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NMF: Neurology > OPTHALMOLOGY > Flashcards

OPTHALMOLOGY Flashcards

1
Q

Diplopia worse walking down the stairs

A

fourth nerve palsy

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2
Q

headache + ptosis + miosis

A

aka Painful Horner’s syndrome

–> due to internal carotid dissection

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3
Q

Progressive headache 6/10, ptosis and right dilated unreactive eye

A

3rd nerve palsy described possibly due to posterior communicating artery aneurysm

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4
Q

Obese lady on COCP develops morning headaches which are worse on coughing and diploplia. What’s causing double vision?

A

sixth nerve palsy duue to benign intercranial hypertension

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5
Q

Retro-orbital boring pain 10/10 lasting 20 minutes. 10 episodes per week.

A

Cluster headache

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6
Q

A 30-year-old female presented with double vision and ataxia. Three years earlier she had an episode where she lost vision in her left eye for two weeks. On exam, she was mildly ataxic, with brisk reflexes, and both horizontal and vertical nystagmus. What is the most likely diagnosis?

A

Multiple sclerosis

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7
Q

What are the two parts of the pupillary light reflex?

A

AFFERENT - optic nerve

EFFERENT - oculomotor nerve

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8
Q

Give signs of optic nerve dysfunction

A

Decrease in visual acuity (VA).
Dyschromatopsia: visual colour impairment.
Visual field defects.
Diminished contrast sensitivity.
Relative afferent pupillary defect (RAPD).

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9
Q

What condition can cause optic neuritis?

A

MS

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10
Q

Give clinical features of MS

A
  • sensory loss
  • muscle cramping and weakness
  • bladder, bowel + sexual dysfunction
  • Charcot’s triad (tremor +dysarthria + ataxia)
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11
Q

What is l’hermitte sign?

A

a clinical feature of MS - electrical shock on neck flexion

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12
Q

What is Uhthoff phenomenon?

A

worsening of MS symptoms due to increase in temperature

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13
Q

Features of optic neuritis

A

unilateral pain exacerbated by eye movements, decreased VA visual field defect (central scotoma), dyschromatopsia and RAPD.

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14
Q

How do you investigate MS?

A

MRI - demyelinating plaques

Lumbar puncture - oligoclonal bands in CSF

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15
Q

Treat optic neuritis

A

IV methylprednisolone then oral prednisolone

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16
Q

Horner’s syndrome features

A

ptosis (due to muller muscle dysfunction), miosis (causing anisocoria) and ipsilateral anhydrosis (if lesion below superior cervical ganglion).

17
Q

What is Adie’s pupil?

A

affected pupil is dilated with absent light reflex due to damage to ciliary ganglion

18
Q

What is Holmes-Adie syndrome?

A

diminished/absent deep tendon reflexes of lower limbs + Adie’s pupil +/- orthostatic hypotension

19
Q

What is Argyll Robertson (prostitute’s) pupil?

A

bilateral, irregular small pupils that dont react but do accomodate
- due to diabetes or syphilis

20
Q

Clinical features of 3rd nerve palsy

A

ptosis
down and out eye
dilated pupil with abnormal accomodation

21
Q

Clinical features of 6th nerve palsy

A

horizontal double vision, esotropia (inwards) and limited abduction

22
Q

What is mysathenia gravis?

A

autoimmune disease of AcH receptors at post-synaptic neuromuscular junctions

23
Q

Clinical features of myasthenia gravis

A

bilateral ptosis
lid twitch elicited by looking down then up
diplopia
opthalmoplegia
weakness of muscles of facial expression and proximal limbs

24
Q

Investigate myasthenia gravis

A
  • ptosis improves after 2min of ice
  • anti-ACh receptor antibody and anti-muscle specific kinase
  • electromyography and muscle biopsy
  • image throax for thymoma
25
Q

management of myasthenia gravis

A

Pyridostigmine (anticholinesterase), steroids and immunomodulators.
Surgery if thymoma is present (thymectomy).

26
Q

What is myotonic dystrophy?

A

AD condition due to tri-nucleotide repeat on chromosome 19.

Causes delayed muscle reaction and wasting

27
Q

Give the ocular features of myotonic dystrophy

A
  • early onset cataracts
  • ptosis
  • hypermetropia (long sighted)
  • opthalmoplegia
28
Q

Lateral optic nerve lesion immediately anterior to the chiasma would result in which vision defect?

A

junctional scomatoma

29
Q

optic tract lesion

A

homonymous hemianopia of opposite side

30
Q

Damage to the optic radiation will cause which visual defect?

A

bilateral quadrantopia

NMF: Neurology (9 decks)

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