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MRCP PART 1 > Opthal > Flashcards

Opthal Flashcards

1
Q

Primary open angle glaucoma pneuonic for symptoms and whats seen on fundoscopy? Which visual field lost first?

A

OPENs

-Optic dis atrophy
-Pressure >21mmHg -> Optic disc cupping (increased cup:disc ratio [>0.7]). Pallor also seen
-Emerging vessles from optic disc
-Nasal + superior visual fields lost first

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2
Q

Most common type of glaucoma - affects both eyes ?

A

Primary open angle glaucoma

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3
Q

Aute painful red eye. Long-sighted, episodes of blurred vision, headaches, nausea, halos around lights … which glaucoma? How does it look on exam?

A

Acute angle closure glaucoma

Semi diated with a fixed pupil, decreased acuity and may be hard on palpation

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4
Q

men or women primary angle closure glaucoma

A

women - 2:1

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5
Q

What is raised IOP cut off?

A

> 21mmHg

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6
Q

Which receptors increase secretion of aqueous humour

A

B2
[A2 inhibit]

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7
Q

Who gets screened in glaucoma

A

> 60 Screened every 2 years. >70 annually

> 40 annually with 1st degree family member with OAG

> 40 black african annually

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8
Q

Rx of open angle glaucoma

A

Open Lovers Touch Bums

Topical prostaglandin analouge - eg latanoprost [increases aqueous outflow]

Topical B blocker eg timolol [decreases aqueous humour production]

Topical carbonic anhydrase inhibitor eg Brinzolamide [decreases aqueous formation]

[Usually latanoprost then add timolol. Second line therapies include pilocarpine (cholinergic agonist) and brimonidine (A2 agonist) ]

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9
Q

First thing you do with acute angle closure glaucoma

A

Lie patient flat

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10
Q

Rx of acute angle closure glaucoma? Long term?

A

Lie down PAL

Lie patient flat
Pilocarpine eye drops
Acetazolomide (IV/PO) or Dorozolamide drops
[analgesia, antiemetic, timolol]

Peripheral Lazer irodotomy

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11
Q

Open angle glaucoma may also get laser therapy (Trabeculoplasty) or what

A

Shunt formation
[teeny lil one]

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12
Q

Inform DVLA with glaucoma

A

Dont need to if affects one eye

Do need to if affects both

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13
Q

Asymmetric diabetic retinopathy need which 2 investigations ? Why?

A

Carotid doppler
Fluorescein angiography

Raises suspicion of ocular ischemic syndrome which is usually due to atherosclerosis [usually >90% stenosed on affected side]

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14
Q

Which CN does oblique movements ? horizontal?

A

SO4 - Superior oblique = trochlear CN IV
LR6 - lateral rectus = abducens CN VI

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15
Q

If diplopia slowly gets worse through day - what needs excluded ?

A

myasthenia gravis

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16
Q

Painless sudden loss of vision in 1 eye is likely? Seen on fundoscopy / exam?

A

Central retinal artery occlusion

pale oedematous retina with ‘cherry red spot’
RAPD

[If only part of vision lost - may be branch artery occlusion]

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17
Q

Outcomes of retinal artery occulsion are poor. Even with prompt management only 1/3 of people have any improvement.
What can you do?

A

Decrease IOP - Eg IV acetazolomide / b blockers

Dilate renital artery - sublingual isosorbide dinitrate, hyperbaric oxygen

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18
Q

Chronic hyperglycaemia -> diabetic retinopathy. Sight loss is due to neovascularisation. What is the mainstay of treatment (bar addressing factors eg Glycaemic control/BP/Lipids…)

for macular oedema?
Proliferative retinopathy?

A

Focal laser therapy
Intra vitreal injection of Vascular endothelial growth factor

Pan retinal photocoagulation

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19
Q

Diabetic retinopathy
Microanneursyms, exudates, haemorrhages, sight not affected? Symptoms? Rx?

A

Background diabetic retinopathy

Asx

Annual screening
Control of factors eg glucose / lipids / BP

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20
Q

Diabetic retinopathy
widespread changes in retina - cotton wool spots, venous changes, multiple haemorrhages? Symptoms? Rx?

A

Pre-proliferative

ASx

-> routine opthal referral
-> 6 monthly check up

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21
Q

Diabetic retinopathy
Neovascularisation, vitreous haemorrhage? Symptoms?

A

Proliferative

Floaters, blurred vision

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22
Q

Diabetic retinopathy
Retinopathy in the macular region? Symptoms?

A

Diabetic maculopathy

Blurred vision with darkened / distorted vision

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23
Q

What is the earliest clinical sign of diabetic retinopathy? How do they appear?

A

Microaneurysms

small red dots in superficial layers

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24
Q

Cotton wool spots are? When might these affect vision ?

