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My Final Year 4 Revision > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Anti-ccp

A

Rheumatoid arthritis marker

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2
Q

Rheumatoid factor

A

Rheumatoid arthritis marker

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3
Q

Diclofenac

A

Nsaid

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4
Q

Heberdens nodes

A

DIP joint swelling in OA

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5
Q

Allopurinol

A

1st line prophylactic treatment for gout

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6
Q

Methotrexate given with

A

Folic acid

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7
Q

Sulfalazine

A

DMARD – good for fertile women

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8
Q

Monosodium urate crystals

A

Build up in joints leads to gout

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9
Q

Leflunomide

A

DMARD

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10
Q

Colchicine

A

2nd line in gout if nsaids are CI becoz of renal impairment

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11
Q

Hydroxychloroquine

A

DMARD

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12
Q

Bouchards nodes

A

PIP joint swelling in OA

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13
Q

Volar displacement

A

Displacement of the distal radius towards the palm of the hand #

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14
Q

Colles fracture

A

Fracture of the head of the radius with dorsal displacement – towards back of the hand

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15
Q

Weber classification

A

Classifies based on the location of distal fibula fracture relative to the syndesmosis

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16
Q

Calcium pyrophosphate crystals

A

A = distal, B = at same level, C= proximal

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17
Q

The 4 Rs of fractures

A

Pseudogout

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18
Q

Closed reduction

A

Resuscitation, Reduction, Restriction (immobilisation), Rehabilitation

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19
Q

Susceptible nerve in elbow fracture

A

Bones realigned without surgery

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20
Q

Susceptible nerve in humeral neck fracture

A

Ulnar nerve

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21
Q

Susceptible nerve in humeral mid shaft fracture

A

Axillary nerve

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22
Q

Negatively birefringent, needle shape crystals

A

Radial nerve

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23
Q

Weakly positive birefringent, rhomboid shaped crystals

A

Monosodium urate = gout

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24
Q

Pre-patellar bursitis

A

Calcium pyrophosphate = pseudogout

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25
Q

5 common malignancies that spread to bone

A

Housemaids knee – able to flex and relatively pain free

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26
Q

Chondrocalcinosis

A

Thyroid, lung, breast, renal, prostate

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27
Q

Fat pad

A

Radiographic feature of pseudogout – calcifications in the joint space

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28
Q

Mason classification

A

Signe up blood and fat in the joint capsule

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29
Q

Tension band wire

A

Classifies radial head fracturs

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30
Q

Monteggia fracture

A

1=undisplaced 2 = displaced 3=comminuted

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31
Q

Galeazzi fracture

A

Surgical method to fix olecranon #s

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32
Q

Volar tilt

A

of proximal ulna with dislocation of the radial head

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33
Q

Radial inclination

A

of distal radius with dislocation of the distal radio-ulnar joint

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34
Q

Smith’s fracture

A

Normal wrist has 10 degrees volar tilt

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35
Q

Carpal bones

A

Normal wrist has 25 degrees radial inclination

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36
Q

FOOSH

A

Volar displacement of radius head

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37
Q

Clinical signs of scaphoid fracture

A

Bones of the wrist

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38
Q

Swan neck deformity

A

Scaphoid, lunate, triquetral, pisiform

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39
Q

Boutonnieres deformity

A

Trapezium, trapezoid, capitate, hamate

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40
Q

Z shaped thumb

A

Fall on out stretched hand

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41
Q

Ulnar deviation

A

Pain in anatomical snuff box on palpation, pain on palpation of scaphoid tubercle, pain on telescoping of the thumb

