Week 2 - I - Some opthamology questions and anatomy

Question 1

Sudden onset painless loss of vision in the right eye. On ophthalmoscopy you see a classical picture of a pale retina and red spot at the fovea What is this?

Answer 1

Central retinal artery occlusion (CRAO) - red spot at fovea - cherry red spot due to the fovea being very thin can see the choroidal blood supply Retina pale due to ischaemia

Question 2

70 year old lady presents with sudden loss of vision in the right eye, increasing headache, tender scalp and pain in jaw whilst eating. On examination there is a relative afferent pupillary defect and a swollen optic disc. What is this? What disease is it associated with? What is the initial treatment?

Answer 2

This is artertiic ischaemic optic neuropathy due to giant cell arteritis (temporal arteritis) 15% of people will have polymyalgia rheumatica High dose (60mg) steroids (oral prednisolone) before biopsy results come back

Question 3

85 year old woman with a gradual deterioation of sight in bth eyes. Her sight is blurred and worse in bright lights. On examination there is no red reflex present. What is this?

Answer 3

This is cataracts - most commonly nuclear cataratcs - age clouding of the lens

Question 4

76 year old man presents to his GP with gradual distortion of vision with “floters” in the left eye. On examination the retina is partly obscured by blood and diabetic changes are noted Give the possible cause?

Answer 4

Diabetic retinopathy leading to neovascularization of the retina The new vessels are leaking causing vitreous haemorrhage and therefore the floaters are seen

Question 5

68 year old hypertensive man with a sudden loss of vision in one eye with complete resolution in one minute. What is this?

Answer 5

Amaurosis fugax (transient ischaemic attack) - like a curtain coming down Can be a sign of future stroke

Question 6

What is the point where the optic tract becomes the optic radiations known as?

Answer 6

The lateral geniculate nucleus

Question 7

Barry is a 30 year old man who has had an acutely red eye for 4 days. He normally wears soft contact lenses and thinks he may have hurt his eyes putting the lenses in. The lids are stuck together in the morning and for the last 24 hours the pan has become severe and the vision is reduced. On examination, the eye is extremely red and there is a central corneal epithelial defect. There is a white opacity under the epithelial defect and a hypopyn. Most likely diagnosis? differentials of a red eye?

Answer 7

Most likely Corneal abrasion becoming infected leading to keratitis Differentials of red eye Conjunctiviits (bacterial, viral, allergic) Scleritis, episcleritis Subconjunctival haemorrhae Glacuama

Question 8

How would the corneal abrasion defect be seen on slit lamp?

Answer 8

Use topical fluorescein drops to look at the eye and see the epithelial layers

Question 9

What is the factor in this patients scenario predisposing to infection of the eye? What is the hypopyn?

Answer 9

Use of contact lenses increase the likelihood for infection It is the inflammatory cells fighting the infection collecting in the anteriro chamber of the eye

Question 10

How is a culture taken for this patient?

Answer 10

Corneal scraping for a culture

Question 11

What is the most liely causative organisms associated with contact lens wearers in keratitis?

Answer 11

Pseudomaonas or acanthoemeba

Question 12

What is the empiracal treatment for keratitis infections?

Answer 12

Oflaxacin (4-quinolone - 2nd generation fluoroquniolones)

Question 13

Gentleman presents with excessive unilateral eye pain, causing vomiting. The Eye is red. Headache. Fixed dilated pupil. Hyperope. Hazy cornea. What is the diagnosis?

Answer 13

Diagnosis is acute angle closure glaucoma Only other symptom is rock hard eye, common in long sighted (hyperope = hypermetropic)

Question 14

Patient presents with unilateral head ache. Reports painful to brush hair; PV elevated. What is the management? A – High dose steroid B – Refer to psychiatry C – Analgesia and review D – CT head E – Biopsy of affected area F – Septic work up G– Refer to neurology

Answer 14

Paitent has GCA - give high dose steroids External carotid artery gives rise to the temporal artery - just some info

Question 15

Patient presents with unilateral visual loss. On examination the retina is pale, macular is red. Suggestive of CRAO. Why is the macular red? A – The macula tissue has a bleed B – The macula has died and changed colour C – The macula is thin and the choroidal blood supply can be seen through the cells of the macula D – The macula is normally red and its only observable when the res of the retina is pale.