A

Arteriole occlusion

If in fovea

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25
Q

Who gets diabetic retinopathy screening

A

All with diabetes > 12

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26
Q

What are aflibercept and ranibizumab?

A

VEGF inhibitors

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27
Q

What is triamcinolone

A

Intra vitreal Steroid used in proliferative retinopathy / macular oedema

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28
Q

Surgical rx of proliferative retinopathy? Macular oedema

A

Proliferative - pan-retinal photocoagulation

Macular - focal laser therapy

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29
Q

Surgical Rx if lots of blood in vitreous/aggressive proliferative retinopathy? Why? What is it?

A

Vitrectomy - reduce risk of retinal detachment

Cloudy vitreous is replaced with saline
-Often day case under local anaesthetic

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30
Q

What does a posterior communicating artery aneurysm lead to?

A

CN III palsy
(Fixed dilated pupil facing down and out)

+/- SAH

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31
Q

CNIII palsy but painless and sparing of the pupil?

A

Diabetic/hypertensive microangiopathy.

[Due to pupillary fibres on the peripheral surface of nerve and having own vascular supply]

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32
Q

Why aye abduction in CN III palsy?

A

due to unopposed action of Lateral rectus

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33
Q

How does vitreous haemorrhage present? How does it appear on fundoscopy? What is needed?

A

Loss of vision

Hazy/limited fundal view

US scan to check for retinal detachment

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34
Q

The usual cause of CRVO vs BRVO? How does it look on fundoscopy?

A

Central - thrombus
Branch - compression from an adjacent artery

Retinal haemorrhages, cotton wool spots, dilated vessels/tortuosity. Swollen optic disc

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35
Q

Rx of RVO? if macular oedema ?

A

VEGF inhibitors - aflibercept / ranibizumab
intravitreal steroids

focal laser coagulation if macular oedema in BRVO

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36
Q

Which eye condition usually in sarcoidosis ? Usual sarcoid presentation?

A

Anterior uveitis

Bihalar lymphadenopathy and erythema nodosum [+ fever, arthalgia]

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37
Q

What eye condition might be associated with complete heart block and a gradual reduction in eye movements + poor night vision

A

Retinitis pigmentosa

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38
Q

Rx of thyroid eye disease

A

High dose IV steroids
Surgical decompression may be required

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39
Q

Optic neuropathy (eg in thyroid eye disease) typically presents with….

A

loss of colour vision and reduced acuity

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40
Q

When do you see cells in the anterior chamber?

A

Uveitis or inflamation

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41
Q

CMV eye infection looks like?

A

‘brush fire’ (rapidly spreading outwards)
Vasculitis and haemorrhages

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42
Q

VZV and HSV eye infections cause

A

Actute retinal necrosis

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43
Q

Arteriole narrowing, Arterovenous nipping, hard exudates and flame haemorrhages?

A

Hypertensive retinopathy

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44
Q

Rosacea. What seen in eye

A

keratitis

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45
Q

Why would patient with rosecea end up getting cataracts

A

Secondly to steroid treatment for keratitis

46
Q

Vitamin deficiency -> keratitis

A

Vit A

47
Q

What gives a dendritic ulcer

A

HSV keratitis

48
Q

Contact use then swimming -> which protozoal infection

A

Acathamoeba

49
Q

Key thing to not give people with bacterial / viral keratosis

A

Topical corticosteroids

50
Q

Diabetic + unilateral painless visual loss -> with vitreous haemorrhage on fundoscopy. Whats happened

A

Neovascularisation -> haemorrhage
(proliferative diabetic retinopathy)

51
Q

What is supranuclear gaze palsy?

A

Doll’s eye
[dont follow movements up but will continue to focus on object despite head turning]

[Due to a leision between cortex and ocular motor nuclei]

52
Q

Eye feels firm - IE increased IOP. It can be due to many things such as trauma which may cause hyphema (bleeding in iris). First line RX to reduce the pressure

A

Carbonic anhydrase inhibitor (acetazolamide)
[or topical B blockers]

53
Q

Most common side effect of carbonic anhydrase inhibitor eg. cetazolamide, methazolamide, dorzolamide, brinzolamide

A

Finger tingling

54
Q

Which condition always gets optic neuritis in questions? Which type of optic neuritis

A

MS
Retrobulbar neuritis

55
Q

How long is the presentation of optic neuritis

A

Usually few days - 2 weeks. IE sub acute

56
Q

Optic neuritis presents how?

A

Pain
Decreased acuity
Colour desaturation [USUALLY RED]
RAPD

57
Q

Main investigation in optic neuritis

A

Gadolinium enhanced MRI

58
Q

Acute optic neuritis management

A

High dose Mpred
Eg 1000mg IV for 3 days

59
Q

Heavy smoker with unilateral ptosis and constricted pupil? What is this describing? why?

