Brainscape's Knowledge GenomeTM

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


See full index

Finals: Speciality Blocks > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Difficulty in reading text and recognising faces, and problems with vision in dim light are typical features of which condition

A

Dry AMD

“Old people like to read the newpaper and thus they notice if they cant anymore (age related)”

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

Difficulty driving at night is a typical feature of which condition

A

Cataracts

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

Patients often complain of knocking over objects is a typical feature of which condition

A

Chronic open angle glaucoma

In chronic OAG the peripheral visual fields is affected first so patients often complain of knocking over objects.

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

Likely Dx

Painful ear, purulent discharge and keen swimmer

A

Otitis externa

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

Potential complication of otitis externa

A

Malignant otitis externa

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

Likely Dx

Otalgia (ear pain) worse at night
Otorrhoea (ear discharge)
Granulation tissue seen in the external auditory canal on otoscopy
+/- facial palsy

A

Malignant otitis externa

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

Likely Dx

Acute-onset otalgia +/- fever which often precedes an upper respiratory tract infection

A

Acute otitis media

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

What is the otoscopic features of an acute otitis media

A

Hyperaemic, bulging and featureless tympanic membrane

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

Acute mastoiditis is a complication of what condition

A

Acute otitis media

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

Likely Dx
Retro-auricular pain
Conductive hearing loss
Fever
On examination, the tympanic membrane is protruding forwards
Recent Hx of acute otitis media

A

Acute mastoiditis

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

What are the two most common organisms that causes otitis externa?

A

Pseudomonas spp
Staphylococcus aureus

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

What is the best treatment for blepharitis

A

Hot compress and mechanical removal of the debris +/- artificial tears if patients report dry eyes

Hot compresses to soft the eyelid margin
Removal of debris with cotton buds dipped in cooled boiled water

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

Dendritic ulcers seen under slit lamp with fluorescein applied is pathognomonic for which condition?

A

Herpes simplex keratitis

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

What causes Herpes Simplex Keratitis

A

Caused by reactivation of the herpes simplex virus type 1 (HSV1) which lies dormant in the trigeminal ganglion

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

How is Herpes Simplex Keratitis managed

A

Topical acyclovir

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

Likely Dx:

Eye pain out of proportion to the findings
Eye redness
Decreased visual acuity
Contact lens wearer

A

Acanthamoeba keratitis

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

In contact lens wearers, the causative organism in Acanthamoeba keratitis

A

Pseudomonas

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

A painful red eye with photophobia, foreign body sensation and blurring of vision is highly suspicious for what?

A

Keratitis (inflammation of the cornea)

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

Dendritic ulcer with a shingles rash in the ophthalmic dermatome is pathognomonic of which condition?

A

Herpes Zoster Ophthalmicus

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

Management of bacterial keratitis

A

Immediate ophthalmologist referral as it is an emergency

Management involves stopping the use of contact lenses, intensive topical (and sometimes oral) antibiotics – in severe infections, patients need to be admitted

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

Feature of mild non-proliferative diabetic retinopathy

A

Microaneurysms only on fundus

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

Features of moderate non-proliferative diabetic retinopathy

A

One of the following features:
Retinal haemorrhages
Hard exudates
Cotton wool spots
Venous changes (beading/looping)

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

Features of severe non-productive diabetic retinopathy

A

4-2-1 rule
4 quadrants with haemorrhage
OR
2 quadrants with venous beading
OR
1 quadrant with IRMA (intra-retinal microvascular abnormality - an abnormal new vessel between a venule and arteriole that is weak and prone to haemorrhage)

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

What are the features of proliferative diabetic retinopathy seen on fundoscopy

A

New vessels at the retina or optic disc

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

Exudates seen on fundoscopy is pathognomonic for what condition

A

Diabetic retinopathy

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

What are the two treatment options for proliferative retinopathy

A

Panretinal laser photocoagulation ( intentional scarring of peripheral retinal tissue)

AND/OR

Intravitreal VEGF inhibitors

If severe or vitreous haemorrhage: vitreoretinal surgery

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

Likely Dx:

Severe unilateral eye pain, redness and reduced vision.
Pain worsen on eye movement and at night
Photophobia
Background Hx of rheumatological conditions

A

Scleritis

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

What is the distinguishing feature between episcleritis and scleritis

A

Episcleritis:
No pain
No photophobia
No unilateral reduction in vision

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

Scleritis causes severe unilateral eye pain that is worse at what time?

