Ophthalmology

Question 1

macular degeneration retina appearance

Answer 1

• normal disc
• unusual pigmentation around macula
• drusen

Question 2

central retinal vein occlusion retina appearance

Answer 2

• ‘stormy sunset’ appearance
• engorged veins
• haemorrhages

Question 3

Hypertensive retinopathy retina appearance

Answer 3

• narrow and tortuous retinal arteries
• haemorrhages
• if more advanced then ‘starburst’ exudates and papilloedema

Question 4

Papilloedema retina appearance

Answer 4

• swollen disc
• disc margin has disappeared (blurred outline)
• congested veins
• disc may obscure sections of retinal arteries

Question 5

Disc cupping/ glaucoma retina appearance

Answer 5

• pale optic disc

- high disc to cup ratio (middle bit gets bigger)

Question 6

background/mild diabetic retinopathy appearance

Answer 6

• haemorrhages and micro-aneurisms
• hard exudates
• soft exudates/cotton wool spots

Question 7

proliferative diabetic retinopathy

Answer 7

• haemorrhages and micro-aneurisms
• exudates/cotton wool spots
• new vessel formation!!

Question 8

some causes behind retinal artery occlusion

what can you do about it?

Answer 8

• carotid artery disease
• infective emboli from heart

-ocular massage?

Question 9

Retinal artery occlusion retina appearance

Answer 9

• pale oedematous retina
• threadlike vessels
• fovea will still appear red (cherry red spot)

Question 10

potential treatment for retinal vein occlusion

Answer 10

• carbonic anyhydrase inhibitors

- lower ocular pressure to encourage venous flow

Question 11

what might make you loose red reflex?

Answer 11

• retinoblastoma (kids)
• vitreous haemorrhage
• retinal detachment
• cataracts

Question 12

symptoms of wed macular degeneration

Answer 12

• rapid central vision loss

- distortion of images (metamorphosia)

Question 13

treatment of acute closed angle glaucoma

Answer 13

• pilocarpine eye drops (constrict pupil)

- carbonic anhydrase inhibitors

Question 14

what is hutchinson’s sign?

Answer 14

• refers to V1 shingles
• cutaneous involvement of the tip of the nose indicates the nasocilliary nerve is affected
• this increases the likelihood of ocular complications

Question 15

most common cause of viral conjunctivitis

Answer 15

-adenovirus (pink eye)

Question 16

what is keratitis?

Answer 16

-inflammation of the epithelium, stoma and endothelium of cornea

Question 17

what causes dendritic ulcers

Answer 17

-herpetic keratitis

Question 18

treatment of keratitis

Answer 18

depends on cause:

• antibiotic drops (chloramphenicol, levofloxacin?)
• aciclovir
• antiseptic drops (for fungal and antibiotics won’t work)

DO NOT GIVE STEROIDS -> CORNEAL MELT

Question 19

cause of central corneal ulcer

Answer 19

-usually an infective cause

Question 20

cause of a peripheral corneal ulcer

Answer 20

• usually and autoimmune cause

- e.g. RA, vasculitis

Question 21

signs of uveitis (middle layer of eye inflammation)

Answer 21

• flare in anterior chamber (due to inflammatory cells)
• keratic precipitates, hypopyon
• small/irregular pupil (synechiae)

Question 22

what does cyclopentolate do?

Answer 22

• mydratic

- dilates pupil

Question 23

what helps to differentiate between scleritis and episcleritis?

Answer 23

• phenylephrine drops

- if scleritis the redness wont go away

Question 24

what is episcleritis associated with?

Answer 24

• gout

- systemic disease e.g. UC

Question 25

what is chorioretinitis? | what causes it?

Answer 25

- inflammation of the choroid (pigmented layer of eye) - toxoplasmosis, CMV, symphilis, TB - may see floating black spots in vision - 'salt and pepper' retina

Question 26

appearance of CNVI nerve palsy

Answer 26

- esotropia - convergent strabismus - i.e. affected eye turns inwards due to weakness of lateral rectus

Question 27

appearance of CNIV nerve palsy

Answer 27

- hypertropia (with some esotropia) - patient may tilt head to compensate - i.e. eye is up and in and struggles to look down and in

Question 28

CNIII nerve palsy appearance

Answer 28

- exotropia and hypotropia - i.e. eye is positioned down and out - ptosis - mydriasis (dilated pupil)

Question 29

likely diagnosis is lens detaches superiorly

Answer 29

Marfan's syndrome

Question 30

what do short ciliary nerves carry? what is their main function?

Answer 30

- sympathetic nerve fibres (from sympathetic trunk exiting cord T1) - parasympathetic nerve fibres!! -pupil constriction

Question 31

what do long ciliary nerves carry? what is their main function?

Answer 31

- sympathetic nerve fibres (from sympathetic trunk exiting cord T1) - somatic sensory fibres -blink reflex

Question 32

what is horner's syndrome and some of its symptoms?

Answer 32

-interruption of sympathetic fibres leaving trunk at T1 and travelling up neck - miosis (pupil constriction) - ptosis - reduced sweating - increased warmth/redness

Question 33

what produces CSF

Answer 33

- choroid plexus | - located in lateral, third and fourth ventricles

Question 34

Best steroid for penetrating cornea and why?

Answer 34

- prednisolone acetate | - hydrophobic

Question 35

best steroid for remain on eye exterior surface and why?

Answer 35

- prednisolone phosphate | - hydrophilic

Question 36

example of prostanoid

Answer 36

-lotanoprost

Question 37

mechanism of action of lotanoprost

Answer 37

- prostaglandin analogue - increases sclera permeability to aqueous fluid - thus increases aqueous fluid outflow

Question 38

why are beta blockers useful in glaucoma

Answer 38

- block sympathetic stimulation of ciliary bodies | - so reduces aqueous fluid formation

Question 39

examples of carbonic anhydrase inhibitors

Answer 39

- dorzolamide - methazolamide - acetazolamide

Question 40

alpha2 adrenergic agonists example and mechanism

Answer 40

- brimonidine - activates G protein which inhibits cAMP - stops aqueous humour production - also increase prostaglandin production which increase sclera permiability to aqueous fluid

Question 41

what does pilocarpine do?

Answer 41

constricts pupil