29 The Eye
1 A 29-year-old woman seeks medical attention because she has had pain in the right eye for the past 2 days. On physical examination, there is no conjunctival erythema or vascular injection. Funduscopic examination shows no retinal lesions. A slit-lamp examination with fluorescein dye shows a dendritic ulcer on the right cornea. Which of the following most likely produced these findings?
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(E) 2 A 31-year-old man has increasing difficulty seeing at night, but has no problems with his vision during the day. Three years later, his daytime visual acuity also is decreasing. Funduscopic examination shows a branching reticulated pattern to the retina. The optic disc appears pale and waxy, and there is attenuation of retinal blood vessels. These findings are most characteristic of what condition?
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(E) 3 After an uncomplicated pregnancy, a 20-year-old woman gives birth at term to a boy. No abnormalities are noted on a newborn physical examination. During infancy, a well-infant checkup shows leukokoria in the right eye. The eye is enucleated. Molecular analysis of the enucleated tumor cells indicates loss of both normal alleles of the RB gene. In comparison, the infant’s skin fibroblasts do not show any abnormality at the RB locus. Which of the following regarding the intraocular tumor in this infant is most accurate?
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(E) 4 A 63-year-old woman was diagnosed with type 2 diabetes mellitus at age 18 years. She has had increasing difficulty with her vision for the past 10 years. Her most recent hemoglobin A1c level is 9%. Which of the following pathologic findings is funduscopy most likely to show?
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(E) 5 A 61-year-old woman experienced sudden loss of part of the vision in the left eye, which occurred “as though a shade had been pulled across” her field of view. On funduscopic examination, there is a uveal mass. The enucleated eye is shown in transverse section in the figure. What is the most likely diagnosis?
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(G) 6 A 50-year-old man was not using protective goggles while ripping plywood on his table saw and sustained a penetrating injury to the left eye. A wood splinter is removed. On funduscopic examination, there appears to be a partial uveal prolapse, but he has vision in the left eye. Three weeks later, he has loss of accommodation, photophobia, and blurred vision in the right eye. Choroidal infiltrates are now seen on funduscopic examination. What is the most likely diagnosis?
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(E) 7 A 3-year-old boy has been observed by his parents to be increasingly clumsy for the past 6 months. He is brought to the physician, who notes leukocoria with absence of the red reflex in the left eye. The eye is enucleated; the microscopic appearance of an intraocular mass is shown in the figure. What is the most likely diagnosis?
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(G) 8 A 62-year-old woman has had decreasing vision for the past year. She now has increasing headaches. She has worn glasses since childhood because of myopia. Funduscopic examination shows deepening of the optic cup with excavation. The retina appears normal. Screening of which of the following would have detected the disease that led to these findings?
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(E) 9 A pharmaceutical company is developing a product that would be useful to prevent age-related visual loss. A cohort of individuals 60 to 80 years old is followed for 5 years with periodic examinations of visual acuity, funduscopy, and fluorescein angiography. Some of these individuals develop progressive loss of vision characterized initially by diffuse deposits in Bruch membrane and by atrophy of retinal pigment epithelium. Later, a subset of these patients has a further decline in vision because of development of choroidal neovascularization. An antagonist to which of the following molecules is most likely to be useful in reducing vision loss in this subset of patients?
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(E) 10 The parents of a 6-year-old child notice that she has decreased vision. Examination of the eye shows diffuse punctate inflammation of the cornea and pannus extending as a growth of fibrovascular tissue from conjunctiva onto the cornea. Microscopic examination of a corneal scraping shows lymphocytes, plasma cells, neutrophils, and scattered corneal epithelial cells that have cytoplasmic inclusion bodies. What infectious agent is most likely to produce these findings?
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(E) 11 A 68-year-old woman has had decreased visual acuity for the past 5 years. She has no ocular pain. Her intraocular pressure is normal. Findings on funduscopic examination include arteriolar narrowing, flame-shaped hemorrhages, cotton-wool spots, and hard, waxy exudates. What is the most likely diagnosis?
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(E) 12 A 30-year-old man has had decreasing vision for the past 3 years and now has severely impaired vision in both eyes. His brother is similarly affected. Both parents have normal vision. Examination shows diffuse cloudiness of the anterior stroma with aggregates of gray-white opacities in the axial region of the corneal stroma. He undergoes corneal transplantation. The diseased corneas show basophilic deposits in the stroma that stain positively for keratan sulfate. What is the most likely diagnosis?
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(E) 13 A 68-year-old woman has had chronic renal failure for 10 years and has been on hemodialysis. She had a myocardial infarction last year. The figure shows findings characteristic for her retina. These retinal changes are most characteristic for what disease?
(A) 
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