0
Q
In which condition do farway objects appear blurry?
A
Myopia (near-sightedness)
1
Q
Which condition is most common; distant objects are clear, and close-up objects are blurry?
A
Hyperopia (far-sightedness)
2
Q
What is the condition in which refraction is unequal in different meridians of the eye and the cornea or the lens has a slightly different surface curvature. It is often present at birth and may occur in combination with nearsightedness or farsightedness?
A
Astigmatism
3
Q
Which condition is a slow loss of ability to see close objects or small print? It tends to happen with age when the lens becomes less pliable and eventually cannot accommodate in response to the action of the ciliary muscles.
A
Presbyopia
4
Q
What are 9 causes for photophobia?
A
- ) eye infection
- ) acute glaucoma
- ) eye inflammation (uveitis, iritis, keratitis)
- ) corneal disorder (foreign body, abrasion, ulcer)
- ) eye injury
- ) cataracts
- ) conjunctivitis
- ) migraine headache
- ) allergies
5
Q
What is the condition in which a patient experiences area of partial or complete blindness, usually within the central 30-degree area. It is from damage to the nerve fiber layer in the retina and is often seen by the patient as a “dark spot”.
A
Scotoma (blind spots)
6
Q
What type of scotoma is an irregular outline around a luminous patch in the visual field following mental or physical work, eyestrain, or migraine prodrome (visual aura)?
A
Scintillating scotoma
7
Q
What is the term for the perception of floaters?
A
Myodesopia
8
Q
How are floaters visible?
A
They cast shadows on the retina or their refraction of the light passes them.
9
Q
With what 3 things are floaters associated?
A
- ) autoimmune uveitis
- ) diabetic retinopathy
- ) posterior vitreous detachment (PVD) with aging
10
Q
What are 3 types of headaches associated with eye symptoms?
A
- ) cluster
- ) sinusitis
- ) migraines
11
Q
What is the condition for blindness or decreased vision in half of visual field of one or both eyes?
A
Hemianopsia
12
Q
Which type of hemianopsia is same side of both eyes, can be transient, has loss of pupillary reflexes, and is usually an optic tract problem?
A
Homonymous hemianopsia
13
Q
Which type of hemianopsia happens on opposite sides and is often a pituitary problem?
A
Crossed hemianopsia
14
Q
Which type of hemianopsia is at the level of the brain and the pupil reflex present as optic tract is not affected?
A
Quadrant hemianopsia
15
Q
What are 8 etiological conditions associated with dry eyes?
A
- ) aging (esp. postmenopausal)
- ) mal-positioned eyelids
- ) chemical burn to eye
- ) medications (antihistimines, nasal decongestants)
- ) dry climate
- ) dry eye syndromes
- ) post-eye surgery
- ) vit A deficiency
16
Q
Which condition has the following characteristics?
- bilateral dryness of eyes from lack of tears, more common in adult females
- eye redness, swelling, itching, burning, and perhaps reduced vision
- can be in conjunction with autoimmune disease
A
Keratoconjunctivivitis sicca
17
Q
What form of red eye is when the sclera gets very red and is due to minor trauma (i.e. straining, sneezing, coughing). It is not painful, no vision change, no pathological significance, but is alarming to the patient?
A
Hemorrhage of conjunctival vessels
18
Q
Which type of red eye is conjunctival and has peripheral, brick-red, tortuous superficial vessels that fade towards the iris. It moves with the conjunctiva and will blanch and refill with pressure?
A
Injection
19
Q
What are 3 forms of etiology for acute conjunctivitis?
A
- ) allergic (common)
- ) viral
- ) bacterial
20
Q
What are 7 predisposing factors for acute conjunctivitis?
A
- ) irritation from wind
- ) dust
- ) smoke
- ) air pollution
- ) common cold
- ) corneal irritation from intense light
- ) reflection from snow
21
Q
Which type of conjunctivitis has the following signs and sxs?
