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MS4 - MDEMO > Ophthamology > Flashcards

Ophthamology Flashcards

1
Q

Amblyopia

A

Lazy eye

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2
Q

Types of chronic conjunctivitis

A

Vernal keratoconjunctivitis

Atopic keratoconjunctivitis

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3
Q

Features of vernal keratoconjunctivitis

A
  • Children
  • Seasonal
  • FH of atopy
  • Bilateral
  • Ulceration and infiltration of upper cornea
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4
Q

Features of atopic keratoconjunctivitis

A
  • Adults
  • Associated with atopy
  • Bilateral
  • Can cause corneal ulceration and scarring
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5
Q

Neonatal conjunctivitis

A

Ophthalmia neonatorum

Usually secondary to N. gonorrhoeae or Chlamydia trachomatis

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6
Q

Causes of acute red eye

A

Lids:

  • Blepharitis
  • Chalazion
  • Malposition

Conjunctiva:
- Conjunctivitis

Sclera:

  • Episcleritis
  • Scleritis

Cornea:
- Keratitis

Uveal tract:
- Uveitis

Trabecular meshwork:
- Acute glaucoma

Periorbital skin:

  • Preseptal cellulitis
  • Orbital cellulitis
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7
Q

Presentation of Acanthamoeba keratitis

A

Pain
Red eye
Dendritiform epithelial lesions
Non-suppurative ring

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8
Q

Fungal keratitis presentation

A

Red eye
Photophobia
Blurred vision
Discharge

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9
Q

Anisocoria

A

Difference in pupil size > 4mm

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10
Q

Management of fungal keratitis

A

Topical antifungal
Corneal graft if unresponsive

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11
Q

Topical anti-fungals

A

Natamycin

Amphotericin

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12
Q
A

Hyphaema - blood in anterior chamber

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13
Q

Hypopion

A

Pus in anterior chamber

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14
Q

Orbital cellulitis presentation

A

Decreased vision
Unwell pt
Unilateral swollen eyelids
Ophthalmoplegia (reduced eye movements)
Proptosis

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15
Q

Orbital cellulitis Mx

A

Ophthalmological emergency

CT scan
IV antibiotics

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16
Q

Scleritis presentation

A

Extremely painful - often wakes at night
Cellular infiltration or entire sclera thickness

Red eye

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17
Q

Scleritis complications

A

Ischaemia and necrosis

Scleral thinning (Scleromalacia perforans)

Globe perforation

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18
Q

Scleritis prognosis

A

Can be self limiting

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19
Q

Central (/Branch) Retinal Artery Occlusion definition

A

Commonly embolisation from carotid artery

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20
Q

Central (/Branch) Retinal Artery Occlusion presentation

A

Painless
Possible RAPD
Retinal pallor
Cherry red spot

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21
Q

RAPD

A

Relative afferent pupillary defect

Paradoxical dilatation of directly stimulated pupil

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22
Q

Cherry red spot

A

At macula

Retina thinner - see underlying choroid

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23
Q
A

Entropion

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24
Q

Entropion definition

A

Inward turning of lid margin

Malposition of eye lid

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25
Q

Complication of entropion

A

Eyelashes cause corneal abrasions

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26
Q
A

Ectropion

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27
Q

Ectropion definition

A

Outward turning of lid margin

Almost always lower lid

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28
Q

Ectropion complication

A

Exposed conjuctiva can become inflammed, scarred and keratinised

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29
Q
A

Dendritic ulcer on cornea

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30
Q

Bacterial keratitis organisms

A

Pseudomonas aeruginosa

Staph epidermidis

Strep pneumoniae

H. influenzae

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31
Q

Bacterial keratitis presentation

A

Purulent conjunctivitis
Reduced vision
Corneal ulcer / opacity
Hypopyon

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32
Q
A

Blepharitis

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33
Q

Blepharitis definition

A

Infection of lid margins

Overproduction of sebum by lid margin glands

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34
Q

Blepharitis organisms

A

Staphylococcal bacteria

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35
Q

Sx of blepharitis

A

Chronic ocular irritation

Watery eye

Red eye

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36
Q

Signs of blepharitis

A

Crusting and scaling of lash line

Plugs of sebum in meibomian gland orifices

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37
Q
A

Posterior synechiae

Irregular pupil

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38
Q

Muscles of the eye

A

Superior, inferior, medial, lateral rectus
Superior, inferior oblique
Levator palpebrae superioris

