JB-Opthalmology

Question 1

What is glaucoma

Answer 1

Damage to the optic nerve normally by a significant rise in intraocular pressure

Question 2

Definition of open angle glaucoma

Answer 2

Gradual rise in resistance through trabecular meshwork -> increased pressure

Question 3

Key change on fundoscopy in glaucoma

Answer 3

Cupping of optic disc (greater than 0.5) abnormal

Question 4

4 risk factors for open angle glaucoma

Answer 4

Age, FH, black, myopia (nearsightedness)

Question 5

What is myopia

Answer 5

Nearsighted/ short sighted
Cannot see things far away clearly
[shorter word than hypermetropia]

Question 6

Two ways to measure intraocular pressure

Answer 6

Non-contact (puff of air)
Goldmann applanation (gold standard but need slip light)

Question 7

Visual loss in glaucoma

Answer 7

Peripheral -> tunnel vision

Question 8

Open angle glaucoma first line treatment

Answer 8

Prostaglandin analogue eyedrops (lantoprost)
Increase uveoscleral outflow
Eyelash growth, eyelid pigmentation, iris browning

Question 9

Open angle glaucoma management

Answer 9

1:Prostaglandin analogue eyedrops (lantoprost) - increase outflow
2:BB (timolol) - decrease production
3: carbonic anhydrase inhibitor (dorzolamide) - decrease production
4: sympathomimetics (brimonidine) - decrease production
Trabeculectomy

Question 10

Screening in open angle glaucoma

Answer 10

Annual from 40 if 1st line relative

Question 11

Pathophysiology of closed angle glaucoma

Answer 11

Iris bulges forward and seals off trabecular meshwork from anterior chamber -> fluid cannot drain away -> increased pressure

Question 12

Medications which can precipitate acute angle closure glaucoma

Answer 12

Adrenergic (adrenaline), anticholinergic (oxybutynin) and TCAs

Question 13

4 symptoms of AACG

Answer 13

Painful red eye
Blurred vision
Halos around lights
Headaches (nausea and vommiting)

Question 14

Signs in AACG

Answer 14

Red, teary, hazy cornea, fixed and dilated pupil, firm on palpation

Question 15

3 key management steps in AACG

Answer 15

Pilocarpine (mitotic agent to increase room around iris)
Acetazolamide (carbonic anhydrase inhibitor - reduce production)
Lie on back without a pillow

Question 16

Definitive treatment of AACG

Answer 16

Laser iridotomy

Question 17

Most common cause of blindness in UK

Answer 17

Age related macular degeneration

Question 18

Key finding on fundoscopy in macular degeneration

Answer 18

Druseen

Question 19

2 key symptoms in macular degeneration

Answer 19

Worsening central visual loss
Wavy appearance to straight lines

Question 20

Piece of equipment to test for macular degeneration

Answer 20

Amsler grid test (distorted straight lines)
Snellen chart

Optical coherence tomography - wet AMD

Question 21

How is wet AMD diagnosed

Answer 21

Optical coherence tomography

Question 22

Treatment for dry AMD

Answer 22

Stop smoking, control BP
Vitamins (A,C,E and zinc)

Question 23

Treatment for wet AMD

Answer 23

Anti-VEGF medications
Need to be started within 3 months to be beneficial

Question 24

Fundoscopy changes in diabetic retinopathy

Answer 24

Blot haemorrhages
Hard exudates
Microaneurysms
Cotton wall spots

Question 25

3 management options for diabetic retinopathy

Answer 25

Laser photocoagulation Anti-VGEF medications Vitreoretinal surgery

Question 26

2 fundoscopy signs in hypertensive retinopathy that are unlikely in diabetic

Answer 26

Copper wiring AV nipping

Question 27

Classification of hypertensive retinopathy

Answer 27

Keith-Wagener (1-4)

Question 28

RF for cataracts

Answer 28

Age, smoking, alcohol, diabetes, steroids, hypocalcaemia

Question 29

In ophthalmology what causes Central visual loss? Peripheral visual loss? Generalised visual loss?

Answer 29

Central = AMD Peripheral = glaucoma Generalised = cataracts

Question 30

Key complication of cataracts surgery

Answer 30

Endophthalmitis Inflammation of inner eye Treated with intravitreal antibiotics

Question 31

Commonly used eye drops for allergic rhinitis

Answer 31

Anatazoline (antihistamine) Sodium cromoglicate (mast cell stabiliser)

Question 32

topical mydriatics

Answer 32

Tropicamide (used to examine as short half life) Atropine Cocaine and TCAs

Question 33

Drug used to examine for corneal defects

Answer 33

Fluroescein

Question 34

Central retinal vein occlusion presenting complaint

Answer 34

Sudden painless vision loss

Question 35

Central retinal vein occlusion fundoscopy changes

Answer 35

Retinal haemorrhages +++ (sunset appearance) Widespread hyperaemia (red eye)

Question 36

Central retinal artery occlusion presenting complaint

Answer 36

sudden, painless unilateral visual loss

Question 37

Central retinal artery occlusion fundoscopy findings

Answer 37

'cherry red' spot on a ++ pale retina RAPD also present

Question 38

Retinitis pigmentosa presenting complaint (2)

Answer 38

Tunnel vision and night blindness

Question 39

Retinitis pogmentosa fundoscopy changes

Answer 39

Black spicule-shaped pigmentation in the peripheral retina (looks like mottling)

Question 40

Treatment for herpes zoster opthamos

Answer 40

Oral aciclovir treatment for 7-10 days Should start within 72 hrs

Question 41

Cornea changes in Acute angle closure glaucoma

Answer 41

Hazy

Question 42

"Cilliary flush" -> dx

Answer 42

Anterior uveitis Blurred vision and photophobia small, fixed oval pupil, ciliary flush

Question 43

Treatment of anterior uveitis

Answer 43

steroid + cycloplegic (mydriatic) drops

Question 44

"irregular pupil" -> dx

Answer 44

anterior uveitis

Question 45

Are high or low levels of ca a cause of cataracts

Answer 45

Hypocalcaemia causes cataracts (I have no cataracts)