Ophthalmology Formative

Question 1

Lateral rectus = what cranial nerve?

Answer 1

CN VI - abducens nerve

Question 2

Lateral rectus = what eye movement?

Answer 2

Abduction (i.e. moves it laterally)

Question 3

Lateral rectus = What cranial nerve + what eye movement?

Answer 3

CN VI - ABDucens
ABDuction
(i.e. moves it laterally)

Question 4

Medial rectus = what cranial nerve + what eye movement?

Answer 4

CN III (oculomotor nerve)
Adduction (i.e. moves it medially)

Question 5

Superior oblique eye movement?

Answer 5

Pushes the eye DOWN and OUT

Question 6

Inferior oblique eye movement?

Answer 6

Pushes the eye UP and OUT

Question 7

Which eye is this?

Answer 7

Right eye

The optic disc is present on the nasal side of the retina; therefore, this is the right eye. Simply – disc on the right = right eye.

Question 8

What is the test for an RAPD (Relative Afferent Pupillary Defect) ?

Answer 8

‘Swinging light test’

Rapid changes of light stimulation from one eye to the other and both pupils should stay equally constricted.

Question 9

When performing the ‘swinging light test’, which sign shows a RAPD is present?

Answer 9

Dilation of the affected pupil (it should normally constrict)

Question 10

Label:

Answer 10

Question 11

Label:

Answer 11

Question 12

The oculomotor motor (CN III) nerve supplies which muscles of the eye?

Answer 12

inferior rectus, medial rectus, inferior oblique

**The innervation of the muscles of the eye can be remembered by:
LR6, SO4.
(lateral rectus is supplied by CN VI, superior oblique by CN IV)
!!! All others are supplied by CN III !!!
(i.e. superior rectus, inferior rectus, medial rectus and inferior oblique).

Question 13

Superior oblique nerve supply?

Answer 13

CN IV (Trochlear nerve)

Question 14

Inferior oblique nerve supply?

Answer 14

CN III

Remember LR6, SO4.
All other eye muscles are CN III.

Question 15

Child suspected of having pre-septal cellulitis.
What other condition must be ruled out?

Answer 15

Orbital cellulitis.

Causes pain on eye movement or proptosis (eye bulging)

Question 16

Cotton wool spots =

Answer 16

Commonly due to diabetes !

Areas of nerve layer infraction due to hypoxic conditions in the retina and is the result of axonal debris build up

Question 17

Rubeosis iridis =

Answer 17

Rare complication of severely uncontrolled diabetes

Question 18

Cherry red spots =

Answer 18

Retinal artery occlusion

Question 19

Copper wiring =

Answer 19

Hypertensive retinopathy

Question 20

Inner, lower vision has worsened.
Where is the retinal detachment?

Answer 20

Superior temporal retinal detachment

(opposites)

Question 21

Risk factors for retinal detachment

Answer 21

Ageing — over age 50

Previous retinal detachment

Family history of retinal detachment

Extreme shortsightedness (myopia)

Previous eye surgery

Previous severe eye injury

Previous other eye disease or disorder e.g. retinoschisis, uveitis or retinal degeneration

Question 22

Absent red reflex and a dense opacification of the lens

Answer 22

Cataract

Question 23

Treatment for cataracts in both eyes, right eye is worse

Answer 23

Phacoemulsification and insertion of an intra-ocular lens in the right eye.
Left eye to be done at another time.

Question 24

Treatment for cataract

Answer 24

Phacoemulsification and insertion of an intra-ocular lens

Question 25

Pathology affecting the TEMPORAL lobe = what kind of visual pathway defect?

Answer 25

Contralateral homonymous SUPERIOR quadrantinopia

Question 26

Pathology affecting the PARIETAL lobe = what kind of visual pathway defect?

Answer 26

Contralateral homonymous INFERIOR quadrantinopia

Question 27

Bacterial conjunctivitis treatment =

Answer 27

Topical chloramphenicol

Question 28

Viral conjunctivitis treatment =

Answer 28

Conservative management

Question 29

Chlamydial conjunctivitis treatment = topical or systemic?

Answer 29

Both

Question 30

Investigation to distinguish between wet and dry AMRD?

Answer 30

OCT (Optical coherence tomography)

Question 31

Inflammation of the lid margins which may involve the lashes and lash follicles =

Answer 31

Blepharitis

Question 32

Extended use of contact lenses could cause ...

Answer 32

Infectious keratitis

Question 33

What condition?

Answer 33

Hypertensive retinopathy

Question 34

Fixed mid dilated pupil + eyelid is manually elevated due to ptosis. Which nerve palsy?

Answer 34

CN III supplies levator palpebrae superioris + pupil constriction.

Question 35

Which nerve palsy? (down and out appearance)

Answer 35

CN III

Question 36

What happens when rod and cone cells are exposed to light?

Answer 36

Rhodopsin is converted into opsin and trans-retinal therefore sodium channels CLOSE + the membrane is HYPERPOLARISED therefore NO neurotransmitter being released into the synapse An action potential is then generated in the ganglion cells which is propagated to the brain.

Question 37

Acute demyelination of the optic nerve + loss of colour vision (unilateral) = what condition?

Answer 37

Optic neuritis

Question 38

What condition is optic neuritis strongly associated with?

Answer 38

Multiple sclerosis

Question 39

What is happening here?

Answer 39

Swelling of the optic disc

Question 40

What is shown here?

Answer 40

Synechiae (Adhesions between the pupil and iris that can lead to a small/irregular pupil)

Question 41

What is shown here?

Answer 41

Hypopyon (The accumulation of leukocytes in the anterior chamber due to severe intraocular inflammation)

Question 42

A fluorescein dye has been applied, showing what?

Answer 42

A dendritic ulcer. (cornea is inflamed by infection with herpes simplex virus or herpes zoster virus. Lesions follow branching lines, along which tiny blisters may form and break, leaving raw areas.)

Question 43

1. Corneal reflections = asymmetrical 2. Uncovered eye moves OUT to take up fixation

Answer 43

Manifest convergent squint

Question 44

1. Corneal reflections = symmetrical 2. Uncovered eye moves IN to take up fixation

Answer 44

Latent divergent squint

Question 45

Mechanical closure of the aqueous drainage angle = what condition?

Answer 45

Acute angle closure glaucoma - Emergency - Most commonly due to pupillary block

Question 46

Higher intraocular pressure resulting in reduced blood flow to the optic head and subsequent nerve loss = what condition?

Answer 46

Chronic angle closure glaucoma

Question 47

Most dangerous trauma to the eye = ?

Answer 47

Alkali burn - causes a disruptive liquefactive necrosis with breakdown of normal cellular barriers - therefore, deeper penetration of chemicals

Question 48

Why is acid burn to the eye less concerning?

Answer 48

Mainly superficial disease - coagulative necrosis occurs - this prevents further penetration of chemical beyond the cornea