Clinical (1 - 4) Flashcards Preview

Year 2 - Ophthalmology (DP) > Clinical (1 - 4) > Flashcards

Flashcards in Clinical (1 - 4) Deck (119):
1

What can fluorescein eye drops do?

Identify areas of epithelial loss

2

What is a blow out fracture?

Fracture of the inferior orbit

3

What muscle can be trapped in a blow out fracture and how does this present?

Inferior rectus:
-> Eye can't be elevated

4

Even though the medial orbital wall is thinner, why is it less likely to fracture?

Ethmoidal air cells provide some degree of protection

5

What type of haemorrhage can result from a blow out fracture?

Sun-conjunctival haemorrhage

6

What is a hyphaema?

Blood in the anterior chamber

7

What is the potential sequelae of hyphaema?

Blood can block the trabecular meshwork:
-> Increased IOP due to no aqueous drainage

8

How does a dis-inserted iris appear?

Poor border between iris and cornea

9

What is visible in a dislocated lens?

Zonular fibres

10

What conditions can cause a lens dislocated and what direction does the lens move in each?

Marfans:
- Upwards and outwards
Homocystinuria:
- Downwards and inwards

11

How does a retinal detachment appear on fundoscopy?

'Ballooning'
Blood vessels aren't continuous

12

How do the blood vessels appear in a choroidal tear?

Normal

13

What is the name for a bruised retina?

Commotio Retinae

14

What are some signs of a corneal laceration?

Distorted pupil
Siedel's Test:
- Apply a fluorescein strip
- Turns pale due to aqeuous leakage

15

How is a sub-tarsal foreign body treated?

Particle is removed
AND
Chloramphenicol is applied

16

What can cause a intra-lenticular foreign body (IOFB) (ie. within the lens)?

Fast moving particles (hammer and chisel injuries)

17

What investigation must be done in a suspected intra-lenticular foreign body?

X-ray -> Water's view

18

Which of the following is not a typical sign of a small foreign body in the eye:
- Irregular pupil
- Shallow anterior chamber
- Localised cataract
- Hyphaema
- Gross inflammation

Hyphaema

19

What types of chemical burn has easy and rapid penetration; alkali or acid?

Alkali

20

How does an alkali burn affect the eye?

1. Cicatrising changes to conjunctiva and cornea
2. Scar formation
3. Limbal ischaemia -> China White sign

21

What effect does an acid burn have on the eye?

Coagulates proteins

22

When dealing with an ocular chemical burn, what two chemicals must we be weary of?

Lime
Cement

23

What two tests must be done in an ocular chemical burn?

Toxbase
pH

24

How do we treat an ocular chemical burn initially?

IRRIGATE!!:
- Minimum 2L saline
- OR until pH is normal

25

Which of these is not a cardinal feature of neuro-ophthalmic disease:
- Diplopia
- Reduced visual acuity
- Uncomfortable eye movements
- Visual field loss

Uncomfortable eye movements

26

What is the leading cause of neuro-ophthalmic disease?

Vascular disease

27

What type of tumours (primary and secondary) tend to cause neuro-ophthalmic disease?

Space-Occupying lesions (SOL)

28

What other causes of neuro-ophthalmic disease are there?

Trauma
Demyelination -> MS
Inflammation/Infection
Congenital abnormalities

29

What features can help indicate the cause of neuro-ophthalmic disease?

Age
Clinical findings
Site of lesion

30

What imaging modality is important in neuro-ophthalmic disease?

MRI

31

What can cause a CN VI palsy?

Microvascular disease
Increased ICP -> Papilloedema
Tumour
Congenital

32

What are the clinical features of a bilateral CN IV palsy?

Due to blunt head trauma
Torsion
Depressed chin

33

A patient presents with an acutely painful left eye. They have had a headache for about an hour and have noticed double vision for just as long. On examination the eye is protruding and the pupil is dilated. The patient cannot elevate or adduct their eye.

Anuerysm of posterior communicating artery resulting in CN III palsy

34

Which of the following is not a typical cause of CN III palsy:
- Microvascular
- Tumour
- MS
- Trauma
- Congenital

Trauma

35

When we look left, both eyes should look in the same direction, at the same time, at the same speed. What pathways allow this and what condition can affect this?

Inter-nuclear pathways
Inter-Nuclear Ophthalmoplegia

36

What is the optic pathway comprised of?

1. Optic nerve
2. Optic chiasm
3. Optic tracts
4. Optic radiations
5. Cortex

37

What tumours can cause optic neuropathy?

Meningioma
Glioma
Haemangioma

38

What conditions typically causes optic neuritis?

MS

39

In optic neuritis, when is the pain exaggerated?

On movement

40

Which of the following is not a sign/symptom of optic neuritis:
- Colour desaturation
- Central scotoma
- Pain behind eye
- Double vision
- Unilateral, progressive visual loss

Double vision

41

What is central scotoma?

