Spot faces Flashcards
1
Q
Lid retraction in TED
A
Dalrymple sign
2
Q
Lid lag in TED
A
Von Graefe
3
Q
Retinal Dialysis traumatic vs idiopathic location
A
Traumatic dialysis - superonasally
Idiopathic dialysis - inferotemporally
4
Q
Antibodies for Myesthnia Gravis
A
Anti-AChR and Anti-MUSK
5
Q
Myaesthenic crisis
A
Steriods
6
Q
Helminth examples
A
Onchocerca volvulus - transmitted by Simulium blackflies
Toxocara canii causes endophthalmitis in children - host is dogs.
7
Q
Fungal Keratitis
A
Candida
- Patients with AIDS/ immunocompromise/diabetes
- Plaque corneal ulcer with expanding infiltrate
Aspergillus/Fusarium
- History of trauma associated with contact of plants or soil
- White, feathery corneal lesions
8
Q
Candida keratitis tx
A
Voriconazole or amphotericin B drops
9
Q
Filamentous (aspergillus/fusarium) keratitis
A
Natamycin drops
10
Q
Epithelial Dystrophies
A
Cogan (epithelial basement membrane)
- commonest
- map-like subepithelial opacities
Meesman (epithelial)
11
Q
Diabetic Retinopathy pathology and layer
A
Pericyte damage → microaneurysms → flame haemorrhages (nerve fibre layer)
Infarcts → cotton wool spots (axonal debris at infarct margins) (nerve fibre layer)
Increased vessel permeability → Hard exudates (lipoproteins in outer plexiform layer)
Cystoid macular oedema (outer plexiform layer)
Neovascularization
12
Q
Imaging modalities for diagnosing keratoconus
A
Corneal topography (Pentacam)
13
Q
Ketatoconus signs
A
Munson sign - lower lid protrudes on downward gaze
Vogt striae - corneal stromal striations seen on slit lamp
14
Q
Mitochondrial Inheritance
A
Kearns-Sayre syndrome
- Increased concentration of mitochondria in muscles
- Causes to myopathy, ophthalmoplegia, ptosis, salt and pepper retinopathy and cardiac conduction defects
Leber Hereditary optic neuropathy
- Ganglion cell degeneration leading to optic atrophy.
- Young men with progressive painless vision loss
- Fundoscopic triad of pseudo-oedema, telangiectasia and tortuous vessels.
15
Q
Cytomegalovirus Retinitis tx
A
Affect AIDs patients
IV ganciclovir
16
Q
Cyst of Moll vs Zeis
A
Moll - translucent
Zeis - non-translucent
17
Q
Lens Lens Capsule collagen
A
4
18
Q
Willebrand’s knee
A
Junctional scotomas
I.e Left sided lesion of Willebrand’s knee such as a tuberculum sellae meningioma, will result in loss of right superonasal field and left blind eye (junctional scotoma)
19
Q
Lesions of the optic tract
A
contralateral incongruous (asymmetrical) homonymous hemianopia.
+ RAPD
20
Q
Most common cause of blindness in the world
A
Cataract
21
Q
Most common cause infective blindness in the world
A
Trachoma (1st) Onchocerciasis (2nd)
22
Q
Most common cause of visual impairment in the world
A
Refractive error
23
Q
Most common type of colour blindness
A
Red-green
24
Q
Most common cause of nutritional blindness
A
Vitamin A deficiency → nyctalopia
25
Most common cause of irreversible blindness in the world
Glaucoma
26
Layers of the Neurosensory retina
| My nerves get in knots outside our easy practice review
Internal limiting membrane
**Nerve fiber (ganglion cell axons)**
**Ganglion cell layer (ganglion cell bodies)**
Inner plexiform
**Inner nuclear (glial and bipolar cell bodies)**
Outer plexiform
**Outer nuclear (photoreceptor bodies)**
External limiting membrane
Photoreceptors
27
Tamoxifen
vortex keratopathy
28
Duane Syndrome
globe retract during adduction
| co-innervation of both the LR and MR by CN3
29
Brown Syndrome
Limited elevation when adducted
* Upgaze causes a characteristic clicking sensation
* Caused by mechanical restriction of the superior oblique
* Can be found congenitally or after trauma
30
collagens are found in the cornea
1 & 4
31
X-linked Recessive
| COLF
Congenital Retinoschisis
Ocular Albinism
Lowe Syndrome
Fabry Disease
| A son can only be effected if the mother is also effected
32
Sickle cell severity
HbSS - worst systemic disease
HbSC - worst ocular disease
33
Proliferative sickle cell retinopathy classification
Goldberg
34
Autosomal Dominant
* Congenital Cataracts
* Corneal Dystrophies
* Marfan Syndrome
* Stickler Syndrome: defective collagen 2 --> empty vitreous
* Tuberous sclerosis, von-hippel lindau and NF
35
Which IOP lowering agent is contraindicated in phacomorphic glaucoma
Pilocarpine
36
CRVO tx
Neovascularization → Panretinal photocoagulation laser
Macular oedema → **Anti-VEGF** or Ozurdex® (dexamethasone implant)
37
Collagen in Sclera and corneal stroma
1
(Sclera is type 1 and 3)
38
Collagen in Vitreous and Lens capsule
2
39
Collagen in Descemet’s membrane of cornea
4
40
Best test for investigating nasolacrimal anatomy?
