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FRCOphth Part 1 Revision > Pathology > Flashcards

Pathology Flashcards

1
Q

What are the first and last muscles to be affected in Graves’ orbitopathy?

A

First - Inferior rectus

Last - Lateral rectus

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2
Q

In what condition would you find Dalrymple’s, Mobius and von Graefe signs?

A

Graves orbitopathy.

  • Dalrymple’s: widening of palpebral fissure
  • Mobius sign: Inability of eyes to maintain convergence
  • Von Graefe’s sign: Lid lag
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3
Q

What is the main EOM affected in Duane’s syndrome?

A

Lateral rectus

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4
Q

What is Collier’s sign?

A

Lid retraction in midbrain lesion e.g. Parinaud’s syndrome

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5
Q

What should you check for in a patient with recurrent chalazions?

A

Sebaceous gland carcinoma

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6
Q

What is the causative organism in belpharitis acaria?

A

Demodex follicularum (mite)

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7
Q

What is the normal superior marginal reflex distance?

A

4mm

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8
Q

What is the Marcun Gunn jaw winking phenomenon?

A

Synkinesis between CN5 and CN3 - ptosis in primary position, opening mouth causes eyelid to jerk upwards. Congenital.

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9
Q

What is the procedure of choice for severe ptosis with poor LPS function?

A

Frontalis sling

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10
Q

How is congenital ptosis treated?

A

Resection (and strengthening) of LPS

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11
Q

What are 3 drugs that cause trichomegaly?

A

Phenytoin
Prostaglandins
Cyclosporins

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12
Q

What is the most common site of lid coloboma?

A

Medial half of upper lid

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13
Q

What is the most common tumour of the eyelid?

A

BCC

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14
Q

At what gestational age is lid disjunction complete?

A

7 months

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15
Q

What is Duane syndrome and what are the classic pathophysiological findings?

A

Absence of CN VI nuclei. Lateral rectus is innervated by CN III.

On attempted adduction, the eye retracts and may upshoot or downshoot.

In normal adduction, the ipsilateral MR contracts (CN3) and the LR (CN4) relaxes (Sherrington’s Law). In Duane’s syndrome, CN3 contracts both the LR and MR –> retraction of the eye. If the contraction is strong enough one or both of the recti may ‘slip’ causing an upshoot or downshoot.

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16
Q

What is the ‘disc at risk’ for non-arteritic anterior ischaemic optic neuropathy?

A

Small crowded optic discs (reduced cup-disc ratio <0.2) –> predisposition to microvascular flow blockage and ischaemia

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17
Q

What is the classic presentation of NAION?

A

Acute unilateral visual loss + RAPD
Patient: older, vasculopathic risk factors
Cup-disc ratio < 0.2
Disc oedema on examination of fundus

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18
Q

What is the cause of AION?

A

Arteritic anterior ischaemic optic neuropathy

Giant cell arteritis! Predilection for the small (10-20) posterior ciliary arteries supplying the optic nerve

19
Q

What condition are Arlt’s line and Herbert’s pits seen in?

A

Trachoma

20
Q

What is the treatment for onchocerciasis?

A

Ivermectin every 6 months until symptom free

21
Q

What is Mazotti’s test for onchocerciasis?

A

Administration of microfiliaricidal DEC —> mass microfilaria death —> systemic symptoms

22
Q

What is a Hissette Ridley fundus seen in?

A

End stage onchocercal chorioretinal atrophy - typically temporal to macula, with optic disc atrophy as well

23
Q

In what disease can ‘eye worms’ be seen on gross inspection?

A

Loa loa - adult worms migrate through conjunctiva

24
Q

What are the two most common infectious causes of blindness worldwide?

A

Trachoma and onchocerciasis

25
Q

What is the causative organism and vector in onchocerciasis?

A

Onchocerca volvulus. Blackflies (Simulum genus)

26
Q

What is the treatment for trachoma?

A

Single oral dose of azithromycin

27
Q

Mutation of complement factor H is associated with?

A

Age related macular degeneration

28
Q

In gene linkage analysis, genes that undergo recombination 1% of the time are how many centimorgans apart?

A

1 centimorgan apart

29
Q

What percentage of retinoblastoma is inherited?

A

40%

30
Q

What chromosome is the Rb gene located on?

A

Chromosome 13

31
Q

What 2 other tumours are children with heritable retinoblastoma at risk for?

A

Trilateral disease:

  • Bilateral retinoblastoma
  • Pinealomas
  • Osteosarcoma
32
Q

What does the Hardy-Weinberg equation describe?

A

Relationship between genotypes and gene allele frequencies

33
Q

What is the most common lacrimal gland tumour

A

Pleomorphic adenoma

34
Q

What tumour classically has a Swiss cheese appearance

A

Adenoid cystic carcinoma

35
Q

What are the genetic prognostic factors in uveal melanoma

A

Poor prognosis: Loss of chromosome 3, increased copies of chromosome 8q
Good prognosis: More copies of chromosome 6p

36
Q

What is optic nerve glioma associated with

A

NF1

37
Q

What is meningioma associated with? What other malignancies are associated with this disease

A

NF2

Bilateral schwannomas

38
Q

High-grade and low-grade B cell lymphomas - an example of each

A

High-grade: Diffuse large B cell lymphoma

Low-grade: Follicular lymphoma

39
Q

What are risk factors for a lesion being a choroidal melanoma rather than a choroidal naevus?

A
  1. Height > 2mm
  2. Orange pigmentation
  3. Subretinal fluid
40
Q

What is the most common site for uveal melanoma

A

Choroid

41
Q

What are common primaries for ocular metastasis

A

Breast
Lung
Prostate

42
Q

Where does uveal melanoma metastasise to and what is the route of spread

A

Liver; haematogenous

43
Q

Where does retinoblastoma metastasise to and what is the route of spread

A

Brain; via optic nerve

Orbit; trans-scleral

FRCOphth Part 1 Revision (13 decks)

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