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4th Year > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Optic neuritis is the common presenting feature of what condition?

A

MS

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2
Q

Presenting symptoms of optic neuritis?

A

Sudden deterioration in visual acuity Desaturation of colour vision Eye pain on movement

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3
Q

What is strabismus? What is amblyopia

A

Strabismus = Having a squint, this is normally a result of amblyopia which is reduced vision in one eye

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4
Q

What medication is associated with vision becoming yellow?

A

Digoxin

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5
Q

Dendritic ulcer is associated with what virus?

A

HSV

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6
Q

Flashes and floaters are associated with what condition?

A

Vitreous detachment

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7
Q

What conditions are associated with ischaemic optic neuropathy?

A

Atherosclerosis and temporal arteritis

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8
Q

Medications used in treatment of open angle glaucoma?

A

Prostaglandin analogues: latanoprost Beta-blockers: timalol Sympathomimetics: Brominidine Carbonic anydrase inhibitors (mast cell & antihistamine) dorzolamide Miotics: constrict pupil

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9
Q

Aidie pupil presentation?

A

Unilateral (80%) dilated pupil that is slowly reactive to accommodation, but very poorly to light. Associated with absent ankle/knee reflexes

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10
Q

Ptosis and dilated pupil = ? Ptosis and constricted pupil = ?

A

Ptosis and dilated pupil = third nerve palsy Ptosis and constricted pupil = horners syndrome

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11
Q

retinal vein occlusion and artery occlusion present how?

A

Sudden painless loss of vision: Vein - lots of haemorrhages on fundoscopy Artery - white with cherry area on fundoscopy

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12
Q

What is ectropion?

A

When the lower eyelid has come down from the eye. associated with ageing.

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13
Q

Haloes around light sources is indicative of what condition?

A

Cataracts

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14
Q

Three conditions in which anti-VEGF injections may be used?

A

Diabetic retinopathy Wet macular degeneration Retinal vein occlusion (to treat macula oedema)

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15
Q

Sclera is ruptured in blunt or penetrating trauma?

A

penetrating, not in blunt

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16
Q

What does choroidal rupture look like on fundoscopy?

A

like vertical striae

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17
Q

Most likely cause of intraocular foreign body?

A

hammer and chisel injury

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18
Q

What hurts more, intraocular foreign body or corneal foreign body?

A

Corneal

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19
Q

What is latent strabismus (squint)?

A

When it is only seen when one eye is covered up

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20
Q

What is manifest squint?

A

Seen when both eyes are open.

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21
Q

If bilateral deficits are seen to the visual field, is this likely to be neurological or ocular?

A

Neurological

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22
Q

Episcleritis presentation?

A

Superficial vessels dilated, benign, self-limited, frequently recurrent.

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23
Q

Scleritis presentation?

A

Episcleral and scleral vessels injected, relatively benign, does not progress to necrosis

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24
Q

What is different about the presentation of conjunctivitis - compared to scleritis?

A

Cojunctivitis typically spares the limbus.

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25
Q

is ciliary flush seen in conjunctivitis?

A

NO

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26
Q

What red eye condition is worse in morning and what is worse in the evening?

A

Conjunctivitis is worse in the morning, dry eye is worse in the evening.

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27
Q

Risks associated with orbital cellulitis?

A

Within 24 hours could develop septicaemia, cavernous sinus thrombosis

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28
Q

what type of discharge in staphylococcus?

A

Purulent

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29
Q

what type of discharge in Pneumococcal conjunctivitis?

A

Mucopurulent

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30
Q

What type of eye infection in watery serous discharge?

A

Viral (adenovirus?)

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31
Q

Topical ocular anti-inflammatory drugs?

A

Mast cell stabilisers: - Sodium cromoglycate Mast cell stabilisers & antihistamines: - Olopatadine

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32
Q

Damage to the optic nerve would cause what visual deficit?

A

Blindness in one eye

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33
Q

Damage to the optic chiasm would cause what visual deficit?

A

Bitemporal hemianopia

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34
Q

Damage to the right optic tract would cause what visual deficit?

A

left homonymous hemianopia (but not so distinctive)

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35
Q

Damage to the right occipital lobe would cause what visual deficit?

A

left homonymous hemianopia (very distinct cut off)

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36
Q

Blind spot is temporal or nasal?

A

Temporal

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37
Q

What is scotoma?

A

a field defect surrounded by a normal field - relative: not seen in low luminance, but can in high - absolute: no sensitivity within an area at all

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38
Q

Treatment of giant cell arteritis?

A

Steroids

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39
Q

Uveitis treatment?

A

Steroids then methotrexate NSAID in eye.

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40
Q

When would you not use steroids?

