Test 3 In class Quizzes, Practice Exam 3 Questions, Group activities, Exam 3 In class review

Children presenting with a recent history of blunt trauma to the orbit that exhibit acute symptoms of headache and nausea are most likely suffering from the following type of orbital floor fracture:

'White-eyed' fracture

8) A 38-year-old Black male presents complaining of blurry vision at distance with current glasses that are 5 years old. He states he has always had problems seeing well, especially when reading. He denies any history of amblyopia but states both parents had cataracts from birth. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the entrance acuity is OD 20/60 and OS 20/40 and the best-corrected visual acuity is OD 20/20-2 and OS 20/30-2. The lids and lashes are clear OU. The conjunctiva is quiet OU. The cornea is clear OU. The iris is flat and intact OU. There is a well-defined central 2.5-mm white opacity in the posterior aspect of the lens OD and a 3-mm white well-defined central opacity in the posterior aspect of the lens OS. The following is the most likely type of cataract present in both eyes _______ The following is the most appropriate management for this presentation_________

-congenital polar cataract -educate the patient and prescribe new glasses

6) A 30-year-old Asian female presents complaining of redness and very mild discomfort in the left eye that started 2 days ago. In addition, she reports foreign body sensation OS. She denies itching and any discharge and states this is the first time this has happened. The pertinent past ocular, medical, family, and social histories are unremarkable. Upon clinical examination, vision is stable OU. The lids and lashes are clear OU. There is a salmon-pink sectoral area of injection OS. The area is mobile when pushed with a cotton-tipped applicator. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. When 2.5% phenylephrine is applied to the left eye, the injected vessels blanch. The following is the most likely diagnosis _____ The following is the prognosis for this presentation _______

-episcleritis (sectoral) -good, self-limiting

14) A 20-year-old Caucasian female presents for a comprehensive eye examination. She denies any symptoms. The pertinent past ocular, medical, family, and social histories are unremarkable. Upon clinical examination, the uncorrected acuity is 20/20 OD, OS, OU. Pupils, motility, and CVF are normal OU. The lids and lashes are clear and the conjunctiva is quiet OU. You observe a thin grey-white arcuate ridge adjacent to the limbus on the inner surface of the inferotemporal cornea OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. The crystalline lens is clear OU. IOP is 12 mmHg OU @ 12:15 PM. The following is the most likely diagnosis for the corneal findings ____ The following additional procedure is indicated during this examination ______

-posterior embryotoxon -gonioscopy

Lyme disease is caused by an infection with the following microbe 1. _________that is transmitted to humans through the bite of an infected. 2._______.

1. B. burgdorferi 2. tick

Abrupt blunt trauma to the eye can result in a prominent circular pigmented ring on the anterior capsule known as 1._______and the following type of lenticular opacity 2._________.

1. Vossius ring 2. rosette cataract

Any patient presenting with the disorder depicted by the photograph below should be referred to the following specialist 1._______, to rule out the following condition 2. ______.

1. cardiologist 2. aortic aneurysm

Vitamin C has been shown to promote the synthesis of mature collagen by corneal fibroblasts. The following is the maximum daily cumulative dosage of L-ascorbic acid to achieve this benefit before the patient is likely to experience adverse side effects:

2 g/day

List four seronegative spondyloarthropathies that are associated with HLA-B27 and anterior uveitis:

AS, IBS, PA, RA or RS

Patients suffering from dry eye will report that their symptoms are usually worse at this time of the day:

Afternoon

The following disorder is depicted by the photograph below:

Aniridia

24) A 27-year-old Caucasian male presents complaining of pain in the left eye. The symptoms started upon awakening. In addition, he reports photophobia and tearing OS. He states this has happened twice in the past. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. The lids and lashes are clear OU. The conjunctiva is quiet OD and mildly hyperemic OS. You observe diffuse gray map-like patches underneath the corneal epithelium OU and there is a 1.5x1 mm epithelial defect OS. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. Write an appropriate management plan for this presentation: ____

Discuss the findings with the patient. Educate the patient about the condition. Start a broad-spectrum topical antibiotic such as moxifloxacin (Vigamox) 0.5% ophthalmic solution TID OS, cycloplegic such as cyclopentolate 1% TID OS, and PF AT q1-2h OS while awake (placing a soft BCL, Muro 128, doxycycline, amniotic membrane are additional options). Discuss the proper drop instillation technique. Discuss the risks and the potential side effects of the prescribed medications. Dispense prescriptions and written instructions to the patient. Re-evaluate 1 day.

