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Duke Elder > Spot faces > Flashcards

Spot faces Flashcards

1
Q

Lid retraction in TED

A

Dalrymple sign

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2
Q

Lid lag in TED

A

Von Graefe

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3
Q

Retinal Dialysis traumatic vs idiopathic location

A

Traumatic dialysis - superonasally

Idiopathic dialysis - inferotemporally

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4
Q

Antibodies for Myesthnia Gravis

A

Anti-AChR and Anti-MUSK

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5
Q

Myaesthenic crisis

A

Steriods

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6
Q

Helminth examples

A

Onchocerca volvulus - transmitted by Simulium blackflies

Toxocara canii causes endophthalmitis in children - host is dogs.

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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
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8
Q

Candida keratitis tx

A

Voriconazole or amphotericin B drops

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9
Q

Filamentous (aspergillus/fusarium) keratitis

A

Natamycin drops

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10
Q

Epithelial Dystrophies

A

Cogan (epithelial basement membrane)

  • commonest
  • map-like subepithelial opacities

Meesman (epithelial)

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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

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12
Q

Imaging modalities for diagnosing keratoconus

A

Corneal topography (Pentacam)

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13
Q

Ketatoconus signs

A

Munson sign - lower lid protrudes on downward gaze

Vogt striae - corneal stromal striations seen on slit lamp

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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.
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15
Q

Cytomegalovirus Retinitis tx

A

Affect AIDs patients
IV ganciclovir

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16
Q

Cyst of Moll vs Zeis

A

Moll - translucent

Zeis - non-translucent

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17
Q

Lens Lens Capsule collagen

A

4

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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)

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19
Q

Lesions of the optic tract

A

contralateral incongruous (asymmetrical) homonymous hemianopia.

+ RAPD

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20
Q

Most common cause of blindness in the world

A

Cataract

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21
Q

Most common cause infective blindness in the world

A

Trachoma (1st) Onchocerciasis (2nd)

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22
Q

Most common cause of visual impairment in the world

A

Refractive error

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23
Q

Most common type of colour blindness

A

Red-green

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24
Q

Most common cause of nutritional blindness

A

Vitamin A deficiency → nyctalopia

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25
Q

Most common cause of irreversible blindness in the world

A

Glaucoma

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26
Q

Layers of the Neurosensory retina

My nerves get in knots outside our easy practice review

A

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

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27
Q

Tamoxifen

A

vortex keratopathy

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28
Q

Duane Syndrome

A

globe retract during adduction

co-innervation of both the LR and MR by CN3

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29
Q

Brown Syndrome

A

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
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30
Q

collagens are found in the cornea

A

1 & 4

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31
Q

X-linked Recessive

COLF

A

Congenital Retinoschisis
Ocular Albinism
Lowe Syndrome
Fabry Disease

A son can only be effected if the mother is also effected

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32
Q

Sickle cell severity

A

HbSS - worst systemic disease

HbSC - worst ocular disease

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33
Q

Proliferative sickle cell retinopathy classification

A

Goldberg

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34
Q

Autosomal Dominant

A
  • Congenital Cataracts
  • Corneal Dystrophies
  • Marfan Syndrome
  • Stickler Syndrome: defective collagen 2 –> empty vitreous
  • Tuberous sclerosis, von-hippel lindau and NF
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35
Q

Which IOP lowering agent is contraindicated in phacomorphic glaucoma

A

Pilocarpine

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36
Q

CRVO tx

A

Neovascularization → Panretinal photocoagulation laser

Macular oedema → Anti-VEGF or Ozurdex® (dexamethasone implant)

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37
Q

Collagen in Sclera and corneal stroma

A

1

(Sclera is type 1 and 3)

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38
Q

Collagen in Vitreous and Lens capsule

A

2

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39
Q

Collagen in Descemet’s membrane of cornea

A

4

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40
Q

Best test for investigating nasolacrimal anatomy?

A

Dacryocystography

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41
Q

Retinoscopy

A

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

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42
Q

Staphylococcal blepharitis

A

a/w Atopic dermatitis

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43
Q

Acne rosacea is associated with

A

Posterior blepharitis

44
Q

Ligneous Conjunctivitis

A

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
Q

What is used to stain the vitreous in cases of vitreous loss during cataract surgery?

A

Triamcinolon

46
Q

Nd:YAG (Photo-ionization)

A

1064nm

Posterior capsulotomy
Peripheral iridotomy

47
Q

trabeculoplasty (SLT)

A

Frequency doubled Nd:YAG (532nm)

48
Q

Krypton red laser

A

647nm
subretinal neovascular membranes

49
Q

Diode laser

A

810nm
retinopathy of prematurity and ciliary body treatment in glaucoma

50
Q

Argon blue-green

A

blue 488nm
green 514nm

Argon is commonly used for panretinal coagulation (in retinal vascular diseases), macular treatment (macular oedema) and iridoplasty

51
Q

Excimer laser (Photochemical)

A

Corneal ablation during laser refractive surgery

52
Q

DIRECT ophtalmoscope

EVir

A

Erect and virtual
15x mag

53
Q

INDIRECT ophtalmoscope

evIR

A

Inverted and real

54
Q

Iridocorneal Endothelial Syndrome

A

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
Q

Cenegermin

A

topical recombinant human nerve growth factor

For Neurotrophic Keratopathy (corneal ulceration caused by denervation)

56
Q

Tx of regular vs irregular astigmastism

A

regular - soft toric lenses
Irregular - rigid gas permeable contact lenses (RGP CLs)

57
Q

Onchocerciasis

A

Ivermectin

58
Q

Retinoschisis vs Detachement

A
59
Q

Iris coloboma and Limbal dermoids location

A

Inf Temp

60
Q

Adulthood Orbital Tumours

A

Optic nerve sheath meningioma
Cavernous Hemangioma (LFH)

61
Q

What is the commonest macular dystrophy?

