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Oral boards > Wills DDx of Ocular signs > Flashcards

Wills DDx of Ocular signs Flashcards

1
Q

AC hyphema

A

V
I: iris neovascularization, herpes simplex/zoster iridocyclitis
T: traumatic
A: fuchs heterochromic iridocyclitis
M: blood dyscrasia or clotting disorder (e.g. hemophilia)
I: iatrogenic (intraocular surgery or laser), anticoagulation,
N: intraocular tumor (e.g. juvenile xanthogranuloma, RB, angioma)

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2
Q

AC hypopyon

A

V
I: infectious cornea ulcer, endophthalmitis
severe iridocyclitis (e.g. HLA-B27 associated, Behcet disease), severe inflammatory reactions from a recurrent cornea erosion
T
A
M
I: reaction to an intraocular lens (sterile hypopyon), retained lens particle, device contaminant after cataract surgery (TASS), retained intraocular foreign body, drugs (e.g. rifampin)
tight contact lens
chronic cornea edema with ruptured bullae

N: intraocular tumor necrosis (e.g. psuedohypopyon from retinoblastoma)

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3
Q

Blood in Schlemm Canal on Gonioscopy

A

compression of episcleral vessels by gonioprism (iatrogenic)
Sturge-Weber syndrome
AV fistula [e.g. carotid-cavernous sinus fistula (c-c fistula)]
SVC obstruction
hypotony

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4
Q 
Cornea/conjunctival findings
conjunctival swelling (chemosis)
A 
allergy
any ocular/periocular inflammation
post-operative
drugs
venous congestion (e.g. c-c fistula)
angioneurotic edema
myxedema
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5
Q

conjunctival dryness (xerosis)

A

V
I: Sjogren syndrome
post-cicatricial conjunctivitis, chronic dacryoadenitis

T
A: S-J syndrome, OCP
M: vitamin A deficiency
I: exposure (e.g. lagophthalmos, absent blink reflex, proptosis), radiation
N
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6
Q

Cornea edema (congenital)

A

congenital glaucoma
CHED (AR is present at birth, AD form later onset)
PPMD
birth trauma (forceps injury)

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7
Q

Cornea edema (acquired)

A 
V
I: HSV or zoster keratitis, iritis
T: traumatic, exposure, chemical injuries
A
M: fuchs endothelial dystrophy
iridocorneal endothelial (ICE) syndrome
PPMD
I: post-operative edema, aphakic or PBK
failed corneal graft
CL overwear
acute increase in intraocular pressure (e.g. angle-closure glaucoma)
cornea hydrops (decompensated keratoconus)

N

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8
Q

cornea edema -dilated episcleral vessels (w/o ocular irritation or paiN)

A

underlying uveal neoplasm
AV fistula (c-c fistula)
polycynthemai vera
leukemia
ophthalmic vein or cavernous sinus thrombosis
extravascular blockage of ophthalmic/orbital venous outflow

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9
Q

Enlarged cornea nerves: most important

A

MEN2b (medullary carcinoma of the thyroid gland, pheochromocytoma, mucosal neuromas; may have marfanoid habitus)

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10
Q

Enlarged cornea nerves: others

A 
acanthamoeba keratitis
chronic keratitis
keratoconus
neurofibromatosis
fuchs endothelial dystrophy
refsum syndrome
trauma
congenital glaucoma
failed cornea graft
leprosy
ichthyosis
idiopathic
normal variant
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11
Q

Membranous conjunctivitis: difficult removal of membrane with bleeding (membrane = coagulated exudate adherent to conjunctival epithelium)

A

adenovirus
streptococci pneuomococci
ligneous conjunctivitis
cornyebacterium diptheriae

chemical burn
HSV
ocular vaccinia

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12
Q

pseudomembranous conjunctivitis: easy removal without bleeding

A 
OCP
S-J syndrome
Superior limbic keratoconjunctivitis
gonococci
staphylococci
chlamydia in newborns
others
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13
Q

cornea opacification in infancy

A 
congenital glaucoma
birth trauma (forceps injury)
CHED or stromal dystrophy (OU)
PPMD
developmental abnormalitiy of the anterior segment (e.g. Peters anomaly)
metabolic abnormalities (bilateral - e.g. mucopolysaccharidoses, mucolipidoses)
interstitial keratitis
HSV
cornea ulcer
cornea dermoid
sclerocornea
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14
Q

pannus (superficial vascular invasion of the cornea)

A 
ocular rosacea
tight CL or CL overwear
phylectenule
chlamydia (trachoma and inclusion conjunctivitis)
superior limbic keratoconjunctivitis
HSV/HZV
chemical burn
OCP
aniridia
molluscum contagiousm
leprosy
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15
Q

