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Ophthamology > Clinical > Flashcards

Clinical Flashcards

1
Q

what investigation must always be carried out if there is a suspected intra-ocular foreign body?

A

X ray

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2
Q

which is better for the eye- acid or alkali burn? (and explain)

A

acid burn because it coagulates causing little penetration

whereas alkali penetrates the intra-ocular structures

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3
Q

what is the management of chemical injury?

A

immediate irrigate with minimum 2l of saline or until the pH is normal

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4
Q

what are the 3 Cs of describing the optic disc?

A

Contour
Colour
Cup

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5
Q

What is the colour of a healthy optic disc?

A

pinky orange with white centre

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6
Q

where is the optic disc thickest?

A 
Inferior
then Superior
then Nasal
then Temporal
(ISN'T rule)
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7
Q

what happens to the cup when you have a swollen optic nerve?

A

the cup gets smaller

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8
Q

what is optic disc drusen?

A

bits of calcium stuck to the nerve

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9
Q

what can be seen when looking through an ophthalmoscope of a patient with optic disc drusen?

A

contour of optic disc is poorly defined

disc looks lumpy

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10
Q

what may happen to the blind spot of a patient with optic disc drusen?

A

enlarged blind spot

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11
Q

What tests allow you to examine the function of the optic nerve?

A

visual field test
tvisual acuity test
colour vision test
pupillary reflex

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12
Q

which retina is responsible for the nasal field?

A

temporal retina

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13
Q

which retina is responsible for the temporal field?

A

nasal retina

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14
Q

where is the lesion causing a uniocular defect?

A

before the optic chiasm

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15
Q

where is the lesion causing a homonomous hemianopia

A

after the optic chiasm

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16
Q

where is the lesion causing a bitemporal hemianopia?

A

the optic chiasm

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17
Q

what is quadrantanopia?

A

when a specific quadrant of the visual field of an eye is not seen

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18
Q

compare homonomous hemianopia to bitemporal hemianopia?

A

in both half the visual field is lost

homonomous: the lost side is on the same side of both eyes
bitemporal: the lost side is on the temporal side of both eyes (opposite sides)

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19
Q

what kind of molecular weight drugs are able to penetrate the cornea?

A

low molecular weight drugs

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20
Q

compare the stroma and epithelium in terms of what drugs (lipid vs water soluble) can readily penetrate it?

A

lipid soluble drugs penetrate epithelium

water soluble drugs penetrate stroma

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21
Q

what can ocular inflammation do to the hydrophobic nature of the endothelium?

A

makes it more hydrophilic

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22
Q

compare prednisolone acetate and prednisolone phosphate in terms of penetration of uninflamed cornea?

A

prednisolone acetate has a much better penetration of the cornea

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23
Q

when is prednisolone acetate generally used?

A

post operatively

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24
Q

when is prednisolone phosphate generally used?

A

cornea disease

when low dose steroids are required

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25
Q

why is benzalkonium added to some topical drugs?

A

as a preservative, also aids penetration by disrupting lipid layer of tear film

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26
Q

what antibiotic is mainly used for the treatment of infections within the eye?

A

chloramphenicol

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27
Q

what are topical steroids used in?

A

post op cataracts
uveitis
to prevent corneal graft injection

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28
Q

what is anterior uveitis?

A

inflammation of the iris

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29
Q

why might uveitis cause a pain when the eye is hit by light?

A

the muscles of the iris are inflamed so constricting is painful

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30
Q

what type of steroid is uveitis treated with?

A

prednisolone acetate

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31
Q

what are the 3 main local side effects of topical steroids?

A
  • can induce cataracts
  • glaucoma
  • exacerbation of viral infection
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32
Q

what is glaucoma?

A

a group of diseases characterised by a progressive optic neuropathy resulting in characteristic field defects

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33
Q

with glaucoma, what part of the visual field is always preserved?