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42
Q

Garden classification

A

Sign of RA

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43
Q

Intertrochanteric # treatment

A

Hyperflexed DIPJ and hyperextended PIPJ

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44
Q

Intracapsular# treatment

A

Sign of RA

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45
Q

Management of hip OA

A

Hyperextended DIPJ and hyperflexed PIPJ

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46
Q

Commonest hip replacement

A

Sign of RA

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47
Q

The fibula lies on the _______ side

A

MCPJ flexion and IPJ extension

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48
Q

Schatzker classification

A

At the MCP joints

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49
Q

Ankle joint bones

A

Might develop to subluxation

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50
Q

Pilon #

A

For NOF#

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51
Q

Foot bones

A

1 – incomplete fracture, not displaced

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52
Q

Hallux valgus

A

2- complete fracture not displaced

53
Q

Jones fracture

A

3 – complete fracture partially displaced

54
Q

Odontoid peg

A

4- complete fracture completely displaced

55
Q

Bamboo spine

A

Dynamic hip screw

56
Q

Syndesmophytes

A

Cannulated screws for non-displaced fractures

57
Q

Things that make diabetic retinopathy more likely

A

Long duration of diabetesType of diabetes (more common in type 1)Poor glycemic controlIncreased BPPresence of macro or microalbuminuriaIncreased serum cholesterol levelsPregnancyCigarette smokingGenetic factors

58
Q

Screening for diabetic retinopathy

A

All diabetics need annual screening Children screened after five years if have type 1Increased checks if pregnantPhotographs taken - 2 photos of each eye. Disc centred and macula centred, Slit lamps used

59
Q

Why can diabetes lead to blindness

A

MaculopathyNew vessel formation CataractsCVA with field loss

60
Q

Stages of diabetic eye disease0123

A

0- no retinopathy 1- microaneurysms, any exudate, venous loops2- any microvascular changes, venous beading, multiple blot haemorrhage 3- proliferative disease

61
Q

What is glaucoma

A

Chronic progressive optic neuropathyThinning of neuroretinal rim of the optic disc results in characteristic cupping of optic nerve head and visual field loss

62
Q

Risks for primary open angle glaucoma

A

AgeIOPraceFamily history High myopiaCorneal thicknessDiabetes Vascular factors eg CV disease, vasospasms, systemic hypotension

63
Q

Normal intraocular pressure

A

10-21 mmHg15.5 average

64
Q

Optic changes in glaucoma

A

Enlargement of optic cupLoss of disc rimVascular changesPeripappillary atrophy

65
Q

Treatment of primary open angle glaucoma

A

Control the IOPOptions:Prostaglandin analogues eg latanoprost. These increase outflow Beta blockers eg timolol. Decrease productionCarbonic anyhydrase inhibitors eg dorzolamide. Decrease productionAlpha agonists decrease production Cholinergic agonists eg pilocarpine. Increase trabecular outflow.

66
Q

Ocular muscles and innervation

A

Medial rectus- adduction. Third cranial nerveLateral rectus- abduction. Fourth cranial nerveSuperior rectus- up. ThirdInferior rectus- down. ThirdSuperior oblique- fourthInferior oblique- third

67
Q

Horizontal Diplopia cause

A

Sixth nerve palsy as lateral rectus not working - could be trauma, neoplasms, ischamia, demyelination. Autoimmune disorders

68
Q

Vertical diplopia

A

Fourth or third cranial nerve palsy- superior oblique or superior rectus

69
Q

Causes of a mechanical restriction in eye movement

A

Trauma leading to orbital floor fracture leading to vertical Diplopia usuallyThyroid eye disease

70
Q

How to test for RAPD

A

Swinging light testDetects if there is paradoxical dilatation of the pupil when light is shone into it due to an afferent defectDetects an optic neuritis

71
Q

Causes of optic neuritis

A

MS or neuromyelitis optica

72
Q

Blindness by age group16-6465-7475-84 85+

A

16-64 diabetic retinopathy, macular disorders, optic atrophy, hereditary 65-74 AMD75-84 glaucoma 85+ cataracts

73
Q

What eye diseases is smoking linked to?

A

Cataracts Macular degenerationThyroid eye diseaseRetinal vein occlusionRetinal artery occlusion

74
Q

How do you perform a visual acuity test?