Pigmentation/discoloration of the conjunctiva

A 
racial melanosis (perilimbal)
nevus
primary acquired melanosis
melanoma
ocular and oculodermal mealnocytosis (congenital, blue-gray, not conjunctival but episcleral)
Addison disease
pregnancy
radiation
jaundice
resolving SCH
mascara
conjunctival/subconjunctival foreign body
pharmacologic (chlorpromazine, topical epinephrine)
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16
Q

Symblepharon (fusion of the palpebral conjunctiva with the bulbar conjunctiva)

A 
OCP
S-J syndrome
chemical burn
trauma
drugs
long-standing conjunctival or episcleral inflammation
EKC
atopic conjunctivitis
radiation
congenital 
iatrogenic (post-surgical)
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17
Q

whorl-like opacity in the corneal epithelium (verticillata)

A 
amiodarone
chloroquine
fabry disease and carrier state
phenothaizines
indomethacin
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18
Q

bull’s eye macular lesion

A 
AMD
stargardt dz or fundus falvimaculatus
albinism
cone dystrophy
chloroquine or hydroxychloroquine retinopathy
Spielmeyer - Vogt syndrome (Batten)
central areolar choroidal dystrophy
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19
Q

Choroidal folds

A 
orbital or choroidal tumor
idiopathic orbital inflammatory syndrome
thyroid eye disease
posterior scleritis
hypotony
RD
marked hyperopia
scleral laceration
papilledema
post-operative
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20
Q

CNV (gray-green membrane or blood seen deep to the retina) - MC

A 
AMD
ocular histoplasmosis syndrome
high myopia
idiopathic polypoidal choroidal vasculopathy
angioid streaks
choroidal rupture (trauma)
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21
Q

CNV (gray-green membrane or blood seen deep to the retina) - LC

A

drusen of the optic nerve head
tumors
retinal scarring s/p laser photocoagulation
idiopathic

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22
Q

Embolus

A

platelet-fibrin (dull gray and elongated): carotid dz, less common cardiac
Cholesterol (sparkling yellow, usually at an arterial bifurcation): carotid dz
Calcium (dull white, typically around or on the disc): carotid dz
Cardiac myxoma (rare cardiac tumor, common in young pts, particularly in OS; often occludes the ophthalmic or central retinal artery behind the globe and is not seen)
talc/cornstarch (small yellow-white glistening particles in macular arterioles; may produce peripheral retinal NV: IVDA

Lipid or air (CWS not emboli are often seen): 2/2 chest trauma [purtscher retinopathy] and fracture of long bones

Others (tumors, parasites, other FB)

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23
Q

Macular exudates - MC

A

DM, CVNM (subretinal), HTN

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24
Q

Macular exudates - LC

A

Macroaneurysm, Coats dz (children), peripheral retinal capillary hemangioma, RVO, papilledema, radiation retinopathy

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25
Q

Normal DFE in the presence of decreased vision

A

retrobulbar optic neuritis
other optic neuropathy (e.g. Leber hereditary optic neuropathy, tumor, alcohol or tobacco)

cone degeneration
stargardt disease or fundus flavimaculatus
rod monochromatism

amblyopia
nonphysiologic visual loss

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26
Q

Optociliary shunt vessels on the disc

A

Vascular: prior CRVO

chronic papilledema (e.g. pseudotumor cerebri)
chronic open-angle glaucoma

Neoplastic: orbital or intracranial tumor (especially meningioma)
ON glioma

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27
Q

Retinal NVE (posterior pole)

A

DM, s/p CRVO

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28
Q

Retinal NVE (peripheral)

A

Vascular: s/p BRVO
Infectious/inflammatory: syphilis, pars planitis, chronic uveitis
Autoimmune: sarcoidosis,
Metabolic: DM
Iatrogenic/Idiopathic/genetic: sickle cell, coats dz, ROP, Others (leukemia, anemia, Eales, FEVR)

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29
Q

Retinal NVE (retina hemorrhages with white centers) - MC

A

DM, leukemia, septic chroioretinitis (2/2 to bacterial endocarditis)

30
Q

Retinal NVE (retina hemorrhages with white centers) -LC

A

pernicious anemia (and rarely other forms of anemia)
sickle-cell dz
scurvy
lupus and other connective tissue disease

31
Q

Sheathing of retina vessels (periphlebitis) - MC

A

syphilis
sarcoidosis
pars planitis
sickle cell disease

32
Q

Sheathing of retina vessels (periphlebitis) - LC

A 
V
I: TB, MS; viral retinitis (HIV, herpes); fungal retinitis, bacteremia
T
A: Behcet's
M
I
N
33
Q

