Ophthalmology Exam Master Questions With Already Passed Solutions.

Ophthalmology Exam Master Questions With Already Passed Solutions. A client comes into the clinic with a complaint of flaking and scaling around her lashes, along with itching and burning sensation, occurring over the past year. She has also noted her lid margins are red, and some of her lashes are missing. Her history is significant for seborrheic dermatitis of the scalp, eyebrows, and external ears, and diabetes. What is the most likely diagnosis? Blepharitis Chalazion Conjunctivitis Ectropion Foreign Body Blepharitis Blepharitis may be seborrheic or ulcerative. Seborrheic (non-ulcerative) blepharitis is commonly associated with seborrhea of the face, eyebrows, external ears, and scalp. Inflammation of the eyelid margins occurs, with redness, thickening, and often the formation of scales and crusts or shallow marginal ulcers. Ulcerative blepharitis is caused by bacterial infection (usually staphylococcal) of the lash follicles and the meibomian glands. Removal of crusts, topical antibiotics, and /or oral antibiotics remains the mainstay of treatment. A 64-year-old African-American man presents to the emergency department after he went blind in his right eye "out of the blue" 20 minutes ago. There is no pain associated with his symptoms and he is not nauseated. Past medical history is positive for DMII for the past ten years. The pupil reaction on the left side is normal with pressure of 17mmHg. Right pupil evaluation reveals no reaction to light or accommodation with pressure of 20mmHg. Right eye ophthalmoscopy reveals arteriolar narrowing, vascular stasis, and "boxcar" pattern. What is the most likely diagnosis? Occlusion of the central retinal artery Acute glaucoma attack Subconjunctival hemorrhage Retinal detachment Macular degeneration Occlusion of the central retinal artery The symptoms described above are typical for occlusion of the central retinal artery, which is a branch of the ophthalmic artery, in turn a branch of the internal carotid artery. The "boxcar" pattern is segmentation of the venous blood column, bilateral boxcar ring is a useful sign of circulatory arrest and death. Acute central artery occlusion is an emergency, since it results in permanent blindness if circulation is not restored within 30-60 minutes. A 36-year-old woman presents with a small and irregular right pupil. On exam, you note that the pupil does not respond to direct or consensual light stimuli; however, it becomes smaller during an accommodation testing. What is the most likely diagnosis? Transient ischemic attack (TIA) Retinal artery occlusion Retinal vein occlusion Tertiary syphilis Herpes simplex keratitis Tertiary syphilis The clinical picture is suggestive of tertiary syphilis; more specifically, it is likely tabes dorsalis. The pupil describe here is the Argyll Robertson pupil. The pupil reacts poorly to light, but it reacts well to accommodation. A 27-year-old woman presents with a 3-day history of left eye pain. The patient notes sensitivity to light, and she comments that her eye throbs in pain at night. On physical examination, you note a redness and loss of visual acuity. What would be an appropriate treatment for this patient? Cool compresses and artificial tears Cortisporin ointment Dexamethasone and homatropine ophthalmic drops Oral acyclovir IV acetazolamide Dexamethasone and homatropine ophthalmic drops The clinical picture is suggestive of uveitis. Patients with uveitis usually note redness, pain, photophobia, and visual loss. Treatment is with topical steroids and a dilating agent to relieve the discomfort. There are multiple causes of uveitis, but it is primarily immunogenic. A 1.5-year-old boy presents with a squint in the left eye. His mother informed you that the child's eyes were quite normal until about 2 months ago, when she noticed asymmetric movements of her son's eyes. She also felt that the child could not see properly with his left eye. There is no history of trauma to the eye. Child was born at full term and his growth and development were within normal limits. Eye examination showed both eyeballs were equal in size. There was loss of vision in the left eye and a convergent squint in the same eye. Fundus examination showed absence of red reflex in the left eye, and instead a white pupillary reflex (leukocoria) was seen. X-ray of the skull showed calcification within the globe. What is the most likely diagnosis? Retinal detachment Congenital cataract Retinoblastoma Congenital glaucoma Persistent hyperplastic primary vitreous Retinoblastoma The most likely diagnosis is retinoblastoma, as it is the most common primary ocular tumor in children below 5 years of age. 90% of cases are diagnosed below 3 - 4 years of age. The index case is a 1.5-year-old boy who has presented with a recent appearance of squint and absence of normal red reflex in the left eye, replaced instead by a white pupillary reflex (leukocoria). This is due to reflection of light from the white-colored tumor and loss of vision in that eye. The diagnosis is further supported by calcification seen in the globe in the X-ray of the skull. Fundoscopy may show the tumor as a white mass, which may be small and flat or may be large and protuberant. Orbital inflammation, hyphema, and irregular pupil are seen in advanced stages of the disease. Retinoblastoma gene is a recessive gene located on the chromosome13 at the 13q 14 regions, and the tumor may arise from any of the nucleated layers of the retina. Besides direct observation, ultrasonography or CT scan may help to confirm the diagnosis and demonstrate calcification within the mass. As biopsy can lead to the spread of the tumor, histopathological confirmation of the tumor can be made only after removal of the affected eye A 32-year-old woman presents with a 3-day history of irritation, burning, itching, and redness of both eyelids. She denies fever, visual changes, and photophobia. On physical examination, you note the presence of scales clinging to the eyelids bilaterally. What is the proper management in this case? Daily cleaning with a damp cotton applicator and baby shampoo Short-term oral antibiotic therapy for 7 days Short-term oral corticosteroid therapy for 14 days Topical corticosteroid eye drops for 10 days Prompt ophthalmologist referral Daily cleaning with a damp cotton applicator and baby shampoo The scenario presented above depicts a patient with anterior blepharitis, which is a common disorder seen in primary care; it typically consists of a recurrent bilateral inflammation of the lid margins that involves the eyelid skin, eyelashes, and associated glands. Commonly, the underlying cause is seborrhea, which usually originates in the scalp, eyebrows, or ears. Sometimes, anterior blepharitis can be ulcerative, and the origin in the presented case is staphylococci. Anterior blepharitis can typically be