Ophthalmology

Question 1

What is the definitive management of acute closed angle glaucoma?

Answer 1

Laser peripheral iridotomy

Question 2

What fundoscopy signs are seen in chronic glaucoma?

Answer 2

Disc cupping
Disc notching
Disc haemorrhages
Disc pallor
Bayonetting of vessels

Question 3

What is the management of retinal detachment?

Answer 3

Urgent ophthalmology review

Question 4

What is a Holmes-Adie pupil?

Answer 4

Unilateral dilated pupil

Sluggish to react to light and sluggish to re-dilate

Question 5

What is Horner’s syndrome?

Answer 5

1. Miosis
2. Ptosis
3. Anhidrosis

Question 6

How can you determine the lesion in Horner’s syndrome?

Answer 6

S, T, C
Face + trunk CENTRAL LESION – stroke, spyringomyelia

Face only PRE-GANGLIONIC – pancost tumour, trauma, thyroidectomy

No anhidrosis POST-GANGLIONIC – cluster headache, carotid artery dissecton

Question 7

How can you differentiate between episcleritis and scleritis?

Answer 7

Phenylephrine drops

If redness reduces = episcleritis
If redness persists = Scleritis

Question 8

Which organisms are most common in keratitis?

Answer 8

Staph aureus = most common
In contact lens wearers = Pseudomonas

If been swimming (esp if contact lens wearer) - Acanthoemoba

Question 9

Which type of retinitis is common in HIV patients and what is seen on fundoscopy?
How is it managed?

Answer 9

CMV retinits
Fundoscopy = pizza retinitis

Intravitreal Ganciclovir

Question 10

What is retinitis pigmentosa? How does it present and what is seen on fundoscopy?

Answer 10

Congenital condition – degeneration of rods and cones

Night blindness + loss of peripheral vision

Fundoscopy = Bone-spicule pigmentation

Management = ophthal referral

Question 11

What is seen on slit lamp examination in anterior uveitis?

Answer 11

Conjunctival injection
Keratic precipitates
Anterior chamber cells
Posterior synechiae

Question 12

What are signs of optic neuritis?

Answer 12

Central scotoma
Reduced colour saturation esp red
RAPD
Pain on eye movement
Reduced visual acuity

Question 13

What is seen on fundoscopy in optic neuritis?

Answer 13

Pale optic disc

Optic disc swelling

Question 14

What is seen on fluorescin staining in herpes keratitis?

Answer 14

Dendritic ulcer

Question 15

How is papilloedema seen on fundoscopy?

Answer 15

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

Question 16

What risk are children at risk of if you do not correct their childhood squint?

Answer 16

Amblyopia

Question 17

What is herpes zoster ophthalmicus?

Answer 17

Reactivation of varicella zoster in ophthalmic division of the trigeminal nerve
Vesicular rash around the eye

Question 18

What is Hutchinson’s sign?

Answer 18

Rash on the tip or side of nose
Indicates risk of anterior uveitis
urgent ophthalmology review needed

Question 19

How is herpes zoster opthahlmicus managed?

Answer 19

Oral Aciclovir

Question 20

How to manage bacterial conjunctivitis in pregnant women?

Answer 20

Topical fusidic acid

Question 21

What is a Marcus-Gunn pupil?

Answer 21

RAPD

Question 22

What do cotton wool spots on fundoscopy represent?

Answer 22

Areas of retinal infarction

Question 23

What are the four types of cataracts?

Answer 23

Nuclear
Polar
Subcapsular (associated with steroid use)
Dot (associated with diabetes)


Question 24

How is herpes simplex keratitis managed?

Answer 24

Topical aciclovir

Question 25

How is Ramsay Hunt syndrome managed?

Answer 25

Oral acyclovir + Oral prednisolone

Question 26

How does age related macular degeneration present?

Answer 26

Gradual worsening of central field loss (Central scotoma) Reduction of visual acuity (particularly near field objectives) Difficulty seeing at night Flashing lights Distortion of line perception (crooked/wavy appearance) Difficulty recognising faces

Question 27

How can primary open angle glaucoma be investigated?

Answer 27

Applanation tonometry - measures pressure Slit lamp examination Fundoscopy Gonioscopy

Question 28

What is the emergency management of acute angle closure glaucoma? What is the definitive management?

Answer 28

Emergency management Pilocarpine eyedrops - 2% for blue eyes and 4% for brown eyes Beta blocker eyedrops - Timolol IV Acetazolamide Definitive management= laser peripheral iridotomy

Question 29

What is a cataract and how does it present?

Answer 29

``` Lens of the eye becomes cloudy Gradual loss of Generalised reduced vision Faded colour vision Glare Haloes around light ```

Question 30

What are the four stages of hypertensive retinopathy?

Answer 30

Stage 1 = arteriolar narrowing, increased light reflex (silver wiring) Stage 2 = Arteriovenous nipping Stage 3 = Cotton wool spots, flame haemorrhages, blot haemorrhages Stage 4 = Papilloedema

Question 31

What is endopthalmitis and how is it managed?

Answer 31

Inflammation of the interior cavity of the eye, usually caused by infection Complication of intraocular surgery Red eye, pain and vision loss after intraocular surgery Managed with intravitreal vancomycin

Question 32

How to investigate primary open angle glaucoma?

Answer 32

Gonioscopy Slit lamp exam Applanation tonometry

Question 33

How to investigate age related macular degeneration?

Answer 33

Amsler grid testing - wavy lines Fundoscopy Gonioscopy

Question 34

How is wet ARMD managed?

Answer 34

Flourescin angiography