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Opthalmology > General > Flashcards

General Flashcards

1
Q

what is blepharitis?

A

inflammation of the eyelids

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2
Q

is blepharitis usually unilateral or bilateral ?

A

bilateral

if unilateral could be lid tumour

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3
Q

what disease is associated w blepharitis?

A

rosacea

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4
Q

name some lid hygiene techniques used to treat blepharitis?

A

warm compresses
lid massage
lid cleansing

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5
Q

name 3 management points of blepharitis

A

lid hygiene
tear substitutes e.g. hypromellose
chloramphenicol ointment

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6
Q

what is the episclera?

A

thin vascular tissue btw conjunctiva and sclera

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7
Q

“your eye looks a bit red Gary” - others notice red eye - likey to be…

A

episcleritis

mild

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8
Q

what is management of episcleritis

A

reassurance. better in 1-2wks. oral NSAIDs if pain.

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9
Q

dark red eye in older person w PMH autoimmune. on ex its swollen and painful. thinking?

A

scleritis

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10
Q

a pyogenic infection at the follice of eyelash. what’s this?

A

stye

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11
Q

what is a stye?

A

pyogenic infection at follicle of eyelash

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12
Q

what is most likely organism causing stye

A

s.aureus. more likely w blepharitis

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13
Q

if a stye is recurrent, you might think of investigating for what?

A

diabetes

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14
Q

name some ways to manage a stye

A

self limiting. burst in 4ds. hot compresses , avoid contact lens and eye make up. pull out eyelash may help drain.

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15
Q

hordeolum aka

A

stye

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16
Q

what is a chalazion?

A

blockage of meibomian gland –> oily cyst deeper in eyelid

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17
Q

blockage of meibomian gland = what

A

chalazion

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18
Q

what is a rare complication of chalazion

A

orbital cellulitis

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19
Q

management of chalazion?

A

hot compress and massage cyst

if chronic excise and drain under local

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20
Q

two other names for dry eyes

A

keratoconjunctivitis sicca

xeropthalmia (in vit A def)

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21
Q

what do tears do?

A

complex solution of water protein salts lipids mucins

oxygenate and lubricate ocular surface

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22
Q

which glands produce the different components of tears?

A

lacrimal glands - aqueous
meibomian - lipid
conjuncitval goblet - mucous

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23
Q

which cells produce the mucuous layer of tears?

A

conjunctival goblet cells

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24
Q

which glands produce the aqeous layer of tears?

A

lacrimal glands

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25
Q

which glands produce the lipid layer of tears?

A

meibomian

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26
Q

name some causes of dry eyes

A

Sjogrens syndrome
drugs (anticholinergics, antidepressants)
eye disease (conjunctivitis, blepharitis)
facial nerve palsy / parksinsons (blink on the blink)
contact lenses!
vit A def

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27
Q

vit A def cause of dry eyes true or false

A

true. xeropthalmia.

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28
Q

why does facial nerve palsy and parkinsons cause dry eyes

A

blink on the blink

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29
Q

important parts of history in someone w dry eyes

A

drug Hx!

ask about contact lenses!

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30
Q

what is the treatment for dry eyes?

A

TEAR SUBSTITUTES E.G. HYPROMELLOSE DROPS

med rv, avoid contact lenses

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31
Q

name the two bits of conjunctiva

A

palpebral conjunctiva

bulbar conjunctiva

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32
Q

commonest viral cause of conjunctivties

A

adenovirus

plus systemic illness + sore throat

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33
Q

3 categories of conjunctivitis causes

A

viral
allergic
bacterial

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34
Q

commonest cause of bac conjunctivitis in adults

A

staph aureus

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35
Q

commonest cause of bac conjunctivitis in neonates

A

chlamydia/gonorrhoea

opthalmia neonatorum = conjunctivitis in first 28ds of life

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36
Q

tell me about what you can learn from the discharge in conjunctivitis

A 
serous = viral
mucus = allergic
purulent = bacterial
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37
Q

23yr old presents with red eye. discharging serous watery fluid. he has sore throat. most likely type of conjunctivits?

