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ophthalmology Flashcards

1
Q

glaucoma

A

optic nerve damage due to increased intraocular pressure due to blocked aqueous humour

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2
Q

what is aqueous humour

A

in anterior and posterior chambers
supplies nutrients

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3
Q

where is aqueous humour produces

A

by ciliary body

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4
Q

how does aqueous humour circulate

A

anterior chamber ->trabecular meshwork -> canal of schlemm -> general circulation

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5
Q

open angle glaucoma

A

gradual increase in resistance through trabecular meshwork

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6
Q

acute angle-closure glaucoma

A

iris bulges forward and seals of trabecular meshwork from anterior chamber

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7
Q

what happens to the optic disc in increased pressure

A

cupping (indent)

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8
Q

RF open angle glaucoma

A

age
fhx
black
myopia

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9
Q

sx open angle glaucoma

A

tunnel vision
pain
headaches
blurred vision
halos

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10
Q

diagnosis open angle glaucoma

A

goldmann applanation tonometry
fundoscopy
visual field assessment

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11
Q

mx open angle glaucoma

A

if pressure >24mmHg: prostaglandin analogue eyedrops - latanoprost (increases uveoscleral outflow), timolol (BB, reduces aquous humour), trabeculectomy

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12
Q

RF acute angle closure glaucoma

A

age
F
fhx
china and east asian
shallow anterior chamber
meds: noradrenaline, oxybutynin, amytriptyline

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13
Q

presentation acute angle closure glaucoma

A

painful red eye
blurred vision
halos
headache
N+V

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14
Q

findings O/E acute angle closure glaucoma

A

red eye
teary
hazy cornea
reduced visual acuity
dilated fixed pupil
firm eyeball

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15
Q

mx acute angle closure glaucoma

A

lie on back
pilocarpine eye drops - pupil constriction
acetazolamide 500mg - reduce aqueoues humour
other: glycerol/mannitol, timolol
definitive: laser iridotomy

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16
Q

macula layers

A

bottom=chorid (blood vessels)
bruchs membrane
retinal pigment epithelium
photoreceptors

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17
Q

wet AMD

A

new vessels from choroid leading to oedema
stimulated by VEG-F

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18
Q

RF age related macular degeneration

A

age
smoking
white
chinese
fhx
CVD

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19
Q

presentation AMD

A

gradual worsening visual field loss (scotomer)
reduced visual acuity or wavy appearance to straight lines (amsler grid test)
wet AMD more acute

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20
Q

O/E AMD

A

fundoscopy=drusen (yellow protein)
slit lamp biomicrosopic fundus exam
optical coherence tomography

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21
Q

mx dry AMD

A

none specific
mx RF - smoking, CVD, vitamins

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22
Q

mx wet AMD

A

anti VEGF injections e.g. ranibizumab

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23
Q

how does hyperglycaemia damage eyes

A

damages retinal vessels and endothelial cells -> increased vascular permeability, blot haemorrhages, hard exudates (lipid)

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24
Q

types diabetic retinopathy

A

non-proliferative
proliferative
diabetic maculopathy

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25
Q

stages non-proliferative diabetic retinopathy

A

mild=mincroaneurysm
moderate=microaneurysm, blot haemorrhages, hard exudates, cotton wool spots, venous bleeding
severe= blot haemorrhages and microaneurysm in 4 quadrants, venous bleeding in 2 quadrants, intraretinal microvascular abnormality

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26
Q

features proliferative diabetic retinopathy

A

neovascualrisation
vitreuous haemorrhage

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27
Q

features diabetic maculopathy

A

macular oedema
ischaemic
maculopathy

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28
Q

complications diabetic retinopathy

A

retinal detachment
vitreous haemorrhage
rebeosis iridis
optic neuropathy
cataracts

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29
Q

mx diabetic retinopathy

A

laser photocoag
anti VEGF - ramibizumab
vitreoretinal surgery

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30
Q

keith wagener classification hypertensive retinopathy

A

1=mild narrowing arterioles
2=focal constriction of blood vessels and AV nipping
3= cotton-wool patches, exudates, haemorrhage
4=papilloedema

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31
Q

cataracts

A

cloudy and opaque lens

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32
Q

RF cataracts

A

age
smoking
alcohol
DM
steroids
hypocalcaemia

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33
Q

presentation cataracts

A

asymmetrical
slow decrease in vision
blurred vision
colour ->brown/yellow
starbursts around lights
O/E=loss red reflex

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34
Q

mx cataracts

A

surgery - artificial lens to replace

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35
Q

pupil contstriction

A

parasympathetic - CN3

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36
Q

pupil dilation

A

sympathetic NS

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37
Q

causes abnormal pupil shape

A

trauma to sphincter muscles
adhesions from anterior uveitis
acute angle closure glaucoma=vertical oval
rubeosis iridis
coloboma
tadpole pupil - migraines

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38
Q

causes mydriasis (pupil dilation)