A

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
Q

What is the most common cause of choroidal neovascularization?

A

Age related macular degeneration

63
Q

Layers of the Choroid

HSCB

A

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
Q

Wagner and Stckler inherrited conditions

A

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
Q

Layers of the cornea (superficial to deep)

A

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
Q

Glaucoma drugs in pregnancy

A

Brimonidine in first the trimester
Switch to timolol in 3rd

67
Q

Papillae vs Follicles conjunctivits

A

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
Q

Adult lens thickness (unaccommodated)

A

6mm thick

69
Q

Chalazion gland blocked

A

Meibomian or Zeis glands

70
Q

Vortex Keratopathy

FAT CC

A

Fabry’s disease.
Amiodarone
Tamoxifen
Chlorpromazine
Chloroquine

71
Q

Cystoid Macular Oedema

A

Latanoprost
Adrenaline
Glitazones
Nicotine

72
Q

Bull’s-eye Maculopathy

A

Chloroquine (also causes renal toxicity and corneal verticillata)

73
Q

Crystalline Maculopathy

A

Tamoxifen

74
Q

Medications - Optic Nerve Related

A

Ethambutol
Chloramphenicol
Amiodarone
Vigabatrin (also associated with binal visual field defects)
Isoniazid

75
Q

Cataract Inducing medications

A

Steroids
Amiodarone
Allopurinol
Busulphan
Chlorpromazine (a thiazide): fine yellow-brown granules on anterior lens capsule
Gold: innocuous, anterior capsular deposits

76
Q

Meds which raise IOP

A

Topiramate (can result in bilateral acute angle closure secondary to ciliary body swelling

Steroids

77
Q

Meds which lower IOP

A

Cannabinoids and alcohol can transiently lower IOP

78
Q

Lens dislocation Weill-Marchesani syndrome

A

Anterior inferior

79
Q

What is the commonest non-accommodative type of esotropia

A

Infantile Esotropia

80
Q

What is the most appropriate treatment for fully accommodative Esotropia?

A

Cycloplegic hypermetropic correction

81
Q

Tx of esotropia a/w convergence excess

A

Convergence excess → Esotropia for only nearly vision caused by high convergence.

Manage with bifocal glasses or squint surgery

82
Q

Leber congenital amaurosis

A

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
Q

Define presbyopia

A
  • 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
Q

Which sickle cell Hb variation is associated with worst systemic vs ocular disease

A

HbSS = worst systemic disease

HbSC = worst ocular disease

85
Q

Sickle cell non-proliferative

A

Salmon patches (intraretinal haemorrhages and black sunbursts (RPE hyperplasia)

86
Q

Sickle cell proliferative

A

sea fan neovascularization, vitreous haemorrhage and retinal detachment

87
Q

Mx of sever sickle cell retinopathy

A

Scatter laser photocoagulation

88
Q

Which retinal vessels are first affected in retinopathy of prematurity?

A

Peripheral temporal

89
Q

Mx of ROP

A

Transpupillary diode laser within 48 hours

90
Q

Sherrington’s law

A

Increased innervation of an agonist results in a decreased innervation of its antagonist

91
Q

Hering’s law

A

yolk muscles receive equal innervation. I.e contraction of left LR will simultaneously produce equal contraction of the right MR

92
Q

Erythema Multiforme, SJS and TEN type of rnx

A

4

93
Q

Retinal Dialysis idiopathic vs traumatic location

A

Traumatic dialysis - superonasally
Idiopathic dialysis - inferotemporally

94
Q

Schwalbe’s line

A

Seen on gonioscopy - Termination of Descemet’s membrane

95
Q

Most common cause of unilateral proptosis in children

A

Orbital cellulitis

96
Q

WHO SAFE

A

Surgery for trichiasis (bilamellar rotation)
Azithromycin 1g PO
Facial hygiene
Environmental improvement

97
Q

Initial management of CRAO

A

Ocular massage + IV acetazolamide +- AC paracentesis

within 24 hours

98
Q

CRVO

A

occlusion proximal to the lamina cribrosa

99
Q

Mx of CRVO

A

Neovascularization → PRP
Macular oedema → Anti-VEGF or Ozurdex® (dexamethasone implant)

100
Q

Characteristic sign of previous episodes of acute primary angle closure?

A

Glaukomflecken

101
Q

Xerophthalmia

A

Bitot’s spots - triangular conjunctival keratin buildups

102
Q

Bilateral dacryoadenitis should raise suspicion of

A

sarcoidosis

103
Q

Other Causes of Orbital Inflammation

A

Tolosa-Hunt syndrome
Cavernous sinus syndrome
Wegener’s
Sarcoidosis

104
Q

Parinaud Oculoglandular syndrome TRIAD

A
  1. Unilateral granulomatous conjunctivitis
  2. Ipsilateral preauricular lymphadenopathy
  3. Fever

*Bartonella henselae

105
Q

Pellucid Marginal Degeneration

A

butterfly pattern

106
Q

Koganei

A

Clumps of pigmented macrophages found in the iris stroma

Duke Elder (12 decks)

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