Opthalmology

Question 1

What is the examination sequence for the eyes?

Answer 1

Inspection, then AFRO: Acuity (snellen, close reading, colour), Fields (inattention, confrontation, offer blind spot), Reflexes (accommodation, direct, consensual, RAPD), Ophthalmoscopy and ophthalmoplegia (optic disk - cup, colour and contour; four quadrants; macula; H-test for eye movements +/- saccade test +/- ask them to look upwards and count to 20 to check for fatigueability)

Question 2

What is the commonest cause of irreversible loss of vision?

Answer 2

AMD

Question 3

What are the differentials for painless loss of vision?

Answer 3

1) Open angle glaucoma 2) AMD 3) retinal vessel occlusion 4) retinal or vitreous haemorrhage 5) diabetic/hypertensive retinopathy 6) optic neuritis 7) cataracts 8) ischaemic optic neuropathy 9) ethambutol

Question 4

What are the differentials for gradual loss of vision?

Answer 4

1) cataracts 2) corneal opacification 3) AMD 4) Diabetic or hypertensive retinopathy 5) retinitis pigmentosum 6) glaucoma 7) optic neuropathy

Question 5

What are the main risk factors for AMD?

Answer 5

Age, DM, HTN, Caucasian race, smoking, male

Question 6

What are the main findings in wet AMD?

Answer 6

Dry AMD findings + neovascularisation, haemorrhages + disciform scarring

Question 7

What are the typical findings in dry AMD?

Answer 7

Drusen, geographic atrophy, pigmentation changes in the RPE

Question 8

What investigations are indicated in someone with suspected AMD?

Answer 8

Slit-lamp + OCT +/- fluorescein angiography (if early wet suspected)

Question 9

What is the pathophysiology of AMD?

Answer 9

RPE fails to clear lipid waste from rods and cones. These build up and pass through Bruch’s membrane and form deposits. Local ischaemia leads to neovascularisation

Question 10

What treatments are available for AMD?

Answer 10

Lifestyle modification, vitamins and minerals, anti-VEGF injections

Question 11

What is an example of an anti-VEGF injection?

Answer 11

Ranibizumab

Question 12

What is the first line treatment for open angle glaucoma and what is it’s mechanism of action?

Answer 12

Latanoprost - increases uveoscleral outflow

Question 13

What are the risk factors for open angle glaucoma?

Answer 13

IOP, Afro-Carribean, myopia, thin central cornea, family history

Question 14

What are the classic examination findings in glaucoma?

Answer 14

Nasal steps, arcuate field loss, optic disc cupping

Question 15

What is the immediate management of acute angle closure glaucoma?

Answer 15

All topical medication not contraindicated - can include topical beta-blockers, pilocarpine. Also give oral or IV acetozolamide.

Question 16

What are the risk factors for angle-closure glaucoma?

Answer 16

Hypermetropia, Asian, Female, Family history, increasing age (lens thickness increases)

Question 17

What investigations should be done for suspected myaesthenia gravis?

Answer 17

CT/MRI head
Edrephonium test (cholinesterase drops)
Anti-cholinesterase auto antibodies

Question 18

What are the symptoms of cavernous sinus thrombosis?

Answer 18

Recent facial infection
Ophthalmoplegia
Ptosis
Peri-orbital oedema
Headache

Question 19

What is leukocornia?

Answer 19

White pupil - can indicate congenital cataracts or retinoblastoma. Both are serious and need investigation and rapid treatment.

Question 20

What is retinopathy of prematurity and how is it treated?

Answer 20

High O2 levels after birth decreases VEGF, leading to poor formation of retinal blood vessels. Laser photocoagulation needed to prevent retinal haemorrhage or vitreous detachment

Question 21

What causes are there for congenital cataracts?

Answer 21

Inherited - congenital
Viral - rubella, CMV, Varicella
Genetic - Edward’s or Down’s

Question 22

What are the DVLA eye requirements?

Answer 22

At least one eye with 6/12 and 120 degrees of vision

Question 23

What characterises the pre-proliferative stages of diabetic retinopathy?

Answer 23

Mild - more than 1 microaneurysm
Moderate - haemorrhages, microaneurysms, lipid exudate, venous beading, IRMAs
Sever - Haemorrhages or microaneurysms in all 4 quadrants, or venous beading in 2 or more quadrants, + IRMA in at least 1 quadrant

Question 24

What are the two stages of proliferative diabetic retinopathy?

Answer 24

Early - new vessels on retinal

High risk - new vessels and haemorrhage or new vessels >1/4 of the disc.