Central loss of vision

42

Which of the following is optic neuritis not associated with:
- MS
- SLE
- Sarcoidosis
- Drugs (Ethambutol -> Bilateral)
- GCA

GCA

43

How long does optic neuritis take to recover?

Weeks to months

44

What sort of visual loss do optic nerve defects present with (typically)?

Complete unilateral
OR
Abiding the horizontal

45

What tumours can affect the optic chiasm?

Pituitary tumour
Craniopharyngioma
Meningioma

46

What field defect is typical of an optic chiasm pathology?

Bitemporal visual loss

47

What pathologies can affected the optic tracts and radiations?

Primary and secondary tumours
Demyelination
Vascular anomalies

48

What visual defects are seen in optic tract and optic radiation pathologies?

Homonymous (on same side)
Macula not spared
Quadrantanopia (If optic radiation)
Incongruous

49

What visual defects are seen in occipital cortex pathologies?

Homonymous
Macula sparing
Congruous (symmetrical)

50

Which of these is not a cause of sudden visual loss:
- Vascular aetiology
- Retinal detachment
- ARMD (wet type)
- Open angle glaucoma
- Optic neuritis
- CVA

Open angle glaucoma:
- Closed angle glaucoma -> Sudden visual loss

51

Occlusion of what vascular structures can cause sudden visual loss?

Retinal circulation
Optic nerve head circulation

52

Haemorrhage from what vascular structures can cause sudden visual loss?

Abnormal blood vessels (DM + wet ARMD)
Retinal tear

53

Which of the following is not a risk factor for CRAO and CRVO:
- Hypertension
- DM
- High cholesterol
- Alcohol
- Smoking
- Increased IOP (only in CRVO)

Alcohol

54

A patient presents with sudden onset, painless visual loss. It is unilateral and the visual loss is profound. On examination, the swinging light test shows a relative afferent pupillary defect and there is a pale, oedamtous retina.

Central retinal artery occlusion (CRAO)

55

What can cause a CRAO?

Carotid artery disease
Emboli from heart (unusual)

56

How do we manage a CRAO and when would these treatments be appropriate

Ophthalmic management:
- Ocular massage (if within 24 hours)
- Aims to turn CRAO into BRAO
Vascular management:
- Establish embolus source -> Carotid doppler
- Assess/Manage risk factors

57

A patient presents with a painless loss of vision. They described it like 'a curtain coming down'. They said it recovered after around 5 minutes. On examination of the fundus there are no abnormalitis

Amaurosis Fuga (Transient CRAO)

58

How is a transiet CRAO treated?

Referral to TIA clinic
Aspirin

59

How would a migrainous transient visual loss present?

Visual loss followed by headache

60

What is Virchow's Triad and what can it cause?

Triad:
- Athersclerosis
- Hypertension
- Hyperviscosity
CRVO

61

How does increased IOP cause a CRVO?

Venous stasis

62

What would you expect to see on fundoscopy in a CRVO patient?

Retinal haemorrhages
DIlated, tortuous vessels
Disc and macular swelling:

63

How do we manage a CRVO?

Treat systemic/ocular causes:
- Hypertension
- DM
- Glaucoma

64

How do we prevent a vitreous haemorrhage?

Laser treatment of new vessels

65

What is a medical treatment that is directed at preventin new vessel formation in CRVO?

Anti-VEGFs

66

Occlusion of what artery causes Ischaemic Optic Neuropathy?

Posterior ciliary artery

67

What fudoscopy signs point towards an ischaemic optic neuropathy?

Swollen disc

68

What are the two types of ischaemic optic neuropathy and what causes them?

Arteritic:
- Inflammation (GCA) (50%)
Non-Arteritic:
- Athersclerosis (50%)

69

What vessels are inflammed in GCA?

Medium to large sized arteries:
- Giant multinucleated cells invade tissues

70

What are the visual symptoms of GCA?

Sudden loss
Profound -> Counting fingers (CF) - No perception of light
Irreversible blindness

71

What investigations are important in GCA?

Very high CRP, PV, ESR
Temporal artery biopsy

72

Where does haemorrhage typically happen in the eye in terms of sudden visual loss?

Vitreous

73

What vessels can vitreal haemorrhage occur from?

Abnormal vessels:
- Retinal ischaemia and angiogenesis
- CRVO and DM
Normal vessels:
- Retinal tear

74

Which of the following is not a sign/symptoms of vitreous haemorrhage:
- Loss of vision
- Painful
- Floaters
- Loss of red reflex
- Haemorrhage on ophthalmosopy

Painful

75

If a vitreous haemorrhage doesn't resolve, how is it treated?

Vitrectomy

76

A patient presents with a painless loss of vision in their left eye. They noticed a very sudden onset of floaters. On ophthalmoscopy there is clear ballooning of the retina and vessels don't seem to join up.

Retinal detachment

77

What else might be seen on examination and fundoscopy of a retinal detachment (apart from ballooning and vessels not being continuous)?

