Review Flashcards
1
Q
conjunctival xerosis in VAD caused by ->
A
deficiency of mucin produced by goblet cells (degeneration of goblet cells)
2
Q
Can cause hydration of the cornea
A
Hypotony -> reduced compressive force
3
Q
Maps seen in epithelial basement membrane dystrophy show this staining
A
NEGATIVE staining
4
Q
Dellen staining
A
positive or pooling of dye
5
Q
Effect of tetracycline on anticoagulants
A
potentiate anticoagulant effect
6
Q
Treatment options for ocular rosacea
A
Tetracycline (SE no anticoagulant)
Azithromycin (no cardio problems - may cause irregular heart rhythm)
Erythromycin - low adverse reactions
7
Q
Diffuse punctate staining + whorled epithelium with normal schirmer/TBUT
A
Toxic keratitis -> switch to PF alternatives
8
Q
Extra row of eyelashes from ducts of meibomian glands
A
Distichiasis (congenital AD or acquired)
9
Q
Cornea >13mm diagnosis and associated problem during surgery
A
megalocornea -> zonular instability
10
Q
Type of eye a/w increased risk for choroidal effusion during cataract surgery
A
nanophthalmia
11
Q
Condition most commonly a/w posterior embryotoxon
A
Normal eyes
12
Q
Corneal finding in children with untreated congenital syphilis
A
interstitial keratitis develops 6 to 12 yo with progressive corneal edema, ABNORMAL DEEP STROMAL VASCULARIZATION adjacent to descemet membrane
13
Q
Medication that causes chalky white deposits that adhere to corneal epithelial defects
A
topical fluoroquinolone especially ciprofloxacin
14
Q
Band keratopathy made of what substance?
Workup labs for unexplained band keratopathy should include
A
calcium hydroxyapatite
Calcium and phosphate tests -> elevated phosphate can drive precipitation of calcium hydroxyapatite (renal patient)
15
Q
Vision loss in terrier marginal degeneration
A
high against-the-rule, oblique or irregular ASTIGMATISM
16
Q
Monitor patient with cystinosis for –>
Tx for cystinosis –>
A
Nephropathy -may lead to kidney failure by 10 years of age
Topical cysteamine for cornea
Oral cysteamine for posterior segment (retinopathy, optic neuropathy)
17
Q
History you must elicit for keratinized epithelium, cellular debris, corynebacterium xerosis
A
restrictive diet
alcoholism
chronic lipid malabsorption (bowel resection, cystic fibrosis)
18
Q
Surrounded by capsid of primarily glycoproteins more resistant to alcohol
A
Adenoviruses -> diluted bleach
19
Q
Varicella-zoster vaccine reduces the incidence of zoster by –>
A
50% in new cases of zoster and 66% postherpetic neuralgia
Immunity lasts only 5 years
20
Q
follicular conjunctivitis with eyelid nodule with central umbilication would show this pathology
A
eosinophilic intracytoplasmic inclusions (Henderson-Patterson bodies) within epidermal cells surrounding a necrotic core
21
Q
Pathology of herpetic vesicle
A
Vacuolized cytoplasm with multinucleate cells
22
Q
Foamy histiocytes surrounding blood vessels
A
xanthelasma
23
Q
treatment for gram-negative intracellular diplococci
A
intramuscular ceftriaxone 1 g for gonococcal conjunctivitis caused by neisseria gonorrhoeae
24
Q
bandlike or stellate tarsal scarring superior + corneal scarring, trichiasis
A
Trachoma caused by bacterium Chlamydia trachomatis (Serotypes A-C)
25
Tx for fungal keratitis due to infection with filamentous fungi
Fusarium --> Natamycin
26
Dense white-blood-cell reaction following length of corneal nerve
Radial perineuritis
MARKING "L" cornea
M: Multiple Endocrine Neoplasia
