrome: mass compression induced optic neuropathy/atrophy. Then compression of CSF flow results in unilateral papilledema in other eye.

PSeudo Foster Kennedy syndrome: sequential NAION at least 6 weeks apart. One nerve is atrophic already and one is swollen.

Both have one atrophic and one swollen nerve
distinguished by VF defect of the swollen side–> pseudo Foster Kennedy will have altitudinal or arcuate defect like NAION. Pseudo FK will have only enlarged blind spot

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105
Q

latent nystagmus is associated with what kind of deviation? when does it occur?

A

congenital estropia with fast beats AWAY from viewing eye.

Occurs when binocularity is disrupted.

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106
Q

What settings of PRP increase chance of choroidal neovascular membrane?

A

higher power, longer duration, and SMALLER spot size (breaks through Bruch’s membrane)

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107
Q

what’s the magnification of a simple magnifier equation?

A

Msimple magnifier=D x distance

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108
Q

what is oscillopsia?

A

subjective sensation that environment is moving in patients with nystagmus or nystamtoid eye disorders

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109
Q

what are some drugs that causes uveitis?

A

rifabutin, bisphosphonates, sulfonamides, OCPs

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110
Q

What meds are associated with uveitis

A

metoprolol, travaprost.

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111
Q

proliferative sickle cell retinopathy should be treated how?

A

low intensity PRP to ischemic regions

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112
Q

benefits of YAG contact lens?

A

stabilizes eye, reduces depth of field, and magnifies image.

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113
Q

Bacterias that can penetrate intact K epitheliuM?

A

No Hard or Soft Contact Lenses

Neisseria (both), Haemophilis aegyptus, Shigella, Corynebacterium, Listeria

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114
Q

What is Sherrington’s law? what condition violates Sherrington’s law?

A

When one rectus muscle contracts the opposite muscle relaxes. Duane’s violates Sherrington’s thus the globe retracts

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115
Q

What is Herring’s law?what condition violates this?

A

The two eyes are yolked together. so refixation of a hyperopic eye should result in corresponding downward movement of the other eye. Dissociative vertical deviation (DVD) violates this

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116
Q

What is the lens maker’s equation?

A

Power (D)= (n’-n)/r

n’=index of refraction of lens. n=index of refraction of air. R is focal length

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117
Q

how many degrees do you treat when doing CPC?

A

270 –so that 90 degrees are spared–decreases anterior segment necrosis risk.

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118
Q

Plateau iris is diagnosed s/p doing LPI and pressure is still elevated. What should you do to treat plateau iris?

A

ALT

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119
Q

Touton giant cells are associated with what condition?

A

Erdheim-Chester (two tons of chest nuts)
Associated with early cardiac disease
Skin findings of Juvenile Xanthogranuloma (little red bumps)
yellow iris lesions

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120
Q

Unilateral ischemic eye disease with mid periphery retinal hemorrhage seen on exam. What condition is this? what’s the work up?

A

Ocular ischemic syndrome.

You need to do carotid US

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121
Q

Neuroblastoma associations in children?

A

periorbital ecchymosis

Horner’s syndrome

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122
Q

Forster Fuch’s spots. what are they. what condition do you seen them in?

A

RPE changes/hyperpig spots. In high myopia

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123
Q

Dalen Fuch’s spots. What conditions do you see them in?

A

Sympathetic ophthamia

VKH

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124
Q

neuroretinitis with macular star and papilledema. What’s the organism that causes this?

A

Bartonella

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125
Q

magnification of image with a lens is calculated how?

A

Mag=power of eye/power of lens

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126
Q

Bird shot chorioretinitis is characterized by what HLA marker

A

HLA A29

best tested with ERG and VF

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127
Q

Young child who has bilateral ptosis and cannot look up.

A

congenital fibrosis extra ocular muscle syndrome 1. autosomal dominant hesitance of muscle fibrosis.

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128
Q

chandler’s

A

iris atrophy, k edema

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129
Q

energy pathway of the lens? (glucose)

A

anerobic glycolysis

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130
Q

what is pseudoxanthalasma elasticuma?

A

xanthalasmas on skin

Fundus has angio streaks and peau d’orange appearance. These eyes are prone to CNVM, choroidal hemorrhage.

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131
Q

how do retinoblastoma escape the eye and disseminate?

A

via optic nerve

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132
Q

what is bilateral diffuse uveal melanocytes proliferation (BDUMP)

A

leopard spots withOUT leakage on FA. associated with lung cancer.

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133
Q

uveal effusion syndrome

A

leopard spots WITH. leakage on FA

not associated with lung cancer

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134
Q

uncontrolled IIH with progressive vision loss–tx? uncontrolled HA–tx?

A

optic nerve fenestration for vision loss.

lumboperitoneal shunt for headache

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135
Q

When you do surgery on the inferior rectus the lower eye lid tend to go in the direction where you move it. Recession –> lower lid retraction, Resection –>lower lid elevation

A
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136
Q

dieffenbachia house plants can cause what complication?

A

corneal crystals. painful

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137
Q

dorsal midbrain syndrome (parinaud’s syndrome) symptoms?

A

can’t look up
convergence-retraction nystagmus with OKN drum moving down
light-near dissociation
eyelid retraction (collier’s sign)

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138
Q

causes of parinaud’s syndrome?

A

pinealoma, aqueduct stenosis, midbrain stroke

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139
Q

order of occurrence of basal cell carcinoma in terms of location

A

Inferior>medial>superior>lateral.

I aM So Large

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140
Q

what’s the cause of benign intermittent mydriasis?

A

migraines. does not have to be temporally related to headaches.

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141
Q

what procedure do you do to fix astigmatism in PKP patients?

A

arcuate keratotomy

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142
Q

to fix corneal astigmatism with incisional relaxation…which axis (steep or flat) do you incise?

A

steep axis

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143
Q

risk factors for failed trabeculectomy?

A 
younger age, 
aphakia/pseudophakia
prior conj procedures
african american
active inflammation
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144
Q

how long does it take cornea to be in its final refraction after LASIK?

A

2-3 months

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145
Q

myotonic dystrphy patiens tend to have low IOPs because?

A

ciliary body detachments

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146
Q

which EOMs have tertiary actions? what are they?

A

vertical recti muscles and oblique muscles have tertiary actions.

obliques are adduction. verticals are aBDuction

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147
Q

vascular congestion over rectus muscle. What are the two differentials and how to separate them?

A

TED vs dural shunt.
TED will be located just next to the EOM insertion.
dural shunt will be congested from EOM insertion all the way to the limbal area.

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148
Q

what is WAGR

A

Wilms, aniridia, genitourinary defects, retardation.

if aniridia you should order abd US

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149
Q

What is Gullstrands ratio

A

an assumed relationship between anterior and posterior cornea.

In patients s/p refractive surgery (PRK and LASIK only) this would be off as anterior surface has been manipulated.

