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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
Q

Blepharitis CF

A

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
Q

Blepharitis ttt

A

Warm compresses
Gentle scrub
Lid masaage

27
Q

Function of macula in eye

A

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
Q

Cause of age related macular degeneration…..

A

🗞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
Q

Age related macular degeneration CF

A

🔑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
Q

Dry vs Wet macular degeneration

A

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
Q

Diff between Retinal detachment and macular degeneration

A

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
Q

CRAO SS , CF , Ttt

A

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
Q

CRVO SS , Fundoscopy , Ttt

A

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
Q

Retinal detachment CF , fundoscopy ttt

A

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
Q

Vitreous hemorrhage CF , fundoscopy , ttt

A

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
Q

Pathophys of vision loss in vitreous hemorrhage

A

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
Q

Fundoscopy of vitreal hemorrhage

A

Dark red glow
Loss of fundak details

38
Q

Bacterial Conjuctivitis cause and ttt

A

Etiology:

  Staph aureus 
  Strept pneumo 
  Pseudomonas

Ttt:

  Eythromycin ointmnet or 
  Polymyxin Trimethoprim drops 
  FQ drops (contact lens wearers)
39
Q

Viral conjuctivitis etiology and ttt

A

Cause :

  Adenovirus

Ttt:

   Supportive care (warm or cold compress , lubricating drops)
40
Q

Allergic conjuctivitis

A

Etiology :

     Airborne allergens 
(Pollen , dust , pet dander)

Ttt:

     Antihistamine plus decongestant or mast cell stabilizer drops (olopatadine, ketotifen)
41
Q

Viral conjuctivitis CF

A

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
Q

Ttt of viral conjuctivitis

A

Supportive ttt
Cool moist compresses
Artificial tears supportive
Selfresolves in 2w

Prevent by washing hands and sanitize surfaces.

43
Q

Herpes Zoster ophthalmicus CF

A

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
Q

Ttt of herpes zoster ophthalmicus

A

Systemic Antiviral
Oral mostly
IV for severe immunocomp pts

45
Q

Bacterial keratitis CF

A

H/O prolonged or overnight contact lens use.
Painful red eye
Photophobia
Corneal ulcer
Corneal opacification
Scleral injection
Mucopurulent discharge

46
Q

Bacterial keratitis Organism and ttt

A

Staph and pseudomonas

Ttt :

Topical FQ
Discontinue contact lens use

47
Q

Anterior Uveitis CF

A

Ocular pain
Photophobia
Dec visual acuity

PE : Ciliary flush
Pupillary constriction
Hypopyon

48
Q

Common associations of anterior uveitis

A

Infections: herpes , toxoplasmosis , syphilis

Sarcoidosis

Spondyloarthritis ( AS , reactive arthritis)

IBD

49
Q

Tests for Anterior Uveitis

A

Slit lamp examination

HLA B27 ,
pelvis/spine Xray
Chest Xray (Sarcoidosis)
HIV ,
syphilis serology

50
Q

Ttt of anterior uveitis

A

Dilating eye drops cyclopentolate
Topical glucocorticoids

51
Q

Acute conjuctivitis
Viral CF

A

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
Q

Bacterial conjuctivitis CF

A

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
Q

Allergic conjuctivitis CF

A

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
Q

Conjuctivitis def

A

Inflammation of conjuctiva , the mucous mem that lines the inside of eyelids (tarsal conjuctiva) and anterior sclera (bulbar conjuctiva)

55
Q

Atopic keratoconjuctivitis vs allergic conjuctivitis

A

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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