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MSRA > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

In what eye pathology is colour vision affected?

A

Optic neuritis

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2
Q

What is the most common ophthalmological manifestation of sarcoidosis?

A

Bilateral anterior uveitis

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3
Q

Which is painful - episcleritis or scleritis?

A

Scleritis

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4
Q

By what age does congenital lacrimal duct obstruction, causing recurrent watery/sticky eye, tend to resolve by?

A

1 year

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5
Q

What is mydriasis?

A

Dilatation of the pupil

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6
Q

What opthalmic feature is seen in congenital Horner’s syndrome?

A

Heterochromia

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7
Q

What are the features of Horner’s syndrome?

A

Miosis (small pupil)
Ptosis
Anhidrosis
Enophthalmos (sunken eye)

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8
Q

How do you distinguish between Horner’s and a third-nerve palsy?

A

Third nerve palsy = ptosis + DILITATION of the pupil

Horner’s = ptosis + CONSTRICTION of the pupil

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9
Q

If anhidrosis affects the face, arm and trunk, where is the lesion most likely to be in Horner’s syndrome?

A

S’s

Stroke
Syringomyelia
Multiple sclerosis
Tumour
Encephalitis
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10
Q

If anhidrosis only affects the face, where is the lesion most likely to be in Horner’s syndrome?

A

T’s

Pancoast tumour
Thyroidectomy
Trauma
Cervical rib

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11
Q

If there is no anhidrosis (but other features of Horner’s) where is the lesion most likely to be?

A

C’s

Carotid artery dissection
Carotid aneurism
Cavernous sinus thrombosis
Cluster headache

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12
Q

Which opthalmic pathology is the most common cause of floaters?

A

Posterior vitreous detachment

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13
Q

What is seen on fundoscopy in central retinal vein occlusion?

A

Retinal haemorrhages

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14
Q

What is seen on opthalmic imaging in central retinal artery occlusion?

A

A ‘cherry red spot’ on a pale retina

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15
Q

What are the causes of Argyll-Robertson pupil?

A

Neurosyphillis

DM

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16
Q

What should be checked in patients with subconjunctival haemorrhage, that are also on warfarin?

A

INR

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17
Q

How does retinitis pigmentosa present on fundoscopy?

A

Black bone-spicule pigmentation

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18
Q

What is the mot common cause of orbital cellulitis in children?

A

Ethmoidal sinusitis

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19
Q

How do you distinguish between orbital and preseptal cellulitis?

A

Proptosis
Decreased visual acuity and ocular motility

^^don’t usually occur in preseptal cellulitis

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20
Q

What are the characteristics of retinitis pigmentosa?

A

Night blindness and tunnel vision

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21
Q

What diseases are associated with retinitis pigmentosa?

A 
Refsum disease: cerebellar ataxia, peripheral neuropathy, deafness, ichthyosis
Usher syndrome
Abetalipoproteinemia
Lawrence-Moon-Biedl syndrome
Kearns-Sayre syndrome
Alport's syndrome
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22
Q

What is diabetic maculopathy?

A

Any structural abnormality due to diabetes affecting the macula

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23
Q

What is NPDR?

A

Non-proliferative diabetic retinopathy

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24
Q

What defines mild NPDR?

A

1 or more microaneurysm

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25
Q

What defines moderate NPDR?

A

Microaneurysms
Blot haemorrhages
Hard exudates
Cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR

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26
Q

What defines severe NPDR?

A

Blot haemorrhages and microaneurysms in 4 quadrants
Venous beading in at least 2 quadrants
IRMA in at least 1 quadrant

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27
Q

What are the causes of chorioretinitis?

A 
Syphilis
Cytomegalovirus
Toxoplasmosis
Sarcoidosis
Tuberculosis
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28
Q

How does toxoplasmosis retinitis classically present?

A

White focal retinitis with overlying vitreous inflammation

29
Q

What is the first line treatment in glaucoma?

A

Prostaglandin analogue (PGA) eyedrop - e.g. latanoprost

30
Q

What is the second line treatment in glaucoma?

A

Beta-blocker, carbonic anhydrase inhibitor, or sympathomimetic eyedrop

31
Q

What are the adverse effects of miotics (e.g. pilocarpine)?

A

Pupil constriction, blurred vision and headaches

32
Q

Symapathomimetics - e.g. brimonidine - should not be taken with which drugs?

A

MAOI or tricyclic antibiotics

33
Q

How do prostaglandin analogues work in the treatment of glaucoma?

A

Increases uveoscleral outflow

34
Q

How do beta-blockers work in the treatment of glaucoma?