A

Corrective lenses should be wornTest each eye individually Should be 6m away with snellen or 3m with a 3m snellenNumber on chart says distance at which most people can read itRecord as distance from chart over number on chart Test near vision and colour vision

75
Q

Charts to measure visual acuity

A

SnellenLogmar

76
Q

Eye symptoms history questions

A

Has vision been affected When did it startSudden or gradualAre the eyes uncomfortable Pain?Grittiness, dryness, feel tired- dryness problemSharp or stabbing pain- ocular surface problems Dull ache- uveitis, raised IOP, scleritisRednessPrevious eye history or surgeryFHsmoking, alcohol, job, driver

77
Q

Total blindness of right eye- where is lesion

A

Right optic nerve

78
Q

Bitemporal hemianopia- where lesion

A

Optic chiasm- think pituitary tumour

79
Q

Left visual field loss

A

Right occipital lobe- could be posterior circulation stroke

80
Q

Peripheral field loss- what’s the problem

A

Could be glaucoma

81
Q

Left homonymous inferior quadrantanopia

A

Right parietal lobe lesion or stroke

82
Q

Right homonymous superior quadrantanopia

A

Left temporal lobe lesion or stroke

83
Q

What are you looking for on optic disc

A

CupColour- should be orange with pale centre. Can be pale in optic atrophy eg optic neuritis advanced glaucomaContour- circle should be well defined, if not then could be papilloedema

84
Q

Cataracts

A

Common cause of visual loss in the elderlyGradual blurring of distant then near vision If cataracts is posterior in the lens then they experience glare and vision is better out of sunlight Correct with surgery and intraocular implant

85
Q

Younger patients with cataracts

A

Diabetes, steroid use, chronic uveitis, FH

86
Q

Primary open angle glaucoma How does it presentWho is at risk

A

Progressive painless visual field lossRisk factor include Afro Caribbean, family history, hypertensionOften picked up by opticians or at glaucoma screening

87
Q

What are changes in ARMD?

A

Central visionReading, faces and fine detail affected. Colour is also affected

88
Q

Dilating agents

A

TropicamideCyclopentolatePhenylephrine

89
Q

Absent red reflex

A

Cataracts Retinoblastoma (rare)

90
Q

Drusen

A

Lipid deposits Think ARMD

91
Q

Flat retina- means not

A

Not glaucoma as this causes cupping

92
Q

Retinal haemorrhages

A

Hypertension Retinal vein occlusion Diabetes In baby could be shaken baby

93
Q

Retinal elevation

A

Retinal detachment

94
Q

Dry ARMD

A

Gradual loss of central visionRisk factors- female, smoking, HTN, previous cataracts surgery

95
Q

Side effects of latanoprost

A

Blurred vision, stinging, long eyelashes, foreign body sensation, hyperaemia

96
Q

Eyes and the DVLAAcuityGlaucoma ARMDCataractsOptic neuritis Diplopia

A

Must have at least 6/12 vision If glaucoma need to inform DVLA so they can do tests to see if safeMacular degeneration- inform if both eyes affectedCataracts- don’t need to tell DVLA if still over 6/12Optic neuritis- tell DVLA Diplopia- can drive once adaptations of once settled. HGV drivers can’t even with prisms

97
Q

What is wet macular degeneration

A

Fluid and or blood develops in the retinaSudden loss of central vision Needs instant referral for anti VEGFV injections

98
Q

Blurred vision Red eye Nausea and vomiting Headache Differential?

A

Acute angle closure glaucoma

99
Q

Why blurred vision in AACG

A

IOP increases leading to oedema of cornea and it becomes cloudy Therefore affects vision

100
Q

Who does AACG affect

A

Long sighted Female

101
Q

Treatment of acute angle closure glaucoma

A

Reduce pressure with drops- acetazolamidePeripheral iridotomy to restore aqueous flow Treat other eye prophylactically

102
Q

Cherry red spot with pale retina

A

Central retinal artery occlusion

103
Q

Why does central retinal artery occlusion happen

A

Non inflammatory vascular problems Raised cholesterol, HTN, atherosclerosis, diabetesAlongside angina and TIAGet smoking Hx, CV exam, routine bloods

104
Q

Sudden onset of floaters

A

Most likely to be retinal detachment

105
Q

Risk factors for retinal detachment

A

Trauma eg high velocity Myopia is also a risk

106
Q

Treatment for retinal detachment

A

Surgery! Vitreous removed. Flatten retina with gas or oil

107
Q

Child with eye pain, oedema, erythema, chemosis (swelling of conjunctiva), restricted eye movement, systemically unwell

A

Orbital cellulitis!

108
Q

Once identified or suspected orbital cellulitis, what is next step

A

True emergency! Get senior! May need referral to oculoplastic team or ENT.Investigation- blood cultures, swabs, orbital scan, FBCCephalosporins or penicillin IV. If abscess present may need surgery Check obs and visual acuity hourly

109
Q

Common organisms causing orbital cellulitis

A

Usually a bacterial infection spread from paranasal sinuses. Commonly staphylococcus aureus, strep pneumoniae, h influenzae. Could be fungal in severely immunosuppressed.

110
Q

What is a hypopyon?

A

Red eye, fluid level in anterior chamber of the eye, this indicates an accumulation of WBCCan be a sign of bacterial keratitis. Leads to a risk of corneal perforationTreat with broad spec antibiotics

111
Q

Red eye, pain and reduced vision

A

Refer!

112
Q

Questions with query conjunctivitis

A

Contact lensesSexually active (could be chlamydial) URTI recently (indicates probably viral cause)Any contact with people with red eyesAllergies

113
Q

Symptoms of conjunctivitis

A

Redness of conjunctivaNormal visual acuityReactive pupilsMucoid discharge

114
Q

Tests in conjunctivitis

A

Swabs- bacterial, viral, chlamydial

115
Q

Treatment of conjunctivitis

A

Usually bacterial usually self limiting. 60% resolve in five days without treatment. Chloramphenicol drops. Ointments and gel provide a higher concentration for longer periods than drops but daytime use is limited because of blurred vision. Cold compressesLubricantsIf allergic conjunctivitis then remove trigger. Antihistamines.

116
Q

If conjunctivitis does not go away after chloramphenicol…

A

PCR may be required as more likely to be viral or chlamydial

117
Q

Fluoroscein eye drops would help reveal..

A

Corneal abrasion, dendritic ulcers and microbial keratitis

118
Q

Dendritic ulcers

A

When herpes simplex infects corneal epithelium Treat with Aciclovir drops

119
Q

Young male with red eye

A

Conjunctivitis? Anterior uveitis? Ask about back painAsk about IBD

120
Q

Investigation into Diplopia

A

HistoryTests to measure squintAssess range of eye movements Use Hess chartDo bloods and head scans to determine cause of eye palsy (could be aneurysm, SOL, could be microvascular infarcts)

121
Q

Treatment of eye palsy

A

80% of palsies due to microvascular infarct resolve in 6 months. Therefore symptom treatment eg temporary plastic prism can be fitted to patients glasses then Botox into medial rectus muscle to reduce size of squint

122
Q

Ptosis, eye divergent and depressed. Large pupil

A

The pupil involvement suggests pressure on nerve rather than microvascular cause

123
Q

Causes of Diplopia

A

Poor blood supply, direct pressure on nerve (aneurysm), tumour, head injury, inflammation near nerve

124
Q

Presence of large pupil as well as nerve palsy, treatment

A

Indicates Pressure on nerve. Therefore is a medical emergency! This could be dangerous swelling of blood supply in the brain (posterior communicating artery). Imaging required! Go from there.

125
Q

Trauma to eye area

A

Could lead to inferior orbital floor fracture. Orbital fat and muscle can get stuck in fracture and lead to diplopia. Get max fax involved, prescribe broad spec antibiotic. Do not blow nose! Ask about loss of sensation below orbit

126
Q

Variable or progressive weakness of eyelid and ocular muscle

A

Think myasthenia gravis

127
Q

Symptoms of optic neuritis

A

Sudden vision lossDecreased contrast and colour sensitivity Pain with eye movement RAPD

128
Q

Child with white pupil

A

Retinoblastoma!Congenital cataracts

129
Q

Retinopathy of prematurity

A

Underdeveloped Retina. The retina is susceptible to the high oxygen that premature babies are often exposed to.Babies born on or before 31 weeks gestation, under 1500g. Laser photocoagulation is the treatment of choice.

My Final Year 4 Revision (16 decks)

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