secondary care

Question 1

what is loss of RG colour vision and indicator of

Answer 1

optic neuritis

Question 2

direct/consensual light pathway

Answer 2

optic nerve -> pretectal nucleus -> edinger-westphal nucleus (ipsilaterally and contralaterally) -> CN III (ipsi+contra) -> pupil constriction

Question 3

what pupil reaction is seen in neurosyphilis

Answer 3

pupil doesn’t react well to light (i.e. doesn’t constrict) but does accommodate

Question 4

what is the effect of cocaine on pupils (and how does it occur)

Answer 4

blocked the reuptake of NA in sympathetic neurons => repeated sympathetic stimulation -> pupils dilate

Question 5

2 types of CN III palsy and which is an emergency

Answer 5

pupil sparing vs pupil involving

pupil involving is an emergency

Question 6

superior vs inferior quadrantinopia lesions

Answer 6

PITS - parietal inferior, temporal superior

Question 7

what diplopia is seen in 4th nerve palsy an what might a pt do to compensate

Answer 7

vertical/tilted diplopia -> pt may have a compensatory head tilt

Question 8

3 things to comment on about the optic nerve

Answer 8

cup, colour, contour

Question 9

what drug class is a risk factor for glaucoma

Answer 9

steroids

Question 10

what is a pinhole used to check in a visual acuity exam

Answer 10

whether the problem is refractive (gets better w pinhole, fixable w glasses) or due to non-refractive factors (corneal problems, glaucoma etc.)

Question 11

what 3 things are tested for in pupil exam

Answer 11

1. direct and consensual light reflex
2. swinging light test
3. accommodation

Question 12

function of ocular oblique muscles

Answer 12

look in

Question 13

what symptom may be seen in lateral rectus palsy

Answer 13

compensatory head turn -> head turned inorder to diminish diplopia

Question 14

why is the eye in the down and out position in CN III palsy

Answer 14

only LR and SO function -> LR is stronger than SO and so pulls the eye out (even tho SO pulls it in) and then SO pulls it down

Question 15

what is the primary function of the superior oblique (when looking straight ahead)

Answer 15

intorsion

Question 16

what is the likely cause for a CN IV palsy

Answer 16

trauma to the head (the nerve has a long journey through the brain)

Question 17

5 conditions that may cause and increase in size of the blind spot

Answer 17

1. glaucoma
2. papilloedema
3. CRVO
4. CRAO
5. optic neuritis

Question 18

how to tell where in the optic tract tell is a lesion causing HH arises from

Answer 18

field defect congruity -> if less symmetrical between the eyes then more likely to be an anterior lesion, if symmetrical then more likely to be posteior lesion

Question 19

what visual field defect is likely to arise from a pit gland tumour

Answer 19

bitemporal superior quadrantinopia

Question 20

5 causes of asymmetrical hemifield loss

Answer 20

1. optic neuritis
2. inf. BRVO/BRAO
3. glaucoma
4. inf. space occupying lesion
5. retinal detachment

Question 21

what daily function may someone w CN IV palsy struggle with?

Answer 21

reading or walking down stairs -> can’t brings eyes in + down

Question 22

4 fundoscopy findings of hypertensive retinopathy

Answer 22

1. AV nipping;
2. hard exudates/cotton wool spots;
3. silver wiring;
4. optic disc swelling

Question 23

what is retinitis pigmentosa

Answer 23

pigment deposit in the periphery of the retinal casing damage to rods

Question 24

where is the macula found on fundoscopy

Answer 24

the area between the temporal branch retinal veins

Question 25

what does retinitis pigmentosa present with

Answer 25

night blindness - loss of rods

Question 26

retinitis pigmentosa fundoscopy findings (3)

Answer 26

classic clinical triad:
1. arteriolar attenuation;
2. retinal pigmentary changes (could be either hypopigmentation and/or hyperpigmentation in form of bone-spicule and pigment clumpings)
3. waxy disc pallor

Question 27

causes of papilloedema (7)

Answer 27

papilloedema must arise from raised ICP - this can be due to many causes:

1. malignant HTN
2. glaucoma
3. chronic CO2 retention
4. venous sinus thrombosis
5. metabolic hypocalcaemia;
6. acute altitude sickness;
7. zero gravity