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MRCP - Part 1 > Medical Opthalmology > Flashcards

Medical Opthalmology Flashcards

1
Q

Risk factors for infective keratitis

A

Poor contact lens hygeine
Swimming / showering in lenses
Sleeping in lenses

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2
Q

Does a corneal abrasion cause an infiltrate?

A

No

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3
Q

What is keratitis

A

Inflammation of the cornea

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4
Q

What is a hypopynon

A

Accumulation of white blood cells in the anterior chamber

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5
Q

Most common causes of hypopynon

A

Infective keratitis
Uveitis

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6
Q

Causes of keratitis

A

Trauma
Vitamin A deficieny
Chemical injury
Contact lenses
Infection
- bacterial
- fungal
- viral
- protozoal
Corenal dystrophy
Keratoconjunctivitis sicca (dry eye)

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7
Q

Presentation of corneal ulcer / keratitis

A

Severe eye pain
Epiphoria (watery eye)
Visual loss (more common in corneal abrasions)
Red eye
Foreign body sensation
Photophobia
Corneal oedema
+/- signs of anterior uveitis
- miosis
- aqueous flare (protein)

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8
Q

A PAINFUL, acute unilateral third nerve palsy should raise the immediate suspicison of what

A

PCA aneurysm

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9
Q

What is the saying for retrobulbar neuritis

A

The patient sees nothing and the doctor sees nothing
(the inflammation is behind the optic nerve head (i.e. retrobulbar) as opposed to optic neuritis, and therefore the optic nerve head or the optic disc appears normal)

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10
Q

Presentation of retrobulbar neuritis

A

Visual acuity reduced to a very variable degree
Relative afferent pupillary defect will be apparent during the “swinging flashlight test”
Colour vision reduced to a greater extent than might be predicted from visual acuity
Red desaturation
Visual field defects (typically a central scotoma) but defect can vary

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11
Q

What is red desaturation

A

When red looks more washed out to one eye than the other
Sensitive sign of optic nerve dysfunction

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12
Q

What can an episode of optic or retrobulbular neuritis contribute to a diagnosis of

A

MS

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13
Q

What is Holmes Adie pupil

A

Idopathic condition
Typically affects young women
Presents with an enlarged pupil that is poorly reactice to light and only sluggishly accomodates
Absent ankle jerks frequently assosiated
Consensual pupil reflex typically unaffected

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14
Q

What is parinaud syndrome

A

Lesion in the dorsal midbrainn
Causes a variety of signs
Mid dilated pupils
Upper lid retraction
Paralysis of upward gaze

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15
Q

Sight threatning causes of red eye

A

Acute glaucoma
Corneal laceration
Contact lens related ulcer
Corneal ulcer
Endopthalmitis (inflammation of vitroeus and aqueous fluids)
Intraocular foreign body
Trauma
Chemical injury

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16
Q

WHat is trichiasis

A

Eyelashes directed in towards the cornea

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17
Q

Conditions assosiated with anterior uveritis

A

UC
AS

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18
Q

HLA assosiation of anterior uveitis

A

HLA-B27

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19
Q

Presentation of anterior uveitis

A

Red
Painful
conjunctival injection
cells and flare in anterior chamber
photophobia

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20
Q

Ocular manifestations of marfans syndrome

A

Upward lens dislocation
Myopia
Keratoconus
Retinal detachment

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21
Q

Signs of optic nerve dysfunction

A

Reduced visual acuity
Loss of colour vision
Central scotoma
Optic disc swelling

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22
Q

Presentation of CRAO

A

Sudden, painless loss of vision

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23
Q

What does the retina look like in CRAO

A

Pale
Cherry red spot in the macula

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24
Q

Presentation of CRVO

A

Sudden, painless loss of vision

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25
Q

What does examination look like in CRVO

A

Swollen optic disc
Flame shaped haemorrhages
Dilated veins
Tortuoisty
Cotton wool spots

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26
Q

Fundoscopy of HTN retinopathy

A

Arteriolar narrowing
AV crossing
Nipping
Retinal flame haemorrhages and exudates

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27
Q

How does sight loss occur in diabetic retinopathy

A

Neovascularisation
- leading to tractional retinal detachment or glaucoma
Macular disease

