Robbin's Qs Flashcards
Mucor can result in ___
Sinusitis
What is presentation of Sialadenitis?
Inflammation of salivary gland: localized, tender nodule in oral cavity
How to differentiate Sialadenitis from a Fibroma?
Sialadenitis is tender
Fibroma is non-tender
How does oral candidiasis present?
Oral thrush: white-gray plaque on tongue
What is the clinical histology of candida?
Budding yeast w/ pseudohyphae
How does herpes labialis present?
Vesicles that can rupture and ulcerate
Pregnant woman comes in with rapidly growing oral vesicular lesion that regresses on its own.
What is it?
Pyogenic granuloma
Clinical difference between thrush and oral hairy leukoplakia:
Candidiasis: can be scraped off as pseudomembrane
Oral hairy leukoplakia: can’t be scraped off
Guy with Type 1 Diabetes and ketoacidosis is at risk for:
Fungal sinusitis with Mucor
Velvety, erythematous area with focal surface erosion on buccal mucosa
Histology: dysplastic squamous epithelium
What is it?
Erythroplakia
Erythroplakia vs Leukoplakia
Which is more likely to progress to SCC?
Erythroplakia
How does leukoplakia present?
Raised white patch on hard palate; can’t be scraped off
Histology: thickened mucosa
What mutation is often found in oral SCC?
TP53
Where are dentigerous cysts usually found?
Crown of an unerupted tooth, typically 3rd molar
What are periapical cysts/granulomas?
Inflammatory lesions at apex of teeth; complications of long-standing pulpitis
Inflammatory nasal polyps are associated with what chronic condition?
Recurrent allergic rhinitis: Type 1 hypersensitivity often called hay fever
Exam: glistening, translucent, polypoid masses filling nasal cavities
What lab finding?
Inflammatory nasal polyps –> high serum IgE
Exam: painless progressive swelling of left face
CT: circumscribed multilocular cyst of left mandibular ramus
Histology: cysts lined by stratified squamous epithelium w/ prominent basal layer; no inflammation or granulation
What is it?
Odontogenic keratocyst
Presentation: abrupt onset, hoarsness, difficulty breathing and swallowing, throat pain
What is it?
Acute bacterial epiglottitis – H. influenzae
3 year old w/ difficulty breathing, harsh cough, inspiratory stridor, steeple sign
What is it? Most common cause?
Croup; most commonly from Parainfluenza virus
Postinfectious conditions of Group A strep:
- Rheumatic fever –> Rheumatic heart disease
- Poststreptococcal glomerulonephritis
EBV associated with what cancer in East Asian adults?
Nasopharyngeal carcinoma
Male singer who smokes
What does he likely have?
Reactive nodules (aka. Vocal cord polyps, singer’s nodules)
What is a potential complication of a kid with chronic otitis media?
Cholesteatoma—cystic masses lined by squamous epithelium
Painless movable nodule at neck
If lateral, it is likely what?
If medial, it is likely what?
Lateral= Branchial cyst Medial= Thyroglossal duct cyst
Where and how do paragangliomas usually present?
Solid mass adjacent to carotid bifurcation
Chromogranin and S-100 positive
Old guy with Parkinson’s (being treated) has xerostomia for 3 months. What’s the likely cause?
Anticholinergic drug use
Suppurative inflammation of parotid gland. Likely infectious agent?
Sialadenitis — S. aureus
Very old/Very young person with blue, translucent nodule on inside of lip. What caused it?
Local trauma causing mucocele of a minor salivary gland
Woman with nontender, mobile, discrete mass on face
Histology: ductal epithelial cells in myxoid stroma w/ islands of chondroidlike tissue and bone
What is it?
Pleomorphic adenoma
1st and 2nd most common Parotid tumors
- Pleomorphic adenoma
2. Warthin tumor
What is a malignant tumor of a minor salivary gland called?
Mucoepidermoid carcinoma
What is likely to occur 1 week after a nerve graft?
Fragmentation of distal axons and myelin sheaths
Regrowth potential with Axonotmesis vs. Neurotmesis:
Axonotmesis: Wallerian degenration, no damage to myelin sheath. Regeneration = no problem
Neurotmesis: transection of nerve. Regneration only with exact alignment
Rapidly progressive, ascending motor weakness following sickness. Has lymphocytic infiltrations and segmental demyelination in peripheral nerves
What is it?
