Year 5 passmed

Question 1

Histopathologically where is the inflammation in GCA and what are things are deposited in the walls on the arteries causing inflammation and later on ischaemia.

Answer 1

Histopathologically, GCA is marked by transmural inflammation of the intima, media, and adventitia of affected arteries, as well as patchy infiltration by lymphocytes, macrophages, and multinucleated giant cells. Mural hyperplasia can narrow the arterial lumen, resulting in distal ischemia

Question 2

4 most common causes of sudden vision loss

Answer 2

ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery
vitreous haemorrhage
retinal detachment
retinal migraine

Question 3

fundoscopy features of papilloedema

Answer 3

Swollen optic disc: The optic disc, or optic nerve head, appears swollen and elevated above the retina.
Indistinct margins: The margins of the optic disc appear fluffy and indistinct.
Tortuous retinal veins: The retinal veins appear congested, dilated, and twisted.

Question 4

why cant topical steriods be used in herpes simplex keratitis

Answer 4

corticosteroids are contraindicated in active herpes simplex keratitis.

Using corticosteroids in this condition can exacerbate the viral infection and lead to more severe complications, such as corneal perforation.

Question 5

what is a scotoma

Answer 5

a medical term for a blind spot or visual field abnormality that can appear in one or both eyes

seen in glaucoma or macular, optic neuritis, degeneration or stroke or tumours

Question 6

if yoi see RAPD

Answer 6

optic neuritis

Question 7

hyphema or blood in the anterior chamber of the eye

Answer 7

needs urgent referral to opthal

Question 8

Peripheral curtain over vision + spider webs + flashing lights in vision

Answer 8

retinal detachement

Question 9

contact lens associted keratitis - what causative organism

Answer 9

pseudomonas aeruginosa

Question 10

blurring of the optic disc edges and enlargement of the surrounding veins. There are small haemorrhages (patches of red) surrounding the optic disc which are also seen in

Answer 10

in papilloedema.

something like an optic nerve tumour

Question 11

positive family history of glaucoma - screening starts when

Answer 11

Those with a positive family history of glaucoma should be screened annually from aged 40 years

Question 12

what steriod eye drops can cause corneal ulcers

Answer 12

Steroid eye drops can lead to fungal infections, which in turn can cause corneal ulcers

Question 13

panretinal photo procedure for Diabetic retinopathy can do what

Answer 13

reduce night vision post procedure

Question 14

flashes and floaters new onset in eyes

Answer 14

Any patient who presents with new-onset flashes or floaters should be referred urgently for assessment by an ophthalmologist within 24 hours

Question 15

difference between macular degeneration and chronic glaucoma field loss findings

Answer 15

Macular degeneration is associated with central field loss
Primary open-angle glaucoma is associated with peripheral field loss

Question 16

can you wear contact lenses in conjunctivitis

Answer 16

Contact lens may be worn once topical antibiotic treatment has been started

Question 17

what is retinitis pigmentose and what are the main signs

Answer 17

Retinitis pigmentosa primarily affects the peripheral retina resulting in tunnel vision

night blindness is often the initial sign
tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)
fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

Question 18

what abx increase the risk of idiopathic intracranila hypetnsion

Fundoscopy reveals bilateral optic disc swelling.
whoosing sound in head
dull headaches

Answer 18

tetracylcines like lymecycline

Question 19

A 34-year-old man with a history of ankylosing spondylitis presents with a painful right eye associated with mild photophobia:
given cyclopeptic drops

Answer 19

ant uveitis

Question 20

in ant uveitis why are cyclopeptic drugs given

Answer 20

to dilate the eye reducing pain s pupil is normally small due to constrcition

Question 21

three features of behcets disease

Answer 21

Oral ulcers + genital ulcers + anterior uveitis = Behcet’s

Question 22

how do you treat diabetic retinopathy

Answer 22

Intravitreal VEGF inhibitors + pan-retinal photocoagulation laser

Question 23

rod cells are located in the peripheral retina - what cell are predominately repsonsible for vision in low light or night

Answer 23

rod cells

which is why you loose night vision and this gets worse

Question 24

Subacute unilateral visual loss, eye pain worse on movements

Answer 24

optic neuritis

Question 25

Central scotoma
Painful eye movements
Affected colour vision
Relative afferent pupillary defect (RAPD)
decreased visual acuity over days or hours

Answer 25

optic neuritis

Question 26

mx of optic neutiris

Answer 26

`MRI - gandolinium
high dose steriod
4-6 w recovery

Question 27

optic neuritis what happens with white matter lesions with prognosis for MS

Answer 27

MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%

Question 28

Vitreous haemorrhage occurs as a result of

thus what are the risk factors

Answer 28

bleeding into the vitreous humour, most often from unstable retinal neo-vasculature. Therefore, any condition which risks the formation of retinal neo-vasculature is a risk factor for vitreous haemorrhage, including diabetic retinopathy and hypertensive retinopathy.

