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Question 1

RA ocular involvement

Answer 1

Autoimmune disease:
DED
Keratoconjuntivitis
Precursor to Sjrogrens
Peripheral corneal ulceration

Question 2

Sterile corneal ulceration causes:

Answer 2

DED
SS/RA
GPC

Question 3

Confluent drusen in one eye treatment:

Answer 3

Treated as AMD
OCT (severity)
VA + Amsler
“confluent” > recheck 3-6m
Return if vision changes/amser

Question 4

DDX Red/sore eye

Answer 4

Keratitis
CLARE
Foreign body/Pterygium flare

Question 5

DDX gritty/burning eyes:

Answer 5

DED (CL/Meds/SLE)
Allergic conjuntivitis
Bacterial conjuntivitis

Question 6

Idiopathic macula oedema testing:

Answer 6

OCT (AMD)
Fundoscopy (uveitis/RP)
Medical history (HT)
Drug use (Lanaprost>Glauc)

Question 7

Chlamydial infection presentation

Answer 7

Unilateral > bilateral, Mucopurulent discharge, hyperaemia, lid chemosis
Trachoma: repeated infection, Large papillae + follicles, conj. scarring, entropion
Acute inclusion: large follicles
Bacterial culture is recomended
Both with oral doxycycline 100mg BID 4 weeks

Question 8

Patho nuclear cataract:

Answer 8

Age> Barrier before cortex, prevents glutathione transport
Post translational modifation> Glycation/calpain/tryptophan addition

Question 9

Patho PSC:

Answer 9

Age, stress, DM > GF alterations
Loss of growth factors impede epithelial differentiation to lens fibers
Undifferentiated cells with organelles micrate to posterior pole
Abnormal pump function>swelling> vacuole formation > disruption of lens organisation

Question 10

Risk factors of hypertension:

Answer 10

Family history
Smoking/alcohol
Obesity
Age

Question 11

Distinct features of retinal BV in HT:

Answer 11

Lack sympathetic nerve supply
Autoregulation of flow
Blood retinal barrier

Question 12

HT pathophysiology:

Answer 12

BP > stress induced vasospasm > arteriole narrowing
Sustained BP > vessel hyperplasia/wall degeneration > AV nipping, vein tortuisity, copper wiring
Loss of BBB > fluid leakage/ischemia > hemorrhage (dot/blot), hard exudate, CWS
Intracranial HT > optic nerve ischemia/swelling/pallor

Question 13

Thickening of arteries:

Answer 13

Vasospasms > compensatory hypertrophy of smooth muscle > loss of transparency (copper wiring) / AV nipping

Question 14

AV nipping:

Answer 14

Artery hyperplasia > thickening > increased pressure on venules
Ususally veins under artery is visible (transparent arteries), hyperplasia > decreased transparency
Leads to vein tortuisity

Question 15

Retinal haemorrgahes:

Answer 15

Dot/Blot: bleed within retina
Flame: bleed in NFL (wont occur in DR)

Question 16

Exudates:

Answer 16

Hard: lipid deposit on retina
Soft: CWS (NFL swelling)
Macula star: radial hard exudates around macula

Question 17

HT related conditions:

Answer 17

CRAO/CRVO
BRAO/BRVO
AMD
CSR

Question 18

Diabetic retinopathy patho:

Answer 18

Hyperglycemia > damaged vessel pericytes > weakening capiliary walls/increased permeability > microanerysms/hard exudates (lipid leaks) > ischemia > VEGF production > CNV > vit. Bleed / RD

Question 19

TED presentation:

Answer 19

Exopthalmos
DED > corneal erosion
Lid retraction
Optic neuropathy

Question 20

TED causes/risks:

Answer 20

Graves disease
RA
DM
Smoking

Question 21

Assessment of lacrimal drainage:

Answer 21

NaFL drops > cleared in 5m > present in sneeze
Assessment of the tear film meniscus (should be >0.1mm)

Question 22

Vernal vs Atopic keratoconjunctivitis:

Answer 22

Vernal: 20y, mucoid discharge, cobblestone papillae, trantas dots, seasonal, type 1 IgE

Question 23

Presentation of trachoma from chlamydia:

Answer 23

Follicles, Pannus (corneal infiltrate), hyperaemia, mucopurulent discharge
Later forms entropion (inward lid turn), corneal scar

Question 24

Prevention of HSV recurrence

Answer 24

Acyclovir 400mg bid

Question 25

Scleritis/episcleritis assessment:

Answer 25

Phenelephrine 2.5% (vessels remain) Episcleritis is painless, scleritis is painful Episcleritis self resolves 2w Scleritis needs oral prednisolone

Question 26

Macula hole:

Answer 26

Unilateral, painless loss of central vision (metamorphopsia if pucker) Related to PVD Requires gas and face down.

Question 27

Optic neuritis:

Answer 27

Inflammation of optic nerve, commonly from MS Unilateral loss of vision over days Swollen optic disc

Question 28

Anterior ischaemic optic neuropathy:

Answer 28

Ischaemia of ON, commonly from HT/BV inflammation Sudden painless loss of vision Optic disc oedema / crowding

Question 29

Common cause of CN3 palsy:

Answer 29

Compressive lesion from communicating artery anerysm

Question 30

Clinical testing for keratitis/conjuntivitis:

Answer 30

Slit lamp w/NaFL (ulcer analysis) Pain (scale/Q-tip) Pressure lacrimal duct/maibomian (lacrimal infection, meibum) Corneal scrape (lab assessment)

Question 31

DDX for Macula oedema:

Answer 31

AMD (look for drusen) Uveitis (several RDs, pain) DR (haemorrhages) CSR (stress, corticosteroids, male)

Question 32

HT pathophysiology:

Answer 32

BP > stress induced vasospasm (autoregulation) > arteriole narrowing Sustained BP > vessel arteriosclerosis (hyperplasia)/wall lumen degeneration > AV nipping, vein tortuosity, copper wiring Loss of BBB > fluid leakage/ischemia > hemorrhage (dot/blot), hard exudate, CWS Intracranial HT > optic nerve ischemia/swelling/pallor

Question 33

Non pharmacologic treatment of allergic conjuntivitis:

Answer 33

Avoid allergen Lubricants (wash away allergen) Cold compress (vasoconstriction)

Question 34

Pharmacologic treatment of allergic conjuntivitis:

Answer 34

Antihistamine levocabastine drop 0.05% bid Mast cell stabiliser: Loxamide NSAID: Ketorolac Topical corticosteroids: Fluromethalone 0.1% qid

Question 35

PSC history:

Answer 35

Age (usually young) Glare at day Steroid use/inflammation (uveitis)

Question 36

PSC patho:

Answer 36

Corticosteroid, trauma, inflammation > altered GF expression Abberrant lens cell migration from germinative zone to visual axis at posterior pole

Question 37

DM on cataract:

Answer 37

Post translational modification (glycation) of proteins > conformation change Gucose influx > sorbitol influx > water influx > RI increase