A

Reduces aqueous production

35
Q

How do sympathomimetics work in the treatment of glaucoma?

A

Reduces aqueous production and increases outflow

36
Q

How do carbonic anhydrase inhibitors work int he treatment of glaucoma?

A

Reduces aqueous production

37
Q

How should bacterial conjunctivitis be treated in pregnancy?

A

Fuscidic acid eye drops

38
Q

What is a Holmes-Adie pupil?

A

Benign condition most commonly seen in women.
Dilated pupil - unilateral in 80% of cases
Once the pupil has constricted it remains small for an abnormally long time
Slowly reactive to accommodation but very poorly (if at all) to light

39
Q

What is Holmes-Adie syndrome?

A

Association of Holmes-Adie pupil with absent ankle/knee reflexes

40
Q

What does Keith-Wagener classification system classify?

A

Degrees of hypertensive retinopathy

41
Q

What is a stage I hypertensive retinopathy?

A

Arteriolar narrowing and tortuosity

Increased light reflex - silver wiring

42
Q

What is a stage II hypertensive retinopathy?

A

Arteriovenous nipping

43
Q

What is a stage III hypertensive retinopathy?

A

Cotton-wool exudates

Flame and blot haemorrhages

44
Q

What is a stage IV retinopathy?

A

Papilloedema

45
Q

What is proliferative retinopathy?

A

Retinal neovascularisation - may lead to vitrous haemorrhage

It’s more common in T1DM, with rates of blindness being 50% within 5 years

46
Q

What are the features of papilloedema on fundoscopy?

A

Venous engorgement: usually the first sign
Loss of venous pulsation: although many normal patients do not have normal pulsation
Blurring of the optic disc margin
Elevation of optic disc
Loss of the optic cup
Paton’s lines: concentric/radial retinal lines cascading from the optic disc

47
Q

How is anterior uveitis?

A

Steroid + cycloplegic (mydriatic) eye drops

48
Q

What is the most common ocular presentation of RA?

A

Keratoconjunctivitis sicca - characterised by dry, burning and gritty eyes caused by decreased tear production

49
Q

What can cause blurred vision several years after cataract surgery?

A

Posterior capsule opacification

50
Q

When should you refer a child with a squint to secondary care?

A

> 3/12 - intermittent squint at 3/12 is normal and does not need investigating

51
Q

Where do drusen accumulate in the eye in AMD?

A

Bruch’s membrane and the retinal pigment epithelium

52
Q

What are hard exudates?

A

Lipoprotein leaked from blood vessels
Seen in DM and HTN
Well-defined, yellow-white, often in rings

53
Q

What are soft exudates?

A

Look like cotton-wool
Occur in infarcted retina
Due to swelling in the axons in the nerve fibre layer of the retina

54
Q

What are the first/second/third line options for glaucoma?

A 
First = Latanoprost
Second = Timolol
Third = Brimonidine or Brinzolamide
55
Q

How does central retinal artery occlusion present?

A

Pale+++ retina and ‘cherry red spot’

56
Q

What type of visual field defect is classical to glaucoma?

A

Arcuate scotoma

57
Q

What type of visual field defect is classic of disease affecting the macula?

A

Central scotoma

58
Q

What type of visual field defect is classic in toxic neuropathy?

A

Centrocaecal scotoma

59
Q

What type of visual field defect is seen in retinitis pigmentosa?

A

Ring scotoma

60
Q

What are the causes of cataracts?

A 
Myotonic dystrophy
Ageing
DM
Rubella/CMV/Syphillis
Steroids
Radiation
Trauma
61
Q

Which drug should be co-prescribed when ethambutol is prescribed for TB to reduce the risk of optic neuritis?

A

Pyridoxine (vitamin B6)

62
Q

When should laser trabeculoplasty be considered in glaucoma?

A

When there has been x2 unsuccessful trials of pharmacological agents

63
Q

How may optic neuritis be treated?

A

IV methylprednisolone

64
Q

What type of lesion is Bell’s palsy?

A

Lower motor neurone problem

65
Q

When should you suspect an UMN lesion with a Bell’s palsy-like presentation?

A

When the forehead is unaffected. Forehead will be affected in true Bell’s palsy

66
Q

What is the criteria for the certification of blindness (severely sight-impaired)?

A

<3/60 with a full visual field, whilst wearing glasses as prescribed

67
Q

What might aqueous flare indicate?

A

Anterior uveitis

68
Q

What diagnosis should be suspected in paediatric proptosis?

A

Rhabdomyosarcoma

69
Q

What test may improve VA in cataracts?

A

Pinhole test

MSRA (18 decks)

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