- sudden, mild to moderate, bilateral severe swelling of conjunctiva and lids
- conjunctiva appears pale but easily visible blood vessels
- not painful, but pruritus is extremely common
- clear, watery discharge is typical
A
Acute allergic conjunctivitis
22
Q
Which type of allergic conjunctivitis is non-seasonal (on/off throughout the year)? There is little evidence of inflammation but itching, burning, and photophobia may be present. Additionally, eyelid eversion may show velvety projections or palpebral conjunctiva may be misdiagnosed as dry eye syndrome.
A
Chronic allergic conjunctivitis
23
Q
Which type of conjunctivitis is allergy to soft contact lenses; and may be slow to develop?
A
Giant papillary conjunctivitis
24
What is the etiology of giant papillary conjunctivitis?
An autoimmune response to patient's own proteins or to the "trauma" of the lens wear.
25
What are 3 signs and sxs of giant papillary conjunctivitis?
1. ) excessive pruritus
2. ) mucous production
3. ) increasing intolerance to contact use
26
What are 4 physical findings of giant papillary conjunctivitis?
1. ) inflamed conjunctiva (red, itchy, and irritated)
2. ) may have a thick discharge
3. ) worse in the morning
4. ) eyelid eversion (see giant papillae usually on upper palpebral conjunctiva (cobblestone granulations)
27
What type of conjunctivitis is an adenovirus, is common, and lasts 1-2 weeks?
Viral conjunctivitis
28
What are 5 signs and sxs of viral conjunctivitis?
1. ) pruritus
2. ) minimal pain
3. ) clear, thin, watery discharge is typical
4. ) occasionally severe photophobia
5. ) foreign-body sensation
29
What are 2 common concomitants of viral conjunctivitis?
1. ) sore throat
| 2. ) nasal discharge
30
Which type of conjunctivitis affects only 1 eye, most often occurs on the cornea which results in herpes keratitis recurrences (in susceptible patients), and usually take form of dendritic keratitis with a characteristic raised lesion of the cornea "veins of a leaf"; nodules at terminal end of each "branch"?
Herpes Simplex virus conjuctivitis
31
What are 4 early signs and sxs of HSV conjunctivitis?
1. ) foreign body sensation
2. ) photophobia
3. ) lacrimation
4. ) conjunctival injection
32
What are 3 late signs and sxs of HSV conjunctivitis?
1. ) anesthesia of cornea
2. ) dendritic keratitis lesion diagnostic ulceration
3. ) permanent scarring of cornea (may result in vision loss)
33
What are 7 triggers for HSV conjunctivitis?
1. ) fever
2. ) stress
3. ) sunlight
4. ) trauma
5. ) associated with oral and genital herpes
6. ) immunocompromised (HIV or DM)
7. ) zoster (shingles) on tip of nose, moving to cornea, resulting in uveitis and glaucoma
34
Staph and strep are the most common pathogens for which type of conjunctivitis?
Bacterial conjunctivitis
35
What are 3 signs and sxs of bacterial conjunctivitis?
1. ) acute onset
2. ) minimal pain
3. ) occasional pruritus
36
Which 2 condition of physical exam may be present in bacterial conjunctivitis?
1. ) preauricular adenopathy
| 2. ) chemosis (common)
37
Copious, thick, purulent discharge along with moderate to marked conjunctival injection is characteristic of which type of conjunctivitis?
Bacterial conjunctivitis
38
Which rare condition happens in adults, has a 12-48 hour incubation period, is severe with purulent discharge, is usually unilateral, and has swollen lids?
Neisseria gonorrhea
39
What are 3 complications of Neisseria gonorrhe?
1. ) corneal ulceration
2. ) abscess
3. ) blindness
40
How soon after birth can neisseria gonorrhea be seen? What are 2 characteristics?
2-5 days after birth;
1. ) purulent discharge
2. ) severe lid edema
41
What are 2 ways in which an adult can be exposed to chlamydia trachomatis?
