Ophthalmology

Question 1

acute glaucoma mx

Answer 1

• BBs: reduce aqueous production
• prostaglandins (latanoprost): ++ uveoscleral outflow (+ eyelash length, brown iris)
• miotics/muscarinic receptor agonist (pilocarpine): ++ uveoscleral outflow

Question 2

vertical diplopia vs horizontal diplopia

Answer 2

trochlear vs abducens

Question 3

… is a serious but rare complication of cataract surgery which needs urgent treatment

Answer 3

Post-operative endophthalmitis
(red, painful, hypopryon)

Question 4

small, irregular pupils
no response to light but there is a response to accommodate

Answer 4

Argyll-Robertson pupil - neurosyphillis, DM

Question 5

Unilaterally dilated pupil which is unresponsive to light, compression of CNIII (tumour)

Answer 5

Hutchinson’s

Question 6

RAPD, damage to CNII/retina

Answer 6

Marcus-Gunn pupil

Question 7

Tonically dilated pupil, slowly reactive to light with more definite accommodation response.

damage to parasympathetic innervation of the eye due to viral or bacterial infection.

females, accompanied by absent knee or ankle jerks

Answer 7

Adie pupil

Question 8

A decrease in night vision is a potential complication of …

Answer 8

panretinal photocoagulation

Question 9

… is contraindicated for patients with penetrating eye injuries or acute narrow angle glaucoma, as it increases intra-ocular pressure

Answer 9

Suxamethonium

Question 10

hypermetropia RF for
myopia RF for

Answer 10

• acute angle glaucoma
• posterior vitreous detachment // retinal detachment // open angle glaucoma

Question 11

night vision difficulties, charles-bonnet syndrome, flashing lights

Answer 11

ARMD

Question 12

hay fever, bilateral conjunctiva & haemorrhage, itchy swollen eyelids mx

Answer 12

allergic conjunctivitis
topical/systemic antihistamines –> topical mast cell stabilisers

Question 13

diagnosis & associations

anterior uveitis

Answer 13

acute red painful eye with small pupil & photophobia
lacrimating with ciliary flush and hypopyon

ank spond
reactive arthritis
IBD
Bechet’s
sarcoid

Question 14

anterior uveitis Mx

Answer 14

cycloplegics + steroids
urgent referral

Question 15

conditions where blepharitis is common

Answer 15

sub derma // rosea

Question 16

if the blurring improves with … then likely cause is a refractive error

Answer 16

a pinhole occluder

Question 17

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

Answer 17

central retinal artery occlusion

Question 18

sudden, painless unilateral visual loss
hyperaemia, retinal haemorrhages ‘stormy sunset’

Answer 18

central retinal vein occlusion

Question 19

presentation & aetiologies of corneal ulcer

Answer 19

eye pain
photophobia
watering of the eye
focal fluorescein staining of the cornea

HZV- dendritic ulcer
contact lens - acanthamobea

Question 20

keratitis features & mx

Answer 20

red painful eye with photophobia, gritty sensation and hypopyon. mx

topical quinolones 1st line
cycloplegic pain relief

Question 21

optic neuritis features & mx

Answer 21

unilateral decrease in acuity
pain worse on movement
red desaturation
RAPD
central scotoma

MRI with contrast // high dose steroids

Question 22

papilloedema features

Answer 22

venous engorgement
blurred optic disc
loss of optic cup

Question 23

posterior vitreous detachment vs retinal detachment vs vitreous haemorrhage features

Answer 23

sudden floaters
flashes peripherally
blurred vision/cobweb

dark curtain coming down (peripheral -> centre)
curvy lines
central vision loss

use anticoagulants
proliferative diabetic retinopathy

Question 24

open glaucoma features

Answer 24

peripheral visual field loss (tunnel vision)
– acuity & opic disc cupping

Question 25

Trochlear nerve palsy

Abducens nerve palsy

Oculomotor nerve palsy

Answer 25

• internally rotate and depress while adducted (Vision worse going down stairs) - sTairs with 4 steps
  vertical diplopia
• horizontal diplopia and inward deviation of the eye
• impaired horizontal eye movement and weak adduction of the affected eye.

Question 26

PITS for homonomous quadrontopia

Answer 26

parietal –> inferior
temporal –> supoerior