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Year 2 Clinical Studies and Dispensing > Normal vs Abnormal > Flashcards

Normal vs Abnormal Flashcards

1
Q

What is the referral urgency for POAG?

A

Routine

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2
Q

What are the signs for POAG?

A

Optic disc cupping - vertical size changes, not following ISNT
Reproducible VF defect consistent with disc appearance
IOP >21mmHg

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3
Q

What are the symptoms for POAG?

A

Usually asymptomatic until significant VF loss

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4
Q

What are the signs of POAG at the optic disc?

A

Loss of ISNT rule
Asymmetrical discs >0.2
Vertical enlargement
CD >0.7 (changed since last visit or new px)
Focal narrowing or notching of NRR
Concentric/generalised atrophy
Peripapillary Atrophy (PPA)
Sharpened nasal edge
Visible lamina cribosa
Pallor
Saucerisation
Baring of circumlinear vessels
Bayonetting (vessels entering at 90 degrees)
Collaterals
Disc haem (flame-shaped at rim)
RNFL thinning

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5
Q

What are the risk factors for POAG?

A

Increasing age
Female
OHT
FH for first degree relative
Thin CCT
Myopia >4D
Diabetes
Systemic hypertension
West African or African-Caribbean ethnicity (onsets at younger age)

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6
Q

What are the differential diagnoses for POAG?

A

OHT
Tilted discs
Physiological cupping
Disc drusen
Anterior ischaemic optic neuropathy
Secondary glaucoma
Optic atrophy
Glaucomatous VF defect from another condition

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7
Q

What are the signs of OHT?

A

IOP >21mmHg with no other glaucomatous signs or sxs

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8
Q

What is the referral urgency for OHT?

A

Routine

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9
Q

What are the RFs for OHT?

A

HBP
Afro-Caribbean race
Increasing age

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10
Q

What are the differential diagnoses for OHT?

A

POAG
PACG
Secondary OAG

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11
Q

What is the referral urgency for NTG?

A

Routine

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12
Q

What are the signs of NTG?

A

IOP consistently <21mmHg
Glaucomatous VF defect
Glaucomatous optic disc
Peripheral vasospasm

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13
Q

What are the symptoms of NTG?

A

Migraines
Otherwise asymptomatic

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14
Q

What are the differential diagnoses for NTG?

A

POAG
Intermittent ACG
Secondary OAG
Ischaemic optic neuropathy

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15
Q

What are the RFs for NTG?

A

Hypotension
Thin cornea
Female
Glaucomatous discs

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16
Q

What is the referral urgency for Acute ACG?

A

Emergency (same day)

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17
Q

What are the signs of Acute ACG?

A

Dilated limbal/conjunctival vessels - hyperaemia
V high IOP (40-80mmHg)
Corneal epithelial/stromal oedema
Descemet’s folds due to oedema
Shallow or flat AC
Fixed, mid dilated, oval pupil which doesn’t react to light (RAPD present)
Iris bombe
Peripheral anterior synechiae

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18
Q

What are the symptoms of Acute ACG?

A

Reduced vision
Haloed lights
Headache
Pain
Nausea and/or vomiting

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19
Q

What are the risk factors for Acute ACG?

A

FH of AACG
Hyperopia
Chinese ethnicity
40-50 years old
Female

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20
Q

What are the differential diagnoses for Acute ACG?

A

Acute conjunctivitis
Uveitis
Keratitis
Trauma
Inflammation
Neovascular glaucoma
Secondary ACG

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21
Q

What is the referral urgency for optic neuritis?

A

Urgent

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22
Q

What causes optic neuritis?

A

Inflammatory or demyelinating disorder of the optic nerve head unilaterally

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23
Q

What are the symptoms of optic neuritis?

A

Rapid vision loss in one eye
Retro-orbital pain
Ocular pain
Visual loss worse in heat or during exercise

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24
Q

What are the signs of optic neuritis?