1. ) "Swimming pool conjunctivitis - exposure to infected genital secretions
2. ) sharing eye makeup
42
What are 4 other considerations with chlamydia trachomatis in adults?
1. ) tends to be chronic with exacerbation and remission
2. ) pre-auricular adenopathy is occasional
3. ) discharge is scant and seropurulent
4. ) conjunctival injection is moderate
43
With neonatal inclusion conjunctivitis (including blennorrhe - exposure from the cervix), what is the incubation period and what are 4 characteristics?
5-14 day incubation
1. ) chemosis
2. ) mucopurulent d/c
3. ) often bilateral
4. ) no corneal damage occurs
44
Which condition is characterized by chronic infection of the cornea and conjunctivitis cause by chlamydia? It is endemic to Africa, Asia, Middle East, Latin America, Pacific Islands and aboriginal communities of Australia and is an active disease most common in preschool children?
Trachoma
45
What is the incubation period and most contagious time for trachoma?
- 7 days incubation
| - most contagious in early stages
46
What are 8 signs and sxs of trachoma?
1. ) usually bilateral mucopurulent keratoconjunctivitis
2. ) conjunctival congestion
3. ) eyelid edema
4. ) photophobia
5. ) lacrimation
6. ) pain
7. ) within 7-10 days follicles develop in upper lid and gradually form yellow-gray granules
8. ) may cause corneal ulceration
47
Which condition has the following physical exam findings:
- conjunctival surface of the upper eyelid shows a follicular/inflammatory response
- cornea may have limbal follicles, superior neovascularization (pannus), and punctate keratitis
Trachoma
48
Which condition has harmless, slightly raised bumps, fatty deposits (yellow-white material) under conjunctiva (nasal side), has no tendency to grow onto the cornea, and may become inflamed and red?
Pinguecula
49
Which condition is a conjunctival thickening from chronic inflammation from wind and dust, and often has a distinct triangular lesion which may grow over cornea and affect vision?
Pterygium
50
What is the etiology for corneal trauma?
foreign body and/or abrasion
51
What are 4 signs and sxs of corneal trauma?
1. ) pain
2. ) photophobia
3. ) blepharospasm
4. ) blurred vision
52
In addition to everting the lid to check for particles, using fluorescein stain, and checking for PERRLA, an ophthalmoscopic exam should be done in the case of corneal trauma, what 2 things could the exam reveal?
1. ) retinal or vitreous hemorrhages
| 2. ) retinal detachment
53
What are 6 etiological conditions associated with corneal ulcer?
1. ) HSV (most common)
2. ) traumatic corneal injury
3. ) varicella-zoster virus (VZV)
4. ) contact lenses (particularly soft lenses)
5. ) chronic topical use
6. ) bacterial infections
54
Relating to corneal ulcer, which sign is associated with the nasociliary branch of CN V which enervates the tip of the nose and cornea leading to loss of corneal sensation and potential blindness?
Hutchinson's sign
55
What are 6 signs and sxs of corneal ulcer?
1. ) erythema of eyelid and conjunctiva
2. ) foreign body sensation
3. ) photophobia
4. ) mucopurulent discharge
5. ) blurred vision
6. ) pain
56
Which condition is characterized by hard, white, calcified plaques (bands) at 2, 5, 7, and 10 o'clock of limbus and may be hypercalcemia, secondary to kidney disease?
Band keratopathy
57
Which condition has the following characteristics?
- whitish deposits around limbus
- usually in elderly
- may be related to hyperlipoproteinemia
Arcus senilis (corneal arcus)
58
Exposure to UV lights, welding arcs, "snow blindness" and cumulative radiation damage to the corneal epithelium is consistent with which condition?
UV keratitis
59
What are 7 signs and sxs of UV keratitis?
1. ) onset of foreign-body sensation
2. ) irritation
3. ) pain
4. ) photophobia
5. ) tearing
6. ) blepharospasm
7. ) decreased visual acuity 6-12 hours after the exposure
60
What are 3 characteristics of a physical exam involving UV keratitis?
1. ) diffuse staining with fluorescein dye (loss of epithelium)
2. ) lid edema
3. ) conjunctival hyperemia is variable
61
Which condition is inflammation of the uveal tract (iris, ciliary body, choroids) and is most common in adults (age 20-50 yrs)?
Acute uveitis
62
What are the 3 anterior anatomical classifications of acute uveitis?
1. ) anterior (iritis)
2. ) ciliary body (cyclitis)
3. ) both (iridocyclitis)
63
What is the intermediate anatomical classification of acute uveitis?
Intermediate (peripheral uveitis)
64
What are the 2 posterior anatomical classifications of acute uveitis?
Posterior; rare, serious condition
1. ) choroiditis
2. ) chorioretinitis
65
What are 5 etiologic signs of acute uveitis?
1. ) ankylosing spondylitis (more common in men)
2. ) reactive arthritis
3. ) infection (HSV, cytomegalovirus, TB, VZV, toxoplasmosis, syphilis)
4. ) sarcoidosis
5. ) auto-immune (collagen vascular dx, juvenile RA, Sjorgren's)
66
What are 5 signs and sxs of acute anterior uveitis?
1. ) unilateral
2. ) painful ciliary flush
3. ) blurred vision
4. ) photophobia
5. ) tearing
67
What are 3 signs and sxs of intermediate uveitis?
1. ) painless
2. ) floaters
3. ) blurred vision
68
What are 4 signs and sxs of posterior uveitis?
1. ) blurred vision
2. ) floaters
3. ) eye pain
4. ) photophobia
69
What condition is opacity of the lens with painless, progressive, gradual visual loss? May see with a light or ophthalmoscope (positive diopters).
Cataract
70
What are 2 etiological characteristics of developmental "juvenile cataract"?
1. ) congenital or early life from poor diet
| 2. ) toxic inflammation or hereditary metabolic causes
71
What are 6 etiological conditions of degenerative cataract?
1. ) senile degeneration
2. ) x-ray
3. ) UV light
4. ) trauma
5. ) diabetes
6. ) use of cortisone
72
What are 4 signs and sxs of cataract?
1. ) decreased visual acuity is the most common complaint
2. ) increased glare (bright sunlight)
3. ) progression leads to mild-to-moderate myopia
4. ) no red reflex
73
What condition is increased intraocular pressure?
Glaucoma
74
T/F Acute closed angle glaucoma is just a progressive part of glaucoma
FALSE!!! Acute closed angle glaucoma will have red eye and constitutes an EMERGENCY!
75
What is the etiology of acute closed angle glaucoma and what are 2 precipitating factors?
Mechanical blockage of outflow channels in angle
1. ) drugs (sympathomimetics, anticholinergics, antidepressants)
2. ) rapid correction of hyperglycemia
76
What are 8 signs and sxs of acute closed angle glaucoma?
1.) elderly
2.) hyperopic
3.) no history of glaucoma
Most commonly:
4.) present with peri-orbital pain
5.) visual deficits
6.) pain is "boring"
7.) concomitant ipsilateral headache
8.) blurry vision (describes seeing "halos around objects")
77
What should be done with a patient presenting with acute closed angle glaucoma? Why?
REFER immediately! Eyesight may be lost permanently from increased pressure on optic nerve.
78
What is the key difference of chronic open angle glaucoma compared with acute closed angle glaucoma?
No red eye
79
Which condition is 90% of all glaucoma and is caused by a malfunction of the eye's drainage system, often from organic changes associated with aging?
Chronic open angle glaucoma
80
What are 3 signs and sxs of chronic open angle glaucoma?
1. ) gradual loss of peripheral vision
2. ) when uncontrolled, late loss of central vision
3. ) ultimate blindness
81
What are the prevention measures of chronic open angle glaucoma?
Ocular tonometry every 3-5 years or with family history yearly
82
What is the condition of hemorrhage into anterior chamber from trauma and has a danger of recurrent bleeding which may cause glaucoma and visual loss?
Hyphema
83
What is the condition in which there is inflammation/infection of the eyelid and surrounding skin anterior to the orbital septum (common in kids)?
Preseptal (periorbital) cellulitis
84
What are 7 etiologic conditions of preseptal (periorbital) cellulitis?
1. ) trauma
2. ) infection spread from nasal sinus or tooth
3. ) insect bite on face
4. ) seeding from bacteremia
5. ) eyelid injury
6. ) conjunctivitis
7. ) chalazion
85
What are 3 signs and sxs of preseptal (periorbital) cellulitis?
1.) tenderness
2.) swelling warmth
3.) redness
all of the eyelid
86
What condition is infection of the orbital tissues (fat and muscle) posterior to the orbital septum? It is more common in kids.
Orbital cellulitis
87
T/F: Orbital cellulitis is an emergency!
TRUE!
88
T/F: Orbital cellulitis is a gradual condition that rarely leads to other conditions
FALSE!!!! Orbital cellulitis progresses rapidly and can cause retinal artery or vein thrombosis, increased intraocular pressure, retinal damage, brain abscess, meningitis, and cavernous sinus thrombosis.
89
What are 7 signs and sxs of orbital cellulitis?
1. ) swelling and redness of eyelid and surrounding tissues (proptosis down and lateral)
2. ) extreme orbital pain (unilateral)
3. ) pain with eye movement
4. ) decreased eye motility
5. ) conjunctival hyperemia
6. ) chemosis
7. ) decreased visual acuity
90
Depending on the cause of the orbital cellulitis what are 3 extra signs and sxs?
1. ) nasal discharge
2. ) sinus bleeding
3. ) tooth abscess
91
What would the presence of fever, malaise, and headache raise suspicions of?
Meningitis
92
What condition is bulging of eyes and also referred to as "proptosis"?
Exopthalomos
93
What are 6 etiological conditions associated with exopthalomos?
1. ) orbital inflammation
2. ) edema
3. ) injuries
4. ) hyperthyroid
5. ) leukemia
6. ) meningioma
94
T/F: Retinal detachment is an emergency
TRUE!
95
What are 5 causes of retinal detachment?
1. ) trauma
2. ) diabetes
3. ) inflammatory disorder
4. ) posterior vitreous detachment (MOST COMMON)
5. ) may be idiopathic
96
What are 7 signs and sxs of retinal detachment?
1. ) painless
2. ) dark or irregular floaters
3. ) flashes of light (photopsia)
4. ) blurred vision which worsens progressively
5. ) curtain or veil in the field of vision
6. ) no redness
7. ) tears or retinal pieces hanging in vitreous humor
97
Which condition happens with age and the vitrious gel can collapse and pull forward (may tear the retinal in the process)?
Posterior vitreous detachment
98
What are 3 signs and sxs of posterior vitreous detachment?
1. ) painless
2. ) floaters
3. ) flashes of light
99
What is the leading cause of visual loss in the elderly (more common in caucasian than in African American, is a hemorrhagic disturbance in the macular region of the involved eye, happens slow or sudden, and is a painless loss of central visual acuity (wavy lines on Amsler grid)?
Macular degeneration
100
What does a ophthalmoscopic exam reveal with cases of macular degeneration?
Drusen bodies
101
What is the major cause of blindness in diabetics?
Diabetic retinopathy
102
What are the 3 early signs of diabetic retinopathy?
1. ) venous dilation
2. ) small, red, well demarcated lesions (microaneurisms)
3. ) development of macular edema which affects vision
103
What are 3 late signs of diabetic retinopathy?
1. ) soft exudates (cotton-wool spots)
2. ) micro-infarcts caused by anoxia
3. ) hard, white-yellow, waxy exudates caused by chronic edema from damaged capillaries
104
What would be a reason to refer when a patient has diabetic retinopathy?
If developed blurred vision (over 2 days) not associated with elevated glucose , sudden loss of vision in one or both eyes, black spots, cobwebs or flashing lights in the field of vision.
105
What are 7 conditions associated with hypertensive retinopathy (vascular changes with extent and persistence of hypertension)
1. ) copper wire
2. ) silver wire
3. ) AV nicking
4. ) hemorrhages (often flame hemorrhages)
5. ) soft exudates - "cotton wool" (retinal edema)
6. ) hard exudates (macular star)
7. ) papilledema
106
What condition is inherited, slowly progressive, bilateral, retinal degeneration which leads to loss of photoreceptors and blindness, night blindness, and peripheral vision loss that may become symptomatic in early childhood? Additionally, the central island of vision gradually constricts over time.
Retinitis pigmentosa
107
What is the condition in which there is inflammation of lid margins causing irritation, itching, and occasionally red eye?
Blepharitis
108
What are 9 causes of blepharitis?
1. ) rosacea
2. ) seborrheic dermatitis
3. ) allergic or contact dermatitis
4. ) dry eye syndromes
5. ) chalazion
6. ) trichiasis
7. ) conjunctivitis
8. ) Sjorgren's syndrome
9. ) exposure to chemicals or irritants
109
What are 8 signs and sxs of blepharitis?
1. ) eye irritation (burning, gritty sensation, watering)
2. ) itching
3. ) erythema of the lids
4. ) tearing
5. ) photophobia
6. ) blurred vision
7. ) crusting and matting of the lashes and medial canthus (esp. in the AM)
8. ) typically a chronic course with intermittent exacerbations and eruptions
110
What condition is an acute localized infection or inflammation of the eyelid margin involving sebaceous gland? It involves Straphylococcus aureus in 90-95% of cases and is most common in kids.
Hordeolum (external) "stye"
111
What is the SSX sequence of hordeolum external?
Pain --> redness --> tenderness of lid margin --> small, round, tender induration --> lacrimation --> photophobia --> foreign body sensation --> pustule on lid margin --> ruptures --> heals spontaneously
112
What condition is acute inflammation of meibomian gland, usually more severe than its other type, has pain, redness, edema is more localized, abscess can form, spontaneous rupture is rare, and recurrence is common?
Hordeolum (internal)
113
What condition is chronic enlargement of meibomian gland from infection and occlusion of its duct, often following inflammation of the gland? At onset, looks like a stye but painless, chronic stage may appear like BCC or SCC, after a few days, infection resolves leaving a painless, slowly growing, firm mass in the lid.
Chalazion or meibomian cyst
114
What is the term for lid inversion?
Entropion
115
What is the problem with entropion?
Lid area is atrophic in the elderly or scarred, then lashes grow inward, causing irritation, blepharospasm, and may lead to corneal ulceration and scarring.
116
What is the term for a lid that turns outward?
Ectropion
117
What is the problem with ectropion?
Tissue relaxes with aging resulting in edema, and leads to poor drainage of tears, excess tearing, redness, and irritation
118
What condition has an enlarged lacrimal gland on upper lateral aspect of eye, is tender, red (if acute), painless (if chronic), and can abscess?
Dacryoadenitis
119
What condition has inflammation of lacrimal sac (seen in infants), usually secondary to obstruction of nasolacrimal duct, has tenderness, swelling, redness, and may express pus from sac?
Dacryocystitis
120
Which condition is a congenitally narrowed lacrimal duct in neonates, with excess tearing, may be pus expressed, and usually resolves in 6 months?
Daycryostenosis
121
What are 9 reasons for immediate and urgent referral?
1. ) acute angle-closure glaucoma
2. ) corneal ulcer
3. ) traumatized eye
4. ) intraocular infection after eye surgery
5. ) retinal artery occlusion
6. ) retinal detachment
7. ) eye trauma (foreign bodies, corneal abrasion)
8. ) orbital cellulitis
9. ) field defects
CPD 1
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