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Ophthalmology Flashcards

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USMLE® Step 1 flashcards
1
Q

Age-related macular degeneration (ARMD)

  1. Cause
  2. Initial investigation

Dry

  1. What percentage is dry, + time frame
  2. Risk factors
  3. Cause, + where cause builds up
  4. Macular dysfunction symptoms (4)
  5. Management - general

Wet

  1. What percentage is wet, + time frame
  2. Pathology
  3. Investigation is wet ARMD suspected
  4. Management + how it works
  5. Juvenile macular degeneration - AKA
  6. What is the macula
A
  1. Cone cell defect so macula cannot function as well
  2. Slit lamp microscopy
  3. 85%, gradual
  4. Female, smoking, HTN, previous cataract surgery
  5. Drusen deposits between RPE and Bruch’s membrane
  6. Painless, blurred central vision (peripheries unaffected), metamorphopsia (straight lines look wavy), micropsia / macropsia, decreased reading/colours/facial recognition
  7. Good diet/exercise, stop smoking, low vision clinic + aids
  8. 15%, subacute (days-weeks)
  9. Neovascularisation in attempt to correct vision
  10. Fluorescein angiography
  11. Anti-vitreal anti VEGF injections into the eye (monthly initially), laser therapy - stops neovascularisation
  12. Stargardt’s disease
  13. Part of retina responsible for central vision
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2
Q

Diabetic retinopathy

  1. Risk factors (5)
  2. Manifestations (4)
  3. Screening - when
  4. R1 (0 = none)
  5. R2 - refer
  6. R3
  7. M1 (0 = none) - refer
  8. Examination in maculopathy
  9. Management - lifestyle
  10. Management - if proliferative
  11. End points if not managed properly (2)
  12. Vitrectomy - indication
  13. Fundoscopy findings - end stage
A
  1. Type 1, HTN, poor control, rapid improvement, macro-micro albuminuria
  2. Maculopathy, new vessel disease, cataracts, CVA
  3. Kids 5 years post-diagnosis, increased in pregnancy
  4. Mild, non-P (microaneurysms, haemorrhages)
  5. Moderate/severe, non-P (exudate, cotton wool spots, venous bleeding, microvascular abnormalities)
  6. Proliferative - retinal neovascularisation
  7. Diabetic maculopathy
  8. Check acuity; reduction in acuity due either to cataracts or maculopathy
  9. Reduce BP, blood lipid levels, + HbA1C (slowly)
  10. Panretinal photocoagulation
  11. Tractional retinal detachment, rubeotic glaucoma
  12. Treat retinal detachment / macular oedema
  13. Scarring (white scar tissue bands) + retinal traction
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3
Q

Central retinal artery occlusion

  1. Main arteries supplying eye (2)
  2. Embolic causes (+ origins) (3)
  3. Causes - other (4)
  4. Symptoms (3)
  5. Fundoscopy - typical retinal sign
  6. What it leads to
  7. What to exclude

Management

  1. Drug to reduce intra-ocular pressure
  2. Drugs to start prophylactically
  3. Examination on follow-up
A
  1. Central retinal artery, posterior ciliary artery
  2. Fibrin-platelet (carotid arteries), Cholesterol (carotid arteries), Calcific (heart valves)
  3. Arteritis, migraine, syphilis, HSV
  4. Acute painless loss of vision, profound drop in visual acuity, RAPD in that pupil
  5. White (pale retina) but with a cherry red spot
  6. Ischaemia of the inner retinal layers and therefore oedema of nerve fibre layers
  7. GCA (potential reversible cause)
  8. Acetazolamide (arteriole dilatation)
  9. Aspirin, statin
  10. Check for carotid bruits and heart murmur
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4
Q

Blunt/sharp injuries to eye

Definitions

  1. Ecchymosis
  2. Hyphaema
  3. Substance used to visualise the corneal surface
  4. USS for what

Management

  1. Used to reduce inflammation and prevent rebleeding
  2. Blackball hyphaema
  3. Traumatic iritis - what is it
  4. Symptoms (3)
  5. Slit lamp finding
  6. Management
  7. Retrobulbar haemorrhage - what is it
  8. Symptoms
  9. Management
  10. Orbital floor fracture - presentation
  11. Urgent repair - indication
  12. Non-urgent repair - indication
A
  1. Skin discolouration due to bleeding
  2. Collection of blood in the anterior chamber
  3. Fluorescien
  4. Supra/subretinal haemorrhage
  5. Steroid, dilating drops (phenylephrine)
  6. Surgical washout
  7. Inflammation of the anterior chamber
  8. Pain, photophobia, blurred vision
  9. White cells and flare
  10. Steroid, mydriatic drops
  11. Compartment syndrome within the orbit
  12. Pain, proptosis, decreased vision, poor pupil reactions
  13. Emergency lateral canthotomy, cantholysis
  14. Diplopia, limited eye movements
  15. Painful restriction of upward gaze
  16. Persistent restricted eye movement / enophthalmos after one week
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5
Q

Retinal detachment

  1. Causes
  2. Who more at risk + why
  3. Common symptoms
  4. When is visual acuity normal
  5. Fundoscopy findings
  6. Rhegmatogenous detachment - definition/management
  7. Tractional detachment - definition/management
  8. Exudative detachment - definition/management
A
  1. Age-related retinal thinning, trauma
  2. Myopia - larger eyes, thinner far peripheral retina
  3. Posterior vitreous detachment symptoms: sudden unilateral floater(s), photopsia (flashes of light)
    then retinal detachment: gradual blurred vision, ‘shadow’ spreading across vision
  4. When the macula is spared
  5. Tobacco dust in the anterior vitreous
  6. Full thickness tear e.g. myopia; reattachment via laser cryotherapy and surgery with vitrectomy
  7. Fibrous / vascular membranes growing abnormally in the vitreous e.g patient with diabetic retinopathy; relieve traction
  8. Inflammatory / neoplastic condition leads to serous exudation from leaking BV beneath the retina; treat cause
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6
Q

Giant cell (temporal) arteritis

  1. What it is
  2. Associated disease
  3. Risk factors
  4. Ophthalmic features (2)
  5. Neuro-ophthalmic features (4)
  6. Systemic features
  7. Sign (temples)
  8. Examination finding
  9. Fundoscopy findings
  10. Important blood test
  11. Management
A
  1. Vasculitis manifesting in the eye
  2. Polymyalgia rheumatica
  3. > 50, female
  4. Unilateral acute loss of vision (amaurosis fugax), diplopia due to CN palsies
  5. Headache and scalp tenderness, hair loss, jaw claudication (all features rapid onset)
  6. Myalgia, anorexia, weight loss
  7. Tendorness over temporal artery
  8. RAPD
  9. White and swollen optic nerve, cotton wool spots and haemorrhages
  10. ESR (raised)
  11. Prednisolone 1mg/kg
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7
Q

Cataracts

  1. Definition
  2. Risk factors (including refractive error)
  3. Causes (4)
  4. Drug causes (3)
  5. Symptoms (3)
  6. Fundoscopy finding
  7. Management - conservative
  8. Management - definitive, + disadvantage of this
  9. Congenital cataracts - inheritance
  10. Other identifiable causes (4)
  11. Associated conditions (5)
A
  1. Opacity of the lens of the eye
  2. Myopia, DM
  3. Old age (commonest), trauma, radiation, surgery
  4. Steroids, phenothiazines, amiodarone
  5. Reduced colour, halos around lights, worsens in bright light/darkness ‘starbursts’
  6. Loss of red reflex
  7. Stronger glasses/ contact lens, brighter lighting
  8. Lens replacement; accommodation reflex is lost
  9. Autosomal dominant
  10. Chromasome abnormaility, Metabolic disorders, Intra-uterine infections
  11. Rubella, Down/Edward syndrome, varicella, CMV
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8
Q

Orbital cellulitis

  1. Pathology
  2. History
  3. Pre-septal / periorbital - involvement
  4. Presentation
  5. Management
  6. Orbital - causative organisms (3)
  7. Associated conditions
  8. Symptoms
  9. Associated pupillary defect
  10. Bloods
  11. Bedside tests
  12. Imaging
  13. Complications (4)
A
  1. Infection / inflammation of orbital soft tissue with ocular dysfunction
  2. Recent sinus infection, trauma
  3. Only eyelids (skin symptoms but no eye symptoms)
  4. Both eyes are swollen and tender
  5. IV ABX
  6. H.influenzae, streptococcus, staphylococcus
  7. URTI, undiagnosed sinusitis
  8. Painful, swollen eye, erythema, chemosis, reduced vision, reduced/painful eye movements, systemically unwell
  9. RAPD - due to CN 2 compression
  10. FBC, WBC, CRP, consider blood culture
  11. Swabs
  12. CT sinus and orbits
  13. Sepsis, meningitis, optic nerve damage, cavernous sinus thrombosis
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9
Q

Red eye - general

  1. Chemosis - meaning
  2. History - important points
  3. Differentials (5)
  4. Subconjunctival haemorrhage - causes (2), presentation
  5. Anterior uveitis/iritis - presentation
  6. Acute glaucoma - presentation
  7. Likelier to present in
  8. Symptoms
  9. Scleritis - presentation (give NSAIDs)
  10. Conjunctivitis - presentation
  11. Endophthalmitis - presentation
  12. Episcleritis - presentation
A
  1. Red, swollen conjunctiva
  2. Contact lens use, sexual activity, recent URTI, allergies, contact with other people with red eyes
  3. Conjunctivitis, anterior uveitis (iritis), bacterial keratitis, ACAG, dendritic ulcer, subconjunctival haemorrhage, scleritis, endophthalmitis
  4. Trauma, HTN (history of trauma/coughing bouts); painless bright red blood patch, vision unaffected
  5. Pain, photophobia, less/blurred vision, small fixed oval pupil
  6. Red eye, mild dilated pupil, fixed, hazy cornea
  7. Dim light (pupils dilate)
  8. Pain, photophobia, nausea
  9. Severe pain (worse on movement), autoimmune links
  10. Discharge - purulent (bacterial) / clear (viral)
  11. Red eye, pain, visual loss following ocular surgery
  12. Mostly PAINLESS, watering, mild photophobia, improves after phenylephrine (if not then scleritis)
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10
Q

Strabismus + refraction

  1. Concomitant strabismus - definition
  2. Incomitant strabismus - definition
  3. Strabismus in children - cause
  4. Emmetropia - definition
  5. Hypermetropia - definition
  6. What eyeball shape, + relation between light/retina
  7. Management
  8. Myopia - definition
  9. What eyeball shape, + relation between light/retina
  10. Management
  11. Astigmatism - definition
  12. What eyeball shape, + relation between light/retina
  13. Presbyopia - definition
  14. Cause
A
  1. Deviations remains the same in all positions of gaze
  2. Angle of deviated eye changes with gaze position i.e. it’s not constant
  3. Amblyopic eye
  4. Normal eye with no refractive error
  5. Long sightedness (can see in distance but not near)
  6. Small eyeball, light behind retina (blurry close-up)
  7. Convex glasses
  8. Short sightedness (can see near but not far away)
  9. Stretched eye, light in front of retina (blurry far away)
  10. Concave glasses
  11. Unequal refraction
  12. Imperfectly-shaped lens/cornea; uneven light on retina (blurry at any distance)
  13. Gradual loss of focusing/accommodation power
  14. Age-related lens stiffening
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11
Q

Glaucoma

  1. Classification (3 questions)
  2. Definition
  3. Which part of vision lost
  4. Risk factors - vascular (3)
  5. Risk factors - non-vascular
  6. Screening if positive FH
  7. What is used to measure IOP
  8. Raised IOP leads to
  9. Fundoscopy - findings
  10. Other examination - findings
A
  1. Primary/secondary, open/closed angle, acute/chronic
  2. Multifocal optic neuropathy
  3. Peripheral
  4. CVD, vasospasm (migraine, raynaud’s), systemic hypotension
  5. Age, raised IOP, FH, race, myopia, decreased corneal thickness, DM, tight collar/tie
  6. Annually from 35yo
  7. Goldmann applanation tonometer
  8. Axon loss
  9. Cupping (thinning of optic disc neuroretinal rim), peripapillary atrophy, vascular/RNFL changes
  10. Decreased visual fields (+ VA if central VF affected)
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12
Q

Visual field defects - lesion site

  1. Tests to check (2)
  2. Optic nerve
  3. Optic chiasm (pituitary adenoma)
  4. Optic tract
  5. Optic radiation
  6. Sudden painless loss of vision - causes (5)
A
  1. Inattention (2 eyes, significant VF loss/stroke), Confrontation (1 eye, numbers/movement)
  2. Ipsilateral mononuclear visual loss
  3. Bitemporal hemianopia
  4. Contralateral homonymous hemianopia
  5. Contralateral homonymous hemianopia w/ macular sparing
  6. Amaurosis fugax from ischaemic/vascular (thrombosis, embolism, GCA, ischaemic optic neuropathy), Retinal vein occlusion, Retinal artery occlusion, Vitreous haemorrhage, Retinal detachment
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13
Q

Optic disc pathology

  1. Unilateral disc swelling - causes
  2. Vascular (4)
  3. Inflammatory (5)
  4. Infiltrative (1)
  5. Infective (2)
  6. Bilateral disc swelling - causes (3)
  7. Retinal dystrophy - types (2)

Optic atrophy - causes

  1. Main vascular
  2. Nutritional (3)
  3. Inflammatory (2)
  4. Neurological (1)
  5. Presentation
  6. Optic pallor - causes (5)
A
  1. Central retinal vein occlusion, Diabetic papillopathy
  2. Ischaemic optic neuropathy, GCA
  3. Papilitis, SLE, paranasal sinus disease, MS, sarcoidosis
  4. Lymphoma
  5. Herpes, Toxoplasmosis
  6. SOL, Hydrocephalus, Malignant HTN
  7. Cone dystrophy, Retinitis pigmentosa (night blindness, bone spicule pigmentation in mid-peripheral retina)
  8. Central retinal artery occlusion
  9. Vit B12 deficiency, tobacco, alcohol
  10. Sarcoidosis, polyarteritis nodosa
  11. Demyelination (+ neuritis)
  12. Reduced visual acuity, central scotoma, pale disc, RAPD
  13. SOL, optic neuritis, low B12/folate glaucoma, disc infarct
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14
Q

Hypertensive retinopathy

  1. Stage 1
  2. Stage 2
  3. Stage 3
  4. Stage 4
  5. Above classification name
A
  1. Arteriolar narrowing and tortuosity (silver/copper wiring), increased light reflex
  2. Arteriovenous nipping
  3. Cotton wool exudates, flame and blot haemorrhages
  4. Papilloedema
  5. Keith-Wagener Classification
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15
Q

Conjunctivitis

  1. Causes (4 broad)
  2. General signs
  3. Investigations
  4. Management - lifestyle
  5. Viral - history
  6. Commonest virus
  7. Spread
  8. Examination
  9. Discharge
  10. Management
  11. Allergic - history
  12. Examination
  13. Discharge
  14. Management
  15. Chlamydial - history
  16. Examination
  17. Discharge
  18. Management
A
  1. Bacterial, viral, allergic, chlamydial
  2. Red eye (conjunctival injection), mucoid discharge, reactive pupils, normal visual acuity
  3. Swabs - bacterial / viral / chlamydial
  4. No contact lenses for 48hrs after symptom resolution, wash hands, avoid sharing towels
  5. History of cough/cold; weeks duration
  6. Adenovirus (non-enveloped, double-stranded DNA)
  7. Respiratory/ocular secretions
  8. Diffuse redness +/- follicles/lymphadenopathy
  9. Clear discharge
  10. Self-limiting; hygiene measures
  11. Itchy, history of atopy or contact with chemicals/eye drops
  12. Chemosis, +/- papillae
  13. Clear stringy discharge
  14. Topical/oral antihistamines, topical steroids
  15. Young patient, chronic and bilateral, STI symptoms
  16. Diffuse, injection +/- follicles, keratitis +/- pannus
  17. Mucopurulent discharge
  18. Topical ABX; test partner for STI
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16
Q

Uveitis

  1. What it is
  2. Anterior uveitis - definition
  3. Symptoms
  4. Signs
  5. Management
  6. Associated with
A
  1. Inflammation of the uveal tract (iris, ciiary body, retina, choroid
  2. Inflammation of iris (iritis) or ciliary body
  3. Pain on looking at bright lights, blurry vision, acute onset, dull ache, lacrimation
  4. IOP raised (posterior synechiae), unilateral non-blanching red conjunctiva around cornea (ciliary flush), injected iris, small/irregular pupil (iris stuck to lens - PS). No discharge
  5. Topical steroid drop (can’t drive), cyclopentolate drop (dilating for pain relief)
  6. HLA-B27 (and associated conditions)
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17
Q

Corneal ulcer

  1. Keratitis - definition
  2. Investigation - how to examine
  3. IOP
  4. Bacterial keratitis - definition
  5. Management
  6. Dendritic ulcer - causative organism
  7. Presentation
  8. Management
  9. What not to use
  10. Thickened cornea/central opacification - suggests what
A
  1. Inflammation of cornea
  2. Use fluorescin (orange) under cobalt blue filter
  3. Normal/raised
  4. Corneal ulcer caused by bacteria
  5. Topical broad spectrum ABX
  6. HSV 1
  7. Pain, red, burning, irritation, photophobia, vesicles around eye, watering, ‘foreign body sensation’
  8. Aciclovir 3% eye ointment tds for 3 days
  9. Steroids
  10. Disciform keratitis
18
Q

Presentations

  1. Migraine
  2. Optic neuritis
  3. Benign intracranial HTN
  4. Central retinal vein occlusion
A
  1. Unilateral headache, maybe aura/prodromal symptoms, photophobia, nausea, maybe triggers, vision normal
  2. Unilateral decrease in VA, colour vision loss, PAIN on eye movement, may have RAPD
  3. Headache (ICP symptoms) blurred vision, N+V
  4. Sudden PAINLESS loss of vision, retinal haemorrhages (flame and blot), oedema (disc, macula)
19
Q

Vitreous haemorrhage

  1. Risk factors
  2. Presentation

Retinopathy of prematurity

  1. Why it occurs
  2. Management
  3. Result if left untreated
  4. Screen if
A
  1. DM, bleeding disorders/anticoagulants, retinopathy of prematurity
  2. Sudden painless loss of vision, dark spots
  3. Exposure to increased concentrations of ambient oxygen
  4. Transpupillary diode laser therapy
  5. Vitreous haemorrhage, retinal detachment, blindness
  6. Born before 32 weeks or under 1.5kg
20
Q

Pupil - other findings

  1. Argyll-Robertson Pupil - findings
  2. Significance
  3. Holmes-Adie pupil - findings
  4. Common patient
  5. Associated findings
  6. Marcus Gunn pupil (RAPD) - finding
  7. Pathophysiology
  8. Causes (2)
  9. Tadpole pupil
  10. Acute angle closure glaucoma
  11. Constricted - causes
  12. Dilated - causes
A
  1. ARP (accomodation reflex present), PRA (pupillary reflex absent) - no response to light, constricts to close object
  2. Neurosyphilis, diabetic neuropthy
  3. Unilateral dilated, slow to redilate post- constriction
  4. Female
  5. Absent ankle/knee reflexes
  6. Affected pupil remains dilated when light shone in but dilates when a bright light is swung from the unaffected eye to the affected eye
  7. Caused by lesion anterior to optic chiasm i.e. optic nerve or retina (optic pathway)
  8. Retinal detachment, optic neuritis
  9. Temporary; migraines
  10. Vertical oval (dilated, fixed)
  11. Horner’s, cluster, A-R, opiates, nicotine, pilocarpine
  12. CN 3 palsy, H-A, raised ICP, anticholinergics
21
Q

Vision loss - important history

  1. Timing
  2. Pattern
  3. PMH
  4. FH
  5. SH
A
  1. Acute/subacute/chronic
  2. One (which) or both eyes, pattern (patchy, VF, central)
  3. Ophthalmic disease/surgery, ocular injury (mechanism important), ambylopia (lazy eye), spectacle/lens use (up to date prescription?)
  4. Unexplained visual loss
  5. Smoking/drinking, occupation, whether they drive
22
Q

Visual acuity - examination

  1. How it should be tested
  2. Next steps if patient cannot read top line of Snellen chart at 1.5 metres
  3. Maximum VA
  4. LogMAR VA - when to stop
  5. Best score
A
  1. 6m Snellen Chart
    Wear corrective lenses
    If still wrong, use pin holes (record VA stating PHs used)
    If patient cannot see top line at 6m, do 3m, then 1.5m
  2. Check hand movements, perception to light, then ‘NPL’
  3. 6/4.5 to 6/3.5
  4. If patient gets 4/5 letters on a line wrong
  5. Best scores closest to 0
23
Q

Anatomy

  1. Retina - number of layers
  2. Important layers (2)
  3. Arterial supply (branch of what)
  4. Cornea - structure composed of what
  5. Number of layers
  6. Derives oxygen from where
  7. Sclera - structure composed of what
A
  1. 10 layers
  2. Retinal pigment epithelium; Photoreceptor layer - rods (night), cones (colour/day)
  3. Ophthalmic artery (branch of carotid)
  4. Regular arranged collagen fibres
  5. 5
  6. Avascular; so oxygen dervied from tear film and aqueous
  7. Irregular arranged collagen fibres
24
Q

Fundoscopy - general

  1. Stages (5)
  2. When might red reflex not be present (4)
  3. White red reflex - aka
  4. White red reflex - causes (3)
  5. What to say when looking for peripheral changes
  6. What to say when want to look at macula
  7. What to look for in optic disc (3 Cs)
  8. C1 - normal finding
  9. What is cupping, found when
  10. C2 - normal finding
  11. Abnormal finding
  12. C3 - normal finding
  13. Abnormal findings
A
  1. Red reflex, retinal imaging (follow to optic disc), four vascular arcades, peripheral changes, macula
  2. Problem with cornea, anterior chanber, lens, vitreous cavity
  3. Leukocoria
  4. Lens (cataract), Vitreous (haemorrhage), Retina (retinoblastoma)
  5. Look up/down/left/right
  6. Look directly at light
  7. Cup, colour, contour
  8. Rim 0.3 of centre
  9. Increased rim:centre ratio; glaucomatous change
  10. Should be pinky/orange
  11. White is avascular
  12. Clear borders
  13. Blurred borders; suggest papilloedema
25
Q

DVLA regulations

  1. General
  2. Diplopia
A
  1. Must be able to read number plate at 20m
    At least 6/12 in best eye if car driver
    At least 6/7.5 in best eye if lorry/bus driver
    At least 6/60 in other eye
    Glasses acceptable (max 8 prescription strength)
    Visual fields: 160 degrees horizontal, 30 degrees vertical
  2. Stop immediately, inform DVLA, can restart if treated/resolves
26
Q

Retinoblastoma

  1. Commonest what
  2. Why it occurs
  3. Types (2)
  4. Predisposing gene
  5. Non-heritable - specific features (3)
A
  1. Primary paediatric intra-ocular malignancy
  2. Malignant transformation of primitive retinal cells before differentiation around 3 years old
  3. Heritable (40%), Non-Heritable (60%)
  4. RB1 at 13q14
  5. Unilateral, non-transmissible, doesn’t pre-dispose to secondary non-ocular cancers
27
Q

Bacterial conjunctivitis

  1. History
  2. Common causative organisms
  3. Examination
  4. Discharge
  5. Management
  6. Management - H.Influenzae in children
  7. Less severe + unresponsive to treatment, do what
  8. Severe in adults - organism
  9. Management
  10. Severe in children - organism
  11. Management
A
  1. Unilateral/bilateral
  2. Strep pneumoniae, Staph aureus ,Haemophillius influenzae (kids), Moraxella catarrhalis
  3. Diffuse redness
  4. Mucopurulent discharge
  5. Chloramphenicol eye drops QDS, hygiene measures
  6. PO amoxicillin, Clavulanic acid
  7. Do PCR; rule out chlamydial or viral conjunctivitis
  8. Neisseria gonorrhoeae
  9. Ceftriaxone/quinolone/macrolide
  10. Meningitidis - meningococcal conjunctivitis
  11. IM benzylpenicillin/ceftriaxone or PO ciprofloxacin
28
Q

Endophthalmitis

  1. What it is
  2. Commonly occurs when
  3. Commonest causes (3)
  4. Symptoms
  5. Management - medical
  6. Management - surgical
  7. Vancomycin covers what
  8. Ceftadizime covers what
A
  1. Inflammation of the interior of the eye
  2. Post-op complication (mainly cataract surgery)
  3. Infective (bacterial or fungal), trauma, allergic reaction
  4. Unilateral severe pain, acute loss of vision, conjunctival/episcleral redness (‘injected’), hypopynon in anterior chamber
  5. Urgent intra-vitreal antibiotics (vancomycin and ceftazidime), steroids
  6. Pars plana vitrectomy/evisceration
  7. Gram positive bacteria
  8. Gram negative bacteria
29
Q

Herpes simplex virus (HSV)

  1. Difference between HSV1 and HSV2
  2. Childhood primary infection - ophthalmic signs (2)
  3. Other symptoms (3)
  4. Herpes zoster ophthalmicus - what is it
  5. Signs
  6. Management
A
  1. HSV 1 - infection above waist (face, lips, eyes)
    HSV 2 - genital herpes, neonatal conjunctivitis
  2. Blepharitis, conjunctivitis
  3. Mild fever, malaise, URT symptoms
  4. Shingles (varicella zoster virus) affecting ophthalmic branch of facial nerve
  5. Peri/orbital vesicular rash, huntington’s sign (rash on side/tip of nose)
  6. PO/IV antivirals, topical steroid if inflamed
30
Q

Random points to remember

  1. Fluorescin staining - useful when (3)
  2. Steroids - do not prescribe in what (3)
  3. Retinal vessels formed when, from what
  4. When avascular, retina produces what
A
  1. Dendritic ulcers, Corneal abrasion, Microbial keratitis
  2. Conjunctivitis, bacterial keratitis, dendritic ulcers
  3. 4th month of gestation; from hyaloid vessels
  4. VEGF
31
Q

Aqueous humour

  1. Secreted from
  2. Subsequent path
  3. Leaves eye via (2)
  4. Conventional pathway - structures involved (3)
  5. Unconventional pathway
  6. Drainage angle - structures involved
A
  1. Ciliary processes
  2. CP, posterior chamber, pupil, anterior chamber, leaves eye
  3. Conventional (84%) or unconventional/uvoscleral (6%) pathway
  4. Trabecular meshwork (at drainage angle), Schlemm’s canal, Episcleral veins
  5. Ciliary body, through suprachoroidal space, into venous circulation
  6. Iris, cornea
32
Q

Acute closed angle glaucoma

  1. What this means
  2. Risk factors
  3. IOP
  4. Potential complaint
  5. Do not prescribe what + why
  6. Immediate management (+ MOA)
  7. Maintenance management
  8. Surgical preventative measures
  9. Secondary glaucoma - commonest cause
  10. Other causes (6)
  11. Normal tension glaucoma - normal IOP
  12. Commonest race
A
  1. Peripheral iris covers the trabecular meshwork
  2. SE Asian, females, small/hypermetropic eyes (shallow anterior chambers), cataracts
  3. 60-79mmHg
4. Preceding transient episodes of headache and coloured halos around bright lights on affected side
Headache and vomiting (raised IOP)
Painful, hard, red eye
Dilated and fixed pupil (oval)
Decreased VA, cloudy oedematous cornea
  1. Pupil dilators e.g. tropicamide/phenylephrine; can close off angle completely
  2. IV acetazolamide (suppress aqueous production), pilocarpine (opens angle)
  3. PO acetazolamide
  4. Laser peripheral cridotomy, surgical iridectomy
  5. Trabecular network obstruction
  6. Cataracts, hyphaema, uveitis, dispersion syndrome, pseudo-exfoliative, steroid-induced
  7. 12-22mmHg
  8. Japanese
33
Q

Open angle glaucoma

  1. Commonest type (of all glaucomas)
  2. What this means
  3. Who more at risk

Primary open angle (POAG)

  1. Early symptoms
  2. Bit of vision lost first
  3. Management - 1st line + SE
  4. 2nd line (2) + SEs
  5. Which are aqueous suppressors
  6. Prophylactic topical drops
A
  1. Chronic open angle (COAG)
  2. Peripheral iris is clear of the trabecular meshwork
  3. Black people, myopia
  4. Asymptomatic
  5. Peripheral field
  6. Prostaglandin analogue ‘prost’ (eyelash growth)
  7. Timolol (cardiac, impotence) OR carbonic anhydrase inhibitors e.g. olamide (bitter)
  8. Beta blockers, alpha agonists, carbonic anhydrase inhibitors
  9. Phenylphrine, tropicamide
34
Q

Blowout fracture

  1. Signs/symptoms
  2. Management - non-surgical
  3. What to avoid + why
A
  1. Vertical diplopia (mechanical restriction)
    Raised IOP - echymosis, enophthalmous, swelling
    Infra-orbital paraesthesia (V2 from CN 5 affected)
  2. Broad-spectrum ABX
  3. Don’t blow nose (communication with sinuses - bacteria enters orbit)
35
Q

Diplopia

  1. History
  2. Important PMH
  3. Differentials
  4. Examination - considerations (3)
  5. Vertical causes
  6. Horizontal causes
  7. Horizontal + vertical causes
  8. TED - symptoms
  9. Management - temporary
  10. Management - permanent
A
  1. Speed of onset, sudden pain, where is diplopia
  2. Trauma, DM, HTN
  3. CN 4/6 palsy, thyroid eye disease, blowout fracture
  4. No glasses (frames get in the way), Ask for diplopia/pain in each position, Use light + always look for corneal reflection
  5. CN 4 palsy (+ torsion), blowout fracture
  6. CN 6 palsy (worst when looking towards palsy/distance fixation)
  7. Thyroid eye disease
  8. Pain, proptosis, lid retraction, chemosis, periorbital oedema, epiphora (but still feels dry)
  9. Patch/fresnel prism
  10. Long-term prism/surgical realignment
36
Q

Uncomfortable eyes - description

  1. Dry eye
  2. Ocular surface problems
  3. Uveitis/scleritis/increased eye pressure
A
  1. Gritty/dry/want to close
  2. Sharp/stabbling/like needles
  3. Dull ache (like toothache)
37
Q

Dilating eye drops

  1. Common examples (3)
  2. Which to use in children
  3. Which to visualise corneal surface
  4. Which to manage uveitis
  5. When not to use (2)
A
  1. Topicomide 1%, Cyclopentalate 1%, Phenylephrine 2.5%
  2. Cyclopentolate
  3. Phenylephrine
  4. Cyclopentolate
  5. Painful red eye, narrow angle glaucoma
38
Q

Retinal vascular disease - general

  1. Causes
  2. Changes seen in capillary occlusion (3)
  3. Changes seen in capillary leakage (3)
A
  1. DM, HTN, GCA
  2. Cotton wool spots, irregular retinal veins, new vessel formation
  3. Lipid exudates, oedema, haemorrhages
39
Q

Corneal disease - general

  1. Main types (4)
  2. Which is age-related
  3. Which is inflammatory
  4. Which involves thinning/astigmatism
  5. Abrasion - examination with what
  6. Presentation
  7. Management
A
  1. Fuch’s dystrophy, keratitis, HSV/shingles, keratoconus
  2. Fuch’s dystrophy
  3. Keratitis - commonest is HSV
  4. Keratoconus
  5. Fluorescin dye
  6. Pain, red, photophobia, foreign body sensation, watering, blurry
  7. Topical ABX (chloramphenicol drops), analgesia
40
Q

Eyelid problems

  1. Blepharitis - eyelid margin inflammation
  2. Stye (hordoleum) - external, what it infected
  3. Internal - what is infected
  4. Management
  5. Chalazion - aka
  6. Presentation
  7. Management
  8. Entropion - complications
  9. Ectropion - complication
A
  1. Gritty, itchy, dry sensation - hot compress, gentle clean
  2. Glands of Zeis / glands of Moll
  3. Meibomian glands
  4. Hot compress, analgesia, chloramphenicol if persistent or + conjunctivitis
  5. Meibomian cyst
  6. Eyelid swelling, most non-tender (can be tender/red)
  7. Hot compress, analgesia, chloramphenicol if acutely inflamed
  8. Corneal damage / ulceration
  9. Exposure keratopathy

Medical School (28 decks)

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