Ocular Disease - Midterm II

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Ocular Disease - Midterm II - Quiz


Questions and Answers
  • 1. 

    A patient has walked in for an appointment, for their chief complaint they wrote that they have a "red eye". In the waiting room the patient can barely keep their eyes open because of the "bright" lights in the reception room. In the exam room you find the patient has 20/200 vision OD and the patient also reports pain. Their records show that 2 months ago they were 20/20 OD, OS. Which of the following diagnoses is the LEAST likely to be causing the patient's signs and symptoms.

    • A.

      Iritis

    • B.

      Keratoconjunctivitis

    • C.

      Conjuntivitis

    • D.

      Uveitis

    Correct Answer
    C. Conjuntivitis
    Explanation
    Group Notes 3-23 @ 10am

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  • 2. 

    According to Dr. S if a patient with "red eye" reports photophobia you should consider which two conditionsfor your differential diagnosis?

    • A.

      Episcleritis

    • B.

      Iritis

    • C.

      Keratitis

    • D.

      Foreign Body

    • E.

      Cytomegalovirus

    Correct Answer(s)
    B. Iritis
    C. Keratitis
    Explanation
    If a patient with "red eye" reports photophobia, two possible conditions to consider in the differential diagnosis are iritis and keratitis. Iritis is inflammation of the iris, which can cause redness and sensitivity to light. Keratitis is inflammation of the cornea, which can also result in redness and photophobia. These two conditions are often associated with "red eye" and photophobia, making them important considerations in the differential diagnosis.

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  • 3. 

    Infections acquired in utero or during the birth process are a significant cause of fetal and neonatal mortality and an important contributor to early and later childhood morbidity. The original concept of the TORCH perinatal infections was to group five infections with similar presentations, including rash and ocular findings. Which of the following is not one of these infections covered by the acronym. 

    • A.

      Toxoplasmosis

    • B.

      Chlymdiae

    • C.

      Herpes zoster

    • D.

      Rubella

    • E.

      Other - e.g syphilis

    Correct Answer(s)
    B. Chlymdiae
    C. Herpes zoster
    Explanation
    The correct answer is Chlymdiae and Herpes zoster. The question asks for the infection that is not covered by the acronym TORCH, which stands for Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes simplex virus. Chlymdiae and Herpes zoster are not included in the TORCH acronym, so they are the correct answer.

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  • 4. 

    Your patient is a 65 yoF, you just put them on a glaucoma medication. About 3 months later later they come back, you pull their lower lid down, and they got some follicles in there. You check their lymph nodes and they report "I can’t feel anything", what do you think the follicles are due to?

    • A.

      Vernal keratoconjunctivitis

    • B.

      Toxcity

    • C.

      Contact lens wear

    • D.

      An STD

    Correct Answer
    B. Toxcity
    Explanation
    Toxicity – most likely due to the preservative in the glaucoma medication.

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  • 5. 

    According to Dr. S when you see  follicles on the upper lid what condition should you begin to consider and how would you treat the condition?

    • A.

      Chronic conjunctivitis treat condition orally to prevent re-inoculation

    • B.

      Chronic conjunctivitis to be treated topically and with mast cell stabilizers

    • C.

      Allergic conjunctivitis to be treated with mast cell stabilizers

    • D.

      Vernal keratoconjunctivitis to be treated topically with steroids

    Correct Answer
    A. Chronic conjunctivitis treat condition orally to prevent re-inoculation
    Explanation
    Chronic conjunctivitises in which a patient gets a conjunctivitis and it goes away, and they get a conjunctivitis and it goes away, you flip the upper lid and you see follicles. That’s a sexually transmitted disease. Therefore do you think it needs to be treat orally to prevent re-inoculation

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  • 6. 

    Select the pairing that is incorrect concerning discharge.

    • A.

      Allergy - Scant, ropy mucus

    • B.

      Hyperacute bacterial conjunctivitis - copious overflowing discharge

    • C.

      Vernal conjunctivitis - mucopurulent

    • D.

      Epidemic keratoconjunctivitis - watery discharge accompanied by a foreign body sensation

    Correct Answer
    C. Vernal conjunctivitis - mucopurulent
    Explanation
    Option 3 is incorrect Vernal conjunctivitis - if they did have discharge would chronically be removing disabiling thick mucus strands; often visually blurring. - pg. 25-26

    Option 4 - pg. 39

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  • 7. 

    According to Dr. S when you when you see a membrane on your patient, your first thought should go EKC, and your second thought should be bacterial.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Group notes - Lecture 1

    When membranes form, they tell you classically that they form from EKC, which is an adenovirus. They can also form from serious bacterial infections. But when you see a membrane, your first thought should go EKC, and your second thought should be bacterial. Now if they have pain, you should be thinking virus, but if they have breakdown of their conj and basically what would be sub conj hemes, you would be thinking bacterial.

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  • 8. 

    Select the false statement concerning Herpes simplex conjunctivitis.

    • A.

      Follicles are typically associated with herpes simplex and not with herpes zoster

    • B.

