Ophthalmology Flashcards
1
Q
CNIII palsy
A
down + out pupil (diplopia), ptosis, mydriasis
2
Q
down + out pupil, ptosis, mydriasis
A
CNIII palsy
3
Q
surgical CNIII palsy
A
down + out pupil (diplopia), ptosis, mydriasis, fixed dilated pupil
4
Q
down + out pupil, ptosis, mydriasis, fixed dilated pupil
A
surgical CNIII palsy
5
Q
ciliary body produces
A
aqueous humour
6
Q
aqueous humour is produced by the
A
ciliary body
7
Q
Horner’s syndrome
A
partial ptosis, fixed constricted pupil (miosis), enopthalmos, anhidrosis
8
Q
partial ptosis, fixed constricted pupil
A
Horner’s syndrome
9
Q
superior oblique is supplied by
A
CNIV
10
Q
CNIV supplies the
A
superior oblique
11
Q
lateral rectus is supplied by
A
CNVI
12
Q
CNVI supplies the
A
lateral rectus
13
Q
surgical CNIII palsies are most likely caused by
A
posterior communicating artery aneurysms
14
Q
(non-surgical) CNIII palsies are more likely caused by
A
ischaemia
15
Q
levator palpebrae
A
lid opening, CNIII
16
Q
Muller muscle
A
lid opening, sympathetic
17
Q
orbicularis oculi
A
lid closing, CNVII
18
Q
why partial ptosis in Horner’s?
A
sympathetic affected, levator palpebrae superior still able to open the eye a bit
19
Q
lid opening, CNIII
A
levator palpebrae
20
Q
lid opening, sympathetic
A
Muller muscle
21
Q
lid closing, CNVII
A
orbicularis oculi
22
Q
8-20 mmHg
A
normal intraocular pressure
23
Q
things to describe on fundoscopy (optic disk)
A
colour, CDR, contour, anything else (tortuous blood vessels, neovascularisation, haemorrhage, drusen)
24
Q
Argyll-Robertson pupil
A
small irregular pupils, no response to light but response to accommodate
25
small irregular pupils, no response to light but response to accommodate
Argyll-Robertson pupil
26
Argyll-Robertson pupil
ARP but PRA = accommodation reflex present but pupillary reflex absent
27
ARP but PRA = accommodation reflex present but pupillary reflex absent
Argyll-Robertson pupil
28
Holmes-Adie pupil
ux, dilated pupil, once constricted remains small for a long time
29
ux, dilated pupil, once constricted remains small for a long time
Holmes-Adie pupil
30
Holmes-Adie pupil is associated with
absent ankle/knee reflexes
31
absent ankle/knee reflexes are associated with
Holmes-Adie pupil
32
Argyll-Robertson pupil is caused by
diabetes mellitus, syphilis
33
diabetes mellitus, syphilis can cause
Argyll-Robertson pupil
34
ghost veins
sign of a previous occlusion, remnants of the vessel
35
sign of a previous occlusion, remnants of the vessel
ghost vessels
36
blot haemorrhage vs aneurysm on fundoscopy
can't tell the difference
37
asteroid hyalosis
degenerative condition, small white opacities in vitreous humour
38
degenerative condition, small white opacities in vitreous humour
asteroid hyalosis
39
ocular hypertension
intraocular presssure over 20, without nerve damage
40
intraocular presssure over 20, without nerve damage
ocular hypertension
41
glaucoma pressure
intraocular presssure over 20, with nerve damage
42
intraocular presssure over 20, with nerve damage
glaucoma
43
posterior vitreous detachment
age related change where vitreous shrinks and pulls some of the retina with it
44
age related change where vitreous shrinks and pulls some of the retina with it
posterior vitreous detachment
45
photocoagulation
using laser to seal off holes in retina, shrink unhealthy tissue/blood vessels
46
using laser to seal off holes in retina, shrink unhealthy tissue/blood vessels
photocoagulation
47
drusen
yellow round spot in Bruch's membrane, linked with dry/early age-related macular degeneration
48
yellow round spot in Bruch's membrane, linked with dry/early age-related macular degeneration
drusen
49
types of AMD (age-related macular degeneration)
```
dry/early = drusen, changes to retinal pigment epithelium
wet/late = exudative, choroidal neovascularisation, worse prognosis, potential for rapid decrease in visual acquity
```
50
AMD (age-related macular degeneration) risk factors
over 60, smoking, family history, Caucasian, sunlight exposure, female sex
51
over 60, smoking, family history, Caucasian, sunlight exposure and female sex are risk factors for what
age-related macular degeneration
52
features of age-related macular degeneration
