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Finals > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

How do you record the results of someones snellen chart reading

A

Testing distance/line they can correctly read

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2
Q

What do you do if a patient can’t read the top line of the snellen chart

A

Try at 3 metres instead of 6
If still can’t then get them to count fingers at 1 metre
If still can’t get them to recognise hand movement at 1 metre
If still can’t then test light perception

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3
Q

How do you examine the macula during fundoscopy

A

Ask the patient to look into the light

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4
Q

Drops used to dilate pupils

A

Tropicamide 1% - antimuscarinic
Cyclopentolate 1% - antimuscarinic
Phenylephrine 2.5% - alpha-1 agonist

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5
Q

On a humphrey visual field test what to the black ring, black dot and triangles represent

A

Black ring = they CAN see it
Black dot = they CAN’T see it
Triangle - normal, physiological blind spots

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6
Q

What are the early changes of age related macular degeneration

A

Drusen
Macular pigmentary changes
Normal/near normal vision

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7
Q

What are the 2 main types of age related macular degeneration

A

Geographic atrophy/atrophic/dry

Neovascular/exudative/wet

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8
Q

What is the most common type of age related macular degeneration - wet or dry

A

Dry

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9
Q

Risk factors for age related macular degeneration

A 
Age >65
Smoker
FH
Female 
HTN
Obesity
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10
Q

Typical findings/symptoms associated with dry ARMD

A 
Gradual loss of central vision (scotoma)
May begin as distortion
Difficulty reading/seeing fine detail
Struggle to see faces clearly
Peripheral vision spared
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11
Q

Fundoscopy findings of dry ARMD

A

Drusen in the macular area

Macular atrophy - pale, mottled macula

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12
Q

Typical findings/symptoms associated with wet ARMD

A

Sudden loss of central vision and distortion

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13
Q

How do you manage wet ARMD

A

Urgent referral for anti-VEGF injections - progresses quickly and has a high chance of 2nd eye involvement
Or photodynamic therapy

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14
Q

Fundoscopy findings of wet ARMD

A

Drusen in the macular area
Macular atrophy - pale, mottled macula
Choroidal neovascularisation - small focal pale pink-yellow or green-grey elevations at the macula. Microhaemorrhage and exudates.

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15
Q

What can be used to assess whether patients vision is being distorted, or whether they have loss of central vision

A

Amsler grid

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16
Q

Names of the anti-VEGF injections used for wet ARMD

A

Ranibizumab (Lucentis)

Aflibercept (Eylea)

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17
Q

How often are anti-VEGF injections for wet ARMD

A

Every 1-2 months for as long as necessary

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18
Q

What are the 2 main types of diabetic retinopathy

A

Non-proliferative

Proliferative

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19
Q

Fundoscopy findings of non-proliferative diabetic retinopathy

A

Microaneurysms
Macular oedema
Hard exudates
Cotton wool spots

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20
Q

What is the key feature of proliferative diabetic retinopathy

A

Neovascularisation

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21
Q

Main management options for proliferative diabetic retinopathy

A

Anti-VEGF injections

Laser treatment

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22
Q

What are macular holes

A

As we age vitreous shrinks + pulls away from retinal surface, if attached too firmly can tear retina as it does this, fluid seeps through hole onto macular –> central vision blurring + distortion.

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23
Q

Management of macular holes

A

Vitrectomy + fill with gas to hold edges of macular hole in place as it heals

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24
Q

What is the most common hereditary retinal degeneration/dystrophy

A

Stargardt disease

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25
Q

Risk factors for open angle glaucoma

A 
Age >40
Raised intraocular pressure
African
DM
FH
Myopia
Steroid use
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26
Q

Patho of open angle glaucoma

A

Clogging of trabecular meshwork/reduced drainage –> gradual increase in IOP –> vascular compression –> ischaemia of optic nerve –> progressive visual impairment

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27
Q

Clinical features/history of open angle glaucoma

A

Initially often asymptomatic
Slowly progresses into non-specific symptoms such as mild headaches, impaired adaptation to darkness
Generally bilateral progressive visual field loss from peripheral to central vision
Halos around lights may occur

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28
Q

Fundoscopy findings of open angle glaucoma

A

Cupping and pallor of the optic disc

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29
Q

How do we measure intraocular pressure

A

Tonometry

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30
Q

How do we visualise/assess the iridocorneal angle (e.g. in cases of suspected closed angle glaucoma)

A

Gonioscopy

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31
Q

Management of open angle glaucoma

A

Topical prostaglandins - Latanoprost
AND
Topical beta blocker - Timolol OR alpha2 agonists - Apraclonidine

