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Revision Qs > Eyes And Ears > Flashcards

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
Q

Management options for POAG?

A

Prostaglandin analogues (latanoprost)
B blockers
Carbonic anhydrase inhibitors
Sympathomimetics

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26
Q

What side effect can prostaglandin analogue drops have on the eye?

A

Turn iris/brown

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27
Q

What is primary angle-closure glaucoma?

A

Intrinsically narrow iridocorneal angle which causes predisposition to angle closure and acutely raised IOP

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28
Q

5 stages of primary angle closure glaucoma?

A 
Latent (anatomical predisposition)
Subacute
Acute
Chronic
Absolute
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29
Q

What can secondary angle closure glaucoma be due to?

A

Hyphaema, DM retinopathy, hypertensive uveitis

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30
Q

Presentation of acute primary angle closure glaucoma?

A

Pain - orbital/frontal, generalised headache
Blurred vision leading to loss, some Hx of subacute attacks
Systemic signs - nausea, vomiting

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31
Q

What can precipitate the onset of acute angle closure glaucoma?

A

Dilation of the pupil - pupil gets caught mid-dilated

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32
Q

Examination signs of primary angle closure glaucoma?

A

Generally unwell
Non or minimally reactive pupil, mid-dilated
Red eye, hazy cornea
Raised IOP

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33
Q

RFs for normal tension glaucoma?

A

Raynaud’s phenomenon
Migraines
Paraproteinaemia

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34
Q

What is the most common cause of cataracts?

A

Age-related lens deterioration and opacification

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35
Q

What cataract is typically associated with steroid use?

A

Central (posterior subcapsular) cataract

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36
Q

What is the ‘ageing’ cataract?

A

Nuclear cataract

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37
Q

How is a patient’s visual acuity recorded when using a Snellen chart?

A

E.g. 6/10

Patient distance/lowest line they can read

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38
Q

‘Extra’ eye tests that you say you’d do?

A 
Near vision testing
Colour vision
Blind spot 
Central fields
Ocular alignment and nystagmus
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39
Q

What does a lesion in the optic chiasm cause?

A

Bitemporal hemianopia

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40
Q

What does a lesion in the optic tract cause?

A

A Contralateral homonymous hemianopia

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41
Q

What lesion gives a pie in the sky Contralateral deficit?

A

A lesion in the lower optical radiations in the temporal lobe

42
Q

What lesion gives a Contralateral lower quadrant visual field deficit?

A

Lesion in the upper optic radiations in the parietal lobe

43
Q

What does an occipital or posterior parietal lobe lesion cause in terms of VFD?

A

Contralateral homonymous hemianopia with macular sparing

44
Q

What is the word for one pupil being bigger than the other?

A

Anisocoria

45
Q

What does a full CN3 lesion cause?

A

A down and out lesion of the eye
Ptosis
Mydriosis

46
Q

Causes of periorbital swelling?

A 
Periorbital cellulitis
Angioedema
CCF, nephrotic syndrome
Allergic eye disease
Thyroid eye disease
47
Q

3 causes of ptosis?

A

Horners syndrome
CN3 lesion
MG

48
Q

What does eye movement pain with a white eye suggest?

A

Optic neuritis

49
Q

Common cause of ‘feeling like there’s something in your eye’/dry eyes?

A

Blepharitis

50
Q

What does ocular pain and a red eye suggest?

A

Scleritis

51
Q

What type of chronic visual impairment predisposes to acute angle closure glaucoma?

A

Hypermetropism (long sightedness)

52
Q

Common causes of unilateral acute visual loss?

A

Retinal artery/vein occlusion

53
Q

What are haloes associated with?

A

Angle closure glaucoma

54
Q

What may flashes and floaters precede?

A

Retinal detachment

55
Q

What is cortical blindness?

A

Often unilateral visual loss with a cortical cause e.g. POCS

Vision absent however pupillary reflexes present in the affected eye +/- macular sparing

56
Q

What is Riddoch syndrome in the context of cortical blindness?

A

Ability to perceive light or movement subconsciously but not static objects

57
Q

What about diabetes particularly are the 2 most important risk factors for developing retinopathy?

A

Duration

Control

58
Q

What are the two stages of non-proliferative DM retinopathy?

A

Background

Maculopathy

59
Q

What is the first stage of DM retinopathy?

A

Background retinopathy

60
Q

What 4 peripheral features on fundoscopy are characteristic of background DM retinopathy?

A

Microaneurysms (bobbly arteries)
Retinal haemorrhage - flame (superficial) or dot/blot (deep)
Hard exudates (oedema and lipid deposition)
Cotton wool spots (soft exudates) - microinfarcts

61
Q

What feature of background DM retinopathy is suggestive of forthcoming proliferative disease?

