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Year 2 - Ophthalmology (DP) > Clinical (5 + 6) > Flashcards

Flashcards in Clinical (5 + 6) Deck (81):
1

What is the most common cause of red eye?

Conjunctivitis (Blepharoconjunctivitis)

2

What do eyelid secrete for defence?

Meibomian

3

What is contained in tears?

Lysozyme
IgA and IgG
Complement

4

What can ocular pain be presenting as?

Foreign body/Grittiness/Dryness
Ache

5

What are the following features of:
- Seborrhoeic (squamous) scales on lashes
- Staphylococcal infection of lash follicle
- Lid margin redder than deeper part of lid

Anterior blepharitis

6

What are the following features of:
- Meibomian gland dysfunction
- Redness in deeper lid
- Lid margin often appears normal

Posterior blepharitis

7

Which of the following is not a symptom of blepharitis:
- Gritty eyes
- Foreign body sensation
- Mild discharge
- Vascular injection into sclera

Vascular injection into sclera

8

What conditions is blepharitis associated with?

Conjunctivitis
Keratitis (Marginal and SPK)
Episcleritis

9

What are styes and what condition are they indicative of?

Ulcers of lid margins
Staphylococcal anterior blephatitis

10

What is trichiasis and what can it be a sign of?

Ingrown eyelashes
Staphylococcal anterior blepharitis

11

What causes corneal staining and marginal ulcers in Staphylococcal anterior blepharitis?

Exotoxin

12

How do the meibomian glands appear in posterior blepharitis?

Pouting
Swollen

13

What are chalazia?

Meibomian cysts

14

What is posterior blepharitis associated with?

Acne rosacea

15

How is blepharitis treated?

Lid hygiene:
- Daily bathing
- Warm compresses
Supplementary tears drops
Oral doxycycline for 2-3 months

16

What are common infective causes of conjunctivitis?

Viral
Bacterial
Chlamydial

17

Apart from infective causes of conjunctivitis, what else can cause it?

Allergy
Chemicals/Drugs
Skin disease -> Eczema

18

Which of the following is not a symptoms of infective conjuncitivitis:
- Red eye
- Gritty eye
- Discharge (sticky eye)
- Itch
- Unaffected vision

Itch:
- This suggests allergy

19

What sign of conjunctivitis is specific to viral causes?

Preauricular glands

20

How long does bacterial conjunctivitis take to clear without treatment?

~14 days

21

How can we treat bacterial conjunctivitis?

Topical chloramphenicol

22

What bacteria most commonly cause conjunctivitis?

Staph. aureus
Strep. pneumoniae
H. influenzae

23

Which of the following does not cause follicular conjunctivitis?
- Adenovirus
- HSV
- Herpes zoster
- Drugs (Propine and Trusopt)
- Allergy
- Chlamydia

Allergy

24

Which of the following is not a cause of chronic conjunctivitis:
- Blepharitis
- Chlamydial conjunctivitis
- HSV
- Keratoconjunctivits sicca
- Chronic dacrocystitis
- Topical glaucoma medication
- Subtarsal foreign body

HSV

25

What are the three layers of the cornea from external to internal?

Epithelium
Stroma
Endothelium

26

What causes central corneal ulcers?

Infections:
- Viral
- Fungal
- Bacterial
- Acanthamoeba

27

What causes peripheral corneal ulcers?

Autoimmunity:
- RA
- Hypersensitivity (eg. Marginal ulcers)
- Rarely GPA and Polyarteritis

28

What are the characteristics of the pain in corneal ulcers?

Needle like
Severe
Corneal sensation affected by Herpes

29

What is the pattern of red eye in corneal ulcers?

Circumcorneal

30

What are three other symptoms of corneal ulcers (apart from pain and red eye)?

Photophobia
Profuse lacrimation
Possible reduced vision

31

Which of the following is not a sign of corneal ulcers:
- Circumcorneal redness
- Abnormal reflection on corneal reflex
- Corneal opacity
- Vascular injections into sclera and cornea
- Fluorescein staining
- Hypopyon

Vascular injections into sclera and cornea

32

Corneal dryness due to inadequate lid closure in thyroid disease or CN VII palsy

Exposure keratitis

33

This condition is due to either:
- Reduced tear production
- Increased tear evaporation
It is commonly seen in Sjogren's

Keratoconjunctivitis sicca

34

What type of keratitis is causes by herpes zoster in CN V1?

Neurotrophic keratitis

35

What vitamin deficiency can cause corneal ulcers?

Vitamin A deficiency

36

How do we identify the cause of a corneal ulcer?

Corneal scrape:
- Gram stain
- Culture

37

How do we treat bacterial corneal ulcers?

Ofloxacin hourly

38

How do we treat herpetic corneal ulcers?

Aciclovir ointment 5 times daily

39

How do we treat autoimmune corneal ulcers?

Oral/Topical steroids

40

Which of the following autoimmune conditions is not associated with anterior uveitis:
- Reiter's syndrome
- UC
- Ankylosing spondylitis
- Sarcoidosis
- Sjogren's syndrome

Sjogren's

41

What malignancy can cause anterior uveitis?

Leukaemia

42

Which of the following infections is not associated with anterior uveitis:
- TB
- HPV
- Syphilis
- Herpes simplex
- Herpes zoster

HPV

43

Which of the following is not a symptoms of anterior uveitis:
- Pain (and referred pain)
- Reduced vision
- Discharge
- Photophobia
- Circumcorneal red eye

Discharge

44

What is a synechiae and what is it a sign of?

