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Medicine > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

CNIII palsy

A

down + out pupil (diplopia), ptosis, mydriasis

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2
Q

down + out pupil, ptosis, mydriasis

A

CNIII palsy

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3
Q

surgical CNIII palsy

A

down + out pupil (diplopia), ptosis, mydriasis, fixed dilated pupil

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4
Q

down + out pupil, ptosis, mydriasis, fixed dilated pupil

A

surgical CNIII palsy

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5
Q

ciliary body produces

A

aqueous humour

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6
Q

aqueous humour is produced by the

A

ciliary body

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7
Q

Horner’s syndrome

A

partial ptosis, fixed constricted pupil (miosis), enopthalmos, anhidrosis

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8
Q

partial ptosis, fixed constricted pupil

A

Horner’s syndrome

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9
Q

superior oblique is supplied by

A

CNIV

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10
Q

CNIV supplies the

A

superior oblique

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11
Q

lateral rectus is supplied by

A

CNVI

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12
Q

CNVI supplies the

A

lateral rectus

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13
Q

surgical CNIII palsies are most likely caused by

A

posterior communicating artery aneurysms

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14
Q

(non-surgical) CNIII palsies are more likely caused by

A

ischaemia

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15
Q

levator palpebrae

A

lid opening, CNIII

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16
Q

Muller muscle

A

lid opening, sympathetic

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17
Q

orbicularis oculi

A

lid closing, CNVII

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18
Q

why partial ptosis in Horner’s?

A

sympathetic affected, levator palpebrae superior still able to open the eye a bit

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19
Q

lid opening, CNIII

A

levator palpebrae

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20
Q

lid opening, sympathetic

A

Muller muscle

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21
Q

lid closing, CNVII

A

orbicularis oculi

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22
Q

8-20 mmHg

A

normal intraocular pressure

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23
Q

things to describe on fundoscopy (optic disk)

A

colour, CDR, contour, anything else (tortuous blood vessels, neovascularisation, haemorrhage, drusen)

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24
Q

Argyll-Robertson pupil

A

small irregular pupils, no response to light but response to accommodate

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25
Q

small irregular pupils, no response to light but response to accommodate

A

Argyll-Robertson pupil

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26
Q

Argyll-Robertson pupil

A

ARP but PRA = accommodation reflex present but pupillary reflex absent

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27
Q

ARP but PRA = accommodation reflex present but pupillary reflex absent

A

Argyll-Robertson pupil

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28
Q

Holmes-Adie pupil

A

ux, dilated pupil, once constricted remains small for a long time

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29
Q

ux, dilated pupil, once constricted remains small for a long time

A

Holmes-Adie pupil

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30
Q

Holmes-Adie pupil is associated with

A

absent ankle/knee reflexes

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31
Q

absent ankle/knee reflexes are associated with

A

Holmes-Adie pupil

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32
Q

Argyll-Robertson pupil is caused by

A

diabetes mellitus, syphilis

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33
Q

diabetes mellitus, syphilis can cause

A

Argyll-Robertson pupil

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34
Q

ghost veins

A

sign of a previous occlusion, remnants of the vessel

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35
Q

sign of a previous occlusion, remnants of the vessel

A

ghost vessels

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36
Q

blot haemorrhage vs aneurysm on fundoscopy

A

can’t tell the difference

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37
Q

asteroid hyalosis

A

degenerative condition, small white opacities in vitreous humour

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38
Q

degenerative condition, small white opacities in vitreous humour

A

asteroid hyalosis

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39
Q

ocular hypertension

A

intraocular presssure over 20, without nerve damage

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40
Q

intraocular presssure over 20, without nerve damage

A

ocular hypertension

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41
Q

glaucoma pressure

A

intraocular presssure over 20, with nerve damage

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42
Q

intraocular presssure over 20, with nerve damage

A

glaucoma

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43
Q

posterior vitreous detachment

A

age related change where vitreous shrinks and pulls some of the retina with it

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44
Q

age related change where vitreous shrinks and pulls some of the retina with it

A

posterior vitreous detachment

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45
Q

photocoagulation

A

using laser to seal off holes in retina, shrink unhealthy tissue/blood vessels

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46
Q

using laser to seal off holes in retina, shrink unhealthy tissue/blood vessels

A

photocoagulation

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47
Q

drusen

A

yellow round spot in Bruch’s membrane, linked with dry/early age-related macular degeneration

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48
Q

yellow round spot in Bruch’s membrane, linked with dry/early age-related macular degeneration

A

drusen

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49
Q

types of AMD (age-related macular degeneration)

A 
dry/early = drusen, changes to retinal pigment epithelium
wet/late = exudative, choroidal neovascularisation, worse prognosis, potential for rapid decrease in visual acquity
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50
Q

AMD (age-related macular degeneration) risk factors

A

over 60, smoking, family history, Caucasian, sunlight exposure, female sex

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51
Q

over 60, smoking, family history, Caucasian, sunlight exposure and female sex are risk factors for what

A

age-related macular degeneration

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52
Q

features of age-related macular degeneration

A

reduced visual acquity (blurred, distorted, central vision affected first, straight lines appear crooked/wavy), central scotoma

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53
Q

reduced visual acquity (blurred, distorted, central vision affected first, straight lines appear crooked/wavy), central scotoma are features of

A

age realted macular degeneration

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54
Q

general treatment for age related macular degeneration

A

stop smoking, high dose beta carotene, vitamins C, E, zinc

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55
Q

stop smoking, high dose beta carotene, vitamins C, E, zinc is advised in

A

age related macular degeneration

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56
Q

wet/late age-related macular degeneration treatment

A

photocoagulation, photodynamic therapy, anti-VEGF

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57
Q

photocoagulation, photodynamic therapy, anti-VEGF is treatment for

A

wet/late age related macular degeneration

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58
Q

general cataract causes

A

age, sunlight exposure

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59
Q

age, sunlight exposure generally cause

A

cataracts

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60
Q

systemic causes of cataracts

A

diabetes mellitus, steroids, infection (congenital rubella), metabolic (hypocalcaemia, galactosaemia), myotonic dystrophy, Down syndrome

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61
Q

diabetes mellitus, steroids, infection (congenital rubella), metabolic (hypocalcaemia, galactosaemia), myotonic dystrophy, Down syndrome are systemic causes of

A

cataracts

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62
Q

ocular causes of cataracts

A

trauma, uveitis, high myopia, topical steroids

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63
Q

trauma, uveitis, high myopia, topical steroids are ocular causes of

A

cataracts

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64
Q

classification of cataracts

A

nuclear = change lens refractive index, common in elderly
polar = localised, inherited, in visual axis
subcapsular = steroid use, in visual axis
dot opacities = normal lenses, diabetes, myotonic dystrophy

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65
Q

acute angle closure glaucoma symptoms

A

red eye, severe pain, reduced visual acquity, hazy cornea (corneal oedema), haloes, semi-dilated non-reactive pupil, worse with mydriasis, hard eye, systemic upset e.g. N, V, abdo pain

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66
Q

acute anterior uveitis symptoms

A

red eye, acute onset, pain, blurred vision, photophobia, small fixed oval pupil, ciliary flush

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67
Q

red eye, severe pain, reduced visual acquity, hazy cornea, haloes, semi-dilated pupil are symptoms of

A

acute angle closure glaucoma

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68
Q

red eye, acute onset, pain, blurred vision, photophobia, small fixed oval pupil, ciliary flush are symptoms of

A

uveitis

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69
Q

scleritis symptoms

A

red eye, severe pain (maybe worse on movement), tenderness, deep injection, ?underlying autoimmune condition e.g. rheumatoid arthritis

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70
Q

red eye, severe pain (maybe worse on movement), tenderness, ?underlying autoimmune condition e.g. rheumatoid arthritis are symptoms of

A

scleritis

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71
Q

conjunctivitis symptoms

A

red eye, purulent discharge (bacterial), clear discharge (viral)

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72
Q

red eye, purulent discharge (bacterial), clear discharge (viral) are symptoms of

A

conjunctivitis

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73
Q

subconjunctival haemorrhage

A

red eye, history of trauma/coughing

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74
Q

red eye, history of trauma/coughing are symptoms of

A

subconjunctival haemorrhage

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75
Q

blepharitis causes

A

meibomian gland dysfunction (common posterior blepharaitis), or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis)

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76
Q

meibomian gland dysfunction (common posterior blepharaitis), or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis) are causes of

A

blepharitis

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77
Q

blepharitis is more common in patients with

A

roseacea

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78
Q

patients with roseacea are more likely to develop

A

blepharitis

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79
Q

features of blepharitis

A

bilateral, grittiness, discomfort around lid margins, morning sticky eyes, red eyelid margins, swollen in staphylococal blepharitis, styes + chalazion are more common, secondary conjunctivitis may occur

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80
Q

bilateral, grittiness, discomfort around lid margins, morning sticky eyes, red eyelid margins, swollen, styes + chalazion are more common, secondary conjunctivitis may occur in

A

blepharitis

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81
Q

management of blepharitis

A

hot compressions BD, mechanical removal of debris, artificaial tears

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82
Q

hot compressions BD, mechanical removal of debris, artificaial tears is the management of

A

blepharitis

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83
Q

most common causes of sudden painless loss of vision

A

ischaemic optic neuropathy, occlusion of central retinal vein, artery, vitreous haemorrhage, retinal detachment

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84
Q

ischaemic optic neuropathy, occlusion of central retinal vein, artery, vitreous haemorrhage, retinal detachment are the most common cause of

A

sudden painless loss of vision

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85
Q

ischaemic optic neuropathy may be due to

A

arteritis (e.g. temporal arteritis) or atherosclerosis (hypertensive, diabetic, older patient)

86
Q

arteritis (e.g. temporal arteritis) or atherosclerosis (hypertensive, diabetic, older patient) may cause

A

ischaemic optic neuropathy

87
Q

the pathophysiology of ischaemic optic neuropathy is

A

occlusion of the short posterior ciliary arteries causing damage to the optic nerve, leading to sudden painless loss of vision

88
Q

occlusion of the short posterior ciliary arteries causing damage to the optic nerve causes

A

ischaemic optic neuropathy

89
Q

field defects in ischaemic optic neuropathy are

A

altitudinal field defects

90
Q

altitudinal field defects are

A

when only the upper or lover half of the field is affected by vision loss

91
Q

when only the upper or lover half of the field is affected by vision loss

A

altitudinal field defect

92
Q

altitudinal field defects are seen in

A

ischaemic optic neuropathy

93
Q

central retinal artery occlusion is due to

A

thromboembolism (from atherosclerosis) or arteritis (temporal arteritis)

94
Q

thromboembolism (from atherosclerosis) or arteritis (temporal arteritis) can cause

A

central retinal artery occlusion

95
Q

central retinal vein occlusion incidence

A

increases with age, more common than central retinal artery occlusion

96
Q

increases with age, more common than central retinal artery occlusion

A

central retinal vein occlusion

97
Q

causes of central retinal vein occlusion

A

glaucoma, polycythaemia, hypertension

98
Q

glaucoma, polycythaemia, hypertension can cause

A

central retinal vein occlusion

99
Q

central retinal vein occlusion on fundoscopy

A

severe retinal haemorrhages

100
Q

severe retinal haemorrhages seen of fundoscopy

A

central retinal vein occlusion

101
Q

features of central retinal artery occlusion

A

relative afferent pupillary delay, cherry red spot on a pale retina, sudden painless loss of vision

102
Q

relative afferent pupillary delay, cherry red spot on a pale retina, sudden painless loss of vision are features of

A

central retinal artery occlusion

103
Q

causes of vitreous haemorrhage

A

diabetes, bleeding disorders

104
Q

diabetes, bleeding disorders can cause

A

vitreous haemorrhage

105
Q

features of vitreous haemorrhage include

A

sudden painless visual loss (large bleeds), dark spots (moderate bleeds), floaters (small bleeds)

106
Q

sudden painless visual loss, dark spots, floaters

A

vitreous haemorrhage

107
Q

posterior vitreous detachment features

A

photopsia (peripheral vision), floaters (temporal side of central vision)

108
Q

photopsia (peripheral vision), floaters (temporal side of central vision) are features of

A

posterior vitreous detachment

109
Q

retinal detachment features

A

dense shadow (starts peripherally, moves centrally), veil/curtain over field of vision, straight lines appear curved, central vision loss

110
Q

dense shadow (starts peripherally, moves centrally), veil/curtain over field of vision, straight lines appear curved, central vision loss are features of

A

retinal detachment

111
Q

symptoms of retinitis pigmentosa

A

night blindness, tunnel vision

112
Q

night blindness, tunnel vision are symptoms of

A

retinitis pigmentosa

113
Q

retinitis pigmentosa on fundoscopy

A

black bone spicule shaped pigmentation in peripheral retina, mottling of retinal pigment epithelium

114
Q

black bone spicule shaped pigmentation in peripheral retina, mottling of retinal pigment epithelium on fundoscopy indicates

A

retinitis pigmentosa

115
Q

features of dacryocystitis

A

epiphoria, swelling and erythema at the inner canthus of the eye

116
Q

epiphoria, swelling and erythema at the inner canthus of the eye are features of

A

dacryocystitis

117
Q

management of dacryocystitis

A

systemic antibiotics (IV if periorbital cellulitis)

118
Q

systemic antibiotics (IV if periorbital cellulitis) is the management for

A

dacryocystitis

119
Q

congenital lacrimal duct obstruciton features

A

epiphoria, secondary infection may occur, resolves by 1 year of age

120
Q

epiphoria, secondary infection may occur, resolves by 1 year of age describes features of

A

congenital lacrimal duct obstruction

121
Q

suspected CNIII palsy management

A

CTA head to rule out post communicating a aneurysm

122
Q

CTA head to rule out post communicating a aneurysm

A

in suspected CNIII palsy

123
Q

retinoblastoma

A

leukocoria

124
Q

leukocoria causes

A

retinoblastoma, cataracts

125
Q

retinoblastoma management

A

radiotherapy, chemotherapy, eye enucleation, surveillance of other eye (if inheritable form), genetic counselling

126
Q

radiotherapy, chemotherapy, eye enucleation, surveillance of other eye (if inheritable form), genetic counselling management for

A

retinoblastoma

127
Q

optic neuritis

A

inflammation of optic nerve, sudden deterioration in VA, colur desaturation, eye pain, think MS

128
Q

inflammation of optic nerve, sudden deterioration in VA, colur desaturation, eye pain, think MS

A

opti neuritis

129
Q

osteogenesis imperfecta eye signs

A

blue tinge to sclera

130
Q

blue tinge to sclera

A

osteogenesis imperfecta

131
Q

infective causes of uveitis

A

viral: HSV, CMV, HZV, EBV
bacterial: TB, Borrelia burgdorferi, syphilis
fungal: Candida, Aspergillus, histoplasmosis
protozoal: Toxoplasma gondii, Toxocara canis

132
Q

non-infective causes of uveitis

A

granulomatous: sarcoid, GPA, vasculitidies
non-granulomatous, seropositive: RA, Sjogren’s, polyarteritis nodosa, juvenile idiopathic arthritis
non-granulomatous, seronegative: ankylosing spondylitis, Bechet’s

133
Q

complications of uveitis

A

posterior synaechiae, glaucoma, hypotony, band keratopathy, cataract, cystoid macular oedema

134
Q

which type of uvelitis can cause loss of vision

A

posterior uveitis

135
Q

uveitis can causes posterior synaechiae by

A

iris + lens adhesion make it increasingly difficult for aqueous to leave pupil into trabeculum, post chanber build up of P, iris bows forward, compromises angle further called an iris bombe

136
Q

uveitis can causes glaucoma by

A

clogging up trabecular meshwork from inflammatory cells, iris bombe, steroid induced increased ocular P

137
Q

uveitis can cause hypotony by

A

inflammation + shutdown of the cilliary body

138
Q

uveitis can cause band keratopathy by

A

chronic inflammation changes pH of ocular surface favouring Ca salts precipitaion

139
Q

uveitis can cause cataracts by

A

1’ or 2’ to systemic steroids/long term steroid drops

140
Q

uveitis can cause cystoid macular oedema by

A

inflammation disturbing the blood-retina barrier

141
Q

uveitis is

A

inflammation of the uveal tract

142
Q

uveitis can be

A

anterior, intermediate, posterior, pan-uveitis

143
Q

acute anterior uveitis describes inflammation of the

A

iris + cilliary body

144
Q

retinitis describes inflammation of the

A

retina

145
Q

scleritis describes inflammation of the

A

sclera

146
Q

acute anterior uveitis O/E

A

red eye, conjunctival circumciliary injection , kerato precipitates (WBC) on corneal endothelium, posterior synechiae, cells + flare in ant chamber (slit lamp)

147
Q

intermediate uveitis symptoms

A

floaters, blurred vision, no pain

148
Q

intermediate uveitis O/E

A

vitreous cells, snowballs, snow-banking, macular oedema

149
Q

posterior uveitis symptoms

A

painless bluring of vision, floaters, photopsia,

150
Q

posterior uveitis O/E

A

variable cells in ant chamber + vitreous, choroiditis, retinitis (cotton wool spots, haemorrhages, cuffing, attenuation/dilatation of vessels),

151
Q

uveitis Ix

A

FBC, U+E, CXR, ACE, HLA-B27, HLA-A29, syphilis, lyme serology, anti-ANA, anti-ANCA

152
Q

Mx of non-infectious uveitis

A

corticosteroids (topical/PO/IV)

153
Q

posterior scleritis

A

white eye, posterior scleral thickening, vision loss, severe pain, ocular tenderness, diplopia, painful eye movements

154
Q

posterior scleritis Ix

A

Rh factor, ANA, p-ANCA, c-ANCA

155
Q

posterior scleritis Mx

A

NSAIDs, corticosteriods (topical/PO/IV),

156
Q

acute vision loss

A

posterior scleritis, posterior uveitis, anterior ischaemic optic neuropathy, optic neuronitis, idiopathic intracranial hypertension, migraine, haemorrhage from pituitary tumour

157
Q

sudden loss of vision w/o inflammation suspect

A

temporal arteritis

158
Q

consider temporal arteritis in

A

> 50, visual disturbance, headache

159
Q

glaucoma Mx

A

refer immediately to hospital/opthalmologist, medical, surgical (e.g. iridotomy/trabeculotomy)

160
Q

orbital cellulitis vs preorbital cellulitis

A

orbital = reduced VA, proptosis, painon eye movements

161
Q

orbital cellulitis features

A

eye pain, swelling, erythema around eye, fever, lethargy/malaise, opthalmoplegia, proptosis

162
Q

complications of untreated entropion

A

corneal ulcer

163
Q

entropion Mx

A

Sx, eye lubrication, tape to pull eyelid outwards

164
Q

eye pain, swelling, erythema around eye, fever, lethargy/malaise, opthalmoplegia, proptosis describes

A

orbital cellulitis

165
Q

diabetic retinopathy pathophysiology

A

hyperglycaemia causes increased retinal blood flow, abnormal metabolism in the retinal vessel walls, damage to endothelial cells + pericytes, increased vascular permeability

166
Q

diabetic retinopathy can be divided into

A

non-proliferative diabetic retinopathy (NPDR) + proliferative diabetic retinopathy (PDR)

167
Q

mild NPDR

A

1 or > aneurysm

168
Q

moderate NPDR

A

microaneurysms, blot haemorrhages, hard exdate, cotton wool spots, venous bleeding/looping, intraretinal microvascular abnormalities

169
Q

severe NPDR

A

blot haemorrhages + microaneurysms in 4 quadrants, venous bleeding in 2 quadrants, intraretinal microvascular abnormalities in 1 quadrant

170
Q

PDR

A

retinal neovascularisation (my lead to vitreous haemorrhage), fibrous tissue forming ant to retinal disc, > common in T1DM, blind in 5 years

171
Q

maculopathy

A

based on location > severity, hard exudate, background changes to macula, check VA, > common in T2DM

172
Q

1 or > aneurysm

A

mild NPDR

173
Q

microaneurysms, blot haemorrhages, hard exdate, cotton wool spots, venous bleeding/looping, intraretinal microvascular abnormalities

A

moderate NPDR

174
Q

blot haemorrhages + microaneurysms in 4 quadrants, venous bleeding in 2 quadrants, intraretinal microvascular abnormalities in 1 quadrant

