EENT EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED GRADED A++
Blepharitis Overview
-inflammation of both eyelids
-common in patients with Down's and eczema
Blepharitis Etiologies
1. anterior: involves the skin and base of the eyelashes
-less common
-2 types: infectious (s. aureus of s. epidermis, viruses), seborrheic
2. posterior: meibomian gland dysfunction (associated with rosacea and allergic
dermatitis)
Blepharitis Clinical Manifestations
1. eye irritation/itching
2. eyelid: burning, erythema, crusting, scaling, red rimming of the eyelid, and eyelash
flaking
3. +/- entropion or ectropion (especially with posterior)
Blepharitis Management
,1. anterior: eyelid hygiene (warm compresses, eyelid scrubbing/washing with baby
shampoo) +/- ABXs (azithromycin solution or ointment, erythromycin or bacitracin)
2. posterior: eyelid hygiene, regular massage/expression of the meibomian gland +/-
systemic ABXs in severe or unresponsive cases (tetracyclines or azithromycin)
Macular Degneration Overview
-risk factors: age > 50, caucasians, females, smokers
-MC cause of permanent legal blindness and visual loss in the elderly (> 75 years)
-the macula is responsible for central vision as well as detail and color
Macular Degneration Types
1. dry (atrophic)
-gradual breakdown of the macula -> gradual blurring of central vision
-drusen: small round yellow-white spots on the outer retina (scattered, diffuse); the
accumulation of waste products from the retinal pigment epithelium
2. wet (neovascular or exudative)
-new, abnormal vessels grow under the central retina, which leak and bleed -> retinal
scarring
-rarer than dry but progresses more rapidly
Macular Degneration Clinical Manifestations
1. bilateral blurred or loss of central vision (including details and colors)
,2. scotomas (blind spots, shadows), metamorphosis (straight lines appear bent),
micropsia (object seen by the effected eye looks smaller than in the unaffected eye)
Macular Degneration Diagnosis of Wet
-fluorescein angiography
Macular Degneration Management
1. dry
-amsler grid at home to monitor stability
-zinc, vitamin A/C/E may slow progression
2. wet
-intravitreal anti angiogenics (Bevacizumab): inhibit vascular endothelial growth factor
(VEGF) -> reduces neovascularization
-laser photocoagulation
-optical tomography done to monitor treatment response
Retinal Detachment Types
1. rhegmatogenous (MC type)
-retinal tear -> retinal inner sensory layer detaches from choroid plexus
-MC predisposing factors are myopia (nearsightedness) and cataracts
2. traction
-adhesions separate the retina from its base (proliferative DM retinopathy, sickle cell,
trauma)
, 3. exudative (serous)
-fluid accumulates beneath the retina -> detachment
-HTN, CRVO, papilledema
Retinal Detachment Clinical Manifestations
1. photopsia: flashing lights with detachment -> floaters -> progressive unilateral vision
loss (shadow "curtain coming down" in periphery initially -> loss of central visual
field)
2. no pain/redness
Retinal Detachment Diagnosis
-funduscopy
-retinal tear (detached tissue "flapping" in the vitreous humor)
-positive Shafer's sign: clumping of brown colored pigment cells in the anterior
vitreous humor resembling "tobacco dust"
Retinal Detachment Management
-ophtho emergency: keep patient supine while awaiting consult (don't use miotic drops)
-laser, cryotherapy, ocular surgery
Retinal Detachment Differential
-amaurosis fugax: temporary "curtain" that lifts up usually within 1 hour
Corneal Abrasion/Ocular Foreign Body Clinical Manifestations
-foreign body sensation, tearing, red, and painful eye
Corneal Abrasion/Ocular Foreign Body Diagnosis
COMPLETE SOLUTIONS VERIFIED GRADED A++
Blepharitis Overview
-inflammation of both eyelids
-common in patients with Down's and eczema
Blepharitis Etiologies
1. anterior: involves the skin and base of the eyelashes
-less common
-2 types: infectious (s. aureus of s. epidermis, viruses), seborrheic
2. posterior: meibomian gland dysfunction (associated with rosacea and allergic
dermatitis)
Blepharitis Clinical Manifestations
1. eye irritation/itching
2. eyelid: burning, erythema, crusting, scaling, red rimming of the eyelid, and eyelash
flaking
3. +/- entropion or ectropion (especially with posterior)
Blepharitis Management
,1. anterior: eyelid hygiene (warm compresses, eyelid scrubbing/washing with baby
shampoo) +/- ABXs (azithromycin solution or ointment, erythromycin or bacitracin)
2. posterior: eyelid hygiene, regular massage/expression of the meibomian gland +/-
systemic ABXs in severe or unresponsive cases (tetracyclines or azithromycin)
Macular Degneration Overview
-risk factors: age > 50, caucasians, females, smokers
-MC cause of permanent legal blindness and visual loss in the elderly (> 75 years)
-the macula is responsible for central vision as well as detail and color
Macular Degneration Types
1. dry (atrophic)
-gradual breakdown of the macula -> gradual blurring of central vision
-drusen: small round yellow-white spots on the outer retina (scattered, diffuse); the
accumulation of waste products from the retinal pigment epithelium
2. wet (neovascular or exudative)
-new, abnormal vessels grow under the central retina, which leak and bleed -> retinal
scarring
-rarer than dry but progresses more rapidly
Macular Degneration Clinical Manifestations
1. bilateral blurred or loss of central vision (including details and colors)
,2. scotomas (blind spots, shadows), metamorphosis (straight lines appear bent),
micropsia (object seen by the effected eye looks smaller than in the unaffected eye)
Macular Degneration Diagnosis of Wet
-fluorescein angiography
Macular Degneration Management
1. dry
-amsler grid at home to monitor stability
-zinc, vitamin A/C/E may slow progression
2. wet
-intravitreal anti angiogenics (Bevacizumab): inhibit vascular endothelial growth factor
(VEGF) -> reduces neovascularization
-laser photocoagulation
-optical tomography done to monitor treatment response
Retinal Detachment Types
1. rhegmatogenous (MC type)
-retinal tear -> retinal inner sensory layer detaches from choroid plexus
-MC predisposing factors are myopia (nearsightedness) and cataracts
2. traction
-adhesions separate the retina from its base (proliferative DM retinopathy, sickle cell,
trauma)
, 3. exudative (serous)
-fluid accumulates beneath the retina -> detachment
-HTN, CRVO, papilledema
Retinal Detachment Clinical Manifestations
1. photopsia: flashing lights with detachment -> floaters -> progressive unilateral vision
loss (shadow "curtain coming down" in periphery initially -> loss of central visual
field)
2. no pain/redness
Retinal Detachment Diagnosis
-funduscopy
-retinal tear (detached tissue "flapping" in the vitreous humor)
-positive Shafer's sign: clumping of brown colored pigment cells in the anterior
vitreous humor resembling "tobacco dust"
Retinal Detachment Management
-ophtho emergency: keep patient supine while awaiting consult (don't use miotic drops)
-laser, cryotherapy, ocular surgery
Retinal Detachment Differential
-amaurosis fugax: temporary "curtain" that lifts up usually within 1 hour
Corneal Abrasion/Ocular Foreign Body Clinical Manifestations
-foreign body sensation, tearing, red, and painful eye
Corneal Abrasion/Ocular Foreign Body Diagnosis