A

RAPD
VA loss
Central scotoma
Severely impaired colour vision
Fundus normal but blurred disc margins
Swollen veins

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25
What are the RFs for optic neuritis?
Younger age Female MS Viral infections Tuberculosis Syphilis
26
What are the differential diagnoses for optic neuritis?
Arteritic anterior ischaemic optic neuropathy Non-arteritic anterior ischaemic optic neuropathy Papilloedema
27
What is papilloedema?
Swelling of the optic nerve - inflammatory or demyelinating bilaterally
28
What are the mechanical signs of papilloedema?
ONH elevation Blurred optic disc margin Physiological cup filling in Peripapillary RNFL oedema Retinal and/or choroidal folds
29
What are the vascular signs of papilloedema?
Disc hyperaemia Loss of spontaneous venous pulsation and venous congestion Papillary/peripapillary haem Hard exudates Cotton wool spots Enlarged blind spot on VF Diplopia due to CN VI palsy
30
What is the referral urgency for papilloedema?
Urgent
31
What can cause papilloedema?
Brain tumours Meningitis Hydrocephalus Pseudo-tumour cerebri (raised intracranial pressure with no other intracranial pathology)
32
What are the symptoms of papilloedema?
Severe headaches Nausea Explosive vomiting Amaurosis fugax (transient blanking of vision - otherwise normal)
33
What are the differential diagnoses for papilloedema?
Optic disc drusen Malignant hypertension Pseudopapilloedema CRVO Anterior ischaemic optic neuropathy Optic neuropathy
34
What is the referral urgency for hypertensive retinopathy?
Emergency
35
What are the signs of hypertensive retinopathy?
Focal arteriolar narrowing Arteriosclerotic changes Flame haem on nerve fibres Cotton wool spots Disc oedema Macular star
36
What are the symptoms of hypertensive retinopathy?
Headache Blurred vision Altered conscious state Palpitations Chest pain
37
What are the differential diagnoses for hypertensive retinopathy?
Diabetic retinopathy (esp if less sxs) CRVO Radiation retinopathy
38
What are the signs of CRVO?
Haem in all quadrants (deep and dark) due to ishchaemia Dilated, tortuous veins RAPD Multiple cotton wool spots due to ischaemia Macular oedema Poss rubeosis iridis (iris neovasc) Neovasc (disc or elsewhere - NVD or NVE)
39
What is the referral urgency for CRVO?
Urgent
40
What are the symptoms of CRVO?
Sudden vision loss (<6/36) No pain
41
What are the RFs for CRVO?
Smoking Diabetes Hypertension Hyperlipidaemia Hyperviscosity of blood
42
What are the differential diagnoses for CRVO?
POAG BRVO Hypertensive retinopathy Diabetic retinopathy
43
What are the signs for BRVO?
Flame, dot and blot haem next to dilated and tortuous vein Only in one area of retina, not usually crossing horizontal midline Exudates Occlusion at A/V crossing (arteriole anterior to vein)
44
What are the symptoms for BRVO?
Often asymptomatic unless affecting large area of retina or the macula
45
What is the referral urgency for BRVO?
Urgent
46
What are the RFs for BRVO?
Hypertension Cardiovascular disease Lipid abnormality
47
What are the differential diagnoses for BRVO?
CRVO Hypertensive retinopathy Diabetic retinopathy
48
What are the signs of CRAO?
VA = LP or worse RAPD Poss visible emboli in vessel Narrowed vessels Pale retina Macula cherry red spot Optic disc pallor (paler as NFs degenerate)
49
What is the referral urgency for CRAO?
Emergency
50
What are the symptoms of CRAO?
Severe, sudden, painless loss of vision unilaterally Poss previous amaurosis fugax (transient loss of vision)
51
What are the differential diagnoses for CRAO?
Macular haem Retinal detachment Anterior ischaemic optic neuropathy
52
What are the signs of BRAO?
Areas of retinal infarction (whitening) Narrowed vessels (Size of affected area and likelihood of macular oedema dependant on location of occlusion)
53