Acute increase in IOP

A 
V: suprachoroidal hemorrhage, hyphema, c-c fistula, retrobulbar hemorrhage
I: inflammatory OAG, 
T
A
M
I: acute angle-closure glaucoma, glaucomatocycltic crisis (Posner-Schlossman syndrome)
malignant glaucoma
post-operative
N: other orbital dz
34
Q

Decreased IOP (hypotony)

A 
V: ocular ischemia
I: irdiocyclitis
T: ruptured globe, cyclodialysis cleft, traumatic ciliary body shut-down.
A
M:
I: phthisis bulbi, retinal/choroidal detachment
severe dehydration
drugs (e.g. glaucoma medications)
post-operative
N
35
Q

Iris heterochromia (involved iris is lighter than normal)

A

V
I: Fuchs heterochromic iridocyclitis, chronic uveitis
T
A
M: congenital Horner syndrome, Waardenburg syndrome
I
N: metastatic carcinoma

36
Q

Iris heterochromia (involved iris is darker than normal)

A

V
I: Fuchs heterochromic iridocyclitis (depends on blue/brown eye)
T: retained IOFB
A
M: hemosiderosis, siderosis, ICE, ocular melanocytosis or oculodermal melanocytosis
I
N: ocular malignant melanoma, diffuse iris nevus, RB, leukemia, lymphoma

37
Q

Spontaneous hyphema in child Ddx?

A 
JXG
Retinoblastoma
ROP
PFV
Coat’s disease
Herpes simplex uveitis
38
Q

Iris lesion - melanotic (brown)

A

nevus, melanoma, adenoma, or adenocarcinom of the iris pigment epithelium

39
Q

Iris lesion - amelanotic (white, yellow, orange)

A 
V
I: inflammatory nodule or granuloma (sarcoidosis, TB, leprosy, other granulomatous dz), neurofibroma
patchy hypermia of syphilis
T
A
M
I: foreign body
N: amelanotic melanoma, juvenile xanthogranuloma, cyst, leiomyoma, seeding from posterior segment tumor
40
Q

NVI

A 
V: ocular ischemic syndrome, s/p vein/artery occlusion, other vascular dz
I: chronic uveitis
T
A
M: DM
I: chronic RD
N: intraocular tumor (melanoma, RB)
41
Q

iridescent lens particles

A 
drugs
hypocalcemia
myotonic dystrophy
hypothyroidism
familial
idiopathic
42
Q

Lenticonus anterior (marked convexity of the anterior lens)

A

Alport syndrome (hereditary nephritis)

43
Q

Lenticonus posterior (marked convexity of the posterior lens)

A

usually idiopathic, may be associated with persistent fetal vasculature

44
Q

APD - severe 2+ to 3+

A

optic nerve disease (e.g. ischemic optic neuropathy, optic neuritis, tumor, glaucoma)
CRAO or CRVO
less commonly - lesion of optic chiasm/tract

45
Q

APD - mild 1+

A 
any of the preceding, amblyopia
dense vitreous hemorrhage
advanced AMD
BRVO or BRAO
RD or other retinal disease
46
Q

limitation of ocular motility without exophthalmos and resistance to retropulsion

A

V: multiple ocular motor nerve palsies (such as cavernous sinus syndrome)
I
T: orbital blow-out fracture with muscle entrapment
A: CPEO and associated syndromes, myasthenia gravis
M: Duane syndrome
I: other CNS disorder, ophthalmoplegic migraine
isolated CN3, 4, 6 palsy
N

47
Q

optic disc atrophy - MC

A

V: s/p CRVO/CRAO, prior ischemic optic neuropathy
I: chronic optic neuritis
T: prior traumatic optic neuropathy
A
M
I: chronic optic neuritis/papilledema, glaucoma,
N: compression of optic nerve/chiasm/tract 2/2 tumor/aneurysm

48
Q

optic disc atrophy - LC

A 
V
I: syphilis
T
A
M: retinal degeneration (RP), toxic or metabolic optic neuropathy, Leber hereditary optic atrophy, Leber cogenital amaurosis, lysosomal storage dz (Tay Sachs)
other forms of congenital or hereditary optic atrophy (nystagmus almost always present in congenital forms)
I: radiation neuropathy
N
49
Q

Paradoxical Pupillary Reaction (Pupil Dilates in Light and Constricts in Darkness)

A 
"BARADOXICAL"
Best's
Achromatopsia
RP
Albinism
Dominant Optic nerve atrophy
ON hypoplasia
XI
CSNB
Amblyopia (rare)
Leber's congenital amaurosis
50
Q

EOM thickening on imaging - MC

A 
Thyroid orbitopathy (often spares tendon)
Idiopathic Orbital Inflammatory Syndrome
51
Q

