Clinical pathology

Question 1

What is cataracts?

Answer 1

Opacification of the lens

Question 2

What is the commonest cause of cataracts?

Answer 2

Age degeneration due to UVB damage

Question 3

What are other causes besides age that can cause cataracts?

Answer 3

Hypertension
Smoking
Post op and trauma
Metabolic disorder
Genetic
T1 and T2DM

Question 4

What is glaucoma?

Answer 4

Abnormal increase in pressure in the eye

Question 5

What determines the pressure in the eye?

Answer 5

Amount of vitreous fluid and anteriorly aqueous humour
Produced in the ciliary body and exits through the canal of schlemm at the iridocorneal angle through trabecular meshwork

Question 6

What will glaucoma do to the optic nerve and disc?

Answer 6

Damage - will cause optic atrophy (white optic disc)

Question 7

What is primary open glaucoma?

Answer 7

Poor drainage through the trabecular meshwork or canal of schlemm

Question 8

What is angle closure glaucoma?

Answer 8

Iris is opposed to the anterior eye and therefore aqueous humour stuck in the posterior segment of the anterior chamber of the eye

Question 9

Compare open and closed glaucoma?

Answer 9

Open is a slow onset - often asymptomatic and now screened for
Closed angle is an emergency

Question 10

What will closed angle glaucoma present with?

Answer 10

Acute red eye
Visual loss
Headache with nausea and vomiting

Question 11

What is the treatment for open glaucoma?

Answer 11

Pharmacological therapy to slow down the widening of the canal

Question 12

What is the treatment for closed angle glaucoma?

Answer 12

Create a hole in the iris with a laser

Question 13

What is cupping?

Answer 13

Raised intraocular pressure damages the optic disc and nerve and so the edges of the disc become rolled up and the centre becomes depressed

Question 14

What is papilloedema?

Answer 14

Swelling of the optic nerve/ disc

Non-specific finding related to increased ICP

Question 15

What is conjunctivitis?

Answer 15

Inflammation of conjunctiva
Swelling, redness, pain and heat
Usually viral but can be bacterial or allergic

Question 16

What conditions are associated with scleritis?

Answer 16

SLE

HLA-B27 - ankylosing spondylitis

Question 17

What can be seen on fundoscopy of macular degeneration?

Answer 17

Drusen - proteins, lipids and inflammatory mediators

Question 18

What is the difference between dry and wet ARMD?

Answer 18

Dry - no vascular proliferation

Wet - neovascularization in choroid mediated by VEGF. More likely to result in visual loss

Question 19

How can wet ARMD be treated?

Answer 19

Anti-VEGF intraocular injections

Question 20

What effect does hyperglycemia have on the eye?

Answer 20

Changes osmotic pressures in the anterior chamber of the eye and in front of the lens

Question 21

What is an argyll robertson pupil?

Answer 21

Pupil accommodates but doesn’t react to light

Question 22

How can diabetes mellitus cause cataracts?

Answer 22

Increased sugar content in the lens causes conversion of glucose to sorbitol - altered osmotic gradient leading to swelling and fibre disruption

Question 23

What is rubeotic glaucoma?

Answer 23

New vessel formation on iris causes an obstructing angle

Question 24

What will diabetic retinopathy show on examination?

Answer 24

Dot and blot haemorrhages
Hard exudates
New vessel formation
Microaneurysms

Question 25

What vascular issues can occur with the eye?

Answer 25

Central retinal artery occlusion

Central retinal vein occlusion