A

central part

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34
Q

what is the main treatment of glaucoma?

A

lantanoprost drops

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35
Q

how are antibiotics delivered in endophthalmitis?

A

intravitreal injections

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36
Q

what is anti-VEGF for?

A

anti- vascular endothelial growth factor

prevents the growing of new blood vessels

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37
Q

how is anti-VEGF administed?

A

intravitreal injection

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38
Q

how are intra-ocular injections administered?

A

intravitreal injection

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39
Q

what are the 4 main uses for local anaesthetic drops?

A

foreign body removal
tonometry
corneal scraping
comfort

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40
Q

what is tonometry?

A

intra-ocular pressure measurement

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41
Q

what are the 4 main functions of fluorescein?

A
  • shows corneal abrasion
  • tonometry
  • diagnostic nasolacrimal duct obstruction
  • angiography
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42
Q

what is a rare but serious side effect of mydriatics?

A

acute angle closure glaucoma

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43
Q

how will you detect if someone has AACG after a mydriatic drop?

A

they will have a bad headache after

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44
Q

how do mydriatics work?

A

blocks parasympathetic supply to iris and causes pupil dilation

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45
Q

how do sympathomimetics work?

A

act on sympathetic system to cause pupil dilation

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46
Q

why do mydriatics cause visual blurring but sympathomimetics dont?

A

mydriatics affect the ciliary muscle

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47
Q

what epilepsy medication can constrict visual fields?

A

vigabatrin

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48
Q

what TB medication can cause optic neuropathy?

A

Ethambutol

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49
Q

what rheumatology drug can cause maculopathy in the long term?

A

hydroxychloroquine

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50
Q

what drug causes corneal verticillata?

A

amiodarone

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51
Q

what are the 3 key features of neuro-ophthalmic disease?

A

double vision
loss of visual acuity
visual field loss

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52
Q

what is the main cause of neuro-ophthalmic disease?

A

vascular disease

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53
Q

what happens in CN VI nerve palsy?

A

loss of abduction

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54
Q

what are the 3 main causes of CN VI nerve palsy?

A

microvascular event
raised intracranial pressure
tumour

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55
Q

why can raised intracranial pressure cause CN VI palsy?

A

squashes CN VI against the petrous part of the temporal bone

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56
Q

the majority of IV nerve palsy is caused by what?

A

congenital causes

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57
Q

what are the 3 main causes of unilateral CN IV palsy?

A

congenital
microvascular events
tumour

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58
Q

what is the main cause of bilateral CN IV palsy?

A

blunt head trauma

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59
Q

what is the ocular position in a CN III nerve palsy?

A

down and out

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60
Q

what are the 3 signs within the eye which show CN III nerve palsy?

A

down and out position
ptosis
dilated pupil

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61
Q

what are the 3 main causes of CN III nerve palsy?

A

microvascular
tumour
aneurysm

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62
Q

how do you differentiate between CN III palsy caused by microvascular event and a CN III palsy caused by aneurysm?

A

aneurysm is sore and causes dilated pupil

microvascular event, not painful, normal pupil

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63
Q

why does a microvascular event cause CN III nerve palsy without a dilated pupil?

A

parasympathetics are superficial in the nerve and aren’t involved in a microvascular event

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64
Q

what is inter-nuclear ophthalmoplegia?

A

disorder of conjugate lateral gaze causing diplopia

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65
Q

what is the most common cause of inter-nuclear ophthalmoplegia?

A

MS

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66
Q

what cranial nerves are involved in inter-nuclear ophthalmoplegia?

A

CN III and CN VI

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67
Q

a problem in what area of the brain causes inter-nuclear ophthalmoplegia?

A

medial longitudinal fasciculus

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68
Q

how does MS cause inter-nuclear ophthalmoplegia or a visual field defect?

A

through demyelination

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69
Q

explain progression of optic neuritis?

