Ophthalmology Board Review: Pearls of Wisdom, Second Edition: Medicine & Health Science Books @ cehalfperbfamsce.gq Download as PDF, TXT or read online from Scribd . VA Scott E.D. FLs Sumit K. M.D. M. M.D. M. Retina Service The University of Texas Department of Ophthalmology Board Review: Pearls of Wisdom will help you pass ophthalmology .. Second-order neuron— leaves the spinal cord. travels through the brainstem and. ophthalmology board review: pearls of wisdom, second edition board review: pearls of wisdom fri, 25 jan gmt pance prep pearls pdf -.
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PEE are depressions. They are both formed from fibrinous exudate. Preauricular and Submandibular. Madarosis is patchy or diffuse loss of lashes. Demodex folliculorum and Demodex brevis. Thinning of the sclera allows the color of the uvea to come through.
The glands of Wolfring are located in the tarsus. A focal conjunctival granuloma caused by insect and arachnid hairs. Wessely ring. While xanthelasma occurs in patients with hypercholesterolemia.
Goblet cells. They are horizontal lines in the corneal epithelium and are associated with old age. Nonsuppurative — monocytes. Phlyctenular keratoconjunctivitis has been associated with tuberculosis.
Hot compresses. Describe a few. They pass through the long ciliary nerves. Tear Breakup Time normal greater than 10 seconds. Staphylococcal blepharitis. Inspection of the tear meniscus normal is 1.
Staph aureus infection. Fornix reconstruction. What two classic signs of this disease may be clinically apparent in the conjunctiva?
Mucous debris in tear film. Decreased tear lake. Primary or recurrent pterygium. Cicatricial strabismus. Cholesterol and neutral fats in the corneal stroma. Conjunctival and corneal staining with rose bengal. Repair after conjunctival excisional surgery neoplasms. Herpes zoster iritis is a lymphocytic vasculitis. Systemic diseases such as leukemia. Decreased tear breakup time.
Meibomian glands. List some of these. Oral doxycycline. What are likely findings on slip lamp exam and retinoscopy?
What other tests might be helpful in making the diagnosis? The most likely diagnosis is keratoconus. It is a congenital nevus of the conjunctiva and uvea with ipsilateral blue nevus of the periocular skin.
The drop in best-corrected acuity is due to irregular astigmatism. Qualitative exam with a placido disc or computerized corneal topography will help confirm the diagnosis. Slit lamp exam may reveal central corneal thinning. A scissors reflect or teardrop reflex might be seen. Oral erythromycin. Increasing lipid solubility increases drug absorption of topical medications by allowing the drug to penetrate the intact.
The accessory lacrimal glands of Krause and Wolfring. Retinoscopy can help confirm the presence of irregular astigmatism.
Retinal exam is normal. Trabecular hyperpigmentation is present. Ipsilateral iris hyperchromia is common. Melanocytes in the episclera produce a blue color to the overlying conjunctiva. Main lacrimal gland. Recurrence in corneal grafts is very common. Treatment with topical Amphotericin B and oral itraconazole have been reported to be successful.
What is the most likely diagnosis? What is the easiest test to perform to confirm this diagnosis? Microsporidial keratoconjunctivitis caused by an obligate intracellular protozoal parasite. The cornea. They can develop a chlamydial pneumonitis. Giemsa stain to identify intracytoplasmic inclusion bodies. Fusarium and Aspergillus are the most common causes of fungal keratitis in the southern U. Autosomal dominant.
Minimal conjunctivitis is present. Gram stain of conjunctival scrapings will often reveal the gram positive spore form. The cornea is otherwise clear and the rest of the ocular exam is normal. There is a very mild papillary conjunctivitis.
Normal intraocular pressure and normal corneal diameter help distinguish this entity from congenital glaucoma. IgA and secretory IgA. Serotypes A to C. Deafness is sometimes an associated finding. Ceftriaxone 1 gm IM for 5 consecutive days. Congenital hereditary endothelial dystrophy. It is a peripheral ulcerative keratitis caused by ischemic necrosis from vasculitis of limbal vessels. Serotypes D to K. It can produce a brownish.
Two forms are recognized. It stains for mucopolysaccharides and is used to stain specimens with macular dystrophy. Dry eye is a well-known but poorly understood complication of HIV infection. Scleromalacia perforans. Topical phenylephrine will blanch the inflamed episcleral vessels. Complications of systemic vasculitis. They are vertical stress lines in the corneal stroma which disappear with external pressure and are an early sign of keratoconus.