A

viral

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38
Q

27yr old presents with red eye. discharging mucus fluid and itchy.. likely type of conjunctivitis?

A

allergic

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39
Q

22yr old presents w red eye. discharging purulent fluid. most likely type of conjunctivitis?

A

bacterial

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40
Q

should the cornea look ok in conjunctivits?

A

yes

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41
Q

when do you refer to opthalm w conjunctivitis?

A

neonatal
severe purulent
non-response to treatment

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42
Q

mostly treatment of conjunctivits is just self-limiting and reassurance. if bac, you might add what? if allergic, you might add what?

A

bac - ?chloramphenicol

allergic - ?topical antihistamines

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43
Q

is episcleritis usually painful?

A

no

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44
Q

epicleritis and conjunctivitis are two acute non-painful causes of red eye. give me 4 acute PAINFUL causes.

A

acute angle closure glaucoma
acute anterior uveitis
keratitis
scleritis

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45
Q

62 yr old presents w nausea and vomiting, headache and a painful red eye. she has an OVAL pupil, HAZY cornea, and eye feels HARD. She has blurred vision with a HALO around light sources. what do you do?

A

refer IMMEDIATELY

acute angle closure glaucoma

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46
Q

OVAL HAZY HARD HALO what does this make you think of

A

acute angle closure glaucoma

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47
Q

inflammation of cornea = what?

A

keratitis

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48
Q

what is keratitis?

A

inflammation of cornea

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49
Q

name some signs of acute angle closure glaucoma

A 
systemically unwell
hard eye
oval pupil
hazy cornea
halo around light sources
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50
Q

aqueous humour can’t drain, so iris pushed up against cornea by fluid and increased pressure. what’s this?

A

acute angle closure glaucoma

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51
Q

how soon do you refer acute angle closure glaucoma to opthalm

A

IMMEDIATEMENT

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52
Q

keratitis is infl of cornea. can be bac, fungal or viral. what sign might you see?

A

hypopyon

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53
Q

what is hypopyon?

A

pus in anterior chamber

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54
Q

uvea is made up of what?

A

iris
ciliary body
choroid

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55
Q

iris, ciliary body and choroid = what?

A

uvea

vascular layer of eye

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56
Q

32 yr old with UC and ank spond presents w painful red eye, and pain on accomodating. she has an irregular pupil with keratitic precipitates. what do you do?

A

anterior uveitis

refer within 24hrs

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57
Q

how soon do you refer anterior uveitis to opthalm

A

within 24hrs

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58
Q

how soon do you refer keratitis to opthalm

A

within 24hrs

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59
Q

inflammation of the whites of the eye (sclera) = what?

A

scleritis

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60
Q

70 yr old present w red eye and a severe borrring type pain, radiating to forehead. it is dark red. he has a diagnosis of Wegener’s granulomatosis. what do you do?

A

scleritis

refer within 24hrs

61
Q

what is enopthalmitis?

A

infl of interior of eye

62
Q

what is inflammation of the interior of the eye?

A

endopthalmitis

63
Q

when can endopthalmitis happen?

A

after cataract surgery, in penetrating trauma, in imm comp

64
Q

25 yr old stuck a fence in his eye and now has severe pain, redness, loss of vision and a hypopyon. what does he need?

A

immediate referral for Abx

endopthalmitis

65
Q

scratched your eye w contact lenses. what’s this?

A

corneal abrasion

if contact lens might be infected w pseudomonas

66
Q

bilateral red eye is usually less serious than unilateral, true or false?

A

true

pain and loss of vision and unilateral often mean cause is serious (i.e. not episcleritis, conjunctivits)

67
Q

name 3 common causes of gradual loss of vision

A

cataracts
chronic open angle glaucoma
macular degeneration

68
Q

which TORCH infection is most likely to cause congenital cataracts

A

rubella

69
Q

name 3 risk factors for cataracts

A

ageing, corticiosteroid use, malnutrition

indian

70
Q

what is a cataract?

