Ophthalmology

Question 1

Describe how anterior uveitis presents

Answer 1

acute, painful red eye associated with photophobia and blurred vision

O/E: pupil is small + irregular; hypopyon [fluid level]. Visual acuity normal –> impaired

Question 2

What condition is scleritis associated with?

Answer 2

Rheumatoid arthritis

Question 3

Describe how scleritis presents

Answer 3

Severe, constant pain in eye

O/E: eye red + photophobia, visual acuity normal

Question 4

How to differentiate episcleritis from scleritis

Answer 4

Pain

Question 5

Pilocarpine mechanism of action

Answer 5

Pupil constriction (via agonist to muscarinic receptors)

works like the parasympathetic nervous system

Question 6

Atropine mechanism of action

Answer 6

Pupil dilation (via anti-muscaranic/anti-cholinergic)

Like sympathetic NS

Question 7

Risk factors for posterior vitreous detachment

Answer 7

Elderly

Short sighted!!!

Question 8

Describe the presentation of posterior vitreous detachment

Answer 8

Floater on the temporal field of vision

Visual acuity is normal

Question 9

Cupping of the optic disc is seen in what?

Answer 9

Glaucoma

Question 10

What does fundoscopy reveal in central retinal artery occlusion

Answer 10

Chery red spot/macula

Pale retina

Question 11

Describe a Holmes Adie pupil

Answer 11

Unilateral dilated pupil; slowly reactive to accommodation; poorly reactive to light

Absent ankle/knee jerks

Question 12

How does retinitis pigmentose present?

Answer 12

Night blindness
Tunnel vision (as peripheral retina affected)

Question 13

What are some ocular manifestations of RA?

Answer 13

keratoconjunctivitis sicca (most common)
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis

Iatrogenic
steroid-induced cataracts
chloroquine retinopathy

Question 14

What is the commonest ocular manifestation of RA?

Answer 14

keratoconjunctivitis sicca (dryness)

Question 15

How do prostaglandin analogue eye drops work?

Answer 15

Increases uveoscleral outflow

Question 16

How do beta blocker eye drops work in glaucoma?

Answer 16

Reduces aqueous production

Question 17

How do Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist) eye drops work in glaucoma?

Answer 17

Reduces aqueous production and increases outflow

Question 18

How do Carbonic anhydrase inhibitors (e.g. Dorzolamide, acetazolamide) eye drops work in glaucoma?

Answer 18

Reduces aqueous production

Question 19

How do Miotics (e.g. pilocarpine, a muscarinic receptor agonist) work in glaucoma?

Answer 19

Acute: constrict pupil

Chronic glaucoma: Increases uveoscleral outflow

Question 20

How does glaucoma cause visual loss?

Answer 20

Increased ocular pressure –> optic disc/nerve atrophy

Question 21

Describe Argyll Robertson pupil

Answer 21

Small irregular pupils
No response to light, but can accommodate

[to remember - prostitute pupil - accommodates but doesnt react/have a good time]

(seen in neurosyphilis)

Question 22

Initial investigation in age related macular degeneration?

Answer 22

Slit lamp microscopy

Question 23

What 2nd line investigation if you suspect neovascular ARMD?

Answer 23

Fluoroscein angiography

Question 24

Treatment for dry age related macular degeneration

Answer 24

Zinc + anti-oxidant vitamine (ACE)

Stop smoking

Question 25

What charcaterises dry ARMD?

Answer 25

Drusen

Question 26

how to measure pressure in the eye?

Answer 26

Tonometry

Question 27

Why does orbital cellulitis require immediate admission/IV antibiotics?

Answer 27

risk of cavernous sinus thrombosis and intracranial spread