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MRCP > Ophthal > Flashcards

Ophthal Flashcards

1
Q

What is the difference between anterior and posterior uveitis?

A

Anterior - inflammation of the iris

Posterior - inflammation of the choroid

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2
Q

What are the risk factors for uveitis?

A

Autoimmune disease
HLA-B27
Intra-ocular lymphoma
Idiopathic

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3
Q

What are the symptoms of anterior uveitis?

A

Pain
Redness
Photophobia
Diplopia

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4
Q

What are the symptoms of posterior uveitis?

A

Gradual visual loss
Blurred vision
Absence of anterior symptoms

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5
Q

What is seen on fundoscopy in anterior uveitis?

A

Diffuse conjunctival injection
Hazy aqueous
Anterior synechiae
Keratitic precipitates on cornea

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6
Q

What is seen on fundoscopy in posterior uveitis?

A

Inflammatory cells in the vitreous

Oedeomatous optic nerve and disc

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7
Q

What is the treatment of uveitis?

A

Topical/PO steroids

Cyclopentolate (cycloplegic-mydriatic drug) to paralyse ciliary body, relieve pain and prevent adhesions

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8
Q

What are the features of episcleritis?

A

Mild pain/discomfort
Grittiness
Watering

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9
Q

What is the most common type of scleritis?

A

Anterior

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10
Q

What are the risk factors for scleritis?

A

RA and GPA
CTDs
Sarcoid
UC

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11
Q

What are the features of scleritis?

A

Severe boring pain radiating to forehead/jaw
Localised or diffuse red eye
Gradual decrease in vision

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12
Q

What are the signs of scleritis?

A

Reduced visual acuity
Bluish tinge to sclera
Sectoral or diffuse redness
Tender globe

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13
Q

What percentage of scleritis patients have a systemic vasculitis?

A

15%

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14
Q

How is scleritis diagnosed?

A

B-scan USS of globe

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15
Q

What is the treatment of scleritis?

A

PO NSAIDs –> PO pred –> MTX/AZA

If necrotising, skip furst step

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16
Q

What are the 3 types of blepharitis?

A

Staphylococcal
Seborrhoeic
Meibomian

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17
Q

What are the complications of scleritis?

A

Scleral thinning
Raised IOP
Retinal detachment
Phthisis (globe atrophy)

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18
Q

What is chalazion?

A

Meibomian cyst

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19
Q

What is madarosis?

A

Loss of eyelash

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20
Q

How can you differentitate keratitis from uveitis?

A

Normal pupillary reaction in keratitis

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21
Q

How is herpes simplex keratitis diagnosed?

A

Dendritic corneal ulcer - fluoroscein stainin

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22
Q

What is orbital cellulitis?

A

Infection of the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe

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23
Q

What is periorbital cellulitis?

A

Infection anterior to the orbital septum

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24
Q

What is the clinical difference between orbital and periorbital cellulitis?

A

In periorbital - no visual changes, proptosis, ophthalmoplegia, or pain with eye movements

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25
Q

How is orbital cellulitis diagnosed?

A

CT with contrast
Swab
Blood cultures

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26
Q

What is seen on examination in orbital cellulitis?

A

Reduced visual acuity
Afferent pupillary defect
Proptosis
Oedema and erythema

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27
Q

Where do the changes of macular degeneration occur?

A

Central area of retina - macula

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28
Q

What are the characteristics of dry AMD?

A 
Soft drusen (Yellow round spots in Bruch's membrane)
Atrophy and changes to pigment of the retinal pigment epithelium (RPE)
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29
Q

What are the characteristics of wet AMD?

A

New blood vessels grow in from the choriocapillaris under the retina

They spread around the RPE, are fragile and leak easily

Cause disciform scarring

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30
Q

Name 5 risk factors for AMD?

A 
Smoking
Age
Family history
Obesity
AMD in one eye
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31
Q

How does AMD present?

A

Scotoma
Reduced visual acuity particularly for near vision
Decreased contrast, colour, dark adaptation
Photopsia and light glare

Wet - diplopia and distortion

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32
Q

How is dry AMD diagnosed?

A

Distortion of Amsler grid lines

Fundoscopy - drusen, yellow macular scar, hypo/hyperpigmentation of RPE

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33
Q

How is wet AMD diagnosed?

A

Well demarcated red patches - retinal/sub RPE haemorrhages

Fluorescein angiography

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34
Q

What does colour fundus photography do?

A

Records the appearance of the retina

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35
Q

What is the treatment of dry AMD?

A

Stop smoking

Zinc with vit A, C, E reduce progression in 1/3

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36
Q

For which patients is zinc and anti-oxidants contraindicated?

A

Smokers - beta-carotene increases risk of lung cancer

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37
Q

What is the treatment of wet AMD?

A

Intra-vitreal anti-VEGF e.g. ranibizumab

Laser photocoagulation

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38
Q

What is VEGF?

A

Pro-angiogenic growth factor which stimulates vascular permeability

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39
Q

What is damaged in glaucoma?

