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Flashcards in Eyes And Ears Deck (101):
1

RFs for cataracts?

Female
DM
Steroid use
Eye trauma, UV exposure, uveitis

2

3 types of acquired cataracts?

Central (posterior subcapsular)
Nuclear sclerosis
Cortical

3

Infections that can cause congenital cataracts?

TORCH

4

Childhood metabolic abnormality associated with cataracts?

Galactosaemia

5

Classical symptoms of cataracts?

Painless loss of visual acuity, often initially presenting as reading difficulties
Trouble recognising faces, reading, watching TV etc.
If central - can cause glare and near-vision deterioration

6

Best sign on examination of eyes of cataracts?

Absent or defective red reflex

7

Does pinholing improve vision in cataracts?

No

8

What cataract is typically associated with DM?

Peripheral cortical

9

Surgical technique used in repairing cataracts?

Phaecoemulsification

10

Important consideration to be made regarding cataracts and driving?

Does it interfere? Do DVLA need to be informed?

11

What is glaucoma?

A group of conditions resulting in damage to the optic nerve head and hence loss of the visual field, typically associated with raised intraocular pressure

12

What is the affected anatomical part of the eye in glaucoma?

Optic nerve head

13

What is the most common type of glaucoma?

Primary open angle glaucoma

14

Mechanism behind raised IOP causing glaucoma?

Compression of the microvasculature of the optic nerve head

15

Progression of primary open angle glaucoma?

Starts peripherally and works inwards - by the time symptoms are manifest the optic nerve may be 90% damaged

16

RFs generally for glaucoma?

DM
Black ethnicity
Raised IOP
Myopia
FH

17

What is the measurement of the irido-corneal angle called?

Gonioscopy

18

What 'angle' is affected in glaucoma?

Irido-corneal angle

19

What is tonometry?

Objective measurement of IOP (normally 10-21)

20

What method is used to measure IOP?

Tonometry

21

What key pathological changes are observed in the optic disc in glaucoma?

Increasing cup:disc ratio - neuroretinal ring

22

What is the 'precursor' to glaucoma?

Ocular hypertension

23

What findings on examination and investigation indicate primary open angle glaucoma?

Tonometry indicating IOP>21 at least once
Open iridocorneal angle
Glaucomatous optic neuropathy indicated on optic disc examination by increasing cup:disc ratio
-> VFD compatible with this damage

24

Findings in terms of VFDs as POAG progresses?

Mild VFDs
Arcuate scotoma, thinning of neuroretinal ring (cupping)
Extensive VFDs accompanied by cup:disc ratio 0.9-1

25

Management options for POAG?

Prostaglandin analogues (latanoprost)
B blockers
Carbonic anhydrase inhibitors
Sympathomimetics

26

What side effect can prostaglandin analogue drops have on the eye?

Turn iris/brown

27

What is primary angle-closure glaucoma?

Intrinsically narrow iridocorneal angle which causes predisposition to angle closure and acutely raised IOP

28

5 stages of primary angle closure glaucoma?

Latent (anatomical predisposition)
Subacute
Acute
Chronic
Absolute

29

What can secondary angle closure glaucoma be due to?

Hyphaema, DM retinopathy, hypertensive uveitis

30

Presentation of acute primary angle closure glaucoma?

Pain - orbital/frontal, generalised headache
Blurred vision leading to loss, some Hx of subacute attacks
Systemic signs - nausea, vomiting

31

What can precipitate the onset of acute angle closure glaucoma?

Dilation of the pupil - pupil gets caught mid-dilated

32

Examination signs of primary angle closure glaucoma?

Generally unwell
Non or minimally reactive pupil, mid-dilated
Red eye, hazy cornea
Raised IOP

33

RFs for normal tension glaucoma?

Raynaud's phenomenon
Migraines
Paraproteinaemia

34

What is the most common cause of cataracts?

Age-related lens deterioration and opacification

35

What cataract is typically associated with steroid use?

Central (posterior subcapsular) cataract

36

What is the 'ageing' cataract?

Nuclear cataract

37

How is a patient's visual acuity recorded when using a Snellen chart?

E.g. 6/10
Patient distance/lowest line they can read

38

'Extra' eye tests that you say you'd do?

Near vision testing
Colour vision
Blind spot
Central fields
Ocular alignment and nystagmus

39

What does a lesion in the optic chiasm cause?

Bitemporal hemianopia

40

What does a lesion in the optic tract cause?

A Contralateral homonymous hemianopia

41

What lesion gives a pie in the sky Contralateral deficit?

A lesion in the lower optical radiations in the temporal lobe

42

What lesion gives a Contralateral lower quadrant visual field deficit?

Lesion in the upper optic radiations in the parietal lobe

43

What does an occipital or posterior parietal lobe lesion cause in terms of VFD?

Contralateral homonymous hemianopia with macular sparing

44

What is the word for one pupil being bigger than the other?

Anisocoria

45

What does a full CN3 lesion cause?

A down and out lesion of the eye
Ptosis
Mydriosis

46

Causes of periorbital swelling?

Periorbital cellulitis
Angioedema
CCF, nephrotic syndrome
Allergic eye disease
Thyroid eye disease

47

3 causes of ptosis?

Horners syndrome
CN3 lesion
MG

48

What does eye movement pain with a white eye suggest?

Optic neuritis

49

Common cause of 'feeling like there's something in your eye'/dry eyes?

Blepharitis

50

What does ocular pain and a red eye suggest?

Scleritis

51

What type of chronic visual impairment predisposes to acute angle closure glaucoma?

Hypermetropism (long sightedness)

52

Common causes of unilateral acute visual loss?

