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3B GH > Opthalmology > Flashcards

Opthalmology Flashcards

(101 cards)

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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
what are the 2 types of diabetic retinopathy and how are they distinguished
proliferative and non-proliferative proliferative = new vessels on the retina [neovascularisation]
26
signs of non-proliferative diabetic retinopathy
``` microaneurysms [dots] haemorrhages [blots] hard exudates [yellow patches] engorged tortuous veins cotton wool spots ```
27
what can non-proliferative diabetic retinopathy progress to?
sight threatening proliferative DR
28
signs in proliferative diabetic retinopathy
fine new vessels on optic disc, retina | vitreous haemorrhage
29
what is maculopathy in diabetic retinopathy?
leakage of vessels close to the macula - causing oedema and vision loss
30
when + how often should diabetics have eyes screened
at diagnosis and annually
31
define glaucoma
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!]
32
risk factors for glaucoma [chronic simple open-angle]
``` ^IOP african-caribbean FH ^age myopia thyroid eye disease DM eye disease ```
33
what is required for glaucoma diagnosis [CSOAG]
``` IOP visual fields central corneal thickness optic nerve /fundus exam Gonioscopy ```
34
screening for glaucoma
tonometry [pressure] visual fields optic disc exam
35
Mx of COA glaucoma
``` drops: prostaglandin analogues (latanoprost) B blockers (timolol) alpha agonists (apraclonidine) miotics (pilocarpine) ``` laser therapy surgery
36
systemic drugs that can cause glaucoma
steroid drops mydriatics anticholinergics [tricyclics, some parkinsons drugs]
37
risks of steroid eye drops (used in allergic eye disease)
^ocular pressure cataract formation propagate a missed dendritic ulcer > blind
38
Mx of diabetic retinopathy
``` BP control DM control laser photocoagulation Triamcinolone anti-VEGF drugs [Vascular endothelial growth factor] ```
39
what factors may accelerate diabetic retinopathy
``` pregnancy smoking dyslipidaemia ^BP renal disease anaemia ```
40
describe subconjunctival haemorrhage
blood behind conjunctiva from small bleed | harmless
41
differences between scleritis and episcleritis [how common? how dangerous?]
episcleritis common, scleritis rare | episcleritis benign, scleritis sight-threatening + ass. w/ systemic disease
42
how to differentiate scleritis and episcleritis on examination
episcleral vessels move with cotton bud and blanch with phenylephrine. Scleral won't.
43
Sx of episcleritis
``` red eye acute onset dull ache, tender wedge of engorged vessels acuity ok ```
44
Mx of episcleritis
articficial tears | topical/ systemic analgesia [NSAIDs]
45
presentation of scleritis
``` red eye pain bores into back of eye painful ocular movements headache photophobia ```
46
Mx of scleritis
NSAIDs PO pred PO cyclophos/ritux if posterior/ necrotizing surgery if imminent globe perf
47
differentials for a red eye
``` foreign body episcleritis scleritis subconjunct. haemorrhage conjunctivitis corneal ulcer uveitis acute glaucoma ```
48
what does the anterior uvea comprise of
iris and ciliary body
49
give 3 system diseases that cause or are ass. w/ uveitis
``` ank spond sarcoid IBD reactive arthritis herpes TB syphilis HIV MS lymphoma ```
50
Sx of anterior uveitis
``` red eye pain blurred vision photophopia ^lacrimation small or irregular pupil ```
51
what would be seen on slit lamp in anterior uveitis
leucocytes in the ant chamber
52
Mx of anterior uveitis
pred drops cyclopentolate [keep pupil dilated] control underlying disease [inflix]
53
Sx of conjunctivitis
``` red inflamed eye itch burn tears, sticky discharge acuity NOT affected ```
54
give 5 causes of conjunctivitis
``` allergy virus [adenovirus] gonococcal contact lenses autoimmune ```
55
Ix in conjunctivitis
conjunctival cultures [in neonatal/ chlam/ gon/ refractive]
56
Mx of conjunctivitis
viral - artificial tears allergic - antihist drops bact - topical chloramphenicol/ fusidic acid [but self limiting]
57
how would you help diagnose a corneal abrasion/lesion/ulcer?
fluorescin drops and blue light | [lesions stain green]
58
define keratitis
corneal inflammation- white area on cornea [collection of white cells]
59
causes of corneal ulcers
``` bacterial herpetic fungal [candida, aspergillus] protozoal vasculitis [e.g. in RA] ```
60
management of opthalmic shingles
aciclovir
61
