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Ophthalmology > Ocular pathology > Flashcards

Ocular pathology Flashcards

1
Q

What are the 12 areas that can be affected by pathology?

A 
Superficial
Conjunctiva
Cornea
Sclera
Anterior Chamber
Iris
Lens
Posterior chamber
Retina
Panglobal
Blood vessels
Nerves
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2
Q

What categories of pathology can affect the superficial eye?

A

Cellulitis
Blepharitis
Connective tissue disease

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3
Q

How can orbital cellulitis present?

A

Red eye
Reddening of skin round orbit
Damage to conjunctiva

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4
Q

What is very dangerous about orbital cellulitis?

A

Can travel back towards brain causing abscesses

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5
Q

What is blepharitis?

A

Inflammation of the eyelid

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6
Q

What is a stye?

A

Inflammation of a hair follicle on the eyelid

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7
Q

What can cause blepharitis?

A

Seborrhoeic
Staph
Meibomian gland dysfunction
Acne Rosacea

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8
Q

How does blepharitis present?

A 
Similar to conjunctivitis
Gritty eyes
Mild discharge
Red eye
Ulcers
Scales in eyelids
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9
Q

Where does a feeling of grittiness in the eye suggest the issue is?

A

Superficial

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10
Q

Where does an aching feeling in the eye suggest the issue is?

A

Deep

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11
Q

How do you treat blepharitis?

A

Lid hygiene- Bath it regularly
Tear drops
Oral doxycycline

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12
Q

What connective tissue diseases can affect the eye?

A

SLE- Ocular inflammation
RA- Dry eyes, Scleritis, Corneal melt
Sjogren’s syndrome- Shiney featureless tongue,

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13
Q

What can SLE cause to the eye?

A

Ocular inflammation

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14
Q

What can RA cause in the eye?

A

Dry eyes
Scleritis
Corneal melt

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15
Q

What can Sjogren’s syndrome cause?

A

Keratoconjunctivitis sicca
Xerostomia
Shiney featureless tongue

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16
Q

What is xerostomia?

A

Dry mouth

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17
Q

What does sicca mean?

A

Dry

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18
Q

What pathologies can occur in the conjunctiva?

A

Conjunctivitis

Conjunctival hemorrhage

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19
Q

hat can cause conjunctivitis?

A 
Viral- Bilateral
Bacteria
Chlamydia- Unilateral
Allergic
Drugs
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20
Q

How can conjunctivitis present?

A 
Swelling 
Redness
Pain
Heat
Grittiness
Discharge
Itch
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21
Q

What is the most common cause of conjunctivitis?

A

Bacterial

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22
Q

WHat is a common feature of bacterial conjunctivitis?

A

Papilla

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23
Q

Describe papilla and how they differ from follicles

A

Papillae have blood vessels in center of lump

Follicles have blood vessels round edge (look like grains of rice) and bigger.

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24
Q

How do you treat bacterial conjunctivitis?

A

Self-resolve

Chloramphenicol

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25
Q

How does conjunctival heamorrhage present?

A

Red eye (basically bruised eye)

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26
Q

How do you treat conjunctival heamorrhage?

A

Resolves on its own

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27
Q

What is the main pathology affecting the cornea?

A

Keratitis

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28
Q

What can cause keratitis?

A 
Chronic exposure
Bacteria
Viral
Acanthamoeba- associated with contact lenses 
Fungi
RA
Hypersensitivity
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29
Q

What can lead to chronic exposure of the cornea?

A

In ability to close lids

Inability to produce tears

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30
Q

What is acanthamoeba infection of the cornea associated with?

A

Contact lenses

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31
Q

How does keratitis present?

A 
Corneal ulcers
Needle like pain
Photophobia
Discharge
Red eye
Opacity
Hypopyon
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32
Q

How can you test for keratitis?

A

Fluorescence staining

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33
Q

How do you treat keratitis?

A

ID cause- corneal scrape under LA
Antibiotics if bacterial
Antivirals if viral
Anti Inflammatory if autoimmune

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34
Q

What must you not give for corneal damage?

A

Steroids!!!

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35
Q

What two diseases can affect the sclera?

A

Scleritis and episcleritis

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36
Q

What is the difference between Scleritis and episcleritis?

A

Scleritis affects body of sclera

Episcleritis affects peripheral surface

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37
Q

Which is more serious between Scleritis and episcleritis?

A

Scleritis

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38
Q

What can cause scleritis?

A

Autoimmune

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39
Q

How does scleritis present?

A

Pain on eye movement

Purple looking

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40
Q

How do you treat scleritis?

A

Steroids and NSAIDs

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41
Q

What is scleritis often associated with?

A

Uveitis

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42
Q

What is episcleritis associated with?

A

Gout

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43
Q

How do you treat episcleritis?

A

Self Resolves

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44
Q

What systemic disease can affect the anterior chamber of the eye?

A

Diabetes

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45
Q

What does diabetes cause in the anterior chamber of the eye?

A

Argyll Robertson/Prostitutes pupil

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46
Q

What is an Argyll Robertson/Prostitutes pupil?

A

A pupil that can accommodate (focus light) but not react to light (pupil doesn’t constrict)

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47
Q

What symptoms can an Argyll Robertson/Prostitutes pupil lead too?

A

Blurred vision

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48
Q

What pathology can affect the anterior chamber of the eye?

A

Glaucoma

Diabetes

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49
Q

What is glaucoma?

A

Raised pressure in the anterior chamber of the eye

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50
Q

What is normal pressure glaucoma?

A

Glaucoma in the presence of a normal anterior chamber pressure.

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51
Q

What are the two types of glaucoma?

A

Open angle

Closed angle

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52
Q

What causes glaucoma?

A

Too much aqueous humour

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53
Q

How can you get too much aqueous humour?

A

Too much production

Not enough drainage

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54
Q

Where does aqueous humour drain through?

A

Trabecular meshwork

Schlemm canals

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55
Q

What causes open angle glaucoma?

A

Blockage in trabecular meshwork or Schlemm canals

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56
Q

How does open angle glaucoma present?

A

Slow onset and often asymptomatic

Visual loss starting in the periphery

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57
Q

What causes closed angle glaucoma?

A

Iris stuck to lens preventing aqueous humour flow

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58
Q

What can predispose you to closed angle glaucoma?

A

Being long sighted (eyeball too small)

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59
Q

How does closed angle glaucoma often present?

A 
Acutely (often an emergency)
Acute red eye
Visual loss
Headaches with N+V
Pain
Dilated pupil
Cloudy cornea
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60
Q

How do you treat closed angle glaucoma?

A

Burn hole in iris with laser

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61
Q

How do you treat open angle glaucoma?

A

Pharmacology

Trabeculectomy

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62
Q

What can cause glaucoma?

A

Many things

Diabetes important to know

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63
Q

How can diabetes cause glaucoma?

A

Rubeotic glaucoma

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64
Q

WHat is rubeotic glaucoma?

A

Formation of new blood vessels in the iris causing blockage of flow.

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65
Q

How can glaucoma damage the eye?

A

Put pressure on the optic disk thus causing sight loss

66
Q

What pathology can occur in the iris?

A

Uveitis

67
Q

What can cause uveitis?

A

Autoimmune
Infection
Trauma
Malignancy

68
Q

What autoimmune diseases can cause uveitis?

A

UC
Ank Spon
Sarcoidosis

69
Q

What is the most common autoimmune cause of uveitis?

A

Ank Spon

70
Q

What part of the eye can sarcoidosis affect?

A

Whole eye

71
Q

What ket term is associated with sarcoidosis?

A

Bilateral Hilar Lymphadenopathy

72
Q

What infections can cause uveitis?

A 
TB
Syphilis
Herpes simplex
Herpes zoster
Toxoplasmosis
73
Q

How can uveitis present?

A 
Pain
Reduced vision
Photophobia
Red eye
Ciliary injection
Hypopyon
Synechiae- Iris sticks to lens
Keratic precipitates- Cells stick to back of cornea
74
Q

What is a hypopyon?

A

Level of dead cells in anterior chamber

75
Q

What is synechiae?

A

Inflammation causing iris to stick to lens

76
Q

What are Keratic precipitates?

A

Cells sticking to the back of the cornea

77
Q

How do you treat uveitis?

A

Topical steroids

Investigate for systemic involvement

78
Q

What pathology can affect the lens?

A

Cataracts

79
Q

What is a cataract?

A

Opacity of the lens

80
Q

What can cause cataracts?

A 
UVB
Trauma
Diabetes
Age
Steroids
Glaucoma
Hypertension
Smoking
Genetics
81
Q

How can age cause cataracts?

A

As we age the lens thickens and accumulates damage

82
Q

How can diabetes cause cataracts?

A

Raised glucose and swelling damages lens

83
Q

What are the symptoms of cataracts?

