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Eyes And Ears Flashcards

1
Q

RFs for cataracts?

A

Female
DM
Steroid use
Eye trauma, UV exposure, uveitis

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2
Q

3 types of acquired cataracts?

A

Central (posterior subcapsular)
Nuclear sclerosis
Cortical

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3
Q

Infections that can cause congenital cataracts?

A

TORCH

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4
Q

Childhood metabolic abnormality associated with cataracts?

A

Galactosaemia

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5
Q

Classical symptoms of cataracts?

A

Painless loss of visual acuity, often initially presenting as reading difficulties
Trouble recognising faces, reading, watching TV etc.
If central - can cause glare and near-vision deterioration

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6
Q

Best sign on examination of eyes of cataracts?

A

Absent or defective red reflex

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7
Q

Does pinholing improve vision in cataracts?

A

No

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8
Q

What cataract is typically associated with DM?

A

Peripheral cortical

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9
Q

Surgical technique used in repairing cataracts?

A

Phaecoemulsification

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10
Q

Important consideration to be made regarding cataracts and driving?

A

Does it interfere? Do DVLA need to be informed?

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11
Q

What is glaucoma?

A

A group of conditions resulting in damage to the optic nerve head and hence loss of the visual field, typically associated with raised intraocular pressure

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12
Q

What is the affected anatomical part of the eye in glaucoma?

A

Optic nerve head

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13
Q

What is the most common type of glaucoma?

A

Primary open angle glaucoma

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14
Q

Mechanism behind raised IOP causing glaucoma?

A

Compression of the microvasculature of the optic nerve head

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15
Q

Progression of primary open angle glaucoma?

A

Starts peripherally and works inwards - by the time symptoms are manifest the optic nerve may be 90% damaged

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16
Q

RFs generally for glaucoma?

A 
DM
Black ethnicity
Raised IOP
Myopia
FH
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17
Q

What is the measurement of the irido-corneal angle called?

A

Gonioscopy

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18
Q

What ‘angle’ is affected in glaucoma?

A

Irido-corneal angle

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19
Q

What is tonometry?

A

Objective measurement of IOP (normally 10-21)

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20
Q

What method is used to measure IOP?

A

Tonometry

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21
Q

What key pathological changes are observed in the optic disc in glaucoma?

A

Increasing cup:disc ratio - neuroretinal ring

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22
Q

What is the ‘precursor’ to glaucoma?

A

Ocular hypertension

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23
Q

What findings on examination and investigation indicate primary open angle glaucoma?

A

Tonometry indicating IOP>21 at least once
Open iridocorneal angle
Glaucomatous optic neuropathy indicated on optic disc examination by increasing cup:disc ratio
-> VFD compatible with this damage

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24
Q

Findings in terms of VFDs as POAG progresses?

A

Mild VFDs
Arcuate scotoma, thinning of neuroretinal ring (cupping)
Extensive VFDs accompanied by cup:disc ratio 0.9-1