A

opacity in lens

clouding caused by protein aggregation

71
Q

what might you see on examination of cataract

A

defect in red reflex

looks white/brown when light shone on

72
Q

nuclear sclerosis, cortical, posterior subscapular are all types of what

A

cataract

73
Q

what is the surgery for cataracts?

A

lens extraction and replacement

74
Q

what is the commonest type of gluacoma?

A

chronic open angle glaucoma

75
Q

where does the aqueous humour leave the eye

A

through the trabecular meshwork

this is the angle

76
Q

what is the pathopysciolog of glaucome

A

dodgy optic nerve assoc w raised intracoular pressure

77
Q

name some RFs for chronic open angle glaucooma

A

> 65yrs, FHx, afro-caribbean

78
Q

do you lose visual acuity or visual field in chronic open angle glaucoma?

A

visual FIELD

painless progressive loss of visual field

79
Q

tunnel vision but good visual acuity makes you think of

A

chronic open angle glaucoma

80
Q

what might you see on fundoscopy in chronic open angle glaucoma

A

optic disc cupping

81
Q

what test might you do to test intra ocular pressure in chronic open angle glaucoma

A

tonometry

82
Q

visual field, once lost, is lost forever. in what disease?

A

chronic open angle glaucoma

83
Q

describe the management of chronic open angle glaucoma

A

refer - drops (e.g. timolol) /laser therapy / surgery

84
Q

what is the macula?

A

part of retina
where visual acuity is highest
contains fovea centralis

85
Q

what is dry AMD?

A

atrophy of retina

86
Q

what is wet amd?

A

new vessel growth in choroid

87
Q

name a symptom of dry AMD?

A

central scotoma

88
Q

name a symptom of wet AMD?

A

distortion

89
Q

how do you check for distortion in wet AMD?

A

Amsler chart

90
Q

drusen in retina are waste materials that collect in retinal epi. make you think of what?

A

AMD

91
Q

68 yr old smoker presents with gradual painless loss of central vision but preseved peripheral vision. what do you do?

A

urgent referral <1wk

AMD

92
Q

why do you do urgent referral for AMD

A

because for wet AMD prompt treatment can preserve vision

93
Q

name a risk factor for AMD

A

smoking

94
Q

what is the treatment for wet AMD

A

intravitreal injections anti-VEGF

95
Q

which form of AMD is more common?

A

dry AMD (90%)

96
Q

name 4 causes of sudden loss of vision

A

vascular (retinal artery/vein occlusion/AION)
optic neuritis
retinal detachment
vitreous haemorrhage

97
Q

name 3 VASCULAR causes of sudden visual loss

A

retinal artery occlusion
retinal vein occlusion
anterior ischaemic optic neuropathy

98
Q

retinal artery occlusions are mainly central, while retinal vein occlusions mainly branch. true or false?

A

true

99
Q

what causes retinal artery occlusion?

A

atherosclerosis/emboli from carotid or heart

100
Q

name two signs of retinal artery occlusion

A

RAPD

cherry spot on fovea

101
Q

how does retinal artery occlusion?

A

sudden unilateral painless vision loss

102
Q

can you get vision back from retinal artery occlusion?

A

:( vision once lost is lost forever

103
Q

how would you manage retinal artery occlusion?

A

emergency referral

secondary prevention of stroke/MI - carotid doppler, dual antiplts, carotid endarterectomy

104
Q

amaurosis fugax and retinal artery occlusion are both sudden painless unliteral vision loss. what is the difference?

A

amaurosis fugax resolves completely, lasts ~30mins

‘curtain coming down’

105
Q

investigation after amaurosis fugax?

A

carotid doppler

dual antiplts

106
Q

name three causes of transient obscurations.

A
  • amaurosis fugax (TIA)
  • GCA
  • papilloedema
107
Q

name two key difference between retinal artery and retinal vein occlusion?

A

retinal artery: always RAPD
retinal vein: sometimes

retinal artery: blackout
retinal vein: blurry

108
Q

what might you see on fundoscopy with retinal vein occlusion?

