Ophthalmology

Question 1

risk factors for cataracts

Answer 1

ageing, smoking, diabetes, alcohol, trauma, steroid use

Question 2

presentation of cataracts

Answer 2

reduced acuity and colour vision
glare and halos of light
absent red reflex

Question 3

investigations in cataracts

Answer 3

ophthalmoscopy - normal
slit lamp - can see cataracts
HbA1C / BMs / OGTT

Question 4

risk factors for macular degeneration

Answer 4

age, female, smoking, FHx, CVD risk factors

Question 5

presentation of macular degeneration

Answer 5

reduced acuity and night vision, fluctuating

Question 6

most common form of macular degeneration

Answer 6

dry - atrophy and drusen

Question 7

describe wet macular degeneration

Answer 7

neovascular degeneration and exudate cause drusen to detach and scar retina irreversibly
less common than dry

Question 8

management of magular degenration

Answer 8

anti VEGF injections and AREDS2 supplementation

Question 9

risk factors for chronic glaucoma

Answer 9

age, FHx, diabetes, black, myopia, HTN, steroids

Question 10

presentation of chronic glaucoma

Answer 10

progressive field loss

tunnel vision

Question 11

what does fundoscopy show in chronic glaucoma

Answer 11

disc cupping
optic disc pallor
bayonetting of the vessels
RAPD

Question 12

management of chronic glaucoma

Answer 12

topical prostaglandins (latanoprost) and beta blockers (timolol)
laser

Question 13

causes of acute angle closure glaucoma

Answer 13

tumours, marfans, trauma, retinopathy, ischaemia

Question 14

presentation of acute angle closure glaucoma

Answer 14

mydriasis (fixed dilated pupil)
nausea and vomiting
headache
pain
redness

Question 15

what would you see on slit lamp experiment in AACG

Answer 15

shallow anterior chamber; and signs of glaucoma: large optic cup, narrowing of the neuroretinal rim, splinter haemorrhage, nerve fibre loss
hazy cornea - oedema
iris atrophy

Question 16

management of AACG

Answer 16

carbonic anhydrase i - topical acetazolamide
topical beta blockers - timolol
topical pilocarpine - pupil constriction
IV mannitol
surgery

Question 17

when do you do diabetic retinopathy screening?

Answer 17

every 2 years, or annual if +ve

Question 18

what are the 4 stages of diabetic retinopathy

Answer 18

1. mild nonproliferative : microaneurysms
2. moderate nonproliferative : microaneurysms, dot and blot hemorrhages, cotton wool spots, venous bleeding
3. severe non proliferative: many hemorrhages and
   cotton wool spots
4. proliferative: new vessels on the disc

Question 19

what are the 4 stages of hypertensive retinopathy

Answer 19

1. narrow and tortuous arterioles
2. elschnig’s spots - choroidal capillary infarction, AV nipping
3. cotton wool spots, flame and blot hemorrhages
4. papilloedema

Question 20

a patients pupils constrict when looking at your finger near their nose (accommodation reflex normal)
when you shine a light in the pupils they fail to constrict (absent pupillary reflex)
what is this?

Answer 20

argyll robertson pupil

neurosyphilis, diabetes

Question 21

explain the Relative afferent pupillary defect

Answer 21

when light is swung from one eye to another the opposite pupil should constrict
in RAPD:
both pupils equal in room light
affected eye constricts when light shone in (normal)
when light shone to other eye both constrict (normal)
when light again shone on affected eye the pupil appears to dilate

Question 22

what causes RAPD

Answer 22

optic nerve damage

severe retinal disease

Question 23

what may cause mydriasis

Answer 23

(dilated pupil)

congenital, 3rd nerve palsy, trauma, AACG, anticholinergics, amphetamines

Question 24

what may cause miosis

Answer 24

(constricted pupil)
horners syndrome
cholinergics
opiods
anterior uveitis
argyll - robertson pupil

Question 25

how does horner's syndrome present and what are the causes

Answer 25

miosis, ptosis, anhidrosis | stroke, MS, tumour (lung - pancoast's), encephalitis, trauma, carotid dissection/aneurysm

Question 26

what do you see in a third nerve palsy

Answer 26

eye is down and out (abducted and infraducted) | diplopia

Question 27

how does 4th nerve palsy present + what muscle

Answer 27

superior oblique muscle vertical diplopia difficulty going down stairs

Question 28

how does a 6th nerve palsy present and what mucle

Answer 28

lateral rectus horizontal diplopia convergent squint (adduction)

Question 29

investigations in HSV keratitis

Answer 29

fluorescein stain - dendritic ulcer | reduced corneal sensation

Question 30

what do you see on slit lamp examination in anterior uveitis

Answer 30

hypopyon, keratotic precipitates, miosed irregular pupil, rubeosis of sclera, non reactive pupil

Question 31

what may cause anterior uveitis

Answer 31

``` ank spond, SLE infection IBD sarcoid MS ```

Question 32

causes, investigations and presentation of retinal detachment

Answer 32

trauma, macular degen, diabetes, myopia, vitreous haemorrhage grey area on retina central scotoma/loss of vision, flashes of light, floaters

Question 33

what do you see on fundoscopy in central retinal artery occlusion

Answer 33

cherry red spot and white retina

Question 34

causes and treatment of periorbital cellulitis

Answer 34

staph aureus / strep pyogenes from sinuses | oral co-amox

Question 35

causes and treatment of orbital cellulitis

Answer 35

strep and HIB spread from ethmoid sinus | IV Abx

Question 36

how do you tell the differenece between scleritis and episcleritis?

Answer 36

in scleritis phenylephrine wont reduce the redness

Question 37

what causes scleritis

Answer 37

RA, SLE

Question 38

ophthalmoscopy findings in central retinal vein occlusion and diagnosis

Answer 38

flame hemorrhages, optic disc swelling, cotton wool spots, tortuous veins fluorescein angiography

Question 39

what is retinitis pigmentosa and what do you see on opthalmoscopy

Answer 39

genetic - degeneration of the retina | bony spicules, optic atrophy, attenuated vessels

Question 40

what eye problem do people with HIV get

Answer 40

CMV retinitis