Ophthalmology

Question 1

Does ARMD present with an RAPD?

Answer 1

No

Question 2

What signs will be present of fundoscopy in dry ARMD?

Answer 2

Hyper/hypopigmentation of retina

Deposition of drusen

Question 3

What is the investigations of choice for wet ARMD?

Answer 3

Fundus fluorescene angiogram

OCT

Question 4

What is the treatment for wet ARMD?

Answer 4

Anti-VEGF

Question 5

What 4 conditions cause a gradual visual loss?

Answer 5

Cataract
ARMD
Chronic open angle glaucoma
Diabetic retinopathy

Question 6

What signs will be seen on fundoscopy of a central retinal artery occlusion?

Answer 6

Pale swollen retina

Cherry-red spot on macula

Question 7

What is the treatment for central retinal artery occlusion?

Answer 7

Ocular massage
Paper bag breathing - CO2 mediated arteriodilation
IV diamox (CA inhibitor)
Anterior chamber paracentesis

Question 8

What signs will be seen on fundoscopy for central retinal vein occlusion?

Answer 8

Flame haemorrhage
Tortuous vessels
Swollen optic disc
Cotton wool spots

Question 9

Does RAPD develop in central retinal artery occlusion and central retinal vein occlusion?

Answer 9

Yes

Yes

Question 10

What is ischaemic optic atrophy?

Answer 10

A cause of moderate to severe visual loss
Associated with 40-60s, hypermetropes, smokers.
Swollen optic disc with hyperaemia

Question 11

What is the treatment for retinal detachment?

Answer 11

Retinal tears can be lasered

“Full-blown” detachment can utilise vitrectomy

Question 12

What are 3 causes of painless, sudden visual loss?

Answer 12

Vasular occlusion (CRVO, CRAO, ischamic optic atrophy, amaurosis fugax)
Retinal detachment
Vitreous haemorrhage

Question 13

What are 3 causes of painful, sudden visual loss?

Answer 13

Acute angle closure glaucoma
Optic neuritis
Giant cell arteritis

Question 14

Is RAPD present in optic neuritis?

Answer 14

Yes

Question 15

What is the treatment for optic nueritis?

Answer 15

Steroids

Beta-interferon

Question 16

What is the treatment of giant cell arteritis?

Answer 16

2 years of steroids

Question 17

What visual loss would a left sided parietal lesion cause?

Answer 17

Right inferior quadrantanopia

Question 18

What would a visual loss would a right sided temporal lesion cause?

Answer 18

Left superior quadrantanopia.

Question 19

Where would a brain lesion allow for sparing of the central vision?

Answer 19

If the lesion is in the visual cortex (cortical blindness)

Question 20

What is Horner’s syndrome?

How can the location, and therefore the underlying cause, of Horner’s be identified?

Answer 20

Disruption to sympathetic innervation of half of the face - leads to unilateral ptosis, anhidrosis and miosis.

Determined by extent of anhidrosis:

• head, arm, trunk - central lesion i.e. stroke, syringomyelia
• face alone - pre-ganglionic i.e. pancoast, cervical rib
• none - post-ganglionic i.e. carotid pathology

Question 21

What is a unique cause of CNIII palsy?

Answer 21

Posterior communicating artery aneurysm

Question 22

What is a unique cause of CNIV palsy?

Answer 22

Congenital

Trauma

Question 23

What is a unique cause of CNVI palsy?

Answer 23

Raised ICP

Question 24

How may scleritis be differentiated from episcleritis?

Answer 24

Localised injection in both

• episcleritis blanches with phenylephrine, or mild ocular pressure
• scleritis does not blanch with phenylephrine (injection is a deeper, purple-ish colour)

Scleritis is associated with connective tissue disease, episcleritis is not.

Pain is worse and deep with scleritis. Only mild or no pain in episcleritis.

Question 25

What is the management for episcleritis?

Answer 25

Self-limiting Topical lubricants NSAIDs

Question 26

What is the management for scleritis?

Answer 26

Oral NSAIDs Systemic steroids Immunosuppression if necrotic

Question 27

What are the signs and symptoms of anterior uveitis/iritis?

Answer 27

``` Dull pain Photophobia Lacrimation Circumcorneal injection Hypopyon Small, fixed pupil ```

Question 28

What is the treatment for anterior uveitis/iritis?

Answer 28

Topical steroids | Topical mydriatic - cyclopentolate, atropine

Question 29

What are the symptoms of acute angle closure glaucoma?

Answer 29

Unilateral eye pain and headache Red eye Cupping Hazy cornea

Question 30

How do you measure intra-ocular pressure?

Answer 30

Tonometry

Question 31

What is the initial management of acute angle closure glaucoma?

Answer 31

1. Pilocarpine - miotic (constricting) agent. 2. Acetazolamide (Diamox) - CA inhibitor, IV or oral. 3. Mannitol/Glycerol - hyperosmotic agent. 4. Timolol - beta-blocker. 5. Brimonidine - sympathomimetic agent.

Question 32

What is the initial management of open angle glaucoma?

Answer 32

1. Prostaglandin eyedrops - latanoprost, first line. 2. Second line drugs: i. Beta-blockers - timolol. ii. CA inhibitors - dorzolamide. iii. Sympathomimetics - brimonidine.

Question 33

A patient has blurry vision and photophobia. On examination, a small, fixed, oval pupil with ciliary flush is observed. What is the likely diagnosis?

Answer 33

Anterior uveitis

Question 34

What are side effects of lantoprost drops?

Answer 34

Eye lash growth, eyelid and iris hyperpigmentation.

Question 35

What is the definitive management of open angle glaucoma?

Answer 35

Trabeculectomy - surgery that opens a hole in the meshwork.

Question 36

What is the definitive management of acute angle closure glaucoma?

Answer 36

Laser iridotomy - makes a hole in iris, allowing drainage into posterior chamber.

Question 37

What is the management for a dendritic keratic ulcer?

Answer 37

Herpes simplex keratitis - topical aciclovir

Question 38

What is Hutchinson's sign?

Answer 38

Shingles affecting tip of nose - strong risk factor for ocular involvement of HZV infection

Question 39

What is the strongest risk factor for ARMD?

Answer 39

Smoking

Question 40

What is the treatment for allergic conjunctivitis?

Answer 40

Topical antihistamines

Question 41

What is Argyll-Robertson pupil? | What are the 2 causes?

Answer 41

A pupil that is not reactive to light but does accommodate. | Syphilis and diabetes mellitus