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MSRA > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Optic disc cupping associated with what?

A

Open angle glaucoma?

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2
Q

What ocular manifestations of RA are there?

A 
keratoconjunctivitis sicca (most common)
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis
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3
Q

Presenting features of retinitis pigmentosa?

A

Night blindness is often the initial sign

Tunnel vision

fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

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4
Q

How does holmes-aide pupil present?

A

Unilateral dilated pupil

Slowly reactive to accommodation and light

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5
Q

Holmes-aide pupil prognosis?

A

Benign

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6
Q

When should you prescribe topical abx for someone with a stye?

A

if conjunctivitis

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7
Q

Difference in administering phenylephrine or neosynephrine eye drops in scleritis and episcleritis

A

Blanch in episcleritis

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8
Q

Pain in scleritis or episcleritis?

A

Pain in scleritis not episcleritis

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9
Q

Typical presentation for open angle glaucoma?

A

Typically through routine IOP measurement.

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10
Q

What IOP needs to be measured for diagnosis of glaucoma?

A

> 24

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11
Q

Medical management of glaucoma - and the adverse effects of these meds?

A

prostaglandin analogue (PGA) eyedrop (latanoprost)

second line: beta-blocker (Timolol), carbonic anhydrase inhibitor (dorzolamide), or sympathomimetic eyedrop (Bimonidine)

if more advanced: surgery or laser treatment can be tried

Prostaglandin analogues (e.g. latanoprost)
- Adverse effects include brown pigmentation of the iris, increased eyelash length

Beta-blockers (e.g. timolol, betaxolol)
- Should be avoided in asthmatics and patients with heart block

Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)

  • Avoid if taking MAOI or tricyclic antidepressants
  • Adverse effects include hyperaemia

Carbonic anhydrase inhibitors (e.g. Dorzolamide)
- Systemic absorption may cause sulphonamide-like reactions

Miotics (e.g. pilocarpine, a muscarinic receptor agonist)
- Adverse effects included a constricted pupil, headache and blurred vision

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12
Q

How does acute angle closure glaucoma present?

A

Characterised by ocular pain, decreased visual acuity, worse with mydriasis (such as in the cinema), haloes around lights. It can also present with a systemic upset.

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13
Q

Definitive management for Acute angle closure glaucoma?

A

laser peripheral iridotomy

- creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle

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14
Q

Causes of RAPD?

A

retina issues - e.g. detachment, artery occulusion, infection

optic nerve e.g. optic neuritis, direct trauma, glaucoma

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15
Q

Dry eye associated with what finding on fluorescein staining?

A

Punctate

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16
Q

On examination of eyes in adenoviral conjunctivitis would would you expect to see?

A

Conjunctival follicles and chemosis (swelling)

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17
Q

How does argyll robertson pupil present?

A

Small, non reactive pupils (bilateral) to light. (will react to accommodation)

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18
Q

Management of anterior uveitis?

A

Refer to ophthal

steroid drops + mydriatic (dilating) drops e.g. Atropine, cyclopentolate

19
Q

Management of allergic conjunctivitis?

A

first-line: topical or systemic antihistamines

second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil

20
Q

Signs of macular degen on examination?

A

distortion of line perception may be noted on Amsler grid testing

fundoscopy reveals the presence of drusen, yellow areas of pigment deposition in the macular area, which may become confluent in late disease to form a macular scar.

in wet ARMD well demarcated red patches may be seen which represent intra-retinal or sub-retinal fluid leakage or haemorrhage.

21
Q

Preauricular lymph nodes in opthal question?

A

Viral aetiology

22
Q

Preauricular lymph nodes in opthal question?

A

Viral aetiology

23
Q

Most common cause of argyll robertson pupil in UK?

A

Diabetes

24
Q

Most common cause of argyll robertson pupil in UK?

A

Diabetes

25
Q

Painless, monocular loss of vision in Marfan’s syndrome?

A

Lens dislocation

26
Q

Most common causes of sudden painless visual loss?

A

ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery

vitreous haemorrhage

retinal detachment

retinal migraine

27
Q

Difference in third nerve palsy and horners?

A

Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner’s

28
Q

Do you give topical pain relief for corneal abrasions?

A

No - it delays healing

29
Q

Difference in chalazion and internal stye?

A

Chalazion - blocked meibonian gland.
- painless swellign of upper eyelid

Stye - infected gland - painful

30
Q

Management of blepharitis?

A

Hot compresses and hygeine

If doesn’t work could try chloramphenicol drops

31
Q

Anti-VEGF for dry or wet AMD

A

Wet

32
Q

How quick referral if worried about AMD?

A

within 1 week

33
Q

Fundoscopy findings of central retinal vein occlusion?

A

haemorrhages

34
Q

Blurring of vision again years after cataract surgery?

A

Posterior capsule opacification

35
Q

Treatment for corneal abrasion?

A

Topical antibiotic

36
Q

treatment for zoster ophthalmicus?

A

Oral aciclovir

37
Q

Presentation of posterior vitreous detachment?

A

Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision

38
Q

Difference in zoster ophthalmicus and herpes simplex keratitis?

A

zoster ophthalmicus

  • vesicular rash around the eye, which may or may not involve the actual eye itself
  • Hutchinson’s sign
  • Use oral aciclovir

Simplex keratitis:

  • red, painful eye
  • photophobia
  • visual acuity may be decreased
  • fluorescein staining may show an epithelial ulcer - feathery/dendritic
39
Q

Most common ocular manifestation of RA?

A

keratoconjunctivitis sicca

40
Q

Intermittent squint in newborns less than 3 months?

A

No need to worry normal

41
Q

Hypertensive retinopathy stages?

A

I Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring

II Arteriovenous nipping

III Cotton-wool exudates
Flame and blot haemorrhages

IV Papilloedema

42
Q

Management of scleritis?

A

Urgent ophthal referral

43
Q

Bacterial conjunctivitis treatment in pregnant women?

A

Topical fusidic acid

44
Q

Stages of diabetic retinopathy?

A

Mild NPDR
1 or more microaneurysm

Moderate NPDR
microaneurysms
blot haemorrhages
hard exudates
cotton wool spots ('soft exudates' - represent areas of retinal infarction), venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR

Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant

Proliferative diabetic retinopathy

Key features
retinal neovascularisation - may lead to vitrous haemorrhage
fibrous tissue forming anterior to retinal disc
more common in Type I DM, 50% blind in 5 years

Maculopathy

Key features
based on location rather than severity, anything is potentially serious
hard exudates and other ‘background’ changes on macula
check visual acuity
more common in Type II DM

MSRA (22 decks)

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