reduced visual acquity (blurred, distorted, central vision affected first, straight lines appear crooked/wavy), central scotoma
53
reduced visual acquity (blurred, distorted, central vision affected first, straight lines appear crooked/wavy), central scotoma are features of
age realted macular degeneration
54
general treatment for age related macular degeneration
stop smoking, high dose beta carotene, vitamins C, E, zinc
55
stop smoking, high dose beta carotene, vitamins C, E, zinc is advised in
age related macular degeneration
56
wet/late age-related macular degeneration treatment
photocoagulation, photodynamic therapy, anti-VEGF
57
photocoagulation, photodynamic therapy, anti-VEGF is treatment for
wet/late age related macular degeneration
58
general cataract causes
age, sunlight exposure
59
age, sunlight exposure generally cause
cataracts
60
systemic causes of cataracts
diabetes mellitus, steroids, infection (congenital rubella), metabolic (hypocalcaemia, galactosaemia), myotonic dystrophy, Down syndrome
61
diabetes mellitus, steroids, infection (congenital rubella), metabolic (hypocalcaemia, galactosaemia), myotonic dystrophy, Down syndrome are systemic causes of
cataracts
62
ocular causes of cataracts
trauma, uveitis, high myopia, topical steroids
63
trauma, uveitis, high myopia, topical steroids are ocular causes of
cataracts
64
classification of cataracts
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
65
acute angle closure glaucoma symptoms
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
66
acute anterior uveitis symptoms
red eye, acute onset, pain, blurred vision, photophobia, small fixed oval pupil, ciliary flush
67
red eye, severe pain, reduced visual acquity, hazy cornea, haloes, semi-dilated pupil are symptoms of
acute angle closure glaucoma
68
red eye, acute onset, pain, blurred vision, photophobia, small fixed oval pupil, ciliary flush are symptoms of
uveitis
69
scleritis symptoms
red eye, severe pain (maybe worse on movement), tenderness, deep injection, ?underlying autoimmune condition e.g. rheumatoid arthritis
70
red eye, severe pain (maybe worse on movement), tenderness, ?underlying autoimmune condition e.g. rheumatoid arthritis are symptoms of
scleritis
71
conjunctivitis symptoms
red eye, purulent discharge (bacterial), clear discharge (viral)
72
red eye, purulent discharge (bacterial), clear discharge (viral) are symptoms of
conjunctivitis
73
subconjunctival haemorrhage
red eye, history of trauma/coughing
74
red eye, history of trauma/coughing are symptoms of
subconjunctival haemorrhage
75
blepharitis causes
meibomian gland dysfunction (common posterior blepharaitis), or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis)
76
meibomian gland dysfunction (common posterior blepharaitis), or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis) are causes of
blepharitis
77
blepharitis is more common in patients with
roseacea
78
patients with roseacea are more likely to develop
blepharitis
79
features of blepharitis
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
80
bilateral, grittiness, discomfort around lid margins, morning sticky eyes, red eyelid margins, swollen, styes + chalazion are more common, secondary conjunctivitis may occur in
blepharitis
81
management of blepharitis
hot compressions BD, mechanical removal of debris, artificaial tears
82
hot compressions BD, mechanical removal of debris, artificaial tears is the management of
blepharitis
83
most common causes of sudden painless loss of vision
ischaemic optic neuropathy, occlusion of central retinal vein, artery, vitreous haemorrhage, retinal detachment
84
ischaemic optic neuropathy, occlusion of central retinal vein, artery, vitreous haemorrhage, retinal detachment are the most common cause of
sudden painless loss of vision
85
ischaemic optic neuropathy may be due to
arteritis (e.g. temporal arteritis) or atherosclerosis (hypertensive, diabetic, older patient)
86
arteritis (e.g. temporal arteritis) or atherosclerosis (hypertensive, diabetic, older patient) may cause
ischaemic optic neuropathy
87
the pathophysiology of ischaemic optic neuropathy is
occlusion of the short posterior ciliary arteries causing damage to the optic nerve, leading to sudden painless loss of vision
