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Memorize for 2nd Year Exams > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What else should you look for in swollen optic discs?

A

Venous congestion

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2
Q

What else should you do in clinic with a patient who has optic disc swelling?

A

Blood pressure

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3
Q

What is the natural history of idiopathic intracranial hypertension?

A

Disc swelling subsides, discs become atrophic and pale

Loss of visual function occurs and blindness may result

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4
Q

Which two muscles control eye opening?

What is the nerve supply to each?

A

Levator palpebrae superioris - CN III

Muller’s muscle - under sympathetic control

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5
Q

What is Horner’s syndrome?

Why does it cause ptosis and miosis

A

A combination of symptoms that arises when the sympathetic trunk is damaged
Mullers muscle is supplied by sympathetic nerves - ptosis
Dilator pupillae is supplied by sympathetic nerves - miosis

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6
Q

What lies just posterior to orbicularis oculi?

A

Orbital septum

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7
Q

What are the two types of conjunctiva?

A

Palpebral - on inner surface of eyelid

Bulbar - lines the eyeball

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8
Q

How do corneal endothelial cells regenerate?

A

They don’t - born with them and you can’t grow more

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9
Q

How is near focusing achieved by the ciliary body and zonules?

A

Ciliary body contracts, pulling the border of the choiroid towards the lens
Zonules (suspensory ligaments) relax
Lens becomes thicker and rounder

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10
Q

How is far focusing achieved by the ciliary body and zonules?

A

Ciliary body relaxes, border of choroid moves away from the lens
Zonules (suspensory ligaments) contract
Lens becomes thinner and longer

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11
Q

Give two differentials for painful Horner’s syndrome

A
  1. Pancoast tumour - compresses sympathetic fibres at the apex of the lung
  2. Paraganglioma - occurs at carotid
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12
Q

Eye positioned down and out with ptosis = ?

A

Complete CN III palsy

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13
Q

Posterior communicating artery aneurysm = which nerve palsy?

A

CN III

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14
Q

What will a lesion in the left trochlear nucleus produce?

A

Contralateral muscle palsy

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15
Q

What is Hutchison’s sign?

A

Herpes zoster on the tip of the nose - likely that the ye will be involved through nasociliary nerve
Start on oral acyclovir asap

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16
Q

Which ocular nerve palsy can occur in raised ICP?

A

CN VI - abducens

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17
Q

Where do the rectus muscles arise from?

Clinical significance?

A

Common tendinous ring

Attached to the optic nerve sheath - this is why optic neuritis causes pain on eye movement

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18
Q

What does the ophthalmic artery branch off of?

A

Internal carotid

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19
Q

Where do the ophthalmic veins drain into?

A

Cavernous sinus

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20
Q

Where do the supraorbital nerve and vessels pass through?

A

Supraorbital notch

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21
Q

What is central scomata?

A

Loss of central vision - occurs in macular degeneration

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22
Q

What is rubeosis iridis?

A

Aka neovascular glaucoma
Retina is so ischaemic that new vessels grow on the iris
Occurs in retinal vein occlusion and severe diabetic retinopathy
You cannot recover from this

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23
Q

Which cells die in retinitis pigmentosa?

A

Rods

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24
Q

Which two layers of the eye separate in retinal detachment?

A

Sensory retina

Retinal pigment epithelium

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25
Q

What is the most common type of retinal detachment?

A

Rhegmatogenous

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26
Q

What happens in Rhegmatogenous retinal detachment?

What causes it?

A

A tear in the retina causes vitreous to pass into the subretinal space
Typically caused by trauma

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27
Q

What happens in exudative retinal detachment?

A

Blood or fluid from the choroid separates the two layers of the retina
It does not involve tears in the retina or traction from the vitreous

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28
Q

What happens in tractional retinal detachment?

Most common cause?

A

Scar/abnormal tissue grows on the surface of the retina, pulling it away from the layer beneath it
Diabetic retinopathy

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29
Q

How does retinal detachment present?

A
  • Flashes
  • Floaters
  • Field loss
  • Fall in acuity
    It is painless
    May describe curtain falling down over lower half as the retina detaches upward
30
Q

Treatment for retinal detachment?

A

If detachment is superior, rest flat etc
Laser photocoagulation therapy
Vitrectomy and gas tamponade

31
Q

What is the most commonly inherited degenerative condition of the retina?

A

Retinitis pigmentosa

32
Q

Symptoms of retinitis pigmentosa?

A

Night blindness followed by peripheral and central daytime vision loss

33
Q

List four risk factors for ARMD

A

Older age
Smoking
CVD
Cataract surgery

34
Q

Pathophysiology of wet ARMD?

A

New blood vessels grow under the retina - leakage causes build up of fluid/blood and eventually scarring

35
Q

Treatment of wet ARMD?

