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Module 3C - Neuro / Ophthal > Fundoscopy spot diagnosis > Flashcards

Fundoscopy spot diagnosis Flashcards

(40 cards)

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1
Q
A
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2
Q

Quadrants of the retina (right eye)

A
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3
Q

Quadrants of retina (right eye)

A
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4
Q

Spot diagnosis + stage of diabetic retinopathy

A

Microaneurysms

  • Background diabetic retinopathy
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5
Q

Spot diagnosis + stage of diabetic retinopathy

A

Dot and blot haemorrhages - arise from bleeding capillaries in middle layers of retina

  • Background diabetic retinopathy
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6
Q

Spot diagnosis + stage of diabetic retinopathy

A

Cotton wool spots - dead nerve cells from ischaemic damage

  • Pre-proliferative diabetic retinopathy
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7
Q

Spot diagnosis + stage of diabetic retinopathy

A

NVD and NVE - insufficient retinal perfusion results in production of VEGF (which results in neovascularization)

  • Proliferative diabetic retinopathy
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8
Q
A

primary treatment for proliferative diabetic retinopathy
- reduces VEGF production by reducing oxygen demand from peripheral retina

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9
Q

Spot diagnosis + type of diabetic retinopathy + management

A

Hard exudates over macula - microaneurysms leak plasma which precipitate in lipid-rich protein deposits

  • Diabetic maculopathy
  • management –> anti-VEGF injections, laser treatment, dexamethasone implants
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10
Q
A

compression of venules at sites of arteriovenous crossing

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11
Q

Spot diagnosis + condition this is seen in

A

Geographic atrophy

  • seen in late-stage form of AMD
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12
Q

Spot diagnosis + condition this is seen in

A
  • extensive haemorrhages + cotton wool spots + optic disc swelling (papilloedema) + ring of exudates around macula (macular star)
  • Malignant hypertension
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13
Q

Spot diagnosis + condition this is seen in

A

“Cupping” - increased vertical cup-to-disc ratio

  • Glaucoma
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14
Q

Spot diagnosis + causes of this pathology

A

Epiretinal membranes - scar tissue on macula

  • Causes: aging, trauma/inflammation, diabetes
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15
Q

Spot diagnosis + management

A

Papilloedema - optic disc swelling secondary to raised ICP

Management: Reduce ICP –> Acetazolamide

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16
Q

Spot diagnosis

A

Optic nerve atrophy - death of nerve fibres within optic nerve

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17
Q

Spot diagnosis + condition this is seen in + management

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A

“cherry-red spot” - occurs due to the intact reflex of the fovea standing out against a pale ischaemic retina

  • Central retinal artery occlusion (CRAO)
  • Management (EMERGENCY) –> ocular massage, IOP-lowering (surgery/paracentesis, timolol/other IOP-lowering drops)
18
Q

Spot diagnosis + management

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A

‘stormy sunset’ - haemorrhages, cotton wool spots, tortuous veins, disc swelling

  • Central retinal vein occlusion (CRVO)
  • Management –> anti-VEGF injections
19
Q

Spot diagnosis + condition this is seen in

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A

Drusen deposits

  • dry AMD (note: dry AMD produces no exudation or neovascularisation)
20
Q

Spot diagnosis

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A

Normal fundus

  • Optic disc (3 C’s) - normal colour, uniform central cup (ratio < 0.5) with a normal neuroretinal rim
  • Inspect all 4 quadrants of retina - no pathology
  • Macula/Fovea - no pathology
  • Blood vessels - retinal veins/arteries normal
21
Q

Spot diagnosis

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A

Multiple retinal haemorrhages

22
Q

Spot diagnosis + Causes + Management

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A

Pre-retinal haemorrhage - boat-shaped

  • Causes: proliferative diabetic retinopathy, trauma, SAH
  • Management –> slef-limiting (observation), avoid anticoagulants and strenuous activities, +/- laser surgery and vitrectomy
23
Q

Spot diagnosis

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A

Glaucoma - increased cup-to-disc ratio (> 0.5), due to raised IOP

24
Q

Spot diagnosis + management

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A

Retinal detachment - bulbous retina with elevation due to fluid

  • management –> Vitrectomy
25
Spot diagnosis + management
Branch retinal vein occlusion - *tortuosity of veins + AV nipping with microaneurysms* - management --> anti-VEGF injections, steroids, laser?
26
Spot diagnosis + type of poor vision associated
Retinitis pigmentosa - *bony spicule pattern + retinal pigmentation (scattered in periphery of retina)* - genetic disease and may be associated hx of poor night vision (primarily affects rods)
27
Spot diagnosis + Management
Glaucoma - *increased cup disc ratio* Management: 1. Prostaglandin analogues --> *latanoprost* 2. Beta-blockers --> *timolol* 3. Surgery --> *laser trabeculoplasty* (If AACG --> *IV acetazolamide + IOP-lowering drops + laser peripheral iridotomy*)
28
Spot diagnosis + conditions this finding is associated with
Flame haemorrhages - *larger haemorrhages with flame-like appearance* - associated with retinal artery/vein occlusion (RAVO), hypertensive retinopathy, and trauma
29
Spot diagnosis + condition seen in + treatment
Neovascularisation - *formation of new blood vessels that appear curly (NVD / NVE)* - seen in proliferative diabetic retinopathy - Treatment --> anti-VEGF injections and/or panretinal laser photocoagulation
30
Aetiology of CRAO and CRVO
- CRAO: usually carotid stenosis / emboli (eg. stroke) blocking central retinal artery/ophthalmic artery/carotid artery OR sometimes vasculitis (GCA) - CRVO: occurs secondary to atherosclerotic thickening of the central retinal artery compressing the central retinal vein at a crossing point
31
Primary and secondary causes of optic nerve atrophy
- Primary: inflammation (optic neuritis), glaucoma or general retinal ischaemia - Secondary: longstanding papilloedema
32
Causes of optic disc swelling (3)
- Raised ICP (papilloedema) - Inflammation (optic neuritis) - IIH
33
Grading of hypertensive retinopathy (4 grades)
- Grade 1: subtle changes (generalised arteriolar narrowing) - Grade 2: areas of focal narrowing + AV nipping - Grade 3: features similar to pre-proliferative diabetic retinopathy (retinal haemorrhages, hard exudates and cotton wool spots) - Grade 4: Malignant hