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Medical Finals 2020 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What do you see on fundoscopy in retinal hypertension?

A
  • AV nipping
  • cotton wool spots
  • blot haemorrhages
  • papilloedema
  • hard exudates
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2
Q

What are risk factors for acute closed angle glaucoma?

A
  • Hypermetropia
  • Family history
  • age
  • hypertension
  • diabetes
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3
Q

How is acute angle closure glaucoma managed?

A
  • Acetazolamide - reduces aqueous secretions
  • pilocarpine - increases papillary constriction

More definitive - iridotomy (laser to allow aqueous humour draining), trabeculectomy (widening of angle)

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4
Q

What do you see on fundoscopy in open angle glaucoma?

A
  • optic disc pallor
  • disc haemorrhage
  • bayonetting of vessels
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5
Q

What is your acute management of anterior uveatis?

A

Atropine or cycopentalate

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6
Q

What muscle does cranial nerve IV control?

A

Trochlear
Superior Ocular
so a palsy of it results in the eye looking up and out (normally used to look down the stairs - down and in)

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7
Q

A patient is complaining of double vision, their right eye is deviated upwards and rotated outwards. On looking to their left they experience double vision. Which nerve palsy is this?

A

4th nerve of right eye

Superior Oblique - depresses eye and moves it inwards - so eye points up and out

Vertical diplopia

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8
Q

What are the features of a 3rd nerve palsy?

A

Fixed dilated pupil
Ptosis
Eye pointing down and out (inability to look inwards)

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9
Q

Give some differentials of red eyes

A 
Conjunctivitis
Keratitis, uveatis
Trauma
Acute glaucoma (headache, n+v)
Sub-acute conjunctiva haemorrhage
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10
Q

What are some causes of painless visual loss?

A

Retinal detachment, CVA, cataract, CRVO, CRAO (vascular pathologies)

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11
Q

What causes loss of colour vision?

A

Optic neuritis
Cataract
Drug toxicity

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12
Q

What is the reaction of the pupil in dim light?

A

Dilation, mydriasis

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13
Q

What causes pupil constriction?

A

CNIII, ACH + MuSc receptor
Parasympathetic
SPhincter pupillae muscle

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14
Q

What causes pupil dilation?

A

CNV (1st branch), NAd + Alpha receptor
Sympathetic
Dilator pupillae muscle

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15
Q

Describe the path the signals travel along the nerves of the eye to reach the Edinger-Westphal nucleus

A

Optic nerve - optic chiasm - optic tract - lateral geniculate body of thalamus - optic radiation - visual cortex

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16
Q

Describe what happens in a relative afferent pupillary defect?

A

In the swinging light test, when swung to the affect eye there is inappropriate pupil dilation
Occurs in incomplete optic nerve damage

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17
Q

What is anisocoria?

A

When the pupil size >2mm different

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18
Q

What can cause anisocoria (3)

A 
Physiological
Horner's
Adie's tonic pupil
CN III palsy
Pharmacological
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19
Q

What are the features of Horner’s Syndrome?

A

Unilateral miosis on afffected side
Anhidrosis (loss of sweat reflex on affected side)
Partial ptosis
Anisocoria

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20
Q

What can cause Horner’s Syndrome?

A

Pancoast’s tumour (Lung cancer)

Brainstem ipsilateral stroke

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21
Q

What are 4 key features in a 3rd nerve palsy?

A

Fixed dilated pupil (not always)
Eye: points down and out
Movement: can’t look in
Ptosis (sometimes partial)

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22
Q

How does a fourth nerve lesion present?

A

Eye: Eye points in
Movement: can’t look down and out
Double vision

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23
Q

What is a Bell’s Palsy and is it ipsilateral or contralateral?

A

Unilateral
LMN lesion
Facial palsy, can be forehead sparing
Drooping mouth, inability to wrinkle the brow

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24
Q

What are some complications of cataracts surgery?

A 
Lens rupture
Dropped nucleus
Intraocular haemorrhage
Inflammation
Infection
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25
Gradual loss of vision with a glare or halos being seen in likely to be...?
Cataracts | May be noticed suddenly because the other eye has compensated for decreasing visual acuity
26
What is the typical (but not necessary) presenting triad for glaucoma?
Visual field loss Optic nerve damage Increased intraocular pressure
27
What is normal intraocular pressure?
<21mmHg
28
What is the emergency presentation of glaucoma? | How does this present and what is your management?
Acute open angle glaucoma - due to high intraocular pressure Presents with unilateral red eye, severe pain and visual loss, n+v Treat with iridotomy
29
What pharmacological medications can be given in glaucoma?
BB- timolol | Prostanoids - latanoprost
30
What are drusden?
Waste material fro photoreceptors the appear in macular degeneration as small white spots
31
What are the two types of macular degeneration?
Wet - new vessel growth causing retinal detachment and disorted central vision (central scotoma) Dry - retinal atrophy and loss of central vision, central scotoma, drusden more common
32
What symptoms might someone with retinal detachment describe?
``` Decrease in vision Floaters (vitreous haemorrhage), flashes Visual field loss Loss of red reflex Peripheral curtain Spider webs, dark shadows Flashing lights in vision ```
33
What do multiple flame and blot-haemorrhages indicate along with painless loss of vision?
Central retinal vein occlusion
34
What are risk factors for a corneal ulcer (microbial keratitis)?
Steroid eye drop Presents with eye pain, photophobia, watering of the eye
35
What is the difference between ectropion and entropion?
Ectropion - eyelid droops down | Entropion - out-turning of the eyelids
36
What is amaurosis fugax?
Painless, transient loss of vision like a curtain coming down TIA association
37
What are some causes of a sudden painless visual loss?
Ischaemic/vascular Vitreous haemorrhage Retinal detachment Retinal migraine
38
What should be done in a child presenting with a squint?
Opthalmology referral
39
What are the two different kinds of squint?
Concomitant and paralytic
40
Does glaucoma have a hereditary involvement and what advice should be given to relatives?
Yes | From age 40+ annual screening
41
What are the stages of diabetic retinopathy?
Pre-proliferative Mild - microaneurysms Moderate - other retinal changes Severe - widespread microaneurysms, dot and blot haemorrhages, venous beading, IRMA
42
Is crusting of the eyelids normal in newborns?
Yes | Unless purulent in which case take a swab for micro investigations
43
What are risk factors in primary open-angle glaucoma?
``` Hypertension FH DMT2 Afro-Carribean ethnicity Myopia Long-term steroid use ```
44
What would you expect to see in someone presenting with a vitreous haemorrhage?
Multiple dark spots in vision Sudden visual loss RF: diabetes, underlying bleeding disorder, hx of trauma
45
What are the stages in hypertensive retinopathy?
1 - arteriolar narrowing + tortuosity, increased light reflex d2 - AV nipping 3 - cotton wool spots, flame and blot haemorrhages 4 - papilloedema
46
What are the most common causes of bacterial and viral conjunctivitis?
Bacterial - staph, strep, morazella | Viral - adenovirus, herpes
47
What is ophthalmia neonatorum?
Conjunctivitis that occurs in the first 3 weeks of life - maternally transmitted from birth canal Common causes include chlamydia, herpes simplex, gonorrhoea or staph aureus
48
What are some symptoms of acute uveatis?
Acute, painful red eyes Unilateral Photophobia May be reduced vision, irregular pupil against red reflex
49
What do flame haemorrhages indicate?
Hypertensive retinopathy | Retinal vein occlusions
50
What are the grades in diabetic retinopathy?
R0: None R1: Background - Microaneurysms (weakening of blood vessel wall), retinal haemorrhages, retinal exudates, macular oedema R2: Pre-proliferative - Venous beading, Venous loop or reduplication, Intraretinal microvascular abnormalities (IRMA), Multiple deep, round of blot haemorrhages R3: Proliferative - New vessels (damaged vessels close off, new vessels are abnormal) haemorrhage or fibrosis
51
What does laser therapy look like in fundoscopy?
Lots of little white spots on the back of the eye, regular, multiple
52
What is the difference between a stye and a chalazion?
Stye - infection of lash follicle - treat with hot compresses, massages Chalazion - granuloma/infection of meibomian gland, beneath the eye
53
Blepharitis can occur as a result of which disease? | How can it present and how is it managed?
Seborrhoeic dermatitis Gritty, irritable eyes, watery discharge Lubricants, lid hygeine, topical antibiotics
54
What does a homonoymous hemianopia refer to?
Half the visual fields are lost, it is the same part in both eyes
55
What does arcuate refer to?
A scotoma that is shaped like the arc of a circle
56
How can you test visual fields?
Humphrey Fields
57
What does a bright red cherry spot on the macula indicate and what symptoms might it present with?
Central Retinal Artery Occlusion Painless, sudden unilateral vision loss Fundoscopy - pale disc and cherry red spot
58
What is nystagmus a sign of in general terms?
Cerebellar disease | Vestibular disease
59
What are the different types of concomitant strabismus?
Convergent, Divergent and Vertical
60
What is hypermetropia? Anisometropia?
Long-sighteness Different prescription in each eye
61
What would you see on fundoscopy in optic neuritis?
Pale fundus Most look normal Swollen disc
62
Give some differentials of painful visual loss?
Anterior uveitis Acute glaucoma Optic neuritis – if loss of red vision then retrobulbar neuritis GCA
63
What do rods and cones functionally do?
Cones – colour vision and visual acuity | Rods – peripheral vision
64
What investigations can you do in sudden painless loss of vision?
dilated fundoscopy slit-lamp examination ultrasound: useful to rule out retinal tear/detachment and if haemorrhage obscures the retina fluorescein angiography: to identify neovascularization orbital CT: used if open globe injury
65
What stops an opthalmology patient from driving?
Poor visual acuity below 6/12
66
What are signs of acute closed angle glaucoma?
``` Hazy cornea Fixed mid-dilated pupil Red eye Painful Non-reactive pupil to light ```
67
What is your management of acute glaucoma?
IV acetazolamide IV mannitol Definitive treatment = laser iridotomy
68
What is the key difference between viral and bacterial conjunctivitis?
Bacterial has purulent discharge
69
What is the difference between episcleritis and scleritis?
Scleritis - more painful and rheumatoid arthritis association, capillaries don't move
70
What signs do you see on slit lamp for anterior uveatis?
``` No cloudy cornea (important differential from acute angle glaucoma) Posterior synechiae (iris sticks to lens) Anterior chamber cells = signs of inflammation (WCC) Hypopoyon = inflammation ```
71
What are the first symptoms patients with cataracts notice?
Problem with night vision and glare | Later daytime visual problems
72
What morphological alterations are associated with diabetic retinopathy?
Thickening of basement membrane Loss of inter-endothelial tight junctions Early and selective loss of pericytes which support the blood vessels Loss of integrity of retinal vessels Increased vascular permeability Neovascularisation
73
What do you get in a VI nerve palsy?
Horizontal diplopia worse on left gaze (lateral rectus - abduction) Commonly affected by raised ICP
74
What is the significance of a dilated pupil?
A compression of the parasympathetic fibres of CNIII CNIII - 3D - dilated pupil, down and out, drooping lid
75
Which cranial nerves supply which muscles of the eye?
III – oculomotor – medial, superior, inferior rectus, inferior oblique (looks up, down and in = elevation, depression, adduction) IV – trochlear – superior oblique – looks up (elevation) VI – Abducens – lateral rectus – looks out (abduction)
76
What is the pathophysiology of acute angle glaucoma?
Aqueous produced in posterior chamber by ciliary body Passes through the iris and circulates in the anterior chamber Drains through the trabecular meshwork Closure of drainage leads to a sudden increase in intraocular pressure Pain arises from the pressure on iris
77
What is your immediate management in acute angle glaucoma?
Beta blocker | Later => trabeculotomy
78
What is your acute management for anterior uveitis?
Pilocarpine - topical eye drop to dilate pupil and relieve pain Steroid eye drop
79
What are potential infectious causes of anterior uveitis?
Herpes simplex

Medical Finals 2020 (25 decks)

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