A

Horners syndrome - Ptsosis (drooping eyelid), miosis (constricted pupil) and anhydrosis (decreased sweating)

Pancoast tumour

60
Q

The location of anhydrosis lets you work out where the lesion causing horners syndrome is.
Face arm and trunk? [1st order]
Face only? [2nd order]
No anhydrosis? [3rd order]

A

Face arm and trunk = MS / encephalitis / brain tumours…1st order [central]

Face only - Thoracic/thyroid carcinomas including Pancoast, Thoracic AAA, Trauma … 2nd order [pre ganglionic]

No anhydrosis - cluster headache, carotid dissection/aneursym, cavenous sinus thrombosis. 3rd order [post ganglionic]

61
Q

finding only in congenital horners syndrome?

A

Heterochromia iridis
[Different coloured bits of iris. ie one blue one brown eye or just in a section]

62
Q

Cocaine test in horners?

A

Cocaine drops in the eye -> block the reuptake of NA which makes pupil dilate
-In horners lack of NA causes a failure of the pupil to dilate (remains constricted)

[Can also use apraclonidine hydrochloride / adrenaline (beta adrenic receptor test) - this test the affected pupil is the one to dilate)

63
Q

How to differentiate between a 3rd order (post ganglionic horners and a 1st/2nd] other than the lack of anhydrosis

A

Hydroxyamphetamine test

If pupil dilation occurs it is a 1st/2nd order
no dilation is a 3rd

64
Q

NF type 1. Seen in the eye?

A

lisch nodules on iris

65
Q

Who gets ash leaf spots on trunk

A

Tuberous sclerosis

66
Q

Best test to look for diabetic retinopathy

A

Fluorescein angiography [ to visualise the micro aneurysms

67
Q

Visual field defects with lesions :
Before chiasm
At chiasm
After chiasm

Biltemporal hemaniopia from below? Above?
Homonymous superior quadrantanopia Top right/left quarter?
Homonymous inferior quadrantanopia?

A

Before chiasm - Ipsilateral eye
At chiasm - bitemporal homonymous hemaniopia [lateral fibres cross]

After chiasm - Homonymous contralateral
Eg right occipital = left side of both eyes

Biltemporal hemaniopia from below = cause from above Eg Pit tumour
Above = lesion from below eg Craniopharyngioma

Homonymous upper quadratic? Temporal lesion
Homonymous inferior quadratic? Parietal

68
Q

Older person with neovascularisation and leakage at macula only on fundoscopy =? 3 key risks factors? which is most important?

A

Wet macular degeneration

Smoking - most important
Hypertension
Cataract surgery

69
Q

Which macular degeneration is there a Rx for?

A

Wet
VGEF inhibitors

70
Q

Differentiate wet and dry macular degeneration? What do they both have

A

Both have
Drussen: Protein/lipid under retinal pigement epithelium (RPE)
RPE - hypo/hyperpigmentation

Only wet has neovascularisation and exudate / haemorrhages

71
Q

Early, intermediate and advanced macular degeneration

A

Early - numerous drussen / mild RPE abnormalities

Intermediate - drussen >125um
-Geographic atrophy NOT involving fovea

Advanced - Atrophy involving fovea
Neovascularisation

72
Q

What do drussen look like ? What does geographical atrophy look like?

A

Yellow deposits in retina

Hypopigmentation of retina

73
Q

What test is required for diagnosis of wet AMD and for monitoring treatment

A

Ocular coherence tomography

74
Q

Intermediate AMD usual therapy

A

Vitamin supplements

Control of risk factors

75
Q

Painful 3rd nerve palsy age 50. Most likely cause

A

PCA Aneurysm

[MS would present earlier]

76
Q

Aortic regurg and Aphakic glassess = ? What eye thing?

A

Marfans
Ectopia lentis [dislocation of lens]

-Aphakia means not having a lens inside your eye. The glasses are big jam jar ones which do the work of the lens

77
Q

Hereditary ectopia lentis. What Ix?

A

homocysteine levels

78
Q

Same day review by opthal in?

A

Corneal ulcer
Acute glaucoma
Endopthalmitis
Foreign body stuck
Trauma / chemical injury

79
Q

Drug causes of closed angle glaucoma

A

A’s

Antidepresents (tricyclics)
Antipsychotics
Antihistamine
Anti-parkinsons
(sulphonamides)

80
Q

What is hypopyon. Symptoms associated

A

‘level’ of inflammatory cells in anterior chamber.

Seen in inflammation Eg anterior uveitis
Pain + photophobia + reduced acuity

[IBD…]

81
Q

Ehlers-danlos sudden painless loss of vision in 1 eye. Normal anterior chamber. What has happened?

