Ophthalmology Flashcards
What is the most common cause of unilateral proptosis?
A ) Cavernous haemangioma of the orbit
B ) Intracranial space-occupying lesion
C ) Lymphoma
D ) Optic nerve sheath meningioma
E ) Orbital cellulitis
F ) Thyroid eye disease
Answer: Thyroid eye disease
Unilateral proptosis is most commonly due to thyroid eye disease. This is the commonest cause for unilateral or bilateral axial proptosis in adults (more common in females). It is further confirmed by the fact that intraocular pressure rises on up gaze due to the involvement of inferior rectus muscle.
A ) Central retinal artery occlusion
B ) Central retinal vein occlusion
C ) Glaucoma
D ) Macular degeneration
E ) Non-proliferative retinopathy
F ) Proliferative retinopathy
Answer: Central retinal artery occlusion
A ) Central retinal artery occlusion
B ) Central retinal vein occlusion
C ) Glaucoma
D ) Macular degeneration
E ) Non-proliferative retinopathy
F ) Proliferative retinopathy
Answer: Proliferative retinopathy
Explanation: Diabetic retinopathy represents microvascular end-organ damage as a result of diabetes. Vascular endothelial growth factor (VEGF) is secreted by the ischemic retina. VEGF leads to increased vascular permeability resulting in retinal swelling/edema and angiogenesis or new blood vessel formation.
Causes of a small pupil include which of the following?
A ) Carbon monoxide poisoning
B ) Ethylene glycol poisoning
C ) Holmes-Adie pupil
D ) Pontine haemorrhage
E ) Third nerve palsy
Answer: Pontine haemorrhage
A ) Central retinal vein occlusion
B ) Diabetic retinopathy
C ) Hypertensive retinopathy
D ) Raised intracranial pressure
E ) Retinal detachment
Answer: Hypertensive retinopathy
A ) Central facial nerve palsy
B ) Fourth nerve palsy
C ) Internuclear ophthalmoplegia (INO)
D ) Peripheral facial nerve palsy
E ) Sixth nerve palsy
F ) Third nerve palsy
= C) Internuclear ophthalmoplegia (INO)
Internuclear ophthalmoplegia is a disconnection syndrome characterised by impaired horizontal gaze. It occurs as a result of interruption to the medial longitudinal fasciculus (MLF), commonly due to multiple sclerosis or haemorrhage. Affected individuals have slowed or limited adduction in the eye ipsilateral to the lesion, with associated abducting nystagmus in the contralateral eye. In the diagram below, the right eye is not able to fully adduct (look toward the left side) while the left eye can fully adduct.
Which ocular pathology is NOT associated with type II diabetes?
A ) Anterior uveitis
B ) Cataracts
C ) Diabetic retinopathy
D ) Extraocular muscle palsy
E ) Glaucoma.
= A) Anterior uveitis
Explanation: Diabetes is associated with retinopathy, cataract (a rare ‘snowflake’ cataract in youth and a greater frequency and earlier onset of age related cataract), glaucoma (but the association of chronic open angle glaucoma is disputed), and extraocular muscle palsy due to microvascular disease of the third, fourth, or sixth cranial nerves
Answer: Maxilla bone
Answer: 10-21mmHg
Glaucoma is a group of eye diseases that cause intraocular pressure (IOP) to rise, in some cases as high as 70mmHg. In primary open-angle glaucoma (POAG), the most common form, there is a reduced outflow of aqueous humour through the trabecular meshwork.
Answer: Zygomatic bone
Which of the following is a cause of sudden visual loss?
A ) Cataracts
B ) Chronic glaucoma
C ) Optic atrophy
D ) Optic neuritis
E ) Tobacco amblyopia
Answer: Optic neuritis
What is the most common cause of orbital cellulitis?
A ) Adenovirus
B ) Chlamydia trachomatis
C ) Pseudomonas aeruginosa
D ) Staphylococcus and streptococcus species
E ) Varicella zoster virus
Answer: Staphylococcus and streptococcus species
Answer: Non-proliferative diabetic retinopathy
In non-proliferative diabetic retinopathy, chronic hyperglycaemia causes damage to retinal capillaries, weakening capillary walls. These microaneurysms can rupture in a dot-like appearance referred to as “dot-and-blot” haemorrhages. Fluid from the leaky vessels can recede, leaving behind lipid byproducts which appear as “hard exudates”.
Answer: Episcleritis
Answer: Separation of the iris (Iridodialysis)
You are performing fundoscopy on a patient with hypertensive retinopathy when you are asked to describe your
findings. What does “copper and silver wiring” refer to?
A ) Abnormal colouring of the arterioles
B ) An enlarged retinal arteriole that crosses a vein and can press down and cause swelling distal to the crossing
C ) Capillary occlusion ischaemia and degeneration of the vascular smooth muscle
D ) Degeneration of retinal blood vessels to the point where they leak plasma and bleed onto the retina
E ) Small areas of yellow-white discolouration on the retina
Answer: Abnormal colouring of the arterioles
Answer: Iritis (anterior uveitis)
How does acute iritis present?
Presentation of acute iritis
- Painful inflammation of the iris
- Uncommon in children – can be acute, chronic or relapsing
- May be associated with other conditions, such as rheumatoid arthritis, Behçet’s disease, malignancy, trauma to eye, infection.
How does viral conjunctivitis present?
Presentation of viral conjunctivitis
- Common condition (more common than bacterial form)
- Presents with pink conjunctiva and dilated blood vessels
- Not usually associated with pain, photophobia or visual disturbance
- Discharge unusual, although the eye may water excessively
- Often associated with a viral URTI
Which of the following ocular emergencies is also life threatening?
A ) Acute glaucoma
B ) Acute iritis
C ) Corneal ulcer
D ) Leukocoria (white reflex)
E ) Lid/globe lacerations
Answer: Leukocoria (white reflex)
A ) Infective endocarditis
B ) Myeloma
C ) Syphilis
D ) Systemic lupus erythematosus
E ) Tay-Sachs disease
Answer: Infective endocarditis
The presence of white-centred haemorrhages (Roth spots) should prompt the consideration of possible infective endocarditis. This patient’s diagnosis was confirmed with echocardiography and blood cultures.
Answer: Optic canal
Answer: Corneal foreign body
Answer: Retinal detachment