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FINALS: Passmed > opthamology > Flashcards

opthamology Flashcards

1
Q

Localised headache, neck pain, and neurological signs (small pupil + droopy eyelid) are indicative of _________

A

coronary artery dissection
Horner’s sign

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2
Q

The presence of painful eye movements and visual disturbance (‘seeing double’ referring to diplopia) in the context of a red, swollen, tender eye = ? Tx?

A

orbital cellulitis
Urgent IV cefotaximr

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3
Q

how to differential orbital cellulitis and preseptal cellulitis?

A

Preseptal: no pain on eye movements, no proptosis, no diplopia, no vision impairment

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4
Q

Contact lens wearers who present with a red painful eye:

A

should be referred to eye casualty to exclude microbial keratitis

Photophobia, reduced visual acuity and increased lacrimation are all seen in microbial keratitis, as are dilated conjunctival and episcleral vessels and eyelid oedema

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5
Q

how to differentiate:
- microbial keratitis
- bacterial conjunctivitis
- herpetic kertatitis
- allergic conjunctivitis
- episcleritis

A
  1. microbial and herpetic keratitis: need slit-lap to differentiate. Unilateral red, painful eye with photophobia, reduced visual acuity, increased lacrimation + dilated conjunctival and episcleral vessels, eyelid oedema.
  2. bacterial conjunctivitis: more of a gritty foreign body sensation than pain, not associated with photophobia or reduced visual acuity
  3. allergic conjunctivitis: bilateral, no photophoba or reduced visual acuity
  4. episcleritis: segmental redness, lacrimation and photophibia present but painless and does not affect visual acuity
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6
Q

blurred vision (caused by turbidity of the aqueous), photophobia and miosis (caused by ciliary muscle spasm) and pain (caused by ciliary muscle spasm and or raised intraocular pressures) –> ?

A

anterior uveitis

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7
Q

Following panretinal laser photocoagulation up to 50% of patients have________________________

A

a noticeable reduction in their visual field

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8
Q

Those with a positive family history of glaucoma should be screened annually from age_________________

A

40 years

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9
Q

Flashes + floaters are most commonly caused by ____________________

A

a posterior vitreous detachment

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10
Q

retinal detachment would present with

A

sudden visual loss, often as a ‘veil’ covering the visual field

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11
Q

__________ is a cause of red eye that is classically painful and may be associated with reduced visual acuity and blurred vision

A

scleritis

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12
Q

how to differentiate scelirits and anterior uveitis?

A

scleritis: PMHx of SLE, painful, deep red injected eye, vessels immobile and eye tender. Visual acuity can be intact.

AU: pain is worse when using eye, ciliary flush (ring of red spreading outwards), hypopyon (pus in anterior chamber), pupil small and irregular due to irregular sphincter muscle contraction

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13
Q

__________________ - sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

A

Central retinal vein occlusion

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14
Q

RF for acute angle-closure glaucoma?

A

hypermetropia

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15
Q

tx for acute angle-closure glaucoma

A

STAMP: supine, timolol (decreases aq production), acetazolamide (reduces aq secretions), pilocarpine (parasympathoimetic, opens trabecular meshwork by causing ciliary muscle contraction)

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16
Q

Tx for age-related macular degeneration

A
  1. Zinc, with anti-oxidant vitamins A,C,E
  2. anti-vascular endothelial growth factors (ranibizumab)
  3. laster photocoagulation (but risk of acute visual loss after treatment)
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17
Q

risks of cataract surgery

A
  • Posterior capsule opacification: thickening of the lens capsule
  • Retinal detachment
  • Posterior capsule rupture
  • Endophthalmitis: inflammation of aqueous and/or vitreous humour
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18
Q

central retinal vein occlusion vs branch retinal vein occlusion

A

BRVO results in a more limited area of the fundus being affected

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19
Q

Ix for corneal abrasion

A

fluorescein staining

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20
Q

what corneal ulcer is specifically associated with contact lens use

A

Acanthamoeba keratitis

21
Q

Diabetic retinopathy with severe vitreous haemorrhage - Tx?

A

vitreoretinal surgery

22
Q

what can be used to distinguish episcleritis from scleritis?

A

phenyleprhine

23
Q

what is Herpes zoster ophthalmicus

A

reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve

24
Q

what is Hutchinson’s sign

A

rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement in herpes zoster opthalmicus

25
Q

what is holmes adie pupil? what is it associated with?

A

dilated pupil that remains constricted for a long time, slowly reactive to accommodation but very poorly to light

absent ankle/knee reflexes

26
Q

Causes and presentations of Horner’s syndrome

A
27
Q

stages of Hypertensive retinopathy

A

1: arteriolar narrowing, tortuosity, increased light reflex (silver wiring)

2: arteriovenous nipping

3: cotton-wool exudates, flames, blot haemorrhages [‘macular star’]

4: papilloedema

28
Q

bacterial causes of keratitis - most common over all, most common in contact lens wearers

A
  1. staph aureus
  2. pseudomonas aeruginosa
29
Q

if someone has keratitis Sx on a background of swimming in dirty water suspect

A

amoebic keratitis, exquisitely painful

30
Q

hypopyon is seen in

A
  1. anterior uveitis
  2. keratitis
31
Q

most common cause of a persistent watery eye in an infant

A

Nasolacrimal duct obstruction

32
Q

eye pain and swelling + proptosis + ‘rock hard’ eyelids + RAPD esp after trauma =

A

oribtal compartment syndrome!!

Urgent lateral canthotomy required to decompress orbit

33
Q

poor discrimination of colours can occur in

A
  • catarcts
  • optic neuritis (red desaturation)
34
Q

pain on eye movement can occur in

A
  • optic neuritis
  • scleritis
  • orbital cellulitis
35
Q

gold standard Ix for optic neuritis

A

MRI of brain and orbits with contrast

36
Q

who is at risk of developing posterior vitreous haemorrhage earlier in life?

A

myopic people

37
Q

HELLP for acute loss of vision

A

Headache - GCA
Eye movements are painful - optic neuritis
Lights/flashes - retinal detachment
Like a curtain - RAO
Poorly controlled DM - vitreous haemorrhage

38
Q

abx for suspected orbital cellulitis

A

IV o-amoxiclav

39
Q

Ix for orbital cellulitis

A

CT with contrast

40
Q

1st line Tx for pts with open-angle galucoma

A

360 degree selective laser trabeculoplasty

41
Q

medications used to treat open-angle glaucoma

A

1st line: prostaglandin analogue like latanoprost (increases uveoscleral outflow) [SE: brown pigmentation of irish]

  1. bblocker like timolo reduces aq production
  2. alpha2 adrenoreceptor agonist like briminodine - reduces aq production
  3. carbonic anhydrase inhibitor like acetozolamide - reduces aq production
  4. miotics like pilocarpine - increases uveoscleral outflow
42
Q

small fixed oval pupil with ciliary flush (red eye) =

A

anterior uveitis

43
Q

causes of RAPD

A

retinal detachment, optic neuritis

44
Q

scleritis Tx

A
  1. same day assessment by opthamologist
  2. oral NSAIDs
45
Q

what is amblyopia

A

the brain fails to fully process inputs from one eye and over time favours the other eye - SE of squint

46
Q

how to detect a squint?

A

corneal light reflection test - holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils

47
Q

[primary open angle glaucoma Tx] First-line treatment in a patient with a history of heart block

A

latanoprost

48
Q

primary open angle glaucoma Tx

A
  1. to increase uveosleral outflow: prostaglandin analogue [lantanoprost], miotics [pilocarpine]
  2. to reduce aqueous production: bblocker (timolol), carbonic anhydrase inhibitor (acetazolamide), briminodine

avoid briminodine if taking MAOI/TCA

49
Q
A

FINALS: Passmed (40 decks)

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