A

At night

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

First line management for mild scleritis

A

Oral NSAIDs

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

First line management for severe or necrotising scleritis

A

Corticosteroids

Either daily oral prednisolone or pulsed IV methylprednisolone

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

Likely Dx:

PMH of diabetic retinopathy
Fundoscopy of the eye shows a red opacity lying in front of it

A

Vitreous haemorrhage

Proliferative diabetic retinopathy is one of the causes of vitreous haemorrhage as the new blood vessels are weak and prone to damage and haemorrhage, which then accumulates in the vitreous

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

Fundoscopy shows serrated area of grey retina.

Diagnosis?

A

Retinal detachment

Detached retina. It is possible to have a concomitant vitreous haemorrhage and retinal detachment and of course, the obscured fundal view because of the haemorrhage makes the detachment difficult to diagnose clinically. As a result, B-scan ultrasound is indicated to check the retina is not detached

16%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Define myopia

A

Short-sightedness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Define hyperopia

A

Far-sightedness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Curtain or shadow progressing to the centre of the visual field from the periphery is pathognomonic of what condition

A

Retinal detachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What kind of the pupillary defect may be detected in retinal detachment

A

Relative afferent pupillary defect if the optic nerve is involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Fundoscopy showing drusen (poorly defined, heterogenous, cloudy-yellow deposits) within the macula is pathognomonic of what condition

A

Dry Age-related macular degeneration (dry-ARMD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Pilocarpine 4% eye drops function

A

Reduces the intraocular pressure

Useful in acute angle closure glaucoma to prevent further damage to the optic nerve and preserve vision.

Other drugs that can be used to reduce the IOP include: oral Acetazolamide, Timolol 0.25% eye drops and Brimonidine 0.1% eye drops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Likely Dx:

Severe eye pain
Blurred vision
Haloes around lights
Fixed-dilated pupil

A

Acute angle closure glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the definitive treatment for acute angle closure glaucoma

A

Laser peripheral iridotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Prednisolone (1%) eye drops is used to treat what eye condition

A

Acute anterior uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the immediate management of acute angle closure glaucoma

A

Reducing the intraocular pressure most commonly with eye drops that can reduce the IOP e.g. Pilocarpine 4% eye drops, oral Acetazolamide, Timolol 0.25% eye drops and Brimonidine 0.1% eye drops

The intraocular pressure must be reduced as soon as possible to prevent further damage to the optic nerve and preserve vision.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Patients with acute angle closure glaucoma is started on a triad of medications.
What is that triad

A

Beta blockers eye drops e.g. Timolol (to reduce aqueous production)

Pilocarpine eye drops (to increase uveoscleral outflow)

IV acetazolamide (to reduce aqueous production)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Pale retina with a cherry red spot at the macula on ophthalmoscopy is a characteristic feature of what condition

A

Central retinal artery occlusion (CRAO)

Pale retina as it no longer receives blood from the retinal artery

Cherry red spot as the retina now receives blood from the choroidal circulation, which lies behind the macula. This relative hyperaemia of the macula compared to the rest of the retina gives CRAO the characteristic ‘cherry red spot’ appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Drusen at the macular on ophthalmoscopy is a characteristic feature of what condition

A

Dry age related macular degeneration (Age AMD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Optic disc cupping on ophthalmoscopy is a characteristic feature of what condition

A

Chronic open angle glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Likely Dx:

Sudden, painless unilateral visual loss
‘Cherry red’ spot on a pale retina

A

Central retinal artery occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Drusen in the macula on fundoscopy is a hallmark of what condition?