A

flame haemorrhages and tortuosity

109
Q

name 2 causes of anterior ischaemic optic neuropathy causing sudden painless unilateral vision loss

A

giant cell arteritis

general CV rfs

110
Q

what investigations would you do for suspected AION

A

ESR, temporal artery biopsy

111
Q

what treatment do you give for AION caused by GCA?

A

high dose prednisolone

+ low dose aspirin
emergency referral

112
Q

name 2 signs of AION

A

RAPD

pale/oedematous optic disc

113
Q

optic neuritis trio?

A

vision loss
colour loss
eye pain

114
Q

is optic neuritis painful?

A

YES

115
Q

apart from MS, name some secondary causes of anterior ischaemic optic neuropathy?

A

TB, syphilis, B12 def, lyme

116
Q

name 3 signs on examination of optic neuropathy

A

RAPD
decreased visual acuity
decreased colour vision

117
Q

investigations in optic neuritis?

A

MRI brain

LP

118
Q

many patients w optic neuritis DONT go on to develop MS. true or false?

A

true

119
Q

treatment for optic neuritis ?

A

oral methylprednisolone (speeds recovery but doesnt affect outcome)

120
Q

in retinal detachment the retina gets detached from the layer below. this can be due to age or diabetic retinopathy. name three symptoms?

A

floaters
flashers
curtain / shadow - starts in peripheries

121
Q

sudden onset painless loss of visual field, shadow starts in peripheries - makes you think of?

A

retinal detachement

emergency referral

122
Q

blood leaks intro vitreous humour. what’s this?

A

vitreous haemorrahge

123
Q

what is the main cause of vitreous haemorrhage

A

DIABETIC RETINOPATHY

can also be precipitated by retinal detachment, posterior vitreous detachment or trauma

124
Q

sudden painless unilateral vision loss w floaters in patient w diabetic retinopathy, could be what

A

vitreous detachment

retinal haemorrhage

125
Q

silver wiring makes you think of

A

hypertensive retinopathy

126
Q

name some signs of diabetic retinopathy

A

hard exudates
cotton wool spots (ischaemia)
blot haemorrhages
new vessels

127
Q

sudden painless unilateral vision loss w floaters in patient w diabetic retinopathy, could be what

A

vitreous detachment

retinal haemorrhage

128
Q

silver wiring makes you think of

A

hypertensive retinopathy

129
Q

name some signs of diabetic retinopathy

A

hard exudates
cotton wool spots (ischaemia)
blot haemorrhages
new vessels

130
Q

what can you use to dilate pupils in opthalmoscopy?

A

tropicamide drops

131
Q

what four things do you look at on opthalmoscopy?

A

red reflex
optic disc
vessels
macula

132
Q

name a condition in which u may not see red reflex

A

cataracts

133
Q

what do you look for when youre looking at the optic disc

A

Colour
Contour
Cup
Circulation

134
Q

sudden painless unilateral vision loss w floaters in patient w diabetic retinopathy, could be what

A

vitreous detachment

retinal haemorrhage

135
Q

silver wiring makes you think of

A

hypertensive retinopathy

136
Q

name some signs of diabetic retinopathy

A

hard exudates
cotton wool spots (ischaemia)
blot haemorrhages
new vessels

137
Q

what can you use to dilate pupils in opthalmoscopy?

A

tropicamide drops

138
Q

where is the macula in relation to the optic disc

A

temporal

139
Q

name a condition in which u may not see red reflex

A

cataracts

140
Q

what do you look for when youre looking at the optic disc

A

Colour
Contour
Cup
Circulation

141
Q

Colour
Contour
Cup
Circulation

is what you look for when?

A

when looking at optic disc in opthalmoscopy

142
Q

there is cupping of the optic disc.

A

glaucoma

143
Q

there is new vessels on the optic disc.

A

diabetic retinopathy

144
Q

there is blurred margins on the optic disc.

A

papilloedema

145
Q

the optic disc is pale.

A

optic atrophy

146
Q

the optic disc is blue

A

normal in BAME pops

147
Q

what is the dot in the middle of the macula

A

fovea

148
Q

tip to find the macula on opthalmoscopy

A

ask them to look directly into the light

Opthalmology (1 decks)

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