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Phase 3 > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

How are diabetic retinopathy and retinal vascular occlusive disease imaged?

A

Fluorescein dye

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2
Q

How is macular oedema best detected?

A

Fluorescein angiography

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3
Q

A 52 year old female presents with two month history of giddiness. Examination reveals a nystagmus to both extremes of gaze and a tendency to fall to the right. She has a deafness of the right ear. What reflex is also likely to be affected and what is the diagnosis?

A

Corneal reflex may be lost

Acoustic neuroma

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4
Q

A 73 year old female presents acutely with nausea vomiting and giddiness. She has recently been treated for heart failure with atrial fibrillation and receives digoxin, furosemide and ramipril. What test should be done to do with her vision? What does she have?

A

Colour vision

Digoxin toxicity

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5
Q

What is conjunctivitis medicamentosa?

A

People use cheap over the counter preparations to treat their dry eyes
Excessive use of topical medications and preservative toxicity causes conjunctivitis

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6
Q

A 40 year old model who enjoys sunbathing is referred to an opthalmologist with 6 month history of vascularisation extending into nasal aspect of the cornea in her right eye. What is it?

A

Pterygium

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7
Q

What is a pterygium?

A

Benign growth of the conjunctiva
Grows from nasal side of conjunctiva
Caused by UV light exposure

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8
Q

A 50 year old man presents to his GP complaining of a foreign body sensation in left eye. GP notices that the lower eye lid is inverted. What is it?

A

Entropion

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9
Q

What is an entropion? How is it treated?

A

Eyelid folds inward
Eyelashes constantly rub on cornea so very uncomfortable
Surgery is indicated

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10
Q

A 40 year old man is referred to opthalmologist with soft yellowish patches over sclera at 3 and 9 o’clock positions. The patient is asymptomatic. What does he have? What should be done about it?

A

Pinguecula

Benign condition can be left alone

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11
Q

How does anterior uveitis present?

A

Pain of acute onset
Lacrimation
Circumcorneal redness
Small pupil/irregular

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12
Q

What will be seen on slit lamp exam in anterior uveitis?

A

White precipitates on back of cornea and cells in anterior chamber

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13
Q

How do you treat anterior uveitis?

A

Steroids

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14
Q

A patient is diagnosed with a dendritic ulcer after fluorescein staining. How should it be managed?

A

Antiviral ointment - aciclovir 3% 5x daily until complete healing

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15
Q

How should acute angle closure glaucoma be managed?

A

Miotic agent - pilocarpine
Carbonic anhydrase inhibitors
Topical beta blockers

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16
Q

How is acute angle closure glaucoma confirmed?

A

Elevated intraocular pressure more than 60mmHg

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17
Q

How might a 3rd nerve palsy due to posterior communicating artery aneurysm differ from one caused by vascular disease such as diabetes?

A

External compression due to aneurysm - external fibres only, fixed dilated pupil followed by partial ten complete palsy
Vascular disease - innermost fibers affected most, pupil function preserved but palsy and ptosis more prevalent

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18
Q

What are some causes of a swollen optic disc?

A 
Malignant HTN
Raised intracranial pressure due to space occupying lesion or infection
Renal failure
Chronic carbon dioxide retention
Idiopathic intracranial HTN
Hypocalcaemia
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19
Q

What is central serous chorioretinopathy?

A

Serous detachment of neurosensory retina occurs over area of leakage from choriocapillaris through retinal pigment epithelium at pole of fundus resulting in diminished visual acuity and distortions of visual perception

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20
Q

What are some causes of central serous chorioretinopathy?

A

Idiopathic

Hypercortisolaemia - pituitary/adrenal disease, corticosteroids, adrenocorticotrophic hormone

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21
Q

What are signs and symptoms of retinal detachment?

A

Flashes
Floaters
Blurring or distortion of vision
Shadow/curtain spreading across vision

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22
Q

Which is the most common area affected in retinal detachment?

A

Superior temporal

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23
Q

How does a dendritic ulcer usually present?

A 
Pain
Photophobia 
Blurred vision
Conjunctivitis 
Chemosis (oedema of the conjunctiva)
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24
Q

Why are steroid drops contraindicated in dendritic ulcer?

A

Induce massive amoeboid ulceration and blindness

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25
Q

A patient has an acute painless loss of vision with flame shaped haemorrhages radiating out from the disc and oedema. What is the problem?

A

Central retinal vein occlusion

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26
Q

What are risk factors for central retinal vein occlusion?

A 
Age over 55
HTN 
Hyperlipidaemia
Diabetes Mellitus 
Oral contraceptive pill
Raised intraoccular pressure
Smoking
Polycythemia 
Myeloma 
SLE
Hypercoagulable states
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27
Q

A 38 year old man has been complaining of headaches, dizziness and poor concentration for some time. He is brought to hospital with weakness on the left side. His haemoglobin is 200. What is going on?

A

Polycythemia Vera causing focal neurological signs as a result of cerebral thrombosis due to increased viscosity

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28
Q

A 70 year old man presents with constant severe pain in his right eye and forehead of one day duration. He has been long sighted for years but the vision in his right eye has rapidly deteriorated over the past 2 days. On examination the eye is red and congested with a dilated non responsive pupil. What is the immediate management?

A

IV acetazolamide

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29
Q

What is dacrocystitis?

A

Inflammation of the lacrimal sac

Usually caused by staph aureus

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30
Q

A 40 year old lady presents acutely to the GP with marked photophobia and decreased vision. The GP notes the presence of corneal injection and a small pupil. Slit lamp examination reveals hazy fluid. What is the likely diagnosis?

A

Uveitis

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31
Q

What are characteristic features of acute uveitis?

A

Photophobia
Circumlimbal injection
Abnormally shaped pupil/different size to unaffected eye

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32
Q

Which drugs can be used for the management of primary open angle glaucoma? How do they work?

A

Prostaglandin analogues: latanoprost, increase uveoscleral outflow
Beta blocker: timolol, reduce aqueous production
Sympathomimetics: brimonidine, reduce aqueous production and increase outflow
Carbonic anhydrase inhibitor: dorzolamide, reduce aqueous production
Miotics: pilocarpine, increase uveoscleral outflow

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33
Q

What is the most common cause of blindness in the U.K.?

A

Age related macular degeneration

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34
Q

What is the management for age related macular degeneration?

A

Refer for opthalmological assessment within 1 week
Stop smoking
High dose beta carotene, vitamin c and e, zinc
Wet AMD: photocoagulation, photodynamic therapy, anti VEGF

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35
Q

What is normal range for intraocular pressure?

A

10-21 mmHg

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36
Q

What are risk factors for primary open angle glaucoma?

A 
Age 
Family history 
Black 
Myopia 
HTN
Diabetes
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37
Q

What are the Keith Wagener grades of hypertensive retinopathy?

A

Grade 1: tortuosity and silver wiring of arteries
Grade 2: AV nipping
Grade 3: flame haemorrhages and cotton wool spots
Grade 4: papilloedema

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38
Q

What are hallmarks of pre proliferative retinopathy?

A

Venous abnormalities - beading, reduplication

Cotton wool spots

39
Q

What are signs of papilloedema on fundoscopy?

A 
Venous engorgement 
Blurring of optic disc margin
Elevation of optic disc
Loss of optic cup
Patons lines: concentric/ radial retinal lines cascading from optic disc
40
Q

What are causes of papilloedema?

A 
Space occupying lesion: neoplastic, vascular
Malignant HTN
Idiopathic intracranial HTN
Hydrocephalus 
Hypercapnia 
Hypoparathyroidism and hypocalcaemia 
Vitamin A toxicity
41
Q

What is the most common cause of contact lens acquired infection?

A

Pseudomonas aeruginosa

42
Q

What is dacryocystitis? How does it present?

A

Infection of lacrimal sac
Watering eye (epiphora)
Swelling and erythema at inner canthus of eye

43
Q

What is a Marcus gunn pupil?

A

Relative afferent pupillary defect
Damage to afferent pathway - retina or optic nerve
Pupil will abnormally dilate when light shone onto it due to consensual relaxation response from healthy eye dominates

44
Q

What is a danger of hyphaema?

A

Secondary glaucoma

45
Q

What is the definition of blindness?

A

Visual acuity less than 3/60 or inability to count fingers in daylight at distance of 3m

46
Q

What is a pinguecula?

A

Conjunctival degeneration

Yellow/white deposit on conjunctiva adjacent to limbus

47
Q

What is entropion of the eye? What is the management?

A

Out turning of the eyelids

Eye lubricants and tape to pull eyelid outwards whilst awaiting surgery

48
Q

What are the most common causes of a sudden painless loss of vision?

A 
Ischaemic optic neuropathy: temporal arteritis, atherosclerosis 
Occlusion of central retinal vein
Occlusion of central retinal artery
Vitreous haemorrhage 
Retinal detachment
49
Q

What are some causes of central retinal vein occlusion?

A

Glaucoma
Polycythemia
Hypertension

50
Q

What factors predispose to acute angle closure glaucoma?

A

Hypermetropia (long sightedness)
Pupillary dilatation
Lens growth associated with age

51
Q

What are features of acute angle closure glaucoma?

A 
Severe pain: ocular or headache
Decreased visual acuity
Symptoms worse with mydriasis (dark room)
Hard red eye
Haloes around lights
Semi dilated non reacting pupil
Corneal oedema - dull or hazy 
Nausea and vomiting
52
Q

What is the appearance on fundoscopy of an eye with central retinal vein occlusion?

A

Severe haemorrhages

Cheese and tomato pizza appearance

53
Q

What are risk factors for primary open angle glaucoma?

A 
Age over 40
Family history 
Black
Myopia 
Hypertension
Diabetes Mellitus
54
Q

How does primary open angle glaucoma present?

A

Peripheral visual field loss
Nasal scotomas progressing to tunnel vision
Decreased visual acuity
Optic disc cupping

55
Q

What is endophthalmitis?

A

Inflammation of interior of eye
Complication of intraocular surgeries, particularly cataracts
Presents with severe pain, loss of vision, red eye, hypopyon

56
Q

What is the most common cause of blindness in adults age 35-65?

A

Diabetic retinopathy

57
Q

What is hutchinsons sign?

A

Rash on tip or side of nose indicates nasociliary involvement with herpes zoster opthalmicus and is a strong risk factor for ocular involvement

58
Q

What is management of herpes zoster opthalmicus?

A

Oral antiviral treatment for 7-10 days ideally started in 72 hours
Ocular involvement requires urgent ophthalmology review

59
Q

What are complications of herpes zoster opthalmicus?

A 
Conjunctivitis 
Keratitis
Episcleritis 
Anterior uveitis
Ptosis 
Post herpetic neuralgia
60
Q

What are causes of tunnel vision?

A 
Papilloedema
Glaucoma
Retinitis pigmentosa
Choroidoretinitis
Optic atrophy secondary to tabes dorsalis
Hysteria
61
Q

What is the mechanism of action of prostaglandin analogues in primary open angle glaucoma?

A

Increases uveoscleral outflow

62
Q

What is the mechanism of action of beta blockers in primary open angle glaucoma?

A

Reduce aqueous production

63
Q

What is the mechanism of action of carbonic anhydrase inhibitors in primary open angle glaucoma?

A

Reduce aqueous production

64
Q

What is the mechanism of action of miotics (pilocarpine) in primary open angle glaucoma?

A

Muscarinic agonist

Increases uveoscleral outflow

65
Q

What are risk factors for primary open angle glaucoma?

A 
FH
Black patients 
Myopia 
HTN
Diabetes
66
Q

What features on examination might suggest primary open angle glaucoma?

A

Peripheral visual field loss, nasal scotomas progressing to tunnel vision
Decreased visual acuity
Optic disc cupping. Cup to disc ratio >0.7
Optic disc pallor
Bayoneting of vessels - have breaks as they disappear into cup and reappear at base
Cup notching
Disc haemorrhages

67
Q

What is the Keith wagener classification of HTN retinopathy?

A

1: arteriolar narrowing and tortuosity. Increased light reflex - silver wiring
2: arteriovenous nipping
3: cotton wool exudates, flame and blot haemorrhages
4: papilloedema

68
Q

What are side effects of prostaglandin analogues used in glaucoma?

A

Increased eyelash length
Iris pigmentation
Periocular pigmentation

69
Q

Which antibiotics should be used for corneal abrasions?

A

Contact lens wearer: topical ciprofloxacin to cover for pseudomonas
Non contact wearer: topical erythromycin

70
Q

What is the name of cataract surgery?

A

Phacoemulsification

71
Q

What are complications of cataract surgery?

A

Early: posterior capsule rupture
Late: posterior capsule opacification
Endopthalmitis

72
Q

What is used to measure intraocular pressure?

A

Tonometer

73
Q

What value is normal for intra ocular pressure?

A

21

74
Q

What is gonioscopy?

A

Measurement of iridocorneal angle used to distinguish between open and closed angle glaucoma

75
Q

What is important to note about the optic disc in open angle glaucoma?

A

Cupping - death of nerve fibres and so enlargement of the optic cup

76
Q

What are risk factors for open angle glaucoma?

A 
Age
Family history
Race - Afro Caribbean 
Myopia 
Intraocular HTN
77
Q

What is used to test for wet AMD?

A

Amsler chart
Slit lamp fundoscopy
Optical coherence tomography
Fluorescein angiography

78
Q

What changes will be seen on a retina with wet AMD?

A

Drusen
Atrophic change
Choroidal neovascularisation
Leaking blood vessels

79
Q

What can be used to treat wet AMD?

A

Photodynamic therapy
Laser photocoagulation
Intravitreal vascular endothelial growth inhibitor

80
Q

What is a serious viral cause of conjunctivitis?

A

Adenovirus - causes supethelial deposits, can cause visual loss

81
Q

What type of conjunctivitis is associated with pre auricular lymphadenopathy?

A

Viral

82
Q

Why does chloramphenicol not work for contact lens wearers with bacterial conjunctivitis?

A

Pseudomonas infection
Chloramphenicol doesn’t cover Gram negative bacteria
Need levofloxacin/gentamicin

83
Q

What are the 3 components of tear film?

A

Oil (outside)
Water
Mucin

84
Q

What are the 2 types of blepharitis?

A

Anterior: skin at base of eyelashes
Posterior: affects meibomian glands along eyelid margins behind base of eyelashes

85
Q

What type of cells produce mucin for tear film?

A

Goblet cells

86
Q

Which cells produce oil for the tear film?

A

Meibomian cells

87
Q

What is a feature of chlamydia conjunctivitis?

A

Unilateral
Sticky/watery discharge
Pseudomembrane - bleeds when flip eyelid

88
Q

How many layers are there in the cornea? What are they?

A 
5
Epithelium (only bit that can regenerate)
Bowmans layer 
Corneal stroma
Descemets membrane
Corneal endothelium
89
Q

What could be causes of sub conjunctival haemorrhage?

A 
Trauma
Coughing/sneezing 
Diabetes 
HTN 
Warfarin 
Bleeding disorders
90
Q

What is a synechiae?

A

Iris adheres to cornea or lens

91
Q

Why do you get vision loss in orbital cellulitis?

A

Proptosis, leads to stretching of optic nerve

92
Q

What is the most common surgery done in the U.K?

A

Cataract surgery

93
Q

What is presbyopia?

A

Stiffening of lens with age

Need reading glasses as can’t focus on near object

94
Q

What makes up the uvea?

A

Iris
Ciliary body
Choroid

Phase 3 (23 decks)

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