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150
Q

Brown syndrome?

A

restricted elevation on ADDuction.

“V” pattern–victor brown

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151
Q

Brown syndrome?

A

restricted elevation on ADDuction.
“V” pattern–victor brown
you should get CT to rule out physical impingement

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152
Q

what gene is associated with congenital glaucoma

A

CYP1B1–baby cyps

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153
Q

what gene is associated with pseudo exfoliation glaucoma

A

LOX1

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154
Q

what gene is associated with POAG?

A

TIGR/MYOC–tiger out in the open

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155
Q

what are the typical immunosuppressants for intermediate uveitis?

A

cyclosporine, methotrexate, and subT steroids

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156
Q

what immunomodulator worsens MS?

A

Infliximab

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157
Q

what’s the mechanism of pilocarpine?

A

muscarinic agonist. It causes longitudinal ciliary muscles to contract and then opens up TM and increases drainage.

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158
Q

what are the conditions leading to false positives in RPR and VDRL

A

SLE/antiphospholipin
pregnancy
liver disease
other treponemal disease (lyme)

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159
Q

how long should temporal artery biopsies be?

A

2-3 cm

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160
Q

pigmentary retinopathy is the MOST COMMON manifestation in congenital rubella. What is the vision like usually?

A

good. usually not affected by retinopathy

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161
Q

how can you tell the difference between diffuse lamellar keratitis (DLK) and infection in LASIK patients?

A

DLK presents <24 hours s/p procedure and only involving flap interface. infection is few days later and more painful and can be anywhere

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162
Q

what is photostress recovery time test

A

shining light in to eye for 10 seconds then measuring when vision comes to baseline (poor man’s ERG)… >90 seconds is abnormal.

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163
Q

what is potential acuity meter

A

testing for visual acuity in the setting of cataract or unclear media

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164
Q

VIP study vs TAP study

A

TAP: classic CNV in AMD–no difference in PDT vs placebo
VIP: occult CNV in AMD <4 disc areas benefited from PDT

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165
Q

treatment progression for CSCR?

A

if vision is good–observe
if vision is involved or if doesn’t resolve in 3-4 months and is >500 microns away from central macula– focal laser
if center involving and doesn’t resolve–PDT
antiVEGF doesn’t work unless there’s CNVM

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166
Q

You MUST control diabetic macular edema prior to cataract surgery. what are the treatment options?

A
  1. Lucentis is preferred

2. focal laser then wait 3 months and if ME has regressed then do cat surg

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167
Q

if patient is on X mg of prednisone for chronic uveitis then they need to be on a immunomodulator… what is the X mg?

A

10 mg

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168
Q

if both eyes are equally esotropic then you don’t get ambyopia due to development of what phenomenon?

A

cross fixation where adducted eye is viewing contralateral temporal field

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169
Q

white streak on DFE s/p trauma to the eye… what’s the diagnosis?

A

choroidal rupture.

observe first… then if CNVM develops (sub retinal bleed)… then do VEGF

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170
Q

circle of zinn Haller supplies what portion of the optic nerve?

A

laminar

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171
Q

Sigiura sign

A

perilimbal vitiligo in VKH

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172
Q

nystagmus types are defined fast or slow phase?

A

slow. fast phase is physiologic and always the same

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173
Q

infantile nystagmus is associated with acceleration or deceleration of slow phase?

A

acceleration

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174
Q

idiopathic justafoveal telangiectasia group 1 vs group 2 vs group 3 characteristics

A

Group 1: unilateral, male, macular edema
Group 2: bilateral, female, retinal atrophy/NV, most common
Group 3: rare. progressive vascular obliteration

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175
Q

prisms (with apex angle >0) always bends light toward apex or base?

A

base

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176
Q

timolol has what effect on LDL and HDL?

A

raises LDL and lowers HDL.

timolol is yellow so it increases bad lipids

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177
Q

how many mm of medial rectus recession to do for 15 diopters of eso?

A

3mm

4mm for 25, 5mm for 35

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178
Q

how many mm of lateral rectus recession to do for 15 diopters of eso?

A

4mm

5mm for 25, 6mm for 35

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179
Q

associations with nanophthalmos

A

hyperopia, short axial length, strabismus

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180
Q

ocular side effects of topical epinephrine drops

A

conj hyperpigmentation, macular edema

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181
Q

minimum endothelial count for corneal transplant graft

A

2000

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182
Q

latent nystagmus features

A

horizontal nystagmus TOWARD uncovered side and head turn toward covered side.
Decelerating in slow phase beat
Associated with eso and only present when one eye is covered

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183
Q

latent nystagmus features

A

horizontal nystagmus TOWARD uncovered side and head turn toward uncovered side
Decelerating in slow phase beat
Associated with eso and only present when one eye is covered

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184
Q

spasm nutans. the triad? why might you want to image these kids?

A
  1. head nodding
  2. asymmetric nystagmus or monocular nystagmus (called shimmering)—usually horizontal but can but otherwise
  3. Torticollis

4-14 months olds
can be associated with parasellar mass

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185
Q

what are the uveitis conditions that immunomodulation should be started early

A

VKH
sympathetic ophthalmia
Bechet’s
necrotizing sclerouveitis

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186
Q

how many percent of people have a common canaliculus

A

90%

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187
Q

Frequency doubling technology visual field tests what cells

A

M cells

Frequenting McDonalds Seems Krazy

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188
Q

SWAP visual field tests what cells

A

konicellular

Frequenting McDonalds Seems Krazy

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189
Q

where is sclera thickest and thinnest?

A

thickest: around ON insertion (1.0mm)
thinnest: immediately posterior to EOMs

avg:0.3mm

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190
Q

see saw nystagmus is associated with what kind of lesions

A

parasellar/midbrain… classically craniopharyngiomas in kids

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191
Q

opsoclonus is associate with what kind of CNS lesions

A

neuroblastoma

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192
Q

downbeat nystagmus is associated with what kind of CNS lesions?

A

cervicomedullary (chiari malformation)

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193
Q

upbeat nystagmus is associated with what kind of CNS lesions?

A

cerebellar, midbrain, medullar

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194
Q

periodic alternating nystagmus is associated with what kind of CNS lesions?

A

cervicomedullary junction

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195
Q

what gases are used in excimer laser

A

argon and fluorine

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196
Q

what is the AGIS finding of ALT vs trabeculectomy sequence in white and black patient

A

black patients: ATT (alt, trab, trab)

white patients: TAT (trab, alt, trab)

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197
Q

PDR is defined as presence of what 3 features?

