Opthamology

Question 0

What is the management of bacterial conjunctivitis?

Answer 0

Topical Abx. (Chloramphenicol)

Question 1

Give 3 common bacteria associated with bacterial conjunctivitis?

Answer 1

Staph. Epidermidis
Staph. Aureus
Strep. Pneumoniae
Haem. Influenzae

Question 2

Give 3 pieces of advice you would give a patient with bacterial conjunctivitis?

Answer 2

Follow up if condition worsens/persists
Frequent hand washing
Min. touching of eyes
Don't share towels
Avoid shaking hands

Question 3

What is the management of allergic conjunctivitis?

Answer 3

1) Artificial tears
2) Mast cell stabiliser (sodium cromoglicate)
3) Mild topical steroid

Question 4

What are the layers of the cornea?

Answer 4

Epithelium
Basement membrane 
Bowmans layer
Stroma
Dua layer
Descemet membrane
Endothelium

Question 5

Give 5 possible presentations of cataract?

Answer 5

Reduced visual acuity
Glare in bright light
Distortion of lines
Altered colours
Monocular diplopia

Question 6

State 2 ways you can manage cataracts?

Answer 6

Glasses prescription

Surgery (phacoemulsification)

Question 7

Describe the path of aqueous humor in the eyeball?

Answer 7

Cilliary body -> Pupil -> Trabecular meshwork -> Canal of schlemm

Question 8

State 4 types of drugs that can be used in glaucoma and say what their mechanism of action is?

Answer 8

Prostaglandin analogues - increase uveoscleral drainage of aqueos humor
Beta blockers - decrease humor production
Alpha adrenergic agonists - reduce production and increase outflow
Carbonic anhydrase inhibitors - decrease production

Question 10

Which 4 parameters/symptoms are used in the screening of open angle glaucoma?

Answer 10

Increased Intraocular pressure (IOP)
Visual field loss
Optic disc appearance (disc cupping)
Open anterior chamber

Question 10

Name 3 sight threatening causes of red eye?

Answer 10

Acute angle closure glaucoma
Corneal ulcer/abscess
Penetrating eye injury

Question 11

Name 4 high risk factors for open angle glaucoma?

Answer 11

> 35yrs with +ve family history
African-Caribbean
Myopia
Diabetic/Thyroid eye disease

Question 12

What are the pathological changes seen in diabetic retinopathy? 5 things

Answer 12

Microaneurysms
Exudates
Haemorrhages
Ischaemia (cotton wool spots)
New vessel growth (proliferative)

Question 13

What 3 systemic conditions can scleritis be associated with?

Answer 13

Wegener’s granulomatosis
Rheumatoid arthritis
SLE

Question 14

Describe the diff. types of diabetic retinopathy severities?

Answer 14

Background - microaneurysms and exudates
Pre-proliferative - ischaemic changes (cotton wool)
Maculopathy - damage to the macula (oedema at macula, haemorrhages)
Proliferative - new fragile vessel growth

Advanced proliferative - retinal detachment/glaucoma

Question 15

Name 3 methods of treatment for diabetic retinopathy and describe them?

Answer 15

Medical - Glycaemic control, BP control, Control associated conditions

Laser - Photocoagulation

Surgery - Vitrectomy (removal of vitreous)

Question 16

Give 4 possible presentations of retinal detachment?

Answer 16

Fall in visual acuity
Flashes (flashing lights = photpsia)
Floaters (small haemorrhages)
Field loss

Question 17

Give 3 risk factors for developing age related macula degeneration?

Answer 17

Genetic predisposition
Cigarette smoking
Associated with vascular disease, hypertension and light exposure

Question 18

In fundoscopy, what is dry ARMD characterised by? 3 things

Answer 18

Soft drusen (small yellow deposits)
Pigment clumping
Macular atrophy

Question 19

How might you clinically differentiate between wet and dry ARMD?

Answer 19

Wet = Sudden loss/distortion of vision
Dry = Gradual loss of vision over years

Question 20

Describe 2 surgical options for managing open angle glaucoma?

Answer 20

Laser surgery - target trabecular network hence lowering IOP

Trabeculectomy - creates opening in anterior angle for drainage

Question 21

Give 6 clinical features suggestive of acute angle closure glaucoma?

Answer 21

Ocular pain
Nausea/vomiting
Intermittent blurring of vision

IOP greater than 30 mm Hg
Mid-dilated non-reactive pupil
Loss of red reflex

Question 22

Which group of patients are likely to suffer from acute angle closure glaucoma?

Answer 22

Hypermetropic patients

Question 23

Suggest 4 visual problems that diabetes can cause?

Answer 23

Diabetic retinopathy
Cataract
Retinal vascular occlusions
Extraocular muscle palsy

Question 24

Name 2 conditions that might cause retinopathy?

Answer 24

Hypertension | Diabetes

Question 25

What is a dendtritic ulcer and how is it treated?

Answer 25

Ulcer caused by herpes simplex virus | Treat with topical acyclovir ointment

Question 26

Aside from trauma identify 3 other types of retinal detachment and explain pathology for each?

Answer 26

Tractional - retina pulled off by membranes growing across its surface Exudative - break down of blood retinal barrier allowing fluid to accumulate in subretinal space Rhegmatogenous - degenerative changes in neurosensory retina creating a hole allowing vitreous fluid to pass in subretinal space

Question 27

What is the clinical difference between episcleritis and scleritis?

Answer 27

Scleritis is associated with pain

Question 28

Give 4 main symptoms of retinitis pigmentosa?

Answer 28

Night blindness (nyctalopia) Decreased peripheral vision Decreased central vision Glare (from cataract)

Question 29

Give 4 ways of managing ARMD?

Answer 29

High dose antioxidant vitamins Possible registration of visually impaired Laser therapy for wet ARMD Anti VEGF drugs for wet ARMD

Question 30

What two tests can you perfom to diagnose squints?

Answer 30

Corneal reflection | Cover test

Question 31

How can you tell the difference between manifest squint and latent squint?

Answer 31

Latent squint: Remove covered eye and it will move to fixate Manifest: Cover normal eye and squint eye will move to take up fixation

Question 32

What 3 ways can you manage a squint?

Answer 32

Optical: Assess refractive state and provide glasses Orthoptic: Patching good eye Operation: Resection of rectus muscles

Question 33

Give 3 ways you can manage acute closed angle glaucoma?

Answer 33

Pilocarpine + Acetazolamide Analgesia Antiemetic Peripheral iridectomy

Question 34

State 4 clinical features seen in anterior uveitis?

Answer 34

``` Pain Photophobia Low acuity Lacrimation Small pupil ```

Question 35

What 2 tests/investigations can you perform to diagnose anterior uveitis?

Answer 35

``` Talbot test (pain increases on convergence of eyes) Slit lamp (pus in anterior chamber) ```

Question 36

How might you treat anterior uveitis?

Answer 36

Prednisolone drops | Keep pupil dilated with cyclopentolate

Question 37

State 3 causes of sudden painless loss of vision?

Answer 37

``` Vitreous haemorrhage Optic neuritis Central retinal artery occlusion Retinal vein occlusion Anterior ischaemic optic neuropathy ```

Question 38

Give 3 ways retinal artery occlusion can be treated?

Answer 38

Ocular massage Surgical removal of aqueous Antihypertensives

Question 39

How does the appearance of the retina differ in arterial and venous occlusions?

Answer 39

Artery: Pale with cherry red (macula) spot Vein: Hyperaemia and haemorrhages (stormy sunset appearance)