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Duke Elder exam > Basic science and investigations > Flashcards

Basic science and investigations Flashcards

1
Q

4 ocular structures derived from surface ectoderm

A 
conjunctival and corneal epithelium 
nasolacrimal duct
lens
lacrimal gland
eyelids
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2
Q

4 ocular structures derived from neuroectoderm

A

neurosensory retina
pigment epithelium of retina, iris and ciliary body
pupillary sphincter and dilator muscles
optic nerve

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3
Q

7 ocular structures derived from neural crest

A 
corneal endothelium 
trabecular meshwork
stroma of cornea, iris and ciliary body
ciliary muscle 
choroid
sclera
orbital cartilage and bone
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4
Q

4 ocular structures derived from mesoderm

A

extraocular muscles
blood vessels
Schlemm’s canal endothelium
sclera (temporal portion)

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5
Q

congenital cataracts is inherited

A

AD

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6
Q

Fuchs’ corneal dystrophy is inherited

A

AD

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7
Q

Best disease is inherited

A

AD

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8
Q

granular and lattice corneal dystrophies are inherited

A

AD

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9
Q

Marfan syndrome is inherited

A

AD

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10
Q

neurofibromatosis is inherited

A

AD

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11
Q

retinitis pigmentosa is inherited

A

AD

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12
Q

retinoblastoma is inherited

A

AD

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13
Q

stickler syndrome is inherited

A

AD

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14
Q

tuberous sclerosis is inherited

A

AD

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15
Q

vHL is inherited

A

AD

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16
Q

congenital glaucoma is inherited

A

AR

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17
Q

oculucutaneous albinism is inherited

A

AR

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18
Q

stargardt disease is inherited

A

AR

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19
Q

fabry disease is inherited

A

XLR

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20
Q

lowe syndrome is inherited q

A

XLR

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21
Q

ocular albinism is inherited

A

XLR

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22
Q

retinoschisis is inherited

A

XLR

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23
Q

alport syndorme is inherited

A

XLD

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24
Q

kearns-sayre syndrome is inherited

A

mitochondrial

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25
Q

leber hereditary optic neuropathy is inherited

A

mitochondrial

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26
Q

how does an XLD disease pass on to the female (same as XLR for male)

A

XLD female = can express condition from father alone even if mother is unaffected

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27
Q

most common cause of endogenous endophthalmitis presenting with white fluffy retinal lesions

A

candida - usually in immunocompromised patients

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28
Q

cause of fungal keratitis

A

aspergillus and fusarium (both filamentous fungi)

common in warm climates, usually following ocular trauma

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29
Q

cause of presumed ocular histoplasmosis syndrome (POHS)

A

histoplasma capsulatum (dimorphic - properties of both yeasts and filamentous fungi)

endemic in Mississippi and Ohio river valleys

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30
Q

cause of congenital/adult toxoplasmosis

A

toxoplasma gondii (protozoa)

cats, faecal-oral, vertical

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31
Q

cause of severe keratitis

A

acanthamoeba (protozoa)

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32
Q

cause of toxocariasis presenting with endophthalmitis in children

A

toxocara (helminth nematode - roundworm)

cats and dogs, faecal

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33
Q

most common helminth-related ocular condition

A

onchocerca volvulus - vector = simulium blackflies

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34
Q

what does onchocerca volvulus cause

A

onchocerciasis (‘river blindness’) endemic in Africa

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35
Q

what is MHC also called in humans

A

human leucocyte antigen (HLA) - found on short arm of chromosome 6

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36
Q

HLA subtype associated with birdshot choroidopathy

A

HLA-A29

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37
Q

HLA associated with sympathetic ophthalmia

A

HLA-A11

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38
Q

HLA associated with POHS

A

HLA-B7

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39
Q

HLA associated with vogt-koyanagi-harada syndrome (VKH)

A

HLA-B22

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40
Q

HLA associated with psoriatic arthritis, ankylosing spondylitis, reactive arthritis and enteropathic arthritis