A

Dendritic ulcer

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41
Q

Treatment for allergic eye disease?

A

steroids (if no dendritic ulcers) sodium cromoglycate olopatadine

42
Q

Treatment for diabetic retinopathy?

A

Anti-VEGF Steroid implants Laser

43
Q

What drug can cause bullseye macula disorder?

A

chloroquine

44
Q

Bells palsy presentation?

A

Facial nerve palsy unilaterally

45
Q

BCC presentation?

A

Only found on the skin, pearly white edges, grows slowly.

46
Q

SCC presentation?

A

scaly, fast growing (90% of mouth cancers)

47
Q

Five things to check when reviewing CN II?

A
  1. Visual acuity 2. Visual fields 3. Colour - ishihara 4. Fundoscopy 5. Reflexes.
48
Q

Treatment for chalazion?

A
  1. watch and wait - massage and heat 2. removal under LA 3. steroid injection
49
Q

Common infected agents associated with conjunctivitis?

A

Staph/strep/pseudomonas (CL) Adenovirus/HSV/Zoster Chlamydia

50
Q

Symptoms of a blocked nasal lacrimal duct

A

Excessive tearing and infections

51
Q

How can diplopia be corrected?

A

Botox Surgery Fresnel prism Occlusion of one eye

52
Q

What is keratitis, what is it caused by?

A

Dryness - in palsy/dry eye UV exposure CL infection

53
Q

What’s more common anterior or posterior uveitis?

A

Anterior

54
Q

Complications with untreated diabetic retinopathy?

A

Vitreous haemorrhage Retinal detachment Vision loss optic neuropathy

55
Q

What can a fluourescein angiogram assess for?

A

Vessel occlusion Macular degen (leaky spot in macula) Other CVD

56
Q

What can cause straight lines to appear curvy?

A

AMD Migraine

57
Q

What can be used to assess whether straight lines are being seen as curvy?

A

Amsler grid

58
Q

What is pterygium?

A

Thickening of the sclera, caused by damage to limbal stem cells or UV exposure, can grow across cornea.

59
Q

What percentage of people over 85 have some degree of AMD?

A

60%

60
Q

Post op care for cataract surgery?

A

Chloramphenicol for 4 weeks. Steroids for 4 weeks

61
Q

Whats more common open or closed angle glaucoma?

A

Open angle

62
Q

Causes of open angle glaucoma?

A

Not totally known Raised intraocular pressure Age Genetics Afro-Caribbean race

63
Q

Cause of a vein occlusion?

A

Atherosclerotic arteries.

64
Q

Retinal detachment for likely to happen to hypermetropic or myopic patients?

A

Myopic (big eyes)

65
Q

Open angle glaucoma more likely to happen to hypermetropic or myopic patients?

A

Myopic (big eyes)

66
Q

Symptoms of retinal detachment/tear?

A

New onset floaters & flashes, painless visual field loss.

67
Q

Significance of unilaterally cupped disc?

A

Optic nerve damage due to raised pressure - glaucoma

68
Q

Ddx in sudden painless loss of vision?

A

ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis) occlusion of central retinal vein occlusion of central retinal artery vitreous haemorrhage retinal detachment

69
Q

Eye anatomy summary from anterior to posterior?

A

Anterior chamber: - Cornea most anterior over the middle - Conjunctiva over the white, Sclera is under this - Iris under cornea (pupil in middle) Posterior chamber - Lens and ciliary body form the posterior border Vitreous body retina, then choroid then sclera

70
Q

Red eye differentials, and their features?

A

Acute angle closure glaucoma: - red eye - severe pain (may be ocular or headache) - decreased visual acuity, patient sees haloes - semi-dilated pupil - hazy cornea Anterior uveitis - Red eye - acute onset - pain - blurred vision and photophobia - small, fixed oval pupil, ciliary flush Scleritis - Severe pain (may be worse on movement) and tenderness - May be underlying autoimmune disease e.g. rheumatoid arthritis Episcleritis - Watery eyes - Mild/no pain - Injected superficial vessels Conjunctivitis - Purulent discharge if bacterial, clear discharge if viral Subconjunctival haemorrhage - History of trauma or coughing bouts Corneal ulcer - foreign body sensation

71
Q

How would you treat dry eye? What may cause it?

A

Caused by: - Meibonian gland dysfunction/blepharitis - Diet issues Use eye lubrication drops

72
Q

What is a chalazion and what is a stye?

A

Chalazion is a cyst in the eyelid (further inwards), red but not painful A stye or hordeolum is a bacterial infection of eyelid glands can be internal (meibonian) or external (lash gland), normally staph

73
Q

What is intropium and ectropium?