Other risk factors include anti-coagulant use and trauma

Question 29

CRAO caused by

Answer 29

CRAO can be caused by atherosclerosis, and therefore is also linked to diabetes and can result in sudden onset unilateral loss of vision in the absence of pain

Question 30

Corneal abrasions refer to any defect of the corneal epithelium and most commonly come about from a recent history of local trauma

how do we treat

Answer 30

topical abx are given to prevent secondary bacterial infection

Question 31

. Amsler grid testing shows the distortion of line perception.

Answer 31

dry macular degeneration

indicating potential issues with the macula in the eye, where a person might see straight lines on the grid appearing wavy, curved, or even missing in certain areas, signifying a potential problem like macular degeneration.

Question 32

Proliferative retinopathy is more common in what type of diabetes

Answer 32

1

Question 33

wet compared to dry macular degenration

Answer 33

more acute vision loss and distortion

funoscopy - neovasularisation

Question 34

RAPD indicates what

A 32-year-old woman presents with visual disturbance. On examination, you swing the penlight from eye to eye quickly and note that the right and left pupils dilate when light is shone into the right eye.

Answer 34

Relative afferent pupillary defect indicates an optic nerve lesion or severe retinal disease

Right retina or optic nerve

Question 35

what are the three tx for macular degeneraion

Answer 35

zinc with anti-oxidant vitamins A,C and E reduced progression of the disease by around one third - dry

vascular endothelial growth factor (VEGF) - wet

laser photocoagulation does slow progression of ARMD where there is new vessel formation

Laser photocoagulation is a treatment option for wet age-related macular degeneration but there is a risk of acute visual loss after treatment, which may be increased in patients with sub-foveal ARMD. For this reason, anti-VEGF therapies are usually preferred.

Question 36

Definitive treatment for wet AMD is

Answer 36

Anti-vascular endothelial growth factor (VEGF)

Question 37

Primary open-angle glaucoma: 360° selective laser trabeculoplasty (SLT) is first-line if the IOP is ≥ 24 mmHg

Answer 37

if stable

Question 38

features of CRAO

Answer 38

relative afferent pupillary defect (RAPD), also known as Marcus Gunn pupil, which is an abnormal response to light in the affected eye due to a severe decrease in the number of functioning retinal ganglion cells. Fundoscopy typically reveals a pale retina with a cherry-red spot at the fovea due to obstruction of blood flow in the central retinal artery.

Question 39

Ocular migraines are more prevalent in children and young adults, which aligns with the age of this patient. Scintillating phenomena are common and patients may describe distortions as shimmering, kaleidoscope or swimming in appearance. In other cases they may have a scotoma or even total monocular visual loss. Crucially these changes develop gradually over

Answer 39

5mins lasting less than an hour

Question 40

difference between pre and central hroners and post

Answer 40

Pre-ganglionic lesions of the sympathetic trunk, such as that seen in an apical lung tumour, cause anhidrosis (loss of sweating) of just the face, and therefore, no sweating on the face is correct.

central cause of Horner’s syndrome, such as a stroke, syringomyelia or multiple sclerosis - sweating face and neck

post no anhidrosis - cs - carotid artery anuerysm , cluster headache, cavernous sinus throbmosis , carotid artery dissetion

Question 41

difference between brand and central retinal vein occlusion

Answer 41

Fundoscopy will shows severe retinal haemorrhages (red patches) confined to a limited area of the retina, making the diagnosis branch retinal vein occlusion.

central - This would have severe retinal haemorrhages throughout, rather than confined to a limited area

Question 42

Patients with orbital cellulitis require admission to hospital for IV antibiotics due to the risk of

Answer 42

cavernous sinus thrombosis and intracranial spread

Question 43

why do you get optic disc cupping

Answer 43

Optic disc cupping occurs when the central depression within the optic nerve head becomes larger, usually due to damage to the optic nerve fibers caused by increased pressure within the eye (glaucoma), leading to a “cup-like” appearance on the optic disc;