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MRCP Master > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Causes of papilloedema

A

space-occupying lesion: neoplastic, vascular
malignant hypertension

idiopathic intracranial hypertension

hydrocephalus

hypercapnia

Rare causes include
hypoparathyroidism and hypocalcaemia
vitamin A toxicity

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2
Q

What is relative afferent pupillary
Marcus-Gunn pupil,
What causes

A

defect is when the affected and normal eye appears to dilate when light is shone on the affected eye

Causes
retina: detachment
optic nerve: optic neuritis e.g. multiple sclerosis

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3
Q

What causes:

dilated pupil

unilateral in 80% of cases

once the pupil has constricted it remains small for an abnormally long time

slowly reactive to accommodation but very poorly (if at all) to light

A

Holmes-Adie pupil

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4
Q

causes of Tunnel vision

A

is the concentric diminution of the visual fields

  1. papilloedema
  2. glaucoma
  3. retinitis pigmentosa
  4. choroidoretinitis
  5. optic atrophy secondary to tabes dorsalis
  6. hysteria
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5
Q

What causes on fundoscopy as irregular dark red streaks radiating from the optic nerve head

A

Angioid retinal streaks -degeneration, calcification and breaks in Bruch’s membrane .

Causes

pseudoxanthoma elasticum

Ehler-Danlos syndrome

Paget’s disease

sickle-cell anaemia

acromegaly

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6
Q

Drugs which may precipitate acute glaucoma

A

include anticholinergics and tricyclic antidepressants

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7
Q

What can Mydriatic drops cause .

A

acute angle closure glaucoma

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8
Q

What is the main difference in Open& closed angle glaucoma

A

peripheral iris is covering the trabecular meshwork= slowing or halting drainage of aqueous humour from the anterior chamber of the eye.
Open in it is impaired
Closed it c ompletely shut off

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9
Q

Risk factor for open angle Glaucoma

A

OPEN ANGLE
Risk factors:
Age esp > 80 years
genetics
Afro Caribbean ethnicity
myopia
hypertension
diabetes mellitus
corticosteroids

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10
Q

2ndary caused of open angle glaucoma

A

2ndar: blocked by cells of retina elements from detachment ,
WBC(uvitis) or
RBC (vitreous haemorrhage

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11
Q

Sx of Open angle Glaucoma

A

Progressive peripheral to central vision less

peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping

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12
Q

Fundoscopy in open angle glaucoma

A
  1. Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen and deepen
  2. Optic disc pallor - indicating optic atrophy
  3. Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base
  4. Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages
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13
Q

IX glaucoma (4)

A
  1. automated perimetry to assess visual field
    slit lamp examination with pupil dilatation to assess optic nerve and fundus for a baseline
  2. **applanation tonometry **to measure IOP

3.central corneal thickness measurement

  1. gonioscopy to assess peripheral anterior chamber configuration and depth

Assess risk of future visual impairment, using risk factors such as IOP, central corneal thickness (CCT), family history, life expectancy

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14
Q

Med that decrease production of aqueous humor ? (2)

A
  1. beta-adrenergic receptor antagonists - timolol,
  2. carbonic anhydrase inhibitors like acetazolamide
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15
Q

Meds that increase the outflow of aqueous humor through the uveoscleral pathway
or via trabecular meshwork

A

prostaglandin analogs like bimatoprost and latanoprost

trabecular meshworkas cholinomimetics like pilocarpine and carbachol,

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16
Q

Medications that Reduces aqueous production and increases outflow
when should they not be used

A

**Sympathomimetics ** brimonidine, an alpha2-adrenoceptor agonist)

Avoid if taking MAOI or tricyclic antidepressants

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17
Q

SE of Prostaglandin analogues (e.g. latanoprost)

A

Adverse effects include brown pigmentation of the iris, increased eyelash length

18
Q

Who should Bblker be not given

A

Should be avoided in asthmatics and patients with heart block

19
Q

SE: Carbonic anhydrase inhibitors (e.g. Dorzolamide)

A

Systemic absorption may cause sulphonamide-like reactions

20
Q

SE Miotics (e.g. pilocarpine, a muscarinic receptor agonist)

A

Adverse effects included a constricted pupil, headache and blurred vision

21
Q

Sx of closed angle glaucoma
Made worse by
visula sx
pupil
Cornea

A
  1. severe pain: may be ocular or headache

2.decreased visual acuity

  1. Sx worse w/ mydriasis (e.g. watching TV in a dark room)
  2. hard, red-eye
  3. haloes around lights
  4. semi-dilated non-reacting pupil

7.corneal oedema results in dull or hazy cornea

  1. systemic upset may be n/v,abdominal pain
22
Q

Management of acute glaucoma

A

Combination of drops
IV acetazolamide
reduces aqueous secretions
Definitive management
laser peripheral iridotomy
creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle

23
Q

2dary cause of closed-angle glaucoma

A

muscarinic blockers -atropine
=mydriasis, or pupil dilation, thus reducing aqueous humor outflow.

24
Q

Lens need in myopia

A

ConCAVE
nearsited

25
Q

Infectious congenital cataract causes

A

TORCH,
Toxoplasma,
Other infectious agents, usually syphilis; Rubella; Cytomegalovirus, and Herpes simplex virus

26
Q

Genetic conditions ass w/ cataracts

A

trisomies 13, 18 and 21, Marfan syndrome,
Alport syndrome,
Refsum disease,
myotonic dystrophy, neurofibromatosis type 2,

and inborn errors of metabolism like galactosemia.

27
Q

Risk factors for cataracts

A

age>60,
smoking,
excessive alcohol use, eye trauma and infections, exposure to UV light, prolonged glucocorticoids,
DM=osmotic cellular injury.

28
Q

conjunctivitis last for wks with preauricular lymphadenopathy

A

Chlamydial

29
Q

Chemosis (swelling of tissue lining eyelids and surface of the eye , conjunctiva)
profuse discharge
corneal ulceration

A

Gonococcal

30
Q

Dendritic ulcer

A

HSV

31
Q

vesicular rash around the eye, which may
with
Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement

A

Harpies zoster
Hutchinson’s sign: strong risk factor for ocular involvement

32
Q

Most common cause of viral conjunctivitis

A

Adenovirus

33
Q

Difference between stye and chalazion

A
34
Q

Conjunctivitis sign ass with gonococall infection

A
35
Q

Sx uveitis

A
36
Q

Causes of uveitis

A
37
Q

What causes retinitis

A
38
Q

HLA associated with graves

A
39
Q

Difference btwn orbital cellulitis and periorbital cellulitis

A
40
Q

Difference btwn orbital cellulitis and periorbital cellulitis

A

MRCP Master (47 decks)

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