88
occlusion of the short posterior ciliary arteries causing damage to the optic nerve causes
ischaemic optic neuropathy
89
field defects in ischaemic optic neuropathy are
altitudinal field defects
90
altitudinal field defects are
when only the upper or lover half of the field is affected by vision loss
91
when only the upper or lover half of the field is affected by vision loss
altitudinal field defect
92
altitudinal field defects are seen in
ischaemic optic neuropathy
93
central retinal artery occlusion is due to
thromboembolism (from atherosclerosis) or arteritis (temporal arteritis)
94
thromboembolism (from atherosclerosis) or arteritis (temporal arteritis) can cause
central retinal artery occlusion
95
central retinal vein occlusion incidence
increases with age, more common than central retinal artery occlusion
96
increases with age, more common than central retinal artery occlusion
central retinal vein occlusion
97
causes of central retinal vein occlusion
glaucoma, polycythaemia, hypertension
98
glaucoma, polycythaemia, hypertension can cause
central retinal vein occlusion
99
central retinal vein occlusion on fundoscopy
severe retinal haemorrhages
100
severe retinal haemorrhages seen of fundoscopy
central retinal vein occlusion
101
features of central retinal artery occlusion
relative afferent pupillary delay, cherry red spot on a pale retina, sudden painless loss of vision
102
relative afferent pupillary delay, cherry red spot on a pale retina, sudden painless loss of vision are features of
central retinal artery occlusion
103
causes of vitreous haemorrhage
diabetes, bleeding disorders
104
diabetes, bleeding disorders can cause
vitreous haemorrhage
105
features of vitreous haemorrhage include
sudden painless visual loss (large bleeds), dark spots (moderate bleeds), floaters (small bleeds)
106
sudden painless visual loss, dark spots, floaters
vitreous haemorrhage
107
posterior vitreous detachment features
photopsia (peripheral vision), floaters (temporal side of central vision)
108
photopsia (peripheral vision), floaters (temporal side of central vision) are features of
posterior vitreous detachment
109
retinal detachment features
dense shadow (starts peripherally, moves centrally), veil/curtain over field of vision, straight lines appear curved, central vision loss
110
dense shadow (starts peripherally, moves centrally), veil/curtain over field of vision, straight lines appear curved, central vision loss are features of
retinal detachment
111
symptoms of retinitis pigmentosa
night blindness, tunnel vision
112
night blindness, tunnel vision are symptoms of
retinitis pigmentosa
113
retinitis pigmentosa on fundoscopy
black bone spicule shaped pigmentation in peripheral retina, mottling of retinal pigment epithelium
114
black bone spicule shaped pigmentation in peripheral retina, mottling of retinal pigment epithelium on fundoscopy indicates
retinitis pigmentosa
115
features of dacryocystitis
epiphoria, swelling and erythema at the inner canthus of the eye
116
epiphoria, swelling and erythema at the inner canthus of the eye are features of
dacryocystitis
117
management of dacryocystitis
systemic antibiotics (IV if periorbital cellulitis)
118
systemic antibiotics (IV if periorbital cellulitis) is the management for
dacryocystitis
119
congenital lacrimal duct obstruciton features
epiphoria, secondary infection may occur, resolves by 1 year of age
120
epiphoria, secondary infection may occur, resolves by 1 year of age describes features of
congenital lacrimal duct obstruction
121
suspected CNIII palsy management
CTA head to rule out post communicating a aneurysm
122
CTA head to rule out post communicating a aneurysm
in suspected CNIII palsy
123
retinoblastoma
leukocoria
124
leukocoria causes
retinoblastoma, cataracts
125
retinoblastoma management
radiotherapy, chemotherapy, eye enucleation, surveillance of other eye (if inheritable form), genetic counselling
126
radiotherapy, chemotherapy, eye enucleation, surveillance of other eye (if inheritable form), genetic counselling management for
retinoblastoma
127
optic neuritis
inflammation of optic nerve, sudden deterioration in VA, colur desaturation, eye pain, think MS
