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Year 6 > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q
A
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2
Q

Marcus-Gunn pupil?

A

Minor constriction to direct light
Dilatation on moving light from normal to abnormal eye
RAPD

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3
Q

Causes of Marcus Gunn Pupil?

A

Optic neuritis
Optic atrophy
Retinal disease

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4
Q

Horner’s syndrome features and causes?

A

Ptosis
Anhidrosis
Miosis
Causes: Central (MS, Lateral Medullary Syndrome)
Pre-ganglionic (Pancoast tumour, CVA insertion)
Post-ganglionic (cavernous sinus thrombus, CN 3-6 palsy)

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5
Q

Causes of fixed and dilated pupil?

A

Mydriatics (i.e. tropicamide)
Iris trauma
Acute glaucoma
CN III compression (surgical)

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6
Q

Holmes-Adie pupil?

A

Dilated pupil [“Holmes has a dilated personality”]
- no response to light
- sluggish accommodation

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7
Q

Causes of Holmes-Adie pupil?

A

Viral/bacterial infection of ANS

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8
Q

Argyll-Robertson pupil?

A

Small, irregular pupil
Sluggish response to light
Accommodation intact

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9
Q

Causes of Argyll-Robertson pupil?

A

DM
Syphilis (quaternary)

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10
Q

Hutchinson’s pupil?
Compressed 3rd nerve

A

Unilaterally dilated pupil
Unresponsive to light

  • [1] ipsilateral pupil constricts (PNS irritation)
  • [2] ipsilateral pupil dilates (PNS inhibited)
  • [3] contralateral pupil constricts (PNS irritation)
  • [4] contralateral pupil dilates (poor prognosis)
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11
Q

Causes of Hutchinson’s pupil?

A

Intracranial mass / raised ICP head trauma

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12
Q

Mx of vitreous haemorrhage?

A

Vitrectomy

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13
Q

Main cause of vitreous haemorrhage?

A

DM

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14
Q

Tx for optic neuritis?

A

Methylprednisolone for 72 hours. Prednisolone for 11 days

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15
Q

Treatment for keratitis?

A

o Mx: referral  topical ABx/aciclovir drops, cycloplegics/mydriatics (cyclopentolate)

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16
Q
  • Scleritis tx?
A

o Mx: referral urgently (<24 hours)  corticosteroids/immunosuppressants, phenylephrine

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17
Q
  • Episcleritis tx?
A

o Mx: topical/systemic NSAIDs

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18
Q
A
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19
Q

Cherry red spot on macular is seen in what condition?

A

Retinal artery artery occlusion

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20
Q

Causes of gradual vision loss?

A

DM, open-angle glaucoma, ARMD, cataracts

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21
Q

o Signs & symptoms of age-related macular degeneration?

A

Central visual loss, old age, blurring of small words, straight lines appearing curvy

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22
Q

Features of dry ARMD?

A

Drusen - white fluffy spots around the macula – fat deposits under the retina)
* Degeneration of macula with slow decline over 1-2 years

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23
Q

Is dry or wet ARMD more common?

A

Dry

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24
Q

Wet ARMD features?

A

subretinal neovascularisation
* Aberrant vessels grow into the retina from the choroid and lead to haemorrhage
* Rapid visual decline (days-weeks) with distortion and macular haemorrhage

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25
Q

AMRD Ix:?

A
  • Investigations: Amsler grid, fundoscopy
    (urgent referral to ophthalmology):
    1st = slit-lamp microscopy (picks up pigmentary, haemorrhagic, exudative changes)
    Wet ARMD = fluorescein angiography (detects abnormal neovascularisation)
    Mandatory = Optical Coherence Tomography (OCT) – high-res images of the retina
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26
Q

Mx of wet ARMD?

A

o Photodynamic therapy
o VEGF inhibitors (intravitreal) – i.e. bevacizumab
o Antioxidant vitamins (A, C, E) and Zinc

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27
Q

Mx of dry ARMD?

A

stop smoking (best to slow degeneration); dry: zinc + vitamin A, C, E;

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28
Q

Mx of wet ARMD?

A

anti-VEGF

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29
Q

Chronic Simple (Open Angle) Glaucoma features?

A

Increased IOP (>21mmHg), reduced blood flow, damaged optic nerve, optic disc atrophy and cupping
o Signs & symptoms  peripheral field loss (central vision maintained); RF: myopia, FHx

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30
Q

Glaucoma pattern of vision loss?

A

Peripheral vision loss first and moves is (tunnel vision)

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31
Q

RF for Chronic Simple (Open Angle) Glaucoma?
These groups can get screening

A

Myopia, >35yo, Afro-Caribbean, FHx, steroid tx, DM, HTN, migraines,

32
Q

Fundoscopy in open angle glaucoma?

A

Cupping of optic disc

33
Q

SEs of prostaglandin analogue?

A

Iris pigmentation, eyelash growth

34
Q

Management (life-long follow-up) for open angle glaucoma?

A

Medical (eye-drops to decrease IOP):
* 1st line (one - the other - a combination of both):
o Beta-blocker (reduces) aqueous production: timolol, betaxolol
o Prostaglandin analogue (increases) uveoscleral outflow: latanoprost

  • 2nd line:
    o Topical alpha-2 agonist (reduces)aqueous production brimonidine tartrate
    o Carbonic anhydrase-I (reduces) aqueous production acetazolamide
    o Topical miotic (M3 agonist) (increases) uveoscleral outflow pilocarpine
  • Surgical (can be used 1st line over medical if desired laser trabeculoplasty
35
Q

Mx of Proliferative retinopathy?

A

Pan-retinal photocoagulation

36
Q

Medical mx of cataracts?

A

o Medical  mydriatic eye drops (tropicamide)

37
Q

Ix of cataracts?

A
  • Investigation: tonometry, fundoscopy (darkened red reflex), acuity testing, BMs
38
Q

Retinitis pigmentosa:

A

o Most common (1 per 2,000) inherited degeneration of the macula
o Inheritance (variable):
 Most common AR
 Best prognosis AD
 Worst prognosis X-linked
o S/S: night blindness, tunnel vision, blind by mid-30s
 Associations: Friedrich’s ataxia, Kearns-Sayre syndrome, Refsum’s disease, Usher’s syndrome
o Ix: fundoscopy (pale optic disc / atrophy, macula-sparing peripheral retinal pigmentation)

39
Q

Retinoblastoma:

A

o Commonest (1 in 15,000) intraocular tumour in children
o Inheritance (variable):
 Hereditary vs. non-hereditary
 AD mutation in RbP gene (a TSG)
 One mutant allele in every retinal cell  acquire +1 mutation and a retinoblastoma develops
o S/S: strabismus, leukocoria (white eye with no red reflex)
 Associations: pineal tumours (5%), osteosarcoma, rhabdomyosarcoma
o Ix: fundoscopy
o Mx (depends on size): enucleation, chemotherapy, radiotherapy

40
Q
  • Inflammatory lid swelling mx?
A

Warm compresses

41
Q
  • Blepharitis?
A

chronic eyelid inflammation - not curable but can be maintained:
o Causes: seborrhoeic dermatitis, staphylococcus
o S/S: red, gritty/itchy eyes with scales on the lashes (like conjunctivitis)
o Mx: compress and clean (warm compress BD, warm water cleaning BD) ± topical ABx (chloramphenicol)

42
Q

What is Entropion?

A

Eyelid inversion - can lead to corneal irritation

43
Q
  • Pterygium?
A

Yellow vascular nodules growing over the cornea - leads to decreased vision:
o Benign growth of the conjunctiva
o Associations with dusty, wind-blown lifestyles and sun exposure (i.e. desert dwellers)

44
Q

Mx of peri-orbital cellulitis?

A

Referral to ophthalmology, IV ABx (cefuroxime)

45
Q

Ix for peri-orbital cellulitis?

A

o Ix: CT scan w/ contrast (orbits, sinuses and brain; assess for posterior spread)

46
Q

Carotid cavernous fistula:

A

o Aetiology: carotid aneurysm rupture leading to reflux of blood into cavernous sinus
o Causes: spontaneous rupture or trauma
o Signs & symptoms:
 Engorgement of eye vessels
 Lid and conjunctival oedema
 Pulsatile exophthalmos
 Eye bruit
o Mx: endovascular treatment

47
Q

Types of cranial nerve palsy?

A

CN III palsy S/S: ptosis, fixed/dilated pupil, ‘down and out’
* Medical  DM, MS, infarction
* Surgical ( ICP)  cavernous sinus thrombosis, PCA aneurysm
CN IV palsy S/S: diplopia going downstairs
* Peripheral  DM (30%), trauma (30%), compression
* Central  MS, SOL, vascular
CN VI palsy S/S: diplopia in horizontal plane; Mx: botulinum toxin
* Peripheral  DM (30%), trauma (30%), compression
* Central  MS, SOL, vascular

48
Q

Describe the two types of strabismus

A

o Concomitant (common) – imbalance in extraocular muscles
o Paralytic (rare) – paralysis of extraocular muscles

49
Q

Squint classifications?

A

o …the nose = esotropia (convergent squint)
 Commonest type in children
 Causes: idiopathic, hypermetropia
o …temporally = exotropia (divergent squint)
 Older children
 Often intermittent
o …superiorly = hypertropia
o …inferiorly = hypotropia

50
Q

Management of strabismus?

A

(4 O’s):
o Ophthalmological review
o Optical (correct refractive errors)
o Orthoptic (eye patches to the good eye to prevent amblyopia)
o Operations (resection of rectus muscles)
Ambylopia = impaired or dim vision without obvious defect or change in the eye.

51
Q

Orbital blowout fracture mx?

A

Mx: maxilla-facial/ophthalmology referral, fracture reduction / muscle release

52
Q
  • Giant Papillary Conjunctivitis (GPC):
A

o Iatrogenic FBs (contact lenses, prostheses, sutures)
o S/S: giant papillae on tarsal conjunctivae
o Mx: removal of FB, mast cell stabilisers

53
Q

Treatment of trachoma?

A

o Mx: tetracycline
Progressively causes blindness

54
Q
  • Onchocerciasis (river blindness) treatment?
A

o Mx: ivermectin

55
Q
  • Xerophthalmia and Keratomalacia: what is it and how to treat?
A

Keratomalacia [manifestation of vitamin A deficiency]:
o S/S: night blindness, dry conjunctiva, corneal ulceration/perforation
o Mx: vitamin A

56
Q

Macular degeneration tx?

A

Amsler grid, fundoscopy → dry - antioxidants (zinc + vitamins A, C and E), wet - anti-VEGF injections

57
Q

Bilateral gradual painless vision loss peripherally to centrally, impaired adaptation to darkness, halos around lights, headaches?

A

Primary open-angle glaucoma

58
Q

Primary open-angle glaucoma risk factors?

A

myopia (short-sighted, African)

59
Q

Treatment for Primary open-angle glaucoma

A

prostaglandin analogue eye drops to increase uveoscleral outflow (latanoprost)

60
Q

Tx of diabetic retinopathy?

A

Tx: NPDR mild - observation, NPDR moderate/severe - focal laser photocoagulation, PDR pan-retinal photocoagulation + anti-VEGF injections

61
Q

Diabetic retinopathy

A

Classification is non-proliferative (NPDR), proliferative (PDR) or maculopathy
NPDR mild - ≥1 microaneurysm, moderate - cotton-wool exudates, flame and blot haemorrhages, hard exudates, severe - involvement of all 4 quadrants

62
Q

Hypertensive retinopathy>?

A

I - AV narrowing and tortuosity (silver wiring)
II - AV nipping
III - cotton-wool exudates, flame and blot haemorrhages
IV - papilloedema

63
Q

Sx: unilateral acute painful vision loss, hard red eye, halos around lights, headaches, N&V, cloudy cornea, semi-dilated unresponsive pupil = what condition?

A

Acute closed angle glaucoma

64
Q

Treatment for acute closed angle glaucoma?

A

Tx: pilocarpine eye drops + acetazolamide

65
Q

Vitreous detachment

A

floaters (cobwebs) and flashes (photopsia)

66
Q

Vitreous haemorrhage

A

Floaters and flashes, blurry vision, red hue to vision

67
Q

Retinal detachment sx?

A

Unilateral sudden acute painless vision loss like a curtain or black shadow moving across vision with preceding floaters and flashes

68
Q

‘pale retina with cherry-red spot in fovea’

A

Central retinal artery occlusion (CRAO)

69
Q

Central retinal vein occlusion (CRVO) sign?

A

cheese and tomato pizza’

70
Q

unilateral acute or gradual visual loss often causing scotomas, red desaturation, pain on eye movements

A

Optic neuritis

71
Q

Temporal arteritis can lead to what?

A

CRAO

72
Q

Sx of keratitis?

A

Sx: unilateral or bilateral acute painful red eye, blurry vision, photophobia, epiphora (watering)
Important to refer contact lens wearers

73
Q

Sx: unilateral acute painful red eye, blurry vision, photophobia, epiphora (watering), hypopyon?

A

Uveitis
Associated with rheumatoid arthritis

74
Q

Treatment of subarachnoid haemorrhage?

A

Aneurysm - coil
Vasospasm - nimodipine
Hydrocephalus - extraventricular drain

75
Q
A

Year 6 (26 decks)

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