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Internal Medicine > Eye > Flashcards

Eye Flashcards

1
Q

Name the risk factors for Open Angle Glaucoma

A

African americans
DM
Fx Hx of Glaucoma

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2
Q

How Open angle Glaucoma presents?

A

Gradual loss vision start from periphery

Increase IOP on tonometry

Fundoscopy findings–> Enlarged Optic cup and cupping of the disc

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3
Q

What are t/m options of Open angle glaucoma?

A

first line–> topical prostaglandins–>increases drainage of aqeuous humor via Uvealsacral pathway

2nd line–> BB

Laser tabeculoplasty

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4
Q

Important point of Open angle glaucoma

A

Avoid to use steriods as it decreases outflow of aqeuous humor from anterior chamber

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5
Q

How steroid causing Open angle glaucoma?

A

decrease drainage of aqueous fluid leads to increase IOP–> Open angle glaucoma
corneal edema leads to central blurriness

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6
Q

How close angle glaucoma presents?

A

seen in old age with headache and nausea
Red,painful eye and blurred vision
Pupil is fixed and mid-dilated without ulceration

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7
Q

Important point of close angle glaucoma

A

Avoid to use pupil dilating medication or sitting in dark place as it will lead to pupil dilation

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8
Q

How to dx Close angle glaucoma?

A

Gold standard–> gonioscopy

Also tonometry

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9
Q

How to t/m closed angle glaucoma?

A

IV acetazolamide and Pressure lowering eye drops

definitive laser iridotomy

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10
Q

D/f b/w in terms of pupil of uveitis / close angle glaucoma / conjunctivitis

A

Uveitis: pupil is constricted with a poor light response

close angle glaucoma:: pupil is dilate with a poor light response

conjunctivitis:: size and response to light are normal without affecting visual acuity

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11
Q

Fundoscopy findings of DM retinopathy

A

Microaneurysm and Hard exudates

Retinal Hx and sometimes neovascularisation

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12
Q

How fundoscopy findings of DM retinopathy from Open angle glaucoma?

A

DM retinopathy::
Disc is normal
and Visual field defects are patchy

Open angle Glaucoma::
Cupping of disc
and visual field defects starts from peripheral

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13
Q

Fundoscopy findings of HTN retinopathy::

A

AV nicking and copper wiring
flames hx and cotton wool spots
optic disc edema

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14
Q

How Aged related macular degeneration d/f from DM retinopathy?

A

In Age related macular degeneration, gradual loss of cental vision

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15
Q

Fundoscopy findings of AGMR

A

Subretinal drusen and pigment anomalies

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16
Q

How Nor-arteritic anterior ischemic optic neuropathy d/f from DM retinopathy?

A

Nor-arteritic anterior ischemic optic neuropathy:::
Painless mono-ocular vision loss
Optic disc edema and afferent pupillary defect

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17
Q

Triad of Optic neuritis

A

acute mono-ocular vision loss
Pain with extra ocular movement
U/L optic disc edema

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18
Q

Name the medicines for glaucoma

A

Trabecular outflow:: muscarinic agonists

Uveoscleral Outflow:: Prostaglandin Agonists

Aqueous humor inflow:: BB / Alpha agonist / carbonic anhydrase inhibitors

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19
Q

What is dacryocystitis?

A

Infection of the lacrimal sac with inflammatory changes in the medial canthal region of eye.

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20
Q

Name the bacteria of causing dacryocystitis

A

S.aureus

B-Hemolytic strept

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21
Q

How dacryocystitis presents?

A

Seen in infants and adults over age 40yrs
sudden onset pain with edema
redness in medial canthal region
Purulent discharge from punctum

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22
Q

What is episcleritis?

A

Inflammation or infection of the episcleral tissue between the conjunctiva and sclera
or inflammation of white of the eye w/o involvement of uveal tract

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23
Q

How episcleritis presents?

