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OSCE - Scott's Notes COPY not copied > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What are the features of an afferent pupillary defect?

A

No direct response but in tact consensual response
No contralateral consensual response
Dilation on moving light from normal to abnormal eye

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2
Q

What are the causes of a Marcus Gunn pupil?

A

Optic neuritis
Optic atrophy
Retinal disease

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3
Q

What are the features of an efferent pupilliary defect?

A

Dilated pupil which does not react to light
Initiates consensual response in contralateral eye
Opthalmoplegia
Ptosis

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4
Q

What is the cause of an efferent pupillary defect?

A

3rd nerve palsy

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5
Q

What are the differentials for a fixed dilated pupil?

A

Mydriatics e/g/ tropicamide
Iris trauma
Acute glaucoma
CN3 compression

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6
Q

What are the features of Horner’s syndrome?

A

PEAS

Ptosis
Enopthalmos
Anhydrosis
Small pupil

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7
Q

What are the causes of Horner’s syndrome?

A

Central, pre-gang, post-gang

Central - MS, LMS

Pre-gang - Pancoast’s tumour (T1), trauma due to CVA insertion

Post-gang - Cav sinus thrombosis, CN3,4,5,6 palsies

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8
Q

What are Argyll Robertson pupils and what causes them?

A

Small irregular pupils which accomodate but dont react to light.

DM
Quaternary syphillis

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9
Q

What are the features of optic atrophy/neuropathy?

A

Reduced acuity and colour vision
Central scotoma
Pale optic disc
RAPD

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10
Q

What are the causs of optic atrophy/neuropathy?

A

CAC VISION
n.b. MS and glaucoma commonest

Congenital - CMT, Leber’s Hereditary optic neuropathy, retinitis pigmentosa

Alcohol etc. - Lead, B12 def

Compression - Neoplasia, glaucoma, Pagets

Vascular - DM, GCS, VTE

Inflamm - MS

Sarcoid

Infection - Zoster, syphillis, TB

Oedema - papilloedema

Neoplastic infiltrates (lymphoma/leukaemia)

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11
Q

What might be the history findings of red eye?

A

Vision - blurred, diplopia, scotoma, floaters, flashes

Sensation - irritation, pain, itching, photophobia, FB

Apperaance - red +- lump

Discharge - watery, sticky, stringy

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12
Q

What are the signs of serious disease in a patient with red eye?

A

Photophobia
Visual impairment
Corneal fluorescein staining
Abnormal pupil

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13
Q

What are the key examination questions in red eye?

A

Is acuity affected?
Is the globe painful?
Are the pupils equal and reactive?
Are the cornea in tact or cloudy?

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14
Q

Comment on each of the following in acute glaucoma:

Pain
Photophobia
Acuity
Cornea
Pupil
IOP
A 
Pain +++
Photophobia nil
Acuity reduced
Cornea hazy/cloudy
Pupil large
IOP raised
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15
Q

Comment on each of the following in anterior uveitis:

Pain
Photophobia
Acuity
Cornea
Pupil
IOP
A 
Pain ++
Photophobia ++
Acuity reduced
Cornea normal
Pupil small
IOP normal
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16
Q

Comment on each of the following in conjunctivitis:

Pain
Photophobia
Acuity
Cornea
Pupil
IOP
A 
Pain +/-
Photophobia +
Acuity normal
Cornea normal
Pupil normal
IOP normal
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17
Q

What is the pathology and thus of acute closed angle glaucoma?

A

Blocked drainage of aqueous humor from anterior to posterior chamber via the canal of Schlem
Pupil dilatation worsens the blockage
IOP rises from 15-20 ->60

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18
Q

What are the risk factors for acute closed angle glaucoma

A 
Hypermetropia (long sightedness)
Shallow ant chamber
Female
FH
Old age
Drugs - anticholinergics, TCAs, anti-histamines
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19
Q

What are the symptoms of acute glaucoma?

A

Severe pain with N/V

Reduced acuity with blurred vision

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20
Q

What are the examination findings of acute glaucoma>

A

Cloudy cornea with circumcorneal injection
Fixed, dilated, irregular pupil
Raised IOP makes eye feel hard

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21
Q

What is the acute management of acute glaucoma?

A

Pilocarpine drops - miosis opens blockage
Topical beta blockade (timolol) - reduces aqueous formation
Acetazolamide 500mg IV state - reduces aqueous formation
Analgesia
Antiemetics

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22
Q

What is the pathophysiology of anterior uveitis?

A

Uvea includes iris, ciliary body and choroid (vascular layer)
These structuresbecome inflamed in ant uveitis

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23
Q

What are the symptoms of anterior uveitis?

A

Acute pain and photophobia

Blurred vision

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24
Q

What are the examination findings of anterior uveitis?

A

Amall pupil initially ->irregular later on
Circumcorneal injection
Hypopyon - pus in ant chamber

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25
Q

What is Tablot’s test and when is it positive?

A

Assesses pain on convergence and is seen in anterior uveiitis

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26
Q

What are the associations with ant uveitis?

A 
Seronegative arthropathies - AnkSpon, psoriatic, Reiters
Stills disease
IBD
Sarcoid
Bechets
Various infections
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27
Q

What is the management of anterior uveitis?

A

Prednisolone drops

Cyclopentolate drops dilate the pupil and prevent adhesions forming between iris and lens

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28
Q

How does episcleritis present and what causes it?

A

Localised reddening which can be moved over the sclera
Painless/mild discomfort
Acuity is preserved

Usually idiopathic

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29
Q

How do you treat episcleritis?

A

Topical or systemic NSAIDs

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30
Q

How might scleritis present?

A

Severe pain worse on movement
Generalised scleral inflammation (vessels wont move unlik episcleritis)
Conjunctival oedema (chemosis)

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31
Q

What are the common causes of scleritis?

A

GwP
RA
SLE
Vasculitides

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32
Q

How is scleritis managed, and what is an important complication to note?

A

Corticosteroids or immunosuppressants

Scleromalacia (thinning) may precede globe perforation

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33
Q

What are the presenting features ofconjunctivitis?

A

Often bilateral with purulent discharge
Discomfort
Conjunctival injection (vessels may be moved over sclera)
Acuity responses and cornea are unaffected

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34
Q

What are the causes of conjunctivitis?

A

Adenovirus
Bacterial - staph, chlamydia, gonogoccal
ALlergic

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35
Q

What is the treatment for conjunctivitis?

A

Chloramphenicol ointment if bacterial

Antihistamine drops if allergic

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36
Q

HOw would you investigate a corneal abrasion?

A

Under a slit lamp with fluorescein stain which marks the defect green

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37
Q

What would you give for a corneal abrasion?

A

Chloramphenicol prophylaxis

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38
Q

What are the features of corneal abrasion?

A

Pain
Photophobia
Blurring

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39
Q

What are the causes of corneal inflammation?

A

Bacterial, herpes, fungi, RA

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40
Q

What are the features of corneal inflammation?

A 
Pain
Photophobia
COnjunctival hyperaemia
Reduced acuity
White corneal opacity
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41
Q

What is the main risk factor for corneal inflammation?

A

Contact lenses

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42
Q

How would you investigate corneal inflammation?

A

Slit lamp and fluorescein

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43
Q

What is the management of corneal inflammation

A 
Immediate referral
Smears and cultures
Abx/aciclovir drops
Mydriatics ease photophobia
Steroids worsen symptoms
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44
Q

What is the presentation of opthalmic shingles?

A

Pain in CNV1 distribution precedes a blistering rash
40% develop keratitis, ant uveitis
Hutchinson’s sign - nose tip zoster due to nasociliary involvement

45
Q

What are the key questions to ask in the event of sudden loss of vision?

A

HELLP

Headache? - GCA
Eye movement pain? - optic neuritis
Lights

46
Q

What are the clinical features of optic neuritis?

A 
Unilateral acuity loss over hours-days
Dyschromatoplasia
Painful eye movements
Enlarged blind spot 
Afferent defect
47
Q

What are the causes of optic neuritis?

A 
MS
DM
Ethambutol, chloramphenicol
Vit def
Zoster/Lyme disease
48
Q

What is the treatment of optic neuritis?

A

IV methyle pred for 72 hrs then oral pred for 11 days

49
Q

What are the common sources of vitreous haemorrhages?

A

Neovascularisation in DM

Retinal tear/detacment/trauma

50
Q

WHat is the resolution of vitreous haemorrhage?

A

Usually undergoes spontaneous resolution

51
Q

WHat is the presentation of central retinal artery occlusion?

A

Dramatic unilateral visual loss in seconds
Afferent pupil defect
Pale retina with cherry red macula

52
Q

What are the causes of central retinal artery occlusion?

A

GCA

Thromboembolism

53
Q

What is the teratment of central retinal artery occlusion?

A

Ocular massage
Surgical aqueous removal
Antihypertensives

54
Q

What are causes of retinal vein occlusion?

A

Arteriosclerosis, HTN, DM, polycythaemia

55
Q

What is the presentation of retinal vein occlusion?

A

Sudden unilateral vision loss associated with RAPD in the case of central retinal vein occlusion

56
Q

What are the fundoscopic findings in central retinal vein occlusion?

A

Central -
Stormy sunset appearance with tortuous dilated vessels
Haemorrhages
Cotton wool spots

57
Q

What are the complications of central retinal vein occlusion?

A

Glaucoma

Neuovascularisation due to VEGF release

58
Q

What are the causes of retinal detachment?

A

SUrgery
Trauma
DM

59
Q

What are the clinical features of retinal detachment?

A

4Fs

Floaters
Flashes
Field loss
Fall in acuity

60
Q

What are the fundoscopic features of retina detachment?

A

Grey opalescent retina with ballooning

61
Q

What is the management of retinal detachment?

A

Urgent surgery with vitrectomy and gas tamponade c laser coagulation to secure the retina

62
Q

What are the causes of transient visual loss?

A

Vascular - TIA, mibgraine
MS
Subacute glaucoma
Papilloedema

63
Q

What are the causes of gradual visual loss?

A 
Common
DM
ARMD
Cataracts
Open angle glaucoma

Rarer
Retinitis pigmentosa
HTN
Optic atrophy

64
Q

WHat are the commonest causes of blindness in those over and under 60?

A

Under 60 - DM retinopathy

Over 60 - ARMD

65
Q

What are the risk factors for ARMD?

A

Age
Smoking
Genes

66
Q

What is the primary presenting feature of ARMD?

A

Central visual loss

67
Q

What is the difference between dry and wet ARMD?

A

Dry presents with fluffy white spots around the macula with degeneration, which may progress to Wet ARMD with neovascularisation, haemorrage and rapid visual decline

68
Q

What is the management of wet ARMD?

A

Photodynamic therapy
VEGF inhibitors
Antioxidants and vitamins

69
Q

What is the typical presentation of open angle glaucoma?

A

Peripheral visual field defect begining superonasally and working inferotemporally

70
Q

What are the risk factors for OA glaucoma?

A 
>35
A-C
FH
Steroids
DM
HTN
Myopia
71
Q

How would you investigate open angle glaucoma, and what would be seen on fundoscopy?

A

Tonometry - IOP>21mmHg
Fundoscopy shows cupping of the optic disc
Peripheral loss on visual field assessment

72
Q

What is the management of OA glaucoma?

A 
Life long folow up
Drops to lower IOP
B blockers - timolol
Prostaglandin analogues - Latanoprost
A-agonists - Brimonide
Carbonic anhydrase inhibitors - acetazolomide
Miotics - pilocarpine

Non medical
Laser trabeculoplasty

73
Q

Why does DM cause cataracts?

A

THe lens absorbs glucose which is converted to sorbitol by aldose reductase

74
Q

WHat is the pathogenesis of diabetic retinopathy?

A

Small vessel disease causes occlusion which leads to ischaemia and neovascularisation which may bleed and result in vitreous haemorrhage with oedema and lipid exudates

Occlusion also causes cotton wool spots as a sign of ischaemia

Microaneurysms may rupture and cause blot haemorrhages

75
Q

What is the screening programme for diabetic retinopathy?

A

All diabetics should be screened annually with fundus photogaphy.
Those with macular degeneration, proliferative and pre-proliferative retinopathy should be referred

76
Q

How else can you investigate DM retinopathy?

A

Fluorescein angiography

77
Q

WHat is the management of DMR?

A

Good BP and glycaemic control
Treat concurrent illnesses
Stop smoking
Laser photocoagulation (Focal/grid for maculopathy, pan-retinal with macular sparing for proliferative disease

78
Q

What are the fundoscopic findings of each stage of DM retinopathy?

A

Background - leakage
Dots - microaneurysms
Blot haemorrhages
Hard exudates - yellow lipid patches

Pre-proliferative - ischaemia
Cotton wool infarcts
Venous beading
Dark haemorrhages
Microvascular abnormalities

Proliferative - Neovascularisation
Vitreous haemorrhage
Retinal detachment

Maculopathy - macular oedema
Inaccuity amy be only sign
Hard exudates within one disc width of the macula

79
Q

What is the typical presentation of cataracts?

A

Myopia
Blurred vision
Dazzling sunshine
Monoocular diplopia

80
Q

What are the causes of cataracts?

A 
Age
DM
Steroids
Idiopathic
Congenital rubella
Myotonic dystrophy
81
Q

What is the management of cataracts?

A

Conservative
Glasses and mydriatic drops

Surgical
Phacoemulsification with lens implant

82
Q

What are the complications of phacoemulsification surgery?

A 
Ant uveitis
Vhaemorrhage
Ret detachment
Glaucoma
Capsule thickening
Irritation
83
Q

What are the various inheritance methods of retinitis pigmentosa?

A

Mostly AR
AD best
XLR worst

84
Q

What is the typical presentation of retinitis pigmentosa?

A

Night blindness

Tunnel vision

85
Q

What are the fundoscopic findings of ret pig?

A

Pale optic disc- (atrophy)

Peripheral pigmentation with macular sparing

86
Q

Give a syndrome which is assocaited with ret pig

A

Friedrich’s ataxia

87
Q

WHat are the findings of a retinoblastoma?

A

Strabismus

White pupil with no red reflex

88
Q

What is the difference between a stye and a chalazion?

A

A stye is an abscess/infection in a lash follicle which points outwards, whereas a chalazion is the same but pointing inwards

89
Q

What is blepharitis and what are its features?

A

Chronic inflammation of the eyelid

Red eyes
Gritty/itching
Scales on lashes
Often w. rosacea

90
Q

What causes blepharitis and how is it treated?

A

Seborrheic dermatitis and staph

Clean crusts with warm soaks +-fusidic acid drops

91
Q

What are en- and ectropia?

A

Entropion is lid inversion leading to corneal irritation

Ectropion is lower lid eversion leading to watering and exposure keratitis

92
Q

What are the causes of ptosis?

A 
Bilateral
Congenital
Senile
Myasthenia
Myotonic dystrophy

Unilateral
3rd nerve palsy
Horner;s
Xanthalesma. trauma

93
Q

What is pterygium?

A

A benign overgowth of the conjunctiva leading to yellow bascular nodules over the cornea

94
Q

What are the causes of expothalmos?

A

Common
Graves (esp in smokers)
Orbital cellulitis
Trauma

Rarer
Idiopathic
GwP
Neoplasm
Carotid cavernous fistula
95
Q

What are myopia and hypermetropia and their treatments?

A

Hypermetropia= long sightedness
Eye is too short so give convex lenses

Myopia = short sightedness
Eye is too long so give concave lenses

96
Q

What are eso and exotropia?

A

Esotropia is a convergent squint

Exotropia is a digergent squint

97
Q

What is the difference between a non-paralytic and paralytic strabismus?

A

Non paralytic is when the strabismus occurs in all directions, while parlytic squint diplopia is present and most notable on looking towards the pull of the paralysed muscle

98
Q

What are the causes of the various paralytic squint?

A

CN3
Medical - DM, MS, infarction
Surgical - raised ICP, CS thrombosis, posterior communicating artery aneurysm

CN4
Peripheral - DM, trauma, compression
Central - MS, vascular, SOL

CN6
as for CN4

99
Q

How would you manage an ocular foreign body?

A

Chloramphenicol prophylaxis
Eye patch
Cyclogenic drops for pain relief (tropicamide

100
Q

What is -and the presentation of -an orbital blow out fracture?

A

Blunt injury causes sudden rise in IOP as orbital contents herniate into the maxillary sinus

Opthalmoplegia 
Diplopia
Loss of sensation to lower lid skin
Ipsilateral epistaxis
Poor light response
101
Q

What causes floaters?

A

Ret detachment
FH
DM
HTN

102
Q

What is the commonest cause of flashes/photopsia?

A

posterior detachment

103
Q

What is the pathophysiology of a trachoma?

A

Caused by Chlamydia trachomatis spread by flies.

results in inflammation -> scarring -> lid distortion -> Entropion -> corneal irritation…..blindness

104
Q

What is the management of trachoma?

A

Tetracycline 1% ointment

105
Q

What are the eye signs in hypertensive retinopathy?

A 
Tortuosity 
Silver wiring
AV nipping
Flame haemorrhages
Cotton wool spots
Papilloedema
106
Q

What are the eye signs in HIV patients?

A

CMV retinitis - pizza pie fundus with flames

HIV retinopathy - cotton wool spots

107
Q

What are the different types of mydriatics commonly used?

A

Anti-muscarinics e.g. Tropicamide

Sympathomimetics e.g. Phenylephrine

108
Q

What are the different types of miotics commonly used and why would you use one?

A

Pilocarpine - muscarinic agonist

Used for acute glaucoma

OSCE - Scott's Notes COPY not copied (21 decks)

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