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Neurology > 27 Jan 24 > Flashcards

27 Jan 24 Flashcards

1
Q

Open angle glaucoma pathophys and cause

A

Atrophy of optic nerve head causing optic neuropathy

Cause :
Diabetes
Genetic
AA

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2
Q

OAG Cf

A

A/S until advanced Dx
Insiduous
Slowly progressive course
Loss of peripheral vision causing tunnel vision
Inc IOP

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3
Q

OAG screen and ttt

A

Tonometry

Ttt:
Topical agents (bimatoprost)
Laser trabeculoplasty

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4
Q

Mechanism of topical prostaglandins in OAG

A

Inc Uveoscleral outflow

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5
Q

Glaucoma ttt and mechanism

A

Aqueous humor inflow :

  BB.  (Dec synthesis from ciliary epi)
  a2 receptor agonists (dec synthesis via vasoconstriction)
  Carbonic anhydrase inhibitors (dec synthesis)

Trabecular outflow:

 Muscrinic agonists pilocarpine   (contraction if ciliary muscle and opening if trabecular meshwork). 🚨 emergency

Uveoscleral outflow :

 Prostaglandin agonists
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6
Q

Subconjuctival hemorrhage cause

A

Minor trauma (rubbing eye)

No cause

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7
Q

SH CF

A

A/S
Normal eye exam
Flat focal area of blood on ocular surface
Painless red eye
Benign

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8
Q

Ttt of SH

A

Reassurance

Recurrent cases warrant investigation

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9
Q

Acute Angle closure Glaucoma

A

Symptoms:

 Headache 
 Ocular pain
 Nausea
 Dec visual acuity

Signs :

Conjuctival redness
Corneal opacity
Fixed mid dilated pupil
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10
Q

DX of ACG

A

Tonometry : measures IOP
Gonioscopy -measures corneal angle

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11
Q

Ttt of ACG

A

Topical ;
Timolol , pilocarpine , apraclonidine

Systemic :
Acetazolamide (or mannitol)

Laser iridotomy

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12
Q

ACG episode

A

Severe eye pain and blurred vision ass with NV

Trigger can happen after pupillary dilation which may occur in dark movie theaters , during times of stress or due to drug intake.

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13
Q

CMV retinitis Etiology

A

Advanced AIDs CD4+ counts <100
Presents with blurred vision floaters and photopsia (sensation of flashing lights)

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14
Q

CMV retinitis Fundoscopy

A

Yellow white fluffy areas of necrosis With hemorrhagic lesions adj to fovea and retinal vessels.

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15
Q

CMV retinitis Ttt

A

Oral Valacyclovir

Intravitreal injections for lesions near fovea to reduce risk of blindness and retinal detachment due to scarring

Antiretroviral therapy
(After 2weeks of beginning CMV ttt )
To prevent recurrence and progression

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16
Q

Presbyopia / farsightedness etiology

A

Loss of elasticity in lens

Ttt: reading glasses

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17
Q

HSV keratitis CF

A

Acute onset eye pain
Photophobia
Tearing
Blurred vision
Ciliary flush ( classic)
Prior episodes affecting same eye

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18
Q

HSV keratitis recurrence RF

A

Outdoor occupation (sun exposure)

Immunodef (HIV)

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19
Q

HSV dx

A

Slit lamp exam with fluroresceine dye :

 Dendritic ulcers (linear branching)
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20
Q

Ttt of HSV keratitis

A

Antiviral topical or systemic
Oral valacyclovir mostly
Daily oral suppressive ttt for recurrence
Avoid topical steroids (risk of vision loss)

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21
Q

Fungal keratitis

A

Thorn in eye (immunocomp patient)

Cornea :multiple infiltrates with feathery edges

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22
Q

Age related macular degeneration Cf

A

Vision loss
Activities that req fine visual acuity are affected first e.g
Driving and reading and seeing a grid

Eye exam : drusen spots on macula
Grid test: Straight lines appear wavy

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23
Q

RF for macular degeneration

A

Increasing age
Smoking

24
Q

Chronic blepharitis contributors

A

Seborrheic dermatitis
Rosacea
Allergic dx
Baterial infections
Viral infection
Demodex mite infestation

