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Medical School Finals > Speciality: Opthalmology > Flashcards

Speciality: Opthalmology Flashcards

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USMLE® Step 1 flashcards
1
Q

Conjunctivitis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Bacterial or Viral.
    - Bacterial = S.aureus, S.epidermidis, Pneumococcus, Haemophilus, Gonorrhoea, chlamydia.
    - Viral = often adenovirus.
  2. Burning and gritty eyes.
    - Vision often normal, maybe blurry on waking.
    - Discharge, often thick.
    - Mild photophobia.
    - Eyes stuck together in the morning.
    - Gonorrhoea - fast onset, unilateral or BL, tender lid oedema, discharge and keratitis + preauricular LAOPTHY.
    - Chlamydia is a slow developing conjunctivitis, green stringy discharge.
  3. Clinical
    - Swab + MC&S if required.
  4. Topical chloramphenicol
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2
Q

Red eye; Glaucoma or Anterior Uveitis

A

Glaucoma = severe pain, haloes, semi-dilated pupil.

Uveitis = Small, fixed pupil and ciliary flush.

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3
Q

Causes of SUDDEN loss of vision

A
  • Ischaemic; stroke (Amaurosis fugax), GCA, occlusion of the central retinal vein or artery.
  • Vitreous haemorrhage
  • Retinal detachment
  • Retinal migraine
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4
Q

Central retinal vein occlusion

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Age.
    - Glaucoma
    - Polycythaemia
    - HTN
    - Hyper viscosity
  2. Unilateral painless blurred or lost vision.
    - Image distortion
    - Field defects.
  3. Fundoscopy - vascular dilatation and tortuous vessels + haemorrhages
  4. Refer to opt.
    - Steroids.
    - Photocoag
    - Rx underlying pathology.
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5
Q

Central Retinal Artery Occlusion

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Thromboembolism
    - GCA
    - Thrombophilia.
    - OCP
    - Retinal migraine - vasospasm
  2. Afferent pupillary defect
    - Sudden vision loss
    - Dark spots
    - Sudden UL vision loss.
  3. Fundoscopy - afferent pupil defect, pale retina. Cherry red spot.
    - ESR/CRP
  4. Refer to OPT.
    - Reperfuse quickly.
    - Nitrates, globe massage etc.
    - Manage risks and prevent further episodes.
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6
Q

Vitreous haemorrhage

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Diabetes
    - Bleeding disorders
    - Anticoagulants
    - Haemorrhage into vitreous
    - Ocular trauma.
  2. Sudden vision loss
    - Dark spots
    - Floaters and cobwebs.
  3. Fundoscopy, retina may be obscured by blood.
  4. Often clears spontaneously
    - Laser photocoag.
    - Vitrectomy.
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7
Q

Retinal detachment

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Rhegmatogenous - retinal break allows liquid to seep through and dissect the retina from the choroid.
    - Non-rhegmatogenous - Exudative or tractional.
  2. Floaters
    - Flashes
    - Field loss
    - Sudden loss of vision.
  3. Loss of RAPD
    - Visual acuity and field loss.
    - Slit-lamp
    - USS/CT/MRI
  4. Refer to OPT
    - Cryo/photocoag.
    - Vitrectomy.
    - Manage underlying pathology.
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8
Q

Primary open-angle glaucoma

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Hereditary
    - Raised IOP w/ open angle.
    - RF’s = Black, myopia, HTN, DM, steroids.
  2. Peripheral field loss progressing to tunnel vision.
    - Decreased visual acuity
    - Often found incidentally.
  3. Fundoscopy; Optic disc cupping, optic disc pallor.
    - Optic pressure measurement.
    - Visual fields measurement
  4. Screening from 40yo if FHx
    - Reduce IOP w/ topical prostaglandin analogues, BB etc.
    - Surgery such as artificial shunts etc.
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9
Q

Diabetic retinopathy classification

A 
Mild = 1 or more micro aneurysm
Mod = Micro aneurysm, blot haemorrhages, hard exudates, cotton wool spots, venous beading. 
Severe = Aneurysm, haemorrhages in all 4 quadrants. Venous beading in 2 quadrants or more. Intra-retinal microvascular abnormalities.
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10
Q

Scleritis Vs Episcleritis

A
  • Scleritis often associated w/ systemic disease such as RA.
  • Scleritis is painful, episcleritis is not.

Rx w/ NSAID’s and steroids if severe.

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11
Q

Chlamydia Conjunctivitis Management in babies.

A
  • Oral erythromycin 50/mg/kg/day asap.