A

severe NPDR

175
Q

retinal neovascularisation (my lead to vitreous haemorrhage), fibrous tissue forming ant to retinal disc, > common in T1DM, blind in 5 years

A

PDR

176
Q

based on location > severity, hard exudate, background changes to macula, check VA, > common in T2DM

A

maculopathy

177
Q

mydratic drops can precipitate

A

AACG

178
Q

AACG can be orecipitated by

A

mydratic drops

179
Q

factors predisposing to AACG

A

hypermetropia (long-sightedness), pupillary dilatation, lens growth with age

180
Q

hypermetropia (long-sightedness), pupillary dilatation, lens growth with age are predisposing foactors for

A

AACG

181
Q

hypertensive retinopathy classification

A 
I = arteriolar narrowing, tortuosity, increased light reflex = silver wiring
II = AV nipping
III = cotton wool exudates, flame + blot haemorrhages
IV = papilloedema
182
Q

AMD Ix

A

optical coherence tomography (cross sectional views of macula), fluorescein angiography (if neovascularisation present)

183
Q

optical coherence tomography (cross sectional views of macula), fluorescein angiography (if neovascularisation present) Ix for

A

AMD

184
Q

optic neuritis O/E

A

RAPD, elevated optic disc, blurred margins

185
Q

causes of optic neuritis

A

MS, DM, syphilis

186
Q

optic neuritis Mx

A

high dose steroids, 4-6/52 recovery

187
Q

RAPD, elevated optic disc, blurred margins O/E

A

optic neuritis

188
Q

MS, DM, syphilis can be causes of

A

optic neuritis

189
Q

Marcus Gunn pupil is diagnosed during the

A

swinging light test, affected eye dilates when light shines in

190
Q

Marcus Gunn pupil can be found in

A

MS, retinal detachment, optic neuritis

191
Q

Argyll Robertson pupil is normally bx or ux?

A

bx

192
Q

Marcus Gunn pupil is characterised by

A

RAPD

193
Q

Holmes-Adie’s pupil is characterised by

A

dilated pupil which poorly reacts to direct light, slowly reacts to accommodation

194
Q

Argyll Robertson pupil is characterise by

A

constricted pupil that doesn’t respond to light, responds to accommodation (ARP accommodation reactive pupil)

195
Q

swinging light test, affected eye dilates when light shines in

A

Marcus Gunn pupil

196
Q

type of pupil seen in MS

A

Marcus Gunn

197
Q

type of pupil that has RAPD

A

Marcus Gunn

198
Q

dilated pupil which poorly reacts to direct light, slowly reacts to accommodation

A

Holmes-Adie’s pupil

199
Q

constricted pupil that doesn’t respond to light, responds to accommodation

A

Argyll Robertson pupil

200
Q

Argyll Robertson pupil is associated with

A

neurosyphilis

201
Q

RAPD is caused by a lesion

A

anterior to the optic chiasm (optic n or retina)

202
Q

RAPD causes

A

MS, optic neuritis, retinal detachement

203
Q

causes of mydrasis

A

CNIII palsy, Holmes-Adie’s pupil, traumatic iridoplegia, phaeochromocytoma, congenital

204
Q

drug causes of mydrasis

A

topical mydratics: tropicamide, atropine
sympathomimetics: amphetamines, cocaine
anticholinergic drugs: TCA

205
Q

CNIII palsy, Holmes-Adie’s pupil, traumatic iridoplegia, phaeochromocytoma, congenital can all causeq

A

mydrasis

206
Q

ptosis + dialted pupil

A

CNIII palsy

207
Q

ptosis + constricted pupil

A

Horner’s S

208
Q

eyelid problems

A

blepharitis (inflammation of eyelid margins), stye (infection of eye gland), chalazion (Meibomian cyst), entropion, ectropion

209
Q

types of stye

A

external (hordeolum externum) staph infection of glands of Zeis or Moll
internal (hordeolum internum) infection of Meibomian glands

210
Q

causes of tunnel vision

A

papilloedema, glaucoma, retinitis pigmentosa, choroidoretinitis, optic atrophy 2’ to tabes dorsalis, hysteria

Medicine (30 decks)

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