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39
Q

Management of chronic conjunctivitis

A

Similar to acute conjunctivitis

Greater use of topical and oral steroids

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40
Q

Uveitis definition

A

Inflammation of uveal tract

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41
Q

Components of uveal tract

A

Includes iris, ciliary body and choroids

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42
Q
A

Iatrogenic / neonatal conjunctivitis

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43
Q

Iatrogenic conjunctivitis definition

A

Drops prescribed can cause occular irritation and red eye

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44
Q

Management of allergic conjunctivitis

A

Topical antihistamine
Topical mast cell stabiliser
Combination of antihistamine and mast cell stabiliser
Systemic antihistamines
Topical steroid

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45
Q

Topical antihistamine for allergic conjunctivitis

A

Levocabastine

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46
Q

Topical mast cell stabiliser for allergic conjunctivitis

A

Sodium cromoglycate

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47
Q

Combined antihistamine and mast cell stabiliser for allergic conjunctivitis

A

Olopatadine

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48
Q

Management of bacterial conjunctivitis

A

Spontaneous resolution
Broad spectrum topical antibiotics

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49
Q

Broad spectrum topical abx for bacterial conjunctivitis

A

Chloramphenicol

Fucithalmic acid

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50
Q

Conjuctiva definition

A

Translucent membrane

Lines inside of lids and sclera up to limbus of cornea

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51
Q

Parts of conjunctiva

A

Palpebral conjunctiva - inside of lids

Bulbar conjunctiva - on sclera

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52
Q

Pupil dilator drugs

A

Tropicamide +/- Phenylephrine

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53
Q

Hypermetropia

A

Long sightedness

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54
Q
A

Acute Angle Closure Glaucoma

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55
Q
A

Corneal abrasion with fluorescein

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56
Q

Causes of Ectropion

A

Ageing (involutional)
Conjuctival scarring (cicatricial)
Paralytic (facial nerve palsy)
Mechanical (lower lid tumours)

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57
Q

Complications of Herpes Zoster Ophthalmicus

A

Scleritis
Secondary glaucoma
Cranial nerve palsies
Retinitis

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58
Q

Herpes Simplex Virus pathogenesis

A

Primary infection, then lies dormant in trigeminal ganglion

Causes recurrent epithelial keratitis

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59
Q

Sx of ophthamological HSV infection

A

Pain
Red eye
Dendritic ulcer
Reduced corneal sensation

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60
Q

Trabecular meshwork pathway

A

Ciliary bodies produce aqueous humour
Bathes lens
Exits anterior chamber via angle

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61
Q

Allergic conjunctivitis presentation

A

Rapid onset
Itching
Red eye
Usually bilateral

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62
Q

Signs of allergic conjunctivitis

A

Giant cobblestone papillae
Conjunctival chemosis (oedema)
Preauricular lymphadenopathy

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63
Q

Myopia

A

Short sightedness

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64
Q

Causes of keratitis

A

Bacterial
Viral
Fungal
Acanthamoeba

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65
Q

Fluorescein

A

Causes yellow staining of epithelial defect
Eg. ulcer, abrasion
More apparent under blue light

