NBEO- Ocular Disease Part 1

Are alkali or acidic burns more harmful to the cornea?

Alkali

Which type of illumination would MOST likely be used to diagnose a patient with EBMD?

A) Sclerotic scatter

B) Optic section

C) Conical beam

D) Indirect illumination

D) Indirect illumination

Which of the following is NOT an appropriate use of a cobalt blue filter during a slit lamp exam?

A) Performing Goldmann IOP with fluorescein

B) TBUT testing

C) Evaluating herpetic dendrites with rose bengal

D) Evaluating fleischer rings in keratoconus without the use of fluorescein

C (white light)

A _____________ is defined as a corneal epithelial defect with no underlying infiltrate.

corneal abrasion

Which of the following should NOT be used in the treatment of a mechanical corneal abrasion?

A) Artificial tears

B) Topical cycloplegic

C) Topical steroid

D) Topical antibiotic

C) Topical steroid

Which of the following is an example of an alkali agent that can cause corneal damage?

A) Sulfuric acid

B) Nitric acid

C) PAVA

D) Airbag residue

D) Airbag residue

Which of the following is an example of an acidic agent that can cause corneal damage?

A) Lime

B) Ammonia

C) PAVA

D) Airbag residue

C) PAVA

____________ is used to determine if an open globe injury exists by painting the injury site with fluorescein.

Seidel's test

Which of the following is NOT a sign associated with an open globe injury?

A) Hyphema

B) Comotio retinae

C) (-) Seidel's test

D) Severe subconjunctival hemorrhage

C (+)

What are the two main etiologies of idiopathic hyphemas (not caused by trauma)? (Choose 2)

A) Sickle cell anemia

B) Hypertension

C) CRVO

D) Blood thinners

A and D

It is recommended not to perform gonioscopy for at least ___________ following a traumatic hyphema.

A) 1 day

B) 1 week

C) 1 month

D) 1 year

C) 1 month

What is the most common corneal endothelial dystrophy?

Fuchs dystrophy

A Grade 4 or complete hyphema is also referred to a ____________ hyphema.

8-ball hyphema

Which of the following is NOT associated with a hyphema.

A) Corneal blood staining

B) Increase in IOP

C) Blood in the anterior chamber

D) Transillumination defects

D) Transillumination defects

What are the two most common demographics associated with Sickle Cell Anemia? (Choose 2)

A) Caucasians

B) African Americans

C) Asians

D) Mediterranean

B and D

Which of the following is NOT recommended when managing a metallic intraocular foreign body?

A) CT scan

B) MRI

C) B scan

D) Seidel's test

B) MRI

Which of the following materials would be the most problematic in an ocular foreign body?

A) Glass

b) Stone

C) Copper

D) Plastic

C) Copper

Orbital floor fractures are the most common location for an orbital fracture because the ____________ bone is the weakest in the orbit.

maxillary bone

What are the 3 main bones that make up the floor of the orbital rim?

Maxillary, Palatine, Zygomatic

Which of the following is NOT a finding associated with an orbital fracture?

A) Pain

B) Binocular diplopia

C) Skew deviation

D) Crepitus

C) Skew deviation

Which of the following would you LEAST likely expect to find in a patient with an orbital fracture?

A) Trapped inferior rectus

B) Trapped superior oblique

C) Trapped inferior oblique

D) Hypoesthesia of the cheek

B (usually orbital floor location)

Are orbital floor fractures more likely to be associated with a (+) forced duction test or (-) forced duction test?

(+) forced duction

Which of the following is a contraindication immediately following an orbital fracture?

A) Eating

B) Running

C) Blowing your nose

D) Sleeping

C) Blowing your nose

Where is the main site of damage for Comotio Retinae?

A) Superficial capillary plexus

B) ONH

C) Between RPE and Photoreceptor outer segments

D) Between RPE and Choroid

C) Between RPE and Photoreceptor outer segments

Comotio Retinae that travels into the macula is known as ____________.

Berlin's edema

Disinsertion of the iris root from the ciliary body is known as _____________.

Iridodialysis

What is the main etiology of Irididodialysis?

Trauma

What are you most concerned about following Iridodialysis?

A) Retinal detachment

B) Angle closure glaucoma

C) Angle recession glaucoma

D) Lens subluxation

C) Angle recession glaucoma

______________ is a pigmented ring on the anterior lens surface that results from contact with the pigmented iris epithelium following trauma.

Vossius ring

What bone is considered to be the thinnest bone in the orbit?

Ethmoid bone

_____________ Retinopathy is associated with acute chest-compressing trauma and is characterized by diffuse retinal hemorrhages, exudates, and cotton wool spots.

Purtscher's retinopathy

Which of the following is NOT an ocular finding associated with Purtscher's retinopathy?

A) Cotton wool spots

B) Sea fan neovascularization

C) Diffuse retinal hemorrhages

D) Exudates

B) Sea fan neovascularization

A choroidal rupture is often caused by trauma has the potential to develop into what ocular finding?

CNVM

Preseptal cellulitis is characterized as an infection anterior to the _______________.

orbital septum

An infection of the lacrimal sac is known as _______________.

Dacryocystitis

Which of the following is NOT a typical cause of preseptal cellulitis?

A) Skin trauma from insect bite

B) Internal hordeolum

C) Middle ear infection

D) Contact lens misuse

D) Contact lens misuse

Which of the following is NOT associated with preseptal cellulitis?

A) Eyelid warmth

B) Eyelid erythema

C) Reduced vision

D) Ptosis

C) Reduced vision

What is the most common bacterial cause of orbital cellulitis in adults?

Staph aureus

What is the most common bacterial cause of orbital cellulitis in children?

Haemophilus influenzae

Which sinus infection is the most likely etiology of an orbital cellulitis?

A) Sphenoid sinusitis

B) Frontal sinusitis

C) Maxillary sinusitis

D) Ethmoid sinusitis

D) Ethmoid sinusitis

Which aggressive fungal infection are Diabetics and immunocompromised patients at risk of getting following an orbital cellulitis?

Mucormycosis

Which of the following findings are associated with BOTH orbital and preseptal cellulitis?

A) Optic nerve compression

B) Eyelid edema

C) Proptosis

D) Fever

B) Eyelid edema

What is the #1 risk factor associated with Thyroid Eye disease?

Smoking

Which of the following is NOT true regarding Thyroid Eye disease?

A) It affects females more than males

B) It primarily affects middle aged patients

C) Alcohol abuse is the #1 risk factor

D) It can cause proptosis

C (Smoking)

Approximately ____________% of patients with Thyroid Eye disease will also develop Myasthenia Gravis.

1%

What is the only FDA approved medication for both depression and smoking cessation?

Buproprion

Is Thyroid Eye disease more often associated with hyperthyroidism or hypothyroidism?

Hyperthyroidism

What is the main pathophysiology of Thyroid Eye disease?

A) ACH antibodies target NMJ

B) TSH antibodies target EOMs and orbital tissue

C) It is a PNS demyelinating condition

D) It is primarily caused by a thyroid secreting hormone tumor

B

Which topical medication is contraindicated in patients with Thyroid Eye disease?

A) Apraclonidine

B) Timolol

C) Phenylephrine 10%

D) Dorzolamide

C) Phenylephrine 10%

Which of the following does NOT occur in Thyroid Eye Disease?

A) Fibroblast proliferation leading to the swelling of EOMs

B) EOM belly inflammation

C) EOM tendon inflammation

D) Hyperthyroidism

C) EOM tendon inflammation

Which of the following is NOT typically associated with Thyroid Eye disease?

A) Proptosis

B) Upper lid retraction

C) It worsens throughout the day

D) EOM restriction

C (gets better)

What is the greatest threat to vision as a result of Thyroid Eye disease?

A) Retinal detachment

B) Optic nerve compression

C) NVG

D) Hyphema

B) Optic nerve compression

What is the most common EOM affected by Thyroid Eye disease?