A

NV, traction membranes, VH

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198
Q

Intacts are good for keratoconus patients with what features

A

low myopes with steep corneas

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199
Q

SSRI is associated with what ocular complications

A

angle closure glaucoma

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200
Q

what risk factor is associated with CRVO and not BRVO… what is associated with BRVO and not CRVO

A

CRVO is associated with DM… not BRVO

CAD is associated with BRVO and not CRVO

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201
Q

why is anterior phimosis associated with conditions of increased zonular laxity

A

loose zonule allow the capsule to contract

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202
Q

NF1 with what feature is associated with increased glaucoma risk

A

plexiform neurofibroma

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203
Q

Pressure induced stromal keratitis in LASIK. what is it?

A

prolonged use of steroids s/p LASIK leads to corneal edema and elevated IOP (but falsely lowered due to edematous K)

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204
Q

myelinated retinal fibers are seen in what condition?

A

Basal cell nevus syndrome (Gorlin-Goltz)–multiple basal cell CA

also amblyopia, unilateral high myopia, and NF1

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205
Q

BPES (blepharophimosis, ptosis, epicanthus inversus syndrome) type 1 is associate with what

A

premature ovarian failure

206
Q

Crosslinking minimal corneal thickness?

A

400 microns as the UVA light penetrates to 300

207
Q

what’s the distinguishing feature of PUK vs Mooren’s ulcer?

A

mooren’s ulcer is more in the cornea. PUK can involve sclera

208
Q

retrobulbar block involves what nerves:

A

II, III, V1, VI. Note 4 is not in the cone

209
Q

small optic disc drusen are associate with what conditions?

A

retinitis pigments, Pseudoxanthogranuloma elasticum

210
Q

dacryocystocele management?

A

without signs of infection or distress –gentle massage x1-2 weeks then surgery/probing

If infected or distress–immediate probing.

211
Q

fetal alcohol syndrome associations

A

strabismus, epicanthus, blepharoptosis, cataracts, axenfled-riger, PHPV, optic nerve hypoplasia

212
Q

treatment for squamous cell carcinoma of conj?

A

excise, cryo, with antimetabolite

213
Q

what are the stages of VKH?

A

prodromal (viral like, aseptic meningitis like)
Uveitic
Convalescent (orange sunset glow, perilimbal vitiligo, alopecia, poliosis, serous RD)
Chronic recurrent

214
Q

associations of Gillespie syndrome

A

Aniridia, intellectual disability, ataxia

215
Q

Louis Barr syndrome (ataxia-telangiectasia syndrome). what ocular association do they have? systemic?

A

cannot initiate saccades

breast cancer and leukemias

216
Q

miotic glaucoma agent side effects (pilocarpine or echothiophate)

A

brow ache, inflammation, RD,

217
Q

bones of superior orbital wall

A

Front Less –frontal and lesser wing of sphenoid

218
Q

bones of medial orbital wall

A

SMEL: sphenoid, maxillary, ethmoid, lacrimal

219
Q

bones of orbital floor

A

MoP Z Floor; Maxillary, Palatine, Zygomatic

220
Q

bones of lateral orbital wall

A

Great Z: greater wing of sphenoid and zygomatic

221
Q

treatment of TASS?

A
  1. r/o endophthalmitis. 2. intensive steroids 3. controlling IOP
222
Q

brown mcclean syndrome–peripheral corneal edema starting inferiorly moving around. orange hue to K. What is associated with this syndrome?

A

intracap cat surgery

223
Q

HIV patients with CD4<50 are at risk of CMV retinitis. How does the CMV infection get there?

A

hematogenous spread

224
Q

birdshot is responsive or not responsive to steroid

A

not responsive. needs immunotherpay

225
Q

what medication causes miosis but preserves accomodation?

A

dapiprazole

226
Q

steep cornea risk for lasik

flat cornea risk for lasik

A

steep-button hole

flat- free cap flap

227
Q

what med is used to treat microsporidium keratitis?

A

topical fumagillin

228
Q

keratoconus is due to fragmentation of what layer of cornea?

A

bowman’s

229
Q

what is Balint syndrome?

A

bilateral parietal occipital atrophy.
1. optic ataxia (poor eye hand coordination)
acquired ocular motor apraxia (can’t imitate saccades), and Simultanagnosia (unable to understand pictures although able to see they mages)

230
Q

myelinated RNFL is associate with what conditions?

A

amblyopia, NF, myopia

231
Q

what’s the difference between peripheral CN VI lesion vs CNVI nuclear lesion?

A

peripheral will be isolated ipsilateral abduction deficient.

CN VI nuclear lesion would result in inability to abduct ipsilaterally and inability to adduct contra laterally (due to the fact that CN VI and contract CNIII are connected via the MLF)
ALSO ipsilateral CN VII palsy are seen in CN VI nuclear lesions.

232
Q

poly arthritis, GI symptoms, and panuvieitis. dx?

A

Whipple dz

233
Q

what bleb location has the highest infection rates?

A

inferior

234
Q

what is brown syndrome?

A 
Brown syndrome is SO restriction. hallmarks include: inability to look up. 
negative positive forced duction
V pattern
NO superior oblique overaction
no torsion
negative head tilt test
235
Q

characteristics of Merkle cell CA of the lid?

A

fusiform progressively growing fusiform lesion. palpable LNs. caucasian males are most frequent

236
Q

what type of collagen is in vitreous?

A

type 2 is in the Goo

237
Q

EVS showed which patients would benefit from immediate vitrectomy as opposed to tap and inject?

A

LP or worse

238
Q

DR4 is associate with what conditions?

A

VKH, sympathetic ophthalmia

239
Q

Birdshot HLA type?

A

A29

240
Q

Behçet diasese HLA association?

A

B51, B12

241
Q

PERK study showed what?

A

RK leads to hyperopic shift

242
Q

what’s the differentiating features of CAR and MAR.

A

CAR affects mostly CONES, likely already has cancer diagnosis.
MAR affects mostly rods, more likely to be the initial symptom

both have photopsia, nyctalopia, initially will have Nl DFE then will have RPE and ON atrophy

243
Q

ocular histoplasmosis syndrome… does it have vitirits?

A

no. if there’s vitrifies think Multifocal Choroiditis and Panuvititis (MCP) white dot syndrome

244
Q

What is Terson syndrome?

A

Terson’s is VH/subhyaloid hemorrhage due to Subarachnoid hemorrhage

245
Q

Reiter syndrome is associated with what organisms

A

chlamydia trachoma’s, shigella, salmonella, yersinia, campy

246
Q

What is apert syndrome?

A

craniosynestosis similar to Crouzon syndrome. Both have FGFR2 mutations. Apert is associated with SYNDACTYLY

247
Q

reactivation toxoplasmosis doesn’t have to be treated if inflammation is mild and pt is asymptomatic. However, it should always be treated in what population?

A

infants, preggos, and immunocompromised

248
Q

paradoxical inversion of OKN response is seeing what condition

A

congenital motor nystagmus…this is the ONLY occasion that you see this

249
Q

what’s a medication that increases aqueous production?

