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PLAB 1 August 2024 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

DDx between:
- Bacterial conjuntivictis
- Viral conjuntivictis
- Alergic conjuntivictis

A

Bacterial conjuntivictis
- Purulent sticky discharge (eyes stuck together upon waking up);
- Delayed Rx strategy (topical antibiotics if symptoms not resolved within 3 weeks);

Viral conjuntivictis
- Serous discharge;
- Preauricular lymphadenopathy;
- H/o of recent URTI (adenovirus);
- Rx is symptomatic (cold presses & artificial tears);

Alergic conjuntivictis
- Bilateral red eye;
- Itching;
- H/o of atopy
- Rx is antihistamines, avoidance of allergen, topical mast cell stabilizers.

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2
Q

Describe what is ophthalmia neonatorum and its cause.

A
  • Conjuctivitis in a newborn within 28 days of birth.

➔ Most common cause:
- Chlamydia trachomatis
- N. gonorrhoeae

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3
Q

What are the symptoms of ophthalmia neonatorum?

A
  • Purulent or mucopurolent discharge;
  • Injected conjunctiva;
  • Lid swelling.
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4
Q

What is the management of ophthalmia neonatorum?

A

➜ Refer to secondary care (same day)

➜ Treatment
◆ Chlamydial infection:
- Oral erythromycin for 14 days
Or
- Oral azytrhromycin for 3 days

◆ Gonorrhoeal infection:
- IV or IM ceftriaxone (single dose)

◆ Viral infection:
- IV acyclovir for 14 days

➜ Prevention
- Screening of mother for STI

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5
Q

What are the symptoms of nasolacrimal duct obstruction?

A
  • Purulent discharge;
  • Child is otherwise well.
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6
Q

What is the management of nasolacrimal duct obstruction?

A
  • Reassurance;
  • Massage of lacrimal duct;
  • Clean with sterile cotton;
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7
Q

Describe what is anterior uveitis (iritis).

A

Inflammation of the iris.

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8
Q

What are the symptoms of anterior uveitis?

A
  • Unilateral (usually);
  • Pain;
  • Redness;
  • Photophobia;
  • Blurring of vision;
  • Iris spasm causing abnormal shape of pupil;
  • Presence of cells on anterior chamber.
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9
Q

What are the associated conditions of anterior uveitis?

A
  • Crohn’s disease / Inflammatory bowel disease;
  • Ankylosing spondylitis
  • Reactive arthritis
  • Saircoidosis
  • Behcet’s disease
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10
Q

What is the Rx of anterior uveitis?

A
  • Corticosteroids;
  • Cyclopentolate (pain and to prevent adhesions)
  • Ciclosporin (if recurrent and affects visual acuity)
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11
Q

Describe the physiology of acute angle closure glaucoma.

A

Impairment of aqueous outflow ⟶ ↑ IOP.

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12
Q

What are the risk factors for acute angle closure glaucoma?

A
  • Hypermetropia / long-sightedness
  • Pupillary dilation
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13
Q

What are the features of acute angle closure glaucoma?

A
  • Acute painful red eye;
  • Semi-dilated non-reactive pupil;
  • H/o coloured halos;
  • H/o of watching TV in dark room (pupillary dilation ➝ ↓ decreases outflow)
  • Globe is hard on palpation
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14
Q

What is the Rx of acute angle closure glaucoma?

A

Acute Rx:
- Pilocarpine drops;
- Acetazolamide IV;
- Prednisolone drops;
- Timolol drops (B-blocker).

Long term Rx:
- Peripheral iridotomy;
- Surgical iridotomy;

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15
Q

What are the complications of acute angle closure glaucoma?

A

If not treated immediately:
- Damage of the optic nerve (due to ⬆︎ IOP);
- Permanent vision loss.

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16
Q

Describe the physiology of PRIMARY open-angle glaucoma.

A

Progressive optic nerve damage due to ⬆︎ IOP.

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17
Q

What are the symptoms of PRIMARY open-angle glaucoma?

A
  • Gradual visual field loss
  • Bilateral
  • Painless
  • Disc cupping: optic neuropathy
  • Open iridocorneal angle
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18
Q

What are the risk factors for PRIMARY open-angle glaucoma?

A
  • Myopia
  • Ocular hypertension
  • > 65 years
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19
Q

What is the Rx of PRIMARY open-angle glaucoma?

A

Medical
- Prostaglandin analogues
- B-blockers topical
- Acetazolamide

Laser & surgical
- Trabeculoplasty
- Laser cycloablation
- Artificial shunts

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20
Q

DDx between:
- Acute angle closure glaucoma
- Anterior uveitis

A

Acute angle closure glaucoma
- Oval pupil
- Nausea
- Vomiting
- Abdominal pain

Anterior uveitis
- Irregular shape pupil
- Ankylosing spondylitis
- Inflammatory bowel disease
- Reactive arthritis

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21
Q

What are the symptoms of acute dacryocystitis?