Retinal artery/vein occlusion

53

What are haloes associated with?

Angle closure glaucoma

54

What may flashes and floaters precede?

Retinal detachment

55

What is cortical blindness?

Often unilateral visual loss with a cortical cause e.g. POCS
Vision absent however pupillary reflexes present in the affected eye +/- macular sparing

56

What is Riddoch syndrome in the context of cortical blindness?

Ability to perceive light or movement subconsciously but not static objects

57

What about diabetes particularly are the 2 most important risk factors for developing retinopathy?

Duration
Control

58

What are the two stages of non-proliferative DM retinopathy?

Background
Maculopathy

59

What is the first stage of DM retinopathy?

Background retinopathy

60

What 4 peripheral features on fundoscopy are characteristic of background DM retinopathy?

Microaneurysms (bobbly arteries)
Retinal haemorrhage - flame (superficial) or dot/blot (deep)
Hard exudates (oedema and lipid deposition)
Cotton wool spots (soft exudates) - microinfarcts

61

What feature of background DM retinopathy is suggestive of forthcoming proliferative disease?

Cotton wool spots (microinfarcts)

62

Signs associated with diabetic maculopathy?

Central damage causing visual blurring
Oedema, ischaemia

63

What sign is typically associated with pre-proliferative DM eye disease?

Venous beading

64

What does venous beading indicate on fundoscopy?

Pre-proliferative DM disease

65

Characteristics of proliferative DM retinopathy?

VEGF production causing neovasculature, maculopathy and blurring

66

Two grades that are given on DM eye screening?

R (retina) 0-3
M (macular) 0 or 1

67

Features of chronic hypertensive retinopathy?

Permanent arterial narrowing
AV nicking
Arteriosclerosis -> copper and silver wiring

68

What in hypertensive retinopathy is a major RF for branch retinal vein occlusion?

AV nicking

69

Features of acute severe hypertensive eye disease?

Haemorrhage - flame and dot/blot
Cotton wool spots
Hard exudates
Optic disc oedema

70

What is the most common type of ARMD and how does it present?

Dry - slowly progressive blurring with less central visual loss
Reading problems, blurring, difficulty recognising faces etc.

71

What investigative findings support a diagnosis of dry AMD?

Atrophic or hyper pigmented retinal pigment epithelium
Flat configuration on OCT

72

Management of dry AMD?

Stop smoking
Low vision aids, dietary advice?

73

What characterises wet AMD?

More abrupt onset
Signs associated with proliferative retinopathy - VEGF production, haemorrhages, leakage and scarring

74

What investigative findings support a diagnosis of wet AMD?

Subretinal fluid on OCT and retinal thickening

75

What is the major management of wet AMD?

Lucentis (anti-VEGF)
Can halt progression and even reverse if done early enough

76

2 investigations used for AMD?

IVFA (intravenous fluroscein angiography) for differentiation between the two types
OCT (optical coherence tomography) is less invasive and good for looking at layers

77

4 main symptoms to enquire about in ear history?

Pain and itch (otalgia/pruritis)
Otorrhoea
Deafness and tinnitus
Vestibular - vertigo and dizziness

78

Common causes of ear pain and itch?

OM, OE, Ramsey Hunt, trauma, Cancer

79

Where can pain refer to the ear from?

Tonsillitis/pharyngitis
TMJ dysfunction

80

Purulent otorrhoea causes?

OE/CSOM

81

Causes of Mucoid otorrhoea?

Eardrum perf/CSF leak

82

What does bloodstained otorrhoea suggest?

Trauma - leaking granulation tissue

83

Common causes of tinnitus?

Presbyacusis
Noise-related damage

84

Is vertigo normally Central or peripheral?

Peripheral

85

4 common causes of peripheral vertigo?

BPPV
Acute labyrinthitis/vestibular neuronitis
Ménière's disease
Drug induced e.g. Gentamycin

86

Discuss acute labyrinthitis/vestibular neuronitis?

Acute onset vertigo goes on for a few days, may be associated with nausea vomiting malaise and ataxia but no hearing loss or tinnitus

87

Discuss BPPV?

Vertigo attacks triggered by laying on the affected ear, no other focal ear signs

88

Discuss Ménière's disease?

Recurrent vertigo, persistent tinnitus and progressive SN hearing loss

89

Central causes of vertigo?

Migraine
CVA
MS

90

What does otorrhoea with no TM retraction or perforation suggest?

OE

91

In which direction does the cone of light point on the TM?

Anteriorly

92

Signs of AOM on otoscopy?

Retraction of TM
Redness
Perf +/- otorrhoea

93

What does a bulging TM suggest?

Fluid behind the TM - OME, middle ear effusion

94

What frequency of tuning fork is used in Rinne's/Webers?

512 Hz

95

Abnormal results in Weber's test?

Lateralisation towards a conductive loss, away from a SN loss
May be equal if bilateral hearing loss

96

Which tuning fork test is more sensitive for a conductive hearing loss?

Weber's

97

What is a positive Rinne's test?

AC>BC - can be falsely positive in case of SN loss

98

What is a negative Rinne's and what does it indicate?

BC>AC, indicating a conductive hearing deficit

99

Common causes of conductive hearing loss?

Wax
Eardrum perforation
Middle ear effusion
OE/OM
Ossicular trauma
Middle ear tumours
Otosclerosis

100

Potentially inheritable cause of conductive hearing loss?

Otosclerosis

101

Common causes of SN hearing loss?

Can be genetic or congenital e.g. TORCH infection
Infection - measles, mumps, meningitis
Presbyacusis or noise-related degeneration (+tinnitus)
Trauma
Ménière's disease
Acoustic neuroma