128
inflammation of optic nerve, sudden deterioration in VA, colur desaturation, eye pain, think MS
opti neuritis
129
osteogenesis imperfecta eye signs
blue tinge to sclera
130
blue tinge to sclera
osteogenesis imperfecta
131
infective causes of uveitis
viral: HSV, CMV, HZV, EBV
bacterial: TB, Borrelia burgdorferi, syphilis
fungal: Candida, Aspergillus, histoplasmosis
protozoal: Toxoplasma gondii, Toxocara canis
132
non-infective causes of uveitis
granulomatous: sarcoid, GPA, vasculitidies
non-granulomatous, seropositive: RA, Sjogren's, polyarteritis nodosa, juvenile idiopathic arthritis
non-granulomatous, seronegative: ankylosing spondylitis, Bechet's
133
complications of uveitis
posterior synaechiae, glaucoma, hypotony, band keratopathy, cataract, cystoid macular oedema
134
which type of uvelitis can cause loss of vision
posterior uveitis
135
uveitis can causes posterior synaechiae by
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
uveitis can causes glaucoma by
clogging up trabecular meshwork from inflammatory cells, iris bombe, steroid induced increased ocular P
137
uveitis can cause hypotony by
inflammation + shutdown of the cilliary body
138
uveitis can cause band keratopathy by
chronic inflammation changes pH of ocular surface favouring Ca salts precipitaion
139
uveitis can cause cataracts by
1' or 2' to systemic steroids/long term steroid drops
140
uveitis can cause cystoid macular oedema by
inflammation disturbing the blood-retina barrier
141
uveitis is
inflammation of the uveal tract
142
uveitis can be
anterior, intermediate, posterior, pan-uveitis
143
acute anterior uveitis describes inflammation of the
iris + cilliary body
144
retinitis describes inflammation of the
retina
145
scleritis describes inflammation of the
sclera
146
acute anterior uveitis O/E
red eye, conjunctival circumciliary injection , kerato precipitates (WBC) on corneal endothelium, posterior synechiae, cells + flare in ant chamber (slit lamp)
147
intermediate uveitis symptoms
floaters, blurred vision, no pain
148
intermediate uveitis O/E
vitreous cells, snowballs, snow-banking, macular oedema
149
posterior uveitis symptoms
painless bluring of vision, floaters, photopsia,
150
posterior uveitis O/E
variable cells in ant chamber + vitreous, choroiditis, retinitis (cotton wool spots, haemorrhages, cuffing, attenuation/dilatation of vessels),
151
uveitis Ix
FBC, U+E, CXR, ACE, HLA-B27, HLA-A29, syphilis, lyme serology, anti-ANA, anti-ANCA
152
Mx of non-infectious uveitis
corticosteroids (topical/PO/IV)
153
posterior scleritis
white eye, posterior scleral thickening, vision loss, severe pain, ocular tenderness, diplopia, painful eye movements
154
posterior scleritis Ix
Rh factor, ANA, p-ANCA, c-ANCA
155
posterior scleritis Mx
NSAIDs, corticosteriods (topical/PO/IV),
156
acute vision loss
posterior scleritis, posterior uveitis, anterior ischaemic optic neuropathy, optic neuronitis, idiopathic intracranial hypertension, migraine, haemorrhage from pituitary tumour
157
sudden loss of vision w/o inflammation suspect
temporal arteritis
158
consider temporal arteritis in
>50, visual disturbance, headache
159
glaucoma Mx
refer immediately to hospital/opthalmologist, medical, surgical (e.g. iridotomy/trabeculotomy)
160
orbital cellulitis vs preorbital cellulitis
orbital = reduced VA, proptosis, painon eye movements
161
orbital cellulitis features
eye pain, swelling, erythema around eye, fever, lethargy/malaise, opthalmoplegia, proptosis
162
complications of untreated entropion
corneal ulcer
163
entropion Mx
Sx, eye lubrication, tape to pull eyelid outwards
164
eye pain, swelling, erythema around eye, fever, lethargy/malaise, opthalmoplegia, proptosis describes
orbital cellulitis
165
diabetic retinopathy pathophysiology
hyperglycaemia causes increased retinal blood flow, abnormal metabolism in the retinal vessel walls, damage to endothelial cells + pericytes, increased vascular permeability
166
diabetic retinopathy can be divided into
non-proliferative diabetic retinopathy (NPDR) + proliferative diabetic retinopathy (PDR)
167
mild NPDR
1 or > aneurysm
168
moderate NPDR