Guillain-Barre Syndrome
Guy with HIV has relapsing motor and sensor problems in all extremities. Nerve conduction studies show demyelination and remyelination.
What is it?
Chronic Inflammatory Demyelination Polyneuropathy
Type of neuropathy associated with Diabetic Mellitus
Segmental demyelination
Onion bulb formation on peripheral nerves is found in what disease?
Refsum disease — hereditery neuropathy
Young woman with numbneess and tingling in both hands for 5 months.
What is it?
Carpal Tunnel Syndrome
Woman has right foot pain for 2 months, worse at end of day. Severe pain at interdigital space between 2nd and 3rd toes.
What does she have?
Morton neuroma = plantar nerve trapped between metatarsal heads
Edrophonium restores muscle strength in ___
Myasthenia Gravis
Old man w/ weight loss, proximal muscle weakness that does not dimish with repetitive movement, difficulty urinating, no improvement w/ AchE Inhibitor
What does he have?
Cancer + Lambert Eaton Myasthenic Syndrome (paraneoplastic)
Man and Wife have blurred vision and weakness for past day, trouble breathing
What likely caused it?
Botulism = C. botulinum ingestion
42 y/o man w/: progresssive weakness in all extremities, dysarthria, and dysphagia for 2 years. Now in wheelchair. No muscle pain or tremor
What is it?
ALS
30 y/o woman w/: fat redistribution in upper trunk, rounded facies, ecchymoses on extremities, BP 150/90, biopsy showing type II muscle fiber atrophy.
What is it?
Cushing Syndrome
Old woman receiving drug to lower cholesterol. CK 2049, Creatinine 2
What is it?
Statin-induced myopathy
5 y/o develops increasing muscle weakness. Unable to keep up with other children b/c of quickly becoming tired.CK 689.
What is it?
Duchenne Muscular Dystrophy
10 y/o girl with non-progressive muscle weakness since childhood. Histology with Gomori trichrome stain shows subsarcolemmal aggregates of rod-shaped intracytoplasmic inclusions.
What is it?
Nemaline rod myopathy - a form of congenital myopathy
Infant displays movement difficulty by 1 month and flaccid paralysis by 1 year.
What is it?
Werdnig-Hoffman disease - a form of spinal muscular atrophy that starts at infancy
Man receives halothane and succinylcholine anesthesia. 30 minutes later, his temp increases to 39.5 and pulse 115.
What mutation does he have?
Calcium ion channel (ryanodine receptor) mutation –> malignant hyperthermia
42 y/o woman with increasing number of subcutaneous nodules, multiple cafe-au-lait spots, now with posterior left thigh pain.
What does she have?
Neurofibromatosis Type 1
What causes neurons, especially pyramidal ones in the hippocampus, to exhibit cytoplasmic eosinophilia, central chromatolysis, spheroidal swellings, and nuclear pyknosis?
- Hypoxic and hypoglycemic injury –> “red” neuron” initial reaction
- Larger pyramidal neurons most sensitive
What cells in the brain have a phagocytic/macrophage-like function?
Microglia
An afebrile patient has severe headache for 2 days; then develops unilateral papilledema, pupil dilation, impaired ocular movement and then later becomes obtunded
How can a glioblastoma cause this?
- Edema
- -> 3rd nerve palsy –> eye symptoms
- -> herniation –> obtunded
16 y/o boy presenting with 9 months of headaches. CT: large lateral ventricles and 3rd ventricles. LP: normal pressure, clear
He likely has ___ causing ___
Ependymoma –> non-communicating hydrocephalus (obstruction below 3rd ventricle)
61 y/o man: worsening mental function, confusion, headaches for 1 year; bilateral papilledema; CT: ventricular system enlargement.
How can a pneumococcal infection cause this?
Pneumococcal meningitis: usually involves vertex (where arachnoid granulations that reabsorb CSF are found) –> communicating hydrocephalus
Patient has an ischemic event that requires 15 minutes to reestablish pulse and BP. Next day: bilateral papilledema, MRI: indistinct cortical gray-white junction, narrowing of ventricles
What intracranial abnormality develped?
Cytotoxic edema
- -due to failure of ATP-dependent ion transport w/ retention of sodium and water
- -BBB remains intact
What causes Duret hemorrhages?
Duret hemorrhages = linear midline hemorrhages in the pons
Cerebral edema –> medial temporal lobe (hippocampal) herniation –> Duret hemorrhages
What lab abnormality can be found in the mother of an anencephalous fetus?
Elevated serum a-fetoprotein level
Fetus ultrasound: single cerebral ventricle, fused thalami.
At birth: small, postaxial polydactyly of hands and feet, cyclopia, microcephaly, cleft lip and palate, rocker-bottom feet
What’s the problem?
Holoprosencephaly = absent or partial cerebral hemispheric development
Can occur w/ trisomy 13 (Patau syndrome) –> cleft lip, palate, rocker-bottom feet
24 y/o man after car accident: impaired pain and temp sensation from shoulder down, normal proprioception and vibratory sense, motor weakness w/ muscle atrophy. MRI: transverse slit-like cavity from C2-C7.
What is it?
Syringomyelia = cavity or slit in spinal cord
–Spinothalamic tracts, anterior horns –> sensory and motor deficits
21 y/o woman has blow to her head from fall, loss of consciousness for 5 min. Exam: diminished deep tendon reflexes, no CT findings, can’t remember event, recovers next week.
What happened?
Concussion:
- altered consciousness
- instantaneous onset of transient neurologic dysfunction
- amnesia for event
- post-concussion syndrom w/ neuropsychiatric-manifestations
- no radiologic or pathologic findings
Old woman falls backward and hits her head. Exam: arounsable, but somnolent, no motor or sensory deficits, no papilladema.
Where has an acute hemorrhage occured?
Inferior frontal lobe –classic “contrecoup”
-Fall backword likely causes contusion to: inferior frontal, temporal tip, inferior temporal
-*Stationary blow to head likely causes “coup” injury”
Head trauma –> loss of consciousness –> “lucid interval” –> comatose
What’s the problem? Cause? CT finding?
EPIdural hematoma = classic “lucid” interval
- Injured middle meningeal artery
- Dura pushed against brain –> lens-shaped
Old woman falls downs stairs –> headache and confusion for 30 hours.
Location of hemorrhage? Cause?
Subdural hematoma
Tearing of bridging veins below dura
Global cerebral eschemia –> brain death.
1 month later, what’s the predominant cell in brain?
Macrophages (ongoing liquefactive necrosis, accumulates 2-3weeks later, can persist for months)
Old man with 6 episodes of dysarthria, weakness in hands and dizziness. Episodes usually last
Transient ischemic attack (TIA)
-Prodrome for Stroke (symptoms >24 hours)
What 3 groups of neurons are most sensitive to damage by hypoxia?
- Hippocampal pyramidal cells
- Cerebellar Purkinje cells
- Neocortical pyramidal cells
Hypertension is usually associated with what cerebrovascular events? Why?
- Hemorrhage: basal ganglia, pontine, or cerebellar
- Small lacunar infarcts
- Hyaline arteriolosclerosis prone to rupture
39 y/o afebrile, normotensive man with headache, aphasia, and reduced level of consciousness for 60 hours. LP: lymphocytic pleocytosis. Biopsy: granulomas involving arterioles and venules What is it? What class of meds can you give? What specific drugs?
- Primary angiitis
- Immunosuppressives
- Cyclophosphamide, methylprenisolone
Old man with DM has step-wise cognitive decline for 5 years, with multiple acute events that leads to worsening symptoms.
What’s wrong with him?
Vascular dementia – classic “step-wise” progression
Old man with progressive inability to perform ADLs, memory loss, but no motor or sensory deficits. Histo: Congo red staining plaques, neurofibrillary tangles
What does he have?
Alzheimer’s Disease (AD)
50 y/o woman w/ sudden severe headache, BP 115/83. LP: numerous RBCs. CT: subarachnoid hemorrhage at base of brain.
What happened?
Ruptured berry aneurysm
Patient with Neisseria meningitidis infection develops: fever, headache, petichial rash, hypotension and DIC
What is this called?
Waterhouse-Friderichsen Syndrome – most severe form of meningococcal septicemia
77 y/o man with bacterial meningitis. Gram stain of CSF is likely to show what? (+/- and shape)
Gram-positive cocci –
- Streptococcus pneumoniae is most common in this age group
- H. influenzae (gram (-) rod) is lower due to immunization
Patient with headache and fever for 2 weeks after severe respiratory tract infection. Exam: no papilledema, no sensation or motor deficits, decreased vision on left half of visual field. CT: sharply demarcated 3-cm ring-enhancing lesion on right occipital. LP: numerous leukocytes, high protein, normal glucose
What does she have?