A
  • Excess tears;
  • Pain;
  • Redness;
  • Swelling of the lacrimal sac.
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22
Q

What are the symptoms of thyroid eye disease?

A
  • Diploplia;
  • Lid lag;
  • Restricted eye movements;
  • Tachychardia.

➔ Investigation: thyroid function test.

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23
Q

Describe what is cytomegalovirus retinitis.

A

Visual deterioration on an HIV patient.

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24
Q

What is the management of chalazion (meibomiam cysts)?

A

➔ Non-infectious obstruction of the meibomiam gland

  • Warm compresses
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25
Q

What are the symptoms retinitis pigmentosa?

A

➔ Inherited disorder of photoreceptors

  • Night blindeness
  • Tunnel vision
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26
Q

What is the management of retinitis pigmentosa?

A

Routine referral to opthalmology.

No need for urgent referral.

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27
Q

What are the symptoms and management of subconjuctival haemorrhage?

A

Symptoms
- Bloodshot eye
- Painless
- Doesn’t affect the vision

Management
- Reassurance

28
Q

What are the symptoms of herpes zoster ophthalmicus?

A

➜ Reactivation of varicella zoster virus in the area innervated by the ophtalmic division of the trigemial nerve.

  • Preherpetic neuralgia;
  • Rash on the forehead and eyelid swelling;
  • Eye pain and photphobia
  • Hutchinson’s sign: tip of the nose involvement.
29
Q

What is the Rx of herpes zoster ophthalmicus?

A
  • Oral aciclovir
  • Oral corticosteroids
30
Q

What are the cause organisms of orbital cellulitis?

A
  • S. aureus;
  • Streptococcus pneumoniae;
  • Streptococcus pyogenes.
31
Q

What are the symptoms of orbital cellulitis?

A
  • Proptosis;
  • Pain on eye movement;
  • Blurred vision;
  • Diploplia;
  • Swelling of conjuctiva and lids.
32
Q

What are the investigations done in orbital cellulitis?

A

Initial:
- CT scan of orbit and brain (rule ot intracranial abscess)

33
Q

What is the Rx of orbital cellulitis?

A

➜ Emergency referral to higher center

  • IV Co-amoxiclav.
34
Q

DDx between:
- Orbital cellulitis;
- Periorbital cellulitis.

A

Orbital cellulitis
- Inflammation of conjuctiva + eyelid

Periorbital cellulitis
- Inflammation of eyelid

35
Q

What are the risk factors for retinal detachment?

A
  • Advancing age;
  • Extreme myopia;
  • Cataract surgery;
  • Trauma.
36
Q

What are the symptoms of retinal detachment?

A
  • Flashes (lights)
  • Floaters
  • Field loss
  • Fall in acuity
37
Q

What is the investigation done in retinal detachment?

A

Ophthalmoscopy
- Grey / opaque retina
- Retina that balloons forward.

38
Q

What is the Rx for retinal detachment?

A
  • Vitrectomy
  • Scleral buckling
  • Pneumatic retinoxepy
  • Retinal tears and holes by cryoteraphy
39
Q

What are the features of cataracts?

A
  • Old age
  • Gradually ⬇︎ vision
  • Glare especially at night
  • Use of steroids (COPD/asthma)
  • ⬆︎ exposure to UV
  • DM
  • Smoking

► Congenital cataracts: caused by Rubella.

40
Q

What is the Rx of cataracts?

A

Lens extraction and intraocular lens implantation.

41
Q

Describe what is optic neuritis.

A

Inflammation of the optic nerve.

➜ Associated with:
- Multiple sclerosis
- Neuromyelites optica

42
Q

What are the symptoms in optic neuritis?

A

Triad
- Pain on eye movement;
- Unilateral ⬇︎ vision;
- Impaired colour vision (initially red);

Multiple sclerosis
- Woman
- Fatigue
- Paresthesia
- Weakness
- Relative afferent pupillary defect

Relative afferent pupillary defect: dilated pupils when light is swung from the normal eye to the affected eye.

43
Q

What is the Rx of optic neuritis?

A

Methylprednisolone.

44
Q

Describe what is retrobulbar neuritis.

A

Inflammation of the optic nerve behind the globe of the eye.

45
Q

What are the symptoms in retrobulbar neuritis?

A
  • Unilateral, sudden vision loss;
  • Eye pain;
  • ⬇︎ colour vision;
  • Relative afferent pupillary defect

► Fundoscopy: optic disk may appear normal initially (inflammation behind the eye).

