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4th year passmed > Ophthal > Flashcards

Ophthal Flashcards

1
Q

What screening should take place for patients with a family history of glaucoma?

A

Annual screening from the age of 40

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2
Q

What are the risk factors for POAG?

A

Genetics A-C Myopia HTN DM Steroids

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3
Q

What are the features of POAG?

A

Peripheral visual loss Reduced acuity Disc cupping +-pallor

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4
Q

How would you investigate for POAG?

A

Automated perimetry Slit lamp with dilatation Tonometry Central corneal thickness measurement Gonioscopy (measures peripheral anterior chamber configuration and depth)

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5
Q

What are the fundoscopic features of ARMD?

A

Drusen - yellow areas of pigment deposition in and around the macula In wet ARMD, well demarcated red patches may be seen representing haemorrhages

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6
Q

What is the typical presentation of ARMD?

A

Subacute vision loss with: Reduced acuity Difficulties in dark adaptation Fluctuations day to day Photopsia

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7
Q

What are the key risk factors for ARMD?

A

Age>75 Smoking FHx HTN DM

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8
Q

What is the first and second line management of allergic conjunctivitis?

A

1st - topical or systemic antihistamines 2nd - topical mast cell stabilisers e.g. sodium cromoglicate

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9
Q

What is the management of ARMD?

A

Vit ACE for dry reduce progression VEGF useful in wet Laser photogoaculation is beneficial but risks acute visual loss

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10
Q

Whatis the goal of treatment in pOAG and what drugs are used?

A

To reduce IOP Beta blockers e.g. timolol PG analogues e.g. latanoprost Sympathomimetics e.g. brimonidine Carb anhydrase inhibitors - Dorzolamide Miotics e.g. pilocarpine

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11
Q

What are the different grades of hypertensive retinopathy, and name the grading system used?

A

Keith-Wagener classification 1 - Tortous vessels with silver wiring 2 - 1+ AV nipping 3 - 2+ Cotton wool exudates and flame/blot haemorrhages 4- 3+ papilloedema

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12
Q

What is seen on fundoscopy of papilloedema?

A

Venous engorgement Loss of venous pulsation Blurring of optic disc margin Elevation of optic disc

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13
Q

What are the causes of papilloedema?

A

SOL Malignant HTN IIH Hydrocephalus Hypercapnia

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14
Q

What are the features of an Argyll Robertson pupil?

A

Small irregular pupils which accomodate but do not respond to light

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15
Q

What is a Hutchinson’s pupil?

A

Unilaterally dilated pupil which is unresponsive to light. A result of compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma)

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16
Q

What are the commonest causes of sudden painless vision loss?

A

Ischaemic/vascular (amaurosis fugax) Vitreous haemorrhage Retinal detachment Retinal migraine

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17
Q

What are the causes of vitreous haemorrhage?

A

DM bleeding diatheses Anticoagulation

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18
Q

What might patients with retinal detachment describe?

A

Dense shadowing that starts peripherally and progresses towards the centre Like a veil or curtein over the field of vision Straight lines may appear curved

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19
Q

What is the management of herpes zoster ophthalmicus?

A

Oral aciclovir

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20
Q

What are the two aims of treatment of acute glaucoma and how is this achieved?

A

Reduce aqueous secretion - acetazolomide Induce papillary constriction - topical pilocarpine

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21
Q

What are the features of acute closed angle glaucoma?

A

Severe pain Reduced acuity symptoms worse with mydriasis Hard red eye Haloing Non-reactive pupil Corneal oedema N/V +- abdo pain

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22
Q

What is seen on fundoscopy of central retinal artery occlusion?

A

Cherry red macula on a pale retina

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23
Q

What ist he management of a stye?

A

Analgesia and hot compress

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24
Q

What distinguishes between non-proliferative and proliferative DMR?

A

Non-proliferative DMR shows microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous bleeding et/ Proliferative DMR also shows neovascularisation +-viteous haemorrhage

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25
Q

What conditions are associated with anterior uveitis?

A

Ank spon Reactive arthritis UC/Crohns Behcets Sarcoid

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26
Q

What is the management of anterior uveitis?

A

Urgent review Cycloplegics - dilate the pupil for pain relief (e.g. Atropine) Steroid drops

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27
Q

What are the classical features of ret pig?

A

Night blindness initially Tunnel vision

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28
Q

What is the strongest risk factor for subcapsular cataracts?

A

Steroids

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29
Q

What are the risk factors for cataracts?

A

Smoking EtOH Trauma DM Steroids Radiation Myotonic dystrophy Hypocalcaemia

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30
Q

Flashers and floaters indicate?

A

Vitreous/retinal detachment

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31
Q

Amaurosis fugax is transient or permanent?

A

Transient

32
Q

What is the most common cause of vitreous haemorrhage?

A

Proliferative DMR

33
Q

What is the commonest cause of persistent watery eye in an infant, andhow is it managed?

A

Nasolacrimal duct obstruction manabed by teaching lacrimal duct massage - 95% of cases will resolve by 1 year

34
Q

What are the side effects of prostaglandin inhibitors such as Latanoprost?

A

Increased eyelash length Iris pigmentation Periocular pigmentation

35
Q

What investigations are used in ARMD?

A

Slit lamp microscopy initially Fluorsecein angiography if neovascular disease is suspected Ocular coherence tomography if needed

36
Q

True or false - optic neuritis is associated with Marcus Gunn pupil?

A

True

37
Q

What should be done for babies with a purulent eye dischagre?

A

Urgent swabs looking for chlamydia and gonogoccus

38
Q

What are some complications of zoster ophthalmicus

A

Ant uveitis (commonest) Conjunctivitis Keratitis Episcleritis Ptosis Post herpetic neuralgia

39
Q

Myopia and hypermetropia relevance to glaucoma?

A

Acute closed angle glaucoma is assocaited with hypermetropia Primary open angle glaucoma is associated with myopia

40
Q

Does hyper or hypocalcaemia predispose to cataracts?

A

Hypocalcaemia

41
Q

What is the strongest predictor of ocular involvement in zoster ophthlalmicus?

A

Hytchinson’s sign

42
Q

When would you see a dendritic ulcer on fluorescein eye staining?

A

Herpes simplex keratitis

43
Q

A 79-year-old gentleman presents with a 3 months history of a red swollen left upper eyelid. He remembers initially developing a bump on the eyelid which was uncomfortable but then got bigger forming a hard lump. He reports no pain currently and has not noted any problems with his vision and the eye itself appears healthy.

A

Chalazion/Meibomian cyst, which occurs after the progression of an internal stye (hordeolum intermum)

44
Q

What is the classical presentation of optic neuritis?

A

Vision loss Eye pain ‘behind the eye’ Red desaturation

45
Q

What type of scan would you do to assess the posterior spread of infection in orbital cellulitis?

A

Contrast CT of the orbits, sinuses and brain

46
Q

What is a contraindication to vitamin/antioxidant therapy for ARMD?

A

Smoking - because beta carotene increases risk of lung cancer

47
Q

Bilateral grittiness worse first thing in the morning indicates?

A

Blepharitis

48
Q

What are the classical features of central retinal vein occlusion?

A

Sudden painless loss of vision with severe retinal haemorrhaging on fundoscopy

49
Q

What should be done for young children with a squint?

A

Ophthal referral

50
Q

Which medication causes brown pigmentation of the iris?

A

Latanoprost

51
Q

What is the first line glaucoma treatment for patients with heart block?

A

Latanoprost

52
Q

What drug causes pupillary copnstriction, blurred vision and headahces?

A

Pilocarpine

53
Q

What conditions cause tunnel vision?

A

Papilloedema Glaucoma Ret Pig Choroidretinitis Optic atrophy

54
Q

What type of eyedrop might cause a corneal ulceration?>

A

Steroids - through fungal infection

55
Q

What are the features of episcleritis?

A

Red eye classically not painful Watering +- mild photophobia Phenylephrine induced blanching of the vessels (not the case in scleritis)

56
Q

How does latanoprost work in the management of POAG?

A

Increases uveoscleral outflow

57
Q

Stormy sunset appearance?

A

Central retinal vein occlusion

58
Q

What clinical feature differentiates scleritis from episcleritis?

A

Pain only seen in scleritis

59
Q

What clinical test may be used to detect a strabismus?

A

orneal light reflection test, where a light source is held 30cm from the child’s face to assess reflection symmetry on the pupils

60
Q

What is the MOA of dorzolamide?

A

Carbonic anhydrase inhibitor

61
Q

What type of visual impairment does POAG cause?

A

Peripheral visual field impairment

62
Q

Long hx of diabetes in an elderly patient presenting with unilateral blurring and halos is strongly indicative of?

A

Cataracts

63
Q
A

Treated diabetic retinopathy

64
Q
A

Age related macular disease

65
Q
A

Papilloedema

66
Q
A

Age related macular degeneration

67
Q
A

Retinal detachment

68
Q
A

Central retinal artery occlusion

69
Q
A

Proliferative retinopathy

70
Q
A

Retinitis pigmentosa

71
Q
A

Treated diabetic retinopathy

72
Q
A

Entropion

73
Q
A

Ectropion

74
Q
A

Retinal detachment

75
Q
A

Age related macular degeneration

76
Q
A

Central retinal vein occlusion

4th year passmed (28 decks)

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