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Year 4 > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What is contained in the anterior chamber

A

Cornea and Iris

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2
Q

What is contained in the posterior chamber

A

Lens

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3
Q

What cell produces aqueous humour

A

Ciliary body

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4
Q

What is the normal intraocular pressure of the eye

A

10-21 mmHg

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5
Q

What cause open-angle glaucoma

A

Gradual increase in resistance of the trabecula meshwork that the aqeous humour has to travel thorugh to get to the anterior chamber

Pressure slowly builds up

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6
Q

What happens to cause acute closed-angle glaucoma

A

The iris bulges forward and completely seals the trabecular meshwork from the anterior chamber

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7
Q

What is cupping of the disc and in which condition is this found

A

Dimpling in the disc

Caused by raised intraocular pressure

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8
Q

Signs of Glaucoma

A

Affectsa peripheral vision first -> tunnel vision

Fluctuating pain, headaches and halos around lights at night

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9
Q

HOw can we measure intraocular pressure

A

Goldmann Applanation tonometry

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10
Q

What is the role of fundosocpy

A

To check the optic disc (e.g., for cupping or detachment)

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11
Q

First line management of glaucoma

A

Prostaglandin eye drops

Latanoprost

INcreases uveoscleral outflow

Second line:
Timolol
Carbonic anhydrase inhibitors
Brimonidine (anympathomimetics)

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12
Q

What surgical intervention can be sued last line for glaucoma

A

Trabeculectomy

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13
Q

What medications can precipitate acut-closure glaucoma

A

Noradrenaline

Oxybutynin

Amitriptyline

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14
Q

Examination findings in acute angle glaucoma

A

Haxy cornea
Dilatation of affected puupil
Fixed pupil size

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15
Q

Initial management of acute angle glaucoma

A

Pilocarpine eye drops

Give Acetazolamide 500mg orally

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16
Q

Role of pilocarpine

A

Causes ciliary muscle contratcion by acting on muscarinic receptors

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17
Q

Role of timolol in glaucoma

A

Reduces production of aqeous humour

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18
Q

What is the definitive treatment of glaucoma

A

Laser Iridotomy

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19
Q

What causes diabetic retinopathy

A

Hyperglycaemia damages retinal small vessels causing microaneurysms -> bleeding.

Damage to nerve fibres cause cootton wool spots

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20
Q

Signs of diabetic retinopathy on fundoscopy

A

Cotton wool spots
Neovascularisation
Microaneurysms
Hard exudates around the fovea from lipid leakage

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21
Q

SIgns of non-proliferattive diabetic retinopathy

A

Microaneyrisms
Blot Haemorrhages
hard exudates and venoud bleeding

All issues with pre-existing blood vessels

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22
Q

Signs of proliferative diabetic retinopathy

A

Neovascularisation

Vitreous Haemorrhage

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23
Q

Signs of diabetic maculopathy

A

Macular oedema

Ischaemic maculopathy

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24
Q

Complications of diabetic retinopathy

A

Retinal detachment

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25
Q

Management of Diabetic retinopathy

A

Laser photocoagulation

Anti-VEGF like ranibizumab

Vitreoretinal surgery

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26
Q

Name two types of age related macular degeneration

A

Wet and Dry

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27
Q

What type of age related macular degeneration has the worst prognosis

A

Wet

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28
Q

Pathophysiology of age related macular degeneration

A

Atrophy of retinal pigment epithelium

Degeneration of photoreceptors

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29
Q

Why is Anti-VEGF used in age related macular degeneration

A

New vessels growing from the choroid layer into the retina can leak fluid (as they’re old) -> oedema -> vision loss.