Cerebral abscess – abscess ringed by fibroblasts that deposit collagen is characteristic
11 y/o boy with Strep pneumonia otitis media.
How can that become an epidural abscess?
Otitis media –> infect mastoid air cells –> spread to skull bone –> spread to epidural space –> pachymeningitis
65 y/o man is apathetic, irritable, withdrawn, worsening mental function over last year. Exam: (+) Romberg sign, pupils constrict with near focus, but not with exposure to light. LP: lymphocytic pleocytosis, elevated protein w/ increased IgG
What does he have?
Tertiary Neurosyphilis from Treponema pallidum infection
- Argyll Robertson pupil
- Tabes dorsalis = syphilitic myelopathy, degeneration of dorsal column
How to differentiate meningitis caused by:
- Cryptococcus neoformans
- Echovirus
- Listeria monocytogenes
- Neisseria meningitidis
- Toxoplasma gondii
- Cryptococal = India ink test positive
- Echovirus = self-limiting, in immunocompromised
- Listeria = Gram positive rod
- N. meningitidis = Gram negative diplococci
- Toxoplasmal = CT shows ring-enhancing lesions
25 y/o woman with confusion and disorientation has generalized tonic-clonic seizure. CT: 3cm recent hemorrhage in left temporal lobe. LP: few mononuclear cells, normal glucose and protein.
What does she have?
Herpes simplex virus encephalitis –> characteristic hemorrhagic lesions of Temporal lobe
33 y/o woman has a stillborn, hydropic fetus w/: marked organomegaly, extensive periventricular necrosis of brain w/ focal calcifications.
What caused this?
Cytomegalovirus –> characteristic periventricular leukomalacia (necrosis of white matter near ventricles)
14 y/o girl from Africa with poor vaccine history has diarrhea over days, then neck stiffness with 3/5 weakness on all extremities and requires mechanical respiration. Symptoms somewhat resolve over next 6 months.
What does she have?
Poliomyelitis –> characteristic minor GI illness –> acute major illness –> recovery –> late post-polio syndrome
Polio = enterovirus attacking LMN –> neurogenic muscle weakness and atrophy.
-Anterior horns of spinal cord has LMN
12 y/o boy develops fever, occasional headaches, malaise, fatigue, and nausea 1 montha after a dog bite.
What is pathognomonic histo finding?
Rabies –> Negri bodies = cytoplasmic inclusions found in hippocampal pyramidal cells and cerebellar Purkinje cells.
37 y/o man with HIV-1 has increasing memory problems, depression, motor dysfunction. MRI: diffuse cerebral atrophy, no focal lesions.
What does he have? What is histo finding?
AIDS dementia complex –> HIV produced encephalitis –> characterized by microglial nodules (reactive microglial cell collection)
52 y/o woman gets chemotherapy for leukemia. 2 months later, develops ataxia, motor weakness in right arm, difficulty swallowing, sensory changes in left leg. MRI: irregular areas of increased attentuation in white matter of cerebral hemispheres and cerebellum. Biopsy: perivascular chronic inflammation, marked gliosis, reactive astrocytes, intranuclear inclusions within oligodendroglia.
What does she have?
Progressive Multifocal Leukoencephalopathy (PML) caused by JC virus
Healthy young man has 5 day severe headache and new-onset seizure. Exam: papilledema. MRI: multiple small cystic periventricular and meningeal lesions. He ate some undercooked pork.
What does he have?
Cysticercosis caused by Taenia solium (pork tapeworm)
- Cysts causing obstructive hydrocephalus
- Neurocysteicercosis –> major cause of seizures
20 y/o man with HIV has decreased consciousness for 1 week and now has a tonic-clonic seizure. MRI: ring enhancing lesions in cerebral gray matter bilaterally. Biopsy: pseudocysts
What does he have?
Toxoplasmosis infection –> abscesses in periphery of brain (bright ring on CT and MRI)
63 y/o woman with increasing severe memory loss over 6 weeks. Exam: myoclonus, afebrile. CT: minimal cerebral atrophy
What does she have?
