random

Question 1

what is argyll Robertson (AR pupil)?

Answer 1

Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

Question 2

AR pupil fetaures?

Answer 2

small, irregular pupils
no response to light but there is a response to accommodate

Question 3

AR pupil causes?

Answer 3

diabetes mellitus
syphilis

Question 4

what does HS keratitis present with?

Answer 4

Herpes simplex keratitis most commonly presents with a dendritic corneal ulcer

Question 5

features of HS keratitis?

Answer 5

red, painful eye
photophobia
epiphora
visual acuity may be decreased
fluorescein staining may show an epithelial ulcer

Question 6

mx of HS keratitis?

Answer 6

immediate referral to an ophthalmologist
topical aciclovir

Question 7

what is HZ ophthalmicus?

Answer 7

reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10% of case of shingles.

Question 8

features of HZ ophthalmicus?

Answer 8

vesicular rash around the eye, which may or may not involve the actual eye itself
Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

Question 9

mx of HZ ophthalmicus?

Answer 9

oral antiviral treatment for 7-10 days
topical corticosteroids may be used to treat any secondary inflammation of the eye
ocular involvement requires urgent ophthalmology review

Question 10

complications of HZ ophthalmicus?

Answer 10

ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
ptosis
post-herpetic neuralgia

Question 11

what is Holmes Adie?

Answer 11

dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light

Question 12

what is holmes Adie syndrome?

Answer 12

association of Holmes-Adie pupil with absent ankle/knee reflexes

Question 13

what is Horner’s syndrome?

Answer 13

miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)

Question 14

how do you differentiate between causes of Horner’s?

Answer 14

heterochromia (difference in iris colour) is seen in congenital Horner’s
anhidrosis: see below
pharmacologic tests
can be useful to confirm the diagnosis of Horner syndrome and localise the lesion
apraclonidine drops (an alpha-adrenergic agonist) can be used: causes pupillary dilation in Horner’s syndrome due to denervation supersensitivity but produces mild pupillary constriction in the normal pupil by down-regulating the norepinephrine release at the synaptic cleft

Question 15

what symptoms in central lesions causing Horner’s?

Answer 15

Anhidrosis of the face, arm and trunk

Question 16

what causes central lesion Horner’s?

Answer 16

Stroke
Syringomyelia
Multiple sclerosis
Tumour
Encephalitis

Question 17

what symptoms in pre-ganglionic lesions causing Horner’s?

Answer 17

Anhidrosis of the face

Question 18

what causes pre-ganglionic lesion Horner’s?

Answer 18

Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib

Question 19

what causes post-ganglionic lesion Horner’s?

Answer 19

Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

Question 20

what symptoms in post-ganglionic lesions causing Horner’s?

Answer 20

No anhidrosis

Question 21

what is RAPD?

Answer 21

Also known as the Marcus-Gunn pupil, a relative afferent pupillary defect is found by the ‘swinging light test’. It is caused by a lesion anterior to the optic chiasm i.e. optic nerve or retina

Question 22

what is a key finding in RAPD?

Answer 22

the affected and normal eye appears to dilate when light is shone on the affected

Question 23

causes of RAPD?

Answer 23

retina: detachment
optic nerve: optic neuritis e.g. multiple sclerosis

Question 24

pathway of pupillary light reflex?

Answer 24

afferent: retina → optic nerve → lateral geniculate body → midbrain
efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve

Question 25

what is retinitis pigmentosa?

Answer 25

Retinitis pigmentosa primarily affects the peripheral retina resulting in tunnel vision

Question 26

features of retinitis pigmentosa?

Answer 26

night blindness is often the initial sign
tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)
fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

Question 27

associated diseases of retinitis pigmentosa?

Answer 27

Refsum disease: cerebellar ataxia, peripheral neuropathy, deafness, ichthyosis
Usher syndrome
abetalipoproteinemia
Lawrence-Moon-Biedl syndrome
Kearns-Sayre syndrome
Alport’s syndrome