A

Sudden onset pain with photophobia

Watery discharge without affect vision or cornea

Diffuse or focal bulbar conjunctival injection

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24
Q

What is hordeolum?

A

abscess of the eyelid due to Staph.aureus

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25
Q

How external hordeolum (stye) presents?

A

erythematous tender nodule at the lid margin

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26
Q

How to t/m external hordeolum(stye)?

A 
warm compresses
if persistent(>1-2wks), incision and curettage
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27
Q

How internal hordeolum presents?

A

Involvement of meibomian gland

tender nodule visible at the palpebral conjunctiva

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28
Q

How chalazion presents?

A

Granulomatous inflammation of meibomian gland presents hard painless lid nodule

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29
Q

Triad of Orbital cellulitis

A

Sudden onset fever proptosis
Restriction of Extra ocular movement is restricted
Eyelids are red and edema

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30
Q

How herpes zoster ophthalmicus presents?

A

Dendriform corneal ulcer and conjunctivitis
vesicular rash in V1 region of trigeminal area
Burning and itching sensation in the periorbital region

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31
Q

Name the condition which show hutchinson signs?

A

herpes zoster ophthalmicus

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32
Q

How herpes simplex keratitis presents?

A

Dendritic corneal ulcer and vesicles
Pain with photophobia and decreased vision
Minor clear vesicles in the corneal epithelium

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33
Q

How to t/m conjunctivitis due to adenovirus?

A

Cool/warm and moist compresses

with or without antihistamine/ decongestant drops

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34
Q

How to t/m conjunctivitis due to bacteria?

A

if contact lens wearer: quinolone drops
Erythromycin ointments
polymyxin-trimethoprim drops
azomax drops

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35
Q

How to t/m conjunctivitis due to allergic?

A

antihistamine/ decongestant drops for intermittent SxS

antihistamine/mast cell stabilizer for frequent episodes

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36
Q

Differentiation d/f causes of conjunctivitis

A

Allergic::
B/L involve with watery scant discharge and itch
Stuck shut of eye with no reappearance of discharge after wiping

Bacterial::
B/L or U/L involve with purulent thick unremitting discharge
Stuck shut of eye with reappearance of discharge after wiping

Viral::
B/L involve with watery scant discharge and burning/gritty
Stuck shut of eye with no reappearance of discharge after wiping

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37
Q

Findings of bacterial conjunctivitis Vs

viral conjunctivitis Vs allergic conjunctivitis

A

bacterial conjunctivitis
Diffuse non follicular injection

viral conjunctivitis
Diffuse bumpy / follicular injection

allergic conjunctivitis
Diffuse bumpy / follicular injection
conjunctival edema (chemosis)

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38
Q

How endophthalmitis presents?

A

Conjunctival irritation
Purulent haziness of the ocular content
Layering out of pus in the anterior chamber (Hypopyon)

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39
Q

Whom is more prone to develop bacterial keratitis?

A

Contact lens wearers

40
Q

Triad of Subconjunctival Hx

A

Local trauma / cough, sneezing, vomiting

well demarcated patch of extravasted blood beneath the conjunctiva

Require no t/m as benign condition

41
Q

How retinal detachment presents?

A

seen in 40-70yrs with Underlying trigger

happened before condition occur
sudden onset Photopsia and floaters

Ophtho findings show grey elevated retina with fold and /or a tear

42
Q

Name the condition in which patient says curtain coming down over the eyes

A

Retinal detachment

amaurosis fugax

43
Q

Name the condition which causes retinal attachment

A

severe myopia / DM retinopathy

Hx of eye surgery or trauma

44
Q

How to managed Retinal detachment?

