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3B GH > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

arcuate scotoma suggests what pathology

A

glaucoma

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2
Q

central scotoma visual field defect suggests what?

A

macular degeneration
macular oedema

or optic nerve pahtolgy

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3
Q

right temporal lobe lesion would cause what visual field defect?

A

left superior quadrantanopia

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4
Q

having a complete lesion on the optic nerve causes what visual defect?
what about the direct and indirect pupillary reflexes?

A

total blindness in that eye

direct absent, indirect intact

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5
Q

optic chiasm lesion will cause what visual defect?

A

bitemporal hemianopia

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6
Q

lesion on the optic tract causes what visual defect

A

a contralateral homonymous hemianopia

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7
Q

lesion on the optic radiation causes what visual defect

A

a contralateral homonymous hemianopia

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8
Q

damage to tip of the occipital lobe causes what visual defect

A

contralateral homonymous hemianopia

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9
Q

causes of visual cortex field defects

A 
ischaemia [TIA, migraine, stroke]
glioma
meningioma
abscess
AV malformation
drugs: ciclosporin
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10
Q

what is a cataract?

A

opacity of the lens

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11
Q

risk factors for cataracts

A 
age
DM [appear earlier]
genetic
steroids
high myopia
myotonic dystrophy
smoking
alcohol
^sunlight
trauma
radiotherapy
HIV
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12
Q

is there red reflex in cataracts?

A

immature: yes

dense cataracts: no

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13
Q

how do cataracts present in adults and in children

A

gradually worsening blurred vision
dazzle, difficulty driving at night

if unilateral, often unnoticed

children: white pupil, squint, nystagmus, amblyopia

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14
Q

cataract Mx

A

mydriatic drops
sunglasses
surgery

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15
Q

Mx of congenital cataract

A

R/F immediately to prevent deprivation amblyopia

TORCH screen

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16
Q

causes of a red eye that requirke urgent referral

A

acute glaucoma
acute iritis
corneal ulcers
scleritis

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17
Q

common causes of red eye

A

conjunc
foreign body
corneal ulceration
subconjunctival haemorrhage

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18
Q

what causes acute closed-angle glaucoma

A

angle of the anterior chamber narrows causing sudden rise in intraocular pressure

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19
Q

risk factors/ causes of acute closed angle glaucoma

A 
shallow anterior chamber
thick lens
thin iris/ciliary bodies
hypermetropic
cyclopentolate
traumatic haemorrhage
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20
Q

peak age incidence of acute closed-angle glaucoma

A

40-60

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21
Q

how does acute closed angle glaucoma present?

A 
N+V
headache
painful red eye
night blurred vision
halos around lights at night
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22
Q

what should be avoided in acute closed-angle glaucoma patients and why?

A

dark room or patch - will worsen the angle closure by dilatation of the pupil

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23
Q

Mx of acute closed-angle glaucoma

A 
BB
pilocarpine
acetazolamide
[analgesia, antiemetics]
peripheral iridectomy
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24
Q

complications of peripheral iridectomy surgery [for acute closed-angle glaucoma]

A

visual loss
central retinal artery or vein occlusions
repeated episodes

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25
Q

what are the 2 types of diabetic retinopathy and how are they distinguished

A

proliferative and non-proliferative

proliferative = new vessels on the retina [neovascularisation]

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26
Q

signs of non-proliferative diabetic retinopathy

A 
microaneurysms [dots]
haemorrhages [blots]
hard exudates [yellow patches]
engorged tortuous veins
cotton wool spots
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27
Q

what can non-proliferative diabetic retinopathy progress to?

A

sight threatening proliferative DR

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28
Q

signs in proliferative diabetic retinopathy

A

fine new vessels on optic disc, retina

vitreous haemorrhage

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29
Q

what is maculopathy in diabetic retinopathy?

A

leakage of vessels close to the macula - causing oedema and vision loss

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30
Q

when + how often should diabetics have eyes screened

A

at diagnosis and annually

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31
Q

define glaucoma

A

optic neuropathy with death of many retinal gangion cells and their optic nerve axons
[IOP may be raised but this isnt part of the definition!]

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32
Q

risk factors for glaucoma [chronic simple open-angle]

A 
^IOP
african-caribbean
FH
^age
myopia
thyroid eye disease
DM eye disease
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33
Q

what is required for glaucoma diagnosis [CSOAG]

A 
IOP
visual fields
central corneal thickness
optic nerve /fundus exam
Gonioscopy
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34
Q

screening for glaucoma

A

tonometry [pressure]
visual fields
optic disc exam

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35
Q

Mx of COA glaucoma

A 
drops:
prostaglandin analogues (latanoprost)
B blockers (timolol)
alpha agonists (apraclonidine)
miotics (pilocarpine)

laser therapy
surgery

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36
Q

systemic drugs that can cause glaucoma

A

steroid drops
mydriatics
anticholinergics [tricyclics, some parkinsons drugs]

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37
Q

risks of steroid eye drops (used in allergic eye disease)

A

^ocular pressure
cataract formation
propagate a missed dendritic ulcer > blind

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38
Q

Mx of diabetic retinopathy

A 
BP control
DM control
laser photocoagulation
Triamcinolone
anti-VEGF drugs [Vascular endothelial growth factor]
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39
Q

what factors may accelerate diabetic retinopathy

A 
pregnancy
smoking
dyslipidaemia
^BP
renal disease
anaemia
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40
Q

describe subconjunctival haemorrhage

A

blood behind conjunctiva from small bleed

harmless

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41
Q

differences between scleritis and episcleritis [how common? how dangerous?]

A

episcleritis common, scleritis rare

episcleritis benign, scleritis sight-threatening + ass. w/ systemic disease

42
Q

how to differentiate scleritis and episcleritis on examination

A

episcleral vessels move with cotton bud and blanch with phenylephrine. Scleral won’t.

43
Q

Sx of episcleritis

A 
red eye
acute onset
dull ache, tender
wedge of engorged vessels
acuity ok
44
Q

Mx of episcleritis

A

articficial tears

topical/ systemic analgesia [NSAIDs]

45
Q

presentation of scleritis

A 
red eye
pain bores into back of eye
painful ocular movements
headache
photophobia
46
Q

Mx of scleritis

A

NSAIDs PO
pred PO
cyclophos/ritux if posterior/ necrotizing
surgery if imminent globe perf

47
Q

differentials for a red eye

A 
foreign body
episcleritis
scleritis
subconjunct. haemorrhage
conjunctivitis
corneal ulcer
uveitis
acute glaucoma
48
Q

what does the anterior uvea comprise of

A

iris and ciliary body

49
Q

give 3 system diseases that cause or are ass. w/ uveitis

A 
ank spond
sarcoid
IBD
reactive arthritis
herpes
TB
syphilis
HIV
MS
lymphoma
50
Q

Sx of anterior uveitis

A 
red eye
pain
blurred vision
photophopia
^lacrimation
small or irregular pupil
51
Q

what would be seen on slit lamp in anterior uveitis

A

leucocytes in the ant chamber

52
Q

Mx of anterior uveitis

A

pred drops
cyclopentolate [keep pupil dilated]
control underlying disease
[inflix]

53
Q

Sx of conjunctivitis

A 
red inflamed eye
itch
burn
tears, sticky discharge
acuity NOT affected
54
Q

give 5 causes of conjunctivitis

A 
allergy
virus [adenovirus]
gonococcal
contact lenses
autoimmune
55
Q

Ix in conjunctivitis

A

conjunctival cultures [in neonatal/ chlam/ gon/ refractive]

56
Q

Mx of conjunctivitis

A

viral - artificial tears
allergic - antihist drops
bact - topical chloramphenicol/ fusidic acid [but self limiting]

57
Q

how would you help diagnose a corneal abrasion/lesion/ulcer?

A

fluorescin drops and blue light

[lesions stain green]

58
Q

define keratitis

A

corneal inflammation- white area on cornea [collection of white cells]

59
Q

causes of corneal ulcers

A 
bacterial 
herpetic
fungal [candida, aspergillus]
protozoal
vasculitis [e.g. in RA]
60
Q

management of opthalmic shingles

A

aciclovir

61
Q

Mx of non-herpetic corneal ulcers: 1 Ix, 2 Tx and what nerve would you examine?

A

cultures

chloramphenicol drops
ofloxacin drops
OR cefuroxime + gent
steroid drops

trigeminal nerve

62
Q

ocular causes of headache

A

acute closed angle glaucoma

ant uveitis

63
Q

Optic neuropathy is damage to the optic nerve from any cause. Give 4 causes of optic neuropathy

A 
GCA
non-arteritic anterior ischaemia optic neuropathy
meningitis
compression
trauma
inflamm/autoimmune
genetic
64
Q

findings in optic neuropathy

A 
monocular partial or complete blindness
central scotoma
afferent pupillary defect
colour blindness
papillitis -> optic atrophy
65
Q

unilateral loss of acuity over hours to days, with red destauration [reds appear less red], eye movements hurt. Diagnosis

A

optic neuritis

66
Q

45-80% of optic neuritis patients develop what condition over the next 15 yrs

A

MS

67
Q

causes of optic neuritis

A 
MS
syphilis
DM
vit deficiency
leber's optic atrophy
68
Q

Mx of optic neuritis

A

methylpred 72 hrs then pred for 11 days

69
Q

give 3 causes of transient vision loss

A 
vascular [atherosclerosis/emboli]
migraine
MS
glaucoma
papilloedema
70
Q

dramatic unilateral visual loss in seconds. Afferent pupil defect. Retina appears white with cherry red spot at macula

A

central retinal artery occlusion

71
Q

what nerves are responsible for afferent and efferent pupil light reflex?
what nerve is responsible to pupilary dilatation

A

afferent optic
efferent oculomotor

parasympathetic [ciliary nerves]

72
Q

causes of afferent pupil defect

A

[optic nerve not receiving light]
optic neuritis
optic atrophy
retinal disease

73
Q

causes/associations of retinal vein occlusion

A 
atherosclerosis
^BP
DM
polycythaemia
glaucoma
^age
74
Q

Mx of retinal vein occlusion

A

photocoagulation [laser]

anti-VEGF injections

75
Q

what causes vitreous haemorrhage

A

neovascularisation in DM or retinal vein occlusion
trauma
retinal tear
retinal detachment

76
Q

give 5 causes of sudden monocular vision loss

A 
retinal detachment
acute glaucoma
migraine
optic neuropathy
optic neuritis
GCA
central retinal artery occlusion
retinal vein occlusion
77
Q

what is a consensual pupil response

A

constricts when light shone in other eye

78
Q

which muscles cause the down and out eye of 3rd nerve palsy

A

superior oblique

lateral rectus

79
Q

causes of 3rd nerve palsy

A 
cavernous sinus lesions
superior orbital fissure syndrome
DM
posterior communicating artery aneurysm
tumour
HTN
80
Q

what runs through the cavernous sinus?

A

CN 3,4,5,6

ICA

81
Q

what is the pathogenesis of horners syndrome. Give some causes of this

A

disruption of sympathetic nerves

posterior inferior cerebellar artery/ basilar artery occlusion
MS
cavernous sinus thrombosis
pancoast's tumour [NSCLC at apex]
hypothalamic lesion
cervical adenopathy
mediastinal mass
aortic aneurysm
82
Q

child with inflamed eye, fever, lid swelling, reduced eye mobility, double vision, painful eye movements, proptosis, chemosis. Diagnoiss?

A

orbital cellulitis

83
Q

complicaitons of orbital cellulitis

A 
absecesses [subperiosteal, orbital]
visual loss[ optic neuritis, retinal vein/artery occlusion]
meningitis
brain abscess
sinus thrombosis
84
Q

Mx of orbital cellulitis

A

Abx as per local guidelines

85
Q

2 ways in which vision is lost in acute glaucoma

A

optic nerve damage

central retinal artery occlusion

86
Q

commonest cause of viral conjunctivitis

A

adenovirus

87
Q

red eye, painful to the point the patient cant sleep, with Hx of RA

A

scleritis

88
Q

how is vision lost in scleritis

A

thinning and perforation of the sclera

89
Q

how does pupil look in acute glauc vs anterior uveitis?

A

glauc = dilated

ant uve = constricted

90
Q

ank spond, red eye

A

ant. uveitis

91
Q

patient describes vision DISTORTION. what part of the eye is affeted?

A

macular

92
Q

sudden or insidious for wet vs dry macular degen

A

wet sudden [bleed]

dry = insidious

93
Q

what is responsible for the neovascularisation in wet MD and DM retinopathy?

A

ischaemia leads to VEGF release

94
Q

Mx of the neovascularisation in wet MD and DM retinopathy

A

antiVEGF injections

95
Q

what is the idea behind laser for DM retinopathy? what’s the downside?

A

burn the peripheral retina where new vessels are growing. sacrifice periperal vision for the sake of preserving central vision

96
Q

flashes and floaters indicate

A

retinal detachment

97
Q

cherry red spot =

A

central retinal artery occlusion

98
Q

“blood and thunder” appearance and diffuse retinal haemorrhages =

A

central retinal vein occlusion

99
Q

swollen optic disc and multiple flame haemorrhages

A

HTN Retinop/ papilloedema

100
Q

6th nerve palsy often caused by what brain pathology

A

^ICP

101
Q

why NGT in DKA?

A

gastroparesis

3B GH (16 decks)

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