cranial and ophtalmology Flashcards
Conjuctivitis
- causes
- Symptoms
- Causes: – Bacterial, Viral or Allergic
-
Symptoms:
- Conjunctival Hyperaemia – “pink eye”
- Chemosis - oedema of the eyelid
- Crust and Discharge
- “Foreign body sensation”
- Photophobia
How do differentiate between viral & bacterial & allergic conjunctivitis?
-
Bacterial
- unilateral
- thick discharge
- reduced vision
- urethtitis/ vaginal discharge (STD)
-
Viral:
- bilateral watery discharge
- Normal vision
- signs of viral infection (fever and Lymphadenopathy)
-
Allergic: (type 1 hypersensitivity )
- triggers such as pollen, dust, chemical scent
- Conjunctivitis symptoms
- plus: Itching Sneezing Red, watery and oedematous eye
Cataract
- causes
- Symptoms
- signs
- causes: clouding of the lens of the eye over 90% is due to age other can be due to (congenital, diabetes, drug induced, trauma)
-
Symptoms:
- Visual impairment
- glare, halos around lights
- Painless
-
Sign:
- reduced red reflex
- clouding of the lens
Glaucoma
causes
Types
Symptoms
Investigations
- causes: optic nerve damage due to raised intraocular pressure
-
Types:
- Primary Open Angle Glaucoma (Commonest type):
- presents acutely with a painful red eye
- due to dysfunction with Trabecular Meshwork
- Closed Angle Glaucoma
- can be acute or chronic
- Increased pressure pushing the iris/lens complex forwards, blocking the trabecular meshwork – vicious cycle
- Risk factors - small eye (hypermetropia), narrow angle at trabecular meshwork
- Treated with peripheral laser iridotomy (creates drainage hole on iris)
- Primary Open Angle Glaucoma (Commonest type):
-
Symptoms:
- progressive peripheral visual loss
- IF acute red painful eye signs
-
Investigations:
- Fundoscopy - disc cupping
- Gonioscope – look at the angle of the iris to determine if closed or open angle glaucoma
- Slit lamp examine whole eye closely
- Tonometry- measures intraocular pressure
How do differentiate between closed and open angle glaucoma?
-
Open:
- bilateral
- progressive vision loss
- initially asymptomatic
- mild non specific symptoms
-
Closed:
- unilateral
- sudden onset
- severely painful
- N&V, cloudy cornea, headache, dilated pupil
Uveitis
causes
Associations:
Types
Investigations
- What is it? inflammation of uvea (iris, ciliary body and choroid)
- causes: Systemic Inflammation Infection
-
Types:
- Anterior
- Posterior
- Complete
- Intermediate
-
Investigations:
- fundoscopy
- slit lamp examination
How do you differentiate between anterior and posterior uveitis?
-
Anterior
- autoimmune condition (seronegative spondyloarthropathies, RA, sarcoidosis, SLE, IBD and Bechet’s)
- painful
- ocular hyperaemia
- blurry vision
- increased lacrimation and photophobia
-
posterior:
- infective causes (viruses like CMV, EBC, HSC, VZV. Bacteria like syphilis and TB, and Lyme disease)
- painless
- blurry vision
- floaters and Scotomata
A 24 year old woman presents to her GP with a red painful eye with blurry vision. She has noticed a lot of clear discharge coming from her eye. She has otherwise been well, apart from some recent diarrhoea. What is the most likely diagnosis?
Viral Conjunctivitis
Bacterial Conjunctivitis
Anterior Uveitis
Posterior Uveitis
Closed angle glaucoma
Viral Conjunctivitis
Bacterial Conjunctivitis
Anterior Uveitis -
Posterior Uveitis
Closed angle glaucoma
What are the different conditions you can get?
What lesions could cause such symptoms?
-
Prechiasmal: ISCHAEMIA (TIA) and INFLAMATION (MS, temporal arteritis)
- One eye only
- Ipsilateral
-
Chiasmal: PITUITARY TUMOUR AND CRANIOPHARYNGIOMA
- Bitemporal hemianopia
-
Post chiasmal tumours, MS, strokes
- Homonymous contrallateral - optic tracts
- homonymous superior quadrantanopia - inferior optic radiation
- homonymous inferior quadrantanopia -superior optic radiation
- Macula sparing - cortex
Neglect syndrome
Cause
Symptoms
Diagnosis
Cause: damage to the right parietal lobe
Symptoms: patient ignores that side- eat only food from one side, shave only one side, wash only one side
Diagnosis: finger wigling
A lack of the direct pulliary reflex would indicate a lesion to which cranial nerve
CN 2- optic
A lack of the consensual pulliary reflex would indicate a lesion to which cranial nerve
CN 3 - oculomotor
What is relative afferent pupillary defect?
What condition causes it?
medical sign observed during the swinging-flashlight test whereupon the patient’s pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye
Seen in optic neuritis and MS
What is the horner triad?
What are the differentials for it? (benign and malignant)
Investigation for Horner?
- What is the horner triad? Ptosis, Miosis, anhidrosis
- What are the differentials for it? (benign and malignant) - anything that pushes on sympathic nerve
-
Benign:
- migraine
- goitre
- cluster headache
- multiple sclerosis
- syringomyelia
-
Malignant:
- Pancoast’s tumour on the lung apex,
- thyroid carcinoma
- cavernous sinus
- thrombosis and carotid artery dissection -artery expands it will compress the nerve
- brainstem stroke -
- Investigations:
- CXR
- CT Head
- MRI/ MR Angiography
describe the difference between mediacl and surgical third nerve palsy?
To understand: parasympathetic nerve is on the periphary and the oculomotor in the center with blood supply
medical third nerve palsy (DM(blood suuply problem)): Pupil sparing - because the blood will first affect the more deeper strucure, as superificial have another blood supply
surgical third nerve palsy: mor liquely to involve the pupil because cut goes superficial and then deep
FIll out the table out
Fill out the table about Neurofibromatosis type 1 and type 2
NF1 more common
How to remember: NF1 associated with problems with body as a whole (you only have 1 body), whereas NF2 associated with ear problems (you have 2 ears)’
Both have increased risk of CNS cancers
What is the condition seen on this image and what are the names these things
NF1 on examination, top left is café-au-lait spots, bottom left is neurofibromas, bottom right is lisch nodules
What are the differences between a pseudobulbar palsy and a bulbar palsy?
Is it upper or lower motor neurone
Which nerves does it affect
what are tehe symptoms
what conditions are they associated with
what is the speech like
what about their emotion?