2nd line = laser trabeculoplasty

Refractory cases = surgical trabeculoplasty

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32
Q

Presentation/history of angle closure glaucoma

A 
Sudden onset painful, red and hard eye
Frontal headache
Blurred vision
Halos around lights
Nausea and vomiting
Dilated and non-reactive pupil
Cloudy cornea
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33
Q

Risk factors for angle closure glaucoma

A 
Hyperopia (short eye)
Age
Female
Previous eye trauma
Mydriasis (meds - Atropine, decongestants, sympathomimetics)
Darkness
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34
Q

Management of angle closure glaucoma

A 
Avoid mydriatic drugs
Avoid darkness/covering the eye
Analgesics and antiemetics
Timolol (beta blocker drop)
Apraclonidine (a2 agonist)
PO/IV Acetazolamide (carbonic anhydrase inhibitor)
IV Mannitol in refractory cases
Iridotomy or iridectomy once acute attack has been managed
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35
Q

Risk factors for/things associated with acquried cataracts

A 
Age
DM, renal insufficiency/dialysis
Smoking, alcohol
HTN
Hypocalcaemia
Wilson's disease, Trisomy 21, Alport syndrome, NF2
Steroids
Trauma
Radiation
Excessive sunlight/UVB
FH
High myopia
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36
Q

Symptoms/presentation of cataracts

A

Reduced visual acuity - blurred, clouded, dim, washed out colour vision (nuclear cataracts)
Painless
Bilateral
Glare - in daylight, low sunlight, headlights, haloes
Opacities within red reflex
Grey/white/yellow/brownish clouding of the lens
Monocular diplopia

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37
Q

Which type of cataract is more common in patient with DM or on high dose steroids

A

Subcapsular cataract

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38
Q

Which type of cataract decreases the colour blue

A

Nuclear cataract

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39
Q

Which type of cataracts look like white, wedge like opacities that start in the periphery and work their way to the centre

A

Cortical cataracts

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40
Q

Risk factors for corneal abrasion

A

Mechanical trauma from external objects
Contact lens - dehydration or improper fit
Occupation and lack of protective eyewear - e.g. cutting/sawing
Prior corneal abrasions

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41
Q

Typical features of the history in corneal abrasion

A

Sudden onset
Sensation of foreign body
Photophobia
Excessive tearing
Blepharospasm (involuntarily squeeze eye shut)
An initiating event
Patients with recurrent/spontaneous erosions have history of trauma/injury from a while back that will have left epithelial structural defect that increases risk of further episodes – report Sx on opening eyes/waking up, daily/weekly/monthly

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42
Q

Features of corneal abrasion on examination

A

Eye is injected
Ciliary flush (red/violet ring around cornea)
Tearing but no pus
May be an obvious foreign body

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43
Q

What do we use to stain the eye when looking for corneal abrasions

A

Fluorescein staining

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44
Q

Management of corneal abrasion

A

Most heal within 1-2 days
Don’t wear contact lenses whilst it’s healing
Topical NSAIDs for analgesia
Topical abx - contact lens wearers at risk of pseudomonas

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45
Q

What are 2 possible complications of corneal abrasions

A

Corneal ulceration

Keratitis

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46
Q

What is infectious keratitis

A

Microbial invasion of the cornea causing inflammation and damage to corneal epithelium/stroma/endothelium

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47
Q

Non-infectious causes of keratitis

A

Exposure keratitis - dryness due to inadequate eyelid closure
Photokeratitis - intense UV exposure
Allergic keratitis

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48
Q

What are the main risk factors for keratitis

A

Contact lens wear
Corneal trauma
Corneal abrasion
Immunocompromisation

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49
Q

Signs and symptoms of keratitis

A 
Painful, red eye
Increased lacrimation
Discharge
Lid oedema
Decreased visual acuity
Photophobia
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50
Q

Management of keratitis

A

Screen for immunosuppression
Broad spectrum topical antibiotic
Oral analgesia
Don’t wear contact lenses whilst eye is inflamed

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51
Q

What is herpes simplex keratitis

A

Caused by type 1 herpes simplex virus
Primary infection in early life may be asymptomatic or have fever/conjunctivitis/swelling
Resolution + latency of virus in trigeminal ganglion
Reactivated and causes epithelial keratitis, risk of reactivation higher if immunocompromised
Typically appears as a dendric ulcer
May heal without scar or progress to stromal keratitis + scar

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52
Q

Management of herpes simplex keratitis

A

Topical antivirals (should heal in around 2 weeks)

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53
Q

What is herpes zoster ophthalmicus

A

Varicella zoster virus
Affects ophthalmis division of trigeminal nerve
Usually has prodromal period

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54
Q

What is the technical term for being near-sighted

A

Myopia

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55
Q

What is the technical term for being long-sighted

A

Hyperopia

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56
Q

Do patients with myopia struggle to see distance or near

A

Distance

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57
Q

Do patients with hyperopia struggle to see distance or near

A

Near (and often distance as well)

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58
Q

What is the shape of the eye like in myopia

A

Too curved, too long or both

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59
Q

What is the shape of the eye like in hyperopia

A

Too flat, too short or both

60
Q

What shape lens is used to correct myopia and is this given a ‘+’ or ‘-‘

A

Spherical Concave (-)

61
Q

What shape lens is used to correct hyperopia and is this given a ‘+’ or ‘-‘

A

Spherical Convex (+)

62
Q

Are the lenses used to for myopia divergent or convergent

A

Divergent

63
Q

Are the lenses used for hyperopia divergent or convergent

A

Convergent

64
Q

What is astigmatism

A

Lens/cornea isn’t spherical, it’s irregular, so there are multiple focal points on the retina

65
Q

What is the shape of the lens used to correct astigmatism

A

Cylindrical

66
Q

What is presbyopia

A

Loss of lens ability to change shape to focus on near objects - due to ageing

67
Q

A central scotoma indicates a lesion/damage to where

A

Macula/retina

68
Q

Monocular loss of vision indicates a lesion where

A

Optic nerve

69
Q

Bitemporal hemianopia indicates a lesion where

A

Optic chiasm

70
Q

Homonymous hemianopia indicates a lesion where

A

Contralateral optic tract or optic radiation

71
Q

Mnemonic for remembering lesion locations in homonymous quadrantinopias

A

PITS (Parietal-Inferior, Temporal-Superior)

72
Q

Homonymous hemianopia with macula sparing indicates a lesion where

A

Contralateral occipital cortex

73
Q

Presentation of central retinal artery occlusion

A

Sudden, painless, severe loss of vision/visual field defect
Usually unilateral
Affected pupil responds poorly to light

74
Q

Causes of central retinal artery occlusion

A

Thrombus - GCA, SLE

Embolus - carotid plaques, endocarditis

75
Q

Fundoscopy appearance of central retinal artery occlusion

A

Pale, opaque fundus with a red fovea (cherry red spot)

76
Q

Management of central retinal artery occlusion

A

If suspected embolus then carotid doppler and echo
If suspected GCA then high dose steroids
Reduce IOP - topical Timolol, oral/IV Acetazolamide
Can try to dislodge an embolus by intermittent digital massage over the closed eyelid or anterior chamber paracentesis

77
Q

Risk factors for central retinal vein occlusion

A 
HTN
Age
Glaucoma
DM
Anything that causes neovascularisation
78
Q

Presentation of central retinal vein occlusion

A

Painless loss of vision - usually sudden but can occur over days/weeks

79
Q

Fundoscopy findings of central retinal vein occlusion

A

Haemorrhages thoughout the retina
Dilated and tortuous retinal veins
Retinal oedema
These changes are typically diffuse if obstruction involves the central retinal vein and are limited to one quadrant if obstruction involves only a branch of the central retinal vein.

80
Q

What are the three main mechanisms for retinal detachment

A

Rhegmatogenous (most common type)
Tractional
Exudative (serous)

81
Q

Describe what causes rhegmatogenous retinal detachment

A

Occurs due to a retinal break/tear/hole that allows fluid from the vitreous cavity between the retina and RPE

82
Q

Describe what causes tractional retinal detachment

A

Occurs when fibrous/fibrovascular tissue (usually formed secondary to injury/inflammation/neovascularisation) attaches to the vitreous and pulls the retina from the RPE. Most commonly due to diabetic retinopathy.

83
Q

Describe what causes exudative retinal detachment

A

Detachment due to a build up of fluid underneath the retina without tear/hole/break. Usually due to an inflammatory condition, but can also be secondary to hypertension, central retinal vein occlusion (haemorrhage), papilloedema or a retinal tumour.

84
Q

Presentation of retinal detachment

A

Usually sudden and significant loss/deterioration in central vision
Preceding flashes of lights in temporal visual field
Loss of peripheral field as dark veil/cloud before loss of central vision

85
Q

What is orbital/periorbital cellulitis

A

Infection of the muscles/fat posterior to the orbital septum, not involving the globe

86
Q

What features would make you think orbital cellulitis rather than periorbital cellulitis

A

Ophthalmoplegia, proptosis, visual disturbances

More significant pain, tenderness, swelling and fever

87
Q

What investigation do you order if you suspect orbital cellulitis

A

CT sinuses and orbits with contrast

88
Q

What is infective endophthalmitis

A

Inflammation of the aqueous and/or vitreous humor.