A

Ibopamine. increases aqueous 4 fold

250
Q

wreathlike clusters on FA is associated with what white dot syndrome

A

MEWDS

251
Q

quenching on FA is seen in what condition? what is quenching?

A

birdshot.

it means leakage of fluorescein out of vessels quickly

252
Q

plateau iris… how is it diagnosed? how is t treated?

A

diagnosed s/p still narrow AC/elevated IOP s/p LPI.
Treated with laser iridoplasty

Can use pilo to help in the mean time

253
Q

sine wave sign at the angle is characteristic of what condition?

A

plateau iris

254
Q

pattern of PAS formation in plateau iris?

A

starts at Schwalbe line and extends posteriorly

255
Q

DCR inserts in to what space?

A

middle meatus. NOT middle turbinate

256
Q

conductive keratoplasty what does it do?

A

it steepens cornea…aka makes it more myopic.

257
Q

who is good for conductive keratoplasty

A

mild hyperopes/presbyopes with mild or no astigmatisms.

258
Q

Rb patients most frequently get what other tumors?

A

osteosarcomas and melanomas

259
Q

decemet’s layer has banded and non banded layers… where is each located

A

anterior is banded, posterior is non banded

260
Q

babies start fixing at what age

A

6 weeks

261
Q

Trilateral lesion…what is the disease and where’s the third laterality

A

Rb. third is in pineal gland

262
Q

early treatment of glaucoma trial showed what

A

62% progression of untreated

45% of progression with betaxolol +laser trabeculoplasty at 6 year follow up

263
Q

solar retinopathy is associated with what meds?

A

Psoralen

Tetracycline

264
Q

what is Hermansky-Pudlak syndrome?

A

oculocutaneous albinism, platelet dysfunction, in puerto ricans

265
Q

Chediak-Higashi syndrome

A

oculocutaneous albinism, recurrent pyogenic infections

266
Q

NS gives second sight to what population

A

presbyopes –can see better at near due to induced myopia

hyperopes will have better distance vision due to induced myopia

267
Q

Pars planitis. laterally, complications?

A

usually bilateral (80%) and will have tractional RD, CME, VH

268
Q

Hutchinson’s sign involves what nerve

A

nasociliary

269
Q

ophthalmia neonatorum has follicles or papillae?

A

papillae

270
Q

Congenital fibrosis syndrome features?

A

congenital onset of trouble looking down due to fibrosis. distinguishing feature from TED is congenital onset

271
Q

Suture placed at 180 degrees does what to theK?

A

steepens K at 180 (bc it squeezes the K)

272
Q

visual cycle

A
  1. 11 cis retinal stimulation via photon and isomerize to all trans retinal
  2. all trans retinal attaches to opsin activations G protein signaling
  3. ion channels close and hyper polarization occurs
273
Q

What is the only light sensitive molecule in the visual cycle?

A

11 cis retinal.

274
Q

what is hemeralopia

A

deterioration of vision in higher light environments . Cone dystrophy

275
Q

what’s Palinopsia

A

recurrent images s/p object being removed

276
Q

strongest attachment points of sclerouveal attachment?

A

anterior to ciliary body

major emissaries canals

277
Q

aphakic glaucoma occurs most in what population

A

microcornea s/p congenital cat extraction early in life

278
Q

what is the tissue of origin for storm, endothelium, and iris pigment

A

neurocrest

279
Q

HLA DR4 associations

A

VKH and sympathetic ophthalmia

280
Q

treatment for pubic lice on eyelashes

A

10 days of ointment. high heat dry all clothes

281
Q

what is encephalotrigeminal angiomatosis

A

storage weber

282
Q

Wyburn Mason syndrome’s other name?

A

Bonnet-Dechaume-Blanc syndrome

Racemose angioma

283
Q

Tuberous sclerosis other name

A

Bouneville disease

284
Q

associations of Palinopsia

A
  • parietal-occipital lesions
  • LSD/mushrooms
  • topiramate
  • stroke
  • CLomiphene
  • trazodone
285
Q

how do you treat herpes zoster in immunocompromised patients

A

IV acyclovir–prevent encephalitis

286
Q

How do you treat VZV

A
  1. valacyclovir 1000mg TID
    OR acyclovir 800mg 5x a day for 7-10 days
  2. PF and cyclo if there’s ocular inflammation
  3. abx for skin–NO topical eye abx.
287
Q

aqueous production during night compared to day?

A

night (1 micrometers per min) is about half as day (2microliters/ min)

288
Q

what is perceptual completion

A

brain’s ability to fill in the blanks so that most people won’t notice scotomas

289
Q

increased ICP is associated with what medication

A

cyclosporine

290
Q

Syndromes presenting with CPEO?

A

Kearn-Sayers
oculopharyngeal dystrophy (French Canadian)
myotonic dystrophy

291
Q

What is optic atrophy of Schnabel?

A

optic atrophy with mucopolysaccharide deposition in optic nerve. associated with atherosclerosis

292
Q

what axial length is associated with RD s/p CE?

A

> 25mm

293
Q

fundus findings of cat-scratch?

A

neuroretinitis (macular star, disc swelling)

fever, malaise, LAD, parinaud oculoglandular syndrome, granulomatous palpebral conj nodules

294
Q

What is oculopalatal myoclonus?

A

bilateral acquired vertical/pendular nystagmus with facial spasms that occurs months to years s/p brains stem (tegretal) stroke at the “triangle of Guillain-Mollaret” (cerebellar flocculus, inferior olivary nucleus of medulla, and red nucleus of midbrain.

295
Q

what is per fluorocarbon liquid used for and what complication is associated with it?

A

It’s used for complex retinal detachment surgeries. Complication is subfoveal per fluorocarbon liquid that can lead to vision loss duet to retinal toxicity

296
Q

segmental optic nerve hypoplasia is associated with what?

A

maternal DM

usually VA is conserved

297
Q

where is the CNS lesion for ocular bobbing?

A

brainstem

298
Q

what did the silicon oil study find regarding SF6, C3F8 and silicon oil?

A

SF6 is INFERIOR to tamponading with C3F8 or silicone oil.

299
Q

what is Gorlin syndrome?

A

multiple basal cell CA’s and jaw tumors.

300
Q

What is viscmodegib used for

A

Gorlin syndrome (multiple basal cell CA’s). it acts in the Hedgehog pathway

301
Q

What are the randleman criteria for?

A

ectasia risk assessment prior to LASIK

302
Q

what is cerebral visual impairment (CVI?)

A

impairment in the visual system posterior to lateral geniculate nucleus. Often seen in premature babies with periventricular leukomalacia

303
Q

power mapping of the cornea–two methods?

A

SAC: sagital=axial measures central K
TIP: tangential=instantaneous measures peripheral K

304
Q

Optic nerve fenestration approaches.