It consists of subconjunctival scarring along the upper tarsal plate and is seen in trachoma. Dellen anterior to horizontal rectus insertions in the elderly. Type IV hypersensitivity to microbial proteins. Lyme disease. It is a foamy white lesion found at the limbus found in association with vitamin A deficiency. Early diagnosis and treatment with systemic steroids may prevent permanent deafness. It is a bilateral interstitial keratitis associated with bilateral deafness.
They are regressed limbal follicles leaving behind depressed scars and are found in trachoma. Polyarteritis nodosa. Staphylococcal and tuberculin. Multiple endocrine adenomatosis MEA.
Note that this is often bilateral but can be present unilaterally. The opposite eye appears normal on slit lamp exam. Medullary thyroid carcinoma. Cultures performed prior to starting her topical antibiotics were negative for bacteria and fungus. What is the diagnosis?
In addition. Dense white ring infiltrates. Lid skin may be thickened and lashes can be absent. Posterior polymorphous dystrophy. Congenital ichthyosis. Slit lamp exam reveals arc shaped superior corneal thinning with blood vessels extending from the limbus across the area of thinning.
The epithelium over the are of thinning is intact. Lipid deposition is present at the central edge of the thinned cornea.
It is an iron deposit in the cornea near a filtering bleb. She was treated previously with two weeks of intense fortified antibiotics. Anesthetic abuse. Suspect the diagnosis in non-healing corneal ulcers or abrasions which are culture negative. Joint hypermobility. Daphragmatic hernia. Its main systemic features are: Relapsing polychondritis. An intraocular tap may be hazardous in patients with this condition. Collagen vascular disorders: Fortified cephalosporins.
Hyperelastic skin that bruises easily and heals slowly. Blue sclera. Anterior segment: Diverticuli of the respiratory and GI tracts.
Unless there has been ocular perforation. Rheumatoid arthritis. Cardiovascular disease. Posterior segment: It is a dominantly inherited collagen disorder caused by a deficiency in hydroxylysine.
It presents as midperipheral.
Enterovirus 70 and coxsackie A Spoke-like lens opacities. It is a disorder caused by a deficiency in the enzyme alpha-galactosidase. Patients develop angiokeratomas. It is the late sequela of a keratitis and may not appear until years after the active disease. What systemic disease may this patient possibly have? Herpes zoster. Furrow degeneration. Systemic lupus erythematosus. What is the most likely cause of this ocular condition? It is an iron deposit on the cornea in front of a pterygium.
This is a Giemsa stain of corneal scrapings of HSV epithelial infection. Vernal and atopic keratoconjunctivitis. They are proteinaceous material resulting from the combined effects of genetic predisposition. Giemsa stain. Ehlers-Danlos syndrome. Mitral valve prolapse.
Atopic dermatitis. Periodic acid-Schiff. Type IV hypersensitivity. Retinitis pigmentosa. Osteogenesis imperfecta. Spheroidal degeneration is characterized by golden brown spherules in the superficial corneal stroma.
Ectopia lentis. It is used primarily for isolation of aerobic bacteria and will allow the growth of saprophytic fungi at room temperature. Gomori Metamine silver stain. Hypercalcemia and hyperphosphatemia. Idiopathic in elderly. Juvenile rheumatoid arthritis. Excision using a no-touch technique with care to include mm of normal adjacent conjunctiva and double freeze-thaw applications to the surrounding conjunctiva.
Metabolic abnormalities mucopolysaccharidoses. Chronic iridocyclitis in adults. Phthirus pubis crab louse. Dystrophies endothelial and stromal. Corneal edema birth trauma. Chronic mercurial exposure. Mycobacteria and Nocardia. Phthisis bulbi. Infectious keratitis rubella. Hereditary band keratopathy. Silicone oil in anterior chamber. Apply 0. The eye is then patched or a bandage contact lens is applied to allow the epithelium to heal.
Hypoplastic dilator pupillae. They are intracytoplasmic inclusion bodies in the hyperplastic epithelium in umbilicated. What is the most likely organism in this case? Staphylococcus aureus. Blue sclerae. It produces a sclerosing keratitis. Fluorescence with thioflavin T. Wide no-touch surgical excision with supplementary cryoablation. The bodies are small and eosinophilic deep inside the lesion but basophilic and larger near the surface. Angle anomalies.