89
Q

Presentation of conjunctivitis

A

Red and discharge without significant pain/photophobia/visual loss

90
Q

What types of conjunctivitis are there

A 
Allergic
Bacterial
Viral
Gonorrheal
Chlamydial
91
Q

Topical antibiotic of choice for superficial eye infections such as conjunctivitis

A

Chloramphenicol

92
Q

Ophthalmic emergencies

A 
Central retinal artery occlusion
Central retinal vein occlusion
Retinal detachment
Orbital/peri-orbital cellulitis
Infective endophthalmitis
93
Q

Presentation of infective endophthalmitis

A 
Photophobia
Ocular discharge
Ocular/periocular inflammation
Injected eye
Hypopyon
Reduced/absent red reflex
Fever
94
Q

Anterior uveitis/iritis is inflammation of which structures

A

Iris and ciliary body

95
Q

Causes of anterior uveitis/iritis

A

Idiopathic
HLA-B27 related - seronegative arthropathy/inflammatory disease
Viral eye disease - herpes, CMV, HIV

96
Q

Presentation of anterior uveitis/iritis

A 
Painful, red eye
Photophobia
Tearing
Dull pain radiating around the orbit
Constricted/non-reactive pupil
Ciliary flush
Idiopathic or infectious are usually unilateral
Inflammatory usually bilateral
97
Q

What is bacterial/microbial keratitis

A

Corneal ulcer - bacterial infection of the cornea

98
Q

Risk factors for bacterial keratitis

A 
Contact lens wear
Foreign bodies
Trauma
Chemical injuries
Dry eyes
Immunosuppression
99
Q

Presentation of bacterial keratitis

A

Rapid onset of pain, redness, photophobia, discharge, decreased vision
Conjunctival injection
Hypopyon
Mucopurulent discharge

100
Q

What in the history would make you consider fungal keratitis

A

Trauma involving organic material

Immunocompromised

101
Q

Which cranial nerve VI and what is its function

A

Abducens
Lateral rectus muscle
Eye abduction

102
Q

What abnormality will you see at rest in a patient with a CN VI palsy

A

Estropia (eye turned in)

103
Q

Cranial nerve IV and its function

A

Trochlear
Superior oblique
Intorts, depresses and abducts the eye

104
Q

Causes of abducens, occulomotor or trochlear nerve palsy

A 
Trauma (head/eye injury)
Microvascular ischaemia - DM, HTN
MS
Vasculitis
Meningitis
Raised IOP
Intracranial lesion
105
Q

In abducens nerve palsy, is the diplopia horizontal or vertical/oblique

A

Horizontal

106
Q

In trochlear nerve palsy is the diplopia horizontal or vertical/oblique

A

Vertical/oblique

107
Q

Which cranial nerve palsy can cause you to tilt your head to the opposite side to compensate for diplopia

A

Trochlear (IV) nerve palsy

108
Q

What is the most common type of orbital fracture

A

Blow out fracture - usually a result of trauma. A direct blow to the orbit causes a sudden increase in intra-orbital pressure which decompresses by fracturing one of the walls of the orbit (most commonly inferior)

109
Q

Clinical findings of an occulomotor nerve palsy

A 
Eye is down and out (infraducted and abducted)
Ptosis
Pupil dilation (mydriasis)
110
Q

CN III

A

Occulomotor

111
Q

What clinical feature can help to differentiate an occulomotor nerve palsy caused by compression Vs microvascular disease

A

Pupil involvement usually indicates a compressive cause

112
Q

Which condition can cause a painless 3rd nerve palsy with pupil sparing in somebody without vascular risk factors/DM

A

Myasthenia gravis

113
Q

What causes myasthenia gravis

A

Autoimmune response which damages ACh receptors

114
Q

Features/symptoms of myasthenia gravis

A

Muscle weakness
Diplopia + ptosis with pupil sparing
Oropharyngeal weakness - dysphagia, dysarthria
Fluctuating symptoms
Failure of respiratory muscles
Symptoms exacerbated by heat and improved by cold
Symptoms worse during physical stress - e.g. infection, surgery

115
Q

2 tests used in the diagnosis of myasthenia gravis

A

Serum ACh receptor antibodies

EMG

116
Q

What medication is used for symptom relief in myasthenia gravis

A

Acetylcholinesterase inhibitors (neostigmine, pyridostigmine)

117
Q

Which gland is thought to be pathogenic in myasthenia gravis

A

Thymus

118
Q

How can you tell the difference between monocular diplopia and binocular diplopia

A

Binocular – one of the two images disappears when either eye is covered
Monocular – resolves when the affected eye is covered but remains when the opposite eye is covered

119
Q

Intermittent diplopia that is worse at the end of the day is suggestive of which disease

A

Myasthenia gravis

120
Q

A painful 3rd nerve palsy with ipsilateral pupil dilatation can be a result of an aneurysm in which vessel

A

Posterior communicating artery

121
Q

Differentials for diplopia

A 
3rd nerve (occulomotor) palsy
4th nerve (trochlear) palsy
6th nerve (abducens) palsy
Previous strabismus or eye surgery
Thyroid eye disease (Graves)
Myasthenia gravis
GCA
122
Q

Which special test can be used to help diagnose myasthenia gravis

A

Tensilon test
Injection of Edrophonium chloride (an anticholinesterase) is given and the patient is observed for symptom improvement as their ACh levels build up

123
Q

What is leukocoria

A

Abnormal white reflection from the pupil (instead of the normal red reflex)

124
Q

Differentials for leukocoria

A 
Retinoblastoma
Congenital cataract
Retinopathy of prematurity
Retinal dysplasia
Endophthalmitis
Persistent hyperplastic primary vitreous
125
Q

Strabismus may be normal until what age

A

3 months

126
Q

What kind of gene is the retinoblastoma gene

A

Tumour supressor gene - mutations can be sporadic (unilateral) or hereditary (bilateral)

127
Q

Causes of congenital cataracts

A

Bilateral - genetic, galactosemia, Wilson disease, diabetes, trisomy 21
Unilateral - usually a result of local dysgenesis/congenital structural abnormality

128
Q

What is retinopathy of prematurity

A

A disease of the retina that affects pre-term infants
Elevated/fluctuating partial pressures of oxygen cause pathological extraretinal neovascularisation that can cause haemorrhages, exudation, tractional retinal detachment

129
Q

What is internuclear ophthalmoplegia

A

Internuclear ophthalmoplegia (INO) is a disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction. When an attempt is made to gaze contralaterally (relative to the affected eye), the affected eye adducts minimally, if at all. The contralateral eye abducts, however with nystagmus

130
Q

‘Stormy sunset’ is the typical fundoscopy appearance of which condition

A

Retinal vein occlusion

131
Q

Cherry red spot is the typical fundoscopy appearance of which condition

A

Central retinal artery occlusion

132
Q

Fundoscopy findings of diabetic retinopathy

A 
Microaneurysms
Hamorrhages
Venous bleeding
Hard exudates
Cotton wool spots
Neovascularisation
Photocoagulation scares
133
Q

Fundoscopy findings of hypertensive retinopathy

A 
Arteriorlar narrowing
AV nicking
Silver wiring
Retinopathy - flame haemorrhages, hard exudates, cotton wool spots
Papilloedema
134
Q

Symptoms of retinal detachment

A 
The 4 'F's
Flashes
Floaters
Field loss
Fall in acuite
"curtain coming down vision)
135
Q

Management of retinal detachment

A

Surgical vitrectomy and gas tamponade

Then cryo/laser coagulation to secure retina

136
Q

Symptoms of retinitis pigmentosa

A

Deteriorating night vision

Tunnel bision

137
Q

Fundoscopy findings of dry ARMD

A

Drusen in the macula

138
Q

Fundoscopy findings of wet ARMD

A

Subretinal haemorrhages in/around macula

Localised retinal elevation and retinal oedema

139
Q

Symptoms of optic neuritis and optic atrophy

A

Reduced visual acuity
Loss of red colour vision
Central scotoma
RAPD

140
Q

Fundoscopy appearance of optic neuritis

A

Swollen optic disc (blurred margin)

141
Q

Fundoscopy appearance of optic atrophy

A

Pale, featureless optic disc

High cup:disc ratio

142
Q

Fundoscopy findings of chronic open angle glaucoma

A

High cup:disc ratio

Optic disc atrophy

143
Q

Management of chronic open angle glaucoma

A

Beta-blocker eye drops
Prostaglandin eye drops
Alpha-agonist eye drops
Carbonic anhydrase inhibitors

144
Q

Symptoms of vitreous haemorrhage

A

Sudden PAINFUL loss of vision/haze

145
Q

Fundoscopy findings of vitreous haemorrhage

A

No red reflex

Difficult/unable to visualise the retina

Finals (32 decks)

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