Ophthalmology

Question 1

Acute angle closure glaucoma predisposing factors

Answer 1

Hypermetropia
Pupillary dilation
lens growth assoc. w/ age

Question 2

Acute angle closure glaucoma features

Answer 2

Semi-dilated non-reacting pupil
haloes around lights, symptoms worse w/ mydriasis
severe pain w/ vomiting

Question 3

Acute angle closure glaucoma mx.:

Answer 3

Pilocarpine (parasympathomimetic)
Timolol
a2-agonist

IV acetazolamide

Question 4

Acute angle closure glaucoma definitive mx.:

Answer 4

Laser peripheral iridotomy

Question 5

Distortion of line perception on amsler grid testing

Answer 5

Age-related macular degeneration

Question 6

Dry age-related macular degeneration tx.

Answer 6

Combination of zinc and anti-oxidant vitamins A,C,E

Question 7

Wet macular degeneration tx:

Answer 7

anti-VEGF (ranibizumab, bevacizumab, pegaptanib)

Question 8

Allergic conjunctivitis mx:

Answer 8

Topical or systemic anti-histamines

Mast-cell stabilisers - sodium cromoglicate

Question 9

Anterior uveitis pupil:

Answer 9

Small, irregular due to sphincter muscle contraction

Hypopyon

Question 10

Anterior uveitis tx.

Answer 10

Urgent review
Cycloplegics (dilate pupil to relieve pain/photophobia)
Steroid eye drops

Question 11

Argyll-Robertson pupil

Answer 11

Small irregular pupils which do NOT react

Question 12

Anterior blepharitis causative conditions:

Answer 12

Seborrhoeic dermatitis/staphylococcal infection

Question 13

Posterior blepharitis causative conditions

Answer 13

Meibomian gland dysfunction

Question 14

Metabolic disorder causing cataracts

Answer 14

Hypocalcaemia

Question 15

Reduced vision, fading colour vision, glare (lights appearing brighter than usual), haloes around lights

Answer 15

Cataracts

Question 16

Non-proliferative diabetic retinopathy - features of moderate disease:

Answer 16

Microaneurysm, blot haemorrhages, hard exudate

cotton wool spots (infarction)

Question 17

Non-proliferative diabetic retinopathy - features of severe disease:

Answer 17

Blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant

Question 18

Key features of proliferative diabetic retinopathy

Answer 18

Retinal neovascularisation
fibrous tissue forming anterior to retinal disc
more common in T1DM

MACULOPATHY

Question 19

Management for maculopathy in PDR

Answer 19

Anti-VEGF

Question 20

Management PDR:

Answer 20

Panretinal laser photocoagulation
intravitreal VEGF inhibitors
vitreoretinal surgery

Question 21

Topical chemical used to differentiate between scleritis and episcleritis

Answer 21

Phenylephrine

Question 22

Herpes simplex keratitis mx:

Answer 22

Immediate referral

Topical aciclovir

Question 23

What is Hutchinson’s sign:

Answer 23

Herpes zoster ophthalmicus
Rash on the tip or side of the nose, indicates nasocilliary involvement and is a strong risk factor for ocular involvement

Question 24

Herpes zoster ophthalmicus mx.:

Answer 24

ORAL antiviral treatment for 7-10 days

Topical anti-viral is not given
Topical corticosteroids may be given to treat any inflammation in the eye

Question 25

Holmes-adie pupil:

Answer 25

``` Dilated pupil (unilateral m/c) once pupil has constricted it remains small for an abnormally long time ```

Question 26

Holmes-adie syndrome:

Answer 26

Holmes-adie pupil w/ absent ankle/knee reflexes

Question 27

Horner's syndrome: central lesion cause:

Answer 27

Anhidrosis of the face arm and trunk

Question 28

Horner's syndrome examples of central lesions:

Answer 28

``` Stroke Syringomyelia Multiple sclerosis Tumour Encephalitis ```

Question 29

Horner's syndrome: pre-ganglionic lesions cause ->

Answer 29

Anhidrosis of the face only

Question 30

Horner's syndrome: examples of pre-ganglionic lesions

Answer 30

pancoast TUMOUR Thyroidectomy Trauma cervical rib The Ts

Question 31

Horner's syndrome: post-ganglionic lesions cause ->

Answer 31

No anhidrosis

Question 32

Horner's syndrome: examples of post-ganglionic lesions:

Answer 32

Carotid artery dissection Carotid aneurysm Cavernous sinus thrombosis Cluster headache The Cs

Question 33

Hypertensive retinopathy stages:

Answer 33

I - Arteriolar narrowing and tortuosity, silver wiring, increased light reflex II - AV nipping III - Cotton-wool exudates, flame and blot haemorrhages IV - Papilloedema

