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Ophthalmology > Basic Science, Investigations and Lasers > Flashcards

Basic Science, Investigations and Lasers Flashcards

1
Q

What ocular structures are derived from the surface ectoderm?

A

Conjunctival nad corneal epithelium

NL duct

Lens

Lacrimal gland

Eye lids

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2
Q

What ocular structures are derived from the neuroectoderm?

A

NS retina
Pigment epithelium or retina, iris and CB
Pupillary sphincter and dilator muscles
Optic nerve

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3
Q

What ocular structures are derived from the neural crest?

A 
Corneal endothelium 
Trabecular meshwork
Stroma of cornea, iris and CB
Ciliary muscle
Choroid 
Sclera
Orbital cartilage and bone
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4
Q

What ocular structures are derived from the mesoderm?

A

Extraocular muscles
Blood vessels
Schlemm’s canal endothelium
Sclera (temporal portion)

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5
Q

List some ocular disorders inherited in an AR fashion

A

Congenital glaucoma (commonly sporadic)
Oculocutaneous albinism
Strargardt disease
Retinitis pigments-like conditions

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6
Q

List some ocular disorders inherited in an XLR fashion

A

Fabry disease
Lowe syndrome
Ocular albinism
Retinoschisis

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7
Q

List some ocular disorders inherited in an XLD fashion

A

Alport syndrome (also AR)

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8
Q

List some ocular disorders inherited in a mitochondrial fashion

A

Kearns-Sayer Syndrome

Leber hereditary optic neuropathy

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9
Q

HLA is found on what arm of which chromosome

A

Short arm (q) of chromosome 6

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10
Q

What condition is associated with HLA-A29?

A

Birdshot choroidopathy

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11
Q

What condition is associated with HLA-A11?

A

Sympathetic ophthalmia

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12
Q

What condition is associated with HLA-B7?

A

Presumed ocular histoplasmosis syndrome (POHS)

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13
Q

What condition is associated with HLA-B22?

A

Vogt-Koyanagi-Harada Syndrome (VKH)

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14
Q

What condition is associated with HLA-B27?

A

Psoriatic arthritis
Reactive arthritis
Enteropathic arthritis

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15
Q

What condition is associated with HLA-B51?

A

Beçhet disease

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16
Q

What condition is associated with HLA-BW5?

A

Posner-Schlossman Syndrome

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17
Q

What condition is associated with HLA-DR2?

A

Pars planitis
POHS
MS

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18
Q

What condition is associated with HLA-DR4?

A

Sympathetic ophthalmia
RA
VKH

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19
Q

What condition is associated with HLA-DR5?

A

JIA

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20
Q

What condition is associated with HLA-DR15?

A

MS

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21
Q

What HLA types are included in MHC-1 category?

A

A, B and C

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22
Q

What is the function fo MHC-1?

A

Expressed on all cells and stimulate CD8+ cytotoxic T cells

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23
Q

What HLA types are included in MHC-2 category?

A

DR, DP, DQ

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24
Q

What is the function fo MHC-2?

A

Stimulate CD4+ T-helper cells and are expressed on specialised antigen-presenting cells such as macrophages

