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Med School Finals > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Meaning of amblyopia, anisocoria, miosis, mydriasis, myopia, hyperopia?

A

Amblyopia = “lazy eye”
Anisocoria = difference in pupil size
Miosis = small pupil
Mydriasis = large pupil
Myopia = short sighted
Hyperopia = far sighted

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2
Q

Nervous control of extraocular muscles?

A

Lateral rectus (CN VI)
Superior oblique (CN IV)
Superior rectus, inferior rectus, medial rectus, inferior oblique, levator palpebrae superioris (CN III)

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3
Q

Homonymous hemianopia lesion sites?

A

Occipital lobe
Optic tract
Optic radiations

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4
Q

Bitemporal hemianopia lesion site?

A

Optic chiasm

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5
Q

Homonymous quadrantanopia lesion site?

A

Superior quadrantanopia = inferior optic radiation (temporal lobe)
Inferior quadrantanopia = superior optic radition (parietal lobe)

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6
Q

Features and main cause of CN III palsy?

A

Eye “down and out”
Ptosis
Mydriasis
Main cause = cranial aneurysm
N.B. painful CN III palsy is indicative of a posterior communicating artery aneurysm

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7
Q

Features and main cause of CN IV palsy?

A

Eye “up and in”
Vertical diplopia
Head tilt to compensate
Main cause = trauma

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8
Q

Features and main cause of CN VI palsy?

A

Eye turned inwards
Horizontal diplopia
Main cause = raised ICP

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9
Q

Classification of strabismus?

A

Direction of deviation:
→ nasally = esotropia
→ temporal = exotropia
→ superiorly = hypertropia
→ inferiorly = hypotropia

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10
Q

Investigation and management of strabismus (squint)?

A

Corneal light reflection test
Management = ophthalmology referral, eye patch to prevent amblyopia

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11
Q

Features and management of infective conjunctivitis?

A

Sore, itchy, red eyes
Excessive discharge
No change in visual acuity
Management = usually self-resolving, chloramphenicol (non-pregnant), fusidic acid (pregnant)

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12
Q

Red flag in suspected conjunctivitis and why?

A

Photophobia (suggests corneal involvement)

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13
Q

Features and management of allergic conjunctivitis?

A

Sore, itchy, red eyes
Eyelid involvement
Seasonal symptoms
PMH atopy e.g. eczema
Management = antihistamines (1st line), mast cell stabilisers (2nd line)

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14
Q

Most common cause of keratitis in contact lens wearers vs non-contact lens wearers?

A

Wearers = pseudomonas auerginosa
Non-wearers = staphylococcus aureus

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15
Q

Keratitis organism in soil or contaminated water?

A

Acanthomoeba

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16
Q

Features and management of keratitis?

A

Acute red eye
Gritty sensation
Loss of visual acuity
Photophobia
Hypopyon, corneal ulcer
Anterior chamber reaction (cells and flare)
Management = topical quinolone + cycloplegic drops

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17
Q

Main cause of a corneal ulcer?

A

Infection e.g. keratitis

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18
Q

HSV keratitis feature and management?

A

Dendritic ulcer on fluorescein stain
Management = topical aciclovir

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19
Q

Most common condition associated with scleritis vs episcleritis?

A

Scleritis = rheumatoid arthritis
Episcleritis = IBD

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20
Q

Features and management of episcleritis?

A

Acute red eye
Classically not painful
Increased lacrimation
Management = supportive e.g. artifical tears

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21
Q

Features and management of scleritis?

A

Acute red eye
Classically painful
Increased lacrimation
Loss of visual acuity
Management = NSAID (1st line), steroid (2nd line)

22
Q

Test to differentiate scleritis from episcleritis and explain?

A

Phenylephrine eye drops
→ blanches conjunctival and episcleral vessels but not scleral
→ if redness improves, episcleritis diagnosed

23
Q

Most common causes of blepharitis?

A

Meibomian gland dysfunction
Seborrhoeic dermatitis
Staphylococcal infection

24
Q

Features and management of blepharitis?

A

Gritty, sore eyes
Eyes stuck together on waking
Styes and chalazions
Management = hot compress + lid hygeiene

25
Q

Features and management of anterior uveitis (iritis)?

A

Acute red eye
Photophobia
Ciliary flush
Small, oval pupils
Hypopyon
Loss of visual acuity
HLA-B27 associations
Anterior chamber reaction (cells and flare)
Management = steroid + cycloplegic drops

26
Q

Features and management of periorbital cellulitis?

A

Generally unwell e.g. fever
Red and swollen eye
Ptosis
Management = admission + oral antibiotics

27
Q

Features and management of orbital cellulitis?

A

Generally unwell e.g. fever
Red and swollen eye
Proptosis
Pain on eye movement
Management = admission + IV antibiotics

28
Q

Investigation for suspected orbital cellulitis?

A

Contrast CT head

29
Q

What are glaucomas?

A

Optic neuropathies associated with raised ICP

30
Q

Features, investigations and management of acute angle-closure glaucoma?

A

Acute, severe pain
Loss of visual acuity
Haloes around lights
Nausea and vomiting
Dilated, nonreactive pupil
Investigations = tonometry (IOP), gonioscopy
Management = timolol + pilocarpine + acetazolamide (acute), laser peripheral iridotomy (definitive)

31
Q

Features and management of primary open-angle glaucoma?

A

Insidious onset
Peripheral visual loss
Loss of visual acuity
Optic disc cupping
Management = treat if IOP ≥24 mmHg, SLT surgery (1st line), medication (2nd line)

32
Q

Normal cup-to-disc ratio?

A

0.4-0.7

33
Q

Mechanism of action of latanoprost vs pilocarpine vs acetazolamide vs timolol?

A

Latanoprost, pilocarpine = increases uveoscleral outflow
Acetazolamide, timolol = reduced aqueous humour production

34
Q

Features and management of central retinal artery occlusion?

A

Sudden painless vision loss
“Cherry red” spot on a pale retina
Management = treat underlying cause

35
Q

Features and management of central retinal vein occlusion?

A

Sudden painless vision loss
Widespread hyperaemia
Severe retinal haemorrhages
“Stormy sunset” appearance
Management = supportive

36
Q

Most common cause of blindness in the UK?

A

Age-related macular degeneration

37
Q

Features and management of dry vs wet macular degeneration?

A

Dry = gradual visual loss, drusen
→ zinc + vitamin A, C and E
Wet = subacute visual loss, neovascularisation, haemorrhages
→ anti-VEGF

38
Q

Tool used to assess line distortion in macular degeneration?

A

Amsler grids

39
Q

Features and management of cataracts?

A

Gradual visual loss
Haloes around lights
Glare from lights
Loss of red reflex
Management = cataract surgery

40
Q

Serious complication of cataract surgery and management?

A

Endophthlamitis
Management = intravitreal vancomycin

41
Q

Investigation to differentiate refractive error vs other pathology causing blurred vision?

A

Pinhole occluders when reading Snellen chart
→ improvement indicates refractive error

42
Q

Pathwway of pupillary light reflex?

A

Afferent = retina → CN II → lateral geniculate body → midbrain
Efferent = Edinger-Westphal nucleus (midbrain) → CN III

43
Q

RAPD clinical finding and causes?

A

Affected and normal eye dilate when light is shone on the affected
→ retinal pathology e.g. detachment
→ CN II pathology e.g. optic neuritis

44
Q

Features, investigation and management of optic neuritis?

A

Loss of visual acuity
Poor colour discrimination
Pain on eye movement
Central scotoma
Investigation = MRI with gadolinium contrast
Management = IV methylprednisolone

45
Q

Classification of diabetic retinopathy?

A

Non-proliferative diabetic retinopathy (NPDR)
Proliferative diabetic retinopathy (PDR)
Maculopathy

46
Q

Features and management of NPDR vs PDR?

A

NPDR = microaneurysms, blot haemorrhages, hard exudates, cotton wool spots
Management = observation

PDR = as above + neovascularisation
Management = panretinal laser photocoagulation + anti-VEGF

47
Q

Staging of hypertensive retinopathy?

A

I = arteriole narrowing, silver wiring
II = arteriovenous nipping
III = cotton wool spots, flame and blot haemorrhages
IV = papilloedema

48
Q

Features of posterior vitreous detachment?

A

Sudden flashes floaters
Loss of visual acuity

49
Q

Features of retinal detachment?

A

Shadow peripheral → central
“Curtain” over visual field
Flashes and floaters
Loss of visual acuity

50
Q

Features of vitreous haemorrhage?

A

Multiple dark spots
Floaters
Red hue
Loss of visual acuity

Med School Finals (18 decks)

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