Spongiform Encephalopathy – most likely sporadic CJD
27 y/o woman with weakness for 3 months. LP: increased IgG with prominent oligoclonal bands. MRI: small, scattered, 0.5cm areas consistent w/ demyelination, mostly located in periventricular white matter.
What does she have?
Multiple Sclerosis –lesions in white matter, sparing gray matter
-Most patients develop optic neuritis
Patient was drunk driving, has MVA, develops hyponatremia. IV fluids correct it in 2 hours, but she rapidly becomes confused and has limb weakness.
What happened?
Central Pontine Myelinolysis – demyelination in basis pontis
-Alcohol abuse increases risk
63 y/o man with increasing irritability and weird behaviors for 3 years, but no memory loss developed aphasia. Exam: no motor or sensory deficits. MRI: bilateral marked temporal and frontal lobe atrophy. Autopsy: extensive neuronal loss, remaning neurons had intracytoplasmic, faintly eosinophilic, rounded inclusions.
What did he have?
Pick Disease = FTLD-Tau w/ Pick bodies.
60 y/o woman with 5 yr history of cogwheel rigidity, festinating gait, expressionless face. Taking L-dopa/carbidopa helped for 2 years, but developed problems performing ADLs and marked cognitive decline and died of aspiration pneumonia. Histo: cortical neurons had spheroidal, intraneuronal, cytoplasmic and eosinophilic inclusions.
What does he have?
Dementia w/ Lewy Bodies (DLB) – characteristic a-synuclein Lewy bodies in CORTEX.
“HaLEWYcinations”
What is the genetics of Huntington’s Disease?
-Autosomal Dominant CAG trinucleotide repeat expansion in huntingtin gene on chromosome 4
4 y/o girl has: difficulty with balance while walking, dysarthria, poor hand coordination, absent deep tendon reflexes, bilateral Babinski sign, diminished light touch and vibratory senses, no muscle weakness. In next 5 years, she develops CHF from hypertrophic cardiomyopathy. Autopsy: increased perinuclear iorn deposition in cardiac myocytes.
What genetic mutation did she have?
Friedreich ataxia – autosomal recessive GAA trinucleotide repeat expansion in frataxin gene
39 y/o man develops progressive, symmetric muscle weakness over 1 year. He can no longer stand, walk or feed himself, but mental function remains intact.
What cells are being affected?
Amyotrophic Lateral Sclerosis (ALS)
- -LMN dysfunction at anterior horn
- -Cortical UMN
53 y/o alcoholic has increasingly clouded sensorium over 2 days and a flapping tremor of outstretched hands. Brain Histo: increased neocortical and basal ganglia astrocytes w/ pale, swollen nuclei. Lab: ammonia 100umol/L
What does he have?
Hepatic Encephalopathy
10 y/o boy has persistent headaches for 3 months. Exam: afebrile, ataxic gait, dysdiadochokinesia. CT: 4cm cystic mass in right cerebellar hemisphere. Mass histo: cyst w/ thin wall, filled with gelatinous material, GFAP +, long, hairlike processes
What does he have?
Pilocytic Astrocytoma
40 y/o man with 3cm mass in right parietal centrum semiovale. Mass histo: sheets of cells w/ round nuclei that have granular chromatin, moderate clear cytoplasm, GFAP +. Genetics has 1p and 19q co-deletions
What does he have?
Oligodendrogliomas— characteristic 1p,19q co-deletion
In children, where do Ependymomas most commonly arise?
Floor of the 4th ventricle –> hydrocephalus, papilledema
5 y/o boy has headaches for 1 week, ataxic gait and sudden vomiting. He becomes comatose. LP: anaplastic cells w/ dark blue nuclei and scant cytoplasm
What does he have? Where?
Medulloblastoma at midline cerebellum (vermi)
39 y/o HIV patient who never had antiretroviral therapy has left-sided wewakness and a generalized seizure. CT: no hemorrhage, 4cm mass in right putamen, 3cm mass in right centram ovale, 1cm mass near corpus cullosum. Masses well circumscribed. Cytology: large cells, large nuclei, scant cytoplasm, CD19+
What does he have?
Large B-Cell Lymphoma
45 y/o woman with unilateral headache for 5 months. CT: mass attached to dura. Mass histo: elongated cells w/ pale, oblong nuclei, pink cytoplasm, occasional psamomma bodies, cytogenetically 22q-
What does she have?