The following disorder is depicted by the photographs below:

EBMD

T/F In cases of scleritis, Phenylephrine 2.5% will blanch the inflamed deep vascular plexus

False

The following degeneration is depicted by the photographs below:

Fleischer ring

Unilateral anterior uveitis presenting with stellate keratic precipitates, iris atrophy, and elevated intraocular pressure is highly suspicious for the following etiology:

Herpetic or viral

The majority of episcleritis cases have the following etiology:

Idiopathic

A 32-year-old Hispanic male presents complaining of pain, redness, and tearing in both eyes. The symptoms started 20 minutes ago after he was exposed to tear gas during a training activity at the Police Academy. The pertinent past ocular, medical, family, and social histories are unremarkable. The patient is not exhibiting any signs of respiratory distress. The following is the most appropriate next step in the care for this patient:

Irrigation

The following degeneration is depicted by the photographs below:

Kayser-Fleischer ring

The following disorder is depicted by the photographs below:

PPMD

The use of corticosteroids is associated with the following type of cataract:

PSC

Doxycycline is more effective for the treatment of the following type of blepharitis:

Posterior

70-80% of patients with rheumatoid arthritis are positive for the following autoantibody:

RF

The following is the most common systemic association of scleritis:

Rheumatoid arthritis

T/F Episcleritis is frequently idiopathic.

True

The following degeneration is depicted by the photographs below:

White limbal girdle of Vogt

List three professions that put workers at higher risk for developing exfoliation syndrome:

bakers, blacksmith, glassblowers, steelworkers

Water cleft, vacuoles, and spokes in the crystalline lens are characteristic of the following condition:

cortical cataract (CC)

The following blood vessels will NOT blanch with 10% phenylephrine

deep vascular plexus

List five symptoms that are most common in patients presenting with uveitis:

pain, photophobia, redness, blurry vision, floaters

List three types of cataracts associated with diabetes:

posterior subcapsular, snowflake, Christmas tree

List a posterior segment condition associated with the disorder depicted by the photograph below:

proliferative diabetic retinopathy central retinal vein occlusion central retinal artery occlusion ocular ischemic syndrome chronic retinal detachment

20) A 25-year-old Asian female presents for a comprehensive eye examination. She denies any symptoms and wants to change her glasses. The pertinent past ocular, medical, family, and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. The lids and lashes are clear and the conjunctiva is quiet OU. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. IOP is 14 mmHg OU @ 11:15 AM. Upon pupillary dilation, you observe multiple blue and white tiny opacities in the cortex of both crystalline lenses. In addition, there is a small circular gray-white opacity inferonasal to the visual axis on the posterior capsule of the left eye. The following is the most likely diagnosis for the lenticular findings in this presentation ____ ____ (2 answers)

- Blue dot cataract -Mittendorf dot

25) A 75-year-old Hispanic male presents complaining of irritation and tearing in the left eye. The symptoms have been progressively getting worse over the past few years. He denies any history of trauma or surgery. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, visual acuity is stable OU. The right eye is normal. The lashes are clear OS. You observe an outward turning of the lower eyelid in the left eye. The cornea OS shows inferior punctate epithelial erosions. The anterior chamber is deep and quiet OS. The iris is flat and intact OS. The following is the most likely diagnosis for the findings in the left eye _______ The following is the most likely etiology of the above condition _____

