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Finals 2024 > Opthalomology Finals > Flashcards

Opthalomology Finals Flashcards

1
Q

How does vitreous haemorrhage present?

A

Painless vision loss

Red Hue in Vision

Floaters/dark spots in vision

Decreased visual acuity

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2
Q

Main cause of vitreous haemorrhage

A

Proliferative Diabetic Retinopathy

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3
Q

What investigations and findings for Vitreous Haemorrhage (3)

A

dilated fundoscopy: may show haemorrhage in the vitreous cavity

slit-lamp examination: red blood cells in the anterior vitreous

fluorescein angiography: to identify neovascularization

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4
Q

Retinal Detachment Signs/Symptoms

A

new onset floaters/flashes

sudden onset, painless vision loss - like a curtain

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5
Q

Mx of retinal detachment

A

Same day emergency referral - there laser therapy

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6
Q

Risk Factors for retinal detachment

A

Diabetes

Myopia (nearsightedness)

Age

Previous surgery for cataracts

Eye trauma - boxing

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7
Q

4 main causes of PAINFUL Red Eye

Hint - ASA

A

A - Anterior Uveitis

S - Scleritis

A - Acute Angle Closure Gluaocoma

BONUS:

Corneal abrasions or ulceration
Keratitis
Foreign body

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8
Q

Features of Anterior Uveitis (Get 5 at least)

A

Hypopyon

Painful Red Eye - DULL ACHE

Ciliary Flush

Abnormally shaped pupils

Photophobia

Lacrimation

Blurred vision

Reduced visual acuity

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9
Q

Causes of Painless Red eye

A

subconjunctival haemorrhage

episcleritis

Conjuncitivitis

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10
Q

Associated Conditions with Anterior Uveitis

A

Ankylosing spondylitis (and other seronegative spondylos)

IBD

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11
Q

Mx of anterior uveitis

A

Urgent referral to opthalmology

Steroid eye drops

Atropine/cyclopentolate

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12
Q

When should screening for glaucoma be done for those with a FHx

A

From age 40, annually

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13
Q

Primary Open Angle Glaucoma features

A

Peripheral vision loss (Think of the ‘O’ as a tunnel)

Optic disc cupping

Decreased visual acuity

Fluctuating pain - headaches sometimes

Halos

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14
Q

Dx of Open Angle Glaucoma (2)

A

Goldmann applanation tonometry for the intraocular pressure

Slit lamp assessment for the cup-disk ratio and optic nerve health

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15
Q

Management of Open Angle Glaucoma

Also 3 medications that can help - (ABCD)

A

360° selective laser trabeculoplasty

Meds:

A - Prostaglandin Analogue - Latanoprost - Increases uveoscleral outflow

B - BB - BLOCKS aqueous production

C - Carbonic anhydrase inhibitor eye drops - (e.g. Dorzolamide) - reduces aqueous production

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16
Q

What is Anisocoria

A

This is uneven pupil size

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17
Q

What is Holme’s Adie Pupil

A

Benign condition, where usually ONE pupil does not constrict - remains dilated

Homer Simpson Lazy

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18
Q

What is Argyll-Robertson pupil (ARP)

A

Accomodation Reflex Present (ARP)

Both pupils do not directly respond to light, but respond when light is shone in OTHER eye

Presents as small, irregular pupils

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19
Q

What is Hutchinson’s sign? What is is caused by?

A

HS - vesicles extending to the tip of the nose.

Caused by Varicella Zoster Virus reactivation (Shingles)

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20
Q

What does Hutchinson’s sign indicate and what are patients at risk of?

A

It indicates ocular involvement (inflammation can spread ‘ocular-ly’).

These patients are at risk of anterior uveitis

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21
Q

2 side effects of Latanoprost (Prostaglandin analogue)

A

‘TAN’ - Brown pigmentation of iris

PR - (PRETTY) Increased eyelash length

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22
Q

Features of MILD NPDR

MOD NPDR (4)

A

MILD - Just micro-aneurysms

MOD - microaneurysms

blot haemorrhages

hard exudates

cotton wool spots (‘soft exudates’ - represent areas of retinal infarction)

venous beading/looping

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23
Q

SEVERE NPDR features (2)

A

blot haemorrhages and micro-aneurysms in 4 quadrants

venous beading in at least 2 quadrants

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24
Q

Features of PDR

A

retinal neovascularisation - may lead to vitrous haemorrhage

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25
Management of NPDR
regular observation if severe/very severe consider PRP
26
Management of Diabetic Maculopathy
if there is a change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors - ranibizumab
27
CMV retinitis sign
PIZZA PIE APPEARANCE
28
CRVO features
Stormy sunset appearance - this represents vitreous haemorrhage Sudden painless loss of vision Retinal oedema Cotton wool spots Hard exudates
29
Why does a branch retinal vein occlusion (BRVO) occur
thought to occur due to blockage of retinal veins at arteriovenous crossings. It results in a more limited area of the fundus being affected.
30
Risk factors of CRVO
increasing age hypertension cardiovascular disease glaucoma polycythaemia
31
Side effects of PRP
Decreased visual fields Decreased night vision
32
Management of CRVO
mainly conservative macular oedema - intravitreal anti-vascular endothelial growth factor (VEGF) agents retinal neovascularization - laser photocoagulation
33
Features of Wet Macular Degeneration
Characterised by choroidal neovascularisation - red patches Gradual loss of central vision - scotoma Crooked or wavy appearance to straight lines (metamorphopsia)
34
Features of Dry Macular Degeneration
characterised by drusen - yellow/amber round spots in Bruch's membrane Gradual loss of central vision - scotoma Crooked or wavy appearance to straight lines (metamorphopsia)
35
Investigations of macular degeneration
Slit lamp examination gives a detailed view of the retina and macula fluorescein angiography is utilised if neovascular ARMD is suspected
36
Mx of DRY Macular degeneration Mx of WET Macular degeneration
combination of zinc with anti-oxidant vitamins A,C and E Anti-vascular endothelial growth factor (VEGF) - ranibizumab, bevacizumab and pegaptanib,. The agents are usually administered by 4 weekly injection.
37
Causes of Central Scotoma
Age related macular degeneration - painless Optic neuritis - Painful
38
Causes of "colour changes" in vision (2)
Optic Neuritis - poor colour discrimination (red desaturation) Cataracts - Faded Colour vision - HARDER to distinguish
39
Causes of "RAPD"
Ocular trauma CRAO Optic Neuritis
40
Ocular Trauma signs
eye pain/swelling proptosis 'rock hard' eyelids relevant afferent pupillary defect hx of trauma
41
Ocular trauma management
opthlamic emergency - urgent lateral canthotomy
42
Associated conditions w/scleritis (3)
rheumatoid arthritis: the most commonly associated condition systemic lupus erythematosus sarcoidosis
43
Scleritis mx
Painful red eye - so same day emergency referral Oral NSAIDS first line Oral glucocorticoids if more severe
44
Episcleritis asx conditions
Rheumatoid Arthritis Inflammatory bowel disease
45
how to differentiate between scleritis and episcleritis?
phenylephrine drops may be used to differentiate - conjunctival and episcleral vessels but not the scleral vessels if the eye redness improves after phenylephrine a diagnosis of episcleritis can be made
46
What group is PDR more common in
T1DM
47
Horner's syndrome
miosis (small pupil) ptosis enophthalmos* (sunken eye) (may have) anhidrosis (loss of sweating one side)
48
Causes of Horner's (4S, 4T, 4C)
4S - Central (cause anhidrosis of face AND body) S – Stroke S – Multiple Sclerosis S – Swelling (tumours) S – Syringomyelia (cyst in the spinal cord) 4T - Pre-ganglionic (cause anhidrosis of face) T – Tumour (Pancoast tumour) T – Trauma T – Thyroidectomy T – Top rib (a cervical rib growing above the first rib and clavicle) 4C's - Post-Ganglionic - no anhidrosis Carotid artery dissection Carotid aneurysm Cavernous sinus thrombosis Cluster headache
49
Signs of congenital Horner's syndrome
heterochromia
50
How to dx Horner's
Cocaine eye drops
51
Squint mx
referal to secondary care Also eye patches to help bad eye develop
52
Investigation for Acute Angle closure glaucoma
tonometry to assess for elevated IOP gonioscopy (literally looking, oscopy, at the angle, gonio): a special lens for the slit lamp that allows visualisation of the angle
53
mx of Acute Angle Closure Glaucoma
Same day emergency referral In community - Lying the patient on their back without a pillow Pilocarpine eye drops (2% for blue and 4% for brown eyes) - miotic agent, opens pathway for aqeuous humour to leave Acetazolamide 500 mg orally - reduces aqueous humour Laser iridotomy is usually required as a definitive treatment.
54
Features of Bacterial Conjunctivitis
Purulent discharge Eyes "stuck" together Highly Contagious
55
Management of bacterial conjunctivitis
Self-limiting usually Hygiene measures - stay away from peeps and do not share THINGS. School exclusion not necessary tho Chloramphenicol or fusidic acid (for pregnant women) eye drops
56
Features of Viral Conjunctivitis
Watery discharge Recent URTI Preauricular lymph nodes
57
Allergic Conjunctivitis Features
Bilateral symptoms conjunctival erythema, conjunctival swelling (chemosis) Itchy swollen eyelids May be a history of atopy May be seasonal (due to pollen) or perennial (due to dust mite, washing powder or other allergens)
58
Keratitis vs conjunctivitis
Conjuncitivits - whites of eyes (conjunctiva) - painless red eye Keratitis - Cornea (colour) - painful red eye
59
Keratitis features
red eye: pain and erythema photophobia foreign body, gritty sensation hypopyon may be seen
60
Causes of bacterial Keratitis and mx
typically Staphylococcus aureus Pseudomonas aeruginosa is seen in contact lens wearers stop using contact lens until the symptoms have fully resolved topical antibiotics typically quinolones are used first-line cycloplegic for pain relief e.g. cyclopentolate
61
Causes of Loss of Red Reflex (2)
Cataracts CRAO
62
Features of acanthamoebic keratitis
increased incidence if eye exposure to soil or contaminated water associated with contact lenses pain is classically out of proportion to the findings
63
Dx of Keratitis
slit-lamp
64
mx of keratitis
Management stop using contact lens until the symptoms have fully resolved topical antibiotics typically quinolones are used first-line cycloplegic for pain relief e.g. cyclopentolate
65
Corneal Abrasion Features
RED eye pain lacrimation photophobia foreign body sensation decreased visual acuity in the affected eye KEY: fluorescein staining examination typically reveals a yellow-stained abrasion
66
Herpes Simplex Keratitis (due to HSV mostly) Features
KEY: DENDRITIC ULCER ON SLIT LAMP red, painful eye photophobia visual acuity decreased
67
Keith Wagener Staging (SAFE)
S - Slim (mild narrowing of aterioles) - STAGE 1 A - AV nicking - STAGE 2 F - Flame - haemorrhages - STAGE 3 (+COTTON WOOL SPOTS) E - Oedema - Papilloedema
68
Mx of Hypertensive retinopathy
managing BP, risk factors
69
Dx of Optic neuritis
MRI of the brain and orbits with gadolinium contrast
70
How to tell Pre-orbital and orbital cellulitis apart mx for orbital
Using a CT mx for orbital - Oral/IV abx
71
Features of a 3rd nerve palsy?
"down and out appearance of eye" dilated and fixed pupil ptosis
72
Causes of a 3rd nerve palsy
diabetes mellitus vasculitis e.g. temporal arteritis, SLE Aneurysm
73
Features of 6th nerve palsy
This will result in a cross eyed look
74
Features of a fourth nerve palsy
vertical diplopia (think of 4 and the number 2) classically noticed when reading a book or going downstairs subjective tilting of objects (torsional diplopia) the patient may develop a head tilt, which they may or may not be aware of - they do this to avoid the vertical diplopia

Finals 2024 (8 decks)

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