- Swab MC&S

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12
Q

Periorbital cellulitis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Infection of the fat and muscles surrounding the eye.
    - Previous sinus infection or URTI
    - Lack of HIB vaccine
    - Recent eyelid infection or bite.
    - Common causes = Strep, Staph aureus, HIB
  2. Redness and swelling around the eye.
    - Ocular pain
    - Visual disturbance
    - Proptosis
    - Pain on eye movements
    - Eyelid oedema and ptosis.
    - Systemic Sx
  3. FBC - raised WCC and ESR/CRP
    - Eye exam - reduced movements, proptosis etc.
    - CT w/ contrast shows inflamm of orbital tissue
    - Blood culture.
  4. Admit + IV ABx
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13
Q

Herpes Zoster Opthalmicus

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Reactivation of the VZV in the area supplied by the ophthalmic branch of the trigeminal nerve.
  2. Vesicular rash around the eye.
    - Hutchinsons sign; rash on the tip or side of the nose.
  3. Clinical
    - Eye tests to ensure the eye is okay.
    - Viral serology.
  4. Oral aciclovir 7-10 days.
    - Topical steroids for any inflammation.
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14
Q

Hypertensive retinopathy stages

A

1 = arteriolar narrowing and tortuosity. Increased light reflex.

2 = AV nipping

3 = Cotton wool exudates and haemorrhages

4 = Papilloedema

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15
Q

Acute Angle glaucoma

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Raised IOP
    - Due to prevention of fluid outflow via the trabecular meshwork.
    - Risks = long-sightedness, pupillary dilatation and lens growth w/ age.
  2. Severe pain
    - Decreased visual acuity
    - Symptoms worsened by pupil dilation.
    - tense and red eye.
    - Semi-dilated non reactive pupil.
    - Corneal oedema
    - Systemic upset.
  3. Clinical; ocular pain + increased IOP on tonometry >21mmHg.
  4. Urgent referral to OPT
    - IV acetazolamide (reduced aqueous humour production)
    - Lay pt flat
    - others include, BB, steroids etc.
    - Surgical iridotomy (holes are made to allow drainage)
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16
Q

Optic neuritis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. MS
    - DM
    - Syphilis
  2. UL decrease in visual acuity
    - Red desaturation
    - Pain on eye movement
    - RAPD
    - Central scotoma
  3. Clinical
    - Visual testing
    - MRI brain for MS
    - LP
    - Opthalmoscopy; elevated optic disc and blurred margins.
  4. High dose steroids
    - Recovers in 4-6 weeks
17
Q

Macular degeneration

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Dry (90%) - drusen and yellow round spots in Bruch’s membrane.
    - Wet (10%) - choroidal neovascularisation, leakage of fluid cause rapid vision loss.
    - RF’s = age, smoking, FHx, CVD, HTN, high cholesterol and DM.
  2. Subacute reduction in visual acuity
    - Hard to adapt to dark
    - Fluctuant visual disturbances
    - Flashing lights and flickering
    - Distortion of lines in Amsler grid testing.
  3. Amsler grid
    - Fundoscopy - drusen, yellow areas of pigment deposition in the macula.
    - In wet, may see haemorrhages.
    - Slit lamp
    - Flueorecein angiography.
  4. Zinc + antioxidants ACE reduce progression.
    - VEGF in wet only.
    - Laser photo coag.
18
Q

Latanoprost

  1. MOA
  2. SE
A
  1. Increases uveoscleral outflow
  2. Brown iris
    - Increased lash length
19
Q

BB drops

  1. MOA
  2. SE
A
  1. Reduces aqueous production

2. Avoid in asthma and Heart block

20
Q

Adie pupil

A
  • Dilated
  • Slow to react to light
  • Damage to parasym fibres, viral or bacterial infection.
21
Q

Argyll-Robertson pupil

A
  • Small pupils
  • Don’t react to bright light
  • Seen in DM
22
Q

Squint

A
  • Misalignment of the visual axes
23
Q

Types of squint

A

Concomitant - imbalance in extraocular muscles.
- Convergent more common than divergent.

Paralytic - Paralysis of the extraocular muscles

24
Q

Management of Squint

A
  • Eye patch

- Secondary care referral

25
Q

Cataract

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Common
    - eye gradually opacifies
    - Aging, smoking, alcohol, DM, steroids, radiation, myotonic dystrophy, hypocalcaemia.
  2. Reduced vision
    - Faded colour vision
    - Glare
    - Halos around lights
  3. Opthalmoscopy - after dilation, normal back of the eye.
    - Slit lamp - visual cataract.
  4. Conservative
    - Surgery; pleomorphemulscification.

Medical School Finals (24 decks)

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