A

Cotton wool spots (microinfarcts)

62
Q

Signs associated with diabetic maculopathy?

A

Central damage causing visual blurring

Oedema, ischaemia

63
Q

What sign is typically associated with pre-proliferative DM eye disease?

A

Venous beading

64
Q

What does venous beading indicate on fundoscopy?

A

Pre-proliferative DM disease

65
Q

Characteristics of proliferative DM retinopathy?

A

VEGF production causing neovasculature, maculopathy and blurring

66
Q

Two grades that are given on DM eye screening?

A

R (retina) 0-3

M (macular) 0 or 1

67
Q

Features of chronic hypertensive retinopathy?

A

Permanent arterial narrowing
AV nicking
Arteriosclerosis -> copper and silver wiring

68
Q

What in hypertensive retinopathy is a major RF for branch retinal vein occlusion?

A

AV nicking

69
Q

Features of acute severe hypertensive eye disease?

A

Haemorrhage - flame and dot/blot
Cotton wool spots
Hard exudates
Optic disc oedema

70
Q

What is the most common type of ARMD and how does it present?

A

Dry - slowly progressive blurring with less central visual loss
Reading problems, blurring, difficulty recognising faces etc.

71
Q

What investigative findings support a diagnosis of dry AMD?

A

Atrophic or hyper pigmented retinal pigment epithelium

Flat configuration on OCT

72
Q

Management of dry AMD?

A

Stop smoking

Low vision aids, dietary advice?

73
Q

What characterises wet AMD?

A

More abrupt onset

Signs associated with proliferative retinopathy - VEGF production, haemorrhages, leakage and scarring

74
Q

What investigative findings support a diagnosis of wet AMD?

A

Subretinal fluid on OCT and retinal thickening

75
Q

What is the major management of wet AMD?

A

Lucentis (anti-VEGF)

Can halt progression and even reverse if done early enough

76
Q

2 investigations used for AMD?

A

IVFA (intravenous fluroscein angiography) for differentiation between the two types
OCT (optical coherence tomography) is less invasive and good for looking at layers

77
Q

4 main symptoms to enquire about in ear history?

A

Pain and itch (otalgia/pruritis)
Otorrhoea
Deafness and tinnitus
Vestibular - vertigo and dizziness

78
Q

Common causes of ear pain and itch?

A

OM, OE, Ramsey Hunt, trauma, Cancer

79
Q

Where can pain refer to the ear from?

A

Tonsillitis/pharyngitis

TMJ dysfunction

80
Q

Purulent otorrhoea causes?

A

OE/CSOM

81
Q

Causes of Mucoid otorrhoea?

A

Eardrum perf/CSF leak

82
Q

What does bloodstained otorrhoea suggest?

A

Trauma - leaking granulation tissue

83
Q

Common causes of tinnitus?

A

Presbyacusis

Noise-related damage

84
Q

Is vertigo normally Central or peripheral?

A

Peripheral

85
Q

4 common causes of peripheral vertigo?

A

BPPV
Acute labyrinthitis/vestibular neuronitis
Ménière’s disease
Drug induced e.g. Gentamycin

86
Q

Discuss acute labyrinthitis/vestibular neuronitis?

A

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
Q

Discuss BPPV?

A

Vertigo attacks triggered by laying on the affected ear, no other focal ear signs

88
Q

Discuss Ménière’s disease?

A

Recurrent vertigo, persistent tinnitus and progressive SN hearing loss

89
Q

Central causes of vertigo?

A

Migraine
CVA
MS

90
Q

What does otorrhoea with no TM retraction or perforation suggest?

A

OE

91
Q

In which direction does the cone of light point on the TM?

A

Anteriorly

92
Q

Signs of AOM on otoscopy?

A

Retraction of TM
Redness
Perf +/- otorrhoea

93
Q

What does a bulging TM suggest?

A

Fluid behind the TM - OME, middle ear effusion

94
Q

What frequency of tuning fork is used in Rinne’s/Webers?

A

512 Hz

95
Q

Abnormal results in Weber’s test?

A

Lateralisation towards a conductive loss, away from a SN loss
May be equal if bilateral hearing loss

96
Q

Which tuning fork test is more sensitive for a conductive hearing loss?

A

Weber’s

97
Q

What is a positive Rinne’s test?

A

AC>BC - can be falsely positive in case of SN loss

98
Q

What is a negative Rinne’s and what does it indicate?

A

BC>AC, indicating a conductive hearing deficit

99
Q

Common causes of conductive hearing loss?

A 
Wax
Eardrum perforation
Middle ear effusion
OE/OM
Ossicular trauma
Middle ear tumours
Otosclerosis
100
Q

Potentially inheritable cause of conductive hearing loss?

A

Otosclerosis

101
Q

Common causes of SN hearing loss?

A

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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