RAPD
Retinal tears

78

What is the commonest cause of blindness in the western world in patients over 65?

Age Related Macular Degeneration

79

What are the two types of ARMD and what vision loss do they cause?

Dry -> Gradual loss
Wet -> Sudden loss

80

What is the pathology of wet ARMD?

1. New blood vessels grow under retina
2. New vessels leak
3. Build up of fluid/blood
4. Scarring

81

Where is the visual loss in wet ARMD, central or peripheral?

Central

82

What is metamorphopsia>

Distortion of vision (ARMD)

83

What were the older treatments for wet ARMD?

Laser
Photodynamic therapy

84

What is the newer treatment for wet ARMD?

Antio-VEGF into vitreous cavity

85

What is the typical pattern of gradual vision loss?

Bilateral
Asymmetric

86

In terms of gradual visual loss, what does the acronym CARDIGAN stand for?

Cataract
ARMD (dry type)
Refractive error
Diabetic retinopathy
Inherited diseases -> Retinitis Pigmentosa
Glaucoma (open-angle)
Access -> To eye clinical
Non-urgent

87

What is a cataract?

Lens cloudiness

88

What congenital causes are there of cataract?

Intrauterine infection

89

Describe the characteristics of the following kinds of cataract:
- Nuclear
- Posterior subcapsular
- Polychromatic

Nuclear:
- Involving central part of lens
Posterior subcapsular:
- Cloudy at back of lens
Polychromatic:
- aka 'Christmas Tree Cataract'

90

When do we manage a cataract?

If symptomatic

91

How do we treat a cataract?

Surgical removal and intra-ocular lens replacement

92

How does dry ARMD appear on fundoscopy?

Drusen:
- Build up of waste below RPE
Atrophic patches of retina

93

What is myopia?

Short-sighted

94

What is hypermetropia?

Long-sighted

95

What causes astigmatism?

Irregular corneal curvature

96

What is presbyopia?

Loss of accommodation with age

97

What is glaucoma?

Progressive optic neuropathy

98

A patient present with a painful red eye and visual loss. They are complaining of headache and vomiting before presenting.

Angle-Closure Glaucoma

99

How is angle-closure glaucoma treated?

Reduce IOP with drops/PO drugs

100

Cupped disc and an arcuate visual field defect are often signs of what?

Open-Angle Glaucoma

101

What is the treatment for open-angle glaucoma?

Preserve vision by reducing IOP:
- Eye drops
- Laser
- Surgery

102

What is the commonest cause of diplopia?

Vascular anomalies:
- eg. Reduced CN VI blood supply -> LR paralysis

103

Which of the following is not a risk factor for diplopia:
- DM
- GCA
- Smoking
- Hypertension
- Hypercholesterolaemia

GCA

104

How can diplopia be controlled?

Eye patch
Temporary prism lense

105

What does RAPD suggest?

Affected eye is less sensitive to light

106

What are retinal causes of RAPD?

Retinal detachment
Vitreous haemorrhage

107

Which of the following is not an optic nerve cause of RAPD?
- Optic neuritis
- Ischaemic Optic Neuropathy
- Pituitary tumour
- Optic nerve compression
- Trauma

Pituitary tumour

108

What does 'swollen optic discs' mean?

Disc swelling secondary to ANY cause

109

What does papilloedema mean?

Disc swelling secondary to raised ICP

110

If there is bilateral papilloedema what should be suspected?

Raised ICP due to a space-occupying lesion

111

What does CN II examination include?

Ophthalmoscopy
Visual acuity
Pupil exam
Visual field assessment
Colour vision

112

What causes disc swelling in the context of raised ICP?

1. Raised ICP transmitted to CN II via subarachnoid space
2. Interruption of axoplasmic flow
3. Venous congestion

113

What contributes to ICP?

Brain (80%)
Blood (10%)
CSF (10%)

114

How can raised ICP result in cardiopulmonary arrest?

Brain is squeezed through foramen magnum

115

What can cause a raised ICP in terms of CSF?

Obstruction to CSF circulation
Overproduction of CSF
Inadequate absorption

116

A 25 year old female presents with an 8 month history of headaches. On examination her BMI is 38 and her visual acuity is 6/6 in both eyes. She informs you she is also on the oral contraceptive pill.

Idiopathic Intracranial Hypertension (IIH)

117

What examination and investigation features are present in IHH?

Bilateral disc swelling
Normal MRI
Increased CSF opening pressure on lumbar puncture

118

Which of the following is not a theory of why the discs swell in IIH:
- Stenosis of transverse cerebral sinuses
- Increased abdominal pressure
- Vitamin A
- Optic nerve head retinal occlusion
- Microemboli in sagittal sinus blocking CSF absorption

Optic nerve head retinal occlusion

119

On examination of a patient with chronic disc swelling, how do the discs appear on fundoscopy?

Atrophic
Pale