      The patient will also exhibit a tender pre-auricular node, it may be dramatically swollen, involving the face and neck.

    • C.

      Vesicle formation can usually be found around the eyelids, because vesicle are classic when you have either herpes simplex or zoster. The vesicular eruptions around and on the lids are often pin-head sized, yello and fluid filled. They may be hidden b/t eyelashes. They may break and dry and forming a yello-brown crust on top.

    • D.

      If it has lead to a keratitis it should never be treated with steroids because it will increase the chances of HS infection

    • E.

      When treating the resulting keratitis, Viroptic drops must be used with caution as it is toxic to the corneal epithelium.

    Correct Answer
    A. Follicles are typically associated with herpes simplex and not with herpes zoster
    Explanation
    pg. 32-33

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  • 9. 

    • Select the false statement:

    • A.

      The three main causes of a "red eye" are a conjunctivitis, acute glaucoma and a uveitis

    • B.

      Acute glaucoma and uveitis are particularly troubling and should always be assessed for in a "red eye" exam because they are disease which can result in loss of vision.

    • C.

      Acute glaucoma is common in eastern Asian females usually over the age of 60

    • D.

      Age is very helpful in differentiating uveitis and conjunctivitis from one another. Since they affect different age groups and ethnicities.

    Correct Answer
    D. Age is very helpful in differentiating uveitis and conjunctivitis from one another. Since they affect different age groups and ethnicities.
    Explanation
    Uveitis - You can also go blind, because the patient can have scarring and can get secondary inflammatory glaucoma, cataract formation – don’t want to miss a uveitis!!!!!!

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  • 10. 

    • Select the true statement regarding Pupils 

    • A.

      Pupils are not important because in conjunctivitis there is always ipsilateral pupillary involvement.

    • B.

      In uveitis the pupils exhibit mydriasis and therefore are huge. The patient will not recoil when you shine a transilluminator into their eye.

    • C.

      Pupils size is unaffected by conjunctivitis unless iritis is also present from severe conjunctivitis and or keratitis

    • D.

      A patient who has acute glaucoma has a mid dilated fixed pupil and is therefore very reactive to light.

    Correct Answer
    C. Pupils size is unaffected by conjunctivitis unless iritis is also present from severe conjunctivitis and or keratitis
    Explanation
    pg. 5
    Group notes - Lecture 1

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  • 11. 

    The presence of subconj hemes as well as the state of the IOPs, pupils, age, race and sex are all equally important in the diagnosis of conjunctivitis. Pupils and EOMs should also always be done together to get to confirm the diagnosis.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Subconj hemes are common, but IOP, pupils and age race and sex are more important.
    When a red eye patient comes in, what must you do? Pupils. EOMs don't help diagnosis of a conjunctivitis according to Dr. S.

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  • 12. 

    • Select the false statement

    • A.

      If the patient has an infectious conjunctivitis according to Dr. S you should avoid Goldmann tonometry. If you are unable to do NCT you can do digital massage

    • B.

      According to Dr.S when doing digital massage of the eyeballs if it feels like a Titleist tour golf ball that could point to an acute glaucoma

    • C.

      The anterior chamber conjunctivitises don’t cause a reaction. You're going to get cells and flare mainly with uveitis, but you can get a few cells with acute glaucoma.

    • D.

      Papillae are sites of lymphocyte aggregation in viral infections, chlamydial infections, toxicity, possibly in chronic allergy.

    Correct Answer
    D. Papillae are sites of lymphocyte aggregation in viral infections, chlamydial infections, toxicity, possibly in chronic allergy.
    Explanation
    Option 4 - pg. 5; the description is for Follicles

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  • 13. 

    In conjunctivitis you do not get a lot of photophobia unless the conjunctivitis is a keratoconjunctivitis that has caused a lot of epithelial damage.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    In conjunctivitis, the inflammation of the conjunctiva, photophobia (sensitivity to light) is not commonly experienced unless the conjunctivitis has also caused significant damage to the cornea (keratoconjunctivitis). This suggests that the statement is true.

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  • 14. 

    Select the false statement

    • A.

      SPK distributed through out the cornea is associated with a viral infection.

    • B.

      Because viruses have a tendency to disperse all over the cornea a patient will often complain of a foreign body sensation.

    • C.

      In PCF, conjunctivitis may concurrently appear with the fever and sore throat.

    • D.

      If a patient administers a drop on their eye that they’re very allergic to it’s only going to be in the interpalperbral area. Therefore you must lift the upper lid during the examination.

    • E.

      Non-specific viral conjunctivitis is the most common form of acute infectious conjunctivitis in both kids and adults

    Correct Answer
    C. In PCF, conjunctivitis may concurrently appear with the fever and sore throat.
    Explanation
    Option 3 - Conjunctivitis may appear after the fever and sore throat, not concurrently. Pg. 44

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  • 15. 

    Select the statement that applies to Chlamydia

    • A.

      It is responsible for 10-15% of infertility in the United States and for cervical cancer about 4%

    • B.

      The patient comes in with a conjunctivitis and PUS is pouring out of their eye like a bucket.

    • C.

