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Ophthalmology > Pathology > Flashcards

Pathology Flashcards

1
Q

What is a cataract?

A

Opacification of the lens

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2
Q

What are potential causes of cataracts?

A

Age
Hypertension
Smoking
Trauma
Metabolic (e.g. diabetes)
Genetic

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3
Q

What produces pressure in the posterior eye?

A

The amount of vitreous fluid present.

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4
Q

What produces pressure in the anterior eye?

A

The amount of aqueous humor.

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5
Q

What are the 2 main forms of glaucoma?

A

Primary open-angled glaucoma
Acute close-angled glaucoma

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6
Q

What is the most common form of glaucoma?

A

Primary open-angle

It is the result of poor drainage through the trabecular meshwork.

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7
Q

What is affected in acute angle closure glaucoma?

A

Gap between the iris and lens has been narrowed, meaning fluid cannot reach the trabecular meshwork for drainage.

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8
Q

Which form of glaucoma has acute onset?

A

Close-angle glaucoma

May present with visual loss and severe headache.

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9
Q

How is acute closed-angle glaucoma treated?

A

Laser iridotomy

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10
Q

Is scleritis or episcleritis typically associated with painful eye movements?

A

Scleritis

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11
Q

What are the 3 forms of macular degeneration?

A

Age-related
Dry
Wet

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12
Q

What is used to differentiate between dry and wet macular degeneration?

A

The degree of vascular proliferation

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13
Q

What mediates the neovascularisation seen in wet macular degeneration?

A

VEGF

As vessels blocked, thus blood cannot get through.

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14
Q

Why does eye appear dark in CRVO?

A

Lots of backed-up blood due to venous occlusion.

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15
Q

Which distance vision is associated with large eyeballs?

A

Short-sightedness

Described as myopia.

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16
Q

Which distance vision is associated with small eyeballs?

A

Long-sightedness

Described as hypermetropia.

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17
Q

What can cause optic neuritis?

A

Demyelination

Most are unilateral

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18
Q

What can OCT be used to identify?

A

The presence of drusen.

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19
Q

What causes cotton wool spots to form?

A

Ischaemia of the retinal ganglion cells.

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20
Q

In which pathology are cherry red spots seen?

A

CRAO

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21
Q

Unilateral visual loss with macular sparing indicates which pathology?

A

Posterior cerebral stroke

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22
Q

What is the most common cause of diabetes in developed countries?

A

Diabetic retinopathy

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23
Q

What are the 3 eye conditions relate to diabetes?

A

Non-proliferative
Proliferative
Macular oedema

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24
Q

Microaneurysms, hard exudates, and intra-retinal haemorrhages, with no symptoms is descriptive of which level of diabetic retinopathy?

A

Mild-moderate non-proliferative

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25
Q

What are the 2 mechanisms involved in diabetic retinopathy?

A

Microvascular occlusion
Microvascular disease

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26
Q

What do cotton wool spots represent?

A

Ischaemia

A sign associated with more severe disease.

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27
Q

What occurs in proliferative retinopathy?

A

Neovascularisation
Vitreous haemorrhage
Traction

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28
Q

How may vitreous haemorrhage present?

A

If small, may describe floaters.

If large, may describe severe/complete visual loss.

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29
Q

How is severe NPDR treated?

A

Pan-retinal photocoagulation

Acts by decreasing total blood supply needed by the retina.

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30
Q

How is diabetic macular oedema treated?

A

Anti-VEGF therapy

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31
Q

How is vitreous haemorrhage/retinal detachment treated?

A

Vitrectomy

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32
Q

Which form of eye shape is associated with increased risk of retinal detachment?

A

Myopia

Associated with a thin retina, which is more likely to tear.

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33
Q

What is the difference between retinal detachment and rhegmatogenous detachment?

A

Retinal detachment involves separation of the sensory retina from the RPE (basement layer).

Rhegmatogenous detachment involves separation of RPE too. Following this, vitreous will get in behind RPE - resulting in retinal cell death.

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34
Q

Is a macular hole an ophthalmic emergency?

A

No - treat within 6 months.

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35
Q

Which cranial nerve is affected if eye appears internally rotated, pointed towards the nose?

A

CNVI palsy

Lateral rectus muscle is not supplied innervation as a result.

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36
Q

How does bilateral CNIV palsy present?

A

Torsion and a depressed chin.

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37
Q

What nerve supplies 6 ocular muscles?

A

CN III

38
Q

What muscle are innervated by CNIII?

A

Medial rectus
Inferior rectus
Superior rectus
Inferior oblique
Levator palpebrae superioris
Sphincter pupillae

39
Q

How does CNIII palsy present?

A

Closed eyelid, with eye deviated outwards and down.

Pupil will also be dilated.

40
Q

What is internuclear ophthalmoplegia?

A

Dysfunction of the medial longitudinal fasciculus, resulting in impaired abduction of the affected eye, and nystagmus on abduction of the contralateral eye.

41
Q

What is the only cause of monocular blindness?

A

CNII palsy

42
Q

What may cause optic nerve palsy?

A

Ischaemic optic neuropathy
Optic neuritis
Tumor

43
Q

What is optic neuritis?

A

Unilateral, progressive visual loss, with colour desaturation, and a central scotoma.

Recovery is gradual.

44
Q

Is macula sparing seen in pathologies affecting the optic tracts/radiation?

A

No, only seen in disease of the occipital cortex.

It is not spared in optic tract/radiation pathology.

45
Q

What can cause myopia?