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25
What are cytokines?
Molecules responsible for recruitment and proliferation of the innate and adaptive immune systems
26
List types of cytokines?
Tumour necrosis factor Interleukins Chemokines Interferons
27
What is tumour necrosis factor?
Pro-inflammatory response produced by macrophages. They help in the activation and differentiation of immune cells and increase vascular permeability.
28
What are interleukins?
Mediate communication between different cells and are important in regulating immune response
29
What is the role of IL-1?
Induces immune responses and causes fever
30
What is the role of IL-2?
Proliferation of T and B cells
31
What is the role of IL-5?
Regulates growth and activation of eosinophils
32
What is the role of IL-6?
Involved in differentiation of B cells and production of CRP
33
What is the role of IL-8?
Attracts neutrophils, T cells, basophils and eosinophils
34
What is the role of IL-10?
Suppresses immune cells
35
What is the role of IL-12?
Differentiates T cells into TH1 and enhances cytotoxicity
36
What are interferons?
Proinflammatory agents/immunomodulatory cells
37
What is the mechanism of beta-blockers in the treatment of glaucoma?
Decreased aqueous production
38
What is the mechanism of prostaglandin analogues in the treatment of glaucoma?
Increase aqueous drainage via uveoscleral outflow
39
What is the mechanism of alpha-2-agonists in the treatment of glaucoma?
Decrease aqueous production and increase uveoscleral outflow
40
What is the mechanism of topical and systemic CAIs in the treatment of glaucoma?
Decrease aqueous production
41
What is the mechanism of miotics in the treatment of glaucoma?
Parasympathomimetics increase aqueous drainage via TM by contracting ciliary muscles
42
What is the mechanism of osmotic agents in the treatment of glaucoma?
Lowers IOP by increasing vitreous volume
43
Timolol is an example of what class of anti-glaucoma medication?
Beta-blocker
44
Latanoprost is an example of what class of anti-glaucoma medication?
Prostaglandin inhibitor
45
Apraclonidine is an example of what class of anti-glaucoma medication?
Alpha-2 agonists
46
Topical dorzolamide and Systemic acetazolamide are examples of what class of anti-glaucoma medication?
Carbonic anhydrase inhibitors
47
Pilocarpine is an example of what class of anti-glaucoma medication?
Miotics
48
Mannitol is an example of what class of anti-glaucoma medication?
Osmotic agent
49
List some side effects of beta-blockers in the treatment of glaucoma
``` Decreased corneal sensation Dry eye Tachyphylaxis Bradycardia Bronchospasm Nocturnal hypotension ```
50
List some side effects of prostaglandin analogues in the treatment of glaucoma
Conjunctival hyperaemia Hyperpigmentation Increased eyelash length CMO
51
List some side effects of alpha-2 agonists in the treatment of glaucoma
``` Follicular conjunctivitis Contact dermatitis Tachyphylaxis Dry mouth Sedation ```
52
List some side effects of CAIs in the treatment of glaucoma
Ocular stinging Bitter taste Punctate keratitis ``` Systemic: Paraesthesia Hypokalaemia SJS Metabolic acidosis ```
53
List some side effects of osmotic agents in the treatment of glaucoma
Cardiovascular overload
54
What drugs cause lens opacification and cataracts? STACA
``` Steroids Tobacco Amiodarone Chlorpromazine Allopurinol ```
55
What drugs are associated with CMO?
Latanoprost, epinephrine, rosiglitazone and nicotinic acid
56
What drugs are associated with Bull's Eye Maculopathy?
Hydroxychloroquine and chloroquine
57
What drugs are associated with crystalline maculopathy?
Tamoxifen
58
What drugs are associated with optic neuropathy?
``` Ethambutol Chloramphenicol Amiodarone Vigabatrin Isoniazid ```
59
What is vortex keratopathy?
Deposition of asymptomatic grey opacities in a vortex pattern on the corneal epithelium
60
What are the causes of vortex keratopathy?
Drugs (amiodarone, chloroquine, indomethacin, phenothiazines) Fabry disease
61
What is Fabry disease?
An XLR condition characterised by a deficiency of alpha-galactosidase Causes burning pain in the extremities, angiokeratomas, renal failure, posterior sub capsular cataracts
62
What is the purpose of keratometry?
Measures the anterior corneal surface curvature
63
What is corneal topography?
