Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

5thyr > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Name and explain the stages of diabetic retinopathy?

A

Diabetic retinopathy

  1. Background
    - Microaneurysms (dots) and haemorrhages (dot and blot)
    - Hard exudates (more severe)
  2. Maculopathy
    - odema/other changes covering 1/3 of the macula
  3. Pre proliferative
    - Soft exudates (cotton wool spots- ischemia of nerves)
  4. Proliferative
    - new vessel formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How would maculopathy present?

A

visual acuity and colour vision loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you treat diabetic retinopathy?

A

Diabetic retinopathy

  • Manage diabetes
  • LASER PHOTOCOAGULATION
  • anti-VEGF injections to prevent new vessel formation
  • Virectomy (only if vitreous bleed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name and explain the stages of hypertensive retinopathy?

A 
LOOK FOR VESSEL CHANGES IN HYPERTENSIVE 
(veins are darker and fatter)
Stage 1 
-Tortuosity of arteries 
-Narrowing of arteries

Stage 2

  • AV nipping (artery nips vein)
  • Silver copper wiring

Stage 3

  • Soft exudates (cotton wool spots- ischemia of nerves)
  • Hard exudates
  • Flame and splinter haemorrhages

Stage 4
-Papilodema (poorly defined margins of optic disk and vessels dont come from clear place)
cupping>atropphy (>80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the treatment for hypertensive retinopathy?

A

Treatment for hypertensive retinopathy is controlling BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the different types of conjunctivitis? What is the discharge like for each?

A

Bacterial - mucopurulent and STICKY
Viral - watery and intermittently ITCHY
Chlamydial - watery
Allergic - stringy and ITCHY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the main treatment for bacterial conjunctivitis?

1st line with CI and 2nd line

A

Antibiotic eye drops
1st line: Chloramphenicol - risk of aplastic anaemia
(CI: pregnant/breastfeeding or personal or FH of aplastic anaemia)

2nd line: Fusidic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When would you suspect gonoccocal/chlamydial conjunctivitis?

Treatment of gonoccoal / chlamydial conjunctivitis?

A

Suspect gonoccocal/chlamydial conjunctivitis when fails to respond to treatment (plus STI risk factors)

Treat as per SYSTEMIC ILLNESS

  • Chalmydia: Doxycycline 7 days (azithromycin if pregnant)
  • Gonococcal: IM injection of CEFTRIAXONE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Whats the most common cause of bacterial conjunctivitis? Most common cause of viral?

A

Bacterial conjunctivitis

  • Strep pneumoniae
  • Staph aureus
  • H. influenzae

Viral=most commonly adenovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does allergic conjunctivitis present?

A

Allergic conjunctivitis

  • Itching and watering
  • Swollen lids and conjunctiva
  • Bilateral (viral more often spreads between eyes/people)

*typically seasonal/history of atopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What the management of allergic conjunctivitis?

A

Management:

1. Remove exposure
2. Cool compress
3. Oral/topical antihistamine (Emedastine or cetirizine hydrochloride)
4. Topical mast-cell stabilisers (both antihistamine and mast stabilisers)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does blepharitis present?

A

Blepharitis

  • Red, swollen and itchy eyelids
  • Gunking = secretions from Meibomian glands
  • Burning feeling
  • Bilateral gritty eyes (if unilateral-think malignancy)
  • Crusting = staph infection
  • Loss of eyelashes
  • Frothy tears
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment of blepharitis?

A

‘LID HYGIENE’
Warmth: hot compress
Massage: cotton buds
Clean: baby shampoo

Artificial tears for gritty eye symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Differentiate between entropion and ectropion?

A

Entropion = inversion of eyelids caused by lower lid laxity so orbicularis muscle overrides tarsal plate

  • Red, itchy, sore, gritty, uncomfortable eyes
  • Irritation from eyelashes can cause corneal ulcer

Ectropion = eversion of eyelids due to laxity causing exposure of tarsal conjunctiva

  • Dryness, redness
  • Frequently discharging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Managment of entropian/ectropian?

A

Entropian

  • tape the eyelid
  • artificial tears (drops for day, ointment for night)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a chalazion?

A

Chalazion

  • Meibomian cyst
  • Blockage of gland > traps sebaceous secretions> chronic granulomatous inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Whats the difference between a sty and chalazion?

A

Stye

  • Lid margin infection
  • on the eye lid
  • Painful ‘spot’

Chalazion

  • blokced gland not infection ‘hard’
  • within the eye lid
  • not usually painful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the management of chalazion?

A
  • Usually self limiting
  • Hot compresses
  • Massage
  • If not resolved: Incision + curettage to drain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What can cause ptosis?

A

Age-related degeneration of levator muscle aponeurosis
CNIII palsy/Horner’s syndrome
Myasthenia gravis/muscular dystrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What most commonly causes a corneal ulcer?

A

Contact lenses

Bacteria
Viruses
Acanthamoeba (live in water)
Fungi (immunocompromised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does a corneal ulcer present?

What is the investigation?

What is the managment?

A

CONTACT LENS USER

  • Redness+ Pain
  • Photophobia
  • Watering

Investigation

  • Fluorescein dye (can see epithelial damage)
  • Appears green in blue light
  • Check for foreign body

Managment
Topical Abx, Local, Eye clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the managment of corneal foreign body?

A

Corneal foreign body

  • lose foreign body can be irrigated with saline
  • can be removed with cotton bud/blunt tip needle
  • DO FLUROSCEIN DYE to check for corneal abrasion
  • consider chloranphenicol eye drops if risk of infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is anterior uveitis/iritis?

What conditions is this assosiated with?

A

Anterior uveitis/iritis?
-Inflammatory of iris and ciliary body

Autoimmune associations

  • Strongly associated with HLA-B27 (70%)
  • Rheumatoid/Bechets/Ank spond/Psoriasis/IBD/sarcoidosis

Infective associations

  • Toxoplasmosis/HIV/TB
  • Herpetic keratitis
  • Recent intraocular surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Symptoms of anterior uveitis?

A

Anterior uveitis

  • PAIN
    • -deep, boring pain
    • -↑with accommodation/movements
    • -photophobia
  • Blurred vision (because not accommodating properly-think of camera lens)
  • May have small pupil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How will the eye look in anterior uveitis?

A

Anterior uveitis

  • red eye (perilimbal ciliary injection)
  • IRREGULAR SHAPED PUPIL may be small (synechiae),
  • may have hypopyon (leukocyte exudate in the anterior chamber)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do you manage uveitis?

A
  • Analgesia + Urgent ophthalmology assessment
  • Opthalmology: Prednisolone 1% eye drops + cycloplegic (e.g. atropine/cyclopentolate) to temporarily paralyse cilary body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How would scleritis present?

A
  • Deep boring pain
    • -Wakes patient up from sleep
    • -Radiates to forehead
    • -Worse on eye movements (muscles)
    • -Tender to touch
  • Red eye
  • Vision may decrease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the treatment for scleritis?

A

Scleritis=systemic treatment. HIGH DOSE SYSTEMIC STEROIDS

*investigat underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How can you tell the difference between scleritis and episcleritis?

A

PHENYLEPHRINE EYE DROPS

branching of vessels=episcleritis (superior blood supply)
blueness or persistent redness after 5 mins=scleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Episcleritis vs Scleritis

symptoms, treatment, assosiations

A

Scleritis= deep pain. Episcleritis=little/no pain + watering
Scleritis=visual changes Episcleritis=no visual changes
Scleritis=systemic steroids. Episcleritis=self limiting (topical NSAIDS)
Scleritis=HLA-B27 conditions. Episcleritis=IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Define glaucoma

A

Death of optic nerve due to raised intraocular pressure (>21mmHg), optic disc cupping and progressive visual loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What type of glaucoma is most common? How does it present?

A

Open angle glaucoma

Bilateral peripheral visual loss (can be asymptomatic)

33
Q

What are the risk factors for open angle glaucoma?

A

Family history
Hypertension
Diabetes
Myopia = short sighted

34
Q

Explain what happens in closed angle glaucoma present?

A
  • Lens pushes against iris > aqueous can’t drain from posterior to anterior chamber
  • Trabecular meshwork also blocked >aqueous cannot drain from ant. chamber
  • RAISED intraocular pressure >sight-threatening
35
Q

Risk factors for closed angle glaucoma ?

A 
Hyperopia (long-sighted) – smaller eyes-easily blocked  
Low light (dilates pupil)
Drugs: sympathomimetics, anticholinergics (dilate pupil) (inhalers)
36
Q

How would closed angle glaucoma present?

A
  • RED and PAINFUL EYE
  • Systemic: nausea, vomiting, headache, abdo pain
  • ‘Halos’ around lights (often in eve-dilation of pupils)
  • Reduced aquity
37
Q

How would pupil look in closed angle glaucoma ? (3)

A
  • Red
  • Hazy cornea
  • MID DILATED PUPIL UNREACTIVE TO LIGHHT
38
Q

Treatment of closed angle glaucoma?

A
  1. Opiate analgesia & antiemetic (Oromorph + Ondansetron)
  2. IV acetazolamide (carbonic anhydrase inhibitor) - reduces aqueous production and ↓IOP
  3. Pilocarpine 1% drops (after 1hr)
    (Topical miotic>constrict the pupil and allows drainage)
  • **Emergency ophthalmic review for DEFINITIVE treatment -Laser peripheral iridotomy
  • Makes an alternate flow for aqueous
39
Q

What is keratitis?

How would this present?

A

Inflammation of cornea – often after trauma (contact lenses, lupus, syphilis)
Potentially sight-threatening

Presentation

  • Pain
  • loss of vision
  • purulent discharge (somethings on the eye and its trying to remove)
40
Q

Managment of keratitis?

A

Management
Same day ophthalmology referral
Stop using contact lens!
Antibiotics (topical +/- IV)

41
Q

Causes of subconjunctival heamorrage?

Treatment?

A

Raise in IOP (sneezing/coughing)
Aspirin (check coag if taking other anticoags)
Trauma
HTN (check BP)

Reassure: Will take 2-3wks to resolve

42
Q

What eye sign may suggest ocular trauma?

What is the management of ocular trauma?

A

-Hyphema may suggest blunt trauma (blood in ant chamber)

Managment (more serious than SCheamorrage)

  • Requires regular ophthalmic review and rest
  • IF PENETRATING GIVE ORAL ANTIBIOTICS and SURGERY
43
Q

How can you tell the difference between Periorbital (pre-septal) cellulitis and orbital cellulitis?

A

Orbital cellulitis (infection of eye mussels/fat

  1. Reduced visual acuity
  2. Proptosis
  3. Ophthalmoplegia / pain
  4. Red eye

Pre septal is just an infection of the skin and soft tissues so wont have these

44
Q

Different managment for Periorbital (pre-septal) cellulitis and orbital cellulitis?

A

Periorbital (pre-septal) cellulitis: Refer to hospital and Oral co-amoxiclav (but rule out orbital)

Orbital cellulitis: Admit for IV abx
CEFOTAXIME + FLUCLOXACILLIN
(may also need surgery)

45
Q

Investigation of choice for orbital cellulitis?

A

contrast CT head if orbital cellulitis is suspected (there is high mortality with orbital cellulitis)

46
Q

What organisms most commonly cause preseptal and orbital cellulitis? How do you treat each?

A

Preseptal

  • Staph aureus
  • Abx: co-amoxiclav 10 days

Orbital

  • Strep pneumoniae
  • Abx: flucloxacillin/ceftriaxone IV
47
Q

What are the main complications of orbital cellulitis?

A

Blindness
Meningitis
Cavernous sinus thrombosis

48
Q

Whats the treatment for open angle glaucoma

A

Latanoprost (prostaglandin analogue) - increases outflow

Timolol (beta-blocker) - reduces aqueous

49
Q

What are the side effects of latanoprost?

A

Thicker, darker, longer lashes

Darker iris + skin around eyes

50
Q

What can cause a painful loss of vision?

A 
Acute angle closure glaucoma
Giant cell arteritis 
Optic neuritis 
Uveitis, slceritis, keratitis 
Shingles 
Orbital cellulitis
51
Q

What can cause a painless loss of vision?

A 
Cataracts
Retinal detachment 
Retinal vessel occlusion 
Diabetic retinopathy 
Age-related macular degeneration 
Optic nerve compression (Berry aneurysm)
52
Q

What is amaurosis fugax?

A

TIA of a retinal artery

Causes transient monocular blindess due to transient retinal ischaemia (preceding central retinal artery occlusion-the MI of the eye)

53
Q

What are risk factors for cataracts?

A
  • old age
  • female
  • diabetes
  • smoking
  • steroids
54
Q

Classic symptoms of cataracts?

Signs of cataracts (2)

A
  • clouding
  • light scattering
  • HALOS
  • GLARRING AT NIGHT
  • obstruction of vision (painless, gradual, worse watching TV/reading)

Signs: loss of red light and opacities

55
Q

Most common cause of cataract (acquired/congenital)

A

Aquired: age
Congenital: rubella (also TORCH/EBV/chicken pox))

56
Q

What are the following tests
Amslers grid test
Tonmetry

A

Amslers grid test: macular degeneration

Tonmetry: pressure in eye

57
Q

Presentation of hepatic ulcer?

Treatment for herpatic ulcer?

A

Red eye, extremely painful, no discharge (unlike keratitis) (fluorescein drops)

treatment: topical Aciclovir drops 2 weeks

58
Q

Treatment for herpes zoster opthalmicus (herpes involving eye)

A

-ORAL aciclovir and topical steroids

59
Q

What signs would vitreous haemorrhage give with fundoscopy?

A

No red reflex
Can’t see retina

(if you can’t see in and patient can’t see out, it is likely vitreous haemorrhage and retinal detachment is the differential)

60
Q

What causes optic atrophy (big cup)?

A

Optic neuritis
End stage glaucoma
Tumour compressing optic nerve

61
Q

What is a central retinal artery occlusion?

How does it present?

A
  • Central retinal artery occlusion is an MI of the eye (caused by thromboembolic disease also in GCA)
  • Sudden onset unilateral LOV (time critical)
62
Q

What does fundoscopy of a retinal artery occlusion look like?

Treatment:

A
  • Pale retina (no blood supply) with oedema
  • Cherry-red macula (still okay because double blood supply)

Treatment-URGENT REFERAL

  • Masage eye (help with blood supply)
  • Nitrates to vasodilate
  • Surgical fibrinolytic
63
Q

What is central retinal vein occlusion?

How does it present?

A
  • PE of the eye (caused by venous thrombosis or nipping by HTN arteries)
  • Painless subacute LOV (few days)
  • More common that central artery occlusion
64
Q

What does fundoscopy of a retinal vein occlusion look like?

A
  • Hypertensive signs or arteries (tortuous, nipping)

- Looks like a cheese and tomato pizza -yellow and redness

65
Q

How do you manage retinal vein occlusion?

A

anti-VEGF

Vascular endothelial growth factor is released to recruit new blood vessels

66
Q

How does ARMD present?

A

Progressive central visual deterioration

67
Q

Differentiate between dry and wet age-related macular degeneration

A

Dry

  • Atrophic
  • Drusen in macula (yellow spots)

Wet

  • Exudative
  • Neovascularisation
  • Subretinal haemorrhages in/around macula
68
Q

Treatment for ARMD

A

Wet ARMD

  • Anti-VEGF - prevents neovascularisation
  • Laser phocoagulation

(no treatment for dry)

69
Q

Management of optic neuritis?

A

High dose methylprednisolone for 72hrs (1000mg/24hr IV)

then prednisolone 1mg/kg/d po for 11 days

70
Q

What is hyperopia vs myopia?

A

Hyperopia (long sighted) = an image of a distant object becomes focused behind the retina, making objects up close appear out of focus

Myopia (short sighted) = an image of a distant object becomes focused in front of the retina, making distant objects appear out of focus

71
Q

Name two types of squint

A 
Convergent squint (esotropia)
Divergent squint (exotropia)
72
Q

Which type of squint is more common? What causes it?

A

Esotropia - either no cause or can be due to hypermetropia

73
Q

How are squints investigated?

A

Corneal reflection

Cover test

74
Q

Describe a corneal reflection test

A

Reflection from a bright light falls centrally and symmetrically if no squint

75
Q

Describe a cover test

What is the cover/uncover test

A

Cover test is used to determine MANIFEST squints (tropias) I.e. squints that are ALWAYS there
-The uncovered eye moves to take up fixation (uncovered eye corrects itself)

Cover/uncover test

  • used to look for LATENT squints (phorias)
  • the eye will only squint when covered, and when uncovered its fine
76
Q

What is a paralytic vs a non paralytic squint?

A

Paralytic (or concomitant) squint is when the squint occurs in all directions of gaze, double vision does not normally occur

Non-paralytic is not constant, occurs when child is tired

77
Q

management of squint

A

Glasses for refractive errors
Eye patches
Operation eg resection and recession of rectus muscles to realign
Botulinum injections

78
Q

Pupil in acute angle closure glaucoma vs anterior uveitis

A

anterior uveitis
-irregular shape
-may be small
+/- hypopyon

acute angle closure glaucoma

  • mid dilated
  • unresponsive to light
  • hazy cornea
79
Q

Vitreous heamorrage vs vitreous detachment vs retinal detachment

A

Vitreous heamorrage

  • Large bleeds cause sudden visual loss (morning as blood is more settled)
  • Diabetics

Vitreous detachment
-Flashes/floaters

Retinal detachment

  • Flashing lights, floaters and loss of vision in the upper outer quadrant of his right eye.
  • Dense shadow that starts peripherally progresses towards the central vision
  • Straight lines appear curved

5thyr (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions