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Medicine, Year 4, Paediatrics > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Retinoblastoma:
1. What is the average age of diagnosis?
2. What is the inheritance pattern?
3. What is the pathology of the Retinoblastoma?
4 What are the presenting features of Retinoblastoma?
5. What is the management?
6. What is the prognosis?

A
  1. Average age = 18 months
  2. Autosomal dominant
  3. Loss of function of Rb tumour suppressor gene on chromosome 13
  4. Absent red reflex, leukocoria, strabismus, visual problems
  5. Enucleation, external beam radiation, chemotherapy, photocoagulation
  6. 90% survive to adulthood, but increased risk of secondary tumours
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2
Q
  1. What is the Keith Wagener classification used for?
  2. Outline: Stage 1, 2, 3, 4
  3. Which stages are symptomatic and asymptomatic?
A

For hypertensive retinopathy

Stage 1: Arteriolar narrowing & tortuosity, increased light reflex, silver wiring

Stage 2: AV nipping

Stage 3: Cotton wool exudates, flame and blot haemorrhages

Stage 4: Papilloedema, Elschnig spots

Stage 1 & 2 = asymptomatic
Stage 3 & 4 = symptomatic

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3
Q
  1. Describe AV nipping?

2. Describe Elshnig spots?

A

AV nipping - A small artery is seen crossing a small vein, causing vein compression on either side of the crossing

Elschnig spots - Black spots surrounded by bright yellow halos seen on the retina

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4
Q
  1. What is Anterior Uveitis?
  2. What are the features of it?
  3. What are the associated conditions of it?
  4. What is the management?
A
  1. Inflammation of the anterior portion of the uvea (iris and ciliary body)
  2. Acute onset of symptoms such as pain, red eye, small and irregular sized pupil, blurred vision, photophobia, ciliary flush
  3. HLA-B27 Conditions, AK, reactive arthritis, UC, Crohn’s Sarcoidosis
  4. Ophthalmology review, Cycloplegics will relieve pain i.e. Atropine, Cyclopentolate. Steroid eye drops
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5
Q
  1. What is Scleritis?
  2. What is the presentation of Scleritis?
  3. What are the associated conditions?
A
  1. Inflammation of the sclera
  2. Red eye, pain WORSE on movement, watering, photophobia, gradual decrease in vision
  3. Rheumatoid Arthritis
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6
Q
  1. What is Episcleritis?
  2. What is the presentation of Episcleritis?
  3. What is the management?
A
  1. Inflammation of the episclera
  2. Red eye, NOT CLASSICALLY painful, watering, photophobia
  3. Conversative, artificial tears may be used
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7
Q

What two things can be done to differentiate between Scleritis and Episcleritis?

A
  1. Apply gentle pressure to sclera. If vessels are mobile = Episcleritis. In Scleritis as the vessels run deeper and do not move.
  2. Use phenylephrine drops. If redness improves = Episcleritis. If they remain unblanched, scleritis
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8
Q
  1. What is Endophthalmitis?
  2. What are the features?
  3. When is it classically seen?
A
  1. Inflammation of interior portion of eye
  2. Red eye, pain, vision loss
  3. Classically seen following intraocular surgery
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9
Q

When is subconjunctival haemorrhages classically seen?

A

History of trauma, bouts of coughing

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10
Q

INFECTIVE CONJUNCTIVITIS

  1. How do you differentiate between bacterial and viral conjunctivitis?
  2. What is the management of conjunctivitis?
  3. What about in pregnant women?
A
  1. In bacterial, purulent discharge with eyes stuck together. In viral, there is serous discharge, a recent URTI, and pre-auricular lymph nodes
  2. Usually settles without treatment, or Chloramphenical eye drops / ointment
  3. Fusidic acid in pregnant women
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11
Q

ALLERGIC CONJUNCTIVITIS

  1. What are the features?
  2. What is the management? 1st / 2nd line
A
  1. Bilateral conjunctivitis, eye-lid swelling, itch, may have a history of atopy, may be seasonal
  2. 1st line: Topical / systemic antihistamines, 2nd line: Topical mast cell stabilisers i.e. Sodium cromoglicate and nedocromil
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12
Q

HORNER’S SYNDROME

  1. What are the features of Horner’s Syndrome?
  2. What is it caused by?
  3. What are the different means of categorising Horner’s based on location?
  4. How can you distinguish between the different types of the above Horner’s?
  5. What can cause each of these Horner’s?
  6. What is congenital Horner’s associated with?
A
  1. Ptosis, Miosis, Anhidrosis, (Enophthalmos)
  2. Damage to the sympathetic nerves
  3. Central, preganglionic, post-ganglionic
  4. By where the patient has anhidrosis. If central, will have anhidrosis of face, arms and neck. If pre-ganglionic, will have anhidrosis of the face. If post-ganglionic, will have no anhidrosis
  5. STC

Central = S, i.e. Stroke, swelling (tumour), multiple Sclerosis, Syringomyelia

Pre-ganglionic = T, i.e. Tumour, thyroidectomy, trauma, top rib

Post-ganglion = C, i.e. Carotid aneurys, carotid artery dissection, cavernous sinus thrombosis, cluster headache

  1. Heterochromia
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13
Q

HOLMES ADIE PUPIL

  1. What is it?
  2. What is it caused by?
A
  1. Unilateral, dilated pupil which is sluggish to react to light. When it is constricted, it SLOWLY dilates. It can ACCOMMODATE however (i.e. come to my home)
  2. Caused by damage to posterior ganglionic fibres
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14
Q

ARGYLL-ROBERTSON PUPIL

  1. What is Argyll-Robertson pupil also known as?
  2. What is it?
  3. What is it caused by?
  4. What is the mnemonic?
A
  1. Prostitutes pupil
  2. Pupil is constricted and unreactive to light, but accommodates
  3. Caused by neurosyphilis
  4. ARP-PRA
    Accommodation reflex present, Pupillary reflex absent
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15
Q

HERPES ZOSTER OPHTHALMICUS

  1. What is it?
  2. What are the features?
  3. What is the management?
  4. What are some complications?
A
  1. Reactivation of the VZV in area supplying the Ophthalmic division (V1) of the Trigeminal nerve
  2. Vesicular rash around the eye, rash on tip of nose / side of nose (HUTCHINSON’S SIGN)
  3. Oral antivirals for 7-10 days, topical steroids
  4. Ocular: Conjunctivitis, keratitis, episcleritis, ptosis, post-herpetic neuralgia
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16
Q

KERATITIS

  1. What is Keratitis?
  2. What is Keratitis most commonly caused by?
  3. In Fluorescein staining of a patient with Herpes Keratitis, what is classically seen?
  4. What is the management?
A
  1. Inflammation of the cornea
  2. Most commonly caused by HERPES SIMPLEX
  3. A DENDRITIC ULCER
  4. Same day assessment by Ophthalmologist, Acyclovir, steroids, corneal transplant
17
Q

PERIORBITAL AND ORBITAL CELLULITIS

  1. What is Periorbital Cellulitis?
  2. What is Orbital Cellulitis?
  3. How do you differentiate between the two?
  4. What is the management for both?
A
  1. Periorbital cellulitis is an eyelid and skin infection anterior to orbital septum
  2. Orbital cellulitis is an eyelid and skin infection posterior to orbital septum
  3. Eye specific symptoms such as reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements = ORBITAL CELLULITIS
  4. Admit to hospital, CT of orbit, IV ABX
18
Q

SQUINTS

  1. What is a squint also known as?
  2. What are the two main causes of squints? Explain them
  3. Of the two types, which are more common?
  4. Of the Concomitant squints, what the two sub-types and which are more common?
  5. What tests can be used to help diagnose a Squint?
  6. What is the management?
  7. What is “eso”tropia and what is “exo”tropia?
  8. What is “tropia” and “phoria”?
A
  1. Strabismus
  2. Concomitant, i.e. imbalance of extra-ocular muscles, or Paralytic, i.e. paralysis of extra-ocular muscles
  3. Concomitant squints are far more common
  4. Convergent > Divergent
  5. Corneal light reflection test i.e. Hirschberg’s test, where holding light 30cm away and see if light reflects symmetrically, and COVER test
  6. Can try eye patches to prevent lazy eye. and always refer to secondary care
  7. Esotropia - turns inwards, exotropia - turns outwards
  8. Tropia - ALWAYS deviated, phobia - SOMETIMES deviated - only visible when testing eye vision and testing eye breaking fusion
19
Q

AGE RELATED MACULAR DEGENERATION

  1. What are the two types of Age Related Macular Degeneration? Which is more common
  2. What are the clinical features of ARMD?
  3. What are risk factors for ARMD?
  4. What are some signs associated with ARMD?
  5. What is the first-line investigation for ARMD? Second? Third?
  6. How do you treat DRY ARMD?
  7. How do you treat WET ARMD?
  8. Which has the WORST prognosis?
A
  1. Wet and dry. DRY = MORE COMMON
  2. Difficulty in dark adaption, reduced vision at night, reduced visual acuity for near objects, photopsia, day to day vision fluctuations
  3. Age, smokers, IHD, HTN, DM, FHx
  4. Distorted line perception on Amsler Grid, Drusen on Fundoscopy
  5. SLIT LAMP, then flouroscein angiography, then OCT
  6. Zinc and Vitamins ACE
  7. Anti-VEGF
  8. Wet = Worse
20
Q

CATARACTS

  1. What is it?
  2. What are the clinical features?
  3. What are the causes?
  4. Which cataracts are associated with Steroids?
  5. What is the management?
A
  1. Common eye condition where the lens becomes more cloudy
  2. Progressively reducing vision, getting worse with no improvement despite stronger prescriptions, faded colour vision, glare and halos around lights
  3. Age, radiation, alcohol, smoking, diabetes, trauma, hypocalcaemia, long term steroids
  4. Subcapsular
  5. Non-surgical, i.e. initially stronger prescriptions, followed by a phacoemulsification
21
Q

THIRD NERVE PALSY

  1. What is Cranial Nerve III?
  2. What are the features of CN3 Palsy?
  3. What Oculomotor muscles does CN3 supply?
A
  1. Oculomotor nerve
  2. Ptosis, mydriasis, down and out pupil
  3. All except Lateral rectus and Superior Oblique
22
Q

MUSCLES OF THE EYE

  1. What is the function of the Medial Rectus?
  2. What is the function of the Lateral Rectus?
  3. What is the function of the Superior Rectus?
  4. What is the function of the Inferior Rectus?
  5. What is the function of the Inferior Oblique?
  6. What is the function of the Superior Oblique?
A
  1. Adduction
  2. Abduction
  3. Elevation, Intorsion, Adduction
  4. Depression, Extortion, Adduction
  5. Extortion, Elevation, Abduction
  6. Intorsion, Depression, Abduction
23
Q

TRACHOMA

  1. What is it?
  2. What are complications?
A
  1. An infectious disease caused by Chlamydia Trachomatis, causing roughening of the inner eyelid surface
  2. Leading cause of blindness, can cause trichiasis (eyelash growing inwards)
24
Q

EYELID DISORDERS

  1. What is Blepharitis and its features?
  2. What is the management of Blepharitis?
  3. What is a stye and its features?
  4. What is a Chalazion?
  5. What is an Entropium?
  6. What is an Ectropium?
A
  1. Inflammation of the eyelid margin, leading to a gritty, dry sensation in eyes
  2. Treat with hot compress, gentle cleaning and mechanical removal
  3. Painful and infected sweat or sebaceous gland
  4. Painless gland
  5. Eyelid turning in
  6. Eyelid turning out
25
Q

GLAUCOMA

  1. What is Glaucoma?
  2. What are the two types?
  3. Which is more common?
  4. What is the pathophysiology of Open Angle Glaucoma?
  5. What are risk factors of Open Angle Glaucoma?
  6. If there is a family history of Open Angle Glaucoma, what can be offered to patients?
  7. What are the clinical features of Open Angle Glaucoma?
  8. What is the pathophysiology of Acute Closed Angle Glaucoma?
  9. What are the risk factors of Acute, Closed Angle Glaucoma?
  10. What are the clinical features of Acute, Closed Angle Glaucoma?
  11. What drug can precipitate Acute, Closed Angle Glaucoma?
A
  1. An optic neuropathy associated with a rise in intraocular pressure
  2. Primary, open angle glaucoma and acute, closed angle glaucoma
  3. Primary, open angle glaucoma
  4. Caused by a gradual blocking of the trabecular meshwork, causing a gradual pressure increase. The angle between the iris and cornea is OPEN
  5. Diabetes, HTN, corticosteroids, being BLACK, MYOPIA (short-sightedness)
  6. Screening from age 40
  7. Peripheral vision loss, decreased visual acuity
  8. Angle between cornea and iris is too small to allow passage for aqueous humour, causing a rise in intraocular pressure
  9. HYPERMETROPIA (long-sightenedness)
  10. Severe pain, decreased visual acuity, hard, red eye, haloes around lights, semi dilated non-reacted pupil, symptoms worse with mydriasis
  11. MYDRIATIC DROPS
26
Q

OPEN ANGLE GLAUCOMA MEDICATIONS

  1. What is the MoA of Latanoprost?
  2. What are the side-effects of Latanoprost?
  3. What is the MoA of Timolol?
  4. What is the MoA of Dorzolamide?
  5. What is the MoA of Pilocarpine?
  6. What are the side-effects of Pilocarpine?
A
  1. Prostaglandin analogue, increases uveoscleral outflow
  2. Brown pigmentation of iris, longer eyelashes
  3. Beta-blocker, reduces aqueous production
  4. Carbonic anhydrase inhibitor, reduces aqueous production
  5. Increases uveoscleral outflow
  6. Headache, constricted pupil, blurred vision

Medicine, Year 4, Paediatrics (16 decks)

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