Ophthalmology - Facts from PassMed Questions

Question 1

Hypermetropia is associated with:

a) Primary open-angle glaucoma
b) Acute angle closure glaucome

Answer 1

b)
Due to their eyes being smaller, having shallower anterior chambers and their angles being narrower
(Myopia and primary open angle are linked)

Question 2

Pathophysiology of a squint

Answer 2

Imbalance of extrocular muscles

Question 3

How to detect a squint

Answer 3

Corneal light reflection test - hold a light source 30cm away from child and see if light hits the pupils symmetrically

Question 4

Management of a squint

Answer 4

Refer to ophthalmology - they may give an eye patch

Question 5

Investigation into nature of squint

Answer 5

Cover test - cover one eye and see how the other moves

Question 6

Management of anterior uveitis

Answer 6

Urgent review by optho
Cycloplegics - dilates pupil to help relieve pain and photophobia e.g. atropine
Steriod eye drops

Question 7

Herpes Zoster Ophthalmicus Mx

Answer 7

Oral antiviral treatment started within 72 hrs - giev for 7-10 days
IV used for severe infection
Topical steroids - used to treat secondary inflammation of eye
Urgent ophtho review - if ocular involvement (Hutchinson’s sign)

Question 8

What do cotton wool spots represent

Answer 8

Areas of retinal infarcion - pre capillary arteriolar occulsion

Question 9

Investigations for Macular degeneration

Answer 9

Slit lamp
Fluorescein angiogrpahy - this can guide intervention eith anti-VEGF therapy
Ocular coherence tomography - used to visulaise the retina

Question 10

Macular degenration Mx

Answer 10

Zinc and antioxidant treatment
anti-VEGF treatment - e.g. ranibizumab. 4 weekly injections
Laser photocoagulation - use if new vessel formation

Question 11

Pathophysiology of Age-related macular degenration

Answer 11

Degeneration of retinal photoreceptors that reulst in the formation of drusen - seen on fundoscopy

Question 12

Difference between episcleritis and scleritis - vessel mobility and pain

Answer 12

In episcelritis, the injected vessels are mobile when gentle pressure is applied on the sclera.
In scleritism vessels are deeper, hence do not move

Epi - no pain (little pain)
Scler - painful

Question 13

What condition presents with night blindness and tunnel visison

Answer 13

Retinitis Pigmentosa 
(Retinal = Re 'Tunnel' vision and Tunnel's are dark ...night blindness

Question 14

What is alport’s syndrome?

Answer 14

Kidney disease + Hearing loss + Eye anbnormality

Question 15

Hypertensive retihnopathy Grading

Answer 15

I - Arteriole narrowing and tortuosity. Increased light reflex - silver wiring
II - Arteriovenous nipping
III - Cotton wool exudates. Blot haemorrhages
IV - Papilloedema

Question 16

What form of metabolic disruption predisposes someone to cataract formation

Answer 16

Hypocalceamia

Question 17

Signs of blepharitis

Answer 17

Bilateral red sore eyelids

Dry gritty eyes

Question 18

Mx of blepharitis

Answer 18

Hot compress & mechanical removal of lid debris

Artificial tears

Question 19

Pathophysiology behind belpharitis

Answer 19

Inflammation of eyelid margins.
Due to meibomian gland dysfunction - they secrete oil onto the eye surface so any condition that affects these, will cause dry eyes

Question 20

High Co2 / Low Ca2 = …

Answer 20

Papilloedema

Question 21

Purulent discharge and crusting of eyelids in newly born baby - what do you do?

Answer 21

Urgent swabs for micro investigation - it is common but it may indicate severe infection (chlamydia or gonococcus) so you must investigate
Start systemic abx treatment for possible infection while awaiting lab results

Question 22

Features of Horner’s syndrome

Answer 22

Miosis
Ptosis
Enophthalmos (sunken eye)
+/- anhidrosis (loss of sweating on affected side)

Question 23

What disease is associated with anterior uveitis

Answer 23

Crohn’s disease

Question 24

What is used to investigate a refractive error as a cause of blurred vision?

Answer 24

Pin hold occluder

Question 25

Contact lense wearers presenting with a red eye

Answer 25

Refer for same day ophtho assessment - at risk of microbial keratitis