A

Too large eye
Too much refractive power
Cornea too curved

46
Q

Which eye shape/vision-type is suited to a converging lens?

A

Long-sightedness/hypermetropia

The focusses light earlier - making it meet on the retina.

47
Q

What type of eye-sight is suited to a diverging lens?

A

Short-sightedness/myopia

Delays the convergence of light.

48
Q

What is affected in an astigmatism?

A

The shape of the cornea

49
Q

What eye complications are associated with myopia?

A

Retinal detachment
Open-angle glaucoma

50
Q

What eye complications are associated with hypermetropia?

A

Closed angle glaucoma

51
Q

What is presbyopia?

A

The reduction in lens contractility due to ageing.

Results in decreased ability to focus.

52
Q

What are common causes of sudden visual loss?

A

Age-related macular degeneration
Bleed/Blocked vessel (e.g. vein/artery)
Closed-angle glaucoma
Detached retina

Think ‘ABCD’ of sudden visual loss.

53
Q

What is the major blood supplying artery to the eye?

A

Ophthalmic artery

This is a branch of the internal carotid artery.

54
Q

Is CRAO painful?

A

No - only symptom is sudden visual loss.

55
Q

How will fundoscopy appear in CRAO?

A

Oedematous
Pale
‘Chery red’ spot

56
Q

What is transient CRAO called?

A

Amaurosis fugax

57
Q

What supplies blood to the optic disc?

A

Posterior ciliary arteries

58
Q

How does temporal arteritis present?

A

Visual symptoms
Headache
Tender scalp
Enlarged temporal artery

59
Q

What is the most common cause of blindness?

A

Age-related macular degeneration

60
Q

What angle is affected in glaucoma?

A

That between the cornea and the iris.

61
Q

What form of glaucoma is a medical emergency?

A

Closed angle glaucoma

Occurs when iris moves forward due to pressure within the eye, blocking off the pathway for fluid to the trabecular meshwork.

62
Q

How does closed-angle glaucoma present?

A

Severe pain
Red eye
Sudden visual loss
Headache
Nausea
Vomiting
Dilated pupil

63
Q

Why does the pupil dilate in closed angle glaucoma?

A

Ischaemia of the iris sphincter

64
Q

How is wet ARMD treated?

A

Anti-VEGF therapy

65
Q

What are common causes of gradual visual loss?

A

ARMD
Blur/Refractive error
Cataracts
Diabetes
Glaucoma

Think ‘ABCDG’ of gradual visual loss.

66
Q

What may cause cataracts?

A

Age
Congenital
Diabetes
Trauma
Drug-induced (e.g. steroids)

67
Q

What is the procedure for resolving a cataracts known as?

A

Phacoemulsification

68
Q

What forms in dry ARMD?

A

Drusen

These are lipid deposits on the retina.

69
Q

How is dry ARMD managed?

A

Supportive only, no pharmacological options are available.

70
Q

What form of visual defect results in focus infront of the retina?

A

Myopia

71
Q

What form of visual defect results in focus behind the retina?

A

Hypermetropia

72
Q

Is open-angled glaucoma an issue to do with angle patency?

A

No, it is an issue with drainage at the trabecular meshwork.

73
Q

What is the difference between drusen and exudates?

A

Drusen is a build-up of waste products.

Exudates are the leakage from vessels within the eye.

74
Q

What should be suspected in those with bilateral optic disc swelling?

A

Raised ICP due to SOL.

75
Q

What 3 components are crucial in determining ICP?

A

Brain
Blood
CSF

76
Q

What may cause bilateral optic disc swelling in young obese women?

A

Idiopathic intracranial hypertension

77
Q

A stellate cataract is pathognomonic of which condition?

A

Myotonic dystrophy

78
Q

How does neurofibromatosis type 1 present in the eye?

A

Optic glioma
Lisch nodules

Remember this is an autosomal dominant condition, linked with cafe-au-lait spots.

79
Q

What is an optic glioma?

A

A lesion of that grows around the optic nerve, resulting in proptosis.

80
Q

What are lisch nodules?

A

Bilateral yellow/brown dome-shaped nodules of the iris which are pathognomonic of NF1.

81
Q

What is the most common cause of both unilateral and bilateral proptosis?

A

Thyroid eye disease

82
Q

What should always be considered as a potential cause of unilateral proptosis?

A

Neoplastic growth

83
Q

How should thyroid eye disease be treated?

A

Treat dysfunction of thyroid gland
Smoking cessation
Selenium supplementation
Lubrication

84
Q

What eye manifestations are linked with dermatomyositis?

A

Dry eyes
Scleritis

Be cautious of dermatomyositis as it can be a paraneoplastic syndrome.

85
Q

What are common features of dermatomyositis?

A

Heliotrope rash (on eyelids)
Gottron’s papules
Proximal muscle weakness

86
Q

Which malignancies must be excluded in those with dermatomyositis?

A

Ovarian
Breast
Lung

87
Q

What eye manifestation is associated with Marfan’s syndrome?

A

A dislocated lens

88
Q

How can dry eyes be diagnosed using fluoroscein?

A

Increased uptake of fluorescein indicates lots of small erosions on the cornea.

Treat with lubricants.

89
Q

Which drugs cause ‘bullseye’ maculopathy?

A

Hydroxychloroquine
Chloroquine

90
Q

Do steroids affect IOP?

A

Yes, cause a gradual rise in IOP bilaterally over a few months of therapy.

91
Q
A

Ophthalmology (8 decks)

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