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Ophthalmology 1 Flashcards

1
Q

Acute angle closure glaucoma
Name three factors predisposing patient to AACG

A
  1. Hypermetropia (long sightedness)
  2. Pupillary dilatation
  3. Lens growth associated with increasing age
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2
Q

Name five features of acute angle closure glaucoma

A

Red, painful eye
Haloes around light
Semi dilated non reacting pupil
Dull/ hazy cornea
Worse in a dark room

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3
Q

Mx acute angle closure glaucoma
Acute: (5)

A
  1. Urgent referral to ophthalmologist
  2. Direct parasympathomimetic (e.g pilocarpine)
  3. BB
  4. Alpha 2 agonist e.g apraclonidine
  5. IV acetazolamide
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4
Q

Mx acute angle closure glaucoma
Definitive management

A

Laser peripheral iridotomy

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5
Q

Most common cause of blindness in the UK

A

Age related macular degeneration

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6
Q

ARMD
Degeneration of what?
Through the formation of what?
Unilat or bilat?

A

Central retina/ macula
Drusen
Bilateral

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7
Q

ARMD
RF (4)

A

Age
Smoking
FH
CVD

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8
Q

Which is more common? Dry or wet macular degeneration?

A

Dry - 90%

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9
Q

What is the difference between dry and wet macular degeneration?

A

Dry - drusen
Wet - exudative, choroidal neovascularisation, rapid loss of vision

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10
Q

ARMD
Features
Onset
Near or far field objects loss of vision
Worse when?
Another feature

A

Subacute onset of visual loss
Near field objects
Worse at night
Flashing lights/ glare

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11
Q

ARMD signs (3)

A

Distortion of line perception on Amsler grid testing
Drusen
Wet ARMD - demarcated red patches

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12
Q

ARMD Ix (3)

A

Slit lamp microscopy
Fluorescein angiography (if wet)
Ocular coherence tomography

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13
Q

ARMD Rx (3)

A
  1. Zinc, vitamins A,C,E
  2. anti-VEGF (wet)
  3. Laser photocoagulation
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14
Q

Mx allergic conjunctivitis (2)

A
  1. Topical/ systemic anti-histamines
  2. Topical mast cell stabilisers e.g sodium cromoglicate and nedocromil
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15
Q

Anterior uveitis
Onset
Pain or no pain
Red or not red
Pupil size
x3 other symptoms
Acuity

A

Acute
Painful and red
Small pupil and irregular
Photophobia
Lacrimation
Ciliary flush (ring of red spreading outwards)
Acuity - initially normal, then impaired

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16
Q

Anterior uveitis
Name five conditions associated with this

A

Ank spond
Reactive arthritis
Behcet’s
IBD
Sarcoidosis

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17
Q

Mx anterior uveitis (3)

A

Urgent ophthalmology review
Cyclplegics e.g atropine
Steroid eye drops

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18
Q

Small irregular pupils
No response to light
Response to accommodate

A

Argyll Robertson pupil

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19
Q

Argyll Robertson pupil associated with which conditions? (2)

A

Syphillis
DM

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20
Q

Argyll Robertson pupil
Features (3)

A

Small irregular pupils
No response to light
Response to accommodate

AID:
Accommodation Reflex Present
Pupillary Reflex Absent

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21
Q

What is blepharitis?
What is it due to?
Common in patients which which condition?

A

Inflammation of the eyelid margins
Meibomian gland dysfunction
Rosacea

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22
Q

Blepharitis
Unilat or bilat?
Sx (4)

A

Bilat
Grittiness and discomfort
Sticky eyes
Red + dry eyes

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23
Q

Blepharitis Mx (3)

A

Hot compress BD
Lid hygiene - cotton wool buds dipped in cooled boiled water + baby shampoo
Artificial tears

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24
Q

Most common cause of blurred vision?

A

Refractive error

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25
Q

What is amaurosis fugax?

A

Sudden loss of vision in an eye due to lack of blood flow to the retina

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26
Q

Features of cataracts (4)

A

Gradual onset of:
Reduced vision
Faded colour vision
Glare
Halos

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27
Q

Cataract sign

A

Defect in the red reflex

28
Q

Complications following cataract surgery (4)

A

Posterior capsule opacification/ thickening of the lens capsule
Retinal detachment
Posterior capsule rupture
Endophthalmitis

29
Q

Sudden painless unilateral visual loss
Cherry red spot
Pale retina
RAPD

A

Central retinal artery occlusion

30
Q

Sudden painless unilateral reduction in visual acuity
Retinal haemorrhages - stormy sunset

A

Central retinal vein occlusion

31
Q

Central retinal artery occlusion
Features (4)
Secondary to what? (2)

A

Pale retina
Cherry red spot
Sudden painless visual loss
RAPD

VTE or temporal arteritis

32
Q

Central retinal vein occlusion
Features (3)

A

Sudden, painless loss of vision
Stormy sunset
Retinal haemorrhages

33
Q

Mx central retinal vein occlusion (2)

A

Anti VEGF
Laser photocoagulation

34
Q

Local trauma, eye pain, photophobia, reduced visual acuity =

A

Corneal abrasion

35
Q

Corneal abrasion fluorescein examination typically reveals what?