medullary carcinoma of the thyroid
Pheochromocytoma
Mucosal neuromas
```
A: Acanthamoeba
R: Refsum's disease (phytanic acid/Riley Day)
K: Keratoconus
I: Icthyosis
N: Neurofibromatosis
G: Grafts (failed) Glaucoma (infantile)
L: Leprosy
```
27
Cause contact dermatoblepharitis
topical medication
Type IV delayed hypersensitivity reaction begin 24-72 hours following instillation of topical agent
28
Tx for chronic atopic dermatitis or atopic keratoconjunctivitis
Oral and topical T-cell inhibitors - Tacrolimus
29
Tx for surface squamous neoplasia
interferon-alpha2b 1 million IU/mL given 4 times daily until resolution (2 to 4 months)
30
Tx for 360 degree conjunctivalization of cornea after unilateral chemical burn
Simple gimbal epithelial transplantation (SLET)
31
Management when uveal prolapse occurs during acute open-globe repair
reposit tissue
32
Dieffenbachia cause keratoconjunctivitis by
calcium oxalate deposition
33
Cornea donors younger than 2 years old not used because
extremely steep and flaccid
34
Leads to myopic shift after cataract surgery with BCVA 20/20
anterior capsular contraction syndrome/lens phimosis
35
Rate of cataract surgery in developed country
10,000 per million population per year
36
Human lens changes with age
increasingly curved, more refractive power. Increase in water-insoluble proteins.
37
How is metabolic waste removed from the lens
aqueous humor
38
Protect the corneal endothelium with this agent in patient with corneal guttae
DISPERSIVE ophthalmic viscosurgical device (OVD)
Cohesive agent would be easily expelled during phaco
39
Helmholtz theory of accomodation
most of change in lens shape occurs at central anterior surface of the lens
40
What change occurs in the lens in the presence of high levels of glucose
Sorbitol pathway activated
Aldose reductase is key enzyme in this pathway
Hexokinase reaction is the rate-limiting step in glucose phosphorylation
41
Terminal differentiation
elongation of lens epithelial cells into lens fibers
42
Sx of cortical cataracts
glare
43
histology of PSC
posterior migration of lens epithelial cells and enlargement
44
Lamellar membrane whorls seen on EM for this cataract
nuclear cataract
45
Cataract a/w chalcosis
"sunflower" cataract
46
Cataract in galactosemia
"oil droplet"
47
Determining AL with immersion technique or contact application most useful in this setting
Dense vitreous hemorrhage
Corneal scarring
PSC
Biometry still possible with silicone oil or aphakia - need adjustment
48
Protect the corneal endothelium with this agent in patient with corneal guttae
DISPERSIVE ophthalmic viscosurgical device (OVD)
Cohesive agent would be easily expelled during phaco
49
Tx for shallow anterior chamber 2/2 ciliary block
aqueous suppressants + cycloplegia
50
IOL most likely to cause negative dysphotopsia
smaller, square-edge optic designs
51
Equivalent in blood of tissue-bound mast cells
Basophils
When they leave bloodstream and go to tissue they become mast cells
52
May present as peripheral necrotizing retinochoroiditis resembling acute ARN
Treponema pallidum Syphilis
53
Risk factor in patient with WNV-associated uveitis increased risk of WNV mortality
DM
54
Coin-shaped lesions circinate stellate KP
CMV anteiror uveitis
55
HSV1/HSV2 Corneal finding
Diffuse stellate KP
+/- granulomatous or non-granulomatous KP
56
Candidemia with decreased vision exam creamy yellowish chorioretinal lesions in posterior pole. Tx?
