Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Years / Progress Test > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

what conditions are ocular emergencies

A

Central Retinal Artery Occlusion

Retinal detachment

Orbital cellulitis

Acute angle closure glaucoma

Giant cell arteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

measuring visual acuity

A

corrective glasses or contact lenses should be worn

pt 6 metres away from snellen chart

record as distance from chart/number of lowest line read

if can’t read top line at 6 metres move closer 1m at a time

if not perfect with corrected lenses then used pinholes to remove refractory error

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is a logMAR

A

a more specialist chart for testing visual acuity where a logarithmic scale is used - used by ophthalmologists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the components of the retina

A

an inner and outer plexiform layer

photoreceptors called rods and cones - rods night vision, cones daylight vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cornea
- vascularity
- layers

A

avascular - derives its oxygen from the tear film and aqueous humour

consists of 5 layers
collagen fibres regularly arranged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

where does the optic nerve enter the orbit

A

through the optic foramen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

where does the ophthalmic artery arise from

A

the carotid artery and supplies the retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

three Cs of the optic disc

A

Cup - pale centre devoid of neuroretinal tissue. estimate cup to disc ratio. 1/3 considered normal. increased ratio=less neuroretinal tissue –> glaucoma

Colour - orange-pink donut with a pale centre.

Contour - should be clear and well defined. if swollen may indicate papilloedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how are pupils best dilated for fundoscopy

when not to use

A

1% tropicamide eye drops - short acting dilation
can also use Cyclopentolate 1%
Phenylephrine 2.5%

don’t use if any symptoms of acute angle closure glaucoma such as a painful sore red eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

dry age related macular degeneration

presentation
risk factors
O/E
treatment

A

gradual loss of central vision (as the macular region is responsible for this area of fine vision).

difficulty with reading and seeing fine detail, and often cannot see people’s faces clearly.
lines can appear distorted

Risk factors include female gender, smoking, hypertension and previous cataract surgery. Peripheral vision is spared.

O/E
visual acuity affected
fundoscopy; optic disc normal, peripheral retina flat, hard to visualise macula with drusen (lipid deposits) usually seen

No treatment currently available
some evidence that high doses of vitamins A, C, E and copper and zinc may slow disease progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the signs and symptoms of glaucomatous optic neuropathy

A

raised intraocular pressure, optic nerve damage (cupping) and peripheral visual field defect (visual acuity usually preserved)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is glaucoma

A

a condition where the optic nerve becomes damaged
usually caused by fluid building up in the front part of the eye, which increases pressure inside the eye. Glaucoma can lead to loss of vision if it’s not diagnosed and treated early.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

glaucoma risk factors

A

race
old age
family history
short sightedness
diabetes
having a thin cornea
wearing tight tie and collar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

normal pressure in the eye

how is it measured

A

10-20mmHg
<5 too low
>22 too high

measured with a Goldmann tanometer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

where does aqueous humour drain out of the eye

A

the canal of schlemm
if blocked can raise pressure in the eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which medications can lower intraocular pressure (used in AACG)

A

betablockers
pilocarpine
prostaglandin analogues
carbonic anhydrase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is wet macular degeneration

A

fluid and/or blood develops in the retina due to neovascularisation which occurs in an attempt to restore function

can present suddenly with loss of central vision and distortion and requires an urgent referral as treatments exist (e.g., intra-vitreal anti VEG-F injections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

risk factors for acute angle closure glaucoma

A

female
near sighted (hypermetropia)
dilatation of pupil
lens growth associated with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

symptoms of acute angle closure glaucoma

A

vomiting
progressive subacute headache
blurred vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

signs of acute angle closure glaucoma

A

red eye
dilated pupil
cloudy cornea
blue iris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what happens to the intraocular pressure in acute angle closure glaucoma

A

quickly rises to >50mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

management of acute angle closure glaucoma

A

peripheral idiotomy to restore the flow of aqueous humour

medical management to reduce pressure

same procedure in other eye prophylactically

follow up in glaucoma clinic to assess visual fields

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how does central retinal artery occlusion present

A

sudden, painless loss of vision - can be reduced to NPL - ophthalmic emergency

cherry red spot on fundoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what other condition must be excluded in a central retinal artery occlusion

A

giant cell (temporal) arteritis

(only in a few patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what causes central retinal artery occlusion in most patients

A

non-inflammatory vascular problems associated with raised cholesterol, hypertension and atherosclerosis

need good personal Hx and FHx of diabetes, hypertension and hypercholesterolaemia as well as other vascular problems and vascular risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

retinal detachment:
- presentation
- risk factors
- management

A

sudden onset of floaters or flashes in vision preceding loss of vision

myopia, trauma, advancing age

needs surgery immediately - retina is usually flattened with gas or oil, after having the vitreous removed

urgency and prognosis (retaining vision) depends on whether macular is detached

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

orbital cellulitis
- presentation
- common pathogens

A

periocular erythema, swelling and pain
reduced eye movements and vision
fever
unwell

life threatening ophthalmic emergency

often associated with a respiratory tract infection and involves common pathogens such as
Haemophilus influenzae
Staphylococcus aureus
Streptococcus pneumoniae
Betahaemolytic streptococcu

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

orbital cellulitis
- investigations
- management

A

orbital scan (MRI or CT)
FBC
swab from conjuctivae
blood cultures

IV antibiotics according to cultures and swabs
hourly observations including visual acuity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

infective endophthalmitis

A

rare ocular emergency presenting with red eye, pain, reduced vision
signs; pus in anterior chamber and injected conjunctiva

can be associated with recent surgery and with recent ocular surgery

refer urgently to ophthalmology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

signs of conjunctivitis

A

injected conjunctiva
normal visual acuity
mucoid discharge
reactive pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

investigations in conjunctivitis

A

bacterial swabs
viral swabs
chalmydia swabs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what can be used to investigate the cornea in a presentation of red eye

A

Fluorescein (sodium fluorescein) - an orange water-soluble dye.
Used intravenously or topically.
Visualized using a cobalt-blue filter which causes the dye to fluoresce a bright green color.

Fluorescein does not stain intact corneal epithelium but does stain the deeper corneal stroma, highlighting the area of the epithelial loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how can herpes simplex infection affect the eye

A

dendritic ulcers of the eye are associated with herpes simplex

Most primary infections are subclinical or cause only mild fever, malaise and upper respiratory tract symptoms.

Blepharitis and follicular conjunctivitis may develop but are usually mild and self-limited.

Treatment, if necessary, involves topical aciclovir ointment for the eye and/or cream for skin lesions

34
Q

what is anterior uveitis
how does it present
what clinical signs

A

inflammation of the uveal tract which involves the iris, ciliary body, retina and choroid

usually red, aching eyes, vision can be blurred
no discharge
refer to ophthalmology

signs of intra-ocular inflammation, such as cells in the anterior chamber and posterior synechiae.
if posterior synechiae (where iris sticks to lens) irregular pupil and raised intraocular pressure can occur

often associated with autoimmune conditions

35
Q

treatment and management of bacterial conjunctivitis

A

send off swabs for PCR
chloramphenicol eye drops
cool compresses

avoid contact lenses for duration of treatment and 48hrs afterwards
irrigation of the eye may be useful in purulent cases

36
Q

what are the common bacterial and viral causes of conjunctivitis

A

bacterial: S. pneumoniae, S. aureus, H. influenzae and Moraxella catarrhalis.
occasional gonnhorhea or chlamydia can

viral: commonly adenoviruses - self limiting

37
Q

what is bacterial keratitis
what can it progress to
management

A

infection of the cornea, usually presenting with an ulcer (pain and redness). more common in contact lense wearers

can progress rapidly to cause a hypopyon, which represents pus in the anterior chamber
this can cause a corneal perforation

refer urgently to ophthalmology
stop contact lens wear
don’t prescribe steroid eye drops
treated with frequent topical antibiotics

38
Q

when do 6th nerve palsies tend to occur

A

tend to be acquired later in life due to other conditions that can damage the nerve such as vascular factors reducing blood supply to the nerves (microvascular palsy) - these can resolve spontaneously

direct pressure on the nerve such as from a tumour or raised intracranial pressure can also cause a lateral rectus palsy

39
Q

features of a 6th nerve palsy

A

double vision (horizontal)
inability to abduct the eye
convergent squint

40
Q

what does a third nerve palsy that includes a dilated pupil indicate

A

that there is mass effect on the nerve ie. an aneurysm or other SOL- neuroimaging required urgently
this is also often associated with pain

can also have vascular causes - less urgent

41
Q

signs of a third nerve palsy

A

horizontal and vertical diplopia
eye is down and out
pupil may be dilated
ptosis

42
Q

management of an orbital floor fracture

A

urgent maxillofacial surgery

broad spectrum antibiotic

advise patient not to blow their nose

43
Q

signs of an orbital floor fracture

A

double vision on upward gaze

infra-orbital parasthesia

44
Q

4th nerve palsy presentation

A

affected eye turns up and out in the forward position

when looking laterally to affected side eye up more

4th nerve innervates superior oblique which moves eye down and in

45
Q

what main condition other than a CN palsy can cause diplopia

A

myasthenia gravis - fatiguing of oculomotor muscles
may present with diplopia and ptosis

46
Q

DVLA double vision

A

patient must stop driving immediately and inform the DVLA

Patients can return to driving after a period of adaptation or if the double vision has resolved.
Patients can hold a Group 1 license (cars/personal vehicles) if their double vision is controlled with prisms or if they occlude (patch) one eye. The other eye however must have sufficient vision (6/12) and adequate visual field.

Drivers of HGV eg lorries, buses (who require a Group 2 license) cannot drive with persistent diplopia (even after period of adaptation) or patched.

47
Q

management options for diplopia

A

All patients should be referred to an orthoptist
options:
- patching eye
- temporary fresnel prism, can be fitted and the power adjusted as the palsy resolves
- if long-lasting then permanent prisms can be fitted to glasses
- surgical intervention can be considered to realign the eyes

48
Q

what complication of otitis can cause diplopia

A

a cavernous sinus thrombosis
- headaches and diplopia

needs to be urgently excluded

49
Q

what is anisocoria

A

unequal pupil size

50
Q

what is leukocoria

causes in children

A

white pupil - red reflex lost - opacity in the optical media of the eye

Congenital cataract
Retinoblastoma
Coat’s disease
Intraocular infection

51
Q

what cause of leukocoria needs to be excluded urgently in children

what does the retina look like

A

retinoblastoma

raised white mass on the retina

52
Q

what dilating drops are used in children

A

Cyclopentolate

53
Q

what is Retinopathy of prematurity (ROP)

A

proliferative retinopathy affecting premature infants of very low birth weight, who have often been exposed to high ambient oxygen concentrations

54
Q

screening for retinopathy of prematurity

A

Babies born at or before 31 weeks gestational age, or weighing 1500 g or less, should be screened for ROP at around 4–7 weeks postnatally. Only about 8% of babies screened actually require treatment.

55
Q

treatment for retinopathy of prematurity

A

Laser photocoagulation is the treatment of choice, and it is successful in around 80% of cases

if left untreated can progress to sight threatening complications such as vitreous haemorrhage and retinal detachment

56
Q

what is retinoblastoma
types
management
spread

A

intraocular malignancy of childhood <3 years - malignant transformation of primitive retinal cells before differentiation

heritable (40% cases, gene on chromosome 13) or non-heritable (60% of cases, unilateral)\

complex treatment depending on how advanced and on vision: combination of chemotherapy, radiotherapy, brachytherapy and enucleation (removing the eyeball)

metastasis can occur especially if optic nerve invasion, massive choroidal invasion, anterior chamber involvement and orbital spread

57
Q

congenital cataracts

A

present with leukocoria in children (3 in 10000 live births)

2/3 bilateral and more likely to be caused by genetic mutation, chromosomal abnormalities, metabolic disorders and intrauterine infections

unilateral more likely to be sporadic

58
Q

surgery in congenital cataracts

A

complex surgeries carried out depending on timing, density and unilateral/bilateral

bilateral dense cataracts - operate at 4-6 weeks to prevent amblyopia

bilateral partial - may not require surgery but done later if so

unilateral dense cataract urgent surgery usually within days and aggressive anti-amblyopia therapy (often poor result)

59
Q

production and flow of aqueous humour

A

produced by the ciliary body
flows from the ciliary body, around the lens and under the iris, through the anterior chamber, through the trabecular meshwork and into the canal of Schlemm