Dacryo**cyst**ography
41
Retinoscopy
Similar to ophthalmoscope - difference is that light source of retinoscope can be quickly moved off the visual axis
Myopia → red reflex moves **against** direction of light
Hyperopia → red reflex moves **with** direction of light
42
Staphylococcal blepharitis
a/w Atopic dermatitis
43
Acne rosacea is associated with
Posterior blepharitis
44
Ligneous Conjunctivitis
An idiopathic chronic conjunctivitis of children, with associated systemic disease. It is characterised by recurrent ‘wood’ like pseudomembranes of the conjunctiva and other mucous membranes.
45
What is used to stain the vitreous in cases of vitreous loss during cataract surgery?
Triamcinolon
46
Nd:YAG (Photo-ionization)
1064nm
Posterior capsulotomy
Peripheral iridotomy
47
trabeculoplasty (SLT)
Frequency doubled Nd:YAG (532nm)
48
Krypton red laser
647nm
subretinal neovascular membranes
49
Diode laser
810nm
retinopathy of prematurity and ciliary body treatment in glaucoma
50
Argon blue-green
blue 488nm
green 514nm
Argon is commonly used for panretinal coagulation (in retinal vascular diseases), macular treatment (macular oedema) and iridoplasty
51
Excimer laser (Photochemical)
Corneal ablation during laser refractive surgery
52
DIRECT ophtalmoscope
| EVir
Erect and virtual
15x mag
53
INDIRECT ophtalmoscope
| evIR
Inverted and real
54
Iridocorneal Endothelial Syndrome
Unilateral ** secondary closed angle glaucoma due to ** abnormal corneal epithelium structure
Chandler syndrome - tissue is **corneal**
Cogan-Reese syndrome - iris stromal tissue change leads to naevi/nodular formations.
55
Cenegermin
topical recombinant human nerve growth factor
For Neurotrophic Keratopathy (corneal ulceration caused by denervation)
56
Tx of regular vs irregular astigmastism
regular - soft toric lenses
Irregular - rigid gas permeable contact lenses (RGP CLs)
57
Onchocerciasis
Ivermectin
58
Retinoschisis vs Detachement
59
Iris coloboma and Limbal dermoids location
Inf Temp
60
Adulthood Orbital Tumours
Optic nerve sheath meningioma
Cavernous Hemangioma (LFH)
61
What is the commonest macular dystrophy?
Stargardt Disease
* AR mutation of ABCA4 on Chr1 l→ diffuse accumulation of lipofuscin in the RPE
* Reading difficulties in teens
* Fundoscopy - beaten bronze macula with diffuse yellow specks
* FFA - dark choroid due to blockage of fluorescence by lipofuscin
62
What is the most common cause of choroidal neovascularization?
Age related macular degeneration
63
Layers of the Choroid
| HSCB
Haller's layer (large vessels)
Sattler's layer (medium vessels)
Choriocapillaris (capillaries)
Bruch's membrane (basement membrane)
The suprachoroidal space is a potential space that sits on top of Haller’s layer. It separates the sclera from the choroid.
64
Wagner and Stckler inherrited conditions
Stickler Syndrome
* AD disorder of T2 collagen synthesis -> multiple systemic abnormalities
* deafness, marfanoid features, micrognathia and cleft palate
* ocular: cataracts, ectopia lentis, glaucoma, RRD and empty vitreous
* Prophylactic tx with retinal laser
Wagner Syndrome
Similar to stickler but no systemic associations
Risk of RDD much lower
65
Layers of the cornea (superficial to deep)
Epithelium: SSNK
Bowman's layer
Stroma: thickest + collagen 1
Descemet's membrane: collagen 4
Endothelium: maintains corneal transparency by mitochondrial pumping of water from stroma to aqueous
66
Glaucoma drugs in pregnancy
Brimonidine in first the trimester
Switch to timolol in 3rd
67
Papillae vs Follicles conjunctivits
Papillae
* Red (blood vessel) centre and fat top
* Upper lid
* Viral, chlamydial & toxic conjunctivitis
Follicles
* Dome shaped discrete transparent lesions
* Lower lid
* bacterial & allergic conjunctivitis
68
Adult lens thickness (unaccommodated)
6mm thick
69
Chalazion gland blocked
Meibomian or Zeis glands
70
Vortex Keratopathy
| FAT CC
Fabry’s disease.