A

Yellow stained abrasion

36
Q

Corneal abrasion rx

A

Topical abx

37
Q

Corneal foreign body
When would you refer to ophthalmology? (7)

A

High velocity penetrating eye injury e.g hammering or drilling
Sharp objects
Significant orbital/ periorbital trauma
Chemical injury
Injury to the centre of the cornea
Organic materials foreign bodies
Or if any red flags

38
Q

What eye condition is more common in contact lens wearers?

A

Corneal ulcers

39
Q

Classification of diabetic retinopathy (1)

A

Non proliferative
Proliferative
Maculopathy

40
Q

What is mild non proliferative diabetic retinopathy? (1)

A

1 or more microaneurysm

41
Q

What is moderate NPDR? (5)

A

Microaneurysms
Blot haemorrhages
Hard exudates
Cotton wool spots (soft exudates)
Venous beading/ looping

42
Q

What is severe NPDR? (3)

A

Blot haemorrhages and microaneurysms in x4 quadrants
Venous beading in 2 quadrants
Intraretinal microvascular abnormalities (IRMA) in 1 quadrant

43
Q

What is proliferative diabetic retinopathy? (3)
Common in which type of diabetes?

A

Retinal neovascularisation
Vitrous haemorrhage
Fibrous tissue
More common in T1DM

44
Q

Maculopathy
Feature (1)
Common in which diabetes?

A

Hard exudates on macula
More common in T2DM

45
Q

Mx for
Maculopathy
NPDR
Proliferative

A

anti-VEGF
Observe +/- laser photocoagulation
Laser photocoagulation + anti-VEGF

46
Q

Example of anti-VEGF medication?

A

Ranibizumab

47
Q

Episcleritis is associated with which two conditions?

A

IBD and RA

48
Q

Episcleritis versus scleritis - pain

A

Episcleritis - not painful
Scleritis - painful

49
Q

Features of episcleritis (4)
Unilateral or bilateral

A

Painless
Red eye
Watery eye
Photophobia
50% bilateral

50
Q

What investigation can be done to differentiate between episcleritis and scleritis?

A

Phenylephrine drops - if eye redness improves then more likely episcleritis

51
Q

Mx episcleritis (1)

A

Artifical tears

52
Q

Scleritis features (4)

A

Red eye
Painful
Watering
Photophobia

53
Q

Dilated pupil
Slow reactive to accommodation
No/ poor reaction to light
Absent ankle/knee reflexes

A

Holmes Adie syndrome

54
Q

Horner’s syndrome features (4)

A

Miosis (small pupil)
Anhidrosis (loss of sweating)
Ptosis
Enopthalmos (sunken eye)

55
Q

What is Horner’s syndrome?

A

Lesion/ problem with the sympathetic pathway to the face

55
Q

Horner’s anhidrosis
Central lesion
Pre-ganglionic
Post-ganglionic

A

Anhidrosis of face, arm and trunk
Face
No anhidrosis

56
Q

Causes of central lesions Horners (5)

A

Stroke
Syringomyelia
MS
Tumour
Enceph

57
Q

Causes of pre-ganglionic lesions Horners (4)

A

Tumour - pancoasts
Thyroidectomy
Trauma
Cervical rib

58
Q

Causes of post-ganglionic lesions Horners (4)

A

Carotid aneurysm
Carotid dissection
Cavernous sinus thrombosis
Cluster headache

59
Q

Sudden loss of vision (4)

A

Central retinal vein occlusion
Central retinal artery occlusion
Retinal detachment
Vitreous haemorrhage

60
Q

Dark spots, haze, sudden visual loss =

A

Vitreous haemorrhage

61
Q

How to differentiate between posterior vitreous detachment, retinal detachment, vitreous haemorrhage

A

Posterior vitreous detachment - flashes of light, floaters often on temporal side
Retinal detachment - veil/ curtain, straight lines appear curvy
Vitreous haemorrhage - dark spots and floaters, haze

62
Q

Floaters worse on temporal side
Flashes of light =

A

Posterior vitreous detachment

63
Q

Curtains/ veil
Straight lines become curvy =

A

Retinal detachment

64
Q

Name four causes of tunnel vision

A

Papilloedema
Glaucoma
Retinitis pigmentosa
Choroidoretinitis

AKT (52 decks)

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