Ophthalmology

Question 1

Homonymous quadranopia defect location

Answer 1

PITS

pituitary inferior, temporal superior

Question 2

Congruent Vs incongruent visual field defects

Answer 2

Incongruent likely optic tract, congruous optic cortex or optic radiation lesion

Question 3

Distinguish between scleritis and episcleritis

Answer 3

Scleritis is painful

Both associated with RA and both have rythema

Question 4

Distinguish between scleritis and episcleritis

Answer 4

Scleritis is painful

Both associated with RA and both have rythema

Question 5

Distinguish between MS and neuromyelitis optica

Answer 5

Brain MRI
Spinal cord MRI involving 3 it more levels
NMO IgG seropositive (antibody against aquaporin 4 antigen)

Question 6

Most common bacterial causes of peri orbital cellulitis

Answer 6

Steptococcus, staph A, haemophylis influenza B (so check for vaccine)

Question 7

Distinguish between glaucoma and uveitis

Answer 7

Glaucoma is severe pain, haloes, semidilated pupils.. hazy cornea
Uveitis is small fixed oval pupil

Question 8

What conditions are associated with angoid streaks

Answer 8

Pseudoxanthoma elasticum
Ehlers danlos
Paget’s disease
Sickle cell

Question 9

Dendritic corneal ulcer on fluorescent staining diagnosis

Answer 9

Herpes simplex keratitis

Question 10

Management of primary open angle glaucoma

Answer 10

Prostaglandins analogue like lantaprost

Question 11

Most common visual problem associated with Charles bonnet syndrome

Answer 11

Age related macular degeneration

Question 12

Patient presents with blurred vision

Fundoscopy shows retinal haemorrhages and necrosis - ‘pizza’ retina

Answer 12

CMV retinits, common in patients with HIV CD4<50

Treat with IV ganciclovir

Question 13

Rheumatoid arthritis, painless eye redness no itch

Answer 13

Episcleritis

If itchy: Keratoconjunctivitis sicca

Question 14

h/o RA +dryness ,itchy

Answer 14

Keratoconjunctivitis sicca (most common ocular manifestation of RA)

Question 15

h/o RA +painfull , redness

Answer 15

Scleritis (episcleritis is painless)

Question 16

Patient who is tall with low IQ has downward lens dislocation… Likely diagnosis?

Answer 16

Homocystinuria (IQ down, lens down)

Marfan’s have normal IQ but upward dislocation

Question 17

Mnemonic for eye movements and cranial nerves

Answer 17

LR6 SO4

ee3

Lateral rectus CN 6,
Superior oblique CN 4
Everything else 3

Question 18

What congenital infection causes chorioretinitis?

Answer 18

75% of patients with congenital toxoplasmosis have it

Patients with rubella can get it but not as common… They mostly get congenital cataracts

Question 19

Sudden painless loss of vision, Flame shaped haemorrhages on fundoscopy

Answer 19

Central retinal vein occlusion

Question 20

patient with Paget’s has irregular dark red streaks radiating from the optic nerve head… Diagnosis?

Answer 20

Angioid retinal streaks

Also associated with Ehlers Danlos, sickle cell, acromegaly, pseudoxanthoma elasticum

Question 21

Which is more common, Central retinal vein or arterial occlusion?

Answer 21

Vein

May see retinal haemorrhage with it too

Question 22

Sudden loss of vision in diabetic, w 2-hour history of progressively enlarging dark spots

Answer 22

Vitreous haemorrhage

Question 23

Pt presents w Flashes and floaters. Normal fundoscopy

Answer 23

Posterior Vitreous detachment is most likely ( 50-75% of >65yr) . But rule out retinal detachment

Can be in vitreous haemorrhage too but is likely to obscure fundoscopy

Question 24

night blindness + tunnel vision

Answer 24

Retinitis pigmentosa

Question 25

MOA of treatments for primary angle glaucoma

Answer 25

PBL ( PBL medschool it makes you want to leave) so pilocarpine, brimonidine and latanoprost improve uveoscleral outflow.

CBT reduced tears, so reduces aqueous production, so Carbonic anhydrase inhibitors, Brimonidine and Timolol reduce aqueous production

Question 26

Patient with heterochromia… Ptosis

Answer 26

Congenital Horner’s

Question 27

What nerve does Herpes zoster ophthalmicus affect

Answer 27

Ophthalmic division of trigeminal nerve

Question 28

Keith-Wagener classification of retinopathy

Answer 28

1-4…

First they start to twist and turn [1: silver wiring], then they nip about the place [2: AV nipping], afterwards they play with cotton wool and fire [3:cotton wool spots, flame and blot haemorrhages], finally they swell up [4: papilloedema]

Question 29

Sudden painless loss of vision w red spot over a pale and opaque retina

Answer 29

Central retinal artery occlusion

Question 30

Mx of patient with severe eye pain, decreased acuity,semi-dilated non-reacting pupil

Answer 30

Acute angle glaucoma…. Treat with IV acetazolamide and pilocarpine

Question 31

Bilateral vitreous haemorrhage

Answer 31

Von Hippel lindau has Retinal and cerebellar haemangiomas

Question 32

Dacryocystitis

Answer 32

Watery eye, swelling and erythema of inner canthus of eye

Treat with abx or IV if periorbital cellulitis

Question 33

Female patient presents with One pupil dilated, when constricts it is slow to dilate. Absent knee/ankle reflex

Answer 33

Holmes Adie syndrome

Question 34

Sluggish pupil, haloes around lights

Answer 34

Acute angle closure glaucoma

Question 35

Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision

Answer 35

Retinal detachment

Question 36

Diabetic patient, poor control, new vessel formation at optic disc

Answer 36

Urgent referral for panretinal photocoagulation by laser