A

J shaped curve

gets worse then gradually gets better

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70
Q

what are the 5 key features of optic neuritis?

A 
unilateral
progressive vision loss
pain behind eye (esp on movement)
colour desaturation
central scotoma
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71
Q

what is a scotoma?

A

gap in visual field

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72
Q

what are the main pathologies of the optic tracts and radiaitons?

A

tumours
demyelination
vascular anomalies

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73
Q

is the macula spared in pathologies of the optic tracts and radiations?

A

no

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74
Q

what does it mean to be ‘cortically blind’?

A

eyes and nerves are normal but you still have areas of visual field loss due to pathology in occipital cortex

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75
Q

is the macula spared in pathologies of the occipital cortex?

A

yes

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76
Q

what neuro-ophthalmological pathology should you suspect in a young child with a head tilt and double vision?

A

congenital 4th nerve palsy

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77
Q

which artery supplies the inner 2/3 of the retina? (including ganglion cells)

A

central retinal artery of the ophthalmic artery

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78
Q

which artery supplies the outer 1/3 of the retina? (including photo receptive layer)

A

posterior ciliary artery of the ophthalmic artery

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79
Q

which artery supplies the head of the optic nerve?

A

posterior ciliary artery of the ophthalmic artery

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80
Q

is central retinal artery occlusion sudden or gradual vision loss?

A

sudden

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81
Q

is the vision loss with central retinal artery occlusion painful?

A

no

82
Q

is the vision loss with central retinal artery occlusion profound or mild?

A

profound

83
Q

why on fundoscopy might you see a small island of normal retina in central retinal artery occlusion?

A

small area supplied by a different artery

84
Q

describe the optic disc of a patient with central retinal artery occlusion?

A

pale

oedematous

85
Q

what are the 2 possible causes of central retinal artery occlusion?

A

carotid artery disease

embolism from heart

86
Q

what is the management of central retinal artery occlusion if presented within 24 hours? and why?

A

ocular massage

to try convert central retinal artery occlusion to branch artery occlusion

87
Q

what is the name of a transient central retinal artery occlusion?

A

amaurosis fugax

88
Q

what type of transient visual loss is usually followed by a headache?

A

migraine

89
Q

how long does amaurosis fugax last?

A

5-10 minutes

90
Q

what is an ocular cause of central retinal vein occlusion? (ie a cause out with CVD)

A

raised intraocular pressure causing venous stasis

91
Q

does central retinal vein occlusion cause sudden or gradual vision loss?

A

sudden

92
Q

does central retinal vein occlusion cause mild or profound vision loss?

A

moderate to severe

93
Q

what are the 4 main signs of central retinal vein occlusion on fundoscopy?

A

retinal haemorrhages
dilated tortuous veins
optic disc swelling
macular swelling

94
Q

apart from treating underlying cause of central retinal venous occlusion, what other treatment can be given?

A

anti VGEF intravitreal injections

95
Q

what is the other name for occlusion of optic nerve head circulation?

A

ischaemic optic neuropathy

96
Q

which arteries are occluded in ischaemic optic neuropathy?

A

posterior ciliary arteries

97
Q

in ischaemic optic neuropathy why might the patient have profound visual loss yet will not go completely blind?

A

posterior ciliary arteries are not end arteries so there is still some other supply

98
Q

what are the 2 types of ischaemic optic neuropathy?

A

arteriric

non-arteritic

99
Q

what causes arteritic ischaemic optic neuropathy?

A

temporal arteritis

100
Q

what causes non-arteritis ischaemic optic neuropathy?

A

atherosclerosis

101
Q

what does the disc look like in ischaemic optic neuropathy?

A

pale and swollen

102
Q

does ischaemic optic neuropathy cause sudden or gradual visual loss?

A

sudden

103
Q

what is bleeding from abnormal retinal vessels associated with?