60
Q

visual changes in glaucoma

A

peripheral vision impaired

61
Q

what medications can precipitate an acute angle closure glaucoma

A

Adrenergic medications such as noradrenalin
Anticholinergic medications such as oxybutynin and solifenacin
Tricyclic antidepressants such as amitriptyline

62
Q

pathophysiology in diabetic retinopathy

A

Hyperglycaemia damages small blood vessels - increased permeability leads to blot haemorrhages and hard exudates

Micro aneurysms
Venous beading
Damage to nerve fibres - cotton wool spots
Intraretinal microvascular abnormalities
Neovascularisation - can cause diabetic macular oedema

63
Q

types of diabetic retinopathy

A

proliferative retinopathy (neovascularisation)

non-proliferative retinopathy

maculopathy (macular oedema and ischaemic maculopathy)

64
Q

complications of diabetic retinopathy

A

Retinal detachment
Vitreous haemorrhage (bleeding in to the vitreous humour)
Rebeosis iridis (new blood vessel formation in the iris)
Optic neuropathy
Cataracts

65
Q

management of diabetic retinopathy

A

Laser photocoagulation
Anti-VEGF medications
Vitreoretinal surgery (keyhole surgery on the eye) may be required in severe disease

66
Q

what is a cataract
what are the symptoms

A

a cataract is where the lens becomes progressively opacified

Very slow reduction in vision
Progressive blurring of vision
Change of colour of vision with colours becoming more brown or yellow
“Starbursts” can appear around lights, particularly at night time
loss of red reflex O/E

67
Q

symptoms of vitreous haemorrhage

A

Painless
Spots of vision loss
Floaters
Flashing lights

68
Q

retinal detachment
- symptoms
- management

A

Peripheral vision loss - often sudden and like a shadow coming across the vision
Blurred or distorted vision
Flashes and floaters

Ophthalmological emergency - needs urgent assessment if suspected

Management of retinal detachment aims to reattach the retina and reduce any traction or pressure that may cause it to detach again.
needs to also be done to any tears to prevent detachment

69
Q

retinal vein occlusion
presentation
treatment

A

thrombus forms in the retinal veins and blocks the drainage of blood from the retina - build up leads to oedema and retinal haemorrhages which damage the retina and cause loss of vision

presents; sudden painless loss of vision

treatment; laser coagulation, intravitreal steroids, antiVEGF therapies

70
Q

subconjunctival haemorrhage

A

small blood vessel rupture within the conjunctiva causing bleeding between the conjunctiva and sclera

causes bright red bleeding across the eye

can be caused by trauma or straining

spontaneously resolve
- check about anticoagulants

71
Q

what is amblyopia

what are the main causes

can it be treated

A

reduced visual acuity due to a problem focusing in early childhood

most commonly due to a strabismus (lazy eye) - treated with patch or dilating drops of good eye for 4-6 hrs a day
other causes include refractive error and congenital cataracts

can only be treated if detected early enough when the neurological plasticity is still present

72
Q

what condition is giant cell arteritis strongly associated with

A

polymyalgia rheumatica

73
Q

management of suspected GCA

A

start oral prednisolone 40-60mg a day
refer urgently to ophthalmology for temporal artery biopsy

if visual loss IV methylprednisolone

74
Q

what is typically the defect causing fluid in a chronic open angle glaucoma

A

defect in the trabecular meshwork which slows down the flow of aqueous humour

75
Q

papilloedema on fundoscopy

A

venous engorgement, blurring of optic disc margin, Loss of optic cup and loss of venous pulsation

76
Q

differentiating between scleritis and episcleritis

A

scleritis is painful whereas episcleritis is not

77
Q

Horners syndorme

A

miosis + ptosis + enophthalmos +/- anhydrosis (loss of sweating on one side)

78
Q

orbital cellulitis needs…

periorbital cellulitis

A

IV antibiotics, admission and regular observations

oral antibiotics usually sufficient

79
Q

screening in those with a FHx of glaucoma

A

annual screening from age 40

80
Q

how can the orbit be decompressed

A

lateral canthotomy

81
Q

management of anterior uveitis

A

urgent ophthalmologist review
pupil dilatation
steroid eye drops

82
Q

proliferative diabetic retinopathy should be

A

referred urgently to hospital

Clinical Years / Progress Test (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions