Passmedicine

Question 1

What is the first line medical management for acute angle closure glaucoma?

Answer 1

Pilocarpine (cholinergic)
Timolol (beta blocker - reduces production of aqueous humor)
Brimonidine (alpha-agonist)

Laser iridotomy is usually required as definitive treatment

Question 2

What is diabetic retinopathy

Answer 2

Where blood vessels in the retina are damaged by prolonged exposure to hyperglycaemia

Question 3

What is the pathophysiology of diabetic retinopathy

Answer 3

1. Damage to small vessels in the retina and endothelial cells (hyperglycaemia)
2. Increased vascular permeability from the damage causes blood vessels to leak
3. Leakage causes blot haemorrhages and the formation of hard exudates (deposits of lipids in the retina)
4. Microaneurysms and venous beading occurs in the blood vessels
5. Damage to nerve fibres causes cotton wool spots

Question 4

What are the classifications of diabetic retinopathy?

Answer 4

1. Non-proliferative (pre-proliferative)
2. Proliferative

Question 5

what are the signs of non-proliferative diabetic retinopathy

Answer 5

Microaneurysms
blot haemorrhages
hard exudates
cotton wool spots
venous bleeding

Question 6

what are the signs of proliferative diabetic neuropathy

Answer 6

1. neovascularisation
2. vitreous haemorrhage

Question 7

what is diabetic maculopathy

Answer 7

macular oedema
ischaemic maculopathy

Question 8

what is the management of diabetic retinopathy

Answer 8

Laser photocoagulation
Anti-VEGF
Vitreoretinal surgery

Question 9

what are the main complications of diabetic retinopathy

Answer 9

retinal detachment
vitreous haemorrhage

Question 10

what is the treatment of bacterial conjunctivitis

Answer 10

topical chloramphenicol

Question 11

what is the most common cause of flashes and floaters

Answer 11

posterior vitreous detachment

Question 12

what are the main differences between glaucoma and uveitis on examination?

Answer 12

Glaucoma - severe pain, haloes around light, semi-dilated pupil, hazy cornea

Uveitis - Small, fixed oval pupil, ciliary flush

Question 13

What are the signs of Horner’s syndrome

Answer 13

mitosis (small pupil)
ptosis (droopy eyelid)
exophthalmos (sunken eye)
anhidrosis (loss of sweating)

Question 14

what is an argyll robertson pupil

Answer 14

caused by neurosyphilis.

A BILATERAL constricted pupil that ACCOMMODATES to objects but doesn’t REACT to light.

• reduce in size on a near object
• do not recude in size (constrict) to light

Question 15

what are the signs and symptoms of optic neuritis

Answer 15

• Unilateral decrease in visual acuity over hours or days
• Poor discrimination of colours (RED is worst)
• Pain worse on eye movement
• Relative afferent pupillary defect
• Central scotoma (a blurry/black spot in the middle of vision)

Question 16

what is the investigation and management of optic neuritis?

Answer 16

Investigation:
MRI of brain and orbits with gadolinium contrast

Management:
High dose steroids
Recovery takes 4-6 weeks

Question 17

what is optic neuritis associated with?

Answer 17

Multiple sclerosis - 50% will go on to develop MS at 5 years if >3 white matter lesions on MRI.

Diabetes
Syphilis

Question 18

What are the signs and symptoms of primary open angle glaucoma

Answer 18

peripheral visual field loss - eventually ends in tunnel vision
decreased visual acuity
optic disc cupping

Question 19

what is the management of open angle glaucoma

Answer 19

1. latanoprost (prostaglandin analogue eye drops) - these increase uveoscleral outflow

Other:
- timolol
- Dorzolamide (carbonic anhydrase inhibitors)
- Brimonidine (sympathomimetics
- Trabeculectomy

Question 20

What are the signs of herpes simplex keratitis?

Answer 20

Dendritic ulcers seen on fluorescein staining
Dendritic ulcer - ulcer affecting the cornea

Question 21

what is the normal cup-to-disc ratio?

Answer 21

0.4 - 0.7

Question 22

which organism causes keratitis in contact lens wearers

Answer 22

pseudomonas aeurginosa

Question 23

what are the main complications of cataract surgery?

Answer 23

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