Mx of non-herpetic corneal ulcers: 1 Ix, 2 Tx and what nerve would you examine?
cultures chloramphenicol drops ofloxacin drops OR cefuroxime + gent steroid drops trigeminal nerve
62
ocular causes of headache
acute closed angle glaucoma | ant uveitis
63
Optic neuropathy is damage to the optic nerve from any cause. Give 4 causes of optic neuropathy
``` GCA non-arteritic anterior ischaemia optic neuropathy meningitis compression trauma inflamm/autoimmune genetic ```
64
findings in optic neuropathy
``` monocular partial or complete blindness central scotoma afferent pupillary defect colour blindness papillitis -> optic atrophy ```
65
unilateral loss of acuity over hours to days, with red destauration [reds appear less red], eye movements hurt. Diagnosis
optic neuritis
66
45-80% of optic neuritis patients develop what condition over the next 15 yrs
MS
67
causes of optic neuritis
``` MS syphilis DM vit deficiency leber's optic atrophy ```
68
Mx of optic neuritis
methylpred 72 hrs then pred for 11 days
69
give 3 causes of transient vision loss
``` vascular [atherosclerosis/emboli] migraine MS glaucoma papilloedema ```
70
dramatic unilateral visual loss in seconds. Afferent pupil defect. Retina appears white with cherry red spot at macula
central retinal artery occlusion
71
what nerves are responsible for afferent and efferent pupil light reflex? what nerve is responsible to pupilary dilatation
afferent optic efferent oculomotor parasympathetic [ciliary nerves]
72
causes of afferent pupil defect
[optic nerve not receiving light] optic neuritis optic atrophy retinal disease
73
causes/associations of retinal vein occlusion
``` atherosclerosis ^BP DM polycythaemia glaucoma ^age ```
74
Mx of retinal vein occlusion
photocoagulation [laser] | anti-VEGF injections
75
what causes vitreous haemorrhage
neovascularisation in DM or retinal vein occlusion trauma retinal tear retinal detachment
76
give 5 causes of sudden monocular vision loss
``` retinal detachment acute glaucoma migraine optic neuropathy optic neuritis GCA central retinal artery occlusion retinal vein occlusion ```
77
what is a consensual pupil response
constricts when light shone in other eye
78
which muscles cause the down and out eye of 3rd nerve palsy
superior oblique | lateral rectus
79
causes of 3rd nerve palsy
``` cavernous sinus lesions superior orbital fissure syndrome DM posterior communicating artery aneurysm tumour HTN ```
80
what runs through the cavernous sinus?
CN 3,4,5,6 | ICA
81
what is the pathogenesis of horners syndrome. Give some causes of this
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
child with inflamed eye, fever, lid swelling, reduced eye mobility, double vision, painful eye movements, proptosis, chemosis. Diagnoiss?
orbital cellulitis
83
complicaitons of orbital cellulitis
``` absecesses [subperiosteal, orbital] visual loss[ optic neuritis, retinal vein/artery occlusion] meningitis brain abscess sinus thrombosis ```
84
Mx of orbital cellulitis
Abx as per local guidelines
85
2 ways in which vision is lost in acute glaucoma
optic nerve damage | central retinal artery occlusion
86
commonest cause of viral conjunctivitis
adenovirus
87
red eye, painful to the point the patient cant sleep, with Hx of RA
scleritis
88
how is vision lost in scleritis
thinning and perforation of the sclera
89
how does pupil look in acute glauc vs anterior uveitis?
glauc = dilated | ant uve = constricted
90
ank spond, red eye
ant. uveitis
91
patient describes vision DISTORTION. what part of the eye is affeted?
macular
92
sudden or insidious for wet vs dry macular degen
wet sudden [bleed] | dry = insidious
93
what is responsible for the neovascularisation in wet MD and DM retinopathy?
ischaemia leads to VEGF release
94
Mx of the neovascularisation in wet MD and DM retinopathy
antiVEGF injections
95
what is the idea behind laser for DM retinopathy? what's the downside?
burn the peripheral retina where new vessels are growing. sacrifice periperal vision for the sake of preserving central vision
96
flashes and floaters indicate
retinal detachment
97
cherry red spot =
central retinal artery occlusion
98
"blood and thunder" appearance and diffuse retinal haemorrhages =
central retinal vein occlusion
99
swollen optic disc and multiple flame haemorrhages
HTN Retinop/ papilloedema
100
6th nerve palsy often caused by what brain pathology
^ICP
101
why NGT in DKA?
gastroparesis

3B GH (16 decks)

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