A

retinal ischaemia and subsequent new vessel formation

104
Q

what is bleeding from normal retinal vessels associated with

A

retinal tear

105
Q

what are the 2 key features of viteous haemorrhage?

A

sudden loss of vision

floaters

106
Q

what are the main signs of viterous haemorrhage on fundoscopy?

A

loss of red reflex

floaters

107
Q

what is the management of viterous haemorrhage?

A

should resolve itself

vitrectomy for non-resolving cases

108
Q

what are the 3 signs of central retinal artery occlusion?

A

relative afferent pupil defect
pale, oedematous retina
thread like retinal vessels

109
Q

what are the 3 main symptoms of retinal detachment?

A

sudden loss of vision
painless
sudden onset of flashes/floaters

110
Q

what are the 2 signs of retinal detachment?

A

may have relative afferent pupil defect

may see tear on ophthalomoscopy

111
Q

what is the management of retinal detachment?

A

surgical

112
Q

what are the black specks seen in retinal detachment?

A

floating bits of retina

113
Q

what causes flashes in retinal detachment?

A

the vitreous fluid pulling on the retina causes flashes

114
Q

what are the 2 types of age related macular degeneration?

A

dry

wet

115
Q

compare dry and wet ARMD in terms of time period of loss of vision?

A

dry: gradual
wet: sudden

116
Q

what causes the visual loss in wet ARMD?

A

new abnormal blood vessels growing under the retina leak fluid and blood which eventually causes scarring

117
Q

what are the 3 main symptoms of wet ARMD?

A

rapid visual loss
central visual loss
metamorphopsia

118
Q

what are the signs of wet ARMD on fundoscopy?

A

haemorrhage/exudate

119
Q

what is the treatment of wet ARMD?

A

anti VEGF intravitreal injections

120
Q

what are the causes of gradual visual loss?

A 
Catartact
ARMD (dry)
Refractive error
Diabetic retinopathy
Inherited disease
Glaucoma
121
Q

why must you check red reflex in neonates?

A

to check for congenital cataracts

122
Q

what is the management of symptomatic cataracts?

A

surgical removal with intraocular lens implant

123
Q

what are the 2 signs of dry ARMD on fundoscopy?

A

drusen

atrophic patches of retina

124
Q

what causes the central vision loss in dry ARMD?

A

the drusen builds up and causes retina to become atrophic and therefore doesn’t function properly

125
Q

what causes closed-angle glaucoma?

A

when aqueous humour builds behind the iris and pushes it forwards causing the angle between the iris and the cornea to close

126
Q

compare presentation of closed and open angle glaucoma?

A

closed: often acute presentation with painful, red eye with vision loss and associated symptoms
open: often no symptoms

127
Q

what is a laser iridotomy?

A

a procedure done to lower the introcular pressure by allowing fluid to pass through a hole in the iris preventing the angle from closing

128
Q

until proven otherwise, all patients with bilateral optic disc swelling should be suspected of having what?

A

raised ICP due to a space occupying lesion

129
Q

why is raised ICP a medical emergency?

A

with raised ICP the brain is squeezed through the foramen magnum, this compresses the brainstem causing the patient to stop breathing and die

130
Q

why must you always check BP of a patient with bilateral optic disc swelling?

A

to rule out malignant hypertension

131
Q

what 2 mechanisms can cause idiopathic intracranial hypertension?

A

obstructed CSF circulation

impaired CSF absorption

132
Q

what are the 9 main causes of an acute red eye?

A 
conjunctivitis
blepharitis
anterior uveitis
scleritits
episcleritis
keratitis
acute angle closure glaucoma
subconjunctival haemorrhage
orbital disease (cellulitis)
133
Q

how do subconjunctival haemorrhages usually present?

A

very red eye

no pain

134
Q

what are the 2 types of eye pain felt?

A

foreign body sensation

aching pain

135
Q

compare the indications of foreign body sensation to aching pain?

