History taking and examination

Question 1

what are microaneurysms

Answer 1

localised outpouchings of capillaries that leak plasma constituents into the retina

Question 2

what are dot and blot haemorrhages

Answer 2

arise from bleeding capillaries

Question 3

what are cotton wool spots

Answer 3

small fluffy white superficial lesions that accumulate from dead nerve cells from ischaemic damage

Question 4

what is neovascularisation

Answer 4

new vessel formation

Question 5

what is rubeosis iridis

Answer 5

neovascularisation on the iris

Question 6

what does pan retinal photocoagulation look like on fundoscopy

Answer 6

punched out appearance widespread over retina

Question 7

what are drusen and in which condition are they seen

Answer 7

lipid deposits seen at the macula in ARMD

Question 8

what is AV nipping and in which condition is it seen

Answer 8

compression of venules at sites of arteriovenous crossing

hypertensive retinopathy

Question 9

how many grades are there in hypertensive retinopathy

Answer 9

1-4

Question 10

what sign makes hypertensive retinopathy grade 4?

Answer 10

optic disc swelling

Question 11

what sign can be seen on fundoscopy in glaucoma

Answer 11

cupping of optic disc

ie increased vertical cup:disc ratio

Question 12

what is papilloedema

Answer 12

optic disc swelling secondary to raised ICP

Question 13

what is the difference between the terms optic disc swelling and papilloedema

Answer 13

optic disc swelling - any cause

papilloedema - as a result of ^ICP

Question 14

sign of optic nerve atrophy on fundoscopy

Answer 14

pale optic disc

Question 15

causes of optic nerve atrophy

Answer 15

glaucoma
inflammation
retinal ischaemia
longstanding papilloedema

Question 16

signs of CRAO on fundoscopy

Answer 16

pale oedematous retina

cherry red spot at fovea

Question 17

signs of CRVO on fundoscopy

Answer 17

tortuous veins
haemorrhages
cotton wool spots
optic disc swelling

Question 18

important points in history to take in visual loss

Answer 18

speed of onset 
pain 
extent of loss 
associated symptoms e.g. flashers and floaters
past ocular history 
PMH

Question 19

what is the blue light on the ophthalmoscope used for

Answer 19

used to examine the front of the eye with fluroscein drops

Question 20

what drops should be administered prior to examination with the ophthalmoscope

Answer 20

mydriatic / dilating drops

e.g. tropicamide 1%

Question 21

if you are examining a patient’s right eye, which eye should you use on the ophthalmoscope

Answer 21

YOUR right eye held with your right hand

Question 22

what is the first thing you should examine with the ophthalmoscope

Answer 22

red reflex

done with the dial at 0 and standing arms length away

Question 23

causes of absent red reflex

Answer 23

cataracts
vitreous haemorrhage
retinal detachment
retinoblastoma

Question 24

after red reflex, what do you dial up your ophthalmoscope to

Answer 24

+10 and come closer to the eye at an angle to observe the external eye structures e.g. cornea, eyelids and lashes
ask the patient to look at the wall behind you

Question 25

after examination of the external eye, what do you do with your ophthalmoscope

Answer 25

dial back down to 0 to get a better view of the back of the eye

Question 26

What process should be followed when examining the fundus

Answer 26

6 point process

• disc
• 4 vascular arcades
• macula

Question 27

what do you assess when looking at the optic disc

Answer 27

cup
colour
contour

Question 28

what are the 4 vascular arcades

Answer 28

superotemporal
superonasal
inferotemporal
inferonasal

Question 29

why is the macula examined last

Answer 29

to avoid patient discomfort

Question 30

when assessing visual fields, glasses can remain on, true or false

Answer 30

false, glasses should be removed

Question 31

what is the first question to ask in visual field testing

Answer 31

is any part of my face missing

or hold up 2 hands

Question 32

describe the steps in visual field assessment

Answer 32

ask the patient to cover one eye (and you cover the eye on the same side)
then ask them to use their open eye to look directly at your open eye
assess quadrants by asking the patient to tell you how many fingers you are holding up
using a white headed pin, bring it in from the periphery to central fields diagonally and ask the patient when they can see it
finally examine blindspot with a red pin, hold pin middway and move temporally, report when it disappears and reappears

Question 33

what is the difference between drusen and exudate

Answer 33

drusen - soft edged pale yellow deposits often occurring in clusters, seen in ARMD
Exudate - well defined deposits, seen in DM and HTN