      It expresses a urogenital symptomology alongside the conjunctivitis.

    • D.

      Males are more susceptible to Chlamydia

    Correct Answer
    A. It is responsible for 10-15% of infertility in the United States and for cervical cancer about 4%
    Explanation
    Option 2 and 3 refer to N.Gon

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  • 16. 

    • Your 4yoM Asian patient presents with a conjunctivitis as well as a recent history of cough, sore throat and a upper respiratory infection. What organism is most likely responsible for the child's condition?

    • A.

      Haemophilus

    • B.

      Allergies

    • C.

      Herpes Simplex

    • D.

      Strep. Alpha Hemolytic strep and Beta hemolytic strep

    Correct Answer
    D. Strep. Alpha Hemolytic strep and Beta hemolytic strep
    Explanation
    The correct answer is Strep. Alpha Hemolytic strep and Beta hemolytic strep. The patient's symptoms of conjunctivitis, cough, sore throat, and upper respiratory infection are consistent with a bacterial infection. Strep. Alpha Hemolytic strep and Beta hemolytic strep are common bacterial pathogens that can cause these symptoms.

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  • 17. 

    Chronic staphloblepharoconjunctivitis is the number one reason why you’re going to see conjunctivitis. It’s not going to be acute it’s going to be the fact that the patient has a preexisting lid disease that got out of control, poured into the conj and now you’re dealing with the blepharoconjunctivitis

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    From group notes

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  • 18. 

    • Why is vitamin A important to the conj?

    • A.

      Lack of Vitamin A triggers factors which activate the herpes simplex

    • B.

      Mucin must have vitamin A and when you deplete vitamin A, mucin you will cause Bitot’s spots to occur.

    • C.

      Vitamin A provides aging corneas with a protective agent against Herpes zoster

    • D.

      Lack of vitamin A allows for delayed hypersensitivity to occur when patients use erythromycin ophthalmic drops.

    Correct Answer
    B. Mucin must have vitamin A and when you deplete vitamin A, mucin you will cause Bitot’s spots to occur.
    Explanation
    Vitamin A is important for the conjunctiva because it is necessary for the production of mucin. Mucin is a component of tears that helps to lubricate and protect the surface of the eye. When there is a lack of vitamin A, the production of mucin is reduced, leading to the development of Bitot's spots, which are white, foamy patches on the conjunctiva. Therefore, the statement "Mucin must have vitamin A and when you deplete vitamin A, mucin you will cause Bitot’s spots to occur" explains the importance of vitamin A for the conjunctiva.

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  • 19. 

    • Select the false statement regarding Ophthalmia neonatorum

    • A.

      Ophthamlia neonatorum is called conjunctivitis of birth, these conditions are passed on from the mother through the birth canal

    • B.

      Onset of symptoms will provide a huge clue as to the condition the baby is suffering from

    • C.

      After 2-3 weeks up to about ten weeks you would expect Chlamydia

    • D.

      Onset of symptoms in the first 24-36 hours points to a diagnosis of CHEMICAL conjunctivitis either induced by silver nitrate or erythromycin within the first 24-36 hours.

    • E.

      If onset of signs is within of 2 days to 5 days and the baby has a swollen upper lid, there is discharge coming out of the eye and it’s within 5 days after birth, your first differential diagnosis is gonorrhea.

    Correct Answer
    C. After 2-3 weeks up to about ten weeks you would expect Chlamydia
    Explanation
    Option 5 could be Chlamydia as well but according to Dr. S your FIRST DDx is always gonorrhea
    After 2-3 weeks up to about ten weeks that’s when the virus comes in and so that’s when Herpes Simplex takes it’s time gets self established into the sensory ganglia and that’s when Herpes Simplex come up

    Let’s say the kid is 5.1 days old…you go “crap 5.1 it doesn’t fall into my timeline”, you would know immediately, you would say to the physician you probably if you haven’t already, test the kid for gonorrhea and Chlamydia and let me know because we’ll treat the eye based on what’s going on and I’ll initiate a topical antibiotic to see what’s going until the lab test back. But you’ll know it’s gonorrhea or you’ll know it’s Chlamydia and that’s how you have to think.

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  • 20. 

    • Select the false statement regarding IOP.

    • A.

      Conjunctivitis does not affect IOP at all.

    • B.

      IOPs will always be decreased when there is conjunctivitis that has manifested into a keratitis

    • C.

      Uveitis initially makes the IOP go down because the swelling of the ciliary body causes no production of aqueous fluid, so you have a hypotony. After time as the cells build up, the pressure goes up. The pressure only goes up to the 20s, 25, 30.

    • D.

      The pressures of acute glaucoma usually fall in the Mid 50s, 60s.

    Correct Answer
    B. IOPs will always be decreased when there is conjunctivitis that has manifested into a keratitis
    Explanation
    I made up option 2 - in the manual it says IOPs are unaffected by conjunctivitis unless an IRITIS is present

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  • 21. 

    You recieve a consult request from the pediatric ward. A Five day old infant in the neonatal ward presents with "red eye." The lids aren’t as swollen, there is no discharge, however there are some papillae on the lower lid. What is causing the infant's condition?  