A

medial–direct but have to take down MR
epibulbar
supranasal lid crease
temporal

305
Q

in which approach for optic nerve fenestration would there be the highest likelihood of damaging the ciliary ganglion? what would be a physical exam finding?

A

lateral approach. The pupil will be mydriatic but vision will be good.

306
Q

what’s different in AREDS vs AREDS2? what’s in both?

A

both have Zinc oxide, cupric oxide, vitamin E, vitamin C
AREDS have beta carotene
AREDS do does not have beta carotene but does have Zeaxanthin and Lutein

307
Q

when is there highest number of axons in the optic nerve? how many are there?

what does it become on maturation?

A

highest amount is 3.7 million at 16 weeks

Then becomes 1.1 million at 33 weeks

308
Q

ALT settings? size, duration, and power

A

50 micron size, 0.1 sec duration, and 300-1000mW

309
Q

what is another name for autosomal dominant optic atrophy? what gene is affected?

A

Kjer’s disease

the gene is OPA1

310
Q

what is Wolfram’s syndrome?

A

DM, DI, optic atrophy, neurosensory deafness

311
Q

What law does Duane syndrome violate?

A

Sharrington’s law stating that there’s an antagonist action of opposing muscle for every agonist action of a muscle

312
Q

What law does DVD violate?

A

Herrington’s law–stating that yoked muscles receive equal innervation with an action (such as superior gaze both eyes receive equal innervation)

313
Q

What is Alexander’s law?

A

nystagmus is more pronounced with gaze to fast beating direction

314
Q

What is paradoxical pupillary reaction?

A

pupil constriction immediately after turning the light off…
highly suggestive of early onset retinal and optic nerve disease

315
Q

differential for paradoxical pupillary reaction?

A

COLD ARAB

Congenital Stationary Night blindness (CSNB)
Optic hypoplasia
LHOA
DOA

congenital Achromatopsia
RP
Albinism
Best

316
Q

breast cancer mets to the orbit causes what kind of displacement of the globe?

A

exophthalmos

317
Q

Fluocinolone implants are used to treat what? how long does it last?

A

it’s used to treat noninfectious posterior uveitis. lasts for 30 months

318
Q

What role does topical steroid treatment play in HSV corneal conditions

A

do NOT give if there’s any active epithelial keratitis… this is from active viral replication
Give for stromal keratitis and endotheliitis given these are due to immune response—> should be given in combo with antivirals.

319
Q

valacyclovir is associated with what condition in HIV patients?

A

HUS/TTP

320
Q

avg axial length of new born eye?

A

15-17mm

321
Q

avg corneal diameter of new born eye?

A

9-10mm

322
Q

what is the definition of a prism diopter?

A

decentration (in meters) at 1 meter away

323
Q

a patient becomes 20/20 after LASIK but then again becomes myopic… what is the most likely cause?

A

remodeling and scarring–epithelial cells grow in and fills in the gap thereby taking away some of the effect of the ablation

324
Q

what is Gillespie syndrome?

A

aniridia
ataxia
mental retardation

–dizzy Gillespie on AM radio

325
Q

how long after a uveitic episode should you wait before doing any intraocualr surgeries

A

3 months

326
Q

what is the SRK formula?

A

Aconstant-2.5AL-0.9Kavg= lens power

327
Q

differential for scrolled up decemet’s on pathology

A

keratoconus s/p hydrops, Haas striae, terrien marginal degeneration

328
Q

most common cause of dacryoadenitis?

A

EBV

329
Q

What is a hot mirror?

What’s a cold mirror?

A

Hot mirror: reflects infrared and transmits visible light

Cold mirror: reflects visible lights and transmits infrared

330
Q

what’s a gaussian filter?

A

blurs image to make the details less

331
Q

what are the three main patterns of congenital nystagmus?

A

Pendular (VA usually at least 20/200), Jerk, Searching (VA usually worse than 20/200)

332
Q

which muscle is most affected in TED?

A

inferior>medial>superior>lateral

333
Q

PPMD features?

A

endothelial vesicles, glaucoma/PAS
Similar to ICE but is bilatera
autosomal dominant.

334
Q

what percentage of microvascular CN III palsies involve pupil? and what should you do?

A

about 20%. However, whenever there’s anisocoria you must work it up with MRA or CTA

335
Q

What is Refsum disease? how do you treat it?

A

it’s RP, anosmia, hearing loss, cardiomyopathy, ataxia.

low phytanic acid diet

336
Q

nyctalopia (Pigmentary retinopathy), foul smelling stools, growth retardation is what condition?

A

abetaproteinemia.

supplement vitamin DEAK

337
Q

Von Kassa Stains calcium. What other stain stains calcium?

A

Alizarin Red

338
Q

what combination of hemoglobinopathies results in the most severe ocular complications?

A

SC and Sthal

339
Q

what is latanoprostene bunod?

A

it’s prostaglandin and nitric oxide… thereby increasing uveal scleral and trabecular meshwork drainage.

340
Q

hard contacts cause what corneal abnl

A

central k edema

341
Q

within 1-2 weeks of PRK/LASIK… if the patient has been mildly over corrected… what is one way that you can try to mitigate the over correction?

A

taper off the steroids faster to let the stroma recover to decrease ablated effect.

342
Q

MLF is located in what structure?

A

pons

343
Q

chemical ophthalmia neonatorum timeline?

A

24 hours

344
Q

gonorrhea vs chlamydia ophthalmia neonatorum timeline?

A

gonorrhea 3 days

chlamydia 7 days

345
Q

differential for inclusion/follicular conjunctivitis

A

Molluscum
Chlamydia
HSV
drug toxicity

346
Q 
features of:
trichoepithelioma
trichofolliculoma
tricholemma
pilomatrixoma
A
  • trichoepithelioma resembles basal cell CA (epithelial)
  • trichofolliculoma appears umbilicate (like a follicle)
  • Tricolemma is warty like a lemon
  • pilomatrixoma is purple and red in color
347
Q

radial corneal incision induces flattening or steepening in meridian and 90degrees away?

A

radial incisions lead to flattening BOTH in meridian and 90 away

arcuate incisions flattens along meridian of incision and steepens 90 away

348
Q

inheritance pattern of megalocornea?

A

x linked. maternal carriers have slightly larger K diameters

349
Q

scleralmalacia perforans is associate with what serology marker

A

RF (RF is IgM against IgG)

350
Q

which Volk indirect lens has 1:1 magnification

A

the super 66

351
Q

in Internuclear ophthalmoplegia… the affected eye is usually also affected in what way other than unable to abduct?

A

CN III is usually involved and therefore causes Hypertropia and intorsion of the affected side

352
Q

anterior persistent fetal vasculature associations?

A

microphthalmos, long ciliary process, shallow chambers/glaucoma

353
Q

when is grid PRP recommended in the BRVOS

A

chronic macular edema >3 months WITH retinal perfusion with VA worse than 20/40…
gridding improves VA about 2 lines

354
Q

lithium toxicity causes what kind of nystagmus?