- ectropion - involutional

27) A 65-year-old Caucasian male presents complaining of a droopy eyelid that is preventing him from seeing from the right eye. The symptoms started this morning. He reports poor compliance with the treatment he was prescribed for diabetes, hypertension, and hyperlipidemia. His pertinent past ocular, family, and social histories are unremarkable. Upon clinical examination, vision is stable OU. You observe drooping of the right upper eyelid that completely covers the right eye. You elevate the upper eyelid and notice exotropia and hypotropia of the right eye. Extraocular motility is partially limited in the right eye. Pupils are equal, round, and reactive to light with no RAPD OU. The following is the etiology of this presentation ______ The drooping of the right upper eyelid is secondary to inactivation of the following muscle ______

- third nerve palsy - LPS

26) A 73-year-old Hispanic female presents complaining of glare and blurry vision while driving at night OU. The symptoms started a few years ago but have been progressively getting worse. She has a history of age-related macular degeneration and is taking AREDS2 BID po as recommended at the last visit. Her pertinent past medical, family, and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/80 OD and 20/60 OS. The lids and lashes are clear OU. The conjunctiva is quiet OU. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. You observe cortical spoking in 3 quadrants OU. The following grade of cortical cataract is present in both eyes _____ The following procedure can help you decide the level of acuity expected after a successful cataract extraction _______

-3+ -potential acuity meter

1) An 85-year-old Asian female presents for an attending physician-directed 6-months follow-up visit. She complains of fluctuating vision OU throughout the day. She experiences blurry vision in the morning more so in both eyes. She has a history of meibomian gland dysfunction and she reports compliance with the treatment prescribed at the last visit. She is instilling Refresh Relieva drops twice daily OU. She has a history of successful cataract surgery OU. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the best-corrected acuity is 20/30 OD and 20/30 OS. The lashes are clear OU. There is mild meibomian gland capping OU. The conjunctiva is quiet OU. The corneal epithelium in normal OU. There is a white 1-mm wide stromal corneal ring separated from the limbus by a clear zone OU. You observe a multitude of central excrescences of the Descemet membrane and a few pigment spots on the central endothelium OU. The angle is a grade 4 by Van Herick OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. The IOP is 12 mmHg OU @ 8:20 AM. The intraocular lens is well-centered and clear OU. You perform corneal pachymetry which yields CCT OD 650 microns and OS 665 microns and confocal ECC which yields OD 985 cells/mm2 and OS 970 cells/mm2 with increased polymegathism and pleomorphism OU. The following is the most likely diagnosis for the central corneal findings ____- The following topical agent is likely to relieve the fluctuation in vision (provide name and concentration) ______ The following is the expected normal average CCT for this patient's race ______ The following is the expected normal ECC range for this patient's age group ________

-Fuchs endothelial corneal dystrophy -Muro 128 5% ophthalmic solution/552 -microns/1,000 to 2,000 cells/mm2

21) A 32-year-old Caucasian male presents complaining of mild pain, photophobia, and tearing in the right eye. The symptoms started yesterday. He is instilling Systane Balance but has felt no relief. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is OD 20/25+2 and OS 20/20. Lids and lashes are clear OU. The conjunctiva is mildly hyperemic OD and quiet OS. You observe a thin linear heaped up branching lesion with club-shaped terminal bulbs at the end of each branch below the visual axis OD. The cornea OS is clear. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. The following is the most likely diagnosis for the corneal findings in the right eye ______ Provide a prescription for appropriate medication for the treatment of this presentation: Rx: _______ Sig: ______ Disp: ______ Refill: _______

-HSV epithelial keratitis Rx: Valtrex 500 mg tablet Sig: take 1 tablet TID by mouth for 7 days Disp: 21 tablets Refill: 0

13) A 69-year-old Caucasian male presents for a comprehensive eye examination. He denies any symptoms. He has a history of glaucoma and instills brimonidine 0.15% BID OU. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. Pupils and motility are normal OU. The lids and lasher are clear and the conjunctiva is mildly hyperemic OU. You observe a collection of pigment in the shape of a spindle deposited on the corneal endothelium OU. The anterior chamber is deep and quiet OU. IOP is 16 mmHg OU @ 10:30 AM. The following term is used to describe the corneal findings_____ You expect to find the following while examining the iris _______