Meningioma –benign neoplasm arising from meningothelia cells of arachnoid.
76 y/o man with single episode of grand mal seizure. He has 1cm darkly pigmented skin lesion on upper back. MRI: 3 solid mass lesions w/o ring enhancement located at gray-white junction.
What does he have?
Metastatic carcinoma –characteristic multiple discrete lesions found at gray-white junction
18 y/o student has 14 scattered hyperpigmented skin lesions w/ irregular borders on extremities and torso. Optic nerve glioma is excised after decreased vision. Schwannoma is found on right wrist.
What does she have?
Neurofibromatosis Type 1 –characteristic cafe-au-lait spots and propensity for nerve sheath tumors
41 y/o woman with diminished hearing for 4 months. MRI: large mass in left cerebellar-pontine angle w/ smaller one on the right.
What does she have?
Neurofibromatosis Type 2 –pathognomonic bilateral acoustic schwannomas
7 y/o boy has decreased vision for 4 months. Exam: diffuse punctate inflammation of cornea and pannus extending as a growth of fibrovascular tissue from conjunctiva onto cornea. Histo: lymphocytes, plasma cells, neutrophils, and corneal epithelial cells that have cytoplasmic inclusion bodies.
What does he have?
Trachoma (C. trachomatis) – most common cause of blindness worldwide.
–Progressive conjunctival scarring w/ eyelid involvment
82 y/o man who surfs every week develops cloudy vision on right over 1 year. Exam: whitish irregular lesion on conjunctiva extending to cornea
What does he have?
Pterygium “Surfer’s Eye”
27 y/o woman has pain w/ cloudiness of vision in right eye for 2 days. Similar episode 1 year ago. Exam: no erythema or vscular injection. Slit lam –> dendritic ulcer on right cornea
What does she have?
Herpes Simplex infection – most common cause of corneal dendritic ulcers
26 y/o man has severe visual impairment since birth. His astigmatism can’t be better than 20/100 w/ glasses, but can be 20/40 with rigid contact lenses.
What does he have?
Keratoconus – corneal thinning with breaks in Bowman layer –> conical shape corneas
34 y/o man has decreasing vision for 3 years. Exam: diffuse cloudiness of anterior stroma w/ aggregates of gray-white opacities in axial region of the corneal stroma. Diseased cornea show basophilic deposits in stroma that stain with keratan sulfate.
What does he have?
Macular dystrophy – most sever form of corneal stromal dystrophy, autosomal recessive
29 y/o woman has SLE and receives long-term high-dose glucocorticoid therapy. What occular complaint is she at high risk for?
Cataracts – complication of systemic therapy w/ glucocorticoids
77 y/o woman has increasing pain w/ clouded vision on right eye for 36 hours. Fundoxcopic exam: excavation of otpic cup on right.
What does she have?
Primary angle-closure glaucoma – manifests in acute pain b/c narrowing of angle at anterior chamber obstructs aqueous flow
Patient has a penetrating injury to the left eye. 3 weeks later, he has loss of accomodation, photophobia, and blurred vision on his right eye.
What happened?
Sympathetic ophthalmia – release of sequestered antigen from one eye receiving penetrating ocular trauma into the opposite eye causing immune inflammatory reaction
61 y/o woman has decreasing visual acuity in right eye for 6 months, then sudden loss of vision, “shade pulled down”. Fundoscopy: dark uveal mass.
What does she have?
Melanoma – pigmented uveal mass causing retinal detachment; most common intraocular malignancy
75 y/o woman w/ DM and CHF has sudden loss of vision in left eye. Fundoscopy: cherry-red foveola, but pale rest of retina. Right eye normal.
What does she have?
Central retinal artery occlusion – thromboembolization
Child is healthy at birth but develops blindness and failure to meet neuro-developmental milestones. Fundoscopy: pale retinae w/ prominent red macular regions.
What does he have?
Tay-Sachs disease – deficiency in hexosaminadase A
Age-related Macular Degeneration is due to choroidal neovascularization driven by ___
Vascular endothelial growth factor (VEGF)
33 y/o man first develops night blindness, then later daytime visual acuity deficits. Fundoscopy: branching reticulated pattern to retina, optic disc appears pale and waxy.
What does he have?
Retinitis Pigmentosa – characteristic waxy appearance of optic disc