A

HLA-B27

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41
Q

HLA associated with behçet disease

A

HLA-B51

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42
Q

HLA associated with posner-schlossman syndrome

A

HLA-BW5

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43
Q

HLA associated with pars planitis, POHS, multiple sclerosis

A

HLA-DR2

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44
Q

HLA associated with sympathetic ophthalmia, rheumatoid arthritis and VKH

A

HLA-DR2

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45
Q

HLA associated with juvenile idiopathic arthritis

A

HLA-DR5

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46
Q

HLA associated with multiple sclerosis

A

HLA-DR15

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47
Q

4 types of cytokines

A

TNF
interleukins
chemokines
interferons

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48
Q

normal IOP values

A

within +/-2 standard deviations of mean IOP values (10-21mmHg)

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49
Q

2 things causing IOP to increase

A 
age
circadian rhythm (highest in morning)
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50
Q

average diurnal fluctuation of IOP

A

2-6mmHg (>10mmHg in glaucoma patients)

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51
Q

3 IOP-raising agents

A

steroids
tropicamide (close-angle glaucoma)
ketamine

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52
Q

6 drugs that can lower IOP (usually used for treating glaucoma)

A

beta blockers
prostaglandin analogues (e.g. latanoprost)
alpha-2 agonists (e.g. apraclonidine)
topical or systemic carbonic anhyrase inhibitors (CAI) (e.g. dorzolamide, acetazolamide)
miotics (e.g. pilocarpine)
osmotic agents (e.g. mannitol)

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53
Q

3 lowering IOP drugs that work by decreasing aqueous production

A

beta blockers
alpha2 agonists
topical and systemic CAIs

54
Q

2 lowering IOP drugs that work by increasing uveoscleral outflow

A

prostaglandin analogues

alpha2 agonists

55
Q

how do miotics work

A

parasympathomimetics - increase aqueous drainage via trabecular meshwork by causing contraction of ciliary muscles

56
Q

how do osmotic agents work

A

lower IOP by decreasing vitreous volume

57
Q

2 uncommon drugs that can lower IOP

A

cannabinoids

alcohol

58
Q

5 drugs causing lens opacification and cataracts

A 
steroids
amiodarone
allopurinol
chlorpromazine
tobacco smoke
59
Q

4 drugs that can cause cystoid macular oedema

A

latanoprost
epinephrine
rosiglitazone
nicotinic acid

60
Q

2 drugs that can cause bulls-eye maculopathy

A

hydroxychloroquine

chloroquine

61
Q

drug that can cause crystalline maculopathy

A

tamoxifen

62
Q

5 drugs that can cause optic neuropathy

A 
ethambutol 
chloramphenicol 
amiodarone
vigabatrin (causes binasal visual field defects)
isoniazid
63
Q

what is vortex keratopathy (corneal verticillata)

A

deposition of asymptomatic grey opacities in a vortex pattern on the corneal epithelium

64
Q

2 causes of vortex keratopathy

A 
drugs (amiodarone, chloroquines, indomethacin and phenothiazines) 
fabry disease (XLR condition - deficiency of alpha-galactosidase A)
65
Q

5 features of fabry disease

A 
burning pain in extremities
angiokeratomas
renal failure
posterior subcapsular cataracts
vortex keratopathy
66
Q

what is keratometry

A

measures anterior corneal surface curvature

67
Q

what is corneal topography

A

measures and quantifies curvature of whole cornea and provides info on its shape - uses placido-disc systems which project concentric rings of light on anterior corneal surface

68
Q

4 indications of corneal topography

A

keratoconus
astigmatism
laser eye surgery
contact lens fitting

69
Q

what is ultrasonic pachymetry

A

measures central corneal thickness (CCT) using an ultrasonic probe

70
Q

normal central corneal thickness (CCT)

A

530-545 um

71
Q

how does OCT work

A

uses near-infrared waves through the pupil to the retina = cross section and 3D image of retina

72
Q

how does fluorescence angiography (FA) work

A

sodium fluorescence absorbs blue light (465-490nm) and emits a yellow-green light (530nm) - injected into peripheral vein to circulate to eye - passes through short posterior ciliary artery into choriocapillaris about 8-12 seconds post injection and then enters retinal circulation a second later