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66
Q

Peirorbital cellulitis presentation

A

Swelling
No decreased vision
No proptosis
Normal eye movements

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67
Q

Mx of periorbital cellulitis

A

Broad spectrum oral abx

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68
Q

Keratitis risk factors

A

Contact lens
Trauma
Dry eye / blepharitis
Immunosuppression

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69
Q

Presentation of scleritis

A

Extreme pain - wakes at night
Epiphora
Red eye
Scleromalacia perforans

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70
Q

Epiphora

A

Watering of eye

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71
Q

Scleromalacia perforans

A

Scleral necrosis and thinning

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72
Q

Corneal sensation nerve

A

Trigeminal nerve

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73
Q

Amaurosis Fugax definition

A

Embolus from carotid passes through retinal vasculature
Transient loss of vision

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74
Q

Types of uveitis

A

Anterior uveitis (iritis)
Intermediate uveitis
Posterior uveitis

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75
Q

Anterior uveitis definition

A

Inflammation of iris and anterior chamber

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76
Q

Intermediate uveitis definition

A

Inflammation to vitreous and peripheral retina

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77
Q

Posterior uveitis definition

A

Inflammation of posterior uveal tract and overlying retina

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78
Q

Cause of superior quadrantanopia

A

Post chiasmal lesion within temporal lobe

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79
Q

Presentation of vial conjunctivitis

A

Red eye
Watery discharge
Usually bilateral
Conjunctival follicles
Preauricular lymph nodes

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80
Q

Why is viral conjunctivitis usually bilateral

A

Highly contagious

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81
Q

Causes of viral conjunctivitis

A

Adenovirus

HSV 1

82
Q

Causes of gradual loss of vision

A

Cataracts
Macula degeneration
Retinitis pigmentosa
Diabetic retinopathy
Glaucoma

83
Q

Retinitis pigmentosa presentation

A

Gradual peripheral vision loss

Congenital

Tunnel vision

84
Q

Signs of diabetic retinopathy

A

Cotton wool spots (ischaemia)

Haemorrhages

85
Q

Management of scleritis

A

Oral prednisolone
Immunosuppressive agents

86
Q

Immunosuppressants used for scleritis

A

Mycophenolate mofetil

Azathioprine

87
Q

Herpes Zoster Ophthalmicus cause

A

VZV

Aka shingles

88
Q

Herpes Zoster Ophthalmicus pathogenesis

A

VZV lies dormant in trigeminal ganglion

89
Q

Mx of Herpes Zoster Ophthalmicus

A

Oral Aciclovir
Topical steroids

90
Q

Sign of Herpes Zoster Ophthalmicus

A

Lesions on nose

91
Q
A

Giant cobblestone papillae

Allergic conjunctivitis

92
Q
A

Acanthamoeba keratitis

93
Q

Acanthamoeba keratitis definition

A

Protozoan (especially in water)

Consider with pts who swam in contact lenses

94
Q
A

Keratitis

95
Q

Keratitis definition

A

Inflammation of cornea

96
Q

Keratitis complications

A

Ophthalmologic emergency

May permanently impair vision or perforate eye

97
Q

Management of episcleritis

A

Observation
Simple lubricants
Oral NSAIDs
Topical steroids

98
Q
A

Bacterial conjunctivitis

99
Q
A

Orbital cellulitis

100
Q

Types of allergic conjunctivitis

A

Seasonal allergic rhinoconjunctivitis
Perennial allergic rhinoconjunctivitis

101
Q

Seasonal allergic rhinoconjunctivitis allergen

A

Commonly pollen

102
Q

Perennial allergic rhinoconjunctivitis allergen

A

Eg. house dust mite

103
Q

Blink reflex nerve

A

Facial nerve

104
Q

Central (/Branch) Retinal Vein Occlusion Sx

A

Painless
Loss of vision

Possible RAPD

105
Q

Signs of central (/branch) retinal vein occlusion

A

Dot haemorrhages
Flame haemorrhages
Cotton wool spots
Swollen optic disc
Macular oedema
Neovascularisation