Inferior rectus

Which of the following is NOT a sign associated with Thyroid Eye disease?

A) Von Graefe's sign

B) Kaminsky sign

C) Kocher's sign

D) Dalrymple's sign

B) Kaminsky sign

What is the normal range of Hertel Exophthalmometry for Caucasian adults?

12-22mm

What is the normal range of Hertel Exophthalmometry for Asian adults?

12-18mm

What is the normal range of Hertel Exophthalmometry for African Amerian adults?

12-24mm

An asymmetry greater than or equal to ___________ mm between eyes on Hertel Exophthalmometry is considered abnormal.

3 mm

Which EOM enlargement is most likely to cause optic nerve compression in patients with Thyroid Eye Disease?

A) Inferior rectus

B) Medial rectus

C) Superior rectus

D) Lateral rectus

B) Medial rectus

Chemosis, pulsatile proptosis, and an ocular bruit is a unique clinical triad associated with which ocular condition?

Carotid-Cavernous Fistula

Which of the following is NOT true regarding Capillary Hemangioma?

A) It is the most common benign orbital tumor in children

B) It is usually diagnosed before 6 months of age

C) It is associated with Sturge Weber Syndrome

D) It can often lead to amblyopia

C

What is the most common benign orbital tumor in children?

Capillary hemangioma

What is the most common benign orbital tumor in adults?

Cavernous Hemangioma

A neurofibroma is a benign, yellow-white tumor of _________ that is common in young to middle-aged adults.

A) Schwann cells

B) Epithelial cells

C) Connective tissue

D) Astrocytes

D) Astrocytes

______________ is the most common intrinsic tumor of the optic nerve and typically is diagnosed between ages 2-6.

Optic nerve glioma

A ___________ is the most common benign brain tumor and typically arises from the sphenoid bone before it invades the orbit.

Meningioma

Which Orbital tumor is known to cause rapid bone destruction that progressively leads to unilateral proptosis?

A) Neuroblastoma

B) Lymphoma

C) Rhabdomyosarcoma

D) Optic nerve glioma

C) Rhabdomyosarcoma

Which of the following is NOT typically associated with orbital tumors?

A) APD

B) Diplopia

C) Rapid onset proptosis

D) Progressive vision loss

C (progressive proptosis)

________________ is the most common primary pediatric orbital malignancy and leads to rapid bone destruction.

Rhabdomyosarcoma

_____________ is the most common secondary pediatric orbital malignancy and commonly arises from a tumor in the abdomen, mediastinum, or neck.

Neuroblastoma

Which of the following Malignant Orbital Tumors would you most likely see in an elderly patient?

A) Rhabdomyosarcoma

B) Neuroblastoma

C) Lymphoma

C) Lymphoma

What is the most common cause of proptosis in a patient older than 50 years old?

Lymphoma

Which Malignant Orbital Tumor is associated with salmon patches in the conjunctiva?

Lymphoma

Which of the following is a risk factor for Lymphoma?

A) Hypertension

B) Primary Sjogren's

C) Diabetes

D) Myasthenia Gravis

B) Primary Sjogren's

Which of the following is NOT considered a malignant orbital tumor?

A) Rhabdomyosarcoma

B) Cavernous hemangioma

C) Lymphoma

D) Neuroblastoma

B) Cavernous hemangioma

Which of the following is NOT true regarding Orbital Pseudotumor?

A) Primarily affects young to middle age children

B) It affects the EOMs but not the muscle tendons

C) It is an idiopathic inflammatory condition

D) It can be diagnosed with a CT/MRI

B (affects both EOMs and tendons)

Which of the following is NOT a finding associated with Orbital Pseudotumor?

A) Lacrimal gland enlargement

B) Unilateral increase of IOP

C) Unilateral conjunctival chemosis

D) Myopic shift

D (hyperopic shift)

What are two main differentials for unilateral chemosis? (Choose 2)

A) Thyroid Eye disease

B) Orbital Pseudotumor

C) Capillary hemangioma

D) Allergies

B and D

Is Orbital Pseudotumor usually a bilateral or unilateral inflammatory process?

unilateral

Which of the following is NOT a main differential for a patient that presents with Bilateral Orbital Pseudotumor?

A) Wegener's granulomatosis

B) Rheumatoid arthritis

C) Polyarteritis nodosa

D) Lymphoma

B) Rheumatoid arthritis

Tolosa-Hunt syndrome primarily targets which region?

A) Orbit

B) Cavernous sinus

C) Visual cortex

D) Carotid arteries

B) Cavernous sinus

Ocular Rosacea is condition that primarily targets which two types of glands? (Choose 2)

A) Meibomian glands

B) Glands of Zeiss

C) Glands of Moll

D) Lacrimal gland

A and B

Meibomian gland disease, telengiectasia, and rhinophyma are classic clinical findings associated with __________________.

Ocular Rosacea

Which of the following is NOT a common trigger associated with Ocular Rosacea?

A) Marijuana use

B) Alcohol use

C) Spicy foods

D) Caffeine

A) Marijuana use

Ocular Rosacea is a condition that targets sebaceous glands. What is a medication that also targets sebaceous glands?

A) Ceftriaxone

B) Penicillin

C) Accutane

D) Trimethoprim

C) Accutane

Contact dermatitis is what type of hypersensitivity reaction?

Type 4

Which of the following antibiotics would MOST likely cause contact dermatitis?

A) Gentamicin

B) Penicillin

C) Cephalexin

D) Doxycycline

A) Gentamicin

What is the main cell behind the pathophysiology of contact dermatitis?

A) Mast cell

B) B cell

C) T cell

D) NK cell

C) T cell

Which of the following is NOT true regarding Ocular Cicatricial Pemphagoid?

A) It most commonly affects 65 year old females

B) It is primarily caused by a type 3 hypersensitivity reaction

C) It involves scarring of the mucous membranes

D) Progression can lead to severe ocular surface disease

B (Type 2)

Ocular Cicatricial Pemphigoid is associated with which type of hypersensitivity reaction?

Type 2

Which of the following findings is LEAST associated with OCP?

A) Symblepharon

B) Blepharitis

C) Ankyloblepharon

D) Ocular surface disease

B) Blepharitis

Which of the following is NOT a drug that is known to induce OCP?

A) Epinephrine

B) Latanoprost

C) Timolol

D) Pilocarpine

B) Latanoprost

Which ocular condition does NOT include scarring of mucous membranes in most cases?

A) OCP

B) Orbital pseudotumor

C) Steven Johnson Syndrome

D) Trachoma

B) Orbital Pseudotumor

Steven-Johnson syndrome is primarily which type of hypersensitivity reaction? (Choose 2)

A) Type 1

B) Type 2

C) Type 3

D) Type 4

C and D

What is the most common category of drugs that are known to induce Steven-Johnson syndrome?

SULFA

Which diagnoses are associated with symblepharon? (Choose 2)

A) OCP

B) Contact dermatitis

C) Dacryocystitis

D) Steven-Johnson syndrome

A and D

What are the two main conditions that are known to have a prodrome? (Choose 2)

A) OCP

B) Steven-Johnson syndrome

C) Herpes zoster

D) Trachoma

B and C

Which of the following is NOT true regarding Dermatochalasis?

A) It most commonly affects elderly patients

B) It often presents with eyelid ptosis

C) It can often cause an inferior VF defect

D) Main treatment is blepharoplasty

C (superior VF defect)

What are the two main types of blepharitis?

Staphylococcal and Seborrheic

Which of the following is NOT true regarding Blepharitis?

A) The two main types are staphylococcal and seborrheic

B) Staph blepharitis can only cause anterior blepharitis

C) Seborrheic blepharitis is associated with a more oily, greasy looking appearance

D) Seborrheic blepharitis is more associated with madarosis compared to staph blepharitis

B (both of them can cause both anterior and posterior bleph)