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finals > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

define cartaracts

A

accumulation of protein in the lens resulting in opacification and vision loss

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2
Q

risk factors for cataracts

A

old age
diabetes
eye trauma
long term ocular steroid use

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3
Q

presentation of cataracts

A

decrease in acuity
painless, blurred or cloud vision
glare
change in colour vision

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4
Q

post operative complications of cataract surgery

A

endophthalmitis
uveitis
retinal detachment

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5
Q

types of AMD

A 
early/intermediate AMD (drusen deposits, near normal vision)
late AMD (loss of central vision)

2 forms of Late AMD
atrophic/dry and exutative/wet

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6
Q

risk factors for AMD

A

age
Fhx
previous cataract surgery
smoking, hypertension, CVD

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7
Q

fundoscopy findings in AMD

A

early - drusen, loss of retinal epithelium and photoreceptors
dry - thickening of bruch’s membrane, geographical atrophy
wet - subretinal haemorrhage, pigment epithelial detachment, retinal thickening, oedema, lipid exudates

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8
Q

management of AMD

A 
risk modification (cardiovascular risks, smoking, antioxidant and mineral supplements)
dry - no current effective treatment
wet - VEGF intravitreal injection (ranibizumab)
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9
Q

pharmacological treatment of open angle glaucoma

A

latanoprost (prostaglandin analogue - increases uveoscleral outflow)
timolol (beta blocker -decrease aqueous humour production)
brinzolamide (carbonic anhydrase inhibitor - decreases aqueous humour production)
brimonidine (a1 agonist - both)

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10
Q

surgical management of open angle glaucoma

A

trabeculectomy with mitomycin C
tube placement - ahmed valve
laser trabeculoplasty

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11
Q

fundoscopy findings in open angle glaucoma

A

thinning of the neurosensory rim
nerve fibre layer defect
optic disc rim notching and cupping
cup:disc ratio enlarged (>0.6) or asymmetrical (>0.2 between eyes)

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12
Q

presentation of angle closure glaucoma

A 
sudden onset severe painful, red eye
blurred vision
halos around lights
headache
N&V
pupil mid dilated and fixed
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13
Q

management of angle closure glaucoma

A 
topical pilocarpine (reduces IOP)
IV brinzolamide (carbonic anhydrase inhibitor)
YAG laser iridotomy (both eye - prophylactic in the second one)
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14
Q

what is rhegmatogenous RD

A

detachment due to a retinal discontinuity (break/tear)
Whereas, In the tractional form, RD is caused by proliferative membranes, either on the retinal surface or, less commonly, underneath it (sub-retinal strands). No retinal break is present, although it may subsequently develop (combined rhegmatogenous/tractional RD)

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15
Q

risk factors for retinal detachment

A

trauma
myopia
previous cataract surgery, laser refractive surgery
family history

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16
Q

presentation of retinal detachment

A

dense shadowing in peripheral vision moving to central vision
curtains coming down
straight lines appearing curved
floaters or flashing lights

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17
Q

management of retinal detachment

A

Complete detachment = Vitrectomy + Laser retinopexy/Cryopexy (to Seal any holes/breaks)

Haemorrhagic = retinotomy +/- Gas/Oil bubble injection (Tamponades the break)

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18
Q

bacterial causes of conjunctivitis

A

pneumococcus
s. aureus,
haemophilus influenzae

Neisseria gonorrhoea
chlamydia trachomatis

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19
Q

viral causes of conjunxtivitis

A

adenovirus
herpes simplex
epstein barr

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20
Q

presentation of viral conjunctivitis

A

bilateral
red, watery, itchy
follicles

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21
Q

presentation of bacterial conjunctivitis

A

unilateral/bilateral
red, sticky, discharge
papillae

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22
Q

common causative organisms in keratitis

A

bacterial: pseudomonas, s. aureus
viral: herpes simplex, herpes zoster
fungal: aspergillus

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23
Q

risk factors for keratitis

A

bacterial: CL user, dry eyes, lid disease
viral: Hx of HSV, HZV
fungal: trauma from vegetation, ocular corticosteroid use

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24
Q

findings of fluorescein staining in keratitis

A

bacterial: oval/round lesion
viral: dentritic (HSV)
fungal: feathery edges, satellite lesions

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25
Q

investigations for keratitis

A

WCC, CRP
cornel scrapings culture
contact lens and solution culture
fluorescein staining

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26
Q

management of keratitis

A

bacterial: antibiotics
HSV: aciclovir
fungal: anti fungal

photophobia: cyclopentolate
CL hygiene education
avoid CL use - should avoid use until resolved

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27
Q

difference between a corneal abrasion and a corneal ulcer

A

abrasions only affect the epithelium

ulcers involve the stroma

28
Q

how does central retinal artery occlusion present

A

sudden painless central vision loss
decrease visual acuity
RAPD

29
Q

clinical features of CRAO

A

pale/swollen retina
“cherry red spot”
intraretinal haemorrhage

30
Q

investigations for CRAO

A

fluoroscein angiogram - shows slow filling arterioles
lipid panel, aPTT, INR, clotting
ECHO

31
Q

management of CRAO

A

TIA referral (carotid US/CT head, Aspirin/clopidogrel, no driving for a month)

32
Q

risk factors for RVO

A 
atherosclerosis
systemic hypertension
diabetes
smoking
CVD
33
Q

how does RVO present

A

sudden painless vision loss

34
Q

clinical findings of RVO

A

tortuous vessels
disc swelling
flame haemorrhages
cotton wool spots

35
Q

investigations for RVO

A

fluorescein angiogram
optical coherence tomography
electroretinography

36
Q

management of RVO

A

address vascular risk (BP, lipids, DM, smoking)

for macular oedema - VEGF inhibitor, intra vitreal steroids

37
Q

presentation of AION

A 
NAION = reduced vision in one eye, often obscured by a 'shadow' affecting upper or lower half, painless
AAION = + symptoms of temporal arteritis (jaw claudication, scalp tenderness, etc.)
38
Q

investigations for aaion

A

ESR, CRP, temporal artery biopsy

39
Q

management of AION

A

prednisolone

40
Q

describe the 2 types of diabetic retinopathy

A

non proliferative
early stage, leakage of blood vessels -> blurred vision

proliferative
advanced form, neovascularisation -> prone to rupture leading to haemorrhage, vision loss and retinal scarring

41
Q

features of diabetic retinopathy on fundoscopy

A 
microaneurysms
blot/dot haemorrhages
hard exudates
cotton wool spots
new vessels
42
Q

R0 of diabetic retinopathy

A

no signs

43
Q

R1 of diabetic retanopathy

A

mild - at least one dot haemorrhage/microaneurysm without hard exudates

44
Q

R2 of diabetic retinopathy

A

moderate - 4 or more blot haemorrhages in one hemi field

45
Q

R3 of diabetic retinopathy

A

severe: any of the following
4 or more blot haemorrhages in both hemi fields
venous bleeding
intraretinal microvascular abnomality

46
Q

R4 of diabetic retinopathy

A

proliferative disease: new vessels, vitreous haemorrhage

47
Q

investigations for diabetic retinopathy

A

photographs of fundus
optical coherence tomography
fluorescein angiography

48
Q

management of diabetic retinopathy

A

glycaemic control
mild = observe/VEGF inhibitor (ranibizumab)
PDR = pan retinal photocoagulation laser

diabetic macular oedema = intravitreal injections (corticosteroids, anti VEGF)
vitreous haemorrhage = vitrectomy

49
Q

ocular features of hypertension

A 
anterior narrowing
cotton wool spots
retinal haemorrhages
optic nerve swelling
retinal ischaemia and neovascularisation

associated with RAO/RVO

50
Q

how to distinguish between scleritis and episcleritis

A

episcleritis blanches with phenylephrine drops

scleritis does not

51
Q

presentation of optic neuritis

A

painful vison loss
pain on movement of eyes
reduced colour vision
RAPD

52
Q

Management of optic neuritis

A

IV methylprednisolone (speeds up recovery but does not improve visual acuity)

53
Q

features of thyroid eye disease

A

exophthalmos
restricted movements
lid retraction and swelling
chemosis of conjunctiva

54
Q

management of thyroid eye disease

A

smoking cessation
artificial tears and lubrication
systemic steroids if vison affected
surgery (orbital decompression, eye muscle surgery, eyelid surgery)

55
Q

how does cranial nerve III palsy present

A

adduction weakness (outwards and downwards)
ptosis
fixed dilated pupil
vertical diplopia

56
Q

how does 4th nerve palsy present

A

extorsion of the eye (inability to depress and adduct the eye simultaneously)
head tilt to opposite side of lesion
vertical/oblique diplopia

57
Q

how does 6th nerve palsy present

A

esotropia (affected side’s eye drifts towards the midline)

horizontal diplopia

58
Q

define amblyopia

A

Strabismus in children may cause suppression (active process of the central nervous system by which the visual input of one eye is ignored) of the image created by the non-fixating eye, resulting in amblyopia (decreased vision in an anatomically normal eye caused by suppression) and irreversible loss of vision if not adequately treated

59
Q

investigations for strabismus

A

cover test and prism cover test
uncover test
hirschberg test
krimsky test

60
Q

management of stribismus

A

correct any refractive errors
cover the good eye in amblyopia
extraocular muscle surgery
treat any intracranial causes (stroke, masses etc)

61
Q

causes of acute painless vision loss

A 
CRAO
CRVO
AION
retinal detachment
wet ARMD
vitreous/retinal haemorrhage (in diabetic retinopathy)
62
Q

causes of gradual painless vision loss

A

cataract
open angle glaucoma
diabetic retinopathy
dry ARMD

63
Q

causes of an acute red eye

A 
conjunctivitis
corneal ulcer/abrasions
uveitis/iritis
acute angle closure glaucoma
trauma
64
Q

presentation of uveitis

A 
anterior = photophobia, pain, reduced vision
intermediate = reduced vision, floaters, photopsia
posterior = reduced vision, scotoma, floaters, photopsia
65
Q

signs of anterior uveitis

A

limbal injection
hypopyon
anterior chamber cells

66
Q

signs of intermediate/posterior uveitis

A

vitreous haze
snowballs
multifocal choroiditis
retinitis

67
Q

management of uveitis

A

topical pred or dex
systemic steroids if posterior
mycophenolate can be considered

finals (13 decks)

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