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MSRA LS > opthalmology > Flashcards

opthalmology Flashcards

1
Q

painful red eye, fixed mid-dilated pupil
pain on pupillary reaction- non reactive
hx HTN, diabetes

dx?
other classic symptoms?
mx? if have asthma then mx?

A

Acute angle closure glaucoma

symptoms worse with mydriasis (e.g. watching TV in a dark room)

emergency- need to reduce IOP

combination of eye drops, for example:
a direct parasympathomimetic (e.g. pilocarpine, causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)

a beta-blocker (e.g. timolol, decreases aqueous humour production)

an alpha-2 agonist (e.g. apraclonidine, dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)

intravenous acetazolamide: reduces aqueous secretions

ATHMA: LATANOPROST FIRST LINE

Definitive management:
laser peripheral iridotomy
creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle

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2
Q

sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

A

Central retinal vein occlusion

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3
Q

temporary vision loss that resolves in a few minutes.

cause?
dx?

A

Amaurosis fugax

caused by atheroembolism from the carotid arteries. This patient has persistent vision loss.

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4
Q

acute painless vision loss
fundoscopy would reveal a cherry-red macula and a white/pale retina.
afferent pupillary defect

A

Central retinal artery occlusion

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5
Q

patient on warfarin and has a subconjunctival haemorrhage

mx?

A

check INR

Subconjunctival haemorrhage could be an early and clinically important tool in detecting warfarin over anticoagulation

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6
Q

lady had intravitreal injection for age-related macular degeneration(AMD).

Now has a painless bloodshot left eye with bleeding under the conjunctiva.

dx?

A

Iatrogenic subconjunctival haemorrhage is common post intravitreal injections

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7
Q

optic neuritis description?

other conditions you see this in?

A

central scotoma

classic triad:
visual loss over hours or days, periocular pain, and dyschromatopsia, aka impaired COLOUR VISION (change in colour perception)

multiple sclerosis

side note- central scotoma with metamorphopsia is in keeping with wet age related macular degeneration

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8
Q

sudden painless loss of vision with image?

A

Retinal detachment- features of viterous detachment

side note- viterous detachment (r/f HTN, diabetes) first- floaters and flashes. this can lead to retinal detachment- progressive from the peripheral towards central vision, appearing as a veil or curtain!!

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9
Q

most common ocular manifestation of rheumatoid arthritis?

A

Keratoconjunctivitis sicca

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

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10
Q

26-year-old contact lens wearer
left eye, it is red, painful and has a gritty sensation.

dx?

A

keratitis: red eye, photophobia and gritty sensation

side note: corneal uptake of fluorescein indicates corneal ulceration

wearing contact lenses is a r/f

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11
Q

63-year-old man
gradual loss of vision
intraocular pressure of 25mmHg
optic disc cupping
visual loss in peripheral areas.

dx? tx

A

primary open-angle glaucoma

lananoprost: divert overflow
timolol: reducing aqueous production

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12
Q

type 1 diabetes mellitus
sudden onset loss of vision in her right eye
only thing you can see is redness in the vitreous.

A

vitrous haemorrhage due to Proliferative retinopathy is more common in T1DM

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13
Q

eye pain, photophobia
dendritic corneal ulcer.
dx? tx?

A

herpes simplex keratitis
topical aciclovir

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14
Q

Holmes-Adie pupil

A

unilateral in 80% of cases- dilated pupil

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

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15
Q
A

dry macular degeneration. Drusen can be seen around the macula.

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16
Q

woke up with a watery, red eye

A

Episcleritis

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17
Q

progressive, subacute vision loss with features such as loss of central vision like difficulty seeing in dark

clinical finding of distorted line perception on Amsler grid testing

A

DRY!! Age-related macular degeneration

AMY LIKES DRY GIN

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18
Q

features of horners?

A

miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)

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19
Q

mydriatic drops to see eye
driving home, decreased visual acuity

dx?

A

acute closed angle glaucoma- secondary to mydriatic drops

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20
Q

another name for stye?

A

hordeolum externum

21
Q

holmes adie syndrome?

A

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

unilateral in 80% of cases
dilated pupil
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

HOMER IS SO SLOW

22
Q

Marcus-Gunn pupil?

A

Most commonly caused by damage to the optic nerve or severe retinal disease.

Relative afferent pupillary defect, seen during the swinging light examination of pupil response. The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye.