    • A.

      Gonorrhea

    • B.

      Chlamydia

    • C.

      Herpes simplex

    • D.

      Toxicity

    Correct Answer
    B. Chlamydia
    Explanation
    Infants dont have enough lymphoidal tissue yet to produce follicles they can only produce papillae so you just see papillae in the lower lid. Maybe see some papillae in the upper lid

    But you think Chlamydia because it’s between 5 days and 2-3 weeks.

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  • 22. 

    Swollen preauricular nodes are always associated with bacteria. Hyperacute conjunctivitis due to a viral etiology is the exception to the rule.  

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    This is the EXCEPTION TO THE RULE, a bacteria that has preauricular nodes, discharge that’s copious, big ballooned lids, happens very rapidly = hyperacute. Commonly due to Neisseria gonorrhoeae.

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  • 23. 

    When you adminster/prescribe a steroid what should you always do according to Dr. S?

    • A.

      Carefully evaluate the corneal epithelium for signs of perforation

    • B.

      Monitor IOP before treatment and during treatment

    • C.

      Make sure the patient does not have any pre-existing maculopathies

    • D.

      Make sure the pupil response is normal and EOMs are full and unrestricted.

    Correct Answer
    B. Monitor IOP before treatment and during treatment
    Explanation
    When administering or prescribing a steroid, it is important to monitor intraocular pressure (IOP) before and during treatment. Steroids can increase IOP, which can lead to glaucoma or exacerbate existing glaucoma. By regularly monitoring IOP, any potential increase can be detected early and appropriate measures can be taken to prevent complications.

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  • 24. 

    Why should you not allow your patients to rub their eyes?

    • A.

      “No!” because it causes mechanical breakdown of mast cells.

    • B.

      Yes, will help alleviate their symptoms and allow for the mast cells to degrade faster

    • C.

      No! because it will just make the situation/itching worse

    • D.

      Yes! because it will help the corneal absorb medication

    Correct Answer(s)
    A. “No!” because it causes mechanical breakdown of mast cells.
    C. No! because it will just make the situation/itching worse
    Explanation
    Rubbing the eyes can cause mechanical breakdown of mast cells, leading to the release of histamine and exacerbation of symptoms. It can also worsen the itching sensation. Therefore, patients should be advised not to rub their eyes to prevent further irritation and discomfort.

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  • 25. 

    Fluoroquinolones. are the best medications against gram negative infections. Your third and fourth generation (e.g ciprofloxacin, vigamox, or moxifloxacin" are good alternatives right here that you can use every 2-4 hours because basically you’re trying to protect the cornea.   

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Fluoroquinolones, such as ciprofloxacin, vigamox, or moxifloxacin, are considered the best medications against gram-negative infections. These medications can be used every 2-4 hours to protect the cornea. Therefore, the statement "Fluoroquinolones are the best medications against gram negative infections" is true.

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  • 26. 

    • Select the false statement regarding Herpes simplex

    • A.

      It is the number one blinding disease in the U.S. in the young adults

    • B.

      The most severe serotypes of Herpes simplex are caused by 8 and 19. They cause the classics signs of the condition.

    • C.

      Aggravating factors that can result in herpes simplex keratitis are overexposure to UV, trauma, extreme heat, cold, uses of oral steroids, sometimes topical steroids, infectious disease, surgery.

    • D.

      There is no way to get a Primary Herpes conjunctivitis without some history of vesicular eruption around the lids. Pinhead-sized, yellow fluid filled, maybe hidden between the lashes, later break into dry, yellow, crusty. This is where you get the conjunctivitis.

    Correct Answer
    B. The most severe serotypes of Herpes simplex are caused by 8 and 19. They cause the classics signs of the condition.
    Explanation
    Option 2 - refers to EKC

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  • 27. 

    Select the 3 big things you would use to treat herpes simplex according to Dr. S. 

    • A.

      Steroids

    • B.

      Artificial tears

    • C.

      Vasoconstrictors

    • D.

      Cool compresses

    • E.

      Antibiotic ointment prefer an aminoglycoside

    Correct Answer(s)
    B. Artificial tears
    C. Vasoconstrictors
    D. Cool compresses
    Explanation
    Cool compresses, artificial tears, vasoconstrictors, those are probably the big 3 there that you put on the conj to treat the conjunctivitis.

    Some doctors will prophylactically treat the patient if they feel the cornea is it risk. w/ oral antivirals. The topical treatment for Herpes simplex is Viroptic. Incredibly toxic to the eye. We have a new one out there called ganciclovir but it comes in a little gel called Zobrax gel.

    No steroids although there will be a time when Dr Nishimoto will say that steroids are good and he is correct according to Dr.S. We use different ointments but when we treat the keratitis, we only treat it when we actually see something like dendrites. When you have a high risk of it occurring, that’s when you bring in prophylactic treatment.

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  • 28. 