A

laser therapy and cryotherapy to create permanent adhesions b/w neurosensory retina, retinal pigment epithelium and choroid

45
Q

Triad of Choroidal rupture

A

blurred vision following ‘‘blunt trauma” (cause of it)
crescent shaped streak concentric to the optic nerve
central scotoma with hx detachment of the macula

46
Q

Fundoscopy findings of CRAO

A

sudden onset loss of vision
pallor of the optic disc with cherry red fovea
Boxcar segmentation of blood in the retinal veins

47
Q

Fundoscopy findings of CRVO

A

blood and thunder appearance
Disk swelling with venous dilation
tortous retinal Hx
cotton wool spots

48
Q

Name the risk factors for CRVO

A

Factors which increases coagulopathy / glaucoma / atherosclerotic risk factors

49
Q

How to confirm CRVO and t/m?

A

Fluorescein angiography
if macular edema–> Intravitreal injection of VEGF inhibitors
if no macular edema or neovascularisation–>managed conservatively with close observation

50
Q

What is the mcc of vitreous hx?

A

DM

51
Q

triad of Vitreous hx presents

A

Sudden onset loss of vision and onset of floaters

d/f to visualise the fundus

stat consultation otherwise do upright position during sleep

52
Q

Triad Age related macular degeneration

A

seen in over 50 yrs old patient
B/L progressive loss of central vision
Intact peripheral and navigational vision

53
Q

How the ARMG patient describes the findings of Grid tests?

A

Vertical lines bent and wavy

54
Q

D/f types of AGMR

A

Atrophic form–> multiple sores in the macular region

Exudative form–> newly blood vessels leak/ bleed and scar the retina

55
Q

Triad of Posterior capsule opacification

A

Posterior capsule opacification (thickening of the capsule holding the artificial lens)

developed post-cataract surgery

Presents as cloudy vision
T/m is laser

56
Q

How fungal keratitis presents?

A

cornea multiple stromal abscess

57
Q

Fundoscopy findings of CMV retinitis

A

Typically painless condition

fluffy Or granular retinal lesion located near the retinal vessel/yellow white exudates and associated Hx

58
Q

How to t/m CMV retinitis?

A

Anti virals–> valganciclovir

Intra vitreal injections–> if lesions near fovea Or optic nerve (so to avoid the blindness and retinal detachment)

59
Q

How HIV retinopathy presents?

A

NO Floaters or blurred vision usually

Cotton wool retinal lesions which are rarely hx

60
Q

How toxoplasmic chorioretinitis presents?

A

Eye pain & decreased vision

non vascular distribution (not perivascular)

61
Q

How presbyopia presents?

A

affected near vision

but far vision is un-affected

62
Q

How astigmatism presents?

A

Typically presents with blurry vision both at a distance and up close

63
Q

How cataract presents?

A

Hx of d/f with night vision or driving at night

64
Q

Name the d/f types of DM retinopathy

A

Simple retinopathy or Background
Pre proliferative retinopathy
proliferative or malignant retinopathy

65
Q

How Simple retinopathy or Background presents?

A

Micro aneurysms / Hx / Exudates and retinal edema

66
Q

How Pre proliferative retinopathy presents?

A

Cotton wool spots

67
Q

How proliferative or malignant retinopathy presents?

A

newly form vessels

68
Q

How to managed the complications of DM retinopathy?

A

argon laser photocoagulation

69
Q

Triad of Blepharitis

A

b/L Burning or itching of the lids with discharge and crusting

associated with skin disorders

T/m is supportive/ warm compresses/ gentle scrubs / lid massage

70
Q

Triad of Retinoblastoma

A

B/L if inherited and seen in less than 2yrs old

absent red light reflex

Dx is MRI of brain and eyes with no biopsy b/c of seeding

71
Q

Causes of absent red light reflex

3R 1C

A

Retinoblastoma
CMV
Rubella
Retinopathy of prematurity

72
Q

*Triad of Retinitis pigmentosa

A

progressive inherited night blindness
decreased visual acuity
visual field loss

73
Q

Important point of Retinopathy of prematurity

A

retinal detachment causing loss of red reflex

seen in infant born at gestation less than 30 wks

74
Q

How strabismus presents?