A

downbeat

355
Q

dapipirazole effects

A

causes miosis without affecting ciliary muscle/accomodation or changing intraocular pressure.

356
Q

arnold chiari causes what kind of nystagmus?

A

down beat

357
Q

flurbiprofen effects/use?

A

it’s an NSAID. prevents intraoperative prostaglandin induced miosis

358
Q

which prostaglandin drops are prodrugs

A

latanoprost and travaprost. needs corneal esterase to work

bimatoprost is NOT a prodrug

359
Q

what is Aicardi syndrome?

A

oval choroidoretinal lacunae, corpus callosum agenesis, and infantile spasms

360
Q

what’s the mode of inheritance of Aicardi syndrome

A

x-linked dominant (lethal in males other than kleinfelters)

361
Q

what are two conditions with corpus collosum agenesis

A

aicardi syndrome and de morsier

362
Q

findings of ocular toxocariasis?

A

leukocoria

retinal granuloma

363
Q

Batten’s disease?

A

optic atrophy, pigmentary deposits, low ERG, neuronal lipofuscinosis–can have seizures

364
Q

inheritance chance of Rb in unilateral Rb patient versus bilateral (or unilateral with retinocytomas)

A

unilateral: 15% chance as it’s not a germline mutation

bilat or unilat +retinocytoma: 45% as it’s a part of the germline

365
Q

what is sands of sahara?

A

DLK. diffuse sand like appearance on exam.

366
Q

what are the 4 stages of DLK? and treatments?

A

stage 1: granular cells in peripheral only (topical steroids)
stage 2: granular cells in center as well. topical steroids
Stage 3: (threshold DLK) dense clumps centrally. You need to lift the flap/scrape then start topical steroids
Stage 4: stromal melt/scarring (mud cracks)–poor px

367
Q

IOLs with highest PCO rate?

A

P, Si, O

PMMA, Silicone, Ocrylic

368
Q

what environmental stressor triggers HSV reactivation?

A

nothing! according to HEDs

369
Q

what % of the time can medical therapy alone resolve aqueous misdirection

A

50% of the time

370
Q

medical management of aqueous misdirection? surgical?

A

mydriasis/cycloplegia, aqueous suppression, and hyperosomotic. PPV

371
Q

why is accutane use important for possible LASIK candidate?

A

destroys the lacrimal gland

372
Q

which CN III subnuclei is fused bilaterally

A

levator palpebrae

373
Q

which CN III subnuclei crosses to innervate bilaterally?

A

superior rectus

374
Q

EKC adenovirus is associated with what serotype

A

subgroup D

375
Q

wide set eyes, ectopia lentis, seizures… what condition is this

A

sulfite oxidase deficiency

376
Q

what’s the difference between illusions and hallucinations?

A

illusions are destorted external images. Hallucinations are without any external stimuli

377
Q

what is pulfrich phenomenon?

A

when an object appears to be traveling perpendicular when actually moving toward someone. occurs in pt’s recovering from optic neuritis

378
Q

what is micropsia

A

things appear smaller than they are. “alice in wonderland”.. macular OR parietal pathology

379
Q

which goniolens cannot be used for dynamicl gonioscopy?

A

Goldmann bc it’s radius is larger than the K radius

380
Q

what does the dorsal ophthalmic artery become?

What does the ventral ophthalmic artery become?

A

dorsal: becomes the ophthalmic artery –> posterior short, central retinal, and temporal long ciliary artery
ventral becomes the nasal long ciliary artery

381
Q

features of gyrate atrophy?

A

It’s an AR condition involving OAT gene.
Findings of cobble stone RPE lesions that coalesce to form “scalloped borders” between normal and abnormal regions. Associations with PSCs, high myopia.
Metabolically there’s an accumulation of ornithine and tx includes low arginine diet with B6 supplementation

382
Q

what is the most common cause of posterior uveitis in the US?

A

toxoplasma chorioretinitis

383
Q

What is the concept of Murlynn’s formula for LASIK?

A

It generally states that the larger optic zone used for myopic ablation the more tissue has to be removed to achieve the desired power.

384
Q

why is hx of HSV keratitis a relatively strong relative contraindication for refractive surgery?

A

thought is that the UV rays of excimer laser is associated with reactivation

385
Q

what are Cowdry bodies?

A

HSV and VZV inclusion bodies

386
Q

What are Halberstaeder-Powazek bodies?

A

inclusion bodies associated with trachoma

387
Q

Where is first order neurons of sympathetic nerves that can lead to Horner’s syndrome?
Second order?
Third order?

A

1: starts in posterior lateral hypothalamus and decend down medulla/brainstem–first order lesion can be 2/2 wallenberg
2. sympathetic chain from C7-T2
3. Internal carotid artery

388
Q

what is Lowe’s syndrome?

A

oculocerebrorenal syndrome.

glaucoma, cataracts, keloids, renal tubular dysfunction

389
Q

what gene is Weil marchansani syndrome associated with

A

ADAMTS10, fibrillin

390
Q

oculodermal melanocytosis (nevus of Ota) is associated with uveal melanoma. At what frequency?

A

1/400

391
Q

sarcoidosis iris nodules

A

Koeppe, Busacca, and Berline nodules on iris

392
Q

sarcoid. most common ocular site and orbital site?

A

ocular: uveal tract
orbital: lacrimal gland

393
Q

Worth 4 dot. how does it work

A

OD is red, OS is green

distance: 4 is normal. if 2lights then OD dominant, if 3lights then OS dominant. (both 2-3 means suppression scotoma is present)
near: if becomes nl then then it’s monofixation syndrome. if stays at 2 or 3 dots then it’s dense ambyopia

394
Q

what is sattler’s veil?

A

K edema associated with hard contact lens use

395
Q

Meige syndrome. is it present during sleep?

A

bilat bleph spasm associated with facial spasms. not present during sleep

396
Q

beign essential blepharospasm– is it prsent during sleep?

A

no

397
Q

which blepharospasm disorder is present during sleep?

A

hemifacial syndrome

398
Q

which vertical rectus muscle surgery is most associated with undesired eyelid position post op?

A

inferior rectus surgery.
IR recession pulls lower lid down
IR resection allows lid to ride up

399
Q

what is the only AR inherited corneal dystrophy?

A

macular

400
Q

how do you diagnose CPEO?

A

skeletal muscle biopsy to look for ragged red fibers

401
Q

candle wax dripping is associated with what

A

it’s periphlebitis of posterior uveitis. buzz word associated with sarcoid.

402
Q

what is the most sensitive test for r/o sarcoid

A

cxr

403
Q

spiral of tilleaux.

A

M 5.5
I 6.5
L 6.9
S 7.8

404
Q

what is visual confusion vs diplopia?

A

visual confusion is seeing overlapped two different objects.
Diplopia is seeing two of the same object

405
Q

whats’ the difference between central suppression and peripheral suppression?

A

central suppression suppresses visual confusion

peripheral suppression suppresses diplopia

406
Q

what is facultative suppression vs obligatory suppression

A

facultative is intermittent suppression when eye is turned abnl. obligatory is constant suppression bc the eye is constantly turned abnormally (like in amblyopia)

407
Q

congenital IV palsy. do these patients have small or large fusional amplitudes?

A

large. because they’re so used to fusing

408
Q

how can you distinguis Pressure induced stromal keratopathy (PISK) from diffuse lamellar keratopathy (DLK) s/p lasik?

A

get anterior segment OCT–you can see interface fluid in PISK
DLK is days after LASIK. PISK is 2ish weeks after

409
Q

PISK features?

A

timeline is 2-3 weeks
diffuse haze. interface fluid.
IOP is falsely wnl
DYNAMIC CONTOUR tonometry gives you the best IOP estimation

410
Q

thickness of sclera at posterior muscle

A

0.3mm

411
Q

pt should stay out ofthe sun for how long after PDT

A

5 days

412
Q

meibomian gland number on upper lide? lower lid?

A

upper 30-40 lower 20-30

413
Q

vitiligo chorioretinitis refers to waht condition

A

birdshot

414
Q

opsins?

A

they are attached to photoreceptors in combo with 11-cis-retinaldehyde to form rhodopsin. responsible for color and has S, M, L varieties

415
Q

what is chromatic aberration?

A

bending of light through medium-short wave lengths are slwoed down much more than long ones

416
Q

test points in HVF are how many degrees apart

A

6

417
Q

meds associated with poor K healing

A

topical antiviral, beta blocker, NSAID

418
Q

Tyndall effect

A

flare

419
Q

which betablocker is not associate with pulm side effects (topical)

A

betaxalol, carteolol is next best

420
Q

which isolated ocular finding is asosciated with binocular diplopia?

A

ERM. dragged foveal syndrome.

421
Q

What are findings of CNIV palsy?

A

adduction and intorsion are decreased on affected side.
hyperopia on down gaze.
Also there’s a V pattern of gaze if bilateral since superior oblique abducts eye on down gaze

422
Q

strabismus surgery for horizontal deviation does the medial or lateral rectus need to be moved more?

A

lateral bc it’s a long muscle and dose response is less.
Lat 4mm moved for every 15 PD
Med 3mm moved for every 15 PD

423
Q

pleomorphic adenoma of the lacrimal gland is the most common benign pathologic finding. what’s the history look like?

A

glands, stroma, and cartilage

424
Q

at what endothelial count will PBK be a high risk?

A

<1000

425
Q

What is coefficient of variation (CV)?

A

the measure of mean cell area/mean area… CV >0.40 is abnormal–polymegathism– meaning that cell size is highly variable and pt is at risk for post op K edema

426
Q

approx size of endothelial cells?

A

200 microns

427
Q

hexagonality–what value lower limit?

A

<50% means corneal endothelial morphology is Abel

428
Q

ocular side effect of chlorpromazine?

A

pigment deposition to endothelium and anterior lens capsule

RPE loss and nummular lesions, retinopathy

429
Q

spasm of near reflex–triad

A

excessive convergence, miosis, accommodation

430
Q

what is apical alignment, apical bearing, apical clearance?–in relation to rigid gass perm CLs

A

apical alignment means base curvature of CL fits K. this with under lid with good movement is ideal

  • Apical bearing is CL rests at apex of K–too flat
  • Apical clearance is CL is steeper than K and is too tight.
431
Q

what is Kestenbaum’s rule for low vision patients?

A

initial add for reading will be the inverse of the visual acuity (20/40–>+2.00 ADD) in the BETTER SEEING EYE

432
Q

what is Kestenbaum’s rule for low vision patients?

A

initial add for reading will be the inverse of the visual acuity (20/40–>+2.00 ADD) in the BETTER SEEING EYE.

Occluding worse eye also helps low vision patients.

433
Q

ideal soft CL fit?

A

3 point touch with light limbal touch on both sides and light touch at the apex

434
Q

what kind of images do convex mirrors form?

A

VERMIN. virtual and minified. ALWAYS. diopter of convex mirrors are always negative

435
Q

what does the keratometer measure and what does it calculate?

A

It measures the REFLECTING POWER of the cornea and calculates the 1. Radius of curvature and 2. refractive power of the K

436
Q

90% of cones are in or out of the macula?

A

outside

437
Q

what structures are formed by each of the three waves of neurocrest cells?

A

first wave: endothelium
second wave: iris and pupillary membrane
third wave: stroma and sclera

438
Q

ideal therapy for toxo? PO alternatives?

A

ideal: pyrimethamine, sulfadiazine, steroids, folate
Alternatives: Bactrim +/- clind

439
Q

valacyclovir vs acyclovir dosing for HSV?

which is better at preventing postherpetic neuralgia?

A

acyclovir is 800 mg 5 x a day for 7 days
valacyclovir is 1g TID
valacyclovir is better at prevention of post herpetic neuralgia.

440
Q

general rule for follow up for amblyopia?

A

1 week for every year of age. so a 4 year old should be seen every 4 weeks

441
Q

acute hemorrhagic conjunctivitis is caused by what viruses?

A

enterococcus subgroup 70

coxackie virus A24

442
Q

s/p LASIK – cornea power calculation per “clinical history” method?

A

Kpower= Preop K + Sph E - Refraction post

443
Q

What are ocular associations of NF2?

A

wedge cataracts/ PSCs
retinal/RPE hamartomas.
bilateral schwannomas/hearing loss

444
Q

leber’s congenital amaurosis–intellect of these patients are…?

A

normal nondegenerative–unlike LCA-like syndromes such as refsum/Batten

445
Q

ONTT–what is the 10/20/40/60 rule

A

10 year risk for MS is 20% in isolate optic neuritis patients. 40% on avg, and 60% if there are ANY white matter lesions intracranially

446
Q

main other ocular associations with aniridia>?

A 
angle closure glaucoma
progressive K opacification (limbal stem cell deficiency)
cataracts
nystagmus
foveal hypoplasia
447
Q

Lupus retinopathy is most associated with what other systemic symptoms of SLE?

A

seizures/strokes

448
Q

what anesthetic is contraindicated for globe rupture cases? why is that?

A

succinylcholine.

depolarization of muscles can cause contraction and extrusion of globe contents

449
Q

whats normal vertical fusion?

A

1-3 prism diopters

450
Q

brimonidine (alpha 2 agonists) should not be used with tricyclic antidepressants or MAOI why?

A

risk of hypotension

451
Q

where are optic pits usually located?

A

Infratemporally… VF defects are usually paracentral, arcuate scotomas

452
Q

retinoschisis. what’s the most common location? what layers are separated?