Answer 15

C – The macula is thin and the choroidal blood supply can be seen through the cells of the macula Macula is the thinnest part of the retina and therefore if there is a CRAO causing a pale retina the choroidal blood supply will ‘shine through’

Question 16

Aid worker returns from Africa and notices that their eye lashes have inturned. Why has this happened? A – Solar induced scaring B – Chlamydia induced scaring C – Sharp trauma D – Side effect of antimalarial E – Age related degeneration F – HIV induced scaring G– Psychiatric disorder

Answer 16

B - Chlamydia induced scarring - chlamydia infections can cause inturning of the eyelashes (trichiasis) leading to a scratched cornea

Question 17

Acutely presenting history of a curtain descending down his visual field ~2 hours. No flashes, no flaoters. What is the diagnosis? A – Posterior Vitreous Detachment B – Retinal Detachment C – Functional D – Stroke E – Transient Ischemic Attack F – Vasculitis G– Macula hole

Answer 17

E - Transient ischaemic attack - patient has no flashes or floaters

Question 18

Which of these medication opens to uveoscleral outflow? A – Betahistine B – Timolol C – Dorzolamide D – Prednisolone E – Cyclopentolate F – Acyclovir G– Latanoprost

Answer 18

G - Latanoprost This is a prostoglandin analogue and they open the uveoscleral tract to improve drainage of aqueous humour Example of an alpha 2- agonsit is brimonidine

Question 19

What other effects may latanoprost have on the eye? (cosmetic effects)

Answer 19

Can cause longer eyelashes Can also cause heterochromia -one eye is blue and the other is now brown

Question 20

Name the nerves supplying where the arrows are pointing

Answer 20

Red nerve - lesser occipital nerve (C2,3) Yellow - facial nerve Purple - Greater auricular nerve (C2,3) Green - Auricolotemporal nerve (CN V3) Blue - Vagus nerve (inferior 1/3rd of tympanic membrane)

Question 21

Name what the coloured boxes are overlyin

Answer 21

Black - sphenoid sinus Blue - superior nasal conchae Red - middle nasal conchae Green - inferior nasal conchae

Question 22

Where do the different sinuses drain Frontal Maxillary Spehnoid Anterior, middle, posterior ethmoid And where does nasolacrimal duct drain?

Answer 22

Sphenoid - sphenoethmoidal recess Posterior ehtmoidal - superior meatus Anterior ethmoidal, maxillary, frontal - (semilinuar hiatus of) middle meatus Middle ethmoidal - (ethmoidal bulla of) middle meatus Nasolacrimal duct - inferior meatus

Question 23

Name these muscles What are they collectively known as?

Answer 23

1. • omohyoid 2. sternohyoid 3. thyrohyoid 4. sternothyoid These are the strap muscles

Question 24

Which muscle causes abduction of the vocal cords?

Answer 24

The posteriro cricoarytenoid muscle

Question 25

The recurrent laryngeal nerve (RLN) is a branch of the vagus nerve (cranial nerve X) that supplies all the intrinsic muscles of the larynx, with the exception of one What is this muscle and what is its nerve supply?

Answer 25

This is the cricothyroid muscle supplied by the superior laryngeal nerve Recurrent laryngeal nerve becomes the inferior laryngeal nerve at the level of inferior constrictor muscle

Question 26

Name the structures being covered by only the box at the top - move from right to left of pic direction

Answer 26

Trochlea Levator palpebrae superioris - elevates eylid Frontal bone Superior oblique

Question 27

Name the structures being covered by the other three box Move from left box then in a crescent shape to bottom right

Answer 27

Superior rectus Optic nerve Lateral rectus INferior rectus Maxillary bone Inferior rectus

Question 28

What is the region betweeen the cornea and the iris?

Answer 28

The anterior chamber of the eye

Question 29

narrow space behind the peripheral part of the iris, and in front of the suspensory ligament of the lens and the ciliary processes. What is this?

Answer 29

This is the posterior chamber of the eye

Question 30

What structure produces the aqueous humour that then flows into the posterior chamber of the eye?

Answer 30

The ciliary body processes produces the aqueous humour

Question 31

Where do the optic tracts insert?

Answer 31

At the lateral geniculate nucleus

Question 32

What muscle is this? What is the only muscle of mastciation which assists with jaw opening?

Answer 32

This is the temporalis Lateral pterygoid is only muscle to help with jaw opening All supplied by CN V3 - mandibular nerve