What layer in the upper face sags with age and is tightened with face lift?
SMAS (superficial musculoaponeurotic system). In upper face, facial nerve is superficial to SMAS. In lower face, facial nerve is deep to SMAS. Do surgery accordingly (Stay deep to SMAS in upper face, and inverse in lower face).
What is the most common type of congenital cataract?
Avg endothelial cell count per mm2 in young adult?
Avg endothelial cell count per mm2 in senior citizen?
Name three things on differential for hemorrhages in multiple ocular layers
Method used in Europe for diagnosis of ocular toxoplasmosis. Ratio of anti-toxo IgG in aqueous to anti-toxo IgG in serum.
Name three systemic disease associated with recurrent subconjunctival hemorrhage
1. Diabetes 2. Hypertension 3. Poor clotting
Anterior lenticonus is associated with what systemic abnormality?
Alport's syndrome (refer to nephrologist)
What is 1 year risk of severe (1 of 4:2:1) NPDR progressing to PDR? What about very severe NPDR (2 of 4:2:1)?
Severe: 15% Very severe: 45%
Do upside-down single piece lenses affect the final refraction? What about 3-piece lenses?
Single piece lenses don't. Three-piece lenses do. The haptics are in front of the plane of the optic in a three-piece, to keep the optic away from the iris if it is placed in the sulcus. Thus, if placed upside down, optic will be in front of the desired plane, resulting in the need for an increased myopic correction.
Majority of aqueous is produced by what mechansism?
How is the foveola defined?
Where inner nuclear and ganglion cell layers are absent
How big is the FAZ?
250-600 microns (same as foveola)
What is the typical progenitor of Reiter's syndrome?
Dysentery (Shigella, Salmonella, Chlamydia, etc). >90% are HLA-B27 positive.
What finding should make you think skew deviation and not CN IV palsy?
Incyclotorsion of hypertropic eye (would be excyclotorsion in CN IV palsy, since SO is an intorter).
Nerves to EOMs insert how far from origin?
1/3 of way from origin to insertion
Cough, coryza, conjunctivitis -- think what?
Measles, which can cause retinopathy (heme, macular star, disc edema), and eventually look like RP after infection has waned.
Delayed onset nystagmus month-years after brainstem stroke -- think what?
Name some features of oculopalatal nystagmus
Vertical, pendular, bilateral Caused by stroke, usually delayed onset Associated with rhythmic movements of face, tongue, pharynx, larynx, or extremities Hypertrophy of inferior olivary nucleus on MRI is very specific
What three structure define Mollaret's triangle?
Cerebellar flocculus Inferior olivary nucleus Red nucleus
What is the name of the syndrome in which the peripheral cornea becomes progressively more edematous after cataract surgery, while the central cornea remains clear?
Most common benign orbital tumor in adults?
Most common malignant orbital tumor in adults?
Most common benign orbital tumor in children?
Most common malignant orbital tumor in children?
Most common intraocular tumor in all comers?
What was the first gene to be associated with congenital glaucoma?
What is the minimum required endothelial cell count for donor corneas?
Allergic conjunctivitis: what type of hypersensitivity?
Type 1 (preformed IgE antibodies)
Stevens-Johnson: what type of hypersensitivity?
Type 3 (immune complex)
OCP: what type of hypersensitivity?
Type 2 (cytotoxic)
Contact derm: what type of hypersensitivity?
Type 4 (delayed, T cell mediated)
What is the 5 year risk of contralateral involvement with acute NAION?
What is the risk, within weeks, of untreated monocular AAION?
What two associations are important to remember about morning glory disc?
What procedure is done for significant torsional deviation (e.g. bilateral CN IV palsy)?
Harada-Ito Split SO fibers
What is the direction of the NLD as it moves inferiorly?
All the bad connotation directions: down, back, and out
When should ROP screening be done?
4-6 weeks after birth, or 31-33 wga, whichever is later
What glaucoma drop should be avoided if the patient has a history of herpetic keratitis?
Prostaglandins Can cause reactivation
Multiple tricholemmomas -- small crust lesion on face -- marker for breast/thyroid cancer. Eponym?
Where is the most common site for eyelid BCC?
What site heralds the poorest prognosis for eyelid BCC?
Medial canthus May have deeper invasion
Name two diseases on the differential for acute idiopathic enlarged blind spot. What diagnostic test is indicated (besides fields)?
MEWDS AZOOR Get a mERG
Name three weaker steroids that are good to use to avoid steroid response
FML rimexolone (Vexol) medrysone
What is a good rule of thumb for how much skin to leave behind in chalasis surgery?
10 mm from incision to brow 10 mm from incision to margin 20 mm total
What is the most common type of rhabdomyosarcoma?
What is the most lethal type of rhabdomyosarcoma?
Alveolar -- 10 year survival 10% Wave au revoir
What type of rhabdomyosarcoma has the best prognosis?
True or false: surgery is the treatment of choice for rhabdomyosarcoma
FALSE Chemo and radiation
What anti-emetic is contraindicated in infants? Why?
promethazine (Phenergan) severe respiratory depression, death
Do kids with nystagmus prefer to gaze in the direction of the fast phase or slow phase?
Slow phase. Left-beating nystagmus kids will want to look to the right, so they'll have a left head turn. Alexander's law: nystagmus is worse looking toward fast phase. Basically, they will point their head toward the fast phase.
Name another inherited disease besides Axenfeld-Rieger with posterior embyrotoxon
Alagille syndrome Also presents with jaundice, cardiac defects Autosomal dominant JAG1 on chromosome 20
What is the best color laser to use to get through vit heme?
If you have to use a CAI in a patient with history of kidney stones, which do you pick?
What is the most common cause of viral dacryoadenitis?
What causes Bitot spots? foamy deposits at limbus
Vitamin A deficiency related to Corynebacterium, which forms gas that makes lesion foamy
Why does the IOP go up in HSV uveitis?
How can orbital apex syndrome be distinguished from cavernous sinus pathology?
By optic nerve involvement -- if vision is fine, it isn't orbital apex
How long do TVOs last?
What strabismus surgery puts acuity at greatest risk if there is a complication?
Inferior oblique advancement It involves reattachment more posteriorly, and if you perf the eye that's where the macula is.
Treatment of nystagmus: Prisms with apices away from head turn Surgery with rotation of eyes toward head turn
What effect does oral prednisone alone (no IV) have in initial optic neuritis on recurrence?
Oral prednisone as monotherapy DOUBLES the risk of recurrence. So it is never used as monotherapy.
What effect does convergence have on congenital nystagmus?
Convergence dampens congenital nystagmus
Is congenital nystagmus present during sleep
True or false: PRP in areas of traction is a good idea.
FALSE PRP can cause further contraction -- worsening the traction, causing vit heme or RD.
Flat, thin cornea, hyperopia, sheet-like posterior corneal opacity in first decade of life, AD inheritance. Diagnosis?
Posterior amorphous corneal dystrophy
Unilateral arcus senilis should make you do what?
Get a carotid Doppler to look for CONTRALATERAL carotid disease. -- the clear eye might have the pathologic blood supply.
What are the three causes of involutional entropion?
1. Horizontal lid laxity 2. Disinsertion of the lower lid retractors 3. Overriding preseptal orbicularis
Do reinsertion of retractors and lateral tarsal strip to address all of them.
What clinical feature best distinguishes atopic from vernal keratoconjunctivitis?
VKC typically involves only the superior conj AKC affects superior and inferior
Also VKC is seasonal
Third nerve fascicular lesion and contralateral weakness
Weber syndrome W for weakness, W for Weber
Third nerve fascicular lesion and contralateral ataxia/coordination problems
Claude syndrome C for coordination, C for Claude
Third nerve fascicular lesion and contralateral tremor
Benedikt's sysndrome Benedict Arnold trembled before he committed treason