A

Intropium = eyelid turned inward Ectropium = eyelid turned outwards

74
Q

Management of a stye?

A

Hot compress and analgesia Abx only if associated conjunctivitis

75
Q

Causes of heterochromia?

A

Congenital Iron deposits Trauma Congenital horners Use of latanoprost

76
Q

What is a hypopyon and a hyphaema?

A

hypopyon is pus in anterior chamber and hyphaema is blood.

77
Q

When might you see hypoyon?

A

Keratitis, Endophthalmitis (interior of eye), iritis

78
Q

How might anterior uveitis (iritis) present?

A

Usually unilateral. Pain, redness and photophobia are typical. Eye pain is often worse when trying to read. Progressive - occurs over a few hours/days. Blurred vision. There may be excess tear production. Associated headache is common.

79
Q

Presentation of allergic eye?

A

intense itch, burning sensation, red watery Papillae on eversion, conjunctival oedema conjunctival infection

80
Q

What is the difference between follicles and papillae, when are each present?

A

Papillae

  • Allergic
  • Bacterial

Follicles

  • White spots,
  • Associated with viral infections
81
Q

Presentation of thyroid eye disease?

A

Exopthalmos: - Proptosis (eye bulging), sclera seen around iris, lid lag, lid retraction, chemosis.

82
Q

In kids how long do you wait before intervention in a kid diagnosed with sticky/watery eye?

A

2 y/o, latest 4, this is because it may resolve spontaneously, caused by blocked nasal lacrimal duct

83
Q

What is leukocoria, risks in kids?

A

Lack of red light reflex, could be retinoblastoma, congenital cataracts.

84
Q

Other term for a lazy eye? Up till what age is patching useful?

A

Amblyopia Up to 7 years, but could try it up to 10/12 years

85
Q

Difference in a concomitant squint and a paralytic squint?

A

Paralytic squint - Acquired through damage to muscles and nerves - 6th, 4th or 3rd nerve palsies

Concomitant squint - An acquired squint - is the same on all eye movements - normal muscles and nerves

86
Q

What is a fresnel prism?

A

A prism (normally made of plastic) Fitted to glasses to help with double vision or diagnose it

87
Q

How can you correct double vision?

A
  1. botox 2. surgery 3. fresnel prism 4. occlusion of one eye
88
Q

Types of diplopia and their causes?

A

Binocular diplopia

  • Caused by a mismatch between the eyes, normally nerve palsies
  • Disappears when you cover one eye

Monocular

  • A lot less common
  • Remains with only one eye
  • Abnormalities in the cornea, lens or retina
89
Q

Myopia, presbyopia (and hyperopia) and astigmatism?

A

Myopia - Short sightedness - Big eyes Presbyopia - Long sightedness associated with lens hardening and old age Hyperopia - Far sightedness not necessarily associated with increasing age Astigmatism - cornea is unevenly curved

90
Q

phakia and aphakia definition?

A

Phakia - lens Aphakia - no lens

91
Q

What actually is a cataract?

A

An opacity of the lens

92
Q

Rough process of diabetic retinopathy?

A

Retinal damage and microvascular changes 1. Damage to blood vessels, leading to oedema 2. Neovascularisation

93
Q

Retinal detachment presentation?

A

New onset floaters and flashes, dark curtain descending, from periphery to centre No pain

94
Q

Presentation of the two types of glaucoma?

A

Acute closed angle - Sudden onset severe pain - Vomiting and nausea - Hazy cornea - Fixed mid dilated pupil Primary open angle - Peripheral vision loss - >21mmHg - not always noticed until much later

95
Q

Two types of visual field tests?

A

Confrontation - Normal one

you can do Goldmans/humphries

96
Q

What is pappiloedema, optic disc cupping/swelling and their causes?

A

Papilloedema is optic disc swelling specifically caused by raised ICP

Optic disc cupping is optic disc swelling that can be caused by many things:

  • Raised ICP (papilloedema)
  • Optic neuritis
  • Retinal artery or vein occlusion
  • Glaucoma

Image shows normal ratio (small) to large ratio (abnormal)

97
Q

Standard colour sensitivity test?

A

Ishihara plates

98
Q

Blood test abnormalities in temporal arteritis?

A

ESR, CRP and platelets

99
Q

Management of chemical injury to eye?

A

Wash for as long as possible with normal saline, find out what type of chemical, assess pH

100
Q

Orbital cellulitis complications?

A

Intracerebral abscess

Raised IOP

Endophalamitis

Optic nerve damage

Cavernous sinus thrombosis

101
Q

Signs of a direct carotid-cavernous fistula?

A

Pulsatile proptosis

Bruit over eye

102
Q

Visual pathway general? (picture)

A

4th Year (15 decks)

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