Small/Irregular pupil
Anterior uveitis

45

What are the potential treatments of anterior uveitis?

Topical steroids:
- Prednisolone Forte 1% hourly
-> Tapering over 4-8 weeks
Mydriatics:
- Cyclopentolate 1% twice daily

46

How do we manage chronic or recurrent anterior uveitis?

Investigate for systemic causes

47

What joint condition is episcleritis associated with?

Gout

48

What systemic vasculidities is scleritis associated with?

RA
DPA

49

How does scleritis present?

PAINFUL
Injection of deep vascular plexus -> Violaceous line

50

How do we manage episcleritis?

Lubricants
Topical NSAIDs
Mild steroids

51

How do we manage scleritis?

Oral NSAIDs
Oral steroids
Steroid sparing agents (Immunosuppressants)

52

What is the pathophysiology of acute angle-closure glaucoma?

IOP raised acutely due to drainage angle closure (ie Trabecular meshwork and Schlemm's canals)

53

What precipitates acute angle-closure glaucoma?

Pupil dilation

54

What predisposes people to acute angle-closure glaucoma?

Elderly people with hypermetropia

55

Which of the following is not a sign/symptom of acute angle-closure glaucoma:
- Severe pain and nausea
- Photophobia
- Circumcorneal injection
- Cornea cloudy
- Mid-dilated pupil
- Eye stony hard

Photophobia

56

Put the following steps in the pathogenesis of diabetic retinopathy in order:
- Loss of pericytes
- Chronic hyperglycaemia
- Microaneurysm
- Leakage and ischaemia
- Glycosylation of protein and basement membrane (thickens)

1. Chronic hyperglycaemia
2. Glycosylation of protein and basement membrane (thickens)
3. Loss of pericytes
4. Microaneurysm
5. Leakage and ischaemia

57

Which of the following is not a feature of non-proliferative retinopathy:
- Microaneurysms/Dot and blot haemorrhages
- Neovascularisation
- Hard exudate
- Cotton wool patches
- Abnormalities of venous calibre
- Intraretinal microvascular abnormalities (IRMA)

Neovascularisation (this is a sign of proliferative retinopathy)

58

What are cotton wool spots?

Retinal micro-infarcts

59

What do cotton wool spots trigger the release of what what does this cause?

VEGF release:
- Compensatory neovascularisation

60

Where can new vessels grow in proliferative retinopathy?

Optic disc -> NVD
Peripheries -> NVE
Iris (if severe) -> Rubeosis iridis

61

What can happen to the new vessels in proliferative retinopathy? How does this present?

They can haemorrhage:
- Cloud vision
- Retinal ischaemia

62

What results when neovessels haemorrhage?

Fibrovascular proliferation

63

What can result due to the fibrous tissue in proliferative retinopathy?

It can retract:
- Increased risk of tractional retinal detachment

64

Why do diabetics lose their vision?

Retinal oedema affects fovea
Vitreous haemorrhage
Scarring/Tractional retinal haemorrhage

65

What are the three classes of non-proliferative retinopathy?

Mild
Moderate
Severe

66

What are the three stages of maculopathy?

Observable
Referable
Clinically significant

67

What is the main way of managing diabetic retinopathy?

Optimise medical treatment of DM

68

How does Pan-Retinal Photocoagulation (PRP) help in diabetic retinopathy?

1. Reduces hypoxic drive -> Reduces ischaemia
2. Reduces production of VEGF
3. Reduces neovascularisation

69

True or false; Elderly patients with atherosclerosis often have minimal hypertensive changes on fundoscopy?

True

70

Which of the following is not a feature of hypertensive retinopathy:
- Attenuated blood vessels (Copper/Silver wiring)
- Cotton wool spots
- Hard exudates
- Vitreal haemorrhage
- Retinal haemorrhage
- Optic disc oedema

Vitreal haemorrhage

71

What is a cherry red spot a sign of?

CRAO

72

In CRAO, what does the degree of ischaemia correlate to?

Degree of vision reduction
Fundal appearance

73

What infective causes are there of uveitis?

TB
Herpes zoster
Toxoplasmosis
Candidiasis
Syphilis
Lyme Disease

74

What non-infective causes are there of uveitis?

Idiopathic
HLA-B27 -> Reiter's, Anterior uveitis
Juvenile arthritis
Sarcoidosis
Behcets disease (Small vessel vasculitis)

75

Which of the following lid changes is not seen in thyroid eye disease:
- Trichiasis
- Retraction
- Oedema
- Lag
- Pigmentation

Trichiasis

76

Which of the following is a posterior segment sign (instead of anterior segment sign) of thyroid eye disease:
- Chemosis
- Choroidal folds
- Injection
- Exposure
- Glaucoma

Choroidal folds

77

What structures swell in thyroid eye disease?

Extraocular muscles (restrictive myopathy)
Orbital fat

78

What eye features can present in RA?

Keratoconjunctivitis sicca
Scleritis
Corneal melt

79

What is the pathogenesis behind Sjogren's Syndrome?

Lymphocytic infiltration of lacrimal (and salivary) glands

80

What is symblepharon and what dermatological condition is it seen in?

Partial/Complete adhesion of the palpebral conjunctiva to the bulbar conjunctiva:
- Seen in Stevens-Johnson syndrome

81

What other features of Stevens-Johnson syndrome affect the eye?

Occlusion of lacrimal glands
Corneal ulcers