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Year 6 > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

decreased vision in left eye, eye pain,
central area of reduced vision (central scotoma) and a relevant afferent pupillary defect. what is the most likely diagnosis?

investigation?

management?

A

optic neuritis!!

RAPD = key sign, a pupil fails to constrict -> shows damage to optic nerve

central scotoma is seen in demyelinating lesions eg also in MS - associated with this

MRI!!! of brain and orbits with contrast
+ high dose steroids

reduced colour vision may be present

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2
Q

Central retinal artery occlusion typical presentation?

A

sudden, unilateral PAINLESS vision loss +/- RAPD

painless = distinguish from optic neuritis. CRA occlusion also does not have scotoma

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3
Q

anterior uveitis typical presentation?

A

small, irregularly shaped pupil with a potential hypopyon
Painful red eye
Photophobia!!!!
HLA-B27 conditions e.g. ankylosing spondylitis,

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4
Q

Blepharitis symptoms?

causes?
risk factors?

A

grittiness and discomfort, particularly around the eyelid margins
eyes may be sticky in the morning
eyelid margins may be red. Swollen eyelids may be seen in staphylococcal blepharitis
styes and chalazions are more common in patients with blepharitis
secondary conjunctivitis may occur

caused by gland dysfunction or sebbhorriec dermatitis/staph infection

rosacea = risk factor

manage w hot compresses and removal of lid debris

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5
Q

What investigations for Acute angle-closure glaucoma? (painful red eye, DILATED pupil (vs constricted in anterior uveitis) )

initial management?
definitive management?

A

tonometry to assess for elevated IOP
and gonioscopy

eye drops - eg timolol, pilocarpine or apraclonidine, IV acetazolamide

definitive = Laser peripheral iridotomy!!! (creating small hole in iris to relieve pressure)

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6
Q

picture of unilateral red eye. PAINFUL eye movements. history of joint pain treated. most likely diagnosis?

management?

most common association?

A

scleritis!!! - can also cause gradual reduction in vision

episcleritis is NOT painful!!

urgent review by opthalmologist

scleritis most commonly associated with rhuematoid arthritis!!! (but also sle, sarcoidosis)

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7
Q

what are the risk factors for retinal detachment?

A

diabetes mellitus!!!
(occurs as a result of breaks in the retina due to traction by the vitreous humour
these tears may proceed to detachment if left untreated)

myopia!!!!!

age

previous surgery for cataracts (accelerates posterior vitreous detachment)

eye trauma e.g. boxing

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8
Q

how does cataracts present?

A

insidious blurring of total visual field

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9
Q

why do contact wearers with painful red eye showing dilated vessels need to be urgently referred to eye casualty same day!!!?

most common pathogen causing?

A

to exclude keratitis

psuedomonas aueruginosa
Can also be acanthomeba after swimming in open water with lenses

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10
Q

age related macular degeneration

presentation?

findings in 2 subtypes?

management?

A

worsening of CENTRAL vision/ central scotoma type picture (in a 75 year old, this is more likely than optic neuritis). Worsening night time vision. Visual hallucinations.

Dry macular degeneration = DRUSEN = yellow spots

Wet macular degeneration = choroidal neovascularisation + red patches representing hemorrhage

slit-lamp microscopy is the initial investigation of choice, to identify any pigmentary, exudative or haemorrhagic changes affecting the retina
fluorescein angiography is utilised if neovascular ARMD is suspected, as this can guide intervention with anti-VEGF therapy.

supportive measures in dry version - Vitamin supplementation!!!! High dose of beta-carotene, vitamins C and E!!
VEGF in wet version - ranibizumab, bevacizumab and pegaptanib!!

*visual hallucinations may occur in ARMD

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11
Q

Blot hemorrhages and cotton wool spots are seen in what eye disease?

A

hypertensive retinopathy

(meanwhile microaneurysms seen in both Hypertensive retinopathy and diabetic retinopathy)

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12
Q

orbital cellulitis investigation?

A

CT with contrast

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13
Q

primary open angle glaucoma presentation?

risk factors?

treatment?

A

gradual worsening of peripheral vision

diabetes, myopia

offerselective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg !!

prostaglandin analogue (PGA) eyedrops should be used next-line = LATANOPROST.
Then consider beta blockers, carbonic anhydrase inhibitors

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14
Q

findings in moderate non proliferative diabetic retinopathy?

A

Mild NPDR
1 or more microaneurysm

Moderate NPDR
microaneurysms
blot haemorrhages!!!!!
hard exudates!!!!
cotton wool spots !!!!(‘soft exudates’ - represent areas of retinal infarction), venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR

Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant

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15
Q

treatment of diabetic retinopathy?

A

laser photocoagulation

any evidence of maculopathy = VEGF

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16
Q

A 34-year-old man with a history of ankylosing spondylitis presents with a painful right eye associated with mild photophobia:

Cycloplegic drops have recently been given. What is the most likely diagnosis?

name some associated conditions

A

anterior uveitis!!!

unlike scleritis, anterior uveitis is treated with cyclopecig eyedrops!!! which helps dilate the pupil which is typically constricted!!! = key finding + steroids

ankylosing spondylitis!!!
reactive arthritis
ulcerative colitis, Crohn’s disease
Behcet’s disease
sarcoidosis: bilateral disease may be seen

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17
Q

19-year-old bitemporal hemianopia with predominately the lower quadrants being affected. What is the most likely lesion?

A

cranipharyngioma!!

Bitemporal hemianopia
lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma

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18
Q

subscapular cataracts risk factors?

A

diabetes, steroids and hypermetropia

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19
Q

acute loss of vision, pain and redness with hypopon post cataract surgery. most likely diagnosis?

A

endopthalmitis

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20
Q

A 30-year-old man with a family history of early blindness is concerned that he is developing ‘tunnel vision’.

what is most likely diagnosis?

A

retinitis pigmentosa

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21
Q

A 22-year-old man is referred to urology with possible urinary retention. He is passing huge amounts of urine. Post void bladder ultrasound is normal.
what is the most likely visual field defect?

A

Lower bitemporal hemianopia

patient has diabetes insipidus due to a craniopharyngioma.

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22
Q

A 53-year-old man is admitted to the vascular ward for a carotid endarterectomy. His CT head report confirms a left parietal lobe infarct.
what is the most likely visual field defect?

A

Right inferior quadranopia

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23
Q

if there are hard exudates in macula and blot hemmorhages elsewhere in a patient with a history of diabetes and hypertension

no changes in vision

most likely diagnosis?

A

pre proliferative diabetic retinopathy

not proliferative as new blood vessels not forming

not diabetic maculopathy as this is SIGHT threatening, in severe diabetes, visual changes. Also blot hemmorhages are seen outside the macula

not hypertensive retinopathy as typical early changes eg AV nipping or silver wiring, arteriolar narrowing not seen. hard exudates are typically only seen in advanced disease, at which point one would expect a history of vision changes - also hemorrhages, cotton wool spots

24
Q

A 67-year-old man who is known to have raised intraocular pressure is prescribed dorzolamide eye drops. What is the mechanism of action of this drug?

A

carbonic anhydrase inhibitor

25
Q

75 YO diabetic. blurry vision, round figures around lights at night.

most likely diagnosis??

what are the typical symptoms of this condition?

A

cataracts (diabetes is risk factor)

Reduced vision
Faded colour vision: making it more difficult to distinguish different colours
Glare: lights appear brighter than usual
Halos around lights

*note, halos around lights may also be seen with acute closure angle glaucoma but this will also cause severe eye pain, red eye

26
Q

most likely causative organism for keratitis in contact lens wearers?

features of keratitis?

A

pseudomonas

red eye: pain and erythema
photophobia
foreign body, gritty sensation
hypopyon may be seen!!! -> like in anterior uveitis

27
Q

name a severe complication of scleritis

A

perforation of the globe (necrotising scleritis)

others: glaucoma, cataracts, raised intraocular pressure, retinal detachment, and uveitis

28
Q

first line investigation forneovascular ARMD/ Wet armd?

A

fluorescein angiography

29
Q

papilloedema signs on fundoscopy?

A

swelling of the optic disc, blurring of disc margins

30
Q

central retinal vein occlusion symptoms + fundoscop findings?

fundoscopy findings in central retinal artery occlusion?

A

sudden, painless loss of vision and on fundoscopy, there would be widespread retinal haemorrhages (‘blood and thunder’ appearance) along with venous dilation and tortuosity.

cra occlusion -> pale retina with cherry red spot

31
Q

anterior uveitis first line treatment?

A

steroid + cycloplegic (mydriatic) drops

Not antibiotics

32
Q

accumulations of extracellular material between Bruch’s membrane and the retinal pigment epithelium of the eye, Is seen in what condition

A

Age related macular degeneration

33
Q

most important modifiable risk factor for the development of thyroid eye disease

A

Smoking

34
Q

Patient with diabetes, bilateral blurring of vision with thickening and distortion of fovea. Most likely diagnosis?

A

Diabetic maculopathy

35
Q

Vision loss over the last 18 months In man. In the last 3 days, painless loss of vision in left eye with central scotoma. In amsler grid, straight lines appear wavy. Subretinal and itra retinal haemorrhages on fundoscopy. What condition is this?

A

Wet macular degeneration

On a background of dry age related macular degeneration.

36
Q

Most effective intervention to slow progress of age related macular degeneration?

A

Stop smoking

37
Q

Laser scars from treated diabetic retinopathy, how do they appear

A

White spots scattered throughout retina

38
Q

What eye feature is a risk factor for retinal detachment?

A

Myopia - the retina is being stretched as the eyeball is longer in patients with myopia, making it more prone to tearing and detachment.

39
Q

Treatment for severe polyarthritis from reactive arthritis?

A

Systemic corticosteroids

40
Q

Name the rash seen on soles of feet in reactive arthritis

A

Keratoderma blennorrhagica

41
Q

Treatment for herpes simplex keratitis

A

TOPICAL aciclovir
Not IV

42
Q

Those with a positive family history of glaucoma should be screened annually from age?

A

40

43
Q

Any change in vision with thyroid eye disease requires urgent review by a specialist

A
44
Q

Central retinal artery occlusion causes? Treatment?

A

thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)

IV methylpred !

45
Q

Symptoms of posterior vitreous detachment

A

Flashes and floaters occurring in ageing population
Non sight threatening
Small risk of retinal detachment

46
Q

Which medication for primary open angle glaucoma is First-line treatment in a patient with a history of heart block

A

Latanoprost

As you have to avoid beta blockers like Timolol

47
Q

poor vision, gradually progressing.
obvious cataracts in both eyes but corrected visual acuity is only slightly reduced. most apporpriate management?

A

Referral for cataract surgery

Cataract removal operations should never be rationed on the basis of visual acuity

48
Q

complication of pan retinal photocoagulation?

A

decrease in night vision

49
Q

patient with Graves disease proptosis and erythema of the right eye. Visual acuity is 6/9 in both eyes. What complication is she most likely to have developed?

A

exposure keratopathy

50
Q

except given other info, most likely will be dry rather than wet age related macular degeneration

A
51
Q

pan retinal laser photocoagulation is used specifically for which type of diabetic retinopathy

A

proliferative diabetic retinopathy.

52
Q

Complications of orbital cellulitis?

A

Cavernous sinus thrombosis and intracranial spread

53
Q

Proliferative diabetic retinopathy specifically is treated with?

A

Pan retinal photocoagulation

54
Q

Learn how the subtypes of central vein and central artery occlusion present

A
55
Q

how to differentiate retinal detachment from vitreous hemorrhage? as they both cause flashes and floaters

A

in vitreous hemorrhage. A streak of red colour that spreads across your vision is typically present

Year 6 (19 decks)

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