A

Anti-VEGF injected into vitreous cavity

36
Q

Pupil involving CNIII palsy is what until proven otherwise?

A

Circle of Willis aneurysm

37
Q

If pupil is not involved in CN III palsy, what is the likely cause?

A

Microvascular - in middle of nerve bundle

38
Q

What type of trauma causes CN IV palsy?

A

Blunt head trauma

CN IV has a long path forward and so is sensitive to stretching injury when head is knocked forward

39
Q

What head movement do you get in bilateral CN IV palsy?

A

Torsion and chin depression to get single vision

40
Q

What diagnosis is important to keep in mind in VIth nerve palsy?
If this is the diagnosis, what other symptoms might the patient have?

A

Raised ICP

Headache, vomiting

41
Q

Headache, vomiting, convergent squint = ?

A

Raised ICP

42
Q

Failure to adduct one eye and abducting nystagmus in the other = ?
Who is this common in ?

A

Medial longitudinal fasiculus problem

MS patients

43
Q

Describe the aqueous pathway

A

Produced in ciliary body
Passes behind iris/in front of lens
Then through pupil
In front of the iris
Out of eye via irido-corneal angle in the anterior chamber
Filters back into blood through the trabecular meshwork and canal of Schlemm

44
Q

What is the defining feature of glaucoma?

A

Progressive optic neuropathy

45
Q

Which vision tends to be spared in open angle glaucoma?

A

Central vision is spared

Peripheral blindness

46
Q

Prostanoids in glaucoma

  • example
  • mode of action
A

Latanoprost

Increases aqueous outflow

47
Q

Beta blockers in glaucoma

  • example
  • mode of action
A

Timolol

Reduce aqueous production

48
Q

Carbonic anhydrase inhibitors in glaucoma

  • example
  • mode of action
A

Dorzolamide (topical)
Acetazolamide (systemic)
Decreases aqueous production

49
Q

List three things which predispose to acute closed angle glaucoma

A

Hyperopic eyes - naturally shallow anterior chambers
Night time - pupil is dilated and so iris is thicker
Medications that cause pupil dilatation e.g. antihistamines

50
Q

Is the pupil dilated or constricted in acute closed angle glaucoma?

A

Sluggish and dilated

51
Q

Name a miotic drug (used in acute closed angle glaucoma)

A

Pilocarpine

52
Q

What operation should you do in acute closed angle glaucoma?

A

High intensity laser to burn hole through iris to create communication between anterior and posterior chambers

53
Q

What happens when you shine light in an eye with afferent defect?

A

The pupil won’t respond to light, but constricts when light is shone in the other eye (consensual response)

54
Q

Egg yolk macula = ?

A

Best disease

55
Q

Give a risk factor for spontaneous rhegmatogenous retinal detachment

A

Short sightedness (myopic)

56
Q

Long or short sightedness is a risk factor for acute closed angle glaucoma?

A

Long sightedness

57
Q

What is ectropion and entropion?

Give a complication of each

A 
Ectropion = out turning of the lower eyelid - can lead to corneal exposure and drying 
Entropion = in turning of lower eyelid - can lead to corneal abrasion
58
Q

Tender, red, hot, raised lump just medial to medial canthus = ?

A

Dacrocystitis

59
Q

Predominant symptom of herpes simplex keratitis?

A

Photophobia

60
Q

Which conditions in the eye can cause local lymphadenopathy?

A

Adenoviral conjunctivitis or keratitis

61
Q

Treatment of neonatal conjunctivitis?

A

Erythromycin + referral to paediatrician for risk of pneumonitis

62
Q

Photophobia with reduced visual acuity in the absence of itch or discharge = ?

A

Anterior uveitis

63
Q

Patient with clubbing + eye disease = ?

A

Think about malignancy which has metastasized to the choroid

64
Q

Intermittent double vision worse towards the end of the day associated with a variable bilateral ptosis = ?

A

Myasthenia gravis

65
Q

What is investigation of CN VI palsy aimed at?

A

Identifying CVS risk factors e.g. BP, urinalysis, cholesterol, fasting BG

66
Q

Which glaucoma patients should you not give beta blockers?

A

Asthmatic ones

67
Q

Complete left homonymous hemianopia = ?

A

Right occipital lobe stroke

68
Q

What is aniscoria?

A

Unequal sized pupils

69
Q

What type of disease is scleritis?

What is a systemic association?

A

Immune complex deposition

Any type III hypersensitivity vasculitic disease

70
Q

In myopia, where is a distant image focussed?

Type of corrective lens?

A

In front of the retina
Divergent lens
More prone to spontaneous retinal detachment

71
Q

Which type of conjunctivitis can cause pain on eye movement?

A

Viral

Memorize for 2nd Year Exams (13 decks)

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