Oral voriconazole
excellent penetration, no vitreous involvement
57
m/c ocular manifestation of coccidiodomycosis
phlyctenular granulomatous conjunctivitis
58
Percentage chance that PVRL willl develop intracranial disease
60-75%
Primary vitreoretinal lymphoma (PVRL) is a subset of primary central nervous system lymphoma (PCNSL)
59
Band keratopathy histology
deposition of calcium hydroxyapatite at level of bowman membrane
60
Virus a/w PCNSL and PVRL
Epstein-Barr HHV-4
61
Immune response to parasitic infections
Th2-mediated response
62
Immune response in acute anterior uveitis, giant papillary conjunctivitis and VKH
Th1-mediated response
63
antigenic site on antibodies
idiotopes
64
antigenic sites on foreign molecules
epitopes
65
Controls the immunoregulatory processes of the retina and choroid
reitnal pigment epithelium (RPE)
Modulate T-cell activity and convert effector cells into regulatory cells
66
Population who are positive for HLA-B27 and those with Acute Anteiror Uveitis (AAU)
8% HLA-B27
0.012% develop AAU (1 in 667)
67
HLA-DR4
VKH, SO
68
Tumor necrosis factor alpha inhibitors and side effects
```
Adalimumab
Infliximab
Certolizumab
Golimumab
Etanercept
```
CNS demyelination
Lymphoma
HBV reactivitation
69
Therapy that may induce antichimeric antibodies
Infliximab - 75% receiving 3+ infusions developed antinuclear antibodies - drug-indused lupus syndrome
70
Treatment for recurrent noninfectious refractory anterior scleritis
systemic steroids
prednisone 1 mg/kg/day
71
Scleritis you must r/o infectious etiology
NODULAR anterior scleritis especially if necrosis
72
Tx for TINU
responsive to high-dose oral corticosteroids
73
Ankylosing spondylitis 90% HLA-B27 - systemic concern
Pulmonary apical fibrosis --> CXR
Aortic valvular insufficiency --> Cardiac echogram
74
Initial scleritis followed by chronic headaches, tracheomalacia, focal segmental glomerulonephritis BRAO or BRVO or CRAO/CRVO
Granulomatosis with polyangiitis - necrotizing granulomatous vasculitis of upper and lower respiratory tract
Urinalysis (85%) with glomerulonephritis
75
Anti-cyclic citrullinated antibody test
anti-CCP antibody dianosis of RA with high specificity
76
Sarcoid, Behcet and VKH can show involvement of this system
CNS
NOT in MFC + panuveitis
77
White dot syndrome or chorioretinopathy a/w infectious etiology
serpiginous choroiditis or geographic/helicoid choroidopathy --> Mycobacterium tuberculosis
78
Testing preliterate children what optotype has best calibration and reliability
HOTV and LEA symbols
79
Type of deviation in infantile esotropia
comitant deviation -does not vary by more than a few prism diopters in different positions of gaze or with either eye
80
lateral muscular branch supplies
LR, SR, SO, LPS
81
medial muscular branch
IR, MR, IO
82
EOM orbital layer vs global layer
orbital layer --> inserts on muscle pulley
global layer -->tendon inserts on sclera to move globe
83
agonist -->
synergist -->
antagonist -->
agonist - primary muscle moving the eye in a direction
synergist - muscle of same eye accts with agonist to produce same movement
antagonist - muscle in same eye as agonist that actis in direction opposite to that of agonist
84
EOM that has only a primary action and no secondary or tertiary action
medial and lateral rectus muscles
85
in complete third nerve palsy, what action of superior oblique muscle exacerbates abducted position in paretic eye
TERTIARY - abduction
86
moderate amblyopia treatment patching vs pharmacologic treatment
equal
87
right exotropia in ROP
positive angle kappa eg temporal dragging of macula in cicatricial ROP which can simulate exotropia
88
How to test for horizontal deviation using Maddox rod
place rod cylinders horizontally in front of the right eye (180 degree meridian) Fixating on point source of light sees a vertical line with right eye and the point of light with left
89
exodeviation at distance is larger than deviation at near by 10 pd but distance and near become similar after 30-60 minutes of binocular occlusion patch test
pseudodivergence excess intermittent exotropia
90
stereopsis worsens after
alignment and VA testing are dissociating - perfrom sensory testing first
91
Y pattern
exodeviation is greater in upgaze - you will see overelevation of the eye on adduction and slight upgaze
overelevation on horizontal gaze - true IO overaction
92
Surgery for V-pattern esotropia
bilateral MR recession with inferior transposition
MALE
Medial rectus to apex, lateral rectus to empty space
93
pattern of strabismus addressed by bilateral weakening of IO muscles
V pattern - caused by IO overaction
A pattern SO overaction
94
Duane retraction syndrome associated with
Goldenhar syndrome (hemifacial microsomia, ocular dermoids, preauricular skin tags, eyelid colobomas)
95
hearing loss + RP + white forelock
Waardenburg syndrome
96
Type 1 duane retraction syndrome
poor abduction and esotropia
97
Type 2 duane retraction syndrome
poor adduction and exotropia
98
Type 3 duane retraction syndrome
poor abduction and adduction; either esotropia or exotropia
99
Botulinum toxin type A most effective for
small-angle esotropia
100
Anomoly represented by choroidal coloboma
DYSRAPHISM - failure to fuse
101
Process in anophthalmia
Agenesis - developmental failure
102
Hypoplasia
developmental arrest
103
poor visual behavior in 5-month old child without nystagmus
Cerebral visual impairment
pathology posterior to lateral geniculate nucleus --> nystagmus not present
104
blepharophimosis-ptosis-epicanthus inversus syndrome inheritance
sporadic or AUTOSOMAL DOMINANT
blepharophimosis
congenital ptosis
telecanthus
epicanthus inversus
105
Crouzon syndrome vs Apert syndrome
Apert --> extreme syndactyly (can't move fingers APERT)
both have hypertelorism proptosis, inferior scleral show
106
most common strabismus a/w craniosynostosis
v-pattern exotropia
107
neonate with chemosis, discharge 3-4 days of life
neisseria gonorrhoeae
108
neonate 1 week age with minimal-moderate discharge possible psuedomembrane
chlamydial conjunctivitis
109
neonate with conjunctivitis at second week of life
HSV
110
Early manifestation of SJS
mucopurulent conjunctivitis to corneal
111
effect of apraclonidine in patient with Horner syndrome
Reverses anisocoria - causes dilation of affected pupil but no effect on normal pupil.
112
pathophysiology in primary congenital glaucoma
abnormal development of neural crest-derived tissue of anterior chamber angle --> decreased aquous outflow
113
Anterior chamber angle of normal infant eye differs from adult eye
Schwalbe line is less distinct
TM less highly pigmented
Junction between scleral spur and ciliary body is less easily seen
114
PSC seen in association with what dz
NF2
115
m/c etiology of AAU in child
JIA - 15-47%
Antinuclear antibody positivity
RF negative
116
Type 1 ROP
Zone I any stage with plus
Zone I stage 3 w/o plus
Zone II stage 2 or 3 with plus
117
Type 2 ROP
Zone I stage 1 or 2 w/o plus
| Zone II stage 3 w/o plus
118
What percentage of Rb can arise from somatic nonhereditary mutation of both alleles of RB1 in a retinal cell
60% - somatic nonhereditary mutations of both alleles of RB1 in retinal cell
40% - germline mutation in 1 of 2 alleles of RB1 either is inherited from an affected parent (10% of all Rb cases) or occurs spontaneously in 1 of the gametes
119
Optic nerve hypoplasia should undergo MRI to evaluate for
ectopic posterior pituitary bright spot at upper infundibulum --> pituitary hormone defiicencies
absence of septum pellucidum
agenesis of corpus callosum
septo-optic dysplasia
120
m/c ocular manifestation of abusive head trauma
RETINAL HEMORRHAGE 80%
seen in all layers unilateral or bilateral, m/c posterior pole
121
Abnormal number of crossed fibers in the optic chiasm
ocular albinism
prevent stereopsis and cause strabismus
asymmetric VEP
122
characteristic feature of pinhole camera
infinite depth of field
inverted image
lengthy exposure
123
direction of monochromatic light as it passes through a prism
toward the Base
Light toward the BASE
124
concept of magnification appropriate for astronomical telescope
Angular magnification
125
Each line on VA in ETDRS
0.10 LogMAR between lines so that a 3-line change in acuity corresponds to a change of 0.30 LogMAR
126
Far point of a hyperopic eye?