23
Q

bilateral sore eyelids
eyelid margins are erythematous at the margins but are not swollen. stuck together with crusts

dx?
tx?

A

1st line of treatment for blepharitis is hot compresses
‘lid hygiene’ - mechanical removal of the debris from lid margins

24
Q

hypertension, type 2 diabetes, and previous myocardial infarction.

A

preproliferative diabetic retinopathy

hard exudates, cotton wool spots

side note: for proliferative- needs neovascularisation

25
Q

past medical history of cytomegalovirus
2-week history of blurring of vision, sensitivity to light, floaters and redness

fundus examination, you can see a mixture of white and red retinal lesions.

dx? what other tests need to be done?

A

Pizza pie appearance on fundoscopy = chorioretinitis

HIV!!!

RED AND WHITE IS PIZZA AND CHORIO sounds like chirzo on pizza

26
Q

bacterial conjunctivitis in pregnant women

A

Topical fusidic acid

27
Q
A

STYE- HORDEOLUM EXTERNUM

28
Q

31-year-old lady
red left eye
not painful
a gritty sensation
feels the need to blink to clear her vision
Discharge from that eye

dx?

A

Conjunctivitis

29
Q

most likely to predict future eye involvement in patients with previous herpes zoster ophthalmicus?

A

Hutchinson’s sign : presence of rash on tip of nose.

30
Q

most common cause of Argyll-Robertson pupil in the UK

A

diabetes

31
Q

24-year-old man
left eye pain wears contact lenses
‘got something stuck in his eye’
left cornea appears hazy
pupillary reaction is normal

A

KERATITIS

32
Q

Retinitis pigmentosa

FEATURES?

A

night blindness + tunnel vision

33
Q

chronic unilateral conjunctivitis resistant to treatment?

A

Orbital lymphoma

34
Q

37-year-old Arabic woman
increasing haziness over her vision with both eyes
fundoscopy which reveals a lack of the red reflex in both eyes.
Chvostek sign and Trousseau sign are both positive.

whats going on?

A

signs of hypocalcemia
cataracts due to hypocalcemia

35
Q

Blurring of vision again years after cataract surgery ?

A

posterior capsule opacification

cells remaining after cataract surgery grow over the back (posterior) of the capsule

36
Q

6-month-old
recurrent sticky left eye.
negative swab
been treated twice with chloramphenicol drops which did not improve symptoms.

dx?
mx?

A

Congenital tear (lacrimal) duct obstruction

self-resolves by 1 year of age

37
Q

Anterior uveitis tx?

A

steroid + cycloplegic (mydriatic) drops

38
Q

cataract op 4 days ago

Post-operative red eye in association with pain and visual loss

A

Red eye, pain and visual loss following intraocular surgery are red flags for endophthalmitis and warrant urgent ophthalmic review

39
Q

which one is painful?
what medicaiton can be used to tell them apart?

A

scleritis

Phenylephrine 10% eye drops can be used to distinguish between episcleritis and scleritis. It blanches the redness in episcleritis but doesn’t in scleritis.

40
Q

addition of fluorescein dye on the eye which is dry

outcome?

A

Punctate fluorescein staining of the cornea is common in patients with dry eyes

41
Q

stye mx, when to give abx?

A

warm compress and analgesia

Topical antibiotics are only recommended for stye if associated conjunctivitis

42
Q

allergic conjunctivitis.
every summer, watery eyes

Tx?

A

TOPICAL ANTIHISTAMINE

43
Q

describe drusen in dry macular degeneration?

A

small accumulations of extracellular material between Bruch’s membrane and the retinal pigment epithelium of the eye

44
Q

light test results for optic neuritis

A

swinging light test’
afferent pupillary defect
As there is a defect in the afferent nerve on the left side the pupils constrict less than normal, giving the impression of dilation.

45
Q

entropian vs ectropion

A
46
Q

orbital compartment syndrome - following eye injury after playing squash

mx?

A

immediate canthotomy

an assessment should be made for orbital compartment syndrome as this may require immediate decompression prior to imaging etc

47
Q

Optic neuritis causes

A

multiple sclerosis: the commonest associated disease
diabetes
syphilis

48
Q

infective conjunctivitis

bacteria vs viral

causes?

A

adenoviral- viral

49
Q

Painless, monocular loss of vision in Marfan’s syndrome?

A

lens dislocation

MSRA LS (22 decks)

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