Question 34

Infective conjunctivitis: symptoms settle themselves w/in

Answer 34

1-2 weeks

Question 35

Antibiotic commonly offered in infective conjunctivitis:

Answer 35

Chloramphenicol - should not be given to pregnant women - topical fusidic acid instead

Question 36

Keratitis (inflammation of the cornea) causative | bacterial organisms:

Answer 36

Staph aureus | Pseudomonas aeruginosa in contact lens wearers

Question 37

Other causative organisms in keratitis:

Answer 37

Amoebic - acanthomoebic keratitis - increased incidence if eye exposure to soil or contaminated water Parasitic - river blindness

Question 38

Keratitis management:

Answer 38

STOP contact lenses Topical QUINOLONES first line cycloplegic (cyclopentolate) for pain relief

Question 39

Causes of mydriasis

Answer 39

CN3 palsy Holmes-Adie pupil traumatic iridoplegia phaechromocytoma ``` Drug causes: Atropine Amphetamines Cocaine TCA ```

Question 40

Orbital compartment syndrome features:

Answer 40

``` Eye-pain Swelling Proptosis Rock-hard eyelids RAPD ```

Question 41

Orbital compartment syndrome mx.:

Answer 41

Urgent lateral canthotomy (before diagnostic imaging) to decompress orbit

Question 42

Unilateral decrease in visual acuity over hours or days Red desaturation - poor discrimination of colours central scotoma RAPD Pain ++

Answer 42

Optic neuritis

Question 43

Investigation for orbital cellulitis:

Answer 43

CT w/ contrast

Question 44

Most common organisms in orbital cellulitis:

Answer 44

Streptococcus, staphylococcus, Haemophilus influenzae b

Question 45

Posterior vitreous detachment: symptoms

Answer 45

``` Sudden appearance of floaters Flashes of light in vision Blurred vision Cobweb across vision Appearance of dark curtain descending down vision (means there is also retinal detachment) ```

Question 46

Posterior vitreous detachment investigations:

Answer 46

All should be examined by an ophthalmologist within 24 hours

Question 47

Posterior vitreous detachment management:

Answer 47

Symptoms gradually improve over a period of 6 months w/out treatment if there is a tear then surgery will be required

Question 48

Pre-septal cellulitis management:

Answer 48

All cases to secondary care for assessment Oral antibiotics are usually sufficient CO-AMOXICLAV

Question 49

Investigation for increased intra-ocular pressure:

Answer 49

Applanation tomography

Question 50

Investigation for visual fields:

Answer 50

Automated perimetry

Question 51

Mode of action - sympathomimetics in reducing ocular pressure

Answer 51

Reduce aqueous production and increases outflow

Question 52

Examples of sympathomimetics:

Answer 52

Brimonidine - a2 receptor antagonist

Question 53

Mode of action carbonic anhydrase inhibitors

Answer 53

Reduces aqueous production

Question 54

Examples of miotics: | Mechanism of action

Answer 54

Pilocarpine - muscarinic receptor agonist | Increase uveoscleral outflow

Question 55

Normal cup to disc ratio | Cup to disc ratio in glaucoma

Answer 55

0.4-0.7 | >0.7

Question 56

Other name for RAPD:

Answer 56

Marcus-Gunn pupil

Question 57

Pathway of pupillary light reflex:

Answer 57

Afferent = Retina -> optic nerve -> lateral geniculate body -> midbrain Efferent: Edinger-Westphal nucleus -> oculomotor nerve

Question 58

Retinitis pigmentosa initial sign:

Answer 58

Night-blindness

Question 59

What is retinitis pigmentosa:

Answer 59

Primarily affects the peripheral retina resulting in tunnel vision

Question 60

Retinitis pigmentosa on fundoscopy:

Answer 60

Black bone spicule-shaped pigmentation in the peripheral retina mottling of the retinal pigment epithelium

Question 61

Occular manifestations of rheumatoid arthritis:

Answer 61

``` Keratoconjunctivitis sicca (Most common) Episcleritis scleritis corneal ulceration keratitis ```

Question 62

What condition may an untreated squint lead to:

Answer 62

Ambylopia

Question 63

Causes of vitreous haemorrhage:

Answer 63

Diabetes, bleeding disorders, anticoagulants

Question 64

Vitreous haemorrhage px.

Answer 64

Painless visual loss or haze Red hue in the vision Floaters or shadows/dark spots

Question 65

Vision loss in macular degeneration

Answer 65

Reduction in VISUAL ACUITY Difficulty in dark adaptation Deterioration in vision at night Photopsia