behind the eye
emmetropic --> optical infinity
127
cause of positive dysphotopsias
internal reflections within the intraocular lens itself
128
Modulation transfer function of IOL
higher MTF signify higher image quality
Monofocal IOL demonstrate highest modulation transfer funtion MFT peaks
129
Reduction in efficacy of astigmatism correction in toric lens
as little as 10 degrees
130
Diffractive multifocal lenses dissipate about ___ of the light entering the pupil
20%
131
Refractive procedure minimizes optical aberrations
phakic intraocular lens
132
Wavefront aberration is correctable with spectacles
positive defocus (myopia)
133
property of light used by scanning laser polarimeter to measure thickness of NFL
polarization
134
Diagnosis of Charles Bonnet syndrome
Vivid recurrent visual hallucinations
Some degree of vision loss
no other neuro signs/sx
Full insight that what is seen is not real
135
Legal blindness due to VF constriction in the US
Equal or less than 20 degrees around central fixation measured with a Goldmann III4e target
136
2 visual functions displayed on contrast sensitivity curve
spatial frequency and contrast threshold
137
Vitreous attaches to ILM via
fibronectin and Laminin
138
most specific for RPE cell death
FAF
139
measures central retinal ganglion cell function
pattern electroretinogram PERG
140
assesses health of RPE
EOG
141
direct measure of macular function
multifocal ERG
142
test integrity of afferent pathway
visual evoked potential
143
Pelli-Robson
evaluates contrast sensitivity on logarithmic scale
144
FDA approval for Verteporfin
CNV a/w AMD, myopia, POHS
145
Genes for AMD
ARMS2 and CFH
146
BRVO not at AV crossing
vasculitis
147
inheritance of VHL
AD
148
complication of retinal cavernous hemangioma that may need tx
VH
149
initial ROP screen born at 29 weeks
4-6 weeks after birth
150
AZOOR affects this part of retina
outer retinal layer
151
Zone 1 ROP evaluate in
1 week
152
unilateral RP
DUSN
153
Definition of pleiotropy
single gene may lead to multiple phenotypes
154
TIMP3 gene causes early onset drusen + CNV
Sorsby macular dystrophy
155
CYP4V2 gene crystalline deposits in retina with GA
Bietti Crystalline dystophy
156
Batten disease has
bull's eye maculopathy
157
Initial sign of familial amyloidosis
vitreous opacities
158
a/w angle closure glaucoma
anterior persistent fetal vasculature (PFV)
159
siderosis bulbi
peripheral retinal pigmentation
160
Must be calculated using Goldmann equation
UVEOSCLERAL FLOW RATE
outflow facility --> tonography
aqueous humor formation rate --> fluorophotometry
Episcleral venous pressure --> venomanometry
161
false-positive in perimetry
responds even though no visual stimulus was presented
162
PCG this can still change even though IOP appears to be controlled
Axial length
163
PCG after successful surgery should be monitored for
Life!