VGEF stimulates this process

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30
Q

Presentation of age related macular degeneration

A

Gardual worsening of central visual field

Reduced visual acuity

Wavy appearance to straight lines

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31
Q

Onset of wet age related macular degeneration

A

within days you get vision loss

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32
Q

What examinations would you do to test fo rage related macular degeneration

A

Snellen chart

Check for scotomas

Amsler grid test

Fundoscopy

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33
Q

Key finding on fundosocpy for age related macular degeneration

A

Drusen proteins

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34
Q

What is a slip-lamp fundus examination

A

Makes a 3d visualisation of the globes of the eye

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35
Q

What is the GOLD standard to diagnsoe age related macular degeneration

A

Slit lamp

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36
Q

What is optical coherence tomography

A

Checks layers of the retina

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37
Q

What is the role of fluorescein angiogrpahy

A

CHecks vasulcaristaion of the eye (neovascularisation signs)

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38
Q

Management of dry AMD

A

Avoid smoking
Control BP

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39
Q

Management of wet AMD

A

Anti-VEGF medication within 3 months

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40
Q

What classification can be used to grade hypertensive retinopathy

A

Stage 1: Mild narrowing of arterioles

Stage 2: Focal constriction of blood vessels and AV nicking

Stage 3: Cotton-wool patches, exudates and haemorrhages

Dtage 4: Papilloedema

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41
Q

What is AV nipping

A

Arterioles compress veins they cross due to hardening

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42
Q

What screen is used to check for congenital cataracts in neonates

A

Red Reflex

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43
Q

Signs of cataracts in presentation

A

Slow reduction in vision
Progressive blurring of vision
colours becoming more brown or yellow

Starbursts around lights

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44
Q

Glaucoma vs Macular degeneration

A

Glaucoma = peirpheral vision loss

Macular = central vision loss and wavy lines

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45
Q

What is a complictaion of cataract surgery

A

Endophthalmitis

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46
Q

Management of endophthalmitis

A

IV Antibiotics

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47
Q

What is the shape of the pupil in acute angle closure glaucoma

A

Vertical oval

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48
Q

What is Rubeosis Iridis

A

Neovascularisation in the iris from T2DM which can distort pupil shape

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49
Q

What causes tadpole pupil

A

Migraines

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50
Q

What pupil is seen nin neurosyphilis

A

Argyll-ROberttson pupil

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51
Q

What is Argyl-Robertson pupil

A

Doe snot constrict to light but does to distance

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52
Q

What can be used to test for horner’s syndrome

A

Cocaine eye drops

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53
Q

What are the two types of styes

A

Hordeolum externum (points out)

Hordeolum internum (points in towards the eyeball)

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54
Q

Management of a stye

A

Analgesia and hot compress

Second line: Chlorphenanicol

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55
Q

What is a Chalazion vs a stye

A

Chalazion form on inner side of eye lid but are chronic

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56
Q

What is Entropion

A

Where eyelids turn inwards with eyelashes retsing on eyeball

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57
Q

Management of Entropion

A

Tape down eyelid

Refer urgently to opthalmology as it can cause corneal ulceration

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58
Q

IN what disease in entropion commonly seen in

A

Trachoma (chlamidyia infetcion of the eye)

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59
Q

What is Ectropion

A

Eye lid inverts so we see the inner of the eye

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60
Q

Complication fo ectropion

A

Exposure keratopathy

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61
Q

Management of ectropion

A

Urgent same day referral to opthalmology

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62
Q

What is Trichiasis

A

Inwards growth of eyelashes

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63
Q

Management of trichiasis

A

Epilation

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64
Q

Management of periorbital cellulitis

A

Oral or IV antibiotics + admission for observation

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65
Q

Periorbital cellulitis vs orbital cellulitis

A

Periorbital = infection in front of the eye

Orbital = tissues behind orbital septum

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66
Q

Management of orbital cellulitis

A

Admission + IV Antibiotics

EMERGENCY

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67
Q

What lymph nodes are affected in conjunctivitis

A

Periauricular lymph nodes

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68
Q

Management of conjunctivitis

A

Re-assure (goes away after 2 weeks)

If not: Fusidic acid and chlorphenicol eye drops

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69
Q

Management of patients under 1 month of age with conjunctivties

A

Referral to opthalmology to check for gonococcal infection

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70
Q

Name a condition that can cause Chronic Anterior Uveitis

A

Syphilis

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71
Q

Describe the appearance of Anterior iUveitis

A

UNILATERAL:

Posterior Synechiae (abnormally shaped pupil with lobules)

Ciliary flush (redness around the iris)

Hypopyon (filling of the iris

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72
Q

If anyone with AS, IBD, RA etc presents with anterior uveitis, what should be done as first line management

A

Referral to Opthalmology as it is an emergency.