46
Q

Describe the fundoscopy features of cytomegalovirus retinitis.

A
  • Retinal haemorrhages;
  • Yellow-white areas (pizza)
47
Q

What is the Rx of cytomegalovirus retinitis?

A

Ganciclovir
- Intravitreal and IV.

48
Q

What are the symptoms of central retinal artery occlusion?

A
  • Acute painless loss of vision;
  • H/o of amaurosis fugax in the past;
  • Relative afferent pupillary defect.
49
Q

What are the investigations done in central retinal artery occlusion?

A

Ophthalmoscopy
- Pale retina
- Cherry red spot

50
Q

What are the Rx of central retinal artery occlusion?

A

◆If within 90 minutes of onset
- Firm occular massage to dislodge the clot
◆ Topical timolol / IV acetazolamide

51
Q

What are the symptoms of central retinal vein occlusion?

A
  • Unilateral painless loss of vision;
  • Blurred vision
52
Q

What are the investigations done in central retinal vein occlusion?

A

Ophthalmoscopy
- Dot-blot and flame haemorrhage (stormy sunset)
- Macular oedema

53
Q

What are the Rx of central retinal vein occlusion?

A
  • Panretinal photocoagulation
  • Intravitreal anti-VEGF
54
Q

What are the causes of sudden painless vision loss?

A
  • Retinal detachment
  • Vitreous haemorrhage
  • Central retinal artery occlusion
  • Central retinal vein occlusion
  • Occipital cortex stroke
55
Q

DDx between:
- Central retina artery occlusion
- Branch retinal artery occlusion
- Central retina vein occlusion
- Branch retina vein occlusion

A

Central retina artery occlusion
- Acute unilateral painless loss of vision
- Pale retina except the macula which is bright red

Branch retinal artery occlusion
- Acute unilateral painless loss of vision
- Paleness of the retinal quadrant

Central retina vein occlusion
- Unilateral sudden painless loss of vision
- Flame shaped haemorrhage

Branch retina vein occlusion
- Unilateral sudden painless loss of vision
- Flame shaped haemorrhage in the retinal quadrant

56
Q

Describe the features of hypertensive retinopathy.

A
  • Uncontrolled hypertension

Fundoscopy:
- A / V nicking (where artery crosses a vein)
- Copper or silver wiring (attenuation of artery)
- Cotton wool spots
- Optic disk oedema
- Ischaemic changes

57
Q

DDx between:
- Diabetic retinopathy
- Hypertensive retinopathy

A

Diabetic retinopathy
- Neovascularization (formation of new vessels)
- Cotton wool spots (⬆︎⬆︎)
- Haemorrhages

Hypertensive retinopathy
- A / V nicking (where artery crosses a vein)
- Copper or silver wiring (attenuation of artery)
- Cotton wool spots
- Optic disk oedema
- Haemorrhage

58
Q

Describe the lesions in optic pathway:
- One eye vision loss?

A

Injury to optic nerve.

59
Q

Describe the lesions in optic pathway:
- Bitemporal heteronymous hemianopsia (tunnel vision)

High yield

A

Optic chiasm.

Ex: pituitary tumour

60
Q

Describe the lesions in optic pathway:
- Homonymous hemianopsia?

A
  • Optic tract
  • Optic radiation
  • Occipital lobe
61
Q

What are the symptoms of age-related macular degeneration.

A
  • Elderly patient
  • Central vision loss
  • Difficulty in recognising faces
  • Micropsia (objects appear smaller than they are)
  • Metamorphosia (straight lines appear wavy)
62
Q

Name the conditions that cause:
- Central vision loss
- Periheral vision loss

A

Central vision loss first
- Age related macular degeneration

Periheral vision loss first
- Retinitis pigmentosa
- Open angle glaucoma

63
Q

Describe the use of fluorescein dye in the eye

A
  • Herpes simples keratitis (dentric ulcers are seen)
  • Corneal abrasions
  • Corneal ulcers
64
Q

Ophthalmology

Describe the Charles bonnet syndrome.

A
  • An elderly patient that has lost partial or total vision;
  • Without features of dementia or mental health issues;
  • Visual hallucinations that can be simple (lines) or complex (people).
65
Q

What are the investigations done in Charles bonnet syndrome?

A

1st line: Visual acuity test

Others:
- Slit lamp
- Optical tomography

66
Q

What are the **ocular manifestations **of rheumatoid arthritis?

A
  • Keratoconjuctuvitis sicca
  • Episcleritis
  • Scleritis
  • Iatrogenic steroid induced cataracts

PLAB 1 August 2024 (32 decks)

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