164
beta blocker less likely to result in pulmonary adverse effects
betaxolol - selective B1
165
Where does bleeding originate in suprachoroidal hemorrhage
short or long posterior ciliary arteries as they enter the suprachoroidal space from the intrascleral canal
166
Percentage of treated patients s/p laser trabeculoplasty expected to maintain lower IOP
50%
167
best candidate for trab with MMC
patient with previous failed trab without antifibrotics
168
most success with laser trabeculopasty
intolerant to multiple medications and whose current IOP above target pressure
LTP less effective in aphakic or Ps patients compared to phakic
169
Placido disk-based corneal topographer uses
image of a series of concentric rings reflected off the cornea
170
Variable that will affect the depth of laser ablation required to treat a specific degree of myopia
optical zone diameter
Ablation depth = degree of myopia (D) x Optical Zone diameter ^2 /3
171
Condition prevents a 25-year old from being a good PRK candidate
Pregnancy --> wait 3 months after delivery and cessation of breast feeding
172
Cycloplegic refraction recommended for myopic LASIK to prevent
overcorrection
perform manifest and cycloplegic refraction close together
173
Discontinue rigid CL for how long prior to surgery
3 weeks
soft CL 3 days to 2 weeks
174
Arcuate keratotomy changes that may result in overcorrection
incision placed at smaller optical zone, increased length or depth of incision
175
complication of RK after 10 years
progressive hyperopia
176
intrastromal corneal ring segments made of
PMMA
177
Alloplastic corneal inlays can be used to treat
presbyopia
178
Mechanism of action of presbyopic inlays
pinhole effect
179
important preoperative step prior to laser ablation in LASIK
cover the eye not being treated to block fixation
180
wavefront-optimized ablation
improved contrast sensitivity
181
Haze after PRK
deposits from increased keratocyte activity
182
Excimer laser vision overcorrection more common in
older individuals
183
Vitamin used in crosslinking
riboflavin B2 generates singlet oxygen
184
Corneal inlays are approved by the FDA to treat
early to moderate presbyopia
185
Tx for post-lasik ectasia
RGP CL
186
leads to phthisis bulbi
low IOP
SAD - Shrinkage, Atrophy, Disorganization
187
glaucoma a/w angle recession
damage to TM
188
Mutation in nevi of Ota
GNAQ and GNA11 genes found in 50%-85% of blue nevi and uveal melanomas
189
gene mutation in 80% of uveal melanoma with poor prognosis (class 2 tumors)
BAP1
190
Gene a/w cutaneous melanomas
BRAF
191
anterior segment histological findings in PCG
hypoplastic scleral spur and anomalous insertion of ciliary muscle --> arrested development of anterior chamber elements
192
Hemolytic glaucoma caused by accumulation of what material in TM
hemosiderin-laden macrophages
193
nanophthalmos is a/w with
normal lens
short axial length 15-20 mm, thick sclera, normal or slightly enlaarged lens
predisposted to Uveal effusion and glaucoma
194
Alizarin red
stains calcium
195
Stains for acanthamoeba
calcofluor white and acridine orange
196
Nodular fasciitis is what type of process
reactive process
197
embryologically germ cell layer from
surface ectoderm
198
periretinal membranes in PVR are composed of
RPE cells
muller cells, fibrous astrocytes, macrophages, fibroblasts, myofibroblasts
199
ocular fundus finding that identifies carriers of gardner syndrome genetic mutation
CHRPE
4 or more lesions in each eye of patient with gardner syndrome or APC mutation
200
Aniridia is a/w what other ocular finding
CORNEAL PANNUS
cataract, foveal hypoplasia
201
Lipid stains
oil red O or Sudan black B
202
Gene translocation in rhabdomyosarcoma
FOXO1
203
NF1 associated tumor will have what histology
ON glioma --> low grade juvenile pilocytic astrocytoma --> rosenthal fibers --> deeply eosinophilic filaments, degenerated cell processes
204
Psammoma bodies
meningiomas
205
staghorn vascular spaces
hemangiopericytomas and SFTs
206
Verocay bodies
fibrils that resemble sensory corpuscles in antoni a spindle cell pattern in schwannomas (neurilemomas)
207
cells that would stain positive for hemosiderin in a CNS hemorrhage
microglial cells - the CNS hisiocytes that have phagocytic function the "macrophages" of the CNS
208
Coats disease
UNILATERAL
retinal vasculopathy (retinal telangiectasis with exudative maculopathy and/or retinopathy) boys younger than 10 yo
209
m/c secondary tumor in Rb survivors
Osteosarcoma 40% arising within field of radiation and 36% outside field of radiation in patients treated for Rb
210
If parent has bilateral Rb, what is child risk of developing Rb
45%
211
Rb with any retinal lesion of any size within 3 mm of the fovea without focal or diffuse vitreous seeds is this class
group B
212
m/c initial therapy ofr medulloepithelioma
enucleation
213
tx of choice for metastatic carcinoma to choroid
individually tailored tx
chemo+radiation
prior and current chemo and radiation affect treatment
214
m/c finding on eye exam in patients with leukemia
retinal hemorrhages typically white-centered hemorrhages are m/c
Typically have anemia and thrombocytopenia.