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73
Q

What treatment is given for anterior uveitis

A

Oral steroids

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74
Q

Describe the appearance of Episcleritis

A

Blood vessels around the outside of the eye

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75
Q

What conditions can cause episcleritis

A

Rheumatoid Arthritis

IBD

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76
Q

Presentation of Episcleritis

A

Foreign body sensation

Watering of an eye

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77
Q

Management of Episcleritis

A

Refer to Opthalmology

78
Q

Scleritis vs Episcleritis

A

Inflammation of the FULL thickness of the sclera

79
Q

What scleritis is associated with

A

RA
SLE
IBD
Sarcoidosis
Granulomatosis with polyangitis

80
Q

Presentation of scleritis

A

Severe Pain
Pain with eye movement
Photophobia
Eye Watering
Reduced visual acuity

81
Q

Management of scleritis

A

Topical NSAIDs

82
Q

What species can cause infections with contact lenses

A

Pseudomonas

83
Q

Management of herpes keratitis

A

Antiviral eye drops

84
Q

Diagnosis of a corneal abrasion

A

A fluorescein stain

will collect on the abrasions

85
Q

Management of corneal abrasions

A

Antibiotic Chlorphenicol

86
Q

What layer of the cornea is affected in herpes keratitis

A

Epithelial layer of the cornea

Stromal layer

87
Q

Complication of herpes keratitis

A

Corneal blindness

88
Q

Presentation of herpes keratitis in the eye

A

Dendritic corneal ulcer

89
Q

Diagnosing herpes keratitis

A

Fluorescein staining - dendritic corneal ulcer

Swabs for PCR

90
Q

Management of Herpes Keratitis

A

Topical or oral aciclovir

Ganciclovir eye gel

91
Q

How should corneal scarring by stromal keratitis be treated

A

A corneal transplant

92
Q

What conditions may result in subconjunctival haeemorhages

A

Hypertension
Thrombocytopenia
Whooping Cough
Warfarin, NOACs, antiplatelets
Non-accidental injury

93
Q

Are subconjunctival haemorrhages painful

A

No

But precipitated with coughing fit or heavy lifting

94
Q

Management of subconjunctival haemorrhage

A

Resolve spontaneously without treatment

95
Q

What is a posterior vitreous detachment

A

Where the vitreous gel comes away from the retina

96
Q

Presentation of a vitreous haemorrhage

A

Painless
Spots of vision loss
Floaters
Flashing Lights

97
Q

Management of a vitreous haemorrhage

A

No treatment

98
Q

Presentation of retinal detachment

A

Peripheral vision loss.
Blurred or distored visions
Flashes and floaters

99
Q

Management of retinal detachment

A

Refer to opthalmology for laser therapy

Citrectomy
Scleral buckling

100
Q

What is the role of the central retinal vein

A

Drains blood from the retina

101
Q

Why do we get neovascularisation in Central retinal vein occlusion

A

Blockage of the retinal vein causes macular oedema and retinal vessel damage, leading to neovascularisation

