UKMLA Ophthalmology Flashcards
1
Q
Which ethnicity is more prone to developing primary open-angle glaucoma?
A
Black Africans
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
3
Q
What is the fundoscopy finding associated with Primary Open Angle Glaucoma?
A
Cupping of the optic disc with a thin neuroretinal rim
4
Q
What is the gold-standard investigation indicated to diagnose Primary Open Angle Glaucoma?
A
Goldmann applanation tonometry - measures intraocular pressure
5
Q
What is the first line topical drug for the management of Primary Open Angle Glaucoma?
A
Topical prostaglandin analogue e.g., latanoprost
6
Q
What is the mechanism of action of prostaglandin analogues
A
Increases aqueous outflow
7
Q
Hypertrichosis is an adverse effect associated with which drug implicated in the management of Primary Open Angle Glaucoma?
A
Prostaglandin analogues
8
Q
What is the mechanism of action of beta-blockers in the management of Primary Open Angle Glaucoma?
A
Reduces aqueous production
9
Q
What is the indication for selective laser trabeculoplasty or surgery for the management of Primary Open Angle Glaucoma?
A
if IOP >24
10
Q
What is the clinical difference in visual loss presentation between closed-angle versus open-angle glaucoma?
A
Closed angle = painful
11
Q
A fixed mid-dilated pupil is associated with which type of glaucoma?
A
Closed-angle glaucoma
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
13
Q
Which investigation is indicated in closed-angle glaucoma to visualise the angle?
A
- Gonioscopy
14
Q
What is the first line management of closed-angle glaucoma?
A
- Emergency (same day) referral to ophthalmologist
+ miotic agent e..g, pilocarpine
15
Q
How does pilocarpine work?
A
Causes contraction of the ciliary muscle to open the trabecular meshwork
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)
17
Q
What is the definitive management of closed-angle glaucoma?
A
Laser peripheral iridotomy
18
Q
Which organism is implicated in the contact-lens keratitis?
A
Pseudomonas aeruginosa.
19
Q
What is the management of herpes simplex keratitis?
A
Topical acyclovir 5 times/day, for 2 weeks
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.
21
Q
Which stain is used to identify dendritic ulcers in HSV keratitis?
A
- Fluorescence stain
22
Q
What is the presentation of keratitis?
A
- Photophobia
- Lacrimation
- Painful, red-eye
- Foreign body, gritty sensation
- Diminished visual acuity
23
Q
A foreign body gritty sensation and painful red eye is associated with which eye condition?
A
Keratitis
24
Q
What is the management for keratitis?
A
Urgent referral
25
Tractional retinal detachment is associated with which pathology?
Proliferative diabetic retinopathy
26
What is the most common cause of retinal detachment?
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
27
Floaters and flashers + shadow curtain involvement of visual loss is associated with what diagnosis?
Retinal detachment
28
What fundoscopic finding is observed in patients with retinal detachment?
Asymmetrical red reflex
29
What is the definitive management for retinal detachment?
Laser therapy
Vitrectomy
30
Which type of glaucoma is associated with a painless loss of the peripheral visual field (tunnel vision)?
Primary Open Angle Glaucoma
31
What is the presentation of central retinal artery occlusion?
Painless sudden severe unilateral vision loss
RAPD
32
A cherry red spot on fundoscopy is characteristic of which pathology?
Central Retinal Artery Occlusion
33
What is the immediate management of Central Retinal Artery Occlusion ?
Emergency referral - ocular massage or anterior paracentesis to dis-logde the clot
34
What is the aetiology of Central Retinal Artery Occlusion ?
Central retinal artery is blocked by an embolus or inflammation secondary go giant cell arteritis
35
A stormy sunset appearance on fundoscopy is associated with ophthal pathology?
Central Retinal Vein Occlusion
36
What is the mainstay management for Central Retinal Vein Occlusion ?
Panretinal photocoagulation
or Anti-VEGF therapy
37
What are the risk factors for vitreous haemorrhage?
* Proliferative diabetic retinopathy
* Retinal detachment, posterior vitreous detachment
* Coagulation medications
* Trauma (most common in children and young adults).
38
A red-hue in vision + floaters and dark spots in vision is consistent with what diagnosis?
vitreous haemorrhage
39
What is the fundoscopic finding associated with vitreous haemorrhage?
Haemorrhage in vitreous gel
40
Slit-lamp examination findings associated with vitreous Haemorrhage?
Red blood cells in the anterior vitreous
41
How long does it take for a vitreous Haemorrhage to resolve?
Within 3-12 weeks
42
When (weeks) is a vitrectomy indicated if a vitreous Haemorrhage does not clear?
Within 12 weeks
43
Which photoreceptor is degenerated first in Retinitis Pigmentosa ?
Rod cells
44
Rod photoreceptors are responsible for which type of vision?
Low-light vision (RP manifests as night blindness and loss of peripheral vision)
45
What type of visual loss occurs first in Retinitis Pigmentosa ?
Night blindness and loss of peripheral vision
46
Why do cone cells degenerate in Retinitis Pigmentosa ?
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
What are the triad of findings observed on fundoscopy in Retinitis Pigmentosa?