microaneurysms, blot haemorrhages, hard exdate, cotton wool spots, venous bleeding/looping, intraretinal microvascular abnormalities
169
severe NPDR
blot haemorrhages + microaneurysms in 4 quadrants, venous bleeding in 2 quadrants, intraretinal microvascular abnormalities in 1 quadrant
170
PDR
retinal neovascularisation (my lead to vitreous haemorrhage), fibrous tissue forming ant to retinal disc, > common in T1DM, blind in 5 years
171
maculopathy
based on location > severity, hard exudate, background changes to macula, check VA, > common in T2DM
172
1 or > aneurysm
mild NPDR
173
microaneurysms, blot haemorrhages, hard exdate, cotton wool spots, venous bleeding/looping, intraretinal microvascular abnormalities
moderate NPDR
174
blot haemorrhages + microaneurysms in 4 quadrants, venous bleeding in 2 quadrants, intraretinal microvascular abnormalities in 1 quadrant
severe NPDR
175
retinal neovascularisation (my lead to vitreous haemorrhage), fibrous tissue forming ant to retinal disc, > common in T1DM, blind in 5 years
PDR
176
based on location > severity, hard exudate, background changes to macula, check VA, > common in T2DM
maculopathy
177
mydratic drops can precipitate
AACG
178
AACG can be orecipitated by
mydratic drops
179
factors predisposing to AACG
hypermetropia (long-sightedness), pupillary dilatation, lens growth with age
180
hypermetropia (long-sightedness), pupillary dilatation, lens growth with age are predisposing foactors for
AACG
181
hypertensive retinopathy classification
```
I = arteriolar narrowing, tortuosity, increased light reflex = silver wiring
II = AV nipping
III = cotton wool exudates, flame + blot haemorrhages
IV = papilloedema
```
182
AMD Ix
optical coherence tomography (cross sectional views of macula), fluorescein angiography (if neovascularisation present)
183
optical coherence tomography (cross sectional views of macula), fluorescein angiography (if neovascularisation present) Ix for
AMD
184
optic neuritis O/E
RAPD, elevated optic disc, blurred margins
185
causes of optic neuritis
MS, DM, syphilis
186
optic neuritis Mx
high dose steroids, 4-6/52 recovery
187
RAPD, elevated optic disc, blurred margins O/E
optic neuritis
188
MS, DM, syphilis can be causes of
optic neuritis
189
Marcus Gunn pupil is diagnosed during the
swinging light test, affected eye dilates when light shines in
190
Marcus Gunn pupil can be found in
MS, retinal detachment, optic neuritis
191
Argyll Robertson pupil is normally bx or ux?
bx
192
Marcus Gunn pupil is characterised by
RAPD
193
Holmes-Adie's pupil is characterised by
dilated pupil which poorly reacts to direct light, slowly reacts to accommodation
194
Argyll Robertson pupil is characterise by
constricted pupil that doesn't respond to light, responds to accommodation (ARP accommodation reactive pupil)
195
swinging light test, affected eye dilates when light shines in
Marcus Gunn pupil
196
type of pupil seen in MS
Marcus Gunn
197
type of pupil that has RAPD
Marcus Gunn
198
dilated pupil which poorly reacts to direct light, slowly reacts to accommodation
Holmes-Adie's pupil
199
constricted pupil that doesn't respond to light, responds to accommodation
Argyll Robertson pupil
200
Argyll Robertson pupil is associated with
neurosyphilis
201
RAPD is caused by a lesion
anterior to the optic chiasm (optic n or retina)
202
RAPD causes
MS, optic neuritis, retinal detachement
203
causes of mydrasis
CNIII palsy, Holmes-Adie's pupil, traumatic iridoplegia, phaeochromocytoma, congenital
204
drug causes of mydrasis
topical mydratics: tropicamide, atropine
sympathomimetics: amphetamines, cocaine
anticholinergic drugs: TCA
205
CNIII palsy, Holmes-Adie's pupil, traumatic iridoplegia, phaeochromocytoma, congenital can all causeq
mydrasis
206
ptosis + dialted pupil
CNIII palsy
207
ptosis + constricted pupil
Horner's S
208
eyelid problems
blepharitis (inflammation of eyelid margins), stye (infection of eye gland), chalazion (Meibomian cyst), entropion, ectropion
209
types of stye
external (hordeolum externum) staph infection of glands of Zeis or Moll
internal (hordeolum internum) infection of Meibomian glands
210
causes of tunnel vision
papilloedema, glaucoma, retinitis pigmentosa, choroidoretinitis, optic atrophy 2' to tabes dorsalis, hysteria
