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Stage 3 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Painless monocular visual loss that suddenly resolves with normal examination findings?

A

Amaurosis fugax (TIA)

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2
Q

What retinal changes are seen in diabetic retinopathy on ophthalmoscopy?

A

Bilateral hard exudates, bilateral cotton wool spots

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3
Q

What is acute closed-angle glaucoma?

A

A sudden increase in intra-ocular pressure (affecting one eye)

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4
Q

How does acute closed-angle glaucoma present?

A

1) Excruciating pain in the affected eye at rest
2) Nausea
3) Visual haloes
4) Blurred vision
5) Red eye with pupillary abnormalities

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5
Q

What does the eye look like in acute closed-angle glaucoma?

A

Red eye with pupillary abnormalities

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6
Q

What is anterior ischaemic optic neuritis?

A

1) Complication of giant cell/temporal arteritis
2) Involvement of the ophthalmic artery causes spasm, occlusion and subsequent irreversible ischaemia of the retina

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7
Q

Which ophthalmic condition is a complication of giant cell/temporal arteritis?

A

Anterior ischaemic optic neuritis

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8
Q

How does anterior ischaemic optic neuritis present?

A

1) Painless monocular visual loss - irreversible, doesn’t resolve like TIA
2) History of GCA symptoms (e.g. scalp tenderness, jaw claudication, weight loss)

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9
Q

What would ophthalmoscopy show in anterior ischaemic optic neuritis?

A

Chalky white and swollen optic disc

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10
Q

What is the difference between anterior ischaemic optic neuritis and amaurosis fugax?

A

Both have painless monocular visual loss but in anterior ischaemic optic neuritis this does not spontaneously resolve and is irreversible

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11
Q

Chalky white and swollen optic disc?

A

Anterior ischaemic optic neuritis

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12
Q

What are the two causes of vitreous haemorrhage?

A

1) Diabetic eye disease - causes abnormal blood vessels which bleed into the vitreous humour
2) Retinal tears - bleed into the vitreous

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13
Q

What is a vitreous haemorrhage?

A

Bleeding into the vitreous humour

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14
Q

What would you see in ophthalmoscopy of vitreous haemorrhage?

A

Ophthalmoscopy would not be possible in the affected eye in large bleeds, as the retina is obscured

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15
Q

How does vitreous haemorrhage present?

A

Blood in the eye/on ophthalmoscopy, visual loss that would not return spontaneously, signs of diabetic eye disease or retinal tears

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16
Q

What is retinal detachment?

A

When the sensory retina peels away from the underlying pigmented retinal epithelium

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17
Q

What can cause retinal detachment?

A

1) Tear in the retina allowing fluid behind the top layer
2) Tugging of the retina by fibrous tissue in the overlying vitreous humour

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18
Q

How does retinal detachment present?

A

1) Painless visual loss (irreversible but surgery can reduce the extent of damage)
2) History of preceding flashes of light - as the detaching retina tugs on the optic nerve
3) History of floaters - as blood and debris collect in the vitreous

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19
Q

Which part of the optic pathway is disrupted in monocular visual loss?

A

Optic nerve

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20
Q

Which two parts of the optic pathway can be disrupted in contralateral homonymous hemianopia i.e. nasal field of one eye and nasal field of the other eye?

A

1) Optic tract (running from the optic chiasm to the ipsilateral geniculate body of the thalamus)
2) Optic radiation (backward extension of the optic tract - from the lateral geniculate body of the thalamus to the ipsilateral primary visual cortex)

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21
Q

Which part of the optic pathway is disrupted in bitemporal hemianopia?

A

Optic chiasm (here the nasal fibres of each eye cross the midline to join the temporal fibres of the contralateral eye) e.g. pituitary tumour

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22
Q

Which fibres of the optic radiation pass through the temporal lobe?

A

The fibres that carry visual stimuli from the lower retina (which receives stimulation from the upper half of the visual fields)

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23
Q

Which fibres of the optic radiation pass through the parietal lobe?

A

The fibres that carry visual stimuli from the upper retina (which receives stimulation from the lower half of the visual fields)

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24
Q

A lesion in what location would cause a contralateral homonymous superior quadrantanopia?

A

Temporal lobe

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25
Q

A lesion in what location would cause a contralateral homonymous inferior quadrantanopia?

A

Parietal lobe

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26
Q

A lesion in what cerebral location would cause a contralateral homonymous hemianopia with macular sparing?

A

Occipital lobe

27
Q

Pathology in which locations would cause monocular visual loss?

A

Orbit, retina or optic nerve

28
Q

How does preseptal cellulitis present?

A

1) Erythema and oedema around the eyelid of one eye
2) Normal visual acuity and eye movements
3) Background of cold

29
Q

What is preseptal cellulitis?

A

Infection of the superficial tissues around the eyelid

30
Q

How do you manage paediatric preseptal cellulitis?

A

1) Immediate empirical IV abx for 2-5 days OR
2) Empirical oral abx in children with reliable daily follow up

31
Q

Why do you need to treat paediatric preseptal cellulitis immediately with empirical abx?

A

Bc of the risk of occult orbital cellulitis or rarely worsening to orbital cellulitis and its complications

32
Q

What is a serious complication of orbital cellulitis and why?

A

Meningitis - the infection can track from the orbit into the CNS

33
Q

How do you manage orbital cellulitis (deep infection)?

A

1) IV abx
2) IF not a rapid response to IV abx - urgent surgical decompression of the orbit

34
Q

What is the leading cause of blindness in the UK?

A

Age related macular degeneration (ARMD)

35
Q

How does age related macular degeneration present?

A

Subacute loss and/or distortion of the central visual field (central vision loss)

36
Q

What causes age related macular degeneration?

A

Degeneration of photoreceptors in the central retina (macula)

37
Q

What is visible on slit-lamp biomicroscopy/fundoscopy in age related macular degeneration?

A

Drusen in the macula

38
Q

What condition are drusen indicative of?

A

Dry age related macular degeneration

39
Q

What are the risk factors for age related macular degeneration?

A

1) Age (main risk factor)
2) Male sex
3) Smoking
4) FH
5) Cardiovascular risk factors

40
Q

What is conjunctivitis?

A

Conjunctival inflammation

41
Q

What is non-infectious cause of conjunctivitis?

A

Allergic

42
Q

What are bacterial causes of conjunctivitis?

A

1) Staph aureus and epidermis
2) Strep pneumoniae
3) Haemophilus influenzae
4) Consider chlamydia/gonorrhoea

43
Q

What is the most common viral cause of conjunctivitis?

A

Adenovirus

44
Q

How does conjunctivitis present?

A

1) Red, painful eye
2) Gritty/itchy sensation
3) Discharge
4) ± photophobia

45
Q

What is conjunctival discharge like in bacterial conjunctivitis?

A

Purulent

46
Q

What is conjunctival discharge like in (neonatal) chlamydia conjunctivitis?

A

Mucopurulent

47
Q

What is conjunctival discharge like in viral conjunctivitis?

A

Serous

48
Q

What would the presence of photophobia in conjunctivitis suggest?

A

Corneal involvement - keratoconjunctivitis

49
Q

How do you diagnose conjunctivitis?

A

Clinical

50
Q

How do you manage bacterial conjunctivitis?

A

1) Conservative - self limiting, 1-2 weeks
2) Lubricating eye drops
3) Topical chloramphenicol - in severe infections

51
Q

How do you manage viral conjunctivitis?

A

1) Conservative - self-limiting
2) Good eye hygiene to prevent spread to other eye
3) Artificial tears
4) Wash hands regularly and do NOT share towels - very contagious

52
Q

What is the treatment for severe conjunctivitis?

A

Topical chloramphenicol (antibiotic)

53
Q

What is keratitis/corneal ulcer?

A

Infection of the cornea - common sight-threatening ophthalmic emergency

54
Q

What is the most common bacterial cause of keratitis?

A

Pseudomonas

55
Q

Which patients are most susceptible to keratitis/corneal ulcer?

A

Contact lens users

56
Q

What is the most common viral cause of keratitis?

A

Herpes simplex keratitis

57
Q

How does keratitis present?

A

1) Painful, red eye
2) Foreign body sensation
3) Tearing (epiphora)
4) Purulent discharge
5) Corneal ulcer
6) Photophobia

58
Q

What is the key symptom to differentiate between plain conjunctivitis and keratitis?

A

Photophobia

59
Q

How do you diagnose keratitis?

A

1) Slit-lamp examination (with fluorescein staining)
2) Corneal scrape
3) Contact lens (± solution) sent for culture

60
Q

What finding on slit lamp examination is pathognomonic for HSV keratitis?

A

Dendritic ulceration

61
Q

What is the first line investigation in keratitis?

A

Slit-lamp examination (with fluorescein staining)

62
Q

How do you manage bacterial keratitis?

A

1) Emergency referral to ophthalmology
2) Intensive topical/PO abx - chloramphenicol
3) Admission

63
Q

How do you manage viral HSV keratitis?

A

Topical aciclovir

Stage 3 (61 decks)

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