A

ache: intraocular infection

foreign body sensation: ocular surface is irriated

136
Q

what does an itchy eye suggest?

A

allergic reaction

137
Q

compare mucopurulent,stringy mucoid and watery discharge in terms of cause?

A

mucopurulent: bacterial infection
stringy mucoid: allergic
watery: viral infection

138
Q

what keratitis causing parasite are contact lens wheres more likely to get?

A

acantomoeba

139
Q

in what ocular infection/inflammation is there likely to be redness maximal in the limbus?

A 
intraocular inflammation (eg anterior uveitis)
keratitis
140
Q

in what ocular infection/inflammation is there likely to be redness maximal in the fornices?

A

conjunctivitis

141
Q

when palpating an eye with glaucoma, what is the clinical sign?

A

stony hard on palpation

142
Q

compare anterior and posterior blepharitis in terms of what anatomy is affected?

A

anterior blepharitis- eye lashes affected

posterior blepharitis- meibomian glands affected

143
Q

what are the 2 types of anterior blephartiis?

A

seborrhoeic (squamous)

staphylococcal

144
Q

what is seborrhoeic (squamous) anterior blepharitis?

A

scales on the lashes

145
Q

what is staphylococcal anterior blepharitis?

A

infection involving the lash follicle

146
Q

what is posteiror blepharitis?

A

meibomian gland dysfunction

147
Q

compare the location of redness in anterior and posterior blepharitis?

A

anterior: lid margin redder than deeper part of lid

posterior? deeper part of lid redder than margin (often looks quite normal)

148
Q

what is a stye?

A

acute purulent infection of eyelash follicle (anterior blepharitis)

149
Q

what is a tee pee sign and where is it seen?

A

lashes stuck together due to oil and sebaceous matter

seen in seborrheic anterior blepharitis

150
Q

what is the function of the fluid meibomian glands produce?

A

float on tear film preventing evaporation

151
Q

what happens when the meibomian glands get blocked?

A

they become meibomian cysts

152
Q

what is 50% of posteiror blepharitis associated with?

A

acne rosacea

153
Q

what are the 3 infective causes of conjunctivitis?

A

bacterial
viral
chlamydial

154
Q

what are the 3 non-infective causes of conjunctivitis?

A

allergic
chemical/drugs
skin diseased eg eczema

155
Q

compare papillae and follicles of conjunctivitis?

A

bacterial cause: papillae- smaller bumps with a central red dot (blood vessel)

viral/chlamydial: follicle- bigger bump with red around the periphary

156
Q

what type of conjunctivitis is itchy?

A

allergic conjunctivitis

157
Q

in viral conjunctivitis, which lymph nodes become palpable?

A

pre-auricular

158
Q

what are the most common causative bacterial organisms of conjunctivitis?

A

staph aureus
strep pneumoniae
haemophilus influenzae

159
Q

what are the most common causative viral organisms of conjunctivitis?

A

adenovirus
HSV
herpes zoster

160
Q

what is chemosis?

A

conjunctival oedema (like a blister)

161
Q

how long must conjunctivitis last to be called chronic?

A

4 weeks

162
Q

what are the layers of the cornea?

A

epithelium
stroma
endothelium

163
Q

compare infective and autoimmune corneal ulcers in terms of location of ulver?

A

infective: central corneal ulcers
autoimmune: peripheral corneal ulcers (towards limbus)

164
Q

what type of patients tend to get corneal ulcers caused by acanthamoeba?

A

young, contact lens wearers

165
Q

what are the 4 main symptoms of a corneal ulcer?

A

pain
photophobia
profuse lacrimation
sometimes reduced vision

166
Q

what are the 5 main signs of corneal ulcer?

A 
red eye
abnormal corneal reflex
corneal opacity
staining with fluorescein
hypopyon
167
Q

why can a corneal ulcer lead to permanent vision loss?

A

healing occurs by collagen laying down in a haphazard fashion

168
Q

what are the 4 groups of patients at risk of corneal ulcers?