A

Asymmetric corneal light and red reflexes
eye deviation with abnormal cover test
dilated fundoscopic to dx the condition

75
Q

Name the condition causing strabismus

A

retinoblastoma

76
Q

Name the complications occur due to Myopia

A

retinal detachment

macular degeneration

77
Q

What is Hyphema?

A

blood within the anterior chamber

78
Q

Causes of Hyphema

A

if spontaneous—> due to bleeding disorder like vWD or DM

blunt trauma

79
Q

what is Pterygium?

A

wedged shaped proliferation of conjunctival tissue that expands from the lateral of the eye
towards the cornea
occur due to UV light exposure

80
Q

Triad of Retinal micro infarctions

A

Occur due to ischemia
associated with HTN and DM
cotton wool spots (yellow white retinal lesion) on fundoscopy

81
Q

Triad of Orbital cellulitis

A

Painful and limited EOM
Proptosis
Dx via CT orbit and brain with IV Abs as a t/m

82
Q

Name the risk factors causing Orbital cellulitis

A

Sinusitis
Orbital trauma
dental caries or trauma

83
Q

Name the causes of neonatal conjunctivitis

A

Chemical
Gonococcal
Chlamydial

84
Q

Triad of Chlamydial neonatal conjunctivitis

A

Age of onset is 5-14 days after birth
Watery/ mucopurulent/ serosangunineous discharge
T/m is PO azomax as it doesn’t cause pyloric stenosis

85
Q

Triad of Gonococcal neonatal conjunctivitis

A

Age of onset is 2-5 days after birth

Profuse purulent discharge with eyelid edema

PPx is erythromycin ointment or t/m is IM 3rd generation cephalosporin

86
Q

Triad of Chemical conjunctivitis

A

Age of onset is within 24 hours after birth

Due to sliver nitrate usage against gonorrhoea result conjunctival irritation and tearing

T/m is eye lubricant

87
Q

How to t/m dacryostenosis (nasolacrimal duct Obs?

A

Messaging the duct

(It present as U/L tearing and Minimal conjunctival tearing without any eye discharge

88
Q

How endophthalmitis presents?

A

Pain and decrease visual acuity
Occurs within 6 wks of eye surgery due to bacterial or fungal
T/m is Intra vitreal ABx injection or vitrectomy is done

89
Q

How orbital compartment syndrome occur?

A

Swelling and hx within the confined orbital space causes rapidly increasing IOP result ischemia
of the optic nerve and globe

90
Q

Triad of Orbital compartment syndrome

A

Acute eye pain with vision loss and limited EOM
Proptosis with peritoneal Edema and rock hard eyelid / APRD
Instant surgical decompression

91
Q

How Open global injury presents?

A

Extrusion of vitreous and eccentric or teardrop pupil
Decrease visual acuity and IOP
RAPD

92
Q

How Open global injury dx?

A

Fluorescein drops—-> if large injury and puncture drops may leaked from punctured site

93
Q

What does gonioscopy measure?

A

Corneal angle

94
Q

How to manage the angle closure glaucoma?

A

Combination multiple topical therapy given like timolol / Apraclonidine / pilocarpine
Given acetazolamide to further reduce aqueous humour
And last laser iridotomy as a definitive treatment

95
Q

Triad of Strabismus

A

Amblyopia

Asymmetric red reflex and corneal light reflex

Tx: Patching the normal eye OR blurring the vision of the normal eye with cycloplegic drops (like atropine)

96
Q

What are the Examination findigns of Strabismus and what complications would occur if untreated?

A
  • Asymmetric Corneal light and red reflex
  • Deviation of eye on covering the unaffected eye

Complication is ambylopia

97
Q

How to manage Strabismus?

A

1) Correction of Refractive error

2) Patching Or atropine (to blur) in unaffected eye as affected get strengthen

Internal Medicine (14 decks)

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