106
Q

Central vs branch retinal vein occlusion

A

Branch retinal vein occlusion confined to area supplied

107
Q
A

Scleritis

108
Q
A

Scleromalacia perforans

109
Q

Management of viral conjunctivitis

A

Conservative

Lubricants (for comfort)
Antibiotics (chloramphenicol) - prevent secondary bacterial infection
Topical Aciclovir - if HSV-1 isolated
Topical steroid drops - only for severe inflammation

110
Q

Conservative Mx of viral conjunctivitis

A

Usually spontaneously resolves ~ 2 wks

Discomfort may persist for months

111
Q

Presentation of uveitis

A

Photophobia
Red eye
Pain
Blurred vision

112
Q

Signs of uveitis

A

Keratic precipitates
Posterior synechiae

113
Q

Keratic precipitates

A

Clumps of cells on corneal endothelium

114
Q

Posterior synechiae

A

Adhesions between lens and iris

Results in irregular pupil

115
Q

Causes of central retinal vein occlusion

A

Idiopathic
HTN - artery compresses vein
Inflammatory

Thrombophilic tendency

116
Q

Inflammatory causes of CRVO

A

Sarcoidosis

Lyme disease

117
Q

RFs for thrombophillic tendancy

A
  • Hyperviscosity (protein S or C deficiency)
  • Smoking
  • COCP
  • Pregnancy
  • Tumours
118
Q

Causes of sudden loss of vision

A

Central retinal vein occlusion
Central retinal artery occlusion
Anterior Ischaemic Optic Neuropathy
Optic neuritis
Posterior vitreous detachment
Retinal detachment

119
Q

Risk factors for Acute Angle Closure Glaucoma

A

Age
Female
Hypermetropic (smaller eyes)
FH

120
Q
A

Episcleritis

121
Q

Sx of episcleritis

A

Mild discomfort
Epiphora (watering)
Unilateral redness

122
Q

Mx of episcleritis

A

Self limiting and recurrent
Can have underlying systemic disorder

123
Q

Causes of RAPD

A

Optic neuritis
Optic atrophy
Retinal detachments
Central retinal artery occlusion
Optic nerve compression

124
Q

Causes of entropion

A

Ageing (involuntional)

Conjunctival scarring (cicatrical)

Acute spastic entropion (spasm of orbicularis muscle)

125
Q

Causes of conjuntival scarring

A
  • Trachoma
  • Stevens-Johnson syndrome
  • Ocular pemphigoid
126
Q

Management of central retinal vein occlusion

A

Treat underlying condition
Macular oedema - laser treatment
Neovascularisation - laser ischaemic areas

127
Q

Medical Mx of Acute Angle Closure Glaucoma

A

Lower intraocular pressure:

  • IV acetazolamide
  • Topical beta blockers
  • Topical pilocarpine (prevent attack in the fellow eye)
128
Q

Surgical Mx of acute angle closure glaucoma

A

Reverse pathology:

  • Laser iridotomy
  • Trabeculectomy
129
Q

Sx of Acute Angle Closure Glaucoma

A

Haloes
Red eye
N/V
Pain
Photophobia
Visual loss

130
Q

Signs of acute angle closure glaucoma

A

Corneal oedema (hazy)
Fixed semi-dilated pupil
Shallow anterior chamber

131
Q

Viral causes of keratitis

A

HSV

VZV

Adenovirus

132
Q

Causes of scleritis

A

Systemic associations

Infection

Post ocular surgery

133
Q

Systemic causes of scleritis

A

Wegener’s gramulomatosis

Rheumatoid arthritis

Polyerteritis nodosa

134
Q

Infection causes of scleritis

A

Secondary to corneal ulcers

Often pseudomonas

135
Q

Management of central retinal artery occlusion

A

Treat underlying condition
Low dose aspirin and carotid ultrasound

Drop intraocular pressure within first 2 hours

136
Q

Methods to reduce intraocular pressure for CRAO

A
  • Ocular massage
  • Anterior chamber paracentesis
  • IV acetazolamide
137
Q

Fungal keratits pathogens

A

Filamentous fungi (eg. Aspergillus, Fusarium)

Candida albicans

138
Q

Signs of filamentous fungi keratitis

A
  • Grey stromal infiltrate
  • Surrounding satellite infiltrates
  • Hypopyon
139
Q

Signs of candida albicans keratitis

A

Yellow/white ulcer

140
Q

Causes of Adult inclusion conjunctivitis

A

Chlamydia serotypes D-K

141
Q

Presentation of Adult inclusion conjunctivitis

A

Unilateral mucopurulent discharge
May be chronic if untreated
Large conjunctival follicles
Preauricular lymphadenopathy
Subepithelial corneal deposits

142
Q

Mx of adult inclusion conjunctivitis

A

Topical erythromycin - 2 weeks
Referral to GUM clinic for systemic chlamydia abx

143
Q

Causes of conjunctivitis

A

OH GLAD SCABS

Ocular cicatricial pemphigoid
Herpes

Gonococcal infection
Ligneous
Adenoviral infection
Diphtheria infection

Stevens-Johnson syndrome
Candida or Chlamidya infection
Alkali burn
Beta-haemolytic streptococcal infection
Springtime (Allergic conjunctivitis)

144
Q

Cause of Inferior quadrantanopia

A

Post chiasmal lesion in parietal lobe

145
Q

Risk factors for central retinal artery occlusion

A

DM

IHD

Peripheral vascular disease

Smoking

Giant cell (temporal) arteritis

146
Q

Management of uveitis

A 
Topical steroid drops
Mydriatic drops (eg. cyclopentolate) - prevent posterior synechiae
147
Q
A

Keratic precipitates on corneal endothelium

148
Q

Causes of uveitis

A

Idiopathic

HLA-B27 associated arthropathies (PUBCAR)

Infectious

Sarcoidosis

Juvenile Idiopathic Arthritis

149
Q

Infective causes of uveitis

A

Syphilis

TB

Herpes Simplex / Zoster

150
Q

Management of bacterial keratitis

A

Corneal scrape
Broad spectrum topical antibiotics - ofloxacin
Topical steroid - can help scarring and necrosis

151
Q

Presentation of bacterial conjunctivitis

A

Red eye
Eyelids stuck together
Minimal pain
Purulent discharge
Conjunctival papillae

152
Q

Bacterial conjunctivitis organisms

A

Staph aureus

Staph epidermis

Strep pneumoniae

153
Q
A

Chalazion (meibomian cyst)

154
Q

Chalazion / meibomian cyst definition

A

Meibomian gland dysfunction

155
Q

Associations of chalazion / meibomian cyst

A

Acne rosacea

Seborrhoeic dermatitis

156
Q

Mx of chalazion

A
  • Hot spoon bathing
  • Abx
  • Surgical incision and curettage
157
Q

Association of myopia

A

Increased risk of retinal detachment

158
Q

Association of hypermetropia

A

Increased risk of angle-closure glaucoma

159
Q

Sebum

A

Oily waxy

Lubricates and waterproofs skin

160
Q

Meibum

A

Oily

Prevents evaporation of the eye’s tear film

161
Q

Causes of Trachoma

A

Serotypes A-C

162
Q

Trachoma definition

A

Chronic conjunctivitis

Endemic to Africa and Asia

163
Q

Follicle definition

A

Hyperplasia of lymphoid tissue

Diagnostically significant

164
Q

Causes of follicles

A

HSV

Chlamydia

165
Q

Papillae definition

A

Hyperplastic conjunctival epithelium thrown into numerous folds

Non specific

166
Q

Causes of homonymous hemianopia

A

Lesion of optic radiation

Eg. stroke

167
Q

Cause of bitemporal hemianopia

A

Lesion at optic chiasm

Eg. pituitary tumour, craniopharyngeoma

168
Q

Red eye, not responsive to light, pupil dilated

A

Acute angle closure glaucoma

169
Q

Red eye, not responsive to light, pupil constricted

A

Iritis

170
Q

Types of Age related macular degeneration (ARMD)

A

Dry ARMD

Wet ARMD

171
Q

Features of dry ARMD

A

Slow progression

Moderate visual loss

No Rx

172
Q

Features of wet ARMD

A

Quick pregression
Severe visual loss
Sometimes treatable

Neovascularisation

173
Q

Types of dry ARMD

A

1) Drusen
2) Atrophy

174
Q

Mx of wet ARMD

A

Anti-VEGF medication (ranibizumab)

Pan photo-coagulation

175
Q

Causes of flashes / floaters

A

Retinal detachment

Vitreous detachment

176
Q

Pathology of diabetic retinopathy

A

Increased glucose ->

ROS ->

Basement membrane thickening ->

EC proliferation/bleeding

177
Q

Types of diabetic retinopathy

A

Background

Pre-proliferative

Proliferative

178
Q

Background diabetic retinopathy

A
  • micro-aneurysm
  • Exudate
  • Dot haemorrhage
179
Q

Pre-proliferative diabetic retinopathy

A

More extensive ischaemic changes

  • venous dilatation
  • venous bleeding
  • multiple cotton wool spots (>5) (micro infarcts of retina)
180
Q

Proliferative diabetic retinopathy

A

Neovascularisation

Rubeosis iridis

needs pan photocoagulation, if not treated tractional retinal detachment

181
Q

Rubeosis iridis

A

Neovascularisation of the iris

May obstruct drainage of aqueous humour resulting in ‘neovascular glaucoma

182
Q

Ix for diabetic retinopathy

A

Fluorescein Angiography

  • assessing ischaemia
  • localising leakage
183
Q

Mx of diabetic retinopathy

A

Laser to solve:

1) maculopathy - closure of leaking vessels
2) proliferative disease - destroy ischaemic retina, decrease angiogenic growth factors

184
Q

Microvascular complications of DM

A

Retinopathy

Nephropathy

185
Q

Macrovascular complications of DM

A

Neuropathy

Cardiac problems

Ulcers

186
Q

Maculopathy definition

A

Clinically significant macular oedema

Complication of diabetic retinopathy

187
Q

Types of maculopathy

A

Focal maculopathy

Diffuse maculopathy

Ischaemic maculopathy

188
Q

Features of focal maculopathy

A

Focal leakage from a microaneurysm or dilated capillaries

Exudates seen, often in rings around the leaking microvasculature (circinate exudates)

189
Q

Features of diffuse maculopathy

A

Diffuse retinal oedema

Leakage from microvasculature at posterior pole of eye

190
Q

Features of ischaemic maculopathy

A

Closure of perifoveal microvasculature

Confirmed with fluorescein angiography

191
Q

Strabismus other name

A

Squint

192
Q

Types of stabismus

A

Hyper- / Hypo- / Exo- / Eso-:

Tropia

Phoria

193
Q

(Hyper)tropia definition

A

Constant strabismus in one eye

(Hyper looks up)

194
Q

(Hyper)phoria definition

A

Latent strabismus

Present in both eyes

195
Q

Directions of strabismus

A

Hyper: Up

Hypo: Down

Exo: Temporal

Eso: Nasal

196
Q

Test for tropia strabismus

A

Cover test

Cover one eye, eye moves slightly

197
Q

Test for phoria strabismus

A

Alternate cover test

Look at pen whilst covering one eye at time

Pen moves if latent squint present

198
Q

Causes of strabismus in children

A

Refractive error

Neurological

199
Q

Causes of strabismus in adults

A

HTN

Stroke

DM

Myasthenia gravis

200
Q
A

MS4 - MDEMO (4 decks)

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