A

Loss of vision
Blurred vision
Glare at night

84
Q

How do you treat cataracts?

A

Remove and replace

85
Q

What parts of the retina can acquire pathology?

A

Optic disk
Macula
Peripheral retina

86
Q

What pathologies can affect the retina in general?

A

Diabetic retinopathy
Retinal detachment
Retinal melanoma

87
Q

What happens in retinal detachment?

A

Retina peels of choroid layer

88
Q

What can cause retinal detachment?

A

Main one is changes in vitreous humour as we age pulling it off the choroid layer

89
Q

What are some symptoms of retinal detachment?

A

Painless visual loss
Flashes and floaters
Relative Afferent Pupil Defect
Tear on fundoscapy

90
Q

What is a Relative Afferent Pupil Defect?

A

When shine light in one eye then the other rapidly the affected eye doesn’t pick up as much light so constricts less

91
Q

What is diabetic retinopathy?

A

Damage to the retina caused by blood leaking out of blood vessels due to chronic hyperglycemia

92
Q

Describe how chronic hyperglycemia causes diabetic retinopathy

A

Chronic hyperglycemia -> Damage to basement membrane of blood vessels -> Blood leaking -> Ischemia

93
Q

What are some of the symptoms of diabetic retinopathy?

A

Vision loss- if macula involved very serious

94
Q

What are some of the signs of diabetic retinopathy?

A 
Leaky vessels
Dot + blot hemorrhage 
New vessel formation
Oedema
Hard exudate- Drusens
Cotton wool patches
Scarring
95
Q

What causes cotton wool patches?

A

Ischemia

96
Q

What is drusens?

A

Collection of protein/lipid- like atheroma plaques

97
Q

What causes the loss of vision in diabetic retinopathy?

A

Ischemia caused by blood loss

98
Q

What causes new blood vessel formation in diabetic retinopathy?

A

VEGF

99
Q

What kinds of new vessels can be developed in diabetic retinopathy?

A

New vessels on disk (NVD)
New vessels in Periphery (NVE)
Rubeotic glaucoma

100
Q

Why are new blood vessels in the iris a bad sign?

A

Serious patho and no reversing from here

101
Q

How do you treat diabetic retinopathy?

A

Better diabetic control
Laser treatment
Anti-VEGF

102
Q

What does laser treatment of diabetic retinopathy involve?

A

Burning away peripheral tissue to decrease O2 demand and seal leaky blood vessels

103
Q

What kind of laser treatment is done in diabetic retinopathy?

A

PanRetinal Photocoagulation

104
Q

What pathology can affect the macula?

A

Macula degeneration

105
Q

What is the main form of macula degeneration?

A

Age related macular degeneration

106
Q

What are the two forms of age related macular degeneration?

A

Dry

Wet

107
Q

How does wet ARMD differ from dry ARMD?

A

Wet has blood leakage and new vessel formation while dry is atrophic

108
Q

Describe what happens in dry ARMD

A

Drusen plaques form under the macular resulting is slow degeneration

109
Q

Is dry ARMD acute or chronic?

A

Chronic

110
Q

What are are of the symptoms of dry ARMD?

A

Gradual visual loss
Central vision loss
Patches of atrophy
Drusen plaques

111
Q

How do you treat dry ARMD?

A

No cure

Magnify to mitigate damage

112
Q

Describe wet ARMD

A

Formation of new blood vessels results in leaky vessels which results in build up of fluid and scarring.

113
Q

Is wet ARMD acute or chronic in onset?

A

Acute

114
Q

Can dry ARMD progress to wet?

A

Yes

115
Q

What mediated wet ARMD?

A

VEGF

116
Q

What are some of the symptoms of wet ARMD?

A

Rapid visual loss
Disorientation
Hemorrhage- looks bruised
Exudate

117
Q

How do you treat wet ARMD?

A

Anti-VEGF

118
Q

What pathologies can affect the optic disk?

A

Cupping

Swelling

119
Q

What is cupping?

A

Expansion of the optic disk cup due to loss of nerve fibres.

120
Q

What can cause cupping?

A

Raised intraocular pressure

121
Q

What can cause swelling of the optic disk?

A

Papilloedema- just saw swollen as can’t be sure

Hypertension

122
Q

What is papilloedema?

A

Swelling of the optic disk due to raised ICP

123
Q

How do you measure ICP?

A

LP

124
Q

When should you suspect papilloedema?