-Krukenberg spindle -mid-peripheral transillumination defects

3) A 25-year-old Black female presents complaining of pain, photophobia, and redness in the left eye. The symptoms started 2 days ago and are getting progressively worse. The review of systems is negative, The pertinent past ocular, medical, family, and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. The lids and lashes are clear OU. The conjunctiva is quiet OD. There is circumcorneal conjunctival hyperemia OS. The cornea is clear OD. There are small endothelial keratic precipitates OS. The anterior chamber is deep and quiet OD. The chamber OS is deep with 3+ cells and 1+ flare. There is no hypopyon OS. The iris is flat and intact OU but there are small elevated nodules at the pupillary border on the anterior aspect of the iris OS. The crystalline lens is clear OU. IOP is 19 mmHg OU @ 2:15 PM. The following is the most likely diagnosis for the left eye____(be specific) The following term is used for the iris findings in the left eye ______ The following topical agent is most appropriate for the treatment of the pain and photophobia in this presentation ____(provide name, concentration, and dosage) The following topical agent is most appropriate for the treatment of the inflammation in this presentation _____(provide name)

-acute anterior non-granulomatous uveitis -Koeppe nodules -cyclopentolate 2% TID -topical hard corticosteroid: Pred Forte 1% QID

11) A 20-year-old Caucasian male presents complaining of pain, photophobia, redness, and blurry vision in the right eye that started last night. The review of systems reveals pain and increased frequency of urination as well as pain and swelling of both knees. The pertinent past family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is OD 20/60 and OS 20/20. The lids and lashes are clear OU. There is a ring of severe circumcorneal conjunctival hyperemia OD. The cornea is hazy OD. There are small keratic precipitates located inferiorly on the endothelium OD. The anterior chamber is deep with 4+ cells, mild fibrin, and a 2-mm hypopyon. The iris is flat and intact OD. The following is the most likely diagnosis for this presentation _______ The following is the most likely etiology of this presentation _______ This patient is likely to test positive for the following antigen ______and negative for the following factor _______

-acute non-granulomatous anterior uveitis -reactive arthritis -HLA-B27 -rheumatoid

10) A 78-year-old Caucasian female presents with a two-week history of severe sharp and stabbing pain and redness in the left eye. The pain wakes the patient up during the night. In addition, she reports photophobia, blurry vision, and a foreign body sensation in her left eye. She denies any symptoms in her right eye. She reports a history of joint pain and stiffness. The remainder of her review of symptoms is negative. The pertinent past family and social histories are unremarkable. Upon, clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. The lids and lashes are clear OU. The conjunctiva is quiet OD. You observe 2+ conjunctival injection, 6.8 x 3.2 mm ulceration of the conjunctiva and sclera inferotemporally with 50% scleral thinning OS. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. The following is the most likely diagnosis for this presentation ______ The following systemic condition is most commonly associated with this presentation ________

-anterior necrotizing scleritis with inflammation -rheumatoid arthritis

2) A 10-months-old Asian male presents with redness and mucopurulent discharge in the left eye that started 2 days ago. The pertinent past ocular, medical, family, and social histories are non-contributory. Upon clinical examination, he is able to fix-and-follow OD, OS, OU. You observe yellowish mucopurulent discharge over the eyelashes and the hyperemic conjunctiva OS. There are no papillae nor follicles present OS. The cornea is clear OU. The preauricular node is not swollen on either side. The following is the most likely diagnosis for this presentation _____ The following topical antibiotic is FDA-approved for babies two months of age and older ________

-bacterial conjunctivitis -Polytrim or tobramycin ophthalmic solution

19) A 31-year-old Hispanic male presents complaining of mild glare in the right eye. The symptom started a year ago and is slowly getting worse. The pertinent medical, family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is OD 20/20-2 and OS 20/20. The lids and lashes are clear OU. The conjunctiva is quiet OU. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU with blue color OD and brown color OS. IOP is 12 mmHg OU @ 1:45 PM. Upon pupillary dilation, you observe posterior cortical opacities in 3 quadrants OD. The crystalline lens OS is clear. The following term is used to describe the iris findings ______ The following is the most likely etiology of the findings in the right eye________