Dichroism with Congo Red stain. What will the gram stain of the corneal scraping likely show? Large gram negative diplobacilli of Moraxella lacunata. Black fly. Metachromasia with crystal violet stain. Bilateral upward lens subluxation. What is your diagnosis?
Superior limbic keratoconjunctivitis. Vernal keratoconjunctivitis. Nonnutrient agar with heat-killed E. Thermal cautery. Conjunctival resection may be necessary. In mild cases artificial tears and ointment may be sufficient. Onchocerca volvulus.
In more severe cases. Tuberculin antigen was most commonly linked to phlyctenulosis in the past. Copious irrigation with normal saline should be instituted. Atopic keratoconjunctivitis. Ceftriaxone 1gm IM once or IV. They tend to be bilateral and more extensive.
Riley-Day familial dysautonomia or Shy-Drager idiopathic autonomic dysfunction. It is a cytologic stain that highlights eosinophils and their granules. In children?
Pneumococcus and Haemophilus influenza respectively. Chronic infection with Staphylococcus aureus is the most common cause of phlyctenulosis. Since concurrent chlamydial infection has been reported in a third of patients. It most often occurs in the setting of a compromised host. Fortified cephalosporin or vancomycin.
Patients will complain of hazy vision or blur after removing their contact lenses that usually dissipates after about an hour. They are nonspecific intra-giant cell deposits commonly seen in sarcoid. Ingestion of raw or half-cooked pork. This is usually associated with a tight lens fit. Sleeving of eyelash bases. This is central epithelial edema resulting from hypoxic stress. Streptococcus viridans usually causes infectious crystalline keratopathy.
It is iron deposition at the basal epithelium and is diagnostic of keratoconus. Systemic corticosteroids. Calcofluor white stain. OCP produces. In pellucid marginal degeneration. Cycloplegics are used to manage the mild iritis that may be present.
Pemphigus vulgaris forms intraepithelial bullae. Ligneous conjunctivitis is an idiopathic chronic conjunctivitis that usually affects children. What might this represent? Adrenochrome deposit from the use of epinephrine compounds for her glaucoma. They are melanin deposits oriented vertically on the endothelium and are found in pigment dispersion syndrome or pigmentary glaucoma.
They are rapidly developing lesions - onset is typically days to weeks. A biopsy is performed to rule out melanoma but comes back negative for melanin. A fibrinous exudate first develops usually in the upper palpebral conjunctiva.
Neuroparalytic epithelial breakdown and diffuse stromal edema and infiltration. They are composed of granulation tissue and proliferating vascular endothelial cells in reaction to an inciting event such as strabismus surgery.
In patients with HZO. Closed but unstable corneal wounds. Eyes being prepared for a prosthetic shell. Herpes simplex. This complication can be managed by cycloplegia and lens removal. Chronic sterile ulcerations. Aqueous humor. Two days later. How would you manage this case?
An infection is probably unlikely if the hypopyon follows the application of a bandage lens by only 2 or 3 days and if a stromal infiltrate is absent or of long duration. Neovascularization is a sign of healing and should be allowed to take place. Bullous keratopathy. This may respond to soft contact lens wear or to cyanoacrylate gluing in advanced cases. Sterile uveitis and hypopyon has been associated with lens fit too steeply and may be related to anterior segment ischemia.
There is no corneal infiltrate seen. These eyes are poor surgical risks for keratoplasty. Myelination ends within 2 mm of the limbus. Acoustic neuroma.
Early systemic steroid administration will prevent deafness. Corneal dystrophies lattice. Serologic tests for syphilis are negative. Cerebello-pontine angle tumors. Leber cells are macrophages that have phagocytosed debris and are found in the conjunctival stroma in patients with trachoma. Keratitis herpes simplex. Cavernous sinus and superior orbital lesions. Irregular astigmatism. It is a conical reflection on the nasal cornea when a light is shown from the temporal side in an eye with keratoconus.
Scissoring reflex. What is the probable diagnosis and how could deafness be prevented? Dibromopropamidine 0.