    Follicles tell you it’s either viral or it’s toxic. 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The statement suggests that the presence of follicles can indicate whether a condition is caused by a virus or toxicity. This implies that follicles may exhibit distinct characteristics or patterns in these two scenarios, allowing for differentiation between viral and toxic causes. Therefore, the answer "True" suggests that follicles can provide information about the nature of a condition.

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  • 29. 

    • You recieve a call in the middle of the night and from an OD resident. The patient is a 2 year old with inferior follicular conjunctivitis, positive preauricular nodes and vesicle eruption. They also report that they performed a Giemsa stain and they saw an internuclear cytoplasmic inclusion body next to a PMN and a basophil (which you think is bullshit since you could already diagnose the issue clinically). What would be your first differential diagnosis?

    • A.

      Environmental conjunctivitis

    • B.

      Herpes zoster

    • C.

      Herpes simplex

    • D.

      Epidemic keratoconjunctivitis

    Correct Answer
    C. Herpes simplex
    Explanation
    The given symptoms of a 2-year-old patient with inferior follicular conjunctivitis, positive preauricular nodes, vesicle eruption, and the presence of an internuclear cytoplasmic inclusion body suggest a viral infection. Among the options provided, Herpes simplex is the most likely differential diagnosis due to its characteristic vesicle eruption and the presence of inclusion bodies. Environmental conjunctivitis and epidemic keratoconjunctivitis may cause similar symptoms, but the presence of inclusion bodies points towards a viral etiology. Herpes zoster typically presents with a dermatomal distribution, which is not mentioned in the given information. Therefore, Herpes simplex is the most appropriate first differential diagnosis.

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  • 30. 

    Select the following reasons why Hutchinson’s sign important to you as a clinician.

    • A.

      If your patient shows this, there is a good chance your patient will show not only keratitis, but also uveitis.

    • B.

      Because the nasociliary division is at the end of the nose. This is telling you that this nerve ending is also supplying the cornea and the ciliary body, and it’s also a vector.

    • C.

      It is a sign that you will expect vesicle eruption around the eyes

    • D.

      These patients start off with this vesicle eruptions soon, particularly around the dermatome.

    • E.

      It is a cue to you that you may want to take a look at the anterior chamber to make sure the cornea is not involved.

    Correct Answer(s)
    A. If your patient shows this, there is a good chance your patient will show not only keratitis, but also uveitis.
    B. Because the nasociliary division is at the end of the nose. This is telling you that this nerve ending is also supplying the cornea and the ciliary body, and it’s also a vector.
    D. These patients start off with this vesicle eruptions soon, particularly around the dermatome.
    E. It is a cue to you that you may want to take a look at the anterior chamber to make sure the cornea is not involved.
    Explanation
    Option 3 refers to Herpes simplex not zoster.

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  • 31. 

    Select the false statement regarding Herpes zoster 

    • A.

      With herpes zoster you can expect a keratitis that looks like a pseudodendrite or a mucoid plaque

    • B.

      Herpes zoster is characterized by a prodrome, patients get headache malaise, fever, chills like they’re coming down with a cold. The pain is preceded by this vesicular eruption, then the neuralgia.

    • C.

      Once the prodrome has begun to manifest, it is expected that you begin oral acyclovir within 72 hours. Untreated patients 1-1.5% will commit suicide because the post-herpetic neuralgia is so bad. If you start the patient on oral acyclovir in 72 hours, the likelihood of them commiting suicide is dramatically reduced.

    • D.

      You’re going to get it in your office most likely but you might not get the classic subtypes because there are 50, possibly 52 serotypes.

    • E.

      Glaucoma is a significant factor in zoster because patients can develop glaucoma from zoster, you have to watch out for this in older patients.

    Correct Answer
    D. You’re going to get it in your office most likely but you might not get the classic subtypes because there are 50, possibly 52 serotypes.
    Explanation
    Option 4 is in reference to EKC

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  • 32. 

    Select the false statement regarding EKC 

    • A.

      All EKC fall under the category of Adenoviruses so they going to cause an inferior follicular reaction.

    • B.

      They cause an lymphadenopathy and possibly have corneal ramifications.

    • C.

      Although highly contagious once you have had EKC you will have life long immunity from all serotypes

    • D.

      It is the first 8 days that the patient is most dangerous because patients are asymptomatic, and they are also contagious.

    • E.

      Around day 8 the patient comes back, and they have got a florid SPK. So you stain them with NaFl, and you see SPK all over that cornea.

    • F.

      EKC happens in the adult population in the ages between 20-40.

    Correct Answer
    C. Although highly contagious once you have had EKC you will have life long immunity from all serotypes
    Explanation
    Rule of 8's
     First rule was that it is type 8, then in 8 days you start to get what is SPK, and then the second 8 days (16 days later), you develop SEIs. The key thing to remember is that when SEIs develop, it is usually when they are non-contagious. So sometime between the day they got it and day 16, they become contagious. And this is when you saw them, and this is when you have to be suspicious. Classical, or definitive type of 8 days. Less than 5% of the population has neutralizing antibodies, which means basically you don’t usually have any immunity, which means you can contract it again right after you get it

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  • 33. 

    In EKC, pseudomembranes are typically a classic sign. They do not occur in primary herpes simplex, and are infrequent in herpes zoster. They may also cause decrease vision.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Pseudomembranes are typically a classic sign in EKC (Epidemic Keratoconjunctivitis). This means that they are commonly seen in cases of EKC. On the other hand, pseudomembranes do not occur in primary herpes simplex and are infrequent in herpes zoster. Additionally, pseudomembranes can cause a decrease in vision. Therefore, the statement is true.

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  • 34. 

    Your patient comes in with an EKC that has resulted in peripheral SEIs and no change in visual acuity. According to Dr.S what should your next step be?

    • A.

      Treat the condition with a steroid pulse

    • B.

      Prescribe oral acyclovir within 72 hours

    • C.

      No treatment is required unless you are treating a pseudomembrane as well. The idea is you don’t want to use a topical steroid on a corneal SEI, or on a peripheral EKC because it is going to go away by itself.

    • D.

      Wash the eye out with Betadine (povidone - iodine) 5% sterile ophthalmic prep soln immediately

    Correct Answer
    C. No treatment is required unless you are treating a pseudomembrane as well. The idea is you don’t want to use a topical steroid on a corneal SEI, or on a peripheral EKC because it is going to go away by itself.
    Explanation
    The SEIs will respond immediately to the steroid which means they will start to dissipate, but if you take the steroid off too fast, the SEIs will come back. So you have to keep the patient on a low dose SEI treatment if the SEIs are central. IF they are central that is what you want to do. The SEIs can be as deep as the anterior stroma, but usually it is around day 16 that you start to see them.

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  • 35. 

    Patients with EKC complain of a lot of things including photophobia, excessive tearing and you will typically find SPK. However, there will be MINIMAL SYSTEMIC SYPMTOMS. Mild fever if any, SPK that will drop vision a little bit. SEI can drop it below 20/40, and severe kerititis can drop it to 20/200.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Patients with EKC (Epidemic Keratoconjunctivitis) commonly experience symptoms such as photophobia (sensitivity to light), excessive tearing, and the presence of SPK (Superficial Punctate Keratitis). However, it is noted that there are minimal systemic symptoms associated with EKC. This means that patients may not experience significant symptoms outside of the eye, such as a mild fever. Additionally, the presence of SPK can cause a slight decrease in vision, with SEI (Spherical Equivalent Index) potentially dropping it below 20/40. In severe cases of keratitis, vision can drop to 20/200. Therefore, the statement that there will be minimal systemic symptoms in patients with EKC is true.

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  • 36. 

    Which stain will help you differentiate b/t HSV and EKC?

    • A.

      NaFL

    • B.

      Rose Bengal

    Correct Answer
    B. Rose Bengal
    Explanation
    Consider any conjunctivitis to be EKC until proven otherwise, but you also have to consider HSV because where this becomes question is when you have a younger patient coming in and you think they have herpes simplex because they have SPK and sometimes the SPK can look like a dendrite. But when you stain with Rose Bengal it won’t stain on a EKC but will stain on an HSV. So Bengal is your helpful delinating factor. So you rule out dendrites, you write negative dendrites noted on the cornea.

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  • 37. 

    Select the true statements in the treatment of EKC.

    • A.

      You can’t send the patient home with Betadine (povidone - iodine) 5% sterile ophthalmic prep soln . Because it will damage the corneal epithelium over the course of 24-48 hour period and cause your patient pain.

    • B.

      Anti viral medications are key in the treatment of EKC, especially when you need to remove a pseudomembrane

    • C.

      Supportive therapy includes lubricants, sunglasses, vasoconstrictors, as well as aspirin or acetaminophen for adults

    • D.

      The gold standard of treatment of Adenoviruses is Zirgan or gangcyclovir. It works quickly and aggressively.

    • E.

      Steroid use is controversial in treatment. However, it does help reduce the membrane so if you have a pseudo or true membrane that helps but just arbitrarily giving the patient a steroid doesn’t benefit them. It reduces the inflammation but it doesn’t help the virus because you are reducing the immunological response on the eye.

    Correct Answer(s)
    A. You can’t send the patient home with Betadine (povidone - iodine) 5% sterile ophthalmic prep soln . Because it will damage the corneal epithelium over the course of 24-48 hour period and cause your patient pain.
    C. Supportive therapy includes lubricants, sunglasses, vasoconstrictors, as well as aspirin or acetaminophen for adults
    E. Steroid use is controversial in treatment. However, it does help reduce the membrane so if you have a pseudo or true membrane that helps but just arbitrarily giving the patient a steroid doesn’t benefit them. It reduces the inflammation but it doesn’t help the virus because you are reducing the immunological response on the eye.
    Explanation
    The given answer correctly identifies three true statements regarding the treatment of EKC. Firstly, it states that sending the patient home with Betadine 5% sterile ophthalmic prep soln is not recommended because it can damage the corneal epithelium and cause pain. Secondly, it mentions that supportive therapy for EKC includes the use of lubricants, sunglasses, vasoconstrictors, and pain relievers like aspirin or acetaminophen for adults. Lastly, it acknowledges that the use of steroids in EKC treatment is controversial. While steroids can help reduce the membrane in cases of pseudo or true membrane, giving steroids without a specific indication does not benefit the patient as it reduces the immunological response on the eye.

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  • 38. 

    You have diagnosed your patient with EKC. Because they waited to long to see you they now have vision reducing SEIs centrally. Select the following statements that apply to this situation.

    • A.

      You may want to use steroids at that particular time because that will bring the vision back

    • B.

      Topical NSAIDS should be prescribed while you wait for the EKC to disappear.

    • C.

      Use of steroids will not require tapering. So you put the patient on Pred-Forte QID for a week, and then TID for the next week, and make sure you monitor the cornea for any development.

    • D.

      Tell the patient to be extra careful as they are not especially contagious. The appearance of the SEIs confirms this.

    Correct Answer(s)
    A. You may want to use steroids at that particular time because that will bring the vision back
    C. Use of steroids will not require tapering. So you put the patient on Pred-Forte QID for a week, and then TID for the next week, and make sure you monitor the cornea for any development.
  • 39. 

    In 2011 the American Journal of Opthalmology studied  patients with central SEIs that do not go away and who had decreased VAs as a consequence. They found out is that if they use PTK (phototherapeutic kerotectemy) along with low dose mitomycin C you would have improvements in photophobia, best spectacle corrected VA, and contrast sensitivity. This is now a possibly laser therapeutic intervention for patients that are experiencing loss of vision from SEIs. 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Group notes 4-6 9am

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  • 40. 

    You have a 8yo boy who presents with a follicular conjunctivitis. The patient's reports that he has been practicing a lot for a very important swim meet and has been spending hours at the local pool. As you listen to the patient you realize he has a sore throat and also test positive preauricular nodes. When you question the mother further you find out that the boy had a low grade fever last night. What is your first differential diagnosis?

    • A.

      EKC

    • B.

      PCF

    • C.

      Cat scratch disease

    • D.

      Toxic conjunctivitis - probably from the swimming pool.

    Correct Answer
    B. PCF
    Explanation
    The patient's symptoms of follicular conjunctivitis, sore throat, positive preauricular nodes, and low-grade fever are consistent with a diagnosis of PCF (Pharyngoconjunctival fever). PCF is typically caused by adenovirus, which can be transmitted through close contact or contaminated water sources such as swimming pools. This explanation is supported by the patient's history of spending hours at the local pool and the probable exposure to adenovirus in the pool water. EKC (Epidemic Keratoconjunctivitis) is another possible diagnosis, but the absence of severe eye pain and vision loss makes it less likely. Cat scratch disease and toxic conjunctivitis are not consistent with the patient's symptoms and history.

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  • 41. 

    You have a 8yo boy who presents with a follicular conjunctivitis and some photophobia. The patient's reports that he has been practicing a lot for a very important swim meet and has been spending hours at the local pool. As you listen to the patient you realize he has a sore throat and also test positive preauricular nodes. When you question the mother further you find out that the boy had a low grade fever last night. According to Dr. S would you prescribe this little boy aspirin?

    • A.

      Yes

    • B.

      No

    Correct Answer
    B. No
    Explanation
    Avoid Reyes syndrome

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  • 42. 

    Select the false statement regarding PCF

    • A.

      In the severe form of PCF when a kid has a lot of SPK, cant open their eyes, and also has lid edema, you can use much of the same treatment we use for EKC. Only difference is, if SEIs occur centrally and the kid’s vision goes down. It is better to wait on the topical steroid because the visual requirements for this population is not the same.

    • B.

      It is characterized by cough, coryza and conjunctivitis.

    • C.

      No topical antibiotics are going to useful for this disorder

    • D.

      When the SEIs appear the kid is non contagious

    • E.

      You will get a slew of cells in the anterior chamber and you will not have to treat it with a steroid but with a cycloplegic agent instead. Because you are going to take the stress off the ciliary body, and it is going to take the iritis away if one is present

    Correct Answer
    B. It is characterized by cough, coryza and conjunctivitis.
    Explanation
    Option 2 - describes Rubeola conjunctivitis

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  • 43. 

    Koplik's spots are bluish white spots with a red halo, they are often described as having grainy sand appearance. They are typically seen on buccal mucous membrane opposite the pre-molars. What condition is classically associated with koplik's spots?

    • A.

      Cat scratch disease

    • B.

      Herpes simplex conjunctivitis

    • C.

      Rubeola (red measles) conjunctivitis

    • D.

      Rubella (German measles) conjunctivitis

    Correct Answer
    C. Rubeola (red measles) conjunctivitis
    Explanation
    pg. 46

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  • 44. 

    Select the false statement regarding Rubeola ( red measles) conjunctivitis 

    • A.

      Supportive care includes lubricants, vasoconstrictors, and cool compresses. You can give acetominophen for kids under 12. Aspirin should be avoided.

    • B.

      As with PCF and EKC anti-virals are ineffective against Rubeola. Viroptic does not work, acyclovir doesn’t work.

    • C.

      The gold standard of care is Sulfacetamide 10% QID

    • D.

      Broad Spectrum antibiotics may not be necessary unless there is corneal involvement. If you are going to use something use Polytrim, but only if there is a risk of corneal involvement

    Correct Answer
    C. The gold standard of care is Sulfacetamide 10% QID
    Explanation
    You put sulfacetamide 10% you hate that kid, OUCH. Within, 5-10 days you will have a toxic conjunctivitis that you will have to deal with.

    Gentamicin, noffloxacin, ofloxacin or Polytrim QID - Dr. S said he prefers Polytrim

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  • 45. 

    You have just recieved a lab report that states your patient has tested positive on a Thayer-Martin culture. What kind of infection does your patient most likely have?

    • A.

      Fungal

    • B.

      Herpes simplex or herpes zoster

    • C.

      Gonococcal

    • D.

      Tularemia

    • E.

      Syphilis

    Correct Answer
    C. Gonococcal
    Explanation
    Blood and chocolate because Neisseria loves blood and chocolate but boards are going to want you to know Thayer Martin culture recommended for gonococcal along with blood and chocolate. So remember Thayer Martin because if a boards question starts with a positive Thayer Martin culture they’re pointing toward gonoccal.

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  • 46. 

    Many patients that come in with gonorrhea in the eye have an associated chlamydial infection. You may need to not only treat the gonorrhea in the eye but you may need to treat for chlamydia as well. What treatment did Dr. S talk about that was used for the associated chlamydia.?

    • A.

      Ciprofloxacin 500 mg PO

    • B.

      Ofloxacin 400 mg PO

    • C.

      Azithromycin 1 gram PO

    • D.

      Streptomycin 2 grams IM

    • E.

      Ampicillin 3.5 grams PO

    • F.

      Injectable procaine G penicillin

    Correct Answer
    C. Azithromycin 1 gram PO
    Explanation
    Dr. S mentioned that Azithromycin 1 gram PO was used for the associated chlamydia infection in patients with gonorrhea in the eye. This suggests that azithromycin is an effective treatment for chlamydia.

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  • 47. 

    Atopic Keratoconjunctivitis

    • A.

      Is characterized by sub conj hemorrhages

    • B.

      Is a the primary differential diagnosis when the lids have an associated eczematoid change and you flip lid and see allergic response and the pt has a hx of diaper rash, rashes on elbows, rashes on knees, skin disorders.

    • C.

      75% of the time is caused by Staph aureus (gram positive)

    • D.

      Spreads generally through fomites

    Correct Answer
    B. Is a the primary differential diagnosis when the lids have an associated eczematoid change and you flip lid and see allergic response and the pt has a hx of diaper rash, rashes on elbows, rashes on knees, skin disorders.
    Explanation
    Option 1 - refers to S. pneumoniae causing acute bacterial conjunctivitis (pg. 13)
    Option 3 and 4 - refers to acute bacterial conjunctivitis

    If I see sub-conj hemes with red eye, most common is strep pneumonia, but it could also be Haemophilus. So I got possibility of strep or Haemophilus. If there are no sub-conj hemes, most likely staph, especially if it’s an adult who denies an upper respiratory problem

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  • 48. 

    You should never patch a conjunctivitis because it threatens the cornea.  

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Conjunctivitis, also known as pink eye, is an inflammation of the conjunctiva, the thin clear tissue that covers the white part of the eye and lines the inside of the eyelid. Patching the affected eye can create a warm and moist environment, which can promote the growth of bacteria and worsen the infection. Additionally, patching can lead to the accumulation of discharge, increasing the risk of spreading the infection to the other eye or to other people. Therefore, it is recommended not to patch a conjunctivitis as it can threaten the cornea, the clear front surface of the eye.

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  • 49. 

    The most favored drug across the nation is Tobramycin b/c tobramycin, although it is toxic to the cornea, is less toxic than  gentamicin and you can prescribe it for several more days without patients getting toxicity  

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Tobramycin is the most favored drug across the nation because it is less toxic to the cornea compared to gentamicin. This allows doctors to prescribe it for a longer duration without causing toxicity in patients. Therefore, the statement is true.

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  • 50. 

    Select the false statement 

    • A.

      Erythromycin which actually is one of the best drugs for kids. If you want to prescribe a safe medication for the cornea erythromycin is good and it kills gram positive. It comes in ointment form.

    • B.

      Neomycin has an allergy profile of something between 16 and 20%.

    • C.

      Steroids should be prescribed in all stages of acute bacterial conjunctivitis.

    • D.

      Polytrim is one of the better drugs against MRSA. So if we have MRSA infection in the eye, polytrim is actually a great medication because MRSA doesn’t seem to be resistant to polytrim yet.

    • E.

      Fluoroquinolones are just massive bacteria killers. It kills both gram positive and negative bacteria and therefore is used when you want something broad spectrum.

    Correct Answer
    C. Steroids should be prescribed in all stages of acute bacterial conjunctivitis.
    Explanation
    pg. 14
    Steroids mask evolution of infection - AVOID in mild to moderate cases.

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