A

Retinal detachement

[Anterior chamber would not be normal if lens dislocation]

82
Q

Superior homonymous hemianopia

A

Temporal lobe lesion

83
Q

Right eye superior visual field loss

A

Branch retinal artery / vein occulsion

84
Q

Cough, sore lesions on face with facial swelling. Facial palsy. CSF high protein?

If there was uveitis and fever?

A

Neurosarcoid

Heerfordt-waldenstrom syndrome
[Parotid enlargement, uveitis, fever, cranial nerve palsies]- type of neuro sarcoid

85
Q

seizing 10 mins with 2x 10mg rectal diazepam. What next?

A

IV phenytoin loading

86
Q

Essential tremor. 1st line 2 options? Second line and key side effect

A

Propranolol / topiramate

Primidone - drowsiness

[Deep brain stimulation can also be used]

87
Q

Most common cause of viral meningitis ? CSF findings

A

Enterovirus (echovirus/coxsakie)

Mild raised protein, Normal glucose, lymphocytosis

88
Q

When is CSF glucose very low? (2)

A

TB
Fungal

89
Q

Myasthenia gravis which receptor

A

Nicotinic Ach 90%

MuSK - 10%
[Muscle specific tyrosine kinase]

90
Q

What is key assoc with myasthenia gravis

A

Thymus abnormalities 75% (10% thymus Ca)

91
Q

Myasthenic crisis Rx

A

IV Ig
Plasmapheresis
+/- ventilate

92
Q

Myasthenia gene risks. Which is specific for ocular

A

HLA DR3 / B8

HLA DR1 - specific for ocular myasthenia

93
Q

Myasthenia crisis triggered by infection or which class of drug? Other classes to avoid generally

A

Amino-glycosides - gentamicin, neomycin

other -mycin types
-cyclines

B blockers

Antipsychotics

94
Q

Bedside test with 90% sensitivity in MG

A

Ice test
-Ice in glove.
Put on ptosis and it will improve temporary

95
Q

Bar Anti-Ach what tests for MG

A

Anti-MuSK
TFTs
EMG
CT/MRI brain / thymus

96
Q

Why is the edrophonium test no longer done? other name?

A

Tensilon test for MG

No longer done due to severe brady / arrest

97
Q

Rx MG usual drug?
What else initially?
Which -mab?
Surgical

A

Pyridostigmine - cholinesterase inhibitor

Steroids (+ steroid sparing)

Rituximab (think Thymus and T cell driven attack)

Thymectomy

98
Q

Differentiate L5 and S1 lesions. Movement

A

L5 Largest of 5 - dorsiflexion - dorsiflex foot and it will have big toe at top

S1 - Small 1
Plantar flex and lil toe will be bottom

99
Q

Impaired adduction and contralateral nystagmus. Normal accommodation. Where is lesion

A

Medial longitudinal fasiculus

[If R sided adduction issues its on R side]

100
Q

Ipsilateral horners. Facial numbess, horse voice and contralateral limb numbness. [May get nystagmus / limb ataxia]
Called? Lesion is where?

A

Wallenberg syndrome

Lateral medulla

101
Q

Most common type of nystagmus in kids ? Direction

A

Sensory deprivation nystagmus (90%)

Bi - horizontal

102
Q

Vertical nystagmus Upwards - lesion in

A

Medulla (stroke often)

103
Q

Vertical downbeat nystagmus in?

A

Arnold-chiari malformation
- lesion in foramen magnum

104
Q

Acute vs chronic horizontal nystagmus

A

Acute - away from lesion

Chronic - towards lesion

105
Q

Nystagmus with hearing loss / tinitus =

A

Usually peripheral cause
-Trauma
-Menniers
-CN8 lesion

106
Q

Nystagmus that varies with head position

A

BPPV

107
Q

partial dislocation of lens (ectopia lentis), quivering (iridodonesis) of (iris), nearsightedness (myopia). Long arms and legs

A

Cyststhione beta synthase deficiency
(Hereditary homocystineuria)

108
Q

Unilateral visual loss and pain with RAPD

A

Optic neuritis

109
Q

GCA causes anterior ischemic optic neuritis. What is most common thing seen on fundoscopy

A

Optic disk swelling
[occlusive vasculitis -> ischemia of optic nerve which then manifests as swelling visible on exam]

110
Q

Amiodarone deposits in eye sometimes termed?

A

cornea verticillata
vortex keratopathy

111
Q

What are
Band keratopathy?
Hudson -stahli lines?

A

band - Calcium deposition due to chronic hyper Ca

Hudson - iron deposition in normal ageing

MRCP PART 1 (22 decks)

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