A

Dry age-related macular degeneration (ARMD)

DRusen = DRy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

‘stormy sunset’ on fundoscopy is pathognomonic of what condition

A

Central retinal vein occlusion (CRVO)

Stormy sunset is caused by retinal hyperaemia & haemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

flame haemorrhages are characteristics of what condition

A

Central retinal vein occlusion (CRVO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the two complications of diabetic retinopathy that can develop if not managed

A

Vitreous haemorrhage

Retinal detachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Toxoplasma retinitis is a parasite that is transmitted via the faecal-oral route from faeces from what animal

A

Cat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Chorioretinitis (a single, hazy white/yellow lesion) seen on fundoscopy with an adjacent area of hyper-pigmentation of the retina is characteristic of what condition

A

Toxoplasma retinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

‘pizza pie fundus’ on fundoscopy is characteristic of what condition

A

Cytomegalovirus (CMV) retinitis

Typically presents in immunocompromised patients with a CD4 count < 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the mainstay of management of wet AMD

A

Intravitreal injection with vascular endothelial growth factor inhibitors (anti-VEGF)

Vascular disease leads to oedema beneath the macula. To stop the oedema progressing, neovascularisation needs to be blocked through the use of anti-vascular endothelial growth factor injections. A laser cannot be used on the macula as it may damage the photoreceptors which are responsible for most of our functional vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the the biggest risk factor for developing age related macular degeneration

A

Age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Drusen, macular thinning (geographic atrophy) is features of what kind of age related macular degeneration

A

Dry AMD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Neovascularisation, bleeding, leakage of fluid is features of what kind of age related macular degeneration

A

Wet AMD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is an important lifestyle change for patients with age related macular degeneration

A

Smoking cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Red eye post-eye surgery should prompt the diagnosis of what?

A

Endophthalmitis (infection inside the patient’s eye)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Hypopyon, described in the stem as a ‘white fluid level’, which is a collection of pus in the anterior chamber is indicative of what?

A

Intraocular inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How is endophthalmitis managed

A

It is treated with intravitreal vancomycin as the most common causative bugs are gram positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How is endophthalmitis managed

A

Intravitreal vancomycin as the most common causative organisms are gram positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Pts with Bells palsy are advised to tape their affected eye at night and apply artificial tears daily until the palsy has resolved.

What condition are these measures preventing?

A

Exposure keratopathy i.e. damage to the corneal epithelium which may become infected leading to sight-threatening keratitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How are suspected orbital fractures are best assessed

A

Computed tomography (CT) orbits, brain, sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Blunt force trauma to the face with subsequent eye pain can be caused a fracture to what bone most commonly

A

Fracture of the ethmoid bone - the pressure from the force causes fracture of the orbital floor. The ethmoid bone forms the medial wall of the orbit, which is commonly fractured as it is very thin.

Another feature is enophthalmos (sunken in affected eye)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is a common side effect of prostaglandin analogue eye drops e.g. latanoprost

A

Eyelash thickening/lengthening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Fundoscopic/slit-lamp features of chronic open angle glaucoma

A

Pale optic disc – indicates optic nerve atrophy

Optic disc cupping – a cup:disc ratio of >0.7 suggests cupping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the aim of management in chronic open angle glaucoma

A

The aim of management is to prevent progression of glaucoma and preserve visual fields and acuity.

This is done by reducing the intraocular pressure by either reducing aqueous production or increasing uveoscleral outflow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the first line management option of chronic open angle glaucoma

A

Surgery with selective laser trabeculoplasty (SLT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Latanoprost is an example of what kind of eye drop drug class

A

Prostaglandin analogues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Latanoprost eye drop is an example of prostaglandin analogues.

What effect does prostaglandin analogues have in the eye

A

Increases uveoscleral outflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Timolol is an example of what kind of eye drop drug class

A

Beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Timolol eye drop is an example of a beta blocker eye drop.

What effect does beta blockers have in the eye

A

Reduces aqueous production

Beta BLOCKer = BLOCK the production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What two patient groups are Beta blocker eye drops contraindicated in

A

Asthma
Heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is the second line management option for chronic open angle glaucoma

(used when selective laser trabeculoplasty (first line) is not possible and for patients who have chosen not to have SLT or who has progression of glaucoma despite first line treatment)

A

Medical management with eye drops to reduce the intraocular pressure

First line: Prostaglandin analogues e.g. Latanoprost
Second line: Topical beta blockers e.g. Timolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Likely Dx:

Young patient
‘Tunnel vision’
Reduced visual acuity in dim light.

A

Retinitis pigmentosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What features would be noticed in the cerebrospinal fluid (CSF) in multiple sclerosis

A

Oligoclonal bands - which are IgG clones produced in the CSF as a result of the T-cell mediated inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

There are 4 diagnoses requiring urgent referral that must be ruled out for any patient presenting with ocular pain.
What are these four conditions?

A

Acute angle closure glaucoma
Anterior uveitis
Scleritis
Corneal ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Likely Dx:

Ocular pain
Red eye
Blurred vision
Photophobia
Irregular shaped pupil

A

Anterior uveitis

The pupil may be irregular due to adhesions between the lens and iris (termed synechiae)

82
Q

What eye condition is the commonest initial feature of multiple sclerosis

A

Optic neuritis

83
Q

Sudden onset monocular vision loss with relative afferent pupillary defect (RAPD) implies a lesion where in the eye?

A

Optic nerve

Hence, this is usually a feature of a central retinal vein/artery occlusion as these blood vessels are the sole source of blood supply to the retina

84
Q

In otosclerosis, the bone around the base of the stapes becomes thickened and eventually fuses with the bone of the cochlea. The result is bilateral conductive hearing loss and tinnitus.

What is its inheritance pattern for otosclerosis

A

Autosomal dominant condition

85
Q

If a patient presents with anterior uveitis to the GP what is the management option

A

Urgent specialist referral i.e. ophthalmologist

86
Q

Small, pink nodules with a central umbilication that occur in clusters in the eyelids is the classical description of what infection

A

Molluscum contagiosum (sexually transmitted virus)

87
Q

Molluscum contagiosum is caused by what virus

A

Poxvirus - often sexually transmitted

Small, pink nodules with a central umbilication that occur in clusters in the skin including the eyelids

“MOLE = FOX”

88
Q

Treatment for molluscum contagiosum

A

Usually conservative as the lesions are self resolving over a period of 18 months.

Check for other STIs

89
Q

An external hordeolum, commonly called a stye, is an abscess at an eyelash follicle is caused by infection of what organism

A

Staphylococcus.

90
Q

An external hordeolum, commonly called a stye, is an abscess where

A

At an eyelash follicle

91
Q

An internal hordeolum is an abscess of what

A

Meibomian gland

92
Q

Hordeolum (or stye) are often tender to palpation and may emit what kind of discharge

A

Purulent discharge

93
Q

Internal hordeolum is an abscess of the Meibomian gland is often tender to palpation. If blockage of the gland occurs they can leave behind a non-tender swelling known as?

A

Chalazion

Chalazions typically ‘point’ inwards and tend to resolve by themselves over several weeks

94
Q

Chalazion are often non-tender to palpation and may emit what kind of discharge

A

Oily discharge

95
Q

Chalazion are non-tender is a result of an obstruction of the Meibomian gland secondary to what kind of infection

A

Internal hordeolum

96
Q

Likely Dx:

Pulsatile proptosis
Bruit
Severely injected conjunctiva

A

Carotid cavernous fistula (abnormal communication between the carotid artery and the cavernous sinus).

The cranial nerves that run through the cavernous sinus may be affected i.e. CN 3, 4, 5 and 6

97
Q

What signs or symptoms would suggest a diagnosis of orbital cellulitis rather than pre-septal cellulitis?

A

Pain on eye movements, proptosis, chemosis

98
Q

What is the gold standard investigation to distinguish orbital cellulitis from preseptal cellulitis

A

CT orbit

99
Q

How is orbital cellulitis managed

A

Admission for IV antibiotics and close monitoring with input from the ophthalmology, ear, nose and throat and medical teams.

100
Q

How is preorbital cellulitis managed

A

Oral antibiotics and daily outpatient review.

Young or systemically unwell children should be admitted for IV antibiotics.

101
Q

What is the name of the clinical sign displayed in this image?

A

Corneal arcus - white, blue or grey opaque ring

102
Q

What is the name of the clinical sign displayed in the above image?

A

Kayser-Fleischer ring - copper coloured

103
Q

Young women with central retinal artery occlusion (CRAO) and recurrent miscarriage should be investigated for what condition?

A

Antiphospholipid syndrome

This is done by checking for anti-cardiolipin antibodies, anti-beta2-GP I antibodies and a functional assay for lupus anticoagulant phenomenon

104
Q

Name the antibodies that are positive in antiphospholipid syndrome

A

Anti-cardiolipin antibodies
Anti-beta2-GP I antibodies
Functional assay for lupus anticoagulant phenomenon

105
Q

antiphospholipid syndrome is associated with which eye condition

A

Central retinal vein occlusion (CRVO)

106
Q

How is proliferative diabetic retinopathy managed

A

Urgent laser photocoagulation (completed within 72 hours) prevent further neovascularisation

The premise of laser photocoagulation is that by sacrificing the peripheral retina, which has minimal visual utility, one can reduce the production of vascular endothelial growth factor produced by this ischaemic retina and thus prevent neovascularisation. If left untreated, vitreous haemorrhage can lead to blindness.

107
Q

What is the next step in management if you notice an absent red reflex in one of the eyes at baby check

A

Urgent referral (within 2 weeks) for ophthalmological assessment as it could indicate a retinoblastoma (malignant tumour of the retina)

108
Q

What is an important complication of childhood strabismus (eye squint) if left untreated

A

Amblyopia (lazy eye)- occurs when there is reduced visual stimulation to the right eye.

Treatment of amblyopia must be started at an early age (the critical period is up to 8 years old). The good eye is normally patched.

109
Q

What is the pattern of visual field loss in optic nerve pathology

A

Monocular visual loss

110
Q

What is the pattern of visual field loss in optic tract pathology

A

Contralateral homonymous hemianopia

111
Q

What is the pattern of visual field loss in optic chiasm pathology

A

Bitemporal hemianopia

112
Q

What is the pattern of visual field loss in optic radiation pathology

A

Contralateral homonymous hemianopia

113
Q

What is a normal cup:disc ratio

A

< 0.3

114
Q

Myopia (short sightedness) is a risk factor for what kind of glaucoma

A

Primary open angle glaucoma

myOPia = OPen

115
Q

Hypermetropia (far sightedness) is a risk factor for what kind of glaucoma

A

Acute angle closure glaucoma

116
Q

In what condition is Argyll-Robertson pupil seen in

A

Tertiary syphilis and diabetes
It presents with a palsy of the parasympathetic fibres i.e. the eyes would not react to light

117
Q

What is the gold standard test for measuring intra-ocular pressure

A

Goldman’s tonometry

Thus very important investigation for glaucoma to see if the angle is closed (seen as a raised IOP)

118
Q

What is the first line investigation for optic neuritis

A

MRI head

Optic neuritis – an inflammatory demyelinating condition of the optic nerve. A

MRI is used to investigate for any further demyelinating plaques in the CNS that may suggest multiple sclerosis

119
Q

What is the first line treatment for optic neuritis

A

Intravenous (IV) methylprednisolone

120
Q

Likely Dx:

Painless sudden visual loss
Peripheral to central
Flashes of lights, dots and lines in the vision

A

Retinal detachment

The danger is that if the detachment progresses to the macula, sight may be irreparably lost.

121
Q

Management of retinal detachment

A

There are various surgical and non-surgical treatments available depending on the extent of the detachment. These include laser therapy, cryotherapy, vitrectomy, scleral buckling and pneumatic retinopexy.

122
Q

Myopia (near sightedness) is a risk factor for what two conditions

A

Retinal detachment
Primary open angle glaucoma

“OR”

123
Q

Hyper-metropia (far sightedness) is a risk factor for which condition

A

Acute angle closure glaucoma

124
Q

What ocular sign may be associated with infective endocarditis

A

Roth spots

Roth spots are retinal haemorrhages on the retina

Caused by septic emboli

125
Q

If patients symptoms of bacterial conjunctivitis is not managed supportively what is the first line medication used?

A

Topical Chloramphenicol eyedrops

126
Q

On fundoscopy, the appearance of ‘dots’, large ‘blots’, engorged tortuous veins and cotton wool spots are diagnostic of what condition

A

Severe non-proliferative diabetic retinopathy

127
Q

How is cytomegalovirus (CMV) retinitis treated

A

Oral Valganciclovir

128
Q

Vision loss in a HIV patient is pretty much always going to be?

A

Cytomegalovirus (CMV) retinitis

Typically will have retinal haemorrhages and retinal necrosis describe the classical “pizza pie retinopathy”

129
Q

What kind of eye cancer is associated with HIV

A

Kaposi’s sarcoma (although not found only in the eye. It affects the skin and mouth, and sometimes the internal organs)

130
Q

Management of Chalazion

A

Forms due to blockage of the oil producing Meibomian glands. Often secondary to internal

They are the most common cause of an eyelid nodule. They are benign and resolve with conservative measures such as warm compresses

68%

131
Q

Management of Chalazion

A

Forms due to blockage of the oil producing Meibomian glands. Often secondary to internal hordeolum.

Resolve with conservative measures such as warm compresses

132
Q

What type of stroke presents with bilateral painless loss of vision

A

Middle cerebral artery stroke

The stroke causes vision loss via ischaemia of the optic tract and thus would present with an incongruous homonymous hemianopia on the contralateral side to the stroke

133
Q

Management of allergic conjunctivitis

A

Treatment is conservative, aimed at avoiding the allergen and advising the use of artificial tears (dilutes the allergen).

Topical antihistamines or mast cell stabilisers may be prescribed if conservative measures fail for moderate allergic conjunctivitis.

134
Q

Arteriovenous nipping is a characteristic feature of what eye condition

A

Hypertensive retinopathy

135
Q

Hutchinson’s sign

A

Hutchinson’s sign refers to involvement of the nasociliary branch of the trigeminal nerve by herpes zoster virus.
This is seen clinically as vesicles on the tip of the nose.
This nerve also supplies the globe, making ophthalmic involvement of the virus likely

136
Q

Hutchinson’s sign

Hutchinson’s sign refers to involvement of the nasociliary branch of the trigeminal nerve by herpes zoster virus. This is seen clinically as vesicles on the tip of the nose. This nerve also supplies the globe, making ophthalmic involvement of the virus likely

77%

A
137
Q

What clinical sign is present that predicts a higher risk of corneal involvement of the herpes zoster virus making herpes zoster ophthalmicus most likely

A

Hutchinson’s sign

Seen clinically as vesicles on the tip of the nose. This nerve also supplies the globe, making ophthalmic involvement

138
Q

Kayser-Fleischer rings are associated with what condition

A

Wilson’s disease

139
Q

What is the main aetiology for corneal arcus

A

Hyperlipidaemia

Other signs of hyperlipidaemia include xanthelasma (yellow deposits over the eyelids) and xanthomata (yellow deposits over the tendons, especially over the wrist)

140
Q

Name two complications of cataracts operation

A

Endophthalmitis

Posterior lens capsule opacification

141
Q

Posterior lens capsule opacification is a relatively common complication of cataract surgery that usually occurs a few weeks following the operation.

How is it treated

A

Simple laser procedure that can be carried out as an outpatient

142
Q

What is the mainstay of management of cataracts

A

Cataract surgery most commonly phacoemulsification.

involves breaking down the existing lens with ultrasound waves, removing it and then replacing it

143
Q

What eye condition is strongly associated with giant cell arteritis

A

Ischaemic optic neuropathy - inflammation of the arteries supplying the optic nerve

Presents with sudden painless vision loss

Also known as amaurosis fugax

144
Q

Topical phenylephrine is used to determine if the affect vessels in episcleritis/scleritis blanches and can be used to distinguish between them.

What one of these conditions do you expect the blood vessels to blanch

A

Episcleritis

145
Q

Topical phenylephrine is used to determine if the affect vessels in episcleritis/scleritis blanches and can be used to distinguish between them.

What one of these conditions do you expect the blood vessels to NOT blanch

A

Scleritis as the vessels are too deep

146
Q

Management of scleritis

A

NSAIDs for mild scleritis

Corticosteroids for severe or necrotising scleritis (either daily oral prednisolone or pulsed IV methylprednisolone)

147
Q

Palsy of what cranial nerve results in the pt being unable to abduct their eye

A

6th cranial nerve palsy

SO4LR6

148
Q

Palsy of what cranial nerve results in the eye being in a down and out position

A

3rd cranial nerve palsy

149
Q

Palsy of what cranial nerve results in the patient being unable to look down

A

4th cranial nerve palsy

SO4LR6

150
Q

Rash localised to the ophthalmic division of the trigeminal nerve

A

Herpes zoster ophthalmicus

Varicella zoster virus

151
Q

Likely Dx:

Headache
Red watery eye
Onset whilst in the dark

A

Acute closed angle glaucoma

May so have a fixed, mid-dilated pupil and corneal oedema

152
Q

Topical pilocarpine should be used in the meantime in acute closed angle glaucoma whilst waiting to be seen by the ophthalmology team.

What effect does topical pilocarpine have?

A

Constricts the pupil and increases trabecular outflow

153
Q

Diagnostic investigation for orbital cellulitis

A

CT sinus and orbits with contrast

154
Q

What examination is used to confirm a diagnosis of refractive error?

A

Pinhole-aided visual acuity

Confirms a misshapen cornea

The cornea becomes misshapen, such that rays of light that enter the cornea in different places are refracted differently and as a result, are not focused on the same point at the fovea, causing blurry vision. A pinhole directs all of the available light through one point on the patient’s cornea and lens. As a result, the differences in refraction caused by a misshapen cornea are nullified and the patient’s visual acuity improves

155
Q

What fundoscopy feature may be seen in raised intracranial pressure

A

Optic disc swelling

156
Q

What classification tool is used to stage hypertensive retinopathy

A

Keith-Wagner classification

157
Q

Caeruloplasmin level low

Diagnosis and hallmark eye examination finding

A

Wilson’s disease

Kayser-Fleischer rings

158
Q

Management of Dry ARMD

A

Smoking cessation

Zinc and antioxidant vitamin A, C and E supplements have been shown to reduce progression

159
Q

An oculomotor nerve palsy with pupil involvement (sometimes called a surgical 3rd nerve palsy) is considered to be due to what until proven otherwise

A

Posterior communicating artery aneurysm

The pupil becomes fixed and dilated due to paralysis of sphincter pupillae

160
Q

What is a surgical 3rd nerve palsy

A

CN 3 palsy with pupil involvement

the pupil becomes fixed and dilated due to paralysis of sphincter pupillae

161
Q

Investigation of choice for suspected optic neuritis

A

MRI of the brain and orbits with contrast

162
Q

In diabetic retinopathy, cotton wool spots represents

A

Areas of retinal infarction

163
Q

Central scotoma is recognised as a characteristic visual field defect pattern for what condition

A

Optic neuritis

164
Q

First-line treatment for allergic conjunctivitis

A

topical antihistamines

165
Q

Likely Dx:

Temporary monocular painless loss of vision which returns to normal after a short period of time e.g. minutes

‘Black curtain coming down’

A

Amaurosis fugax (translated to ‘transient darkening’)

Common causes include retinal ischaemia due to an embolic or thrombotic event

166
Q

Slit-lamp microscopy is the initial investigation of choice to diagnose ARMD.

If wet-ARMD is suspected, what is the next best investigation

A

Fluorescein angiography as this can guide intervention with anti-VEGF therapy

167
Q

How to tell what eye the fundoscopic image is from

A

Wherever the optic disc sits is the side of the eye (as the optic disc sits on the nasal side of the retina)

i.e. if the optic disc is on the left it is a picture of the left eye
if the optic disc is on the right (as with this image) then it is a right eye

168
Q

night blindness + tunnel vision is hallmark features of?

A

Retinitis pigmentosa

169
Q

new-onset floaters in vision is a hallmark of what condition

A

Retinal detachment

“Rats Float”

170
Q

Management of anterior uveitis (once referred to ophthamology)

A

Steroid + cycloplegic (mydriatic) drops

171
Q

Management of herpes zoster ophthalmicus

A

Oral antiviral treatment for 7-10 days
ideally started within 72 hours

Example: oral aciclovir

172
Q

Likely Dx
Dense shadow that starts peripherally progresses towards the central vision:

A) Retinal detachment
B) Vitreous haemorrhage

A

A) Retinal detachment

“starts Right on the edge = Retinal”

173
Q

Likely Dx:

Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots

A) Retinal detachment
B) Vitreous haemorrhage

A

B) Vitreous haemorrhage

“V = Very black”

174
Q

What features would be more in keeping with conjunctivitis over blepharitis

A

Conjunctivitis = unilateral, associated with discharge

Blepharitis = bilateral

175
Q

Fundoscopy looks like a giant jellyfish is characteristic of?