A

3rd nerve palsy
holmes adie
increased ICP
congenital
trauma
cocaine
anticholinergics

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39
Q

causes miosis

A

horners syndrome
cluster headaches
argyll robertson pupil
opiates
nicotine
pilocarpine

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40
Q

features CN3 palsy

A

ptosis
dilated pupil
divergent strabismus (down and out)

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41
Q

causes CN3 palsy

A

pupil (parasympathetic) sparing = DM, HTN, ischaemia
surgical/full = tumour, trauma, cavernous sinus thrombosis, posterior communicated artery aneurysm, increased ICP

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42
Q

horner syndrome

A

damage to sympathetic NS

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43
Q

features horners syndrome

A

ptosis
miosis
anhidrosis

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44
Q

causes horners syndrome

A

central lesion (anhidrosis in arms and trunk): stroke, MS, swelling, tumour, syringomyelia
pre-ganglionic: tumour, trauma, thyroidectomy,
post-ganglionic (no anhydrosis): carotid aneurysm, carotid artery dissection, cavernous sinus thrombosis, cluster headaceh

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45
Q

holmes adie pupil features

A

unilateral dilated and slow rxn to light
pupil size reduces over time

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46
Q

causes holmes adie pupil

A

damage to post ganglionic parasympathetic fibres

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47
Q

features argyll robertson pupil

A

constricted and accommodates to llight but doesnt react to light

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48
Q

when is argyll robertson pupil present

A

neurosyphilis

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49
Q

blepharitis

A

inflamamtion eyelid margins

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50
Q

features blepharitis

A

gritty
itchy
dry

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51
Q

mx blepharitis

A

hot compress
gentle clean
lubricating drops (hypromellose)

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52
Q

types od stye

A

hordeolum externum
hordeolum internum

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53
Q

hordeolum externum stye

A

glands of zeis/moll
red lump along eyelid

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54
Q

hordeolum internum stye

A

meibomian glands
deeper, may point in

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55
Q

mx stye

A

hot compress
+/- topical abx - chloramphenicol

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56
Q

chalazion

A

meibomian cyst = blocked gland

57
Q

features chalazion

A

non tender swelling

58
Q

mx chalazion

A

hot compress
+/-chloramphenicol

59
Q

entropion

A

eyelid turns in

60
Q

risks entropion

A

pain
corneal damage

61
Q

mx entropion

A

tape eyelid down
surgery

62
Q

extropion

A

eyelid turns out

63
Q

risks extropion

A

exposure keratopathy

64
Q

mx extropion

A

lubricating drops
surgery

65
Q

trichiasis

A

inward growth eyelashes

66
Q

risks trichiasis

A

pain and corneal damage

67
Q

mx trichiasis

A

remove inward growing eyelashes

68
Q

sx periorbital/preorbital cellulitis

A

red, hot, swollen

69
Q

ix preorbital cellulitis

A

CT to differentiate from orbital cellulitis

70
Q

mx periorbital cellulitis

71
Q

sx orbital cellulitis

A

pain on eye movements
visual changes
proptosis

72
Q

mx orbital cellulitis

73
Q

sx conjunctivitis

A

red eye,
bloodshot
itchy
gritty

74
Q

causes conjunctivitis

A

bacterial
viral
allergic

75
Q

features bacterial conjunctivitis

A

purulent discharge
stuck together in moning

76
Q

mx bacterial conjunctivitis

A

chloramphenicol or fusidic acid eye drps

77
Q

features viral conjunctivitis

A

clear discharge

78
Q

mx viral conjunctivitis

A

hygiene
clean

79
Q

features allergic conjunctivitis

A

watery discahrge
itch

80
Q

mx allergic conjunctivitis

A

antihistamines

81
Q

causes painless red eye

A

conjunctivits
episcleritis
subconjunctical haemorrhage

82
Q

causes painful red eye

A

glaucoma
anterior uveitis
scleritis
corneal abrasions
keratitis
foreign body
trauma

83
Q

causes anterior uveitis

A

usually AI
infection
trauma
ischaemia
malignancy

84
Q

associations anterior uveitis

A

acute: HLA B27 (ankylosing spondylitis, IBD, reactive arthritis)
chronic: sarcoidosis, syphilis, lyme disease, TB, herpes

85
Q

presnetation anterior uveitis

A

unilateral
aching
ciliary flush
reduced acuity
floaters
miosis
lacrimation
hypopyon
photophobia

86
Q

mx anteuror uveitis

A

steroids
cyclopentolate
DMARDs

87
Q

associations episcleritis

88
Q

sx episcleritis

A

unilateral
red
watery
mild pain

89
Q

mx episcleritis

A

lubricating drops
cold compress
if severe: NSAIDs, topical steroid

90
Q

what is severe scleritis

A

necrotising scleritis

91
Q

associations scleritis

A

RA
SLE
IBD
sarcoidosis
granulomatosis with polyangitis

92
Q

sx scleritis

A

pain on eye movement
photophobia
watering
reduced acuity
abnormal rxn to light

93
Q

mx slceritis

A

NSAIDs
sterodis

94
Q

how is corneal abrasion diagnosed

A

fluorescein stain

95
Q

mx corneal abrasion

A

lubrication
chloramphenicol
if chemical irrigate 20-30m

96
Q

sx herpes keratitis

A

red
photophobia
vesicles
watery
dendritic corneal ulcer with fluorescein
(only effects epithelium)

97
Q

mx herpes keratitis

A

aciclovir
ganiciclovir

98
Q

cause subconjunctival haemorrhage

A

HTN
thrombosytopenia
whooping cough
warfarin
idiopathic

99
Q

sx conjunctival haemorrhage

A

bright red patch

100
Q

mx conjunctival haemorrhage

A

non
resolves 2w

101
Q

sx posterior vitreous detachment

A

painless
spots vision loss
floaters
flashing lights

102
Q

mx posterior vitreous detachment

A

none
rule out retinal tear or detachment

103
Q

retinal detachment

A

separates from choroid

104
Q

RF retinal detachment

A

posterior vitreous detachment
DM
trauma
malignanct
age
fhx

105
Q

sx retinal detachment

A

peripheral visual loss
blurring
flashers and floaters
no pain

106
Q

mx retinal detachment

A

surgical repair

107
Q

sx retinal vein occlusion

A

sudden painful vision loss

108
Q

RF retinal vein occlusion

A

HTN
cholesterol
DM
smoking
glaucoma
SLE

109
Q

fundoscopy findings retinal vein occlusion

A

flame and blot haemorrhages
optic disc oedema
macula odema

110
Q

mx retinal vein detachment

A

laser photocoag
steroids
anti VEGF

111
Q

cause central retinal artery occlusion

A

atehrosclerosis
GCA

112
Q

sx central retinal artery occlusion

A

sudden painless loss vision
RAPD

113
Q

fundoscopy central retinal artery occlusion

A

pale retina
cherry red spot

114
Q

mx central retinal artery occlusion

A

ocular massage
inhaling carbogen
sublingual isosorbide dinitrate

115
Q

RAPD

A

constricts more when light shone in other eye than it

116
Q

retinitis pigmentosa

A

congenital degeneration rods and cones

117
Q

sx retinitis pigmentosa

A

night blindness
peripheral vision lost first

118
Q

fundocopy retinitis pigmentosa

A

bone spicule pigmentation

119
Q

associations retinitis pigmentosa

A

ushers
bassen-kornzweig

120
Q

mx retinitis pigmentosa

A

visual aids
vitamins

121
Q

causes central scotoma

A

problem with retina

122
Q

cause monocular vision loss

A

optic nerve

123
Q

cause bitemporal hemianopia

A

problem with optic chiasm

124
Q

cause contralateral homonymous hemianopia`

A

problemm with optic tract (lesion in R affets L)

125
Q

cause contralateral superior quadrantopia

A

problem with inferior radiation

126
Q

cause contralateral inferior quadrantopia

A

problem with superior radiation

127
Q

cause contralateral homonymous hemianopia with macular sparing

A

problem with visual cortex in occipial lobe

128
Q

difference between open and closed acute angle glaucoma

A

in closed the iris covers the trabecular meshwork and the angle narrows, in open the iris is clear of the trabecular meshwork but the trabecular meshwork has increased resistance

129
Q

clinical signs anterior uveitis

A

slit lamp=red eye
hypopyon: white cellc/pus in AC
flare (protein)
posterior synechiae: causes an unequal shaped pupil
keratic precipitates

130
Q

sx ophthalmic shingles

A

vesicualr rash around eyes, neuralgia, rash on tip of nose (hutchinsons sign)
V1 branch affected

131
Q

sign associated with ophthalmic shingles

A

hutchinsons sign

132
Q

cause acute CN3 palsy

A

posterior communicating artery aneurysm

133
Q

common sx 4th CN palsy

A

stiff neck as turns head to counteract

134
Q

what cause to rule out CN 6 palsy

A

increased intracranial pressure

135
Q

cause of horners syndrome

A

damage to sympathetic chain
pre-ganglionic lesion: pancoast tumour (lung ca)
post-ganglionic lesio: carotid dissection (usually painful)

136
Q

Mx foreign body

A

Urgent ophthalmology referral - needs urgent surgery
Keep patient NBM
tetanus booster
NO MRI
+/- CT scan
Vision assessment
Plastic shield over eye

137
Q

How to find corneal abrasion

A

Use fluorescein stain and shows up yellow/green

138
Q

Red eye with norm/ near norm vision

A

Painless: subconjunctical haemorrhage
Pain/discomfort: conjunctivitis, blepharitis, dry eyes, episcleritis, scleritis

139
Q

Red eye with impaired vision

A

Normal IOP: corneal abrasion, keratitis, anterior uveitis, endophthalmitis

High IOP: acute angle closure glaucoma

finals (31 decks)

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