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Ophthalmology > Lecture IV > Flashcards

Lecture IV Flashcards

1
Q

What are the two subgroups of optic neuritis?

A
  • Papillitis

- Retrobulbar neuritis

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2
Q

How do you diagnose papillitis? (2)

A

Relative afferent pupillary defect

Disc edema

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3
Q

What is papillitis?

A

Subgroup of optic neuritis involving optic nerve, therefore swollen optic nerve

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4
Q

Who usually gets retrobulbar neuritis?

A

Young adult with a progressive loss of vision over hours to days

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5
Q

What are the s/sx of retrobulbar neuritis? Why?

A

Progressive loss of vision and Pain on ocular movement d/t movement of the optic nerve

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6
Q

What is the difference between papillitis and retrobulbar neuritis?

A

Papillitis is inflammation of the head of the optic nerve

Retrobulbar neuritis is when the posterior part of the optic nerve is inflamed

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7
Q

What cause optic neuritis?

A

Anything that causes inflammation of the optic nerve–(e.g. viral or MS)

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8
Q

What differentiates optic neuritis and retrobulbar neuritis on fundoscopic exam?

A

Papillitis will reveal disc swelling, whilst optic neuritis will not

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9
Q

Are there vision problems or pupillary reflex abnormalities with acute papilledema? Chronic?

A

No, but if left untreated may progress to vision loss

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10
Q

Compare papillitis and papilledema in terms of the presence of hemorrhages.

A

Both have

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11
Q

Compare papillitis and papilledema in terms of etiology.

A

Papillitis is 2/2 inflammation

Papilledema is 2/2 increased ICP

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12
Q

Compare papillitis and papilledema in terms of optic nerve swelling

A

Both have

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13
Q

Compare papillitis and papilledema in terms of vision

A

Reduced with papillitis but normal with papilledema

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14
Q

Compare papillitis and papilledema in terms of pupillary responses.

A

RAPD in papillitis

Normal with papilledema

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15
Q

What is ischemic optic neuropathy?

A

Infarction of the optic disk, which may be 2/2

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16
Q

Who usually gets ischemic neuropathy (age)? Is it more commonly unilateral or bilateral?

A

Over age 55, usually unilateral

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17
Q

What are the s/sx of ischemic optic neuropathy? (4)

A
  • rapid vision loss
  • Cephalalgia/scalp TTP
  • jaw claudication
  • Arthralgias
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18
Q

What is the prognosis for ischemic neuropathy?

A

There is no effective treatment for the arteritic variety, and most lost vision is not recovered

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19
Q

What is giant cell arteritis?

A

vasculitis of large arteries, usually involving the aorta or its branches (e.g. ophthalmic artery). May result in blindness if the ophthalmic artery is occluded

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20
Q

What are the s/sx of giant cell arteritis? (3)

A
  • HA
  • TTP over the temporal artery
  • Polymyalgia rheumatica
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21
Q

What is polymyalgia rheumatica?

A

Diffuse muscle pain that usually appears in the morning, and is caused by idiopathic diffuse inflammation, and WBCs affecting the joints.

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22
Q

What are the labs that are sensitive for giant cell arteritis (but not specific)?

A

CRP and ESR

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23
Q

What is the treatment for giant cell arteritis?

A

ASA and high dose corticosteroids

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24
Q

What age group usually gets giant cell arteritis?

A

Around age 70

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25
Q

What is the only way to definitively diagnose giant cell arteritis? What is the problem with this test?

A

Bx of the artery–if do not bx the correct part, may not diagnose it

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26
Q

What are the exam findings of anterior ischemic optic neuropathy?

A
  • RAPD

- Pale, swollen optic nerve and altitudinal VF defect

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27
Q

What level of ESR is suggestive of anterior ischemic optic neuropathy?

A

More than 60 mm/hr

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28
Q

What is the common exam finding of a avulsion of the optic nerve?

A

RAPD

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29
Q

What is the usual defect with vascular occlusion of the CNS?

A

Homonymous hemianopia or quadrantanopia

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30
Q

Cherry red spot = ?

A

CRAO

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31
Q

In which ethnicity is glaucoma particularly prevalent in?

A

African Americans

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32
Q

What is the insidious symptom of glaucoma?

A

Slow, progressive loss of peripheral vision

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33
Q

What is the normal range of pressure in the eye?

A

10-21 mmHg

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34
Q

What causes the increased pressure with glaucoma?

A

Continuous production and drainage of aqueous fluid

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35
Q

What are the primary and secondary causes of open angle glaucoma?

A

Primary = unclear

Secondary =Blocked trabecular meshwork from WBCs, RBCs, or retinal elements

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36
Q

What causes primary closed angle glaucoma?

A

Enlargement or forward movement of lens against the central iris leading to obstruction or normal aqueous flow through pupil

37
Q

What causes secondary closed angle glaucoma?

A

hypoxia from retinal disease induces vasoproliferation in iris that contracts angle

38
Q

What are the s/sx of acute angle glaucoma?

A

Red, painful eye with decreased vision and markedly increased intraocular pressure

39
Q

What causes the cupping of the optic disc with glaucoma?

A

Increased ocular pressure is exerted through the vitreous humor back onto the optic disc

40
Q

A cup to disc ratio greater than what is concerning?

A

0.5

41
Q

What fraction of all glaucoma cases are primary open angle glaucoma?