73
Q

4 side effects of FA

A

urine discoloration
nausea
vasovagal syncope
anaphylaxis (rare)

74
Q

what is FA contraindicated in

A

shellfish allergy

75
Q

difference between indocyanine green (ICG) angiography and FA

A

uses near-infrared light and has little leakage (low permeability) while passing through the choroid = can visualise choroid vasculature better

76
Q

2 contraindications of ICG angiography

A

pregnancy

seafood and iodine allergies

77
Q

how does fundus autofluorescence work

A

no dye - detects lipofuscin already present within retinal pigment epithelium (RPE)

78
Q

when is fundus autofluorescence used

A

Best disease

monitoring geographic atrophy

79
Q

what does an electroretinogram (ERG) do

A

tests electrical activity of retina in response to a light stimulation

80
Q

what does an electro-oculogram (EOG) do

A

reflects activity of photoreceptors and RPE - therefore retinal diseases proximal to the photoreceptors give normal EOG readings

81
Q

when are ERG and EOG useful

A

aiding diagnosis in Best disease and retinitis pigmentosa

82
Q

4 investigations for glaucoma

A

measure IOP
assess iridocorneal angle
measuring CCT
evaluating optic nerve head and visual fields

83
Q

what is tonometry

A

procedure to measure IOP - Goldmann applanation tonometry most widely used

84
Q

how does tonometry work

A

follows Imbert-Fick law to establish amount of force required to flatten a corneal area of 3.06mm diameted assuming a CCT of 520um

85
Q

4 factors leading to incorrect tonometry measurements

A

excessive fluorescein (overestimates IOP)
low or high CCT (underestimates or overestimates IOP respectively)
astigmatism
calibration errors

86
Q

what is gonioscopy used for

A

to determine whether the iridocorneal angle is open or closed - visualisation of all angle structures = wide-open angle, inability to visualise any structures = closed angle

87
Q

5 angle structures (anteriorly to posteriorly)

A

schwalbe line
nonpigmented trabecular meshwork
pigmented trabecular meshwork (not present at birth, increases following puberty)
scleral spur (marks attachments of ciliary body’s longitudinal fibres)
ciliary body

88
Q

what is perimetry used for

A

to detect visual field defects - commonly used in glaucoma and neuro-ophthalmic conditions

89
Q

3 types of perimetry

A

Humphrey visual field analysis

Goldmann visual field testing

90
Q

5 types of glaucomatous field defects

A

nasal step
paracentral depression (most commonly superonasally)
superior arcuate defect
ring scotoma (superior and inferior arcuate defects)
tunnel vision with temporal sparing

91
Q

how is MRI useful in ophthalmologgy

A

diagnosis of intracranial lesions affecting visual pathway

92
Q

4 indications for CT

A

orbital fractures
orbital cellulitis
thyroid eye disease
cerebral haemorrhages

93
Q

2 indications for CT angiography

A 
investigate for subarachnoid haemorrhage 
intracranial aneurysms (e.g. third nerve palsy)
94
Q

3 fundamental properties of light beams emitted by different types of lasers

A

coherency (all emitted photons are in same phase)
monochromacity (single wavelength)
collimation (narrow with minimal divergence)

95
Q

3 principal parts to construct lasers

A

source of energy (light/electrical)
medium (e.g. gas, liquid (dyes), solid)
optical resonator that uses mirrors to amplify light

96
Q

3 examples of gas mediums in lasers

A

argon
krypton
carbon dioxide

97
Q

example of solid medium in lasers

A

neodymium-doped yttrium aluminium garned (Nd:YAG) crystals

98
Q

how can UV lasers damage the eye

A

photochemical injuries to lens and cornea

99
Q

4 main groups of lasers according to their hazardous effects on body

A

1 = harmless, 4 = most harmful

most used in ophthalmology = 3B and 4

100
Q

where is melanin found in the eye

A

mainly RPE and choroid - absorbs most of visible spectrum and infrared wavelengths

101
Q

where is xanthophyll found in the eye

A

macula - absorbs blue light (450-495nm)