A

exposure keratitis
keratoconjunctivitis sicca
neutrophic keratitis
vit A deficiency

169
Q

how do you acquire a sample of a corneal ulcer for gram stain and culture?

A

corneal scraping

170
Q

what is the treatment of a herpetic corneal ulcer?

A

aciclovir ointment 5x per day

171
Q

what is the treatment of an autoimmune corneal ulcer

A

oral/topical steroids

172
Q

what are the 4 most common autoimmune causes of anterior uveitis?

A

reiters syndrome
ulcerative colitis
ankylosing spondylitis
sarcoidosis

173
Q

what malignancy is known to cause anterior uveitis?

A

leukemia

174
Q

what is a synechiae?

A

small or irregular pupil

175
Q

what are the 3 main symptoms of anterior uveitis?

A

pain (could also be referred)
photophobia
sometimes reduced vision

176
Q

where is the redness in anterior uveitis?

A

circumcorneal

ie around the limbus

177
Q

what are the 5 signs of anterior uveitis?

A 
ciliary injection
cells and flare in anterior chamber
keratic precipitates
hypopyon
synechiae
178
Q

what is the treatment of anterior uveitis?

A

topical steroids

mydriatics

179
Q

what is the purpose of mydriatics within the treatment of anterior uveitis?

A

dilate pupil to stop iris getting stuck down

180
Q

in cases of recurrent or chronic anterior uveitis what should you do?

A

investigate for systemic associations

eg reiters, ank spond, sarcoidosis, UC

181
Q

what condition is associated with episcleritis?

A

gout

182
Q

what is the treatment of episcleritis?

A

self limiting

may need lubricants and topical nsaids/mild steroids

183
Q

how can you tell between episcleritis and scleritis?

A

scleritis is very painful

use vasoconstrictor drops
if blood vessels blanche: episcleritis
if blood vessels don’t blanche: scleritis

184
Q

inflammation of what part of the eye is associated with serious systemic vaculitides? (eg RA, wegners)

A

scleritis

185
Q

what is the treatment of scleritis?

A

oral NSAIDS
oral steroids
if long term- steroid sparing agents

186
Q

does myopia or hypermetropia predispose to acute closed angle glaucoma?

A

hypermetropia

187
Q

does myopia or hypermetropia predispose to retinal dettachment?

A

myopia

188
Q

where are the injected blood vessels seenin acute closed angle glaucoma?

A

circumcorneal

round limbus

189
Q

what happens to the cornea in acute closed angle glaucoma?

A

becomes cloudy due to oedema

190
Q

what happens to the pupil in acute closed angle glaucoma?

A

mid dilated

191
Q

laser therapy causes the retina to turn what colour?

A

white

192
Q

what is rubeosis iridis?

A

blood vessel growth on iris

193
Q

what is rubeosis iridis a sign of?

A

severe ischaemia

194
Q

how will papilloedema affect vision?

A

enlarged blind spot but wont reduce visual acuity

195
Q

why is a cherry red spot seen in central artery occlusion?

A

retinal nerve fibre layer becomes swollen everywhere except fovea (stays red)

196
Q

what is symblepharon?

A

palpebral conjunctiva gets stuck to bublar conjunctiva, causing turning in of eyelid

197
Q

what type of conjunctivitis commonly causes symblpharon?

A

chlamydial conjunctivitis

198
Q

in a red eye, if the pupil is larger in that eye what should you suspect?

A

glaucoma

199
Q

in a red eye, if there is photophobia, what should you suspect?

A

iritis

200
Q

in a red eye, if the cornea stains with fluorescein, what should you suspect?

A

keratitis

201
Q

what does trichiasis mean?

A

lashes touch eyeball

202
Q

if the red eye is bilateral what are the 2 main causes?

A

conjunctivitis

dry eyes

Ophthamology (4 decks)

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