Opthalmology kfp

Question 1

Sudden PAINLESS unilateral loss of vision - ddx

Answer 1

CRAO or CRVO
Giant cell arteritis
TIA/Amaurosis fugax 
retinal detachment
vitreous haemorrhage

Question 2

Sudden onset loss of vision - key features to ask in hx

Answer 2

PMHx for possible causes - GCA, HTN, Diabetes mellitus, hypercoagulopathic state, hypercholesterolaemia.
painful or painless?
onset seconds/mins?

Question 3

Acute angle closure glaucoma - key features in history

Answer 3

sudden onset of unilateral  
severely painful
blurred vision
photophobia
nausea and vomiting
headache
Fhx glaucoma
PMHx hyperopia (longsighted)

Question 4

Acute angle closure glaucoma - key features examination (6)

Answer 4

reduced visual acuity 
ciliary injection (vascular congestion)
mild dilated, non reactive pupil +/- oval shaped pupil
hazy cornea (from oedema)
shallow anterior chamber 
raised intraocular pressure

Question 5

Chronic open angle glaucoma - key features on hx

Answer 5

painless, gradual loss of vision
tunnel vision/peripheral vision loss (arcuate pattern)
PMHx - hypertension, longterm corticosteroid use, previous eye trauma or surgery/posterior synechiae
Diabetes mellitus
hyperopia, miosis (longsightedness)

Question 6

Chronic open angle glaucoma - key features on examination

Answer 6

raised intraocular pressure
increased cup:disk ratio
visual field defect/loss (peripheral vision loss)
+/- reduced visual acuity

Question 7

Acute angle closure glaucoma - management

Answer 7

arrange urgent t/f to hospital for opthalmology management
keep patient in supine position
timolol 0.5% eye drops to affected eye
acetazolamide 500mg IV stat, then 125-250mg 4-6hrly
morphine 2.5-5mg stat
antiemetics for nausea+vomiting

Question 8

Management of chronic open angle glaucoma

Answer 8

goal - reduce IOP

Question 9

Topical rx for glaucoma (classes and 1 example)

Answer 9

alpha adrenergic agonists - brimonidine 0.2% bd
b blockers - timolol 0.5% bd
prostaglandin agonists - bimatoprost 0.03% od
carbonic anhydrase inhibitors - brinzolamide 1% bd

Question 10

Unilateral vision loss - key hx to help identify cause

Answer 10

painful or painless
provoking factors
timing and duration (transient or persistent)
pattern of vision loss
hx head or eye trauma
previous episodes of vision loss
PMHX - HTN, DM, AF, TIA, smoker, high cholesterol, CAD
associated symptoms - N+V, claudication, headache, photophobia, diplopia, neck stiffness, fever

Question 11

Age related macular degeneration - RF (3)

Answer 11

smoking
genetic/fhx
sun/uv light exposure

Question 12

Age related macular degeneration - hx (3)

Answer 12

gradual vision loss
central scotoma
metamorphosia

Question 13

Age related macular degeneration - examination (6)

Answer 13

reduced VA
central visual field defect/
amsler grid - metamorphosia
large soft drusen bodies
retinal pigment epithelium abnormalities -
hyperpigmentation clumps and geographic atrophy (hypopigmentation)
retinal neovascularisation and haemorrhages

Question 14

Age related macular degeneration - mx (5, +2 for wet)

Answer 14

cease smoking (if smoker)
assess ability to drive
magnesium PO
register for visual impairment assistance
referral to opthalmology for optical coherence tomography
wet - lazer photocoagulation, anti-VEGF intravitreal injections

Question 15

CRVO/BRVO - RF (6)

Answer 15

DMT2
hypertension
hypercholesterolaemia/atherosclerosis
glaucoma
vasculitis 
retrobulbar compressive lesions (orbital tumour, thyroid eye disease)

Question 16

CRVO/BRVO - key features examination (6)

Answer 16

• sudden painless loss of VA
• RAPD - if macula/disc involved
  fundoscopy :
• tortuous and dilated veins
• cotton wool spots
• retinal oedema +/- optic disc swelling
• extensive retinal haemorrhage - ‘blood and thunder’ appearance (kinda looks like a cheese + tomato pizza)

Question 17

CRVO/BRVO - Mx (4)

Answer 17

no tx to restore vision already lost
low dose aspirin
emergency referral to opthalmology
screen for and management of risk factors

Question 18

CRAO/BRAO - key features hx

Answer 18

sudden painless loss of vision (withinseconds)

screen for underlying causes - emboli or thrombus from carotid circulation, GCA, trauma, paraneoplastic syndrome

Question 19

CRAO/BRAO - key features examination (6)

Answer 19

• markedly reduced VA (eg <6/60)
• RAPD
• abnormal/absent red reflex affected eye
  fundoscopy:
• pale retina
• cherry red spot in the macula

Question 20

CRAO/BRAO - Mx (5)

Answer 20

- True OPTHAL EMERGENCY - urgent opthalmology referral 
no proven tx but can try:
- ocular massage
- reduce IOP with timolol 0.5% drops or
- acetazolamide 500mg IV
- breathe into paper bag