102
Q

type of light absorbed by haemoglobin

A

blue, green (495-570nm) and yellow (570-590nm)

103
Q

3 main types of laser-tissue interaction

A

photothermal
photochemical
photo-ionizing

104
Q

2 types of photothermal interaction

A

photovaporization - vaporization of water from tissues (e.g. CO2 lasers)

photocoagulation - absorption of laser emissions by tissues = rise in temp = protein denaturation

105
Q

when is photocoagulation often used

A

in panretinal photocoagulation (PRP) in diabetic retinopathy

106
Q

4 types of photocoagulative lasers

A

argon blue-green - absorbed by melanin, Hb and xanthophyll
krypton red (647nm) - absorbed by melanin
frequency-doubled Nd:YAG (532nm) - absorbed by melanin and Hb in RPE and trabecular meshwork
diode (810nm) - emits near-infrared radiation and is absorbed by melanin

107
Q

why type of photocoagulative laser is not used on the macula

A

argon blue-greed (because absorbed by xanthophyll)

108
Q

how does photochemical laser-tissue interaction work

A

breaking chemical bonds that hold tissue together using UV light = photoablation

109
Q

what is an excimer laser

A

laser that causes photoablation

110
Q

3 things an excimer laser is used for

A

photorefractive keratectomy (PRK)
laser-assisted in situ keratomileusis (LASIK)
laser epithelial keratomileusis (LASEK)

111
Q

how does PRK work

A

corneal epithelium removed then laser ablation used to reshape the cornea

112
Q

how does LASIK work

A

corneal flap created then stroma ablated to reshape cornea then flap is replaced

113
Q

how does LASEK work

A

corneal epithelium peeled using 20% ethanol laser ablation is performed and epithelium is replaced

114
Q

how does photo-ionizing laser work

A

causes destruction of tissues by altering stable state between photons and electrons

115
Q

example of photo-ionizing laser

A

Nd:YAG (1064nm)

116
Q

2 uses of Nd:YAG

A

posterior capsulotomy for treating posterior capsular opacification (PCO)
peripheral iridotomy used in managing angle-closure glaucoma

117
Q

3 definitions of severe sight impairment (blindness)

A

VA <3/60 Snellen
VA 3/60-6/60 with reduction in VF
VA >6/60 with significantly reduced VF

118
Q

3 definitions of sight impairment

A

VA 3/60-6/60 with full VF
VA 6/60-6/24 with moderate reduction in VF
VA >6/18 with significant reduction of VF (e.g. homonymous hemianopia)

119
Q

3 DVLA criteria for car and motorcycle drivers

A
  • ability to read car registration plate (post sep 2001) at 20m distance
  • VA >6/12 with both eyes open or 1 if monocular
  • VF of at least 120 degrees on horizontal with extension of at least 50 degrees to right and left, no significant defect encroaching 20 degrees of fixation above or below the horizontal meridian should be present
120
Q

4 specific cases that must be notified to DVLA

A
  • diplopia (can resume if controlled)
  • VF defects e.g. RP, bilateral glaucoma, bilateral hemianopia
  • nyctalopia
  • blepharospasm (mild cases may be licenced)
121
Q

2 types of absorbable suture

A 
polyglactin 910 (VICRYL) 
polyglycolic acid (DEXON)
122
Q

3 types of nonabsorbable suture

A

silk
nylon
polypropylene (PROLENE)

123
Q

suture used for eyelids and sclera

A

silk

124
Q

suture used for conjunctiva, muscles and cornea

A

polyglactin 910

125
Q

suture used for cornea, sclera and limbus

A

nylon

126
Q

suture used for iris

A

polypropylene

127
Q

suture used for limbus

A

polyglycolic acid

128
Q

5 conditions included in Vision 2020

A 
cataract
trachoma 
onchocerciasis
refractive errors
childhood blindness
129
Q

most common cause of infectious blindness

A

trachoma (onchocerciasis second)

130
Q

most common cause of VI

A

uRE (cataracts is most common cause of blindness)

131
Q

4 causes of childhood blindness

A

vit A deficiency
measles
ROP
cataract

Duke Elder exam (5 decks)

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