102
Q

Presenttaion of central retinal vein occlusion

A

Sudden painless loss of vision

103
Q

SIgns of central retinal vein occlusion

A

Flame and blot haemorrhages

Optic Disc Oedema

Macula Oedema

104
Q

Management of retinal vein occlusion

A

Laser photocoagulation and anti-VEGF

105
Q

Define presbyopia

A

Normal aging of the lens - changes to the refractive state of the eye

106
Q

What is Blepharitis

A

Inflammation of the eye lifs

107
Q

Complication of Blepharitis

A

Chalazion

108
Q

Management of Blepharitis

A

Lid Hygeiene

109
Q

What is Dacrocystitis

A

Lump on the size of the nose - lacrimal sac inflammation

110
Q

Management of Dacrocystitis

A

Cephalosporins

111
Q

Most common cause of viral conjunctivitis

A

Adenovirus

112
Q

Management of Chlamidyial Conjunctivtities

A

Topical Erythromycin

113
Q

Management of Gonorrhoeal conjunctivities

A

Topical penecillin

114
Q

Management of Gonnorhoeal infections as an STD

A

IM Ceftriaxone

115
Q

Presentation of Herpes simplex conjunctivities

A

Peri-auricular lymph node involvement
Unilateral symptoms

116
Q

What can aggravate the pain in corneal abrasions

A

Blinking and eye movement as nerve endings are exposed

117
Q

What is a blepharospasm

A

Inability to open the eye

118
Q

Treatment of corneal abrasions

A

Chlorphenicol

119
Q

Define keratitis

A

Corneal inflammation

120
Q

Common cause of keratitis

A

Herpes or contacts

121
Q

What is Keratoconus

A

Where a normal, domed shape cornea thins and bulges out

122
Q

What drugs can cause cataracts

A

Steroids

123
Q

What ethnicity is more commonly affected by open-angle glaucoma

A

Black africans

124
Q

In what conditions are timolol contraindicated

A

Asthma, COPD and heart block

125
Q

What type of drug is Acetazolamide

A

Carbonic Anhydrase Inhibitor - reduce aqueous production

126
Q

Management of Uveitis (medical)

A

Dexamethasone and Cyclopentolate to dilate pupil

127
Q

Signs of papilloedema on fundosocpy

A

Pallor and blurred margins of the optic disc

128
Q

Signs of end stafe hypertensive retinopathy

A

Eye pain

129
Q

What is the intraocular pressure in chronic open-angle glaucoma

A

Normal

130
Q

What is a normal cup to disc ratio

A

<0.5

Over 0.5 = possible glaucoma + cupping

131
Q

If chlamydial conjunctivitis is not treated by topical, what should be given

A

Oral Antibiotics - usually refractive to topical

132
Q

Clinical Features of Cavernous Sinus Thrombosis

A

fever
Headache
Inability to tract objects due to CN III, V1, V2 and 6 compression

133
Q

What arteries can GCA affect

A

Internal carotid or vertebral arteries

134
Q

Ocular symptoms in Marfan Syndrome

A

Partial lens discolouration

135
Q

In what AMD are drusen fibres seen

A

Dry

136
Q

Where are Drusen deposits found in dry AMD

A

Between retinal pigment epithelium and Bruch’s membrane

137
Q

Is retinal detachment painful?

A

No

138
Q

What is the role of Latanoprost

A

Increases aquaeous humour efflux from the eye

139
Q

Can visual field return in primary open-angle glaucoma?

A

No

140
Q

Define Anisocoria

A

Unequal pupil sizes

141
Q

What is a normal pupil size in light + dark

A

Light: 2-4 mm

Dark: 4-8 mm

142
Q

What is Adie’s tonic pupil

A

Where a tonically dilated pupil reacts SLOWLY to light but responds to accommodation (whilst Argyll robertson does not respond to light at all)

143
Q

Primary open-angle vs closed angle glaucoma symptoms

A

Primary is gradual onset vs rapid onset

144
Q

Argyll Robertson pupil vs Holmes Adie Syndrome

A

Argyll Robertson pupil is bilateral vs Unilateral

145
Q

Fundosocpy findings in Branch retinal vein occlusino

A

Retinal haeemorhages confined to a limited area of the retina

146
Q

What is Retinitis Pigmentosa

A

The loss of cells in the retina over time - causes tunnel vision

147
Q

How long are steroids given for HSV Opthalmicus

A

7-10 days

148
Q

Onset of vision loss in vitreous haemorrhages

A

SUDDEN

149
Q

CLinical features distinctive of retinitis pigmentosa

A

FAMILY HISTORY:

Night BLindness + Tunnel Vision

150
Q

What is preferred in pregnant women, Chloramphenicol or Fusidic Acid

A

Topical Fusidic Acid

151
Q

What is posterior vitreous detachment

A

This is the separation of the vitreous membrane form the retina that occurs as we age

152
Q

Management of a posterior vitreous detachment

A

Referral to Opthalmologist within 24 hours

153
Q

What type of cataracts are associated iwth steroid use

A

Subscapular cataracts

154
Q

What is Hutchinson’s sign

A

Where vesicles in HSV are found on the tip of the nose - means ocular involvement in shingles

155
Q

What condition is a central scotoma indicative of

A

Optic Neuritis

156
Q

What is myopia

A

SHort-sightedness

157
Q

WHat complication does Hutchinsob’s sign point to

A

Anterior Uveitis

158
Q

Management of a teary discharge in a neonate

A

Reassurance - usually caused by lacrimal duct obstruction

159
Q

What surgery is indicated for severe diabetic retinopathy

A

Vitreoretinal surgery

160
Q

What infetcion can be cuased by wearing contact lenses

A

Acanthamboeba keratitis

161
Q

What is the Amsler grid

A

Assess someone’s central visual field

162
Q

What supplement can be given in Dry AMD

A

Beta-carotene

163
Q

What distinguishes diabetic macullopathy

A

Central vision loss (as macula is affected)

164
Q

Management of organic foreign bodies in th eeye

A

Immediate refferal to opthlamology

165
Q

Is there pain in central retinal artery occlusion

A

No

166
Q

What causes central retinal artery occlusion

A

Thromboembolism (e.g., from GCA)

167
Q

Management of Herpes Zoster Opthalmicus

A

ORAL aciclovir

168
Q

Risk Factors for Primary open angle glaucoma

A

Age
Diabetes
Family HIstory
Hypertension
Afro-Caribbean

169
Q

When does vision loss in vitreous haemorrhage become worse

A

When lying down flat

170
Q

What eye condition is typically associated with acute closed angle glaucoma

A

Long sightedness

171
Q

In what condition is short-sightedness associated with

A

Primary open angle glaucoma

172
Q

How is latanoprost hiven

A

Topically NOT orally

173
Q

What causes cotton wool spots

A

Arteriolar occlusion (nothing to do with veins)

174
Q

Triad for keratitis

A

Red Eye
Photophobia
Grittiness

175
Q

Role of the Inferior Rectus

A

Adduction and lateral rotation of the eye

176
Q

Innervation of Inferior rectus

A

CN III

177
Q

Innervation of the superior oblique muscle

A

Trochlear nerve

178
Q

Innervation of the inferior oblique nerve

A

CN III

179
Q

ROle of the superior oblique nerve

A

Down and out

180
Q

Role of inferior oblique muscle

A

Up and Out

181
Q

First line management of a squint

A

Refer to Opthalmology

182
Q

WHat is Marcus-Gunn Pupil

A

Where the pupil will dilate when light is shone on it rather than constrict

183
Q

Other than the eye signs in adie holmes pupiles, what else can be elicited on examination

A

Absent leg reflexes

184
Q

First line management at GP level for suspected AMD

A

Urgent referral to Opthalmology as Wet AMD is preventable

185
Q

First line management of closed angle acute glaucoma in someone who has asthma

A

Latanoprost

186
Q

What can we make the patient do to reduce ICP

A

Hyperventilation

187
Q

First line management of red eye in contact lense wearers

A

Refer

188
Q

When should a red eye be referred to secondary care

A

Evidence of:

Trauma
Visual Impairment
Abnormal pupillary reaction
Wears contact lenses

189
Q

neonatal conjunctivitis vs blocked lacrimal ducts

A

Conjunctivtis: White of eye is RED

Lacrimal duct blockage: No redness

190
Q

What causes an entropion

A

Usually benign swelling of tissue in the eye lid (from elderly people)

Year 4 (16 decks)

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