-complete heterochromia -Fuchs heterochromic iridocyclitis

7) A 26-year-old Hispanic male presents complaining of moderate eye pain in the right eye. In addition, he reports tearing and blurry vision OD. The symptoms started immediately after he had been pounding a metal object with a metal chisel yesterday morning. He was not wearing safety glasses and felt something strike his right eye. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is OD HM@1ft and OS 20/20. The lids and lashes are clear OU. Conjunctiva is mildly injected in the right eye and quiet in the left eye. There are no conjunctival laceration and no subconjunctival hemorrhage OD. Cornea shows central 1 mm Seidel-negative full-thickness laceration OD. The anterior chamber is deep with 1+ cells, and no hypopyon or hyphema OD. A dense traumatic cataract with disruption of the anterior lens capsule can be observed in the right eye. No view of the anterior vitreous. This presentation is highly suspicious for the presence of the following _______ The following immunization should be updated prior to any surgical intervention in this presentation _______

-intraocular foreign body (IOFB) -tetanus

22) A 25-year-old Caucasian female presents complaining of redness and discharge in both eyes. The symptoms started 2 days ago. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. You observe dry discharge clumping the eyelashes OU. The conjunctiva is mildly hyperemic OU with moderate mucopurulent discharge. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. The following is the most likely diagnosis for this presentation ______ Provide a prescription for appropriate medication for the treatment of this presentation: Rx: ______ Sig: _____ Disp: ______ Refill: _____

-non-gonococcal bacterial conjunctivitis - Rx: Tobrex 0.3% ophth sol Sig: Instill one drop QID OU x 7 days Disp: 5 mL Refill: 0

16) A 55-year-old Black male presents complaining of glare and haloes around lights while driving at night OD>OS. The symptoms started a month ago and are slowly getting worse. He reports that he is diabetic and takes metformin 1,000 mg po every day. His blood glucose this morning was 103 mg/dL and his last Hb A1C was 6.8%. The pertinent past ocular, family, and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is OD 20/50-2 and OS 20/20. Pupils, motility, and CVFs are normal OU. The lids and lashes are clear and the conjunctiva is quiet OU. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. IOP is 14 mmHg OU @ 3:30 PM. Upon pupillary dilation, you observe that around 40% of the posterior central lenticular area is covered by a granular opacity in the right eye. The following is the most likely diagnosis for the lenticular findings _____ The following additional types of cataracts are associated with diabetes _____ _______ (2 answers) The following device can be used to measure acuity under glare conditions _______

-posterior subcapsular cataract -snowflake cataract -Christmas tree cataract -brightness acuity testing

5) A 56-year-old Swedish female presents complaining of blurry vision at near with her current glasses which are 3 years old. The pertinent past ocular, medical, family, and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU at distance and at near. The lids and lashes are clear and the conjunctiva is quiet OU. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. You observe flaky white material deposited around the pupillary margin and upon a very lengthy pupillary dilation, you observe flaky white material around the anterior capsule OU. IOP is 23 mmHg OU @ 2:15 PM. The following is the most likely condition causing the findings on the lens capsule_________ This patient is at a higher risk for developing the following vision-threatening condition________

-pseudoexfoliation (PXF) -pseudoexfoliative glaucoma

15) A 68-year-old Hispanic male presents complaining of mild blurry vision and sensitivity to light OU. The symptoms started 5 days ago when he boarded a cruise to the Bahamas. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the entrance acuity is 20/25+2 OD, OS, OU. Pupils are round, unreactive to light and dilated. Motility and CVF are normal OU. The lids and lashes are clear and the conjunctiva is quiet OU. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris intact OU. The crystalline lens shows early nuclear sclerotic changes OU. IOP is 15 mmHg OU @ 9:15 AM. You look behind the patient's ears and there is a small round patch over the skin on both sides. The patient reports placing the patches to prevent motion sickness. The following is the most likely ingredient causing this presentation _____ Upon instillation of 2% pilocarpine ophthalmic solution, you expect the following pupillary reaction to occur _________

