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Medicine and Surgery Mushkies > Passmed Ophthalmology Mushkies > Flashcards

Passmed Ophthalmology Mushkies Flashcards

1
Q

Amaurosis fugax defn?

A

Painless transient loss of vision in one or both of the eyes

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2
Q

4 most common causes of sudden painless loss of vision?

A
  1. Ischaemic/vascular
  2. Vitreous haemorrhage
  3. Retinal detachment
  4. Retinal migraine
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3
Q

Cause of ischaemic optic neuropathy?

A

Occlusion of the short posterior ciliary arteries, causing damage to the optic nerve

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4
Q

Recognised ischaemic/vascular visual loss syndromes?

A
  1. Central retinal vein occlusion

2. Central retinal artery occlusion

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5
Q

Which is more common, CRVO or CRAO?

A

CRVO

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6
Q

3 causes of central retinal vein occlusion?

A
  1. Glaucoma
  2. Polycythaemia
  3. Hypertension
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7
Q

2 causes of central retinal artery occlusion?

A
  1. Thromboembolism from atherosclerosis

2. Arteritis e.g. temporal arteritis

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8
Q

CRVO on fundoscopy?

A

Severe retinal haemorrhages

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9
Q

2 features of CRAO?

A
  1. Afferent pupillary defect

2. Cherry red spot on pale retina

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10
Q

3 causes of vitreous haemorrhages?

A
  1. Proliferative DM
  2. Posterior vitreous detachment
  3. Ocular trauma
  4. Bleeding diatheses
  5. Anticogualants
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11
Q

How to differentiate between vitreous haemorrhage, posterior vitreous detachment, and retinal detachment?

A
  1. Vitreous haemorrhage = sudden visual loss(L)/numerous dark spots(M)/floaters(S)
  2. Posterior vitreous detachment = Photopsia in peripheral field of vision, floaters
  3. Retinal detachment = dense shadow that starts peripherally and progresses towards the central vision, straight lines appear curved, central visual loss, a veil or curtain over the field of vision
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12
Q

What is the classification for hypertensive retinopathy?

A

Keith-Wagener

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13
Q

Keith-Wagener classification for hypertensive nephropathy stages?

A
  1. Arteriolar narrowing and tortuisotity, and increased light reflex (silver wiring)
  2. AV nipping
  3. Cotton-wool exudates, flame and blot haemorrhage
  4. Papilloedema
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14
Q

Cataracts defn?

A

A common condition of the eyes where the lens gradually opacifies, making it more difficult for light to reach the retina, causing reduced/blurred vision

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15
Q

Leading cause of blindness worldwide?

A

Cataracts

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16
Q

Cataracts sex preference?

A

Women

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17
Q

Causes of cataracts?

A
  1. Normal ageing process (most common)
  2. Smoking
  3. Diabetes
  4. Alcohol
  5. Trauma
  6. Steroids
  7. Radiation
  8. Hypocalcaemia
  9. Myotonic dystrophy
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18
Q

Symptoms of cataracts?

A
  1. Reduced vision
  2. Faded colour vision
  3. Glare (lights appear brighter)
  4. Halos around light
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19
Q

Signs of cataracts?

A

A defect in the red reflex

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20
Q

Ix of cataracts?

A
  1. Ophthalmoscopy = normal fundus and optic nerve

2. Slit-lamp = visible cataract

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21
Q

Classification of cataracts?

A
  1. Nuclear
  2. Polar
  3. Subscapular
  4. Dot opacities
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22
Q

Nuclear cataracts?

A

Changed lens refractive index, common in old age

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23
Q

Polar cataracts?

A

Localised, commonly inherited, lie in the visual axis

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24
Q

Subscapular cataracts?

A

Due to steroid use, just deep to the lens capsule, in the visual axis

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25
Q

Dot opacities cataracts?

A

Common in normal lenses, also seen in DM and myotonic dystrophy

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26
Q

Mx of cataracts?

A
  1. Conservatively = Stronger glasses, encouraging brighter lighting
  2. Surgery = lens replacement
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27
Q

Post-cataract surgery complications?

A
  1. Retinal detachment
  2. Posterior capsule opacification
  3. Posterior capsule rupture
  4. Endophthalmitis
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28
Q

What is endophthalmitis?

A

Inflammation of the aqueous and/or vitreous humour

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29
Q

Features of Horner’s syndrome?

A
  1. Miosis
  2. Ptosis
  3. Anhidrosis
  4. Enophthalmos (sunken eyes)
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30
Q

How to differentiate between causes of Horner’s syndrome?

A
  1. Central lesions
  2. Pre-ganglionic lesions
  3. Post-ganglionic lesions
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31
Q

Horner’s syndrome defn?

A

Horner syndrome is a combination of signs and symptoms caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body

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32
Q

Feature of central Horner’s lesions?

A

Anhidrosis of face, arm and trunk

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33
Q

Feature of pre-ganglionic Horner’s lesions?

A

Anhidrosis of the face

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34
Q

Feature of post-ganglionic Horner’s lesions?

A

No anhidrosis

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35
Q

Causes of central Horner’s?

A
  1. Stroke
  2. MS
  3. Tumour
  4. Encephalitis
  5. Syringomyelia
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36
Q

Causes of pre-ganglionic Horners?

A

4 Ts

  1. Pancoast’s tumour
  2. Thyroidectomy
  3. Trauma
  4. TCervical Rib
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37
Q

Causes of post-ganglionic Horners?

A

4 Cs

  1. Carotid artery dissection
  2. Carotid aneurysm
  3. Cavernous sinus thrombosis
  4. Cluster headache
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38
Q

Glaucomas defn?

A

Optic neuropathies associated with raised intraocular pressure

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39
Q

Classification of glaucoma is based on?

A

Based on whether the peripheral iris is covering the trabecular meshwork, which is important in the drainage of aqueous humour from the anterior chamber of the eye.

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40
Q

Prevalence of glaucoma?

A
  1. 0.5% > 40y/o

2. 19% > 80y/o

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41
Q

Causes of primary open angle glaucoma?

A
  1. Age

2. Genetics

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42
Q

Symptoms of glaucoma?

A
  1. Visual field defect
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43
Q

Ix of glaucoma?

A
  1. Automated perimetry to assess visual field
  2. Slit lamp to assess optic nerve (damage/cupping)
  3. Applanation tonometry to measure IOP (>24mmHg)
  4. Central corneal thickness measurement
  5. Gonioscopy to assess peripheral anterior chamber configuration
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44
Q

Mx of primary open angle glaucoma?

A
  1. 1st line = Prostaglandin analogue eyedrop
  2. Second line = BB, CA inhibitor, Sympathomimetic eyedrop
  3. Surgery
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45
Q

Prostaglandin analogue for glaucoma and MOA?

A
  1. Latonoprost
  2. Increases uveoscleral outflow
  3. OD
  4. S/e = brown pigmentation of the iris, increased eyelash length
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46
Q

BB for glaucoma and MOA?

A
  1. Timolol, betaxolol

2. Reduced aqueous production

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47
Q

C/I of BBs for glaucoma?

A

Asthmatics and heart block

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48
Q

Sympathomimetics for glaucoma and MOA?

A
  1. Brimonidine, a2-agonist
  2. Reuced aqueous production and increase outflow
  3. S/e = hyperaemia
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49
Q

CA inhibitor for glaucoma and MOA?

A
  1. Dorzolamide

2. Reduces aqueous production

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50
Q

Miotics for glaucoma and MOA?

A
  1. Pilocarpine, muscarinic receptor agonist
  2. Increases uveoscleral flow
  3. S/e = constricted pupil, headache, blurred vision
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51
Q

AACG?

A

Acute angle-closure glaucoma

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52
Q

Factors predisposing to AACG?

A
  1. Hypermetropia (long sightedness)
  2. Pupillary dilatation
  3. Lens growth associated with age
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53
Q

Features of AACG?

A
  1. Pain
  2. Decreased acuity
  3. Hard, red eye
  4. Symptoms worse with mydriasis (e.g. dark room)
  5. Haloes around lights
  6. Semi-dilated non-reacting pupil
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54
Q

Mx of AACG?

A
  1. Urgent referral to ophthalmologist
  2. Reducing aqueous secretion = acetazolamide
  3. Inducing pupillary constriction = topical pilocarpine
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55
Q

Classification of infective conjunctivitis?

A
  1. Viral = serous discharge, recurrent URTI, pre-auricular lymph nodes
  2. Bacterial = purulent discharge, stuck together eyes in the mornin
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56
Q

Mx of infective conjunctivitis?

A
  1. Normally self limiting in 1-2 weeks
  2. Topical Abx e.g. chloramphenicol drops 2-3 hourly/ointment QDS
  3. Topical fusidic acid for pregnant women
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57
Q

Night blindness and tunnel vision?

A

Retinitis pigmentosa

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58
Q

Retinitis pigmentosa defn?

A

A group of rare, genetic disorders that involve a breakdown and loss of cells in the retina

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59
Q

Retinitis pigmentosa on fundoscopy?

A
  1. Black bone spicule-shaped pigmentation in the peripheral retina
  2. Mottling of the retinal pigment epithelium
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60
Q

Non-painful red eye?

A

Episcleritis

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61
Q

Episcleritis fx?

A
  1. Red eye
  2. Classically not painful
  3. Watering and mild photophobia may be present
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62
Q

Differentiating b/w episcleritis and scleritis?

A

Phenylephrine drops blanch the conjunctival and episcleral vessels but not the scleral vessels. If the eye redness improves after phenylephrine a diagnosis of episcleritis can be made

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63
Q

Mx of episcleritis?

A
  1. Conservative

2. Artificial tears may sometimes be used

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64
Q

POAG?

A

Primary open angle glaucoma

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65
Q

RFs to POAG?

A
  1. Genetics
  2. Black
  3. Myopia
  4. HTN
  5. DM
  6. Steroids
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66
Q

Fx of POAG?

A
  1. Peripheral visual field loss
  2. Decreased visual acuity
  3. Optic disc cupping
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67
Q

Fundoscopy signs of POAG?

A
  1. Optic disc cupping (cup-to-disc ratio >0.7)
  2. Optic disc pallor (optic atrophy)
  3. Bayonetting of vessels
  4. Cup notching
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68
Q

S/e of prostaglandin analogues for glaucoma?

A
  1. Increased eyelash length
  2. Iris pigmentation
  3. Periocular pigmentation
69
Q

Classification of squints?

A
  1. Concomitant (common)

2. Paralytic (rare)

70
Q

Cause of concomitant squint?

A

Due to imbalance in extra-ocular muscles, convergent is more common than divergent

71
Q

Cause of paralytic squint?

A

Paralysis of extraocular muscles

72
Q

Dx of squint?

A
  1. Corneal light reflection test

2. Cover test

73
Q

Mx of squint?

A
  1. Referral to secondary care

2. Eye patches may prevent amblyopia

74
Q

Most common cause of blindness in the UK?

A

Age-related macular degeneration

75
Q

Classification of age related macular degeneration?

A
  1. Dry = 90%, chracterised by Drusen (yellow round spots in Bruch’s membrane)
  2. Wet = 10%, characterised by choroidal neovascularisation, worst prognosis
76
Q

ARMD sex preference?

A

2F:1M

77
Q

ARMD RFs?

A
  1. Age
  2. Smoking
  3. FHx
  4. IHD, HTN, DM, dyslipidaemia
78
Q

ARMD symptoms?

A
  1. Reduction in visual acuity esp. for near objects
  2. Worse night vision
  3. Photopsia (flickering/flashing lights)
  4. Glare around objects
79
Q

ARMD on fundoscopy?

A
  1. Dry = Drusen (yellow areas of pigment deposition in macula)
  2. Wet = well demarcated red patches may be seen which represent intra-retinal or sub-retinal fluid leakage or haemorrhage
80
Q

ARMD Mx?

A
  1. Combination of zinc with anti-oxidant vitamins A,C and E
  2. anti-VEGF e.g. ranibizumab, bevacizumab and pegaptanib
  3. Laser photocoagulation
81
Q

Lines appearing curvy + blurring of small words?

A

ARMD

82
Q

Eyelid problems?

A
  1. Blepharitis
  2. Stye
  3. Chalazion
  4. Entropion
  5. Ectropion
83
Q

Blepharitis defn?

A

Inflammation of the eyelid margins typically leading to a red eye

84
Q

Stye defn?

A

Infection of the glands of the eyelid

85
Q

Types of stye?

A
  1. External

2. Internal

86
Q

External stye aka?

A

Hordeolum externum

87
Q

External stye features?

A

Infection of the:

  1. Glands of Zeis (sebum producing)
  2. Glands of Moll (sweat glands)
88
Q

Internal stye aka?

A

Hordeolum internum

89
Q

Internal stye features?

A

Infection of the Meibomian glands, may leave a residual chalazion

90
Q

Mx of stye?

A
  1. Hot compresses
  2. Analgesia
  3. Only recommend topical Abx if associated conjunctivitis
91
Q

Chalazion aka?

A

Meibomian cyst

92
Q

Chalazion defn?

A

A retention cyst of the Meibomian gland, presenting as a firm painless lump in the eyelid

93
Q

Mx of chalazion?

A

Majority of cases resolve spontaneously but some require surgical drainage

94
Q

Causes of blepharitis?

A
  1. Meibomian gland dysfunction –> posterior blepharitis

2. Seborrheic dermatitis/staphylococcal infection –> anterior blepharitis

95
Q

Mx of blepharitis?

A
  1. Hot compresses BD = softening of lid margin
  2. Mechanical removal of debris w/ cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo
  3. Artificial tears
96
Q

AACG hypermetropia or myopia?

A

Hypermetropia

97
Q

POAG hypermetropia or myopia?

A

Myopia

98
Q

Most common cause of flashers and floaters?

A

Posterior vitreous detachment

99
Q

Posterior vitreous detachment (PVD) defn?

A

Separation of the vitreous membrane from the retina

100
Q

What must you rule out in a pt with PVD?

A

Important to rule out retinal tears or retinal detachment in anyone with suspected posterior vitreous detachment, as they may result in permanent loss of vision.

101
Q

RFs for PVD?

A
  1. Age = vitreous fluid in the eye becomes less viscous, and thus, does not hold its shape as well. Therefore, it pulls the vitreous membrane away from the retina towards the centre of the eye.
  2. Myopia = myopic eye has a longer axial length than an emmetropic eye
102
Q

Cobweb across vision?

A

Posterior vitreous detachment

103
Q

Weiss ring on ophthalmoscopy?

A

PVD = detachment of the vitreous membrane around the optic nerve to form a ring-shaped floater

104
Q

Mx of PVD?

A
  1. Sx gradually improve over a period of around 6 months and therefore no treatment is usually necessary
  2. If there is an associated retinal tear or detachment the patient will require surgery to fix this.
105
Q

Ix for neovascular ARMD?

A

Fluorescein angiography

106
Q

Papilloedema defn?

A

Optic disc swelling caused by raised ICP

107
Q

Fx of papilloedema?

A
  1. Venous engorgements and loss of venous pulsation
  2. Blurring of optic disc margin
  3. Paton’s lines = radial retinal lines cascading from the optic disc
108
Q

5 causes of papilloedema?

A
  1. SOL
  2. Hydrocephalus
  3. IIH
  4. Malignant HTN
  5. Hypercapnia
109
Q

3 medical causes of papilloedema?

A
  1. HypoPT and hypocalcaemia

2. Vitamin A toxicity

110
Q

3 causes of optic neuritis?

A
  1. MS
  2. DM
  3. Syphilis
111
Q

Fx of optic neuritis?

A
  1. Unilateral decrease in visual acuity over hrs or days
  2. Red desaturation (poor discrimination of colours)
  3. Pain worse on eye movement
  4. RAPD
  5. Central scotoma
112
Q

Mx of optic neuritis?

A
  1. High dose steroids

2. Recovery usually rakes 4-6 weeks

113
Q

Prognosis of optic neuritis w/ regards to MS?

A

MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%

114
Q

Most common cause of stye?

A

S. aureus

115
Q

Mx of anterior uveitis/

A

Steroid (e.g. prednisolone acetate) + mydriatic eye drops (cyclopentolate)

116
Q

Anterior uveitis defn?

A

Inflammation of the anterior portion of the uvea, namely the iris and ciliary body, and is HLA-B27 associated

117
Q

Conditions associated with anterior uveitis?

A
  1. Ank Spond
  2. Reactive arthritis
  3. IBD
  4. Behcet’s
  5. Sarcoidosis
118
Q

Cheese and tomato pizza on retina?

A

Central retinal vein occlusion

119
Q

Herpes zoster ophthalmicus defn?

A

Reactivation of VZV in the ophthalmic division of the trigeminal nerve, accounting for 10% of cases of shingles

120
Q

Hutchinson’s sign?

A

Rash on tip/side of nose that is strongly indicative of herpes zoster ophthalmicus

121
Q

Mx of herpes zoster ophthalmicus?

A

Oral antiviral tx for 7-10 days

122
Q

Drusen?

A

Dry macular degeneration

123
Q

Differentiating b/w scleritis and episcleritis?

A

Scleritis is painful, whilst episcleritis is not

124
Q

Classification of diabetic retinopathy?

A
  1. Background retinopathy
  2. Pre-proliferative retinopathy
  3. Proliferative retinopathy
125
Q

Background diabetic retinopathy fx?

A
  1. Microaneurysms (dots)
  2. Haemorrhages (blots)
  3. Hard exudates
126
Q

Pre-proliferative diabetic retinopathy fx?

A
  1. Cotton wool spots (soft exudates)
  2. Venous beading
  3. Cluster haemorrhages
127
Q

Proliferative diabetic retinopathy fx?

A
  1. Neovascularisation

2. Fibrous tissue forming anterior to retinal disc

128
Q

Flashers and floaters?

A

Posterior vitreous detachment

129
Q

Most common cause of persistent watery eye in an infant?

A

Nasolacrimal duct obstruction

130
Q

Cause of nasolacrimal duct obstruction?

A

Imperforate membrane, usually at the lower end of the lacrimal duct

131
Q

Mx of nasolacrimal duct obstruction?

A
  1. Teach parents to massage lacrimal duct

2. Unresolved by 1y/o –> ophthalmologist

132
Q

Complication of mydriatic drops?

A

Precipitant of acute angle closure glaucoma

133
Q

Ptosis + dilated pupil?

A

Third nerve palsy

134
Q

Ptosis + constricted pupil?

A

Horner’s syndrome

135
Q

Corneal ulcer defn?

A

Aka microbial keratitis, is an infection of the cornea by a bacteria, fungi, or protists

136
Q

RF for corneal ulcers?

A

Steroid eye drops

137
Q

Mx of allergic conjunctivitis?

A
  1. 1st line = topical/systemic antihistamines

2. 2nd line = topical mast cell stabilisers e.g. sodium cromoglicate

138
Q

Argyll-Robertson pupil?

A

ARP

  1. Accomodation Reflex Present (ARP) but
  2. Pupillary Reflex Absent (PRA)
139
Q

2 causes of Argyll Robertson pupil?

A
  1. Syphilis

2. DM

140
Q

Glaucoma screening?

A

Those with positive FHx should be screened annually from 40 y/o

141
Q

Vitreous haemorrhage presentation?

A
  1. Painless visual loss or haze
  2. Red hue in vision
  3. Floaters/shadows/dark spots in vision
142
Q

Vitreous haemorrhage Ix?

A
  1. Dilated fundoscopy = may show haemorrhage in vitreous cavity
  2. Slit lamp = RBCs in the anterior vitreous
143
Q

Holmes-Adie pupil?

A
  1. Dilated pupil, slowly reactive to light with definite accommodation
  2. Damage to parasympathetic innervation of the eye due to viral/bacterial infection
144
Q

Marcus-Gunn pupil?

A

RAPD

145
Q

Red desaturation?

A

Optic neuritis

146
Q

Orbital cellulitis fx?

A
  1. Painful, swollen eye
  2. Reduced vicual acuity
  3. Proptosis and restriction of eye movement
147
Q

Orbital cellulitis defn?

A

An infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe, usually caused by a spreading URTI from the sinuses

148
Q

Periorbital cellulitis defn?

A

A less serious superficial infection anterior to the orbital septum

149
Q

Mx of orbital cellulitis?

A

Admission to hospital for IV Abx

150
Q

Afferent pupillary defect, cherry red spot on pale retina?

A

Central retinal artery occlusion

151
Q

Entropion?

A

In turning of the eyelids

152
Q

Ectropion?

A

Out-turning of the eyelids

153
Q

Causes of tunnel vision?

A
  1. Papilloedema
  2. Glaucoma
  3. Retinitis pigmentosa
  4. Choroidoretinitis
  5. Hysteria
154
Q

Bilateral eye grittiness?

A

Blepharitis

155
Q

RFs for orbital cellulitis?

A
  1. Childhood
  2. Previous sinus infection
  3. Lack of HiB vaccination
  4. Ear/facial infection
  5. Recent eyelid infection/insect bite on eyelid
156
Q

Esotropia?

A

Squint towards nose

157
Q

Exotropia?

A

Squint temporally

158
Q

Hypertopia?

A

Squint superiorly

159
Q

Hypotropia?

A

Squint inferiorly

160
Q

Fluorescein eye stain shows a dendritic ulcer?

A

Herpes simplex keratitis

161
Q

6 causes of a red eye?

A
  1. Acute angle closure glaucoma
  2. Anterior uveitis
  3. Scleritis
  4. Episcleritis
  5. Conjunctivitis
  6. Subconjunctival haemorrhage
  7. Endophthalmitis
162
Q

Mx of entropion?

A

Eye lubricants and tape to pull eye outwards whilst awaiting surgery

163
Q

Ix for orbital cellulitis?

A

Contrast-enhanced CT scan of the orbits, sinuses and brain

164
Q

How to differentiate orbital from preseptal cellulitis?

A

Reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis

165
Q

2 causes of RAPD?

A
  1. Retina = detachment

2. Optic nerve = optic neuritis e.g. MS

166
Q

Afferent pupillary reflex path?

A

Retina –> optic nerve –> lateral geniculate body –> midbrain

167
Q

Efferent pupillary reflex path?

A

Edinger Westphal nucleus (midbrain) –> oculomotor nerve

168
Q

Holmes Adie Syndrome?

A

Association of Holmes Adie pupil with absent ankle/knee reflexes

169
Q

Why are antioxidant dietary supplements not recommended for smokers?

A

Beta carotene has been found to increase the risk of lung cancer

Medicine and Surgery Mushkies (52 decks)

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