1. Bony spicule pigmentation in the peripheral retina
2. Vascular narrowing
3. Abnormal waxy pallor of the optic disc
48
What is the functional management of Retinitis Pigmentosa?
Low-vision aids, guide dog
49
What feature predominantly differentiates between scleritis and episcleritis?
Pain in scleritis
50
What systemic inflammatory diseases are associated with scleritis?
rheumatoid arthritis, SLE, sarcoidosis, IBD
51
What is the immediate management for scleritis?
Same-day emergency referral to ophthalmologist
52
What is the first line management for scleritis?
Topical/systemic NSAIDs
Steroids
53
What is the most common cause of irreversible blindness in the UK?
Age-related macular degeneration
54
What characteristic finding is observed in dry Age-related macular degeneration ?
Drusen
55
What is Drusen?
Collection of lipid material that accumulate deep to the retinal pigment epithelium
56
What vision loss is associated with Age-related macular degeneration ?
Central vision loss
57
What is the main modifiable risk factor for Age-related macular degeneration ?
Smoking
58
Distortion of vision - where straight lines appear crooked is associated with which type of ophthal pathology?
Age-related macular degeneration
59
What is the clinical presentation of Age-related macular degeneration ?
* 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
What finding is observed on fundoscopy for dry age-related macular degeneration?
Drusen
61
What investigation is performed to assess for distortion of line perception in age-related macular degeneration?
Amsler grid testing
62
Which investigation confirms the diagnosis of age-related macular degeneration?
OCT
63
Which investigation visualises neovascularisation in age-related macular degeneration?
Fluorescein angiography
64
Which glands are implicated in blepharitis?
meibomian glands
65
What are the two causes of anterior blepharitis?
- Bacterial: Staphylococcal blepharitis.
- Seborrhoeic dermatitis
66
What is Blepharitis ?
chronic inflammatory condition affecting the margins of the eyelids, exhibiting a bilateral presentation.
67
When are symptoms of blepharitis worse during the day?
During the morning
68
What is the first line management of blepharitis?
: 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
Which drugs can cause cataracts?
Steroids
70
Which systemic diseases are associated with cataract formation?
- Diabetes mellitus
- Myotonic dystrophy
- Neurofibromatosis type 2
- Atrophic dermatitis
71
What fundoscopy finding is characteristic of cataracts?
opacification of the lens (defects in red reflex)
72
What is the surgical management of cataracts?
Surgical removal and replacement
73
What are the complications associated with cataract surgery?
* Posterior capsule opacification – thickening of the lens capsule
* Retinal detachment
* Posterior capsule rupture
* Endophthalmitis: Inflammation of aqueous and/or vitreous humour.
74
What defect in colour vision is associated with optic neuritis?
red desaturation
75
What are the clinical manifestations of optic neuritis?
* 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
What is the diagnostic investigation for optic neuritis?
MRI of the brain and orbits with gadolinium contrast.
77
What is the first line management of optic neuritis?
High-dose oral or IV methylprednisolone
78
What is the first line management of anterior uveiits?
Topical corticosteroids and cycloplegic-mydriatic drugs e.g., cyclopentolate
79
What are the features of non-proliferative diabetic retinopathy?
- Microaneurysms
- Blot haemorrhages
- Hard exudates – indicate chronic oedema.
- Cotton wool spots (‘soft exudates’ – represent areas of retinal infarction)
80
What are the features of severe diabetic retinopathy?
- Blot haemorrhages and microaneurysms in 4 quadrants
- Venous beading in at least 2 quadrants
- IRMA in at least 1 quadrant
81
What is the first line management for non-proliferative diabetic retinopathy?
Fenofibrate
82
What is the first line management for proliferative diabetic retinopathy?
Panretinal photocoagulation
83
What complications are associated with proliferative diabetic retinopathy?
Decrease in night vision
84
Frequency of monitoring in non-proliferative diabetic retinopathy?
Every 6 to 12 months
85
What are the FOUR features of orbital compartment syndrome?
* Eye pain/swelling
* Proptosis
* ‘Rock hard’ eyelids
* Relevant afferent pupillary defect
86
What is the immediate management of orbital compartment syndrome?
Urgent lateral canthotomy to decompress the orbit
87
A chalazion affects which structure?
meibomian gland
88
A firm painless lump in the upper or lower eyelid is what?
Chalazion (Meibomian Cyst)
89
What is the first line management of a Chalazion (Meibomian Cyst)?
Warm compress and eyelid massage for 10-15 minutes up to 5 times a day
90
What term describes a localised infection/inflammation of the eyelid margin?
Stye
91
What is the most common organism that causes a stye?
staphylococcal infection
92
What is the management of a stye?
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
Which test is used to differentiate episcleritis with scleritis?
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
What is the first line management of bacterial conjunctivitis if symptoms have not resolved within 3 days?
Chloramphenicol 0.5% drops
95
on what day should antibiotics be prescribed for bacterial conjunctivitis?
Day 3 onwards
96
For contact lens users, which investigation should be performed to assess for corneal staining in suspected conjunctivitis?
* Topical fluorescein
97
What are the adverse effects associated with corticosteroid eye drops?
1. Corneal ulceration
2. Increased intraocular pressure
3. Cataract formation
4. Transient blurring
98