-scopolamine -no response

23) A 78-year-old Caucasian female presents complaining of redness in the right eye. The symptom was noted by her husband this morning. She denies pain, itching, tearing, burning, and foreign body sensation. She takes a daily multivitamin and aspirin 81mg po. The pertinent past family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. The lids and lashes are clear and the conjunctiva is quiet OU. There is a bright red area over the temporal sclera in the right eye. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. The following is the most likely diagnosis for the redness in the right eye _______ The redness in the right eye is expected to resolve within the following period of time _____

-subconjunctival hemorrhage -1 to 2 weeks

9) A 28-year-old Hispanic female presents complaining of a progressive decrease in vision and worsening glare in both eyes. The symptoms started 2 months ago. She has a history of Marfan syndrome with aortic stenosis and is taking an oral beta-blocker. She is followed by cardiology on regular basis. The pertinent past family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is OD: -1.75- 5.00 x 045 20/40 and OS: -1.00 - 4.25 x 150 20/50. Pupillary testing and motility are normal OU. The lids and lashes are clear OU. The conjunctiva is quiet OU. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. You observe lens subluxation OU. You expect the lens subluxation to be into the following quadrant _____ If the zonules break and the crystalline lens dislocates into the vitreous cavity, the eye is at risk for developing the following type of uveitis _________

-superotemporal -phacolytic

17) A 28-year-old Hispanic female presents complaining of severe pain and tearing in the left eye. The symptoms started after her son accidentally scraped her eye with a toy. The pertinent past ocular, medical, social, and family histories are unremarkable. Upon clinical examination, the entrance visual acuity is 20/20 OD, OS, OU. Pupils, motility, and CVFs are normal OU. The right eye is normal. The lids and lashes are clear OS. The conjunctiva is moderately hyperemic OS. You observe a 2x1.5 mm epithelial defect on the inferotemporal cornea OS. There is no stromal infiltration nor edema OS. The anterior chamber is deep and quiet OS. The iris is flat and intact OS. The following is the most likely diagnosis for this presentation _____ The following is the most appropriate way to treat the pain in this presentation _____ The following is the most appropriate treatment for the corneal findings in the left eye ______ ______ (2 answers)

-traumatic corneal abrasion -cycloplegia/broad-spectrum topical antibiotic *Discuss findings with the patient and educate the patient about the condition. Start Vigamox 0.5% ophth sol TID OS, cyclopentolate 1% TID OS, and PF AT q1h OS while awake. Follow up tomorrow.

12) A 27-year-old Black male presents complaining of pain and photophobia in the right eye that started after he suffered blunt trauma with a candle 3 days ago. The pertinent past ocular, medical, family, and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. There are stitches over what appears as lacerated skin over the right brow. The lids and lasher are clear OU. You observe mild circumcorneal conjunctival hyperemia OD. Corneal is clear OU. The anterior chamber is deep with 2+ cells, no flare, and no hypopyon OD. The iris is flat and intact OU with a microhyphema at 7 o'clock and a small sphincter tear at the pupil. IOP is 14 mmHg OU @ 9:15 AM. The following is the most likely diagnosis for the ocular findings in the right eye _______ The following is the most appropriate initial treatment for the AC reaction in this presentation _______ The following additional procedures should be performed at the 1-month follow up visit ____ _____ (give 2 answers)

-traumatic iritis -cyclopentolate -gonioscopy -scleral depression

18) A 23-year-old Caucasian female presents complaining of mild discomfort and redness in the left eye. It started 2 days ago and is getting worse. She denies seeing any discharge. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. The right eye is normal. The lids and lashes are clear OS. There is vascular congestion over the superotemporal, temporal and infeortemporal sclera with a nodular elevation inferotemporally about 3 mm away from the limbus. The cornea is clear OS. The anterior chamber is deep and quiet OS. The iris is flat and intact OS. List two clinical techniques or procedures that can help you differentiate between conditions and decide on the final diagnosis for this presentation _______ ______ (2 answers)