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25
Management options for POAG?
Prostaglandin analogues (latanoprost) B blockers Carbonic anhydrase inhibitors Sympathomimetics
26
What side effect can prostaglandin analogue drops have on the eye?
Turn iris/brown
27
What is primary angle-closure glaucoma?
Intrinsically narrow iridocorneal angle which causes predisposition to angle closure and acutely raised IOP
28
5 stages of primary angle closure glaucoma?
``` Latent (anatomical predisposition) Subacute Acute Chronic Absolute ```
29
What can secondary angle closure glaucoma be due to?
Hyphaema, DM retinopathy, hypertensive uveitis
30
Presentation of acute primary angle closure glaucoma?
Pain - orbital/frontal, generalised headache Blurred vision leading to loss, some Hx of subacute attacks Systemic signs - nausea, vomiting
31
What can precipitate the onset of acute angle closure glaucoma?
Dilation of the pupil - pupil gets caught mid-dilated
32
Examination signs of primary angle closure glaucoma?
Generally unwell Non or minimally reactive pupil, mid-dilated Red eye, hazy cornea Raised IOP
33
RFs for normal tension glaucoma?
Raynaud's phenomenon Migraines Paraproteinaemia
34
What is the most common cause of cataracts?
Age-related lens deterioration and opacification
35
What cataract is typically associated with steroid use?
Central (posterior subcapsular) cataract
36
What is the 'ageing' cataract?
Nuclear cataract
37
How is a patient's visual acuity recorded when using a Snellen chart?
E.g. 6/10 | Patient distance/lowest line they can read
38
'Extra' eye tests that you say you'd do?
``` Near vision testing Colour vision Blind spot Central fields Ocular alignment and nystagmus ```
39
What does a lesion in the optic chiasm cause?
Bitemporal hemianopia
40
What does a lesion in the optic tract cause?
A Contralateral homonymous hemianopia
41
What lesion gives a pie in the sky Contralateral deficit?
A lesion in the lower optical radiations in the temporal lobe
42
What lesion gives a Contralateral lower quadrant visual field deficit?
Lesion in the upper optic radiations in the parietal lobe
43
What does an occipital or posterior parietal lobe lesion cause in terms of VFD?
Contralateral homonymous hemianopia with macular sparing
44
What is the word for one pupil being bigger than the other?
Anisocoria
45
What does a full CN3 lesion cause?
A down and out lesion of the eye Ptosis Mydriosis
46
Causes of periorbital swelling?
``` Periorbital cellulitis Angioedema CCF, nephrotic syndrome Allergic eye disease Thyroid eye disease ```
47
3 causes of ptosis?
Horners syndrome CN3 lesion MG
48
What does eye movement pain with a white eye suggest?
Optic neuritis
49
Common cause of 'feeling like there's something in your eye'/dry eyes?
Blepharitis
50
What does ocular pain and a red eye suggest?
Scleritis
51
What type of chronic visual impairment predisposes to acute angle closure glaucoma?
Hypermetropism (long sightedness)
52
Common causes of unilateral acute visual loss?
Retinal artery/vein occlusion
53
What are haloes associated with?
Angle closure glaucoma
54
What may flashes and floaters precede?
Retinal detachment
55
What is cortical blindness?
Often unilateral visual loss with a cortical cause e.g. POCS | Vision absent however pupillary reflexes present in the affected eye +/- macular sparing
56
What is Riddoch syndrome in the context of cortical blindness?
Ability to perceive light or movement subconsciously but not static objects
57
What about diabetes particularly are the 2 most important risk factors for developing retinopathy?
Duration | Control
58
What are the two stages of non-proliferative DM retinopathy?
Background | Maculopathy
59
What is the first stage of DM retinopathy?
Background retinopathy
60
What 4 peripheral features on fundoscopy are characteristic of background DM retinopathy?
Microaneurysms (bobbly arteries) Retinal haemorrhage - flame (superficial) or dot/blot (deep) Hard exudates (oedema and lipid deposition) Cotton wool spots (soft exudates) - microinfarcts
61
What feature of background DM retinopathy is suggestive of forthcoming proliferative disease?
Cotton wool spots (microinfarcts)
62
Signs associated with diabetic maculopathy?
Central damage causing visual blurring | Oedema, ischaemia
