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SBA passmed Flashcards > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

what is the most common cause of blindness in the UK

A

age related macular degeneration

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2
Q

which condition presents with ‘‘red desaturation’’

A

Optic neuritis

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3
Q

what is the management of a patient who presents to the GP with signs of Scleritis ?

A

Urgent referral to an ophthalmologist

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4
Q

how would you distinguish scleritis from episcleritis

A

scleritis : painful, episcleritis : not painful

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5
Q

which condition presents with a cherry red spot

A

central retinal artery occlusion

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6
Q

what is the management of wet ARMD? what is its mechanism

A

Vascular endothelial growth factor.

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7
Q

what is Amslers grid ? what condition does it test for ?

A

it checks for distortion of line perception. It may be useful in testing in patients with suspected age related macular degeneration.

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8
Q

what are the 4 key features of Horner’s syndrome ?

A

Miosis
Ptosis
Enophthalmos - sunken eye
anihydrosis - loss of sweating

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9
Q

which condition presents with Drusen formation

A

Dry age related macular degeneration

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10
Q

___________ presents with fixed dilated pupil with conjunctival injection

A

acute closed angle glaucoma

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11
Q

what is the definitive management of acute closed angle glaucoma

A

laser peripheral iridotomy

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12
Q

what is the diagnostic investigation for optic neuritis

A

MRI of brain and orbits with gadolinium contrast

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13
Q

give 4 differentials for a red eye

A

acute angle closure glaucoma
anterior uveitis
scleritis
conjunctivitis
subconjunctival haemorrhage

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14
Q

which condition presents with a small, fixed oval pupil and ciliary flush

A

anterior uveitis

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15
Q

which condition presents with sudden painless loss of vision and severe retinal haemorrhages on fundoscopy

A

central retinal vein occlusion

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16
Q

____________ is characterised by a dense shadow starting peripherally and progressing centrally

A

Retinal detachment

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17
Q

give 4 causes of sudden loss of vision

A

central retinal vein occlusion
central retinal artery occlusion
vitreous haemorrhage
retinal detachment

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18
Q

what is the management of orbital cellulitis

A

admission to hospital for IV antibiotics

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19
Q

which condition is associated with pus in the anterior chamber

A

anterior uveitis

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20
Q

how would you distinguish periorbital from orbital cellulitis

A

absence of :
painful movements
diplopia
visual impairment

in periorbital celluliitis

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21
Q

which investigation should be performed to assess for orbital cellulitis

A

Contrast enhanced CT of the orbits, sinuses and brain

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22
Q

what is the medical management of anterior uveitis

A

cyloplegics such as atropine and steroids drops

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23
Q

what is the management of a stye

A

regular warm steaming or soaking with a warm flannel

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24
Q

name 4 differentials for sudden painless loss of vision

A

central retinal vein occlusion
central retinal artery occlusion
vitreous haemorrhage
retinal detachment

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25
Q

give 3 management options for retinal detachment

A

Vitrectomy
scleral buckling
pneumatic retinopexy

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26
Q

which condition presents with a dense shadow that starts peripherally and progresses towards the central vision ?

A

retinal detachment

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27
Q

how would you distinguish dry macular degeneration from wet macular degeneration ?

A

-dry macular degeneration : drusen ( yellow round spots in Bruch’s membrane)
-Wet macular degeneration ( Choroidal neovascularization)

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28
Q

give 4 features of optic neuritis

A

Central Scotoma
Red saturation - colour vision affected
Acuity * decreased
Pain on eye movements

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29
Q

what is the management of proliferative retinopathy

A

Panretinal laser photocoagulation

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30
Q

what is Hutchinson’s sign? What condition does it present in ?

A

Rash on the tip / side of the nose indicating nasociliary involvement and strong RF for ocular involvement in Herpes Zoster Opthalmicus

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31
Q

what is the most serious complication of scleritis ?

A

Perforation of the sclera

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32
Q

which medications can precipitate acute angle closure glaucoma

A

adrenergic medications : Noradrenaline
Anti-cholinergic medications : Oxybutynin and Solifencin
TCA - Amitryptiline

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33
Q

what is the mechanism of acetazolamide

A

carbonic anhydrase inhibitor

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34
Q

what eye drops can be used in the management of acute angle closure glaucoma

A

Pilocarpine eye drops

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35
Q

__________ is a beta blocker that reduces the production of aqueous humour in acute angle closure glaucoma

A

Timolol

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36
Q

what produces aqueous humour?

A

Ciliary body

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37
Q

what drains the aqueous humour

A

trabecular meshwork

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38
Q

what is the normal intra-ocular pressure ?

A

10-21 mm Hg

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39
Q

how does visual loss in open angle glaucoma present

A

slow peripheral loss of vision leading to tunnel vision

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40
Q

name 2 ways to measure intra ocular pressure ? which one is gold standard

A
  • Non contact tonometry
    goldmann applanation tonometry ( gold standard)
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41
Q

what is amblyopia ? when does it occur ?

A

it is known as a lazy eye. It occurs when a squint ( exotropia) goes uncorrected

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42
Q

why has someone with open angle glaucoma got increased eyelash length

A

due to the use of prostaglandins such as latanoprost in the management of open angle glaucoma

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43
Q

name 3 side effects of prostaglandin analogues post management of open angle glaucoma

A

increased eyelash length
iris pigmentation
periocular pigmentation

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44
Q

what condition is likely when patient presents with bilateral grittiness and itchiness of the eyes

A

Blepharitis

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45
Q

in _________ the injected vessels are mobile when gentle pressure is applied on the sclera

A

episcleritis

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46
Q

what is the mechanism of vascular endothelial growth factor?

A

It stimulates the development of new blood vessels in the retina.

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47
Q

what is RAPD

A

relative afferent pupillary defect is when the affected and normal eye appear to dilate when the light is shone on the affected eye in the swinging light test

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48
Q

what are the causes of mydriasis ( large pupil)

A

third nerve palsy
Holmes Adie pupil
traumatic idroplegia
phaeochromocytoma
congenital

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49
Q

what is argyll robertson pupil and how does it present

A

clasic pupillary syndrome seen in neurosyphilis. The pupil typically accommodates but does not react.

Accommodation reflex present but Pupillary reflex absent

syphilis= prostitute who accommodates but doesnt react like argyll robertson

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50
Q

what is a holmes adie pupil

A

one of the differentials for a dilated pupil.
unilateral dilated pupil.
D for dilated. once the dilated pupil goes home it stays constricted.
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation / very poorly to light

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51
Q

what are some features of adie’s tonic pupil

A

aniscoria( one pupil bigger than the other) is greater in bright light thus there is an issue with the dilated pupil and its a bility to constrict

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52
Q

what is the management of herpes zoster ophthalmicus

A

oral antivirals ( 7-10 days)

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53
Q

how do you manage anterior uveitis

A

urgent review by ophthalmology
cycloplegic eye drops ( atropine, cyclopentolate)
steroid eye drops

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54
Q

3 most common associations of optic neuritis

A

MS
Diabetes
syphilis

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55
Q

is glaucoma hereditary? how is that managed

A

strong hereditary component . annual glaucoma screening from 40 should be commenced

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56
Q

proliferative diabetic retinopathy is associated with which condition

A

T1DM

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57
Q

what is the management for herpes simplex keratitis

A

topical acicylovir

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58
Q

what do cotton wool spots represent in diabetic retonipathy

A

pre capillary arteriolar occlusion or retinal infarction

59
Q

how to distinguish posterior vitreous detachment and retinal detachment

A

no loss of vision in posterior vitreous detachment

60
Q

what is the most common bacterial cause of keratitis in contact lens wearers

A

pseudomonas aeroginosa

61
Q

when would you refer someone for corneal foreign body to opthalmology

A
  • suspicion of penetrating eye injury
    -significant orbital / periocular trauma
  • chemical injury ( irrigation for 20-30 mins prior to referral)
    organic component
    red flags
62
Q

what are the 4 stages of hypertensive retinopathy

A
  1. Arteriolar narrowing and tortuosity
    Increased light reflex
  2. AV nipping
  3. Cotton wool exudate, flame and blot haemorrhages
    macular star
  4. papilloedema
63
Q

which conditions are blepharitis associated with

A

dry eye syndrome
seborrhoeic dermatitis
acne rosacea

64
Q

what is a stye ?

A

It is an infection of the glands of the eyelids. it is an infection of the glands of zeis or glands of moll and presents as a painful swelling of upper eyelid and is managed with analgesia and hot compress.

Topical antibiotics are recommended if there is an associated conjunctivitis.

65
Q

what is the most common underlying cause of a vitreous haemorrhage?
what are other causes

A

Proliferative diabetic retinopathy - most common

posterior vitreous detachment
ocular trauma

66
Q

what investigations are performed for vitreous haemorrhage

A

dilated fundoscopy : may show haemorrhage in vitreous cavity
slit lamp examination : RBC’s in anterior vitreous
ultrasound : to rule out retinal tear/ detachment
fluorescein angiography : identification of neovascularization
Orbital CT: if there is open globe injury

67
Q

what are the risk factors for retinal detachment

A

damn my eye aches constantly
diabetes mellitus
myopia
eye trauma
age
cataract surgery

68
Q

which ocular conditions can herpes zoster opthalmicus cause

A

conjunctivitis
keratitis
episcleritis
anterior uveitis

69
Q

what condition can affect swimmers wearing contact lenses

A

acanthamoeba keratitis

70
Q

what medications are used in the management of open angle glaucoma and what is their mechanism

A

latanoprost - prostaglandin analogue
beta-blocker : reduces aqueous production
carbonic anhydrase inhibitors : reduce aqueous production
miotics ( pilocarpine) -muscarinic receptor agonist

71
Q

what is the step-wise management of open angle glaucoma

A
  1. trabeculoplasty to those with IOP >- 24 mmHg
  2. prostaglandin analogues
  3. beta blockers
  4. carbonic anhydrase inhibitor eyedrops
72
Q

what is the key presenting feature of anterior uveitis

A

small fixed oval pupil with ciliary flush

73
Q

what is a severe complication of proliferative diabetic retinopathy

A

vitreous haemorrhage

74
Q

what are the complications of pan retinal laser photocoagulation

A

noticeable reduction in visual fields
decrease in night vision

75
Q

how would you distinguish between NPDR and PDR

A

NPDR : presents with micro-aneurysms, blot haemorrhage and cotton wool spots

PDR : retinal neovascularisation

76
Q

what is the most common cause of a watery eye in an infant ? How does it present and how is it managed ?

A

Nasolacrimal duct obstruction presenting with an imperforate membrane. Mostly self resolving - some referred to ophthalmologist for probing

77
Q

what is blepharitis? How does it present? How is it managed?

A

inflammation of the eyelid margins due to Meibomian gland dysfunction or seborrheic dermatitis / staphylococcus infection.

presents with bilateral grittiness and discomfort with sticky eyes in the morning and styes and chalazions

management includes hot compresses and lid hygiene which is the mechanical removal of debris from the lid margins.
cotton wool buds/ sodium bicarbonate

78
Q

what are the risk factors for vitreous haemorrhage

A

CATS and Dogs
Coagulation disorders
Anti-coagulation
Trauma
Severe short sightedness

Diabetes

79
Q

What are the risk factors for central retinal vein occlusion?

A

glaucoma
polycythaemia
HTN

80
Q

what is the management of dry macular degeneration

A

high doses of beta-carotene, vitamin C and E and zinc

81
Q

what are the risk factors for age related macular degeneration ?

A

advancing age - greatest risk factor
smoking
family history

82
Q

what are the classical features of dry and wet ARMD

A

there is a gradual reduction of vision in dry ARMD whereas there is a more subacute reduction of vision in wet ARMD
difficulty in dark adaptation
visual hallucinations if Charles Bonnet syndrome is present

83
Q

what are the signs of ARMD

A

There is distortion of line perception that can be noted on the Amsler grid
Drusen = dry ARMD on fundoscopy
red patches = wet ARMD on fundoscopy

84
Q

what is the most important risk factor in Horner’s syndrome

A

smoking

85
Q

how does a Pancoast tumour present ?

A

Horner’s syndrome + shoulder and arm pain due to brachial plexus invasion

86
Q

what is the most common eye problem presenting to primary care? How does it present ? What are its types?

A

Conjunctivitis - presents with red sore eyes associated with a sticky discharge.

bacterial conjunctivitis presents with purulent discharge and eyes stuck together.

Viral conjunctivitis presents with serous discharge usually preceded by a viral URTI. Periauricular lymph nodes may be swollen.

87
Q

how is infective conjunctivitis managed ?

A

generally self limiting (1-2 weeks)
chloramphenicol eye drops can be given / topical fusidic acid in pregnant women.

88
Q

what advice should be given to contact lens users surrounding infective conjunctivitis

A

topical Fluoresceins
dont wear contact lenses

89
Q

how should purulent eye discharge be associated in neonates

A

urgent eye discharge swabs to rule out chlamydia and gonococcus

90
Q

what is associated with Holmes Adie syndrome

A

absent ankle/ knee reflexes associated with Holmes Adie pupil

91
Q

how would you distinguish Argyll Robertson pupil from Holmes Adie pupil

A

Argyll Robertson pupil is generally small and often irregular and bilateral + associated with neuro-syphilis.

Holmes Adie is generally a unilateral dilated pupil.

92
Q

what is the management of viral conjunctivitis

A

conservative management with cold compresses and good eye hygiene.

93
Q

what is papilledema ? Is it unilateral or bilateral?

A

Optic disc swelling that is caused by increased ICP. It is almost always bilateral.

94
Q

how does papilloedema present on fundoscopy

A

there is venous engorgement, blurring of the optic disc margin and loss of venous pulsation
Paton’s lines - concentral/radial retinal lines cascading from the optic disc

95
Q

what are the causes of papilloedema?

A

space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia

96
Q

what are the causes of central retinal artery occlusion?

A

thromboembolism ( from atherosclerosis)
arteritis ( temporal arteritis)

97
Q

how is central retinal artery occlusion managed?

A

IV steroids - if temporal arteritis
complex management

98
Q

what are the aims of treatment of acute angle glaucoma ?

A

reducing aqueous secretion and inducing pupillary constriction

99
Q

what are the causes of tunnel vision

A

glaucoma
papilloedema
choroidoretinitis
retinitis pigmentosa

100
Q

how does orbital cellulitis present ? How is it managed?

A

redness and swelling
severe ocular pain
visual disturbances
proptosis
ophthalmoplegia / painful eye movements

101
Q

what are the risk factors for orbital cellulitis ?

A

childhood
previous sinus infection
lack of Hib vaccination
recent eyelid infection / insect bite
ear / face infection

102
Q

what are the most common bacterial causes of orbital cellulitis

A

streptococcus
staphylococcus aureus
HiB

103
Q

what is the management of orbital cellulitis

A

IV Abx

104
Q

what is the diagnostic investigation for ARMD if neovascularisation is suspected

A

Fluorescein angiography

105
Q

what is the initial investigation for ARMD

A

Slit lamp microscopy

106
Q

what are the 2 key symptoms that patients complain of in vitreous haemorrhage

A

sudden painless loss of vision
dark spots in vision
red hue in vision

107
Q

how is blurred vision investigated?

A

visual acuity with a Snellen chart
Pinhole occluders to check for refractive errors

108
Q

what is a chalazion and how does it present

A

retention cyst of Meibomian gland presenting as a firm painless lump in the eyelid.

109
Q

what is the difference between entropion and ectropion?

A

entropion : in turning of the eyelids
ectropion : out turning of the eyelids

110
Q

how does herpes simplex keratitis present? What are its features? How is it managed ?

A

dendritic corneal ulcer

red painful eye
photophobia
decreased visual acuity
fluorescein stain : epithelial ulcer
management : urgent referral to ophthalmology
topical acyclovir

111
Q

what are the risk factors for scleritis ?

A

RA
SLE
Sarcoidosis
Granulomatosis with polyangiitis

112
Q

what are the features of scleritis ? How would you distinguish this from episcleritis ?

A

classically painful red eye
watering and photophobia
gradual decrease in vision

Injected vessels are generally mobile in episcleritis unlike scleritis and episcleritis is painless

113
Q

how is a squint management

A

referral to ophthalmology where eye patch may be recommended

114
Q

what is a suitable screening test for childhood squints?

A

corneal light reflection test

115
Q

what are the 2 types of squints?

A

concomitant : imbalance in extra-ocular muscles leading to convergence
Paralytic : paralysis of extra-ocular muscles.

116
Q

How does retinitis pigmentosa present ?

A

night blindness and tunnel vision

117
Q

what points to a diagnosis in chronic open angle glaucoma

A

increased cup to disc ratio

118
Q

what is the pathophysiology of cataract?

A

lens of the eye gradually opacifies and becomes cloudy which makes it difficult for the light to reach the back of the eye ( retina) causing blurred vision.

119
Q

what is the most common cause of cataract? What are the other risk factors?

A

most common cause : ageing

other risk factors include :
smoking
alcohol
trauma
diabetes
steroids
hypocalcaemia

120
Q

what are the signs and symptoms of cataract

A

reduced vision
faded colour vision
glare and halos
defect in red reflex

121
Q

what is the management of cataract

A

non surgical : conservative/ glasses
surgical : dependent on patient choice and visual impairment

122
Q

what are the complications of cataract surgery

A

Posterior capsule opacification: thickening of the lens capsule
Retinal detachment
Posterior capsule rupture
Endophthalmitis: inflammation of aqueous and/or vitreous humour

123
Q

how does corneal abrasion present? How is it investigated and management?

A

eye pain
lacrimation
photophobia
foreign body sensation
decreased visual acuity

investigations : Fluorescein staining

management : topical antibiotic ( chloramphenicol_)

124
Q

what is the action of latanoprost

A

increases uveoscleral outflow

125
Q

what is the action of brimonidine ? what are its contraindications and adverse effects

A

Reduces aqueous production and increases outflow
Avoid if taking MAOI or tricyclic antidepressants

Adverse effects include hyperaemia

126
Q

what is the action of carbonic anhydrase inhibitors ? What are its adverse effects

A

Reduces aqueous production
Systemic absorption may cause sulphonamide-like reactions

127
Q

what is the action of miotics like pilocarpine? What are its adverse affects ?

A

increases uveoscleral outflow
Adverse effects included a constricted pupil, headache and blurred vision

128
Q

what are three key features of central retinal artery occlusion

A

sudden, painless unilateral visual loss
relative afferent pupillary defect
‘cherry red’ spot on a pale retina

129
Q

what is the main complication of ocular trauma

A

raised intra-ocular pressure causing risk to sight

130
Q

what are the features of orbital compartment syndrome

A

eye pain/swelling
proptosis
‘rock hard’ eyelids
relevant afferent pupillary defect

131
Q

what is the management of orbital compartment syndrome

A

urgent lateral canthotomy

132
Q

what 2 investigations can be used to investigate acute angle closure glaucoma

A

tonometry and gonioscopy

133
Q

what complications are those with scleritis most at risk of

A

Perforation of the globe

134
Q

what are the risk factors for primary open angle glaucoma

A

Age
genetics
Afro-Caribbean ethnicity
myopia
HTN
diabetes mellitus
corticosteroids

135
Q

what are the medications used in the management of acute angle closure glaucoma

A

pilocarpine, timolol, apraclonidine and IV Acetazolamide

136
Q

how does endophthalmitis present

A

Painful, red eye following cataract surgery

137
Q

what is normally the most common bacterial cause of keratitis

A

staph. aureus

138
Q

how is keratitis generally managed

A

topical abx and cycloplegics like cyclopentolate

139
Q

what is an example of anti vegf

A

bevacizumab and pegaptanib

140
Q

how does anhydrosis determine site of lesion in Horner’s syndrome

A

head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery

141
Q

what is diabetic maculopathy?

A

progressive eye disease due to diabetes affecting the macula - based on location causing blurred vision / blind spot

142
Q

what type of cataract are the following associated with?

A

subcapsular : steroid use , allopurinol bit less
myotonic dystrophy : dot cataracts
myopia : nuclear cataracts
ocular trauma : nuclear cataract

143
Q
A

SBA passmed Flashcards (30 decks)

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