Users of daily wear soft contact lenses who sometime wore them overnight had 9 times the risk of the users of such lenses who did not. Users of extended wear contact lenses who wore them overnight had a 10 to 15 times greater risk of microbial keratitis as users of daily wear lenses who did not. Propamidine isethionate 0. Mucus and desquamated epithelial cells. Riley-Day syndrome. Neomycin-polymyxin B-gramicidin. Lattice dystrophy type 1 is not associated with any systemic disease.
Iatrogenic cataract and corneal surgery. Trifluridine and idoxuridine. Arcus senilis. Corneal verticillata. Abnormalities of tear pooling. Gonococcal conjunctivitis. Carotid artery work-up is indicated. Cysteamine drops. ICE syndrome iridocorneal endothelial syndrome. Richner-Hanhart syndrome tyrosinemia type II. Erythromycin 0. A follicular response is rarely seen in neonatal inclusion conjunctivitis. The keratitis and uveitis may be unusually severe and have a protracted course.
Use systemic antibiotics to treat the conjunctivitis and diphtheria antitoxin to prevent systemic effects of the exotoxin. The term corneal graft rejection is used to define an immunologically mediated process in which the graft. In the immediate postoperative period. It is a line of keratic precipitates on the endothelial surface of a corneal graft at the margin of the graft and the host occurring during corneal endothelial graft rejection.
Herpes zoster ophthalmicus is probably the most common infection in the anterior segment. Papillary reactions are both seen in allergic and toxic conjunctivitis.
Cat-scratch disease Bartonella henselae. What other serological test would you obtain? An HIV test is necessary in this case. Lymphogranuloma venereum serotypes L1. In AKC. In contrast. VC and GPC tend to have papillae in the superior tarsus. Sporotrichosis Sporotrichum schenckii. The ropy strands have mucous discharge and an elastic quality described as the Maxwell Lyon sign. Chemical injury may result in the complete loss of corneal epithelium and stem cells.
Steven-Johnson syndrome. Vernal conjunctivitis and atopic keratoconjunctivitis but not seasonal or hay-fever allergic conjunctivitis. In vernal conjunctivitis. Tularemia Francisella tularensis. Make sure the patient is not glucosephosphate dehydrogenase-deficient. A follicular response is not seen prior to weeks of life. The most common ocular manifestation is keratoconjunctivitis sicca KCS. Human papilloma virus HPV type 6 and The substantia propria shows basophilic degeneration.
The patient develops chronic papillary conjunctivitis as a result of repeated trauma. Treatment consists of taping the lid closed and wearing a shield. Scissoring of the red reflex. Neisseria gonorrhea or. It is proposed that eversion of the lid occurs during sleep which allows contact of the conjunctiva with the pillow or bedding. Often associated with obesity. Acute corneal hydrops. Dermolipomas arise near the insertion of lateral rectus muscle and may extend upward to the superior fornix.
Progression during adolescence and stabilization when patient is fully-grown. Treatment includes excision. Horizontal lid shortening procedures may also be performed.
Dermoids most commonly involve the inferotemporal limbal corneal and epibulbar region. Glasses and RGP contact lenses.
North Carolina presents with elevated translucent-white limbal lesions which have dilated vessels. Actinic exposure. Heavy cigarette smoking. Light hair and ocular pigmentation.
Soft contact lens wear. Exposure to petroleum products. Conjunctival melanomas share with cutaneous melanomas the ability to invade lymphatics and metastasize. HIV infection. Benign hereditary intraepithelial dyskeratosis.
On questioning his father and grandfather have similar lesions. The patient also has leukoplakic oral lesions. Sympathetic root arises from the plexus around the internal carotid artery and innervates blood vessels of the eye and dilator fibers of the iris.
Ciliary, superior cervical and trigeminal ganglions. The inferior oblique originates from the orbital plate of the maxilla. It is the shape formed by the insertions of the rectus muscles 5. Remember that a suture placed through or under the superior rectus insertion that inadvertently penetrates the sclera could create a hole in the retina. A single branch of the lacrimal artery supplies the lateral rectus, making it the only extraocular muscle supplied by only one vessel.
Inferior oblique and inferior rectus. Fibrillenstruktur fast or twitch movement, individual neuromuscular junctions, acetylcholine receptor -. Orbicularis oculi. It is the thinnest in the body and has no subcutaneous fat. On the anterior surface of the superior tarsus, 3 mm superior to the lid margin.
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