A

inferior temporal. outer nuclear layer

453
Q

retinoschisis. what are the two kinds?

A

typical degenerative

reticular degenerative

454
Q

retinoschisis. how can you tell it’s retinoschisis vs RD? 5

A

schisis is smooth domed, no vitreous hemorrhage/pigment, having absolute scotoma, reaction to photocoagulation, no shifting sub retinal fluid

455
Q

Gradenigo syndrome?

A

inflammatory mastoiditis: ipsilateral facial pain, CN VI and VII palsy

456
Q

macrostriae vs microstriae s/p LASIK

A

macro–large full thickness slippage. need to reflect

micro–small wrinkles in bowman’s. if vision is good then observe. only refloat flap if vision is compromised.

457
Q

Anton syndrome

A

cortical blindness due to impairment of retrochiasmal optic pathway.

458
Q

Pulfrich phenomenon?

A

illusion that an object moving perpendicular to a person’s line of sight is moving toward or away from them.
optic neuritis

459
Q

Riddoch phenomenon?

A

cortical blindness where patient can only see moving objects and not stationary ones.

460
Q

what is a wessely ring?

A

white ring in cornea caused by neomycin. type III hypersensitivity–local ab deposition

461
Q

cyclic eso. treatment?

A

surgery

462
Q

effect of Arcuate keratotomy?

A

coupling. flattens meridian at hand and steepens 90 degrees away

463
Q

what muscle makes up the gray line?

A

pretarsal orbicularis aka muscle of riolan

464
Q

Keratoglobus features?

A

present at birth

correlates with ehler dances, deafness. strong risk of perforation

465
Q

corneal dystrophy frequency by age? by frequency?

A

age: my little granny (Mac, latt, granular)
occurence: may grow lovingly (Mac, granular, and lattice.

466
Q

anatomical/imaging abnormality noted in duane’s syndrome?

A

missing CN VI nucleus

467
Q

collier’s sign

A

bilateral lid retraction with upgaze

468
Q

convergence retraction nystagmus is seen in what condition?

A

parinauds’

469
Q

what color laser for retina should you use to minimize pain?

A

green

470
Q

what color retinal laser should you use with VH?

A

red

471
Q

what color retinal laser should you use for coat’s disease

A

yellow

472
Q

what are hyaloidretinopathies? which ones do these include?

A

these are a group of diseases with optically empty vitreous (aka premature vitreous degeneration) leading to high RD risk.

Wall Street Journal Primarily Republicans (Wagner, Stickler, Jansen, Pierre, Robins).

473
Q

oculomanifestation of lowe’s. systemic symptoms

A

dense discform cataracts in all patients
glaucoma in 50%
hypotonia aggression
fanconi renal tubular acidosis

474
Q

what size are intermeediate drusen?

A

64-124 microns

475
Q

corneal stroma is what type of collagen?

A

type I; 70% by weight

476
Q

fuchs heterochromic iridocyclitis is associated with what virus?

A

rubella

477
Q

how to reduce effect of anisokonia?

A

contact lenses

478
Q

how to reduce effect of anisometropia?

A

reducing vertex distance
reducing surface refractive power
reducing central thickness of glasses

479
Q

what are the three types of magnificatioN?

A

transverse: the ratio
angular: simple magnifier; =power/4
axial aka longitudinal: transverse squared

480
Q

where does the EOMs penetrate the tenon’s capsule?

A

10 mm from insertion

481
Q

contraindication of cyclosporine?

A

uncontrolled HTN?

482
Q

most common cause of recurrent RD s/p repair?

A

PVR. exposure of RPE to glial cells causes fibrotic reaction

483
Q

most common corneal manifestation of EBV?

A

EBV often presents as multifocal infiltrates in K.

Also most common cause of dacryoadenitis.

484
Q

Conj melanomas tend to spread to where?

A

nodes

485
Q

uveal melanoma tend to spread to where?

A

liver

486
Q

what did the diabetic retinopathy vitrectomy study show? (DRVS)

A

typeONE diabetics benefit from early vitrectomy for VH when vision is 20/200 or worse

487
Q

what did the diabetic retinopathy vitrectomy study show? (DRVS)

A

typeONE diabetics benefit from early vitrectomy for VH when vision is 5/200 or worse

488
Q

what mimicks terrien marginal degeneration and is seen in children?

A

fuch’s superficial marginal keratitis

489
Q

lower lid defect…how should you close the wound?

A

vertical closure with horizontally oriented sutures. avoids tension to pull the lid down

490
Q

A pattern is significant at what prism diopters

What about V pattern

A

A is 10 diopters (10A)

V is 15 diopters

491
Q

CD45 is what kind of cell marker

A

immagture B cells

492
Q

holmium: yag is associated with phototermal effect for what condition

A

low hyperopia

493
Q

nystagmus with head turn. how should you orient prisms to fix the nystagmus vs how should you fix via surgery?

A

prisms should shift image toward null zone.

surgery should pull eyes away from null zone

494
Q

does systemic antihelminth work with for ocular cysticercosis?

A

no

495
Q

BK is deoposition of calcium but also could be deposition of what substance

A

urate

496
Q

bilateral symmetrical bulls eye maculopathy with temporal optic nerve atrophy

A

cone dystrophy

497
Q

oncocytoma?

A

dark pigmented lesion w/o significant growth. can mimick melanoma

498
Q

whats the difference between ductions and versions?

A

duction is monocular testing

versions is binocular testing

499
Q

what cells does ethambutol effect? what kind of vf defect?

A

mitochondria of the gangioncells , cecocentral

500
Q

is rhabdomyosarcoma usualy painful?

A

no

501
Q

transpupillary thermal therapy can be used for what

A

for choroidal melanomas… it doesn’t damage ovelryingretina and RPE very much

502
Q

best IOL for uveitis patients

A

acrylic

503
Q

wavelength of femtosecond

A

1053

504
Q

wave length of eximer

A

193

505
Q

two types of blood vessels for choroidal circulation

A

haller (large vessels); sattler (small vessels)

506
Q

how many percent of TAo patients have been hyperthyroid at some point

A

90%

507
Q

how many percent of hyperthyroid patients develop TAO

A

30%

508
Q

whats a normal CDR in new borns

A

<0.3; reversal of cupping can occur with surgery for congenital glaucoma

509
Q

location of berlin, busacca, and koeppe nodules

A

berline angle, busacca mid, koeppe pupil

510
Q

geneva study

A

ozurdex is safe for mac edema in vein occlusions

511
Q

how should you fix an enucleated eye due to melanoma

A

don’t open the eye at all and fix in formalin for 24 hours. formalin penetrates at 1mm per hour

512
Q

three types of melanoma cells per Callendar classification

A

Spindle A, Spindle B, epithelioid

spread via vortex veins to outside of sclera

OPHTHALMOLOGY BCSC (8 decks)

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