A

Bilateral optic disk swelling

125
Q

What are some symptoms of papilloedema?

A 
Loss of cup
BLurred contours
Blurred vision
Headaches
N+V
126
Q

What are some of the symptoms of hypertension caused optic disk swelling?

A 
Copper or silver looking blood vessels
Cotton wool spots- areas of ischemia
Exudate
Heamorrhage
Cattle trucking
Disk oedema
127
Q

What cancers can affect the eye?

A

SCC
BCC
Melanoma

128
Q

What can damage or occlusion to any blood vessel supplying the eye lead to?

A

Visual loss and tissue death

129
Q

What two vessels commonly cause vision loss?

A

Central Retinal Artery

Central Retinal Vein

130
Q

Which is more common out of central retinal artery occlusion (CRAO) or central retinal vein occlusion (CRVO)?

A

CRAO

131
Q

How can you differentiate between an artery and vein on fundoscapy?

A

Artery is smaller

132
Q

What are the symptoms of a CRAO?

A

Sudden painless vision loss
Pale optic disk
Relative afferent pupillary defect (RAPD)
Swollen nerve fibres

133
Q

Why do you get a pale optic disk in CRAO?

A

Disk usually pink due to blood therefore no blood = pale

134
Q

What is Relative afferent pupillary defect (RAPD)?

A

Loss of some light sensing in one eye causes less constriction when light flicked between them

135
Q

What can cause CRAO?

A

Carotid artery disease

Heart emboli- rare

136
Q

What are some variants of CRAO?

A

Amaurosis Fugax- TIA

Branch retinal artery occlusion

137
Q

What is Amaurosis Fugax?

A

TIA of retinal artery

Curtains coming down for ~5min

138
Q

What is Branch retinal artery occlusion?

A

Occlusion of one branch artery in retina

139
Q

What can cause CRVO?

A

Virchow’s triad:
Endothelial damage- Diabetes
Abnormal blood flow- Hypertension
Hypercoagulability

140
Q

What are the symptoms of CRVO?

A

Cotton wool spots

Sudden painless vision loss

141
Q

What can hemorrhage of vessels in the eye cause?

A

Floaters
Visual loss
Loss of red reflex
See on fundoscopy- look like bruising

142
Q

What is Giant Cell Arteritis?

A

Inflammation of the lumen of medium and large vessels

143
Q

Can Giant Cell Arteritis affect the central retinal vessels?

A

No

144
Q

What is GCA associated with?

A

Polymyalgia Rhumatica

145
Q

What can Giant Cell Arteritis cause?

A

Ischemic optic neuropathy

146
Q

What is ischemic optic neuropathy?

A

Occlusion of optic nerve heads

147
Q

What are some symptoms of ischemic optic neuropathy?

A 
Sudden visual loss
Irreversible blindness
Swollen optic nerve
Headache
Jaw claudications
Scalp tenderness
Enlarged scalp arteries
Proptosis- eye protrusion
148
Q

What is proptosis?

A

Abnormal eye protrusion- not normal to see sclera above iris

149
Q

How urgent is it to treat ischemic optic neuropathy?

A

Very urgent to prevent bilateral blindness

150
Q

What can VI (Abducens) nerve palsy cause?

A

In ability to abduct eye- can look normal when looking straight on

151
Q

What can cause VI (Abducens) nerve palsy?

A

Microvascular

Raised ICP

152
Q

What can IV (Trochlea) nerve palsy cause?

A

Vertical double vision

Head tilt to compensate

153
Q

What can cause IV (Trochlea) nerve palsy?

A

Congenital

Microvascular

154
Q

What can III (Oculomotor) nerve palsy cause?

A 
Diplopia
Eye look down and out- due to unopposed IR and SO
Ptosis- due to loss of LPS innervation
Dilated pupil
Eye doesn't move
155
Q

What can cause III (Oculomotor) nerve palsy?

A

Microvascular
Tumour
Aneurysm- painful
Demyelination- MS

156
Q

What causes anterior blepharitis and how does it present?

A

S. Aureus

Skin flakes

157
Q

What types of conjunctivitis do papillae appear with?

A

Allergic and bacteria

158
Q

What type of conjunctivitis do nodules appear with?

A

Viral and chlamydial

159
Q

What can cause corneal ulcers?

A

HSV

160
Q

What can precipitate angle closure glaucoma?

A

Pupil dilation

161
Q

What are cherry red spots a sign of?

A

Arterial occlusion

Ophthalmology (10 decks)

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