EOM thickening on imaging - LC

A 
V: c-c fistula, SO vein thrombosis
I
T
A
M
I
N: Tumor (e.g. lymphoma, metastasis, or spread of lacrimal gland tumor to muscle)
cavernous hemangioma (usually appears IN the muscle cone without muscle thickening)
rhabdomyosarcoma (children)
52
Q

ON Lesion (isolated) - MC

A

optic nerve glioma (esp children)

optic nerve meningioma (esp adults)

53
Q

ON Lesion (isolated) - LC

A 
metastasis
leukemia
idiopathic orbital inflammatory syndrome
sarcoidosis
increased ICP with 2ndary optic nerve swelling
54
Q

Nystagmus in infancy

A 
V
I
T: CNS (thalmic) injury
A
M: congenital nystagmus, albinism
I: Leber congenital amaurosis, spasmus nutans, ON hypoplasia, congenital cataracts, aniridia, congenital corneal opacities
N: ON or chiasmal glioma
55
Q

Shallow AC - accompanied by increased intraocular pressure

A

pupillary block glaucoma
suprachoroidal hemorrhage
malignant glaucoma

56
Q

Shallow AC - accompanied by decreased intraocular pressure

A

wound leak
choroidal detachment
over filtration s/p glaucoma filtering procedure

57
Q

Hypotony

A

wound leak, choroidal detachment, RD, cyclodialysis cleft, ciliary body shutdown, pharmacologic aqueous suppresion

58
Q

Progressive hyperopia

A

V
I: posterior scleritis, Serous elevation of the retina (CSR)
T
A
M: hypoglycemia
I: presbyopia, cataracts, s/p RK or other refractive
N: orbital tumor pressing on the posterior surface of the eye

59
Q

Progressive myopia

A 
V
I
T
A
M: DM
I: high (pathologic) myopia, cataract, staphyloma and other elongation of the globe, K ectasia, medications (miotics, sulfa drugs, tetracycline),childhood (physiologic)
N
60
Q

Altitudinal Field Defect - MC

A

ischemic optic neuropathy, hemi or branch retinal artery or vein occlusion, optic neuritis

61
Q

Altitudinal Field Defect - LC

A

glaucoma, ON or chiasmal lesion, ON coloboma

62
Q

Arcuate Scotoma - MC

A

glaucoma

63
Q

Arcuate Scotoma - LC

A

ischemic optic neuropathy (esp nonarteritic), optic disc drusen, high myopia, optic neuritis

64
Q

binasal field defect - MC

A

glaucoma, bitemporal retinal disease (e.g. RP)

65
Q

binasal field defect - rare

A

bilateral occipital disease, tumor or aneurysm compressing both optic nerves or chiasm

66
Q

bitemporal hemianopsia - MC

A

chiasmal lesion (e.g. pituitary adenoma, meningioma, craniopharyngioma, aneurysm, glioma)

67
Q

bitemporal hemianopsia - LC

A

tilted optic discs (LC) and rare (nasal RP)

68
Q

Blind spot enlargement

A

V
I: MEWDS, acute idiopathic blind spot enlargement syndrome (may be on spectrum with MEWDS)
T
A
M
I: papilledema, glaucoma, optic nerve drusen, ON colobma, myelinated (medullated) nerve fibers off the disc, myopic disc with crescent, drugs
N

69
Q

Central scotoma

A

V: ischemic optic neuropathy (more typically produces an altiduinal field defect)
I
T
A
M
I: optic neuritis, macular disease
N: optic atrophy (e.g. tumor compressing the nerve, toxic or metabolic disease), rarely an occipital cortex lesion

70
Q

constriction of the peripheral fields leaving a small residual central field (tunnel vision)

A

V: s/p PRP or cryotherapy, CRAO with cilioretinal artery sparing, bilateral occiptal lobe infarcation with macular sparing
I: rarely medications (e.g. phenothiazines), vitamin A deficiency
T
A: autoimmune-associated retinopathy,
M: RP or other peripheral retinal disorders (gyrate atrophy)
I: chronic papilledema, nonphysiologic visual loss, glaucoma
N: carcinoma, melanoma

71
Q

homonymous hemianopsia

A

V: temporal, parietal, or occiptal lobe lesion of the brain (MC: stroke and tumor, LC: aneurysm/trauma)
I
T
A
M
I: migraine (transient homonymous hemianopsia)
N: optic tract or lateral geniculate body lesion

72
Q

Vitreous opacities

A

V: VH
I: inflammatory cells from vitritis/posterior uveiits, snowball opacities of pars planitis or sarcoidosis
T: FB
A
M: rarely - amyloidosis or Whipple dz
I: asteroid hyalosis, synchysis scintillans, normal vistreous strands from age-related vitreous degeneration, hyaloid remnants
N: tumor cells

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