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Passmed finals > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Papillodema indicates…

A

Raised ICP

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2
Q

First line management of suspected meningitis (photophobia, headache, neck stiffness)

A

Ceftriaxone

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3
Q

Horner’s syndrome features

A

Miosis
Anhydrosis
Ptosis

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4
Q

Sudden visual loss in diabetics, what test should you do? And what are you thinking of?

A

Slit lamp to try and visualise any RBC in the vitreous

Worried about vitreos haemorrhage due to the extra vessels (proliferative diabetic retinopathy)

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5
Q

Features of vitreous haemorrhage

A

Painless visual loss
Red hue
Hx of diabetes

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6
Q

What is the most common cause of blindness in the UK?

A

Age related macular degeneration

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7
Q

2 forms of macular degneration

A

Wet

Dry

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8
Q

What is age related macular degeneration

A

Degeneration of retinal photoreceptors resulting in the formation of DRUSEN (yellow round spots)

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9
Q

What are drusen?

A

Yellow round spots in the eye

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10
Q

What is the difference between wet and dry ARMD?

A

Wet is more aggressive and can detatch the retina

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11
Q

Signs of ARMD

A

Distortion of vision (e.g. blurred)
Examination shows drusen (yellow areas)
Wet may show red patches of intra-retinal leakage

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12
Q

Pt feels like something stuck in eye, pain, photophobia, dendritic ulcer. Cause?

A

Herpes simplex keratitis

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13
Q

Management of herpes simplex keratitis

A

Topical aciclovir

Referral to opthalmologist

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14
Q

Diagnosis of ARMD

A

Slit lamp to identify any pigment (Druser)and or exudate or haemorrhagic changes

Fluorescein angiography can be used if neovascular ARMD is suspected, which can guid antii-VEG-F therapy

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15
Q

Ptosis and DILATED pupil

A

Third nerve palsy

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16
Q

Ptosis and miosis

A

Horner’s

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17
Q

Treatment of acute optic neuritis

A

High dose steroids

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18
Q

Investigation of choice for MS

A

MRI brain

Then can do lumbar puncture if necessary (oligoclonal bands)

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19
Q

Signs of optic neuritis

A

Blurred vision

Headache

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20
Q

Causes of tunnel vision (narrow visual field)

A

Papilloedema
Glaucoma
Retinitis pigmentosa (genetic loss of vision, often trouble seeing at night)
Choroidoretinitis (inflammation of choroid, the coating of the eye). It’s a form of posterior uveitis.

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21
Q

Causes of sudden loss of vision

A

Vitreous haemorrhage
Retinal detachment
Retinal igrane
Ischaemic/vascular. I.e. occlusion of central retinal vein or artery

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22
Q

Eye stuck together and red Dx?

A

Conjunctivitis

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23
Q

Treatment of conjunctivitis

A

Can watch and wait and see if it improves OR topical chloramphenicol

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24
Q

What is blepharitis?

A

Inflammation of the eyelids (swollen, irritated and red)

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25
Q

Treatment of acute closed angle glaucoma

A 
Pilocarpine drops (constricts the pupil and releases the aqueous humour)
Admit them to hospital
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26
Q

Definitive treatment of acute closed angle glaucoma

A

Laser peripheral iridotomy

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27
Q

Sudden, painless loss of vision.

Severe retinal haemorrhages on fundoscopy

A

Central retinal vein occlusion

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28
Q

Acute visual loss, pale retina with a cherry red spot

A

Central retinal artery occlusion

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29
Q

Red eye NOT painful, slight watering and mild photophobia

A

Episcleritis

Vessels move with gentle pressure as they are very superficial

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30
Q

Scleritis is?

A

Inflammation of deep vessels in the eye, often painful, with blurred vision.

The vessels DO NOT move when gentle pressure is applied

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31
Q

Management of episcleritis

A

Conservative, maybe artifial tears

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32
Q

Differentiating between scleritis and episcleritis

A

Phenylephrine drops

If eye redness improves = episcleritis

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33
Q

Key aspects of ophthalmology history

A 
Onset
1 eye vs 2 eyes
Activities they were doing at the time 
Do they wear glasses 
Any pain 
Any associated symptoms
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34
Q

Aspects of ophthalmologic examination

A

Visualise anterior segment
Slit lamp
Posterior eye examination

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35
Q

Questions to ask in ophthalmology

A 
Redness
Discharge
Itching
Burning 
Oedema
Floaters
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36
Q

Causes of discharge from eye

A 
Corneal trauma
Blepharitis 
Conjunctivitis 
Stye
Chemical = emergency, what chemical was it?
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37
Q

Features of subconjunctival haemorrhage

A

Fragile vessels rupture
Often from straining, check if they have high blood pressure

The cornea is NOT INVOLVED
This will resolve spontaneously

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38
Q

Symptoms of iritis

A

Blurring of vision
Photophobia
Eye pain
Red eye

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39
Q

What is ectropion re eye?

A

The eyelid is turned away from the eyeball

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40
Q

Causes of ectropion

A 
Muscle weakness
Facial paralysis (Bell’s palsy) 
Scars and damaged skin 
Previous surgery 
Growths (pushing the eyelid out of place)
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41
Q

Signs and symptoms of ectropion

A 
Watery eyes (can’t drain properly) 
Excessive dryness
Grittiness
Irritation because they aren’t being irrigated properly 
Sensitivity to light
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42
Q

Mx of ectropion

A

Eye drops

Surgery is the definitive treatment

43
Q

Name of oil secreting glands in eyelash’s

A

Glands of Zeis

44
Q

What causes a stye?

A

Infection of a gland of Zeis in the eye

Causes a swelling like a piece of barley

45
Q

Symptoms of a stye

A

Swelling above the eye
Redness and oedema around the eye
It’s basically an infection

46
Q

Treatment of stye

A

Pluck eyelash to improve drainage
Hot compresses for comfort
Oral antibiotics because get to internal structures better

47
Q

What is the structural support of the eyelid, that also helps with irrigation of the eye?

A

Tarsal plates

48
Q

Gradual onset, swelling of the eyelid

A

Chalazian

49
Q

Symptoms of chalazion

A

Small, almost fatty swelling in the eyelid

Caused by mebomium gland obstruction

50
Q

Mx of chalazion

A

Conservative if not too bad
Hot compresses
Oral antibiotics if significant infection
Steroid injection

Surgery for persistent lesions

51
Q

What is ptosis?

A

From the Greek “to fall”

Drooping of the upper eyelid

52
Q

Acquired causes of ptosis

A

Neurogenic
Myogenic (e.g. myasthenia gravis)
Myopathies
Tumour pulling the eyelid down

Anything affecting nerve -> muscle

53
Q

Mx of ptosis

A

Surgery
Brow suspension

Treat the underlying cause.

54
Q

Myopia is

A

Short sightedness

55
Q

What drains aqueous humour from the anterior chamber?

A

Trabecular meshwork

56
Q

What secretes aqueous humour?

A

Ciliary epithelium

57
Q

What causes glaucoma?

A

Drainage system blocked for aqueous humour

Increases pressure

58
Q

What can the increased pressure in glaucoma lead to?

A

Damage to optic nerve -> vision loss!

59
Q

Pathophysiology of open angle glaucoma

A

The angle between the lens is open
The blockage is from a slow clogging of the trabecular meshwork
Causes a gradual pressure increase

60
Q

Symptoms of open angle glaucoma

A

Gradual loss of peripheral vision because of outer rim atrophy
Continued damage leads to loss of central vision as well

61
Q

Pathophysiology of closed angle glaucoma

A

Angle above lens is too small
Lens is pushed against the iris
Rapid build up of pressure

62
Q

Symptoms of closed angle glaucoma

A 
Eye pain
Redness
Blurry vision
Headaches and nausea 
Visual haloes
63
Q

Diagnosis of glaucoma

A

Tonometry to assess intraocular pressure
Visual field testing
Imaging looking for optic nerve damage (cupping of optic nerve)

64
Q

Mx glaucoma

A

Medications to lower pressure = production or outflow
Production reducers = beta blockers and carbonic anhydrase inhibitors
Increase outflow = prostaglandin analogues

Also alpha adrenergic agonists and surgery (lasers)
Trabeculoplasty to open up trabecular meshwork in open angle
Iridotomy to put a hole in the iris = closed angle glaucoma

65
Q

What is under the optic disc?

A

The head of the optic nerve

66
Q

How do you find the optic disc?

A

Trace the blood vessels to the point of coalescence

67
Q

Pathophysiology of diabetic retinopathy

A

Micro angiopathy causing damage to the small blood vessels of the retina as a result of hyperglycaemia

68
Q

RF of diabetic retinopathy

A

Poor diabetic control

Duration of diabetes

69
Q

What is the spectrum of diabetic retinopathy?

A

Background
Pre proliferative
Proliferative
Advanced

70
Q

Components of background diabetic retinopathy

A

Microaneurysms (appear as little red dots on the retina)

Dot and blot haemorrhages (like bigger dots on the retina)

71
Q

Components of pre-proliferative diabetic retinopathy

A

Any signs of retinal ischaemia

Cotton wool spots (white, fluffy areas of necrotic tissue)

72
Q

Components of proliferative diabetic retinopathy

A

New vessels at the optic disc

New vessels elsewhere

73
Q

Signs of advanced diabetic retinopathy

A

Recurrent vitreous haemorrhage from bleeding areas of neovascularisation (bleeding from new vessels)
Retinal detachment

74
Q

What is the primary treatment for proliferative diabetic retinopathy?

A

Pan retinal coagulation

75
Q

What is the method behind pan retinal photocoagulation?

A

Burn the retina with a laser
Reduce VEGF by reducing oxygen demand of the retina
Stops proliferation of new vessels (which are going to cause you to go blind)

76
Q

Steps of hypertensive retinopathy

A

Grade 1 = very subtle, narrowing of arterioles
Grade 2 = AV nipping
Grade 3 = similar features to diabetic retinopathy, cotton wool spots, hard exudates, retinal haemorrhages

77
Q

Optic disc of malignant hypertension

A

All the features of grade 3 hypertensive retinopathy + optic disc swelling

78
Q

Symptoms of malignant hypertension

A

Headaches
Eye pain
Reduced visual acuity
Focal neurological deficits

79
Q

Mx of malignant hypertension

A

Antihypertensives

Admission to hospital

80
Q

What might you see on fundoscopy for glaucoma?

A

Increased ratio of cup to disc

81
Q

Is optic disc swelling the same as papilloedema?

A

No, papilloedema is specifically due to raised ICP

Optic disc swelling is after any pathology causing it, e.g. malignant hypertension

82
Q

When might you see a pale disc on fundoscopy?

A

Optic nerve atrophy

Caused by optic neuritis, glaucoma or general retinal ischaemia

83
Q

What causes secondary optic nerve atrophy

A

Long-standing papilloedema

84
Q

What should you do if you detect papilloedema?

A

Imaging

85
Q

When might you see a cherry red spot on fundoscopy?

A

Central retinal artery occlusion

86
Q

How might central retinal artery occlusion present?

A

Sudden, profound loss of vision

87
Q

What actually is the cherry red spot seen in central retinal artery occlusion?

A

The fovea against a backdrop of a very pale retina

88
Q

What causes central retinal vein occlusion?

A

Atherosclerotic thickening, compressing and blocking the vein

89
Q

What are you seeing on central retinal vein occlusion?

A

Retinal hypoxia leads to endothelial cell damage which leads to extravasation of blood

90
Q

What does vein occlusion look like on fundoscopy?

A

Like someone has brushed with a purple paint brush

91
Q

Most common cause of irreversible blindness in the uk?

A

Age related macular degeneration

92
Q

1st line treatment of open angle glaucoma

A

Latanoprost (prostoglandin analogue)

93
Q

Eye changes colour when on glaucoma treatment, which drug has this side effect?

A

Latanoprost

94
Q

Treatment of central retinal artery occlusion

A

IV acetazolamide

95
Q

Cupping and high pressure on fundoscopy, with some visual field defects indicates…

A

Glaucoma

96
Q

What does the fourth cranial nerve do in terms of eye movement?

A

Down and in (look towards nose)

Damage e.g. trauma -> can’t do that movement with one side/both

97
Q

Double vision and when asked to look down and in, can’t do it with right eye, which nerve has been affected?

A

4th nerve palsy

98
Q

How does Leber’s optic atrophy usually present?

A

Young patient

Loss of vision in one eye, followed by the other

99
Q

Optic disc pallor indicates…

A

Optic atrophy

100
Q

Causes of optic atrophy

A

Glaucoma due to raised intraocular pressure
Retinitis pigmentosa
Choroiditis
Central retinal artery occlusion
Multiple sclerosis
Leber’s optic atrophy (or Leber’s hereditary optic neuropathy)
Syphilis

101
Q

What does 6/9 (-2) indicate in opthalmogy notation?

A

From 6m, can get to the 9th line, where they made 2 mistakes reading it

102
Q

Most common cause of elderly ‘clouding’ of vision

A

Cataracts

103
Q

Features distinguishing Ramsey-Hunt syndrome from Bell’s palsy

A

Prominent otalgia

Vesicular rash in the external auditory meatus, palate or tongue.

104
Q

A 51 year old female patient attends A&E complaining of a red right eye. She reports that her red eye started suddenly, and she can her a ‘whooshing noise’. She also reports diplopia, a headache and loss of vision.

On examination her visual acuity is 1/60 in her right eye. Her conjunctiva is injected, and she has a restriction in her right eye movements in all direction. The eye is severely proptosed and pulsatile.

What is the most likely diagnosis?

A

Carotid-cavernous fistula

Passmed finals (17 decks)

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