Measures and quantifies the curvature of the whole cornea. It uses placido-disc systems
64
What is ultrasonic pachymetry?
Can be used to measure central corneal thickness
65
What is the normal central corneal thickness?
530-545 micrometers
66
What type of light is used to measure cross-sectional images of the retina in OCT?
Near-infra red
67
How does FA work?
Sodium fluorescence absorbs blue light (465-490nm) and emits yellow-green light (530nm). It is injected in a peripheral vein and passes through the short posterior ciliary artery into the choroicapillaris in 8-12s post injection and the retinal circulation 1s later
68
What are the side effects of FA?
Urine discolouration, nausea, vasovagal syncope and anaphylaxis
69
What allergy is a contraindication to FA?
Shellfish
70
What are the benefits of indocyanine green angiography?
Better choroidal vasculature observation
71
What is fundus autofluorescence?
Detects lipofuscin in the RPE
72
What is autofluorescence used for?
Best disease, RP and monitoring geographic atrophy
73
Tonometry is important in the diagnosis and investigation of glaucoma. How does it work?
Follows the Imbert-Fick Law which says the amount of force required to flatten a corneal area of 3.06mm assuming a CCT of 520 micrometers
74
What factors may decrease the measurements of IOP?
Excessive fluorescein: over-estimates Low or high CCT - underestimates and over respectively Astigmatism Calibration errors
75
What structures visualised in gonioscopy indicate a wide open AC angle
``` Schwalbe line Non-pigmented TM Pigmented TM Scleral spur Ciliary Body ```
76
What are scleral spurs?
Anterior protrusions of the sclera that marks the attachments of the CBs longitudinal fibres
77
What is perimetry?
Used to detect visual fields E.g. Humphrey or Goldmann visual field testings
78
List some types of glaucomatous visual field defects
``` Nasal step Paracentral depressions Arcuate defects Ring scotoma Tunnel vision with temporal sparing ```
79
What are the fundamental properties of lasers?
Coherency (same phase) Monochromaticity (single wavelength) Collimation (minimal divergence)
80
What structures are required for the construction of a laser?
Light source Medium (determine wavelength - e.g. gas, liquid or solid) Optical resonator to amplify light
81
Lasers are classified by their hazardous effects. What types of lasers are used in Ophthalmology?
Class 3B or 4
82
Laser-tissue interaction occurs in what three ways
Photothermal Photochemical Photo-ionising
83
What is photothermal laser-tissue interaction
Uses photovapourisation (high temp) and photocoagulation (protein denaturation)
84
List some different types of photocoagulative lasers?
Argon-blue - not used on macula Krypton red Frequency doubled Nd:YAG Diode (highest wavelength)
85
Give examples of photochemical lasers
Photorefractive keratectomy (PRK) Laser-assisted in situ keratomileusis (LASIK) Laser epithelial keratomileusis (LASEK)
86
What are examples of photo-ionising laser and what are they used for?
Nd:YAG for posterior capsulotomy in PCO and peripheral iridotomy for PACG
87
What are the two registered sight impairment categories?
Severely sight impaired (blind) and sight impaired
88
What are the requirements for blindness registration?
VA <3/60 or VA <6/60 with reduced VFs VA >6/60 with severe VF changes
89
What is the DVLA sight requirements for driving?
1. Read number plate at 20m 2. VA >6/12 in both eyes 3. VF of 120 degrees with extension of 50 degrees. No defect encroaching 20 degrees of horizontal meridian
90
What specific cases must be reported to the DVLA?
Diplopia VF defects Nyctalopia Blepharospasm
91
What type of sutures are suitable for eyelids and sclera?
Silk
92
What type of sutures are suitable for conjunctiva, muscles and cornea?
Polyglactin 910
93
What type of sutures are suitable for cornea, sclera and limbus?
Polypropylene
94
What type of sutures are suitable for the limbus?
Polyglycolic acid
95
What is the most common cause of blindness in the world?
Cataracts
96
What is the most common causes of infective blindness?
Trachoma | Onchoceriasis
97
What is the most common cause of visual impairment?
Refractive errors
98
What is the most common cause of childhood blindness?
Vitamin A deficiency Measles Retinopathy of prematurity Cataract

Ophthalmology (7 decks)

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