A

Retinal detachment

176
Q

What are the 4 key characteristics of optic neuritis

A

Optic neuritis is CRAP:

Central scotoma
Reduced red vision
Acuity (reduced)
Painful eye movement

177
Q

What is the most common cause of abnormal tearing in infants and children, particularly during the first year of life

A

Nasolacrimal duct obstruction

Self-resolves by 1 year of age

178
Q

What examination features are present for Argyll-Robertson Pupil

A

Accommodation Reflex Present (ARP)
Pupillary Reflex Absent (PRA)

“Argyll-Robertson Pupil (ARP) = Accommodation Reflex Present (ARP)”

179
Q

Name the two causes of Argyll-Robertson Pupil

A

Diabetes mellitus
Tertiary syphilis

180
Q

Complications of scleritis if left untreated

A

Perforation of the globe
Glaucoma
Cataracts
Raised intraocular pressure
Retinal detachment
Uveitis

181
Q

What is the aim of acute angle closure glaucoma treatment?

A

Reducing aqueous production

Increasing the outflow of aqueous

Inducing pupillary constriction

182
Q

Those with a positive family history of glaucoma should be screened annually from what age

A

40 years

183
Q

ankylosing spondylitis is associated with what eye disorder

A

Anterior uveilitis
HLAB27 associated conditions

184
Q

Treatment for herpes simplex keratitis

A

Topical aciclovir

185
Q

Dark spots and red hue in vision is pathognomonic of what condition

A

Vitreous haemorrhage

186
Q

What kind of eye drops can lead to fungal infections

A

Steroid eye drops

187
Q

unilateral blurry vision and halos surrounding light sources are strongly suggestive of a diagnosis of?

A

Cataract

188
Q

Ptosis + dilated pupil =

A

third nerve palsy

189
Q

ptosis + constricted pupil =

A

Horner’s

190
Q

Mydriatic drops are a known precipitant of

A

acute angle closure glaucoma

191
Q

Features of hypertensive retinopathy

A

Cotton-wool spots (widespread white-ish areas resulting from ischaemia)

Retinal haemorrhages (red blotches around the centre of the image)

A ‘macular star’ composed of intraretinal lipid exudates (sunburst pattern of white streaks around the macular)

The optic nerve head is swollen

192
Q

Anisocoria worse in bright light implies a problem with what pupil

A

Dilated pupil

Anisocoria means the pupils are not the same size

193
Q

Damage to the ciliary ganglion results in?

A

Constricted pupil

This is because damage to the ciliary ganglion results in a reduction in the parasympathetic innervation to the eye

“SIRI being a GANG member is very CONSTRICTING but they are Powerful’ (Ganglion + constricting pupil + problem with parasympathetic innervation)

194
Q

Anisocoria worse in bright light implies a problem with the ___ pupil

A) Dilated
B) Constricted

A

Anisocoria worse in bright light implies a problem with the DILATED pupil

195
Q

Damage to the cervical ganglion results in?

A

Dilated pupil

This is because damage to the cervical ganglion results in a reduction in the sympathetic innervation to the eye

“you’d be SYMPATHETIC if someone DId Serve time”
Sympathetic = DIlated pupils

196
Q

Likely Dx:

Dilated pupil i.e. no direct or consensual light reflex
Females
Absent leg reflexes
Accommodation is intact

A

Holmes Adie syndrome

Usually idiopathic and benign

197
Q

In-turning of the eyelids is known as?

A

Entropion

198
Q

Out-turning of the eyelids is known as?

A

Ectropion

199
Q

Subcapsular cataracts may be associated with the use of what medication

A

Steroid use

200
Q

Urgent management of orbital compartment syndrome

A

Urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit

Finals: Speciality Blocks (11 decks)

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