Amiodarone
Tamoxifen
Chlorpromazine
Chloroquine
71
Cystoid Macular Oedema
Latanoprost
Adrenaline
Glitazones
Nicotine
72
Bull’s-eye Maculopathy
Chloroquine (also causes renal toxicity and corneal verticillata)
73
Crystalline Maculopathy
Tamoxifen
74
Medications - Optic Nerve Related
Ethambutol
Chloramphenicol
Amiodarone
Vigabatrin (also associated with binal visual field defects)
Isoniazid
75
Cataract Inducing medications
Steroids
Amiodarone
Allopurinol
Busulphan
Chlorpromazine (a thiazide): fine yellow-brown granules on anterior lens capsule
Gold: innocuous, anterior capsular deposits
76
Meds which raise IOP
Topiramate (can result in bilateral acute angle closure secondary to ciliary body swelling
Steroids
77
Meds which lower IOP
Cannabinoids and alcohol can transiently lower IOP
78
Lens dislocation Weill-Marchesani syndrome
Anterior inferior
79
What is the commonest non-accommodative type of esotropia
Infantile Esotropia
80
What is the most appropriate treatment for fully accommodative Esotropia?
Cycloplegic hypermetropic correction
81
Tx of esotropia a/w convergence excess
Convergence excess → Esotropia for only nearly vision caused by high convergence.
Manage with bifocal glasses or squint surgery
82
Leber congenital amaurosis
AR
* Blindness at birth + nystagmus + absent pupil reflexes
* Early disease → normal fundus
* Late disease → **Salt and pepper retinopathy + bull's-eye maculopathy**
Investigations
**ERG is non-recordable **because the photoreceptors are not working
83
Define presbyopia
* It is clinically defined as the **inability to read binocularly (6/12 VA) at 40cm** or at **their habitual working distance**, in a person **>35yrs**
84
Which sickle cell Hb variation is associated with worst systemic vs ocular disease
HbSS = worst systemic disease
HbSC = worst ocular disease
85
Sickle cell non-proliferative
Salmon patches (intraretinal haemorrhages and black sunbursts (RPE hyperplasia)
86
Sickle cell proliferative
sea fan neovascularization, vitreous haemorrhage and retinal detachment
87
Mx of sever sickle cell retinopathy
Scatter laser photocoagulation
88
Which retinal vessels are first affected in retinopathy of prematurity?
Peripheral temporal
89
Mx of ROP
Transpupillary diode laser within 48 hours
90
Sherrington's law
Increased innervation of an agonist results in a decreased innervation of its antagonist
91
Hering's law
yolk muscles receive equal innervation. I.e contraction of left LR will simultaneously produce equal contraction of the right MR
92
Erythema Multiforme, SJS and TEN type of rnx
4
93
Retinal Dialysis idiopathic vs traumatic location
Traumatic dialysis - superonasally
Idiopathic dialysis - inferotemporally
94
Schwalbe’s line
Seen on gonioscopy - Termination of Descemet's membrane
95
Most common cause of unilateral proptosis in children
Orbital cellulitis
96
WHO SAFE
Surgery for trichiasis (bilamellar rotation)
Azithromycin 1g PO
Facial hygiene
Environmental improvement
97
Initial management of CRAO
Ocular massage + IV acetazolamide +- AC paracentesis
| within 24 hours
98
CRVO
occlusion proximal to the lamina cribrosa
99
Mx of CRVO
Neovascularization → PRP
Macular oedema → Anti-VEGF or Ozurdex® (dexamethasone implant)
100
Characteristic sign of previous episodes of acute primary angle closure?
Glaukomflecken
101
Xerophthalmia
Bitot's spots - triangular conjunctival keratin buildups
102
Bilateral dacryoadenitis should raise suspicion of
sarcoidosis
103
Other Causes of Orbital Inflammation
Tolosa-Hunt syndrome
Cavernous sinus syndrome
Wegener’s
Sarcoidosis
104
Parinaud Oculoglandular syndrome TRIAD
1. Unilateral granulomatous conjunctivitis
2. Ipsilateral preauricular lymphadenopathy
3. Fever
*Bartonella henselae
105
Pellucid Marginal Degeneration
butterfly pattern
106
Koganei
Clumps of pigmented macrophages found in the iris stroma