63
What sign is typically associated with pre-proliferative DM eye disease?
Venous beading
64
What does venous beading indicate on fundoscopy?
Pre-proliferative DM disease
65
Characteristics of proliferative DM retinopathy?
VEGF production causing neovasculature, maculopathy and blurring
66
Two grades that are given on DM eye screening?
R (retina) 0-3 | M (macular) 0 or 1
67
Features of chronic hypertensive retinopathy?
Permanent arterial narrowing AV nicking Arteriosclerosis -> copper and silver wiring
68
What in hypertensive retinopathy is a major RF for branch retinal vein occlusion?
AV nicking
69
Features of acute severe hypertensive eye disease?
Haemorrhage - flame and dot/blot Cotton wool spots Hard exudates Optic disc oedema
70
What is the most common type of ARMD and how does it present?
Dry - slowly progressive blurring with less central visual loss Reading problems, blurring, difficulty recognising faces etc.
71
What investigative findings support a diagnosis of dry AMD?
Atrophic or hyper pigmented retinal pigment epithelium | Flat configuration on OCT
72
Management of dry AMD?
Stop smoking | Low vision aids, dietary advice?
73
What characterises wet AMD?
More abrupt onset | Signs associated with proliferative retinopathy - VEGF production, haemorrhages, leakage and scarring
74
What investigative findings support a diagnosis of wet AMD?
Subretinal fluid on OCT and retinal thickening
75
What is the major management of wet AMD?
Lucentis (anti-VEGF) | Can halt progression and even reverse if done early enough
76
2 investigations used for AMD?
IVFA (intravenous fluroscein angiography) for differentiation between the two types OCT (optical coherence tomography) is less invasive and good for looking at layers
77
4 main symptoms to enquire about in ear history?
Pain and itch (otalgia/pruritis) Otorrhoea Deafness and tinnitus Vestibular - vertigo and dizziness
78
Common causes of ear pain and itch?
OM, OE, Ramsey Hunt, trauma, Cancer
79
Where can pain refer to the ear from?
Tonsillitis/pharyngitis | TMJ dysfunction
80
Purulent otorrhoea causes?
OE/CSOM
81
Causes of Mucoid otorrhoea?
Eardrum perf/CSF leak
82
What does bloodstained otorrhoea suggest?
Trauma - leaking granulation tissue
83
Common causes of tinnitus?
Presbyacusis | Noise-related damage
84
Is vertigo normally Central or peripheral?
Peripheral
85
4 common causes of peripheral vertigo?
BPPV Acute labyrinthitis/vestibular neuronitis Ménière's disease Drug induced e.g. Gentamycin
86
Discuss acute labyrinthitis/vestibular neuronitis?
Acute onset vertigo goes on for a few days, may be associated with nausea vomiting malaise and ataxia but no hearing loss or tinnitus
87
Discuss BPPV?
Vertigo attacks triggered by laying on the affected ear, no other focal ear signs
88
Discuss Ménière's disease?
Recurrent vertigo, persistent tinnitus and progressive SN hearing loss
89
Central causes of vertigo?
Migraine CVA MS
90
What does otorrhoea with no TM retraction or perforation suggest?
OE
91
In which direction does the cone of light point on the TM?
Anteriorly
92
Signs of AOM on otoscopy?
Retraction of TM Redness Perf +/- otorrhoea
93
What does a bulging TM suggest?
Fluid behind the TM - OME, middle ear effusion
94
What frequency of tuning fork is used in Rinne's/Webers?
512 Hz
95
Abnormal results in Weber's test?
Lateralisation towards a conductive loss, away from a SN loss May be equal if bilateral hearing loss
96
Which tuning fork test is more sensitive for a conductive hearing loss?
Weber's
97
What is a positive Rinne's test?
AC>BC - can be falsely positive in case of SN loss
98
What is a negative Rinne's and what does it indicate?
BC>AC, indicating a conductive hearing deficit
99
Common causes of conductive hearing loss?
``` Wax Eardrum perforation Middle ear effusion OE/OM Ossicular trauma Middle ear tumours Otosclerosis ```
100
Potentially inheritable cause of conductive hearing loss?
Otosclerosis
101
Common causes of SN hearing loss?
Can be genetic or congenital e.g. TORCH infection Infection - measles, mumps, meningitis Presbyacusis or noise-related degeneration (+tinnitus) Trauma Ménière's disease Acoustic neuroma

Revision Qs (28 decks)

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