A

2/3

42
Q

True or false: primary open angle glaucoma tends to be familial

A

True

43
Q

Is primary open angle glaucoma usually bilateral or unilateral? Symmetric or asymmetric?

A

Bilateral, but can be asymmetric

44
Q

What are the risk factors for primary open angle glaucoma?

A
  • greater than 50 yo
  • FH
  • AA
  • Myopic
45
Q

What is the most common and effective drug for glaucoma?

A

Prostaglandin analogs

46
Q

What is the major cholinergic compound that is used to treat glaucoma?

A

Pilocarpine

47
Q

What are the adrenergic compounds that are used to treat glaucoma?

A

Propine
Iodine
Alphagan

48
Q

Which is common: angle closure or open angle glaucoma?

A

Open angle

49
Q

Which has an acute nd which has a chronic onset: angle closure or open angle glaucoma?

A

Acute = angle closure

Open angle = chronic

50
Q

Which has severe ocular pain: angle closure or open angle glaucoma?

A

Pain = acute angle closure

51
Q

What are the pupil characteristics of angle closure and open angle glaucoma?

A 
Closed = Mid-dilated fixed pupil
Open = normal
52
Q

What happens to vision with angle closure and open angle glaucoma?

A

Acute= blurred vision, halos around lights

Chronic = insidious loss of vision, without halos

53
Q

What are the extraocular s/sx of angle closure and open angle glaucoma?

A 
Open = HA, n/v
Closed = none
54
Q

What can cause acute angle closure glaucoma? (3)

A

Dilating drops
Stress
Sympathomimetic drugs

55
Q

What type of glaucoma is a contraindication to sympathomimetics or other drugs that dilate the eyes?

A

Closed angle

56
Q

What are the 4 drugs that should be started immediately for acute, closed angle glaucoma?

A

Pilocarpine
acetazolamide
Oral glycerine
Mannitol

57
Q

What is the MOA of pilocarpine?

A

Cholinergic drug that causes ciliary muscle contraction and mydriasis

58
Q

What is an iridotomy?

A

Hole punch through the iris to allow flow through the iris and into the trabecular meshwork

59
Q

True or false: miotics are a substitute for an iridotomy

A

False

60
Q

Child with a clouded eye = ?

A

Glaucoma until proven otherwise

61
Q

Increase IOP greater than what is an indication for referral to an ophthalmologist?

A

21 mmHg

62
Q

If there is a greater than (__) difference in pressure between eyes, you should refer them to an ophthalmologist.

A

5 mmHg

63
Q

If there is a cup:disc ratio of what value is an indication to refer to an ophthalmologist?

A

0.5

64
Q

If there is a difference in cup:disc ratio between eyes is an indication to refer to an ophthalmologist?

A

0.2

65
Q

True or false: cataracts are a normal part of the aging process

A

True

66
Q

What is the most successful operation in all of surgery

A

Cataract correction

67
Q

What is the second sight that patients with cataracts can get?

A

Increased myopia causes an increased ability to read close up

68
Q

What are the first few s/sx of cataracts? (3)

A

slight blur
Decreased colors
Diplopia

69
Q

True or false: there is NEVER a RAPD with cataracts

A

True

70
Q

What is the first step in assessing cataracts?

A

Visual acuity test

71
Q

What type of device should be used to assess the eye with cataracts?

A

Slit-lamp

72
Q

What causes the halos around lights with cataracts?

A

Scattering of lights from the cataract

73
Q

When should you refer a patient for cataracts?

A

If interferes with ADLs or causes falls/MVAs

74
Q

What are the early complications that can arise from cataract surgery?

A

Hemorrhage

Infection

75
Q

What are the late complications that can arise from cataract surgery?

A

Corneal/retinal problems

retinal detachment

76
Q

true or false: you have to control DM or other relevant comorbidities prior to treating cataracts

A

True

77
Q

What is the leading cause of blindness in patients over 50?

A

Macular degeneration

78
Q

What is the possible treatment for macular degeneration?

A

laser surgery

79
Q

True or false: often, there is not effective treatment for macular degeneration

A

True

80
Q

What is the natural h/o macular degeneration?

A

Progressive deterioration of vision

81
Q

What is the hallmark finding of macular degeneration?

A

Drusen–hyaline nodules in Bruch’s membrane

82
Q

Which type of macular degeneration is there an effective treatment for: wet or dry

A

Wet

83
Q

What is metamorphopsia?

A

a type of distorted vision in which a grid of straight lines appears wavy and parts of the grid may appear blank

84
Q

What are the s/sx of macular degeneration?

A
  • Sudden loss of vision
  • metamorphopsia
  • Central blind spot if advanced
85
Q

True or false: the amount of drusen correlates well with the vision changes

A

False

86
Q

What is the geographic form of macular degeneration?

A

Progressive loss of pigmentation of the retina

87
Q

What causes the metamorphopsia with macular degeneration?

A

Usually caused by neovascularization beneath the retina, which lifts it up and distorts vision

88
Q

True or false: the peripheral vision is usually greatly affected with macular degeneration?

A

False–Usually remains good

89
Q

What are the risk factors for macular degeneration? (5)

A
  • Age
  • Smoking
  • hyperopia
  • Blue eyes
  • FH

Ophthalmology (14 decks)

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