28
Q

Features of background retinopathy

A

Haemorrhages
Hard exudates
Microaneruysms

29
Q

Features of pre proliferative DR

A

Cotton wool spots
Venous changes
IRMAs

30
Q

Features of proliferative DR

A

Retinal neovascularisation either at the disc or elsewhere

31
Q

Treatment for macular oedema

A

Focal laser therapy
Vascular endothelial growth factor (VEGF) via intravitreal injection

32
Q

Treatment of proliferative DR

A

Pan retinal photocoagulation

33
Q

Progression of DR

A
  1. Background
  2. Pre prolliferative
  3. Proliferative
  4. Maculopathy
34
Q

Criteria for mild non proliferative (background) DR

A

at least one micro aneurysm
Screening criteria also includes exudates

35
Q

Criteria for moderate non proliferative DR

A

Intra retinal haemorrhages
Micro aneurysms

36
Q

Severe non proliferative retinopathy consists of

A

Intra retinal haemorrhages or microaneurysms in all 4 quadrants
Venous beading in 2 quadrants or more
IRMA in one quadrant

37
Q

What way does the eye point in a 3rd nerve palsy

A

Down and out position

38
Q

What does a ptosis and constricted pupil indicate

A

Horners syndrome

39
Q

Diagnosis of holmes aiede pupil

A

Dilute pilocarpine eye drop test

40
Q

Most modified risk factor for ARMD

A

Smoking

41
Q

Treatment for exudative (wet) ARMD

A

Anti-VGEF

42
Q

Treatment for non exudative (dry) ARMD

A

None

43
Q

Changes in macular region seen on examination in MD

A

Drusen
RPE abnormalities (hyper/hpo pigementation)
Geographic atrophy
Neovascular exudate

44
Q

Symptoms of macular degeneration

A

Visual distorsions
Painless loss of central vision
Central scotoma
Difficulty reading or seeing fine detail
Photopsia (flashes of light or floaters)
difficulty adjusting to dim light
visual hallucinations

45
Q

Occular manifestations of sarcoidosis

A

posterior uveitis
optic nerve involvement
cataracts
glaucoma
venous occlusion

46
Q

Treatment of anterior uveitis

A

Intensive prednisolone eye drop therapy

47
Q

Occular manifestations of wilsons disease

A

Kayser fishcers rings

48
Q

What causes a failure of eye abduction

A

Lateral rectus palsy / 6th CN palsy

49
Q

What should asymmetric diabetic retinopathy raise a suspicion of

A

Ocular ischaemic syndrome (OIS) on the side affected worse

50
Q

Investigation of OIS

A

Fluorescin angiography and carrotid doppler ultrasound

51
Q

Method of action of dorzolamide drops (for glaucoma)

A

Carbonic anhydrase inhibitor

52
Q

Drugs that cause acute closed angle glaucoma

A

TC antidepressants e.g. amitriptyline
Antihistamines
Anti PD agents
Antipsychotics
Sulphonamides

53
Q

WHat does a IV CN palsy cause

A

Superior oblique muscle
- outward rotation and tosional element to diplpoia

54
Q

Which is move severe, episcleritis or scleritis

A

Scleritis

55
Q

What is retinitis pigmentosa and what causes it

A

Deteriorating night vision (hereditary)
Defects in rhodopsin

56
Q

What does CMV retinitis look like

A

Vasculitis with haemorrhages
Brush fire appearance

57
Q

Treatment of CMV retinitis

A

Oral valganciclovir

58
Q

Eye conditioon assosiated with wernickes

A

Nystagmus
Opthalmoplegia (usually lateral rectus muscle)

59
Q

How does vitreous haemorrhage commonly occur in diabetic patients

A

Bleeidng of fragile new vessels of the retina
Consistent with neovascularisation in proliferative diabetic retinopathy

60
Q

Eye manifestation NF1

A

Lisch nodules

61
Q

What are patients with ehler danlos syndrome more at risk of

A

Retinal detachment

62
Q

Features on slit lamp examination of scleritis

A

Prominant vessels throughout sclera
Clear views of the retina

63
Q

Features of retinis pigmentosa

A

Progressive loss of night vision
Followed by loss of acuity which begins peripherally
Complete loss of vision is uncommon

64
Q

Inheritance of retinis pigmentosa

A

30-40% AD
50-60% AR
5-15% X linked

65
Q

Fundoscopy changes of retinis pigmentosa

A

Dispersion and aggrevation of retinal pigment bilateralyl, which has the appearance of bony spicules

66
Q
A

MRCP - Part 1 (20 decks)

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