-use a cotton-tipped applicator to see if the nodule is mobile -instill phenylephrine -AS -OCT -UBM -ultrasound

4) A 12-year-old Asian male presents complaining of double vision with both eyes open. The symptoms started after being involved in a physical altercation that resulted in a closed fist blow to the left side of his face. Subsequently, he experiences significant pain when attempting to look up and has a mild associated headache and nausea. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. Pupils and confrontation visual fields are normal OU. Motility in the right eye is normal and OS shows hypotropia in primary gaze. In addition, there is a significantly reduced supraduction and pain when looking up OS. Exopthalmometry is OD 19 mm and OS 16 mm with a 104 mm base. You observe minimal periorbital edema OS with no ecchymosis. The lashes are clear OU. The conjunctiva OS is quiet with few scattered, small sub-conjunctival hemorrhages. The cornea is clear OU. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. IOP is 20 mmHg OU @ 3:30 PM. The dilated retinal fundus examination is normal OU. The following is the most likely diagnosis for this presentation ______ The following is the most appropriate treatment for this condition ______

-white-eyed orbital floor fracture -surgical repair of the orbital floor within 48 hours

The following is a minimal normal result for the following tests: 1) Tear break-up time: _______seconds 2) Schirmer I:______ mm in 5 minutes 3) Schirmer II: _____ mm in 5 minutes

1) 10 2) 2 3) 3

List four (4) different types of blepharitis

1) Anterior staphylococcal blepharitis 2) Anterior Seborrheic blepharitis 3) Posterior blepharitis 4) Angular blepharitis

List the three (3) classifications of dry eye:

1) Sjogren syndrome aqueous deficient dry eye 2) Non-Sjogren syndrome aqueous deficient dry eye 3) Evaporative dry eye

The following four (4) clinical investigations are indicated in patients when dry eye is on the list of differential diagnoses:

1) Tear osmolarity 2) Schirmer test 3) TBUT 4) Staining

Fuchs 1._______, corneal dystrophy is characterized by the formation of central focal excrescences of the Descemet membrane called 2._____, loss of 3.______ cell density, and end-stage disease manifested by corneal edema and the formation of epithelial 4. _______.

1. Endothelial 2. Guttata 3. Endothelial 4. Bullae

Your best friend from college texts you. He is totally spooked. He went to see his optometrist for an eye exam. His vision has changed and he wanted to get new glasses. He says the optometrist took a picture of his eye and told him that he will have to wear contact lenses if he wants to see better. He wants to see better but doesn't want to wear contact lenses. He texts you the picture taken by his optometrist and wants you to tell him if he can get LASIK instead. Q1. The following is the most likely condition depicted above: ________ Q2. The following type of astigmatism depicted in the image above is best-corrected with gas permeable contact lenses: _______

1. keratoconus 2. irregular

Azithromycin is more effective for the treatment of the following type of blepharitis:

Anterior

____________________ constitutes ~ 75% of all cases of uveitis

Anterior uveitis

The following degeneration is depicted by the photographs below:

Band keratopathy

Clear cuffs around the base of the eyelashes are a sign of infestation by the following microorganism species:

Demodex

T/F Axenfeld-Rieger syndrome is characterized by an abnormal corneal endothelial cell layer with a predilection for proliferation and migration across the anterior chamber angle and onto the surface of the iris.

False

T/F Keratitis is a common feature that accompanies episcleritis.

False

T/F Pharmacologically-induced mydriasis of the pupil will respond to the instillation of 2% pilocarpine drops.

False

T/F: Patients presenting with the first episode of moderate unilateral non-granulomatous anterior uveitis require laboratory investigations.

False

In 2008, the International Uveitis Study Group (IUSG) proposed a simplified clinical classification system of uveitis. What were the 3 classifications?

Infectious: viral, bacterial, fungal, protozoan Noninfectious: systemic disease, trauma/surgery Masquerade: neoplastic, non-neoplastic

The following disorder is depicted by the photograph below:

Iris coloboma

List three alkali most commonly associated with ocular chemical burns:

Lye, lime, ammonia

List four systemic diseases that are most commonly associated with chronic granulomatous uveitis:

Lyme disease, sarcoidosis, syphilis, SLE, TB

QuantiFERON-TB Gold is a blood test used to evaluate patients for an infection with the following microbe:

M. tuberculosis

One of the differences between nodular episcleritis and nodular scleritis is that the nodule associated with episcleritits is ________ when pushed with a cotton-tipped applicator and the nodule associated with scleritis is ________.

Mobile, immobile

Patients suffering from blepharitis will report that their symptoms are usually worse at this time of the day:

Morning

The following is a hallmark symptom associated with most types of scleritis

Pain

A 27-year-old Black male presents complaining of foreign body sensation, redness, and tearing in the right eye. The symptoms started yesterday after he left work. He is a car mechanic. He instilled artificial tears but feels no relief. The pertinent past medical, family and social histories are unremarkable. Upon clinical examination, the best-corrected visual acuity is 20/20 OD, OS, OU. The lids and lashes are clear OU. The conjunctiva is moderately hyperemic OD and quiet OS. The superior palpebral conjunctiva is clear OU. There is a 1-mm metallic foreign body surrounded by a dense white stromal infiltrate at 7 o'clock in the corneal mid-periphery OD about 70 microns into the corneal tissue depth. The cornea is clear OS. The anterior chamber is deep and quiet OU. The iris is flat and intact OU. The crystalline lens is clear to view OU. You proceed to remove the foreign body and the rust ring OD behind the slit lamp under topical anesthesia without any complications. Write a prescription for the most appropriate topical antibiotic for the right eye:

Rx: Besivance 0.6% ophth suspension Sig: Instill one drop (OD/OS) q1h around the clock Disp: 5 mL Refill: 0

You are issuing a refill for cyclosporine-A for the next 12 months. Fill in the blanks with the appropriate information: Rx: ______ ______% Ophthalmic ___________ Sig: ________ Disp: _________ Refill: __________

Rx: Restasis 0.05% ophthalmic emulsion Sig: Instill one drop BID OU Disp: 60 vials Refill: 12

The following degeneration is depicted by the photographs below:

Salzmann nodular degeneration

Elevated levels of angiotensin-converting enzyme as well as serum lysozyme with lower-than-normal lymphocytes levels are highly suggestive of the presence of the following systemic disease:

Sarcoidosis

T/F Necrotizing anterior scleritis with inflammation is commonly associated with rheumatoid arthritis, granuloma formation, or surgery.

True

T/F Nodular episcleritis has a more prolonged course than simple episcleritis.

True

T/F Over half of the patients presenting with scleritis have an associated systemic disease.

True

T/F The nodule seen in eyes with scleritis is immobile and has a deeper blue-red color.

True

The tender, red, vascular nodule seen in eyes with nodular episcleritis is mobile.

True

Tiny blue or white lens opacities scattered throughout the lenticular cortex are associated with the following condition:

blue dot cataract Or cerulean cataract

The following remnant consists of tiny brown fleck(s) on the central anterior lens capsule:

epicapsular star

List one of the oral antibiotics most commonly prescribed in the US for the treatment of tuberculosis:

ethambutol isoniazid pyrazinamide rifampin

A 23-year-old male with a history of traumatic iritis in the right eye presents for an attending physician-directed 1-month follow up visit. The following additional procedures are indicated during this visit:

gonioscopy, scleral depression

The following disorder is depicted by the photograph below:

heterochromia

A progressive yellowing and hardening of the crystalline lens nucleus is expected to result in the following refractive error shift:

myopic

Pain is absent on the following type of scleritis

scleromalacia perforans

The following are the two types of episcleritis

simple and nodular

The following condition is characterized by a partial dislocation of the crystalline lens and the lens remaining behind the iris plane:

subluxation

Patients presenting with scleritis and a malar skin rash in a butterfly pattern that covers the cheeks and the bridge of the nose are highly suspicious for the following systemic disease:

systemic lupus erythematosus (SLE)