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Opthalmology Flashcards

1
Q

glaucoma

A

optic neuropathy secondary to increased ocular pressure >21mmHg

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2
Q

patho of primary open angle glaucoma

A
  • Trabuecular network has increases resistance = high IOP = death to retinal ganglion
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3
Q

Ix Primary open angle glaucoma

A
  • slit lamp = cupping
  • Goldmann applanation tonometry
  • gonioscopy = visualise angle between iris and cornea
  • visual field assessment
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4
Q

Open Angle glaucoma tx

A
  • latanoprost drops (prostaglandin analogue)= increases uveoscleral outflow )negative = increased eyelash length)
  • BB timolol = reduces aqueous production
  • Surgery = trabeculectomy
  • 360 Laser = trabeculoplasty = NICE guidance
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5
Q

acute Closed Angle Glaucoma patho

A
  • iris bulges covering trabecular meshwork = acute narrowing of anterior chamber and sudden rise in IOP as preventing drainage
  • sight threatening = emergency
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6
Q

RF open angle glaucoma

A
  • Age
  • FHx
  • Black ethnic origin
  • Myopia (nearsightedness)
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7
Q

S+S acute angle closure glaucoma

A
  • severely painful red eye
  • blurred vision
  • halos around lights
  • headache, N+V
  • red eye, hazy cornea
  • decreased acuity
  • mid dilated pupil, fixed size pupil
  • Hard eyeball
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8
Q

Meds that can precipitate acute closed angle glaucoma

A
  • adrenergics = noradrenaline
  • Anticholinergics = oxybutynin
  • TCA = amitriptyline
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9
Q

tx Acute Closed Angle Glaucoma

A
  • initial = lie down
  • IV acetazolamide= reduce aqueous production
  • pilocarpine drops = constricts pupil
  • iodipine drops
  • bilateral peripheral laser iridotomy = definitive
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10
Q

presentation closed angle glaucoma

A
  • fluctuant pain
  • headaches
  • blurred vision
  • halos around lights
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11
Q

Cataracts patho

A

opacification of lens
- nuclear = old age = middle
- cortical = wedge shaped spokes
- posterior subcapsular = steroids use

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12
Q

RF cataracts

A
  • aging
  • smoking
    = alcohol
  • dm
  • steroids
  • myotonic dystrophy
  • hypercalcaemia
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13
Q

dx cataracts

A

slit lamp

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14
Q

presentation cataracts

A
  • asymmetrical
  • slow reduction acuity
  • progressive blurring
  • colours more faded
  • starbursts around lights
  • loss of red reflex
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15
Q

tx cataracts

A
  • surgery = phacoemulsification
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16
Q

risks cataracts surgery

A
  • posterior capsule opacification
  • endophthalmitis
  • posterior capsule rupture
  • retinal detachment
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17
Q

diabetic retinopathy patho

A
  • hyper causes damage to endothelium/pericytes
  • changes vascular permeability
  • exudates and microaneurysms
  • retinal ischaemia = VEGF = new leaky vessels (neovascularization)
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18
Q

Ix diabetic retinopathy

A
  • slit lamo
  • retinal photography
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19
Q

sudden complete loss of vision in diabetes

A

vitreous haemorrhage
- Minor = floaters
- Severe = painless loss vision
- will see red opacity obscuring retina
- Mx = vitrectomy

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20
Q

moderate NPDR in DNTx DN

A
  • control BP and DM
  • anti VEGF injections
  • photocoagulation
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21
Q

hypertensive retinopathy staging

A

1 =mild generalized retinal arteriolar narrowing
2 = definite focal narrowing and av nipping
3 = 1 plus haemorrhages, exudates and cotton wool spots
4 = 3 plus papilloedema

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22
Q

rf age related macular degeneration

A
  • age
  • cvd
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23
Q

4 layers of macula

A
  • Choroid layer
  • Bruchs membrane
  • Retinal pigment epithelium
  • Photoreceptors
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24
Q

S+S MD

A
  • gradual loss central vision
  • reduced acuity
  • metamorphosia = wavy straight lines
  • struggle to read small text
  • drusen = yellow deposits of proteins and lipids between RPE and bruch
  • atrophy of rpe
  • degeneration of photoreceptors
  • scotoma
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25
Q

Ix MD

A
  • fluorescien angiography
  • photography
  • Optical coherence tomography
  • slit lamp
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26
Q

Mx dry MD

A
  • conservative
    drusen = dry
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27
Q

Is wet MD neovascular or not

A
  • Neovascular
  • new vessels develop from choroid layer and grow into retina = leak and cause oedema
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28
Q

MD wet treatment

A
  • anti VEGF, steroids
  • wet = neovascularisation
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29
Q

retinal detatchment S+S

A
  • flashes and floaters
  • decreased acuity and peripheral vision
  • curtain
  • distorted images
    = emergency
  • most common = rhegmatogenous
30
Q

patho RD

A
  • holes and tears in neurosensory layer retina
  • fluid separates sensory retina from RPE
31
Q

Mx RD

A
  • tilt head
  • laser photocoagulation
  • surgery = vitrectomy and gas/oil tamponade/scleral buckle with cryotherapy to secure
32
Q

retinitis pigmentosa

A
  • genetic
  • progressive retinal degeneration
  • tunnel vision and reduced visual acuity
  • fundoscopy = peripheral bone spicule pigmentation, optic disc pallor, vessel attenutation
33
Q

S+S conjunctivitis

A
  • itchy
  • sticky
  • uncomfortable red
  • weepy
34
Q

conjunctivitis causes

A
  • bacterial = staph, gonococcus (sexual transmission) = purulent discharge, more likely unilateral
  • viral = adenovirus = serous discharge, more likely bilateral
35
Q

mx conj

A
  • bacterial = chloramphenicol
36
Q

dry eyes

A
  • gritty eyes
  • idiopathic, RA, sjogrens
  • Dx = schirmer test, antibody tests, fluouroscein drops and blue light
  • mx = artificial tears, topical cyclosporin, punctal plugs
37
Q

episcleritis is

A

benign and self limiting inflammation of episclera

38
Q

S+S episcleritis

A
  • red eye (localised or diffused)
  • watering
  • not painful
  • mild photophobia
  • engorged vessels
39
Q

episcleritis patho and mx

A

inflammation of episclera = between sclera and conj
- NSAIDs

40
Q

differentiation in scleritis

A
  • cotton wool application with phenylephrine drops
  • epi = vessels blanch
41
Q

scleritis S+S

A
  • severe eye pain
  • dull boring pain
  • red eye
  • POM
  • photophobia
  • fall in acuity
  • blue sclera (thin sclera)
42
Q

scleritis general

A

inflammation of sclera
- may lead to perforation
- RA and granulomatosis common in
- phenylephrine application
- urgent referral, oral steroids, immunosuppression

43
Q

Mx scleritis

A
  • urgent refer
  • NSAIDs
  • steroids
  • Immunosuppress
44
Q

anterior uveitis patho

A
  • inflammation in anterior chamber of eye
  • AC infiltrated by neutrophils lymph and macro
  • hypopyon = fluid collection containing inflammatory cells
45
Q

RF anterior uveitis

A
  • seronegative spond
  • IBD
  • sarcoidosis
  • Behcets
46
Q

S+S anterior uveitis

A
  • red eye
  • blurred vision
  • painful
  • pus
  • lacrimation
  • miosis
  • ciliary flush
    5 clinical signs
  • red eye
  • hypopyon = pus
  • flare (protein)
  • posterior synechiae = abnormal pupil
  • keratic precipitates
47
Q

AU ix and mx

A
  • slit lamp = red eye
  • urgent referral
    -steroids (normally topical)
  • pupil dialtion with cycloplegics (atropine)
48
Q

GCA S+S

A
  • headache
  • raised inflammatory markers
  • pale disc
    = anterior ischaemic optic neuropathy = arteritic (GCA) or non arteritic = insufficient blood supply, painless
49
Q

optic neuritis

A
  • inflammation optic nerve
  • MS = will respond to steroids
  • painful eye movements, decreased acuity, less red colours
  • RAPD
  • Ix = MRI
  • Mx steroids
50
Q

RAPD

A
  • swinging light test
  • normal eye = constricts
  • both eyes dilate = abnormal
51
Q

central retinal artery occlusion

A
  • Sudden painless loss in vision
  • RAPD
  • Pale retina with cherry red spot
  • stroke
  • carotid artery atherosclerosis = most common cause = CA doppler
52
Q

central retinal vein occlusion

A
  • sudden painless loss of vision
  • stormy sunset appearance
53
Q

orbital cellulitis S+S

A
  • severe ocular pain
  • POM
  • diplopia
  • visual disturbance
  • CT orbit = gold standard
  • IV Abx and surgical drainage
    (periorbital = no pain)
54
Q

S+S trauma (small objects)

A
  • severe eye pain
  • hyphema = blood
  • red eye
  • iris prolapse
  • urgent referral
  • XR or CT = NO MRI
  • numbing drops to examine = tetracaine
55
Q

S+S opthalmic shingles

A
  • vesicular rash around eye
  • neuralgia
  • rash on top of nose = hutchinsons sign
56
Q

Ix and mx op shing

A
  • clinical
  • fluroescein dye and UV light = dendritic ulcer
  • aciclovir
57
Q

blepharitis

A
  • inflammation
  • gritty sticky and red
  • seborrheic dermatitis
  • hot compress
  • tears
58
Q

chalazion

A
  • retention of cyst of meibomian gland
  • firm and painlesss
59
Q

stye

A
  • infection of glands
  • hot compress
  • abx drops if bacterial
60
Q

down and out

A

3rd nerve palsy

61
Q

4th enrve palsy

A
  • ## stiff neck
62
Q

pointing in

A

6th nerve palsy

63
Q

horners syndrome

A
  • ptosis
  • miosis
  • anhidrosis
    sympathetic lesion
  • preganglionic = pancoast tumour
  • post ganglionic = carotid dissection = painful
64
Q

fundoscopy findings diabetic retinopathy

A
  • cotton wool spots
  • microaneurysms
  • hard exudates
  • blot haemorrhages
  • neovascularisation
65
Q

grading diabetic retinopathy

A
  • background = aneurysms, retinal haem, hard exudates, cotton wool
  • pre-proliferative = beading, multiple blot haem, IMRA
  • proliferative = neovascularisation and vitreous haem
66
Q

complications diabetic retinopathy

A
  • vision loss
  • retinal detatchment
  • vitreous haem
  • optic neuropathy
  • cataracts
67
Q

Mx diabetic neuropathy

A
  • non proliferative = monitor
    proliferative
  • PRP
  • Anti VEGF
  • Surgery
68
Q

herpetic keratitis S+S, Mx

A
  • primary = mild inflammation
    recurrent
  • painful red eye
  • photophobia
  • vessicles
  • watery dc and reduced acuity
  • fluorescein stain = dendritic corneal ulcer
  • mx = antivirals
69
Q

hypertensive retinopathy findings

A
  • cotton wool
  • silver wiring
  • hard exudates
  • arteriovenous nipping
  • papilloedema
  • retinal haemorrhages
70
Q

keith wagener classification HTN ret

A

1 = mild narrowing arterioles
2 = focal constriction of blood vessels and av nicking
3 = cotton wool exudates and haem
4 = papilloedema

71
Q

Bacterial keratitis

A
  • emergency
  • bacterial infection cornea
  • contact lens use
  • corneal scrape
  • topical quinolone
    pseudomonas aerginosa most common

FINALS (32 decks)

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