UKMLA Ophthalmology Flashcards

1
Q

Which ethnicity is more prone to developing primary open-angle glaucoma?

A

Black Africans

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2
Q

What is the characteristic visual defect associated with Primary Open Angle Glaucoma?

A

Halos and tunnel vision
PAINLESS visual loss of the peripheral field

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3
Q

What is the fundoscopy finding associated with Primary Open Angle Glaucoma?

A

Cupping of the optic disc with a thin neuroretinal rim

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4
Q

What is the gold-standard investigation indicated to diagnose Primary Open Angle Glaucoma?

A

Goldmann applanation tonometry - measures intraocular pressure

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5
Q

What is the first line topical drug for the management of Primary Open Angle Glaucoma?

A

Topical prostaglandin analogue e.g., latanoprost

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6
Q

What is the mechanism of action of prostaglandin analogues

A

Increases aqueous outflow

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7
Q

Hypertrichosis is an adverse effect associated with which drug implicated in the management of Primary Open Angle Glaucoma?

A

Prostaglandin analogues

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8
Q

What is the mechanism of action of beta-blockers in the management of Primary Open Angle Glaucoma?

A

Reduces aqueous production

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9
Q

What is the indication for selective laser trabeculoplasty or surgery for the management of Primary Open Angle Glaucoma?

A

if IOP >24

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10
Q

What is the clinical difference in visual loss presentation between closed-angle versus open-angle glaucoma?

A

Closed angle = painful

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11
Q

A fixed mid-dilated pupil is associated with which type of glaucoma?

A

Closed-angle glaucoma

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12
Q

What is the clinical presentation of closed-angle glaucoma?

A
  • Acute red, painful eye
  • Hazy cornea
  • Corneal oedema
  • Blurred vision
  • Decreased visual acuity
  • Worse with mydriasis (e.g., watching TV in a dark room)
  • Haloes around lights
  • Lacrimation
  • Firm eyeball
  • Fixed mid-dilated pupil
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13
Q

Which investigation is indicated in closed-angle glaucoma to visualise the angle?

A
  • Gonioscopy
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14
Q

What is the first line management of closed-angle glaucoma?

A
  • Emergency (same day) referral to ophthalmologist

+ miotic agent e..g, pilocarpine

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15
Q

How does pilocarpine work?

A

Causes contraction of the ciliary muscle to open the trabecular meshwork

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16
Q

Which drug reduces the production of aqueous humour and is indicated in the the management of closed-angle glaucoma?

A

o Oral or IV carbonic anhydrase inhibitor (e.g., acetazolamide)

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17
Q

What is the definitive management of closed-angle glaucoma?

A

Laser peripheral iridotomy

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18
Q

Which organism is implicated in the contact-lens keratitis?

A

Pseudomonas aeruginosa.

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19
Q

What is the management of herpes simplex keratitis?

A

Topical acyclovir 5 times/day, for 2 weeks

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20
Q

What is the management of contact-lens keratitis?

A

Urgent ophthalmologist referral for ulcer scraping and topical fluoroquinolone (e.g., ofloxacin, levofloxacin, or moxifloxacin). Discontinue contact lens until symptom resolution.

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21
Q

Which stain is used to identify dendritic ulcers in HSV keratitis?

A
  • Fluorescence stain
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22
Q

What is the presentation of keratitis?

A
  • Photophobia
  • Lacrimation
  • Painful, red-eye
  • Foreign body, gritty sensation
  • Diminished visual acuity
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23
Q

A foreign body gritty sensation and painful red eye is associated with which eye condition?

A

Keratitis

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24
Q

What is the management for keratitis?

A

Urgent referral

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25
Q

Tractional retinal detachment is associated with which pathology?

A

Proliferative diabetic retinopathy

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26
Q

What is the most common cause of retinal detachment?

A

Rhegmatogenous (commonest form) – as the vitreous shrinks and partly separates from the retinal surface, a retinal tear may arise, allowing fluid to enter the subretinal space precipitating retinal detachment

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27
Q

Floaters and flashers + shadow curtain involvement of visual loss is associated with what diagnosis?

A

Retinal detachment

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28
Q

What fundoscopic finding is observed in patients with retinal detachment?

A

Asymmetrical red reflex

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29
Q

What is the definitive management for retinal detachment?

A

Laser therapy

Vitrectomy

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30
Q

Which type of glaucoma is associated with a painless loss of the peripheral visual field (tunnel vision)?

A

Primary Open Angle Glaucoma

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31
Q

What is the presentation of central retinal artery occlusion?

A

Painless sudden severe unilateral vision loss

RAPD

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32
Q

A cherry red spot on fundoscopy is characteristic of which pathology?

A

Central Retinal Artery Occlusion

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33
Q

What is the immediate management of Central Retinal Artery Occlusion ?

A

Emergency referral - ocular massage or anterior paracentesis to dis-logde the clot

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34
Q

What is the aetiology of Central Retinal Artery Occlusion ?

A

Central retinal artery is blocked by an embolus or inflammation secondary go giant cell arteritis

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35
Q

A stormy sunset appearance on fundoscopy is associated with ophthal pathology?

A

Central Retinal Vein Occlusion

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36
Q

What is the mainstay management for Central Retinal Vein Occlusion ?

A

Panretinal photocoagulation

or Anti-VEGF therapy

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37
Q

What are the risk factors for vitreous haemorrhage?

A
  • Proliferative diabetic retinopathy
  • Retinal detachment, posterior vitreous detachment
  • Coagulation medications
  • Trauma (most common in children and young adults).
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38
Q

A red-hue in vision + floaters and dark spots in vision is consistent with what diagnosis?

A

vitreous haemorrhage

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39
Q

What is the fundoscopic finding associated with vitreous haemorrhage?

A

Haemorrhage in vitreous gel

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40
Q

Slit-lamp examination findings associated with vitreous Haemorrhage?

A

Red blood cells in the anterior vitreous

41
Q

How long does it take for a vitreous Haemorrhage to resolve?

A

Within 3-12 weeks

42
Q

When (weeks) is a vitrectomy indicated if a vitreous Haemorrhage does not clear?

A

Within 12 weeks

43
Q

Which photoreceptor is degenerated first in Retinitis Pigmentosa ?

A

Rod cells

44
Q

Rod photoreceptors are responsible for which type of vision?

A

Low-light vision (RP manifests as night blindness and loss of peripheral vision)

45
Q

What type of visual loss occurs first in Retinitis Pigmentosa ?

A

Night blindness and loss of peripheral vision

46
Q

Why do cone cells degenerate in Retinitis Pigmentosa ?

A

Cone cells are subjected to a toxic environment as a result of subsequent cell death in the retina, thus, resulting in dyschromatopsia or disturbance of colour perceptions.

47
Q

What are the triad of findings observed on fundoscopy in Retinitis Pigmentosa?

A
  1. Bony spicule pigmentation in the peripheral retina
  2. Vascular narrowing
  3. Abnormal waxy pallor of the optic disc
48
Q

What is the functional management of Retinitis Pigmentosa?

A

Low-vision aids, guide dog

49
Q

What feature predominantly differentiates between scleritis and episcleritis?

A

Pain in scleritis

50
Q

What systemic inflammatory diseases are associated with scleritis?

A

rheumatoid arthritis, SLE, sarcoidosis, IBD

51
Q

What is the immediate management for scleritis?

A

Same-day emergency referral to ophthalmologist

52
Q

What is the first line management for scleritis?

A

Topical/systemic NSAIDs
Steroids

53
Q

What is the most common cause of irreversible blindness in the UK?

A

Age-related macular degeneration

54
Q

What characteristic finding is observed in dry Age-related macular degeneration ?

A

Drusen

55
Q

What is Drusen?

A

Collection of lipid material that accumulate deep to the retinal pigment epithelium

56
Q

What vision loss is associated with Age-related macular degeneration ?

A

Central vision loss

57
Q

What is the main modifiable risk factor for Age-related macular degeneration ?

A

Smoking

58
Q

Distortion of vision - where straight lines appear crooked is associated with which type of ophthal pathology?

A

Age-related macular degeneration

59
Q

What is the clinical presentation of Age-related macular degeneration ?

A
  • Gradual visual deterioration: Difficulty with reading initially with the smallest sizes of print, and then later with larger print.
  • Metamorphopsia: Distortion of vision, where straight lines appear crooked, wavy or bent.
  • Scotoma: Black or grey patch affecting their central field of vision.
  • Light glare
  • Loss of contrast sensitivity
  • Size or colour of objects appears different with each eye
  • Abnormal dark adaptation
  • Photopsia – a perception of flickering or flashing lights
  • Charles–Bonnet syndrome: Visual hallucinations.
60
Q

What finding is observed on fundoscopy for dry age-related macular degeneration?

A

Drusen

61
Q

What investigation is performed to assess for distortion of line perception in age-related macular degeneration?

A

Amsler grid testing

62
Q

Which investigation confirms the diagnosis of age-related macular degeneration?

A

OCT

63
Q

Which investigation visualises neovascularisation in age-related macular degeneration?

A

Fluorescein angiography

64
Q

Which glands are implicated in blepharitis?

A

meibomian glands

65
Q

What are the two causes of anterior blepharitis?

A
  • Bacterial: Staphylococcal blepharitis.
  • Seborrhoeic dermatitis
66
Q

What is Blepharitis ?

A

chronic inflammatory condition affecting the margins of the eyelids, exhibiting a bilateral presentation.

67
Q

When are symptoms of blepharitis worse during the day?

A

During the morning

68
Q

What is the first line management of blepharitis?

A

: Self-care measures including eyelid hygiene and warm compress.
* Eyelid should be cleaned twice daily
- Cotton wool buds dipped in baby shampoo diluted 1:10 with warm water or a sodium bicarbonate solution in warm water.

69
Q

Which drugs can cause cataracts?

A

Steroids

70
Q

Which systemic diseases are associated with cataract formation?

A
  • Diabetes mellitus
  • Myotonic dystrophy
  • Neurofibromatosis type 2
  • Atrophic dermatitis
71
Q

What fundoscopy finding is characteristic of cataracts?

A

opacification of the lens (defects in red reflex)

72
Q

What is the surgical management of cataracts?

A

Surgical removal and replacement

73
Q

What are the complications associated with cataract surgery?

A
  • Posterior capsule opacification – thickening of the lens capsule
  • Retinal detachment
  • Posterior capsule rupture
  • Endophthalmitis: Inflammation of aqueous and/or vitreous humour.
74
Q

What defect in colour vision is associated with optic neuritis?

A

red desaturation

75
Q

What are the clinical manifestations of optic neuritis?

A
  • Subacute blurred vision
  • Unilateral decrease in visual acuity over hours or days.
  • Reduced colour vision
  • Poor discrimination of colours i.e. ‘red desaturation’
  • Eye pain at rest and on eye movement
  • Relative afferent pupillary defect
  • Central scotoma
76
Q

What is the diagnostic investigation for optic neuritis?

A

MRI of the brain and orbits with gadolinium contrast.

77
Q

What is the first line management of optic neuritis?

A

High-dose oral or IV methylprednisolone

78
Q

What is the first line management of anterior uveiits?

A

Topical corticosteroids and cycloplegic-mydriatic drugs e.g., cyclopentolate

79
Q

What are the features of non-proliferative diabetic retinopathy?

A
  • Microaneurysms
  • Blot haemorrhages
  • Hard exudates – indicate chronic oedema.
  • Cotton wool spots (‘soft exudates’ – represent areas of retinal infarction)
80
Q

What are the features of severe diabetic retinopathy?

A
  • Blot haemorrhages and microaneurysms in 4 quadrants
  • Venous beading in at least 2 quadrants
  • IRMA in at least 1 quadrant
81
Q

What is the first line management for non-proliferative diabetic retinopathy?

A

Fenofibrate

82
Q

What is the first line management for proliferative diabetic retinopathy?

A

Panretinal photocoagulation

83
Q

What complications are associated with proliferative diabetic retinopathy?

A

Decrease in night vision

84
Q

Frequency of monitoring in non-proliferative diabetic retinopathy?

A

Every 6 to 12 months

85
Q

What are the FOUR features of orbital compartment syndrome?

A
  • Eye pain/swelling
  • Proptosis
  • ‘Rock hard’ eyelids
  • Relevant afferent pupillary defect
86
Q

What is the immediate management of orbital compartment syndrome?

A

Urgent lateral canthotomy to decompress the orbit

87
Q

A chalazion affects which structure?

A

meibomian gland

88
Q

A firm painless lump in the upper or lower eyelid is what?

A

Chalazion (Meibomian Cyst)

89
Q

What is the first line management of a Chalazion (Meibomian Cyst)?

A

Warm compress and eyelid massage for 10-15 minutes up to 5 times a day

90
Q

What term describes a localised infection/inflammation of the eyelid margin?

A

Stye

91
Q

What is the most common organism that causes a stye?

A

staphylococcal infection

92
Q

What is the management of a stye?

A

1st line: Reassurance and self-care measures with warm compress for 5-10 minutes 2-4 x daily until the style drains.
* Avoid makeup and contact lenses until the area has healed.

Symptom relief:
* Plucking eyelash from the infected follicle to facilitate drainage
* Incision and drainage using a fine sterile needle

93
Q

Which test is used to differentiate episcleritis with scleritis?

A

Phenylephrine drops are applied to differentiate between episcleritis and scleritis. Phenylephrine blanches the conjunctival and episcleral vessels, but not the scleral vessels. – transient improvement of red eye.

94
Q

What is the first line management of bacterial conjunctivitis if symptoms have not resolved within 3 days?

A

Chloramphenicol 0.5% drops

95
Q

on what day should antibiotics be prescribed for bacterial conjunctivitis?

A

Day 3 onwards

96
Q

For contact lens users, which investigation should be performed to assess for corneal staining in suspected conjunctivitis?

A
  • Topical fluorescein
97
Q

What are the adverse effects associated with corticosteroid eye drops?

A
  1. Corneal ulceration
  2. Increased intraocular pressure
  3. Cataract formation
  4. Transient blurring
98
Q
A