Passmedicine Notes

Question 1

What Keith-Wagener stage involves AV nipping?

Answer 1

Stage II

Question 2

What Keith-Wagener stage involves cotton wool spots?

Answer 2

Stage III

Question 3

What Keith-Wagener stage involves papilloedema?

Answer 3

Stage IV

Question 4

What Keith-Wagener stage involves silver wiring (increased light reflex)?

Answer 4

Stage I

Question 5

What Keith-Wagener stage involves flame/blot haemorrhages?

Answer 5

Stage III

Question 6

What Keith-Wagener stage involves arteriolar narrowing and tortuosity?

Answer 6

Stage I

Question 7

What is the triad(plus) associated with Horner’s syndrome?

Answer 7

Miosis (pupillary constriction)

Ptosis

Enopthalmos

+/- anhydrosis

Question 8

Name the five major types of glaucoma

Answer 8

Open-angle glaucoma

Angle-closure glaucoma

Normal-pressure glaucoma

Secondary glaucoma

Congenital/childhood glaucoma

Question 9

Name some causes of secondary glaucoma [5]

Answer 9

Diabetic retinopathy

Central retinal vein occlusion

Uvietis

Long-term steroid use

Ocular trauma

Question 10

Describe the pathophysiology of open-angle glaucoma [4]

Answer 10

Trabecular network resistance increases (via unknown mechanism) leading to gradual increase in intraocular pressure.

(Iridocorneal angle unaffected)

Question 11

Describe the pathophysiology of angle-closure glaucoma [4]

Answer 11

Iridocorneal angle closes causing a mechanical obstruction of uveosleral outflow tract, leading to decreased drainage of aqueous humor and can cause an acute increased intraocular pressure.

Question 12

What is the normal range for intraocular pressure?

Answer 12

10-21mmHg

Question 13

What is the fancy word for testing intraocular pressure?

Answer 13

Tonometry

Question 14

Describe the autonomic nervous system’s affect on aqueous humor production [3]

Answer 14

Alpha-2 stimulation → decreased production and increased drainage

Beta-2 stimulation → increased production

Muscarinic(-2/4) stimulation → decreased drainage

Question 15

Name the five families of medications that can be used to treat glaucoma

Answer 15

Prostaglandin analogues

Carbonic anhydrase inhibitors

Beta-blockers

Sympathomimetics (Alpha-2 agonists)

Muscarinic antagonists

Question 16

What type of glaucoma medication is Timolol?

Answer 16

Beta blocker

Question 17

What type of glaucoma medication is Latanoprost, and list some side effects?

Answer 17

Prostaglandin analogue

• Blurred vision
• Congjunctival hyperaemia
• Brown pigmentation of the iris
• Increased eyelash length

Question 18

What type of glaucoma medication is Dorzolamide, and list some side effects?

Answer 18

Carbonic Anhydrase Inhibitor

• Bitter taste
• Blurred vision
• Headaches
• Steven’s Johnson’s Syndrome

Question 19

What type of glaucoma medication is Pilocarpine, and list some side effects?

Answer 19

Muscarinic receptor antagonist

• Blurred vision
• Miosis
• Headache

Question 20

What type of glaucoma medication is Brimonidine, and what drugs may interact with it?

Answer 20

Alpha-2 receptor agonist

• Tricyclic antidepressants
• Mono-Amine Oxidase inhibitors

Question 21

Which specifice glaucoma medication can cause Steven-Johnson’s Syndrome, and why?

Answer 21

Dorzolamide

It is very similar to the sulphonamide antibiotics, and so if it’s absorbed systemically it can cause this dermatological condition which is heavily associated with sulphonamides