What is the referral urgency for BRAO?
Urgent - if no macular involvement Emergency - of foveal involvement and recent onset
54
What are the symptoms of BRAO?
Unilateral, no pain Poss previous amaurosis fugax (transient loss of vision) Loss of vision if macula involved
55
What are the differential diagnoses for BRAO?
Hypertensive retinopathy Diabetic retinopathy
56
What are the signs of Arteritic Anterior Ischaemic Optic Neuropathy (AAION)?
Sudden, profound, permanent vision loss (preceded by amaurosis fugax attacks) Swollen, pale optic disc Peripapillary haemorrhages Cupping (late stage) Temporal artery thick and pulseless
57
What is the referral urgency for AAION?
Emergency
58
What are the symptoms of AAION?
Headache Pain in temple/neck Scalp tenderness Pain while chewing Weight loss Fatigue Neck stiffness
59
What are the differential diagnoses for AAION?
Non-AAION Optic neuropathy CRAO CRVO
60
What causes AAION?
Occlusion of posterior ciliary artery Associated with Giant cell arteritis
61
What causes Non-Arteritic Anterior Ischaemic optic neuropathy (Non-AAION)?
Atherosclerosis
62
What are the signs of Non-AAION?
Sudden, painless vision loss (not severe, altitudinal hemianopia) Reduced colour vision Pale or oedematous optic disc Fellow eye's cup is small or absent
63
What is the referral urgency for Non-AAION?
Urgent
64
What are the symptoms of Non-AAION?
No systemic symptoms Vision loss
65
What are the differential diagnoses for Non-AAION?
AION Optic neuropathy CRVO Tumour Hypertensive retinopathy
66
What are the signs of Background Diabetic Retinopathy?
Microaneurysms Retinal Haemorrhages Venous loop Hard exudates and Cotton Wool Spots (if other signs present)
67
What are the symptoms of Background Diabetic Retinopathy?
None
68
What is the referral urgency for Background Diabetic Retinopathy?
Refer via GP to diabetic eye screening service (if not already attending)
69
What are the signs of Pre-proliferative Diabetic Retinopathy?
Background DR signs + Venous beading Venous reduplication Multiple deep, round haem or blot haem Intraretinal microvascular abnormality (IRMA): dilated capillaries
70
What is the referral urgency for Pre-proliferative Diabetic Retinopathy?
Refer via GP to diabetic eye screening service (if not already attending)
71
What are the symptoms of Pre-proliferative Diabetic Retinopathy?
None
72
What are the differential diagnoses for Pre-proliferative DR?
Hypertensive Retinopathy CRVO BRVO
73
What are the signs of Proliferative Diabetic Retinopathy?
Neovasc (disc and elsewhere) New pre-retinal haem New vitreous haem New pre-retinal fibrosis New tractional retinal detachment
74
What is the referral urgency for Proliferative Diabetic Retinopathy?
Urgent
75
What are the symptoms of Proliferative Diabetic Retinopathy?
Vision loss May be asymptomatic if macula not involved
76
What are the differential diagnoses for Proliferative DR?
Hypertensive Retinopathy CRVO BRVO
77
What are the signs of diabetic maculopathy?
Exudate within 1 disc diameter of central fovea Group of exudates within macula Macular oedema within 1 disc diameter of central fovea Microaneurysm or haem within 1 disc diameter of central fovea
78
What are the symptoms of diabetic maculopathy?
Central vision loss Metamorphopsia if macular oedema
79
What is the referral urgency for diabetic maculopathy?
Routine Urgent if best VA <6/12
80
What is a retinal break?
Full thickness defect in sensory retina
81
What is a retinal tear?
Retinal break associated with vitreous traction
82
What are the symptoms of the retinal break/tear?
Acute: Flashing lights, recent hx of head or ocular trauma Chronic: may be asymptomatic
83
What is the referral urgency for a retinal break/tear?
Urgent: if incidental finding, no sxs, no subretinal fluid or pigment change at border of break/tear Emergency: if subretinal fluid or sxs
84
What are the signs of a retinal break/tear?
Red lesion
85
What are the types of retinal break/tear?
Flap/horseshoe Operculated Retinal dialysis Giant tear Retinal hole
86
What are the symptoms of a Rhegmatogenous retinal detachment?
Flashes Floaters Veil/curtain/spider webs in vision Wavy/watery vision Poss asx if no macula involvement
87
What are the differential diagnoses for Rhegmatogenous retinal detachment?
Retinoschisis Exudative retinal detachment Tractional retinal detachment
87
What is the referral urgency for Rhegmatogenous retinal detachment?
Emergency
87
What are the signs of Rhegmatogenous retinal detachment?
Elevation of retina from RPE Full thickness retinal break or tear Translucent/corrugated appearance of detached retina No movement of subretinal fluid on eye movements Shafer's sign (tobacco dust) PVD Vitreous haem Reduced IOP RAPD if severe Line of demarcation at posterior if longstanding
88
What is a choroidal naevus?
Common, benign choroidal tumour made up of melanocytes
89
What are the signs of a choroidal naevus?
Flat, pigmented lesion Diffuse edges Grey Subretinal
90
What are the symptoms of a choroidal naevus?
None unless malignant
91
What are the signs of malignancy in a choroidal naevus?
Continued growth through adulthood Over 2mm thick Subretinal fluid Orange pigment (lipofuscin) Edge near optic disc No drusen on the surface of lesion Symptoms: flashes, floaters, vision loss
92
What is the referral urgency for a choroidal naevus?
None if benign Routine or urgent if suspicious
93
What are the signs of Dry AMD?
Drusen (small/hard if mild, large/soft if moderate) Focal pigmentation from RPE Macular atrophy
94
What are the symptoms of Dry AMD?
Blurred vision Slight metamorphopsia
95
What are the RFs for Dry AMD?
Age Smoking
96
What is the differential diagnosis for Dry AMD?
Wet AMD
97
What's the management for Dry AMD?
No referral as no treatment available Advise to look out for change in vision and metamorphopsia (give Amsler chart) Regular monitoring Advise to stop smoking, improve diet
98
What are the signs of Wet AMD?
Choroidal neovascular membrane: grey subretinal distortion Haem and damage in central fundus due to CNM Scars within photoreceptor layers Disciform scarring at macula (late AMD)
99
What are the symptoms of Wet AMD?
Metamorphopsia Major central vision loss/impairment
100
What are the RFs for Wet AMD?
Smoking Age Dry AMD Wet AMD in fellow eye
101
What are the differential diagnoses for Wet AMD?
Diabetic retinopathy Vascular occlusion
102
What is the management for Wet AMD?
Anti-VEGF injections (under HES) Give Amsler chart
103
What is the referral urgency for Wet AMD?
Urgent
104
What is the management for new floaters?
Explain what floaters are and what to watch out for (sxs) Advise of retinal detachment risk Give info leaflet Record discussion on record
105
What are the signs of a Posterior Vitreous detachment (PVD)?
Weiss ring (full or partial) Macular oedema if PVD at macula
106
What are the symptoms of a PVD?
Floaters (new or increase) Flashes in temporal peripheral vision
107
What are the RFs for a PVD?
Age Myopic
108
What is the management/referral urgency for a PVD?
Annual review Emergency referral if signs of retinal detachment or break
109
What are the signs of anterior uveitis?
Hyperaemia (ciliary injection) Keratic Precipitates Aqueous cells Aqueous flare Poss raised IOP Posterior synechiae - may cause pupil block and iris bombe Iris nodules
110
What is the referral urgency for anterior uveitis?
Emergency
111
What are the symptoms of anterior uveitis?
Sudden onset Unilateral (usually) Pain (dull/ache), worse on pupil constriction Photophobia Redness Reduced vision Increased lacrimation
112
What are the differential diagnoses for anterior uveitis?
ACG Conjunctivitis Lens-induced uveitis Intraocular FB
113
What are the other forms of uveitis?
Intermediate (posterior ciliary body and anterior choroid) Posterior (choroid, poss retina, optic disc, retinal vasculature) Panuveitis (whole uvea inflamed)
114
What are the signs of episcleritis?
Hyperaemia (episcleral vessels not conjunctival, blanches with vasoconstrictors) Sectoral or nodular redness Ant Chamb ok Cornea ok Palpebral conj ok VA ok
115
What are the symptoms of episcleritis?
Acute onset Unilateral red eye Mild ache/burning sensation Poss tender on palpation Poss watery Recurrent
116
What is the referral urgency for episcleritis?
Refer for investigation at third episode
117
What are the RFs for episcleritis?
Systemic disorders like rheumatoid arthritis, IBS, systemic lupus erythematous Gout Ocular rosacea Previous episodes Herpes zoster ophthalmicus 40-50 years old
118
What are the differential diagnoses for episcleritis?
Conjunctivitis Scleritis Anterior Uveitis
119
What are the signs of scleritis?
Unilateral Deep hyperaemia (doesn't blanche with vasoconstrictors) Poss anterior uveitis also present Globe tenderness
120
What are the symptoms of scleritis?
Severe pain (worse on eye movement, may disturb sleep) Gradual onset Globe tenderness Photophobia Epiphora (watery) Visual loss Poss prev episodes
121
What is the referral urgency for scleritis?
Emergency
122
What are the RFs for scleritis?
Middle age Female Systemic inflammatory disease (rheumatoid arthritis, IBS, syphilis, systemic lupus erythematous, sarcoidosis, TB) Local causes (trauma, surgery, herpes zoster)
123
What are the differential diagnoses for scleritis?
Episcleritis
124
What are the possible complications from scleritis?
Cataract Glaucoma Retinal detachment
125
What are the signs of bacterial conjunctivitis?
Lid crusting Purulent or mucopurulent discharge Hyperaemia Poss mild papillary reaction on tarsal conjunctiva Cornea ok usually
126
What are the symptoms of bacterial conjunctivis?
Redness Discomfort/grittiness Discharge Blurred vision due to discharge Unilateral (often spreads to other eye)
127
What is the referral urgency for bacterial conjunctivitis?
Only refer is not resolving or corneal involvement
128
What are the signs of viral conjunctivitis?
Watery discharge Hyperaemia Palpebral conjunctiva follicles Petechial subconjunctival haem Pre-auricular lymphadenopathy (poss sore throat and fever) Sometimes corneal involvement
129
What is the referral urgency for viral conjunctivitis?
No referral usually Emergency if very severe (significant keratitis - pain, loss of vision)
130
What are the symptoms of viral conjunctivitis?
Wateriness Redness Discomfort Lids stuck together on waking (no discharge) Unilateral at first
131
What are the differential diagnoses for viral conjunctivitis?
Bacterial or allergic conjunctivitis Chlamydial or herpetic conjunctivitis AACG Keratitis Anterior uveitis
132
What are the signs of allergic conjunctivitis?
Increased lacrimation Hyperaemia Inflammation of tarsal conjunctiva Lid margin ok
133
What are the symptoms of allergic conjunctivitis?
Itching Burning Watery eyes Photophobia Pain Blurred vision Mucous discharge Sneezing Nasal congestion
134
What is the referral urgency for allergic conjunctivitis?
No referral unless persistent or px wants referral
135
What are the differential diagnoses for allergic conjunctivitis?
Atopic bleph Bacterial or chlamydial conjunctivitis Corneal abrasions or ulcers Dry eye Episcleritis Marginal and punctate keratitis Viral infection Tight lens syndrome
136
How can allergic conjunctivitis be treated?
Reduced exposure to trigger Antihistamines Mast cell stabilisers Cold compress Vasoconstrictors Topical steroids Immunotherapy

Year 2 Clinical Studies and Dispensing (14 decks)

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