A

Optic nerve head

Loss of retinal ganglion cells and axons

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40
Q

What is raised intra-ocular pressure?

A

> 21mmHg

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41
Q

What are the causes of secondary glaucoma?

A 
Inflammatory e.g. with uveitis
Phacogenic (caused by capsular rupture of the lens)
Intra-ocular haemorrhage
Steroid induced
Traumatic
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42
Q

What are the characteristics of absolute glaucoma?

A

NO vision
Pupillary reflex lost
Stony eye
Painful +++

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43
Q

What part of the eye produces aqueous humour?

A

Ciliary body

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44
Q

What is the anterior chamber angle?

A

Junction of the iris and cornea at the periphery of the anterior chamber

Aqueous humour drains through the trabecular meshwork here

45
Q

What part of the visual field is affected in glaucoma?

A

Peripheral –> central

46
Q

What is the cause of primary open angle glaucoma?

A

Chronic degenerative obstruction of trabecular meshwork

Painless

47
Q

What is the cause of closed angle glaucoma?

A

Iris displaced against cornea which closes iridocorneal angle - aqueous humour cannot flow from posterior to anterior chamber

48
Q

What are the risk factors for glaucoma?

A 
Raised IOP
Myopia
Diabetes
Positive FH
Women - shallow anterior chambers
Steroids
49
Q

Which drugs precipitate acute glaucoma?

A

Anti-cholinergics

TCAs

50
Q

How does closed angle glaucoma present?

A

Redness
Ocular pain
Blurred vision

51
Q

How does acute closed angle glaucoma present?

A

Severe pain
Coloured halos around lights
Very high IOP
N+V

52
Q

What is a direct marker of disease progression in glaucoma?

A

Diameter of optic disc

53
Q

How is IOP measured?

A

Tonometry

54
Q

What is seen on examination in CAG?

A 
Hazy cornea, redness
Non-mid reactive mid-dilated pupil
Shallow anterior chambers
Closed iridocorneal angles
Corneal epithelial oedema
55
Q

What is the mechanism of topical timolol in glaucoma?

A

Reduce aqueous secretion by inhibiting beta-adrenoreceptors on the ciliary body

56
Q

What is the mechanism of topical prostaglandin analogue in glaucoma?

A

Increase aqueous outflow via the uveoscleral route

57
Q

What are the side effects and contraindications of topical travaprost?

A

SE: change in eye colour, thickening/lengthening of eyelashes

CI: severe asthma, aphakia

58
Q

What is the mechanism of action of topical pilocarpine?

A

Causes contraction of the ciliary muscle, opens the trabecular meshwork, causes increased outflow of the aqueous humour

59
Q

What is surgical management of glaucoma?

A

Laser peripheral iridotomy

Trabeculectomy

60
Q

What is the condition where there is reactivation of VZV in the area supplied by the ophthalmic division of the trigeminal nerve?

A

Herpes Zoster ophthalmicus

61
Q

What is Hutchinson’s sign in herpes zoster ophthalmicus?

A

Rash on tip or side of nose
Indicates nasociliary involvement
Strong risk factor for ocular involvement

62
Q

What are 3 causes of optic neuritis?

A

MS
Diabetes
Syphilis

63
Q

What are the stages of non-proliferative diabetic retinopathy?

A
  1. Background - microaneurysms
  2. Mod - microaneurysms, intraretinal haemorrhages, cotton wool spots, venous beading
  3. Severe - the above in all quadrants
64
Q

What is the treatment of proliferative diabetic retinopathy?

A

Panretinal photocoagulation

65
Q

How is diabetic retinopathy diagnosed?

A

Dilated retinal photography

66
Q

What is the treatment of diabetic maculopathy?

A

Focal laser photocoagulation

67
Q

What are the types of diabetic maculopathy?

A

Focal/diffuse macular oedema
Ischaemic maculopathy
Clinically significant macular oedema

68
Q

What is the Keith-Wagener classification of hypertensive retinopathy?

A
  1. silver wiring
  2. AV nipping
  3. Cotton wool exudates, flame and blot haemorrhages
  4. Papilloedema
69
Q

What is seen on fundoscopy in central retinal artery occlusion?

A

Cherry red spot

70
Q

How is central retinal vein occlusion differentiated from central retinal artery occlusion?

A

Vein - severe retinal haemorrhages, disc oedema

Artery - cherry red spot, RAPD

71
Q

What is the treatment of central retinal vein thrombosis?

A

Panretinal laser photocoagulation if macular oedema/neovascularisation

72
Q

What is the treatment of central retinal artery thrombosis?

A

Ocular massage
Anterior chamber paracentesis/lower IOP
Artery dilatation

73
Q

What is retinal detachment?

A

The neurosensory layer of the retina separates from the underlying retinal pigment epithelium

74
Q

What are 8 risk factors for retinal detachment

A 
Age
Jewish
Marfans
Myopia
FH
Prev cataract surgery
Wet AMD
Lattice degeneration
75
Q

Why is myopia a risk factor for retinal detachment?

A

Eyeball is longer

Peripheral retina is thinner and more likely to tear

76
Q

What is the visual loss in retinal detachment?

A

Peripheral –> central

Flashes and floaters

77
Q

What are the symptoms of vitreous haemorrhage?

A

Floaters, but no flashes

78
Q

What are the symptoms of vitreous detachment?

A

Floaters and flashes

79
Q

What are the signs of retinal detachment?

A

Gross visual defects
Cells in the anterior chamber
Tobacco dust
RAPD

80
Q

What is a risk factor for vitreous haemorrhage?

A

Diabetes

81
Q

What is the pathway of the pupillary light reflex?

A

Afferent: retina –> optic nerve –> lateral geniculate body –> midbrain

Efferent: Edinger-Westphal nucleus in midbrain –> oculomotor nerve

82
Q

What is the cause of Marcus-Gunn pupil?

A

RAPD

Lesion anterior to optic chiasm: optic nerve lesions or severe retinal defect

Retinal detachment
Optic neuritis

83
Q

What is the swinging light test in RAPD?

A

Light shone to unaffected eye - both pupils constrict

Light shone to affected eye - less light detected so both pupils dilate

84
Q

Interruption of the sympathetic nerve supply to the eye is known as?

A

Horner’s syndrome

85
Q

What are the symptoms of Horner’s syndrome?

A

Miosis (constricted pupil)
Ptosis
Enophthalmos (sunken eye)
Anhidrosis (loss of sweating to one side)

86
Q

In what condition is heterochromia seen?

A

Congenital horner’s

87
Q

How can the cause of Horner’s syndrome be differentiated?

A

Anhidrosis
Face, trunk, arms -> central
Face–> pre-ganglionic
None –> post ganglionic

88
Q

What are 5 central causes of Horner’s syndrome?

A 
Stroke
Syringomyelia
MS
Tumour
Encephalitis
89
Q

What are 4 pre-ganglionic causes of Horner’s syndrome?

A

Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib

90
Q

What are 3 post-ganglionic causes of Horner’s syndrome?

A

Carotid artery dissection/aneurysm
Cavernous sinus thrombosis
Cluster headache

91
Q

How is Horner’s syndrome diagnosed?

A

Apraclonidine eye drops - causes dilation

Hydroxyamphetamine

92
Q

Which genetic condition causes night blindness and tunnel vision?

A

Retinitis pigmentosa

93
Q

What is seen on fundoscopy in retinitis pigmentosa?

A

Black bone spicule shaped pigmentation in the peripheral retina, mottling of RPE

94
Q

What is retinis pigmentosa associated with?

A 
Refsum disease
Usher syndrome
Abetalipoproteinaemia
Lawrence-Moon-Biedl syndrmoe
Kearns-Sayer syndrome
Alport syndrome
95
Q

What is the pathophysiology of pseudoxanthoma elasticum?

A

Calcium accumulates in abnormal elastic fibres

96
Q

What are the features of pseudoxanthoma?

A 
Yellow lax wrinkled skin
Claudication, angina, MV prolapse
Cardiomyopathy
Angioid streaks and retinal haemorrhages
Increased risk of miscarriage
97
Q

What are 6 differentials for painless loss of vision?

A 
Cataracts
PVD or RD
Retinal artery/vein occlusion
Amaurosis fugax
POAG
Hydroxychloroquine/isoretinoin
98
Q

What is seen on fundoscopy in papilloedema?

A 
Venous engorgement
Loss of venous pulsation
Elevation of optic disc
Loss of optic cup
Blurring of disc margin
Paton's lines
99
Q

Name 5 causes of papilloedema.

A 
Space occupying lesions
Malignant hypertension
Vitamin A toxicity
Hypercapnia
IIH
100
Q

What are the congenital causes of optic atrophy?

A

Friedreich’s ataxia
Leber’s optic atrophy
DIDMOAD

101
Q

What are the acquired causes of optic atrophy?

A

MS
Raised IOP
Ischaemia
Vit B1, B2, B6, B12 deficiency

102
Q

What are the characteristics of Holmes-Adie pupil?

A

Dilated pupil
Once constricted, remains small for an abnormally long time
Slowly reactive to accommodation but very poorly to light

103
Q

What is Holmes-Adie syndrome associated with?

A

Absent knee and ankle reflexes

104
Q

What are 4 causes of mydriasis?

A

3rd nerve palsy
Holmes Adie pupil
Traumatic iridoplegia
Phaeochromocytoma

105
Q

What drugs cause mydriasis?

A

Atropine, tropicamide
Cocaine
TCAs

106
Q

What is the cause of thyroid eye disease?

A

Cross-reactivity against shared antigens in thyroid and orbital tissue

Stimulates orbital fibroblasts to produce glycosaminoglycans which causes increased T lymphocytes

107
Q

What is a risk factor for thyroid eye disease?

A

Smoking

108
Q

What is a complication of thyroid eye disease?

A

Dysthyroid optic neuropathy - loss of colour vision and reduced acuity

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