25
Blepharitis CF
Inflammation of eyelid margin at the opening of meibomian glands. CF: Burning /itching of eyelids Discharge. Crusting of eyelids in the morning Foreign body sensation Redness swelling scaling at lid margin Involvement of adj conjuctiva Often BL Lipoid plugs at gland openings
26
Blepharitis ttt
Warm compresses Gentle scrub Lid masaage
27
Function of macula in eye
Macula is central portion of retina Responsible for central Vision In macula each cone synapses to a single bipolar cell that synapses to a single ganglion. (Vs peripheral retina where multiple cones converge onto a single ganglion cell) Bcz of this arrangement Visual Acuity (sharpness , contrast ) and metabolic activity are greater in macula than in any other area of retina.
28
Cause of age related macular degeneration…..
🗞oxidative damage that accumulates with Aging 🗞 smoking is major modifiable RF that contributes to oxidative damage 🗞damage affects Retinal pigment epithelium location for glial cells that support retinal neurons 🗞 RPE damage causes accumulation of waste products lipids and protein deposits (drusen) in macula -a metabolically active area
29
Age related macular degeneration CF
🔑Gradually worsening vision most central vision 🔑Initially blur vision and difficulty with contrast sensitivity(reading) and dark adaptation 🔑Over time central/paracentral dark spots and loss of central visual acuity develops in the affected eye 🔑Peripheral vision less likely to be affected
30
Dry vs Wet macular degeneration
Dry : Oxidative damage waste product accumulation drusen in RPE Wet : Retinal hypoxia ⬆️ VEGF neovascularization (fragile and leaky vessels) Hemmorrhage shows as dark spot in vision
31
Diff between Retinal detachment and macular degeneration
Macular Degeneration: loss of central vision , blurred vision , dark spots Retinal detachment : Acute Flashes floaters webs Vision loss starts in periphery progresses to centre. Open angle glaucoma ; Loss of peripheral field first
32
CRAO SS , CF , Ttt
SS: Vision loss with temporal sparing HO amaurosis fugax Fundoscopy: Pale fundus with cherry red spot Ttt: Intrarterial thrombolytics Ocular massage Reduce IOP (anterior chamber paracentesis)
33
CRVO SS , Fundoscopy , Ttt
SS: Blurred vision to severe vision loss Fundoscopy : Diffuse Retinal hemorrhages Swelling of optic disc Dilated tortuous veins Cotton wool spots Ttt: Observe plus intravitreal inj of VEGF inhibitors.
34
Retinal detachment CF , fundoscopy ttt
CF : Floaters photopsia (flashing lights) Progressive visual field defect Fundoscopy: Fundus with vitreous hemorrhage and marked elevation of retina Ttt: Surgical correction (Retinopexy , vitrectomy)
35
Vitreous hemorrhage CF , fundoscopy , ttt
CF : Hazy vision , red hue , vision loss Floaters /shadows. Fundoscopy : Dec or absent red reflex RBCs /floating debris in vitreous , obscured view of fundus. Ttt: Bed rest , HOB elevation 30-45 degree Photocoagulation or vitrectomy in some cases
36
Pathophys of vision loss in vitreous hemorrhage
Abnormal fragile blood vessels in proliferative diabetic nephropathy (neovascularization) on surface of retina can spontaneously break and bleed into vitreous. This blood prevents light from reaching the retina causing pts to exp sudden onset hazy vision (red hue) or vision loss. Floaters and shadows due to floating blood that clots.
37
Fundoscopy of vitreal hemorrhage
Dark red glow Loss of fundak details
38
Bacterial Conjuctivitis cause and ttt
Etiology: Staph aureus Strept pneumo Pseudomonas Ttt: Eythromycin ointmnet or Polymyxin Trimethoprim drops FQ drops (contact lens wearers)
39
Viral conjuctivitis etiology and ttt
Cause : Adenovirus Ttt: Supportive care (warm or cold compress , lubricating drops)
40
Allergic conjuctivitis
Etiology : Airborne allergens (Pollen , dust , pet dander) Ttt: Antihistamine plus decongestant or mast cell stabilizer drops (olopatadine, ketotifen)
41
Viral conjuctivitis CF
Highly contagious outbreaks are common with close contacts Diffuse conjuctival injection UL or BL Discharge watery or mucoid Tarsal conjuctiva has follicular appearance Gritty or burning sensation Prodrome of fever rhinorrhea sorethroat
42
Ttt of viral conjuctivitis
Supportive ttt Cool moist compresses Artificial tears supportive Selfresolves in 2w Prevent by washing hands and sanitize surfaces.
43
Herpes Zoster ophthalmicus CF
Reactivation of patent VZV in trigeminal ganglion ↔️Elderly or immunocomp ↔️Rash along V1 ↔️Burning stabbing pain along V1 ↔️Ocular involvement: Keratitis , corneal ulceration, vision loss
44
Ttt of herpes zoster ophthalmicus
Systemic Antiviral Oral mostly IV for severe immunocomp pts
45
Bacterial keratitis CF
H/O prolonged or overnight contact lens use. Painful red eye Photophobia Corneal ulcer Corneal opacification Scleral injection Mucopurulent discharge
46
Bacterial keratitis Organism and ttt
Staph and pseudomonas Ttt : Topical FQ Discontinue contact lens use
47
Anterior Uveitis CF
Ocular pain Photophobia Dec visual acuity PE : Ciliary flush Pupillary constriction Hypopyon
48
Common associations of anterior uveitis
Infections: herpes , toxoplasmosis , syphilis Sarcoidosis Spondyloarthritis ( AS , reactive arthritis) IBD
49
Tests for Anterior Uveitis
Slit lamp examination HLA B27 , pelvis/spine Xray Chest Xray (Sarcoidosis) HIV , syphilis serology
50
Ttt of anterior uveitis
Dilating eye drops cyclopentolate Topical glucocorticoids
51
Acute conjuctivitis Viral CF
UL/BL Watery /mucoid discharge Diffuse injection ; follicular(bumpy) Ass with viral prodrome Upper resp symptoms accompany If UL involves CL side in 1-2 days. Duration: 1-2w Red flags for alternate cause : Dec visual acuity Photophobia Pain with EOM Fixed / distorted pupil
52
Bacterial conjuctivitis CF
UL/BL Purulent discharge Conjuctiva : diffuse inj ; non follicular Ass features : Unremitting discharge ( Reaccumulates in mins ) Duration : 1-2w Red flags for alternate cause : Dec visual acuity Photophobia Pain with EOM Fixed / distorted pupil
53
Allergic conjuctivitis CF
BL Watery discharge Conjuctiva : Diffuse injection Follicular bumpy Ass : Ocular pruritis H/O atopy Duration : <30mins (often sudden) to perennial Red flags for alternate cause : Dec visual acuity Photophobia Pain with EOM Fixed / distorted pupil
54
Conjuctivitis def
Inflammation of conjuctiva , the mucous mem that lines the inside of eyelids (tarsal conjuctiva) and anterior sclera (bulbar conjuctiva)
55
Atopic keratoconjuctivitis vs allergic conjuctivitis
AKC has chronic SS with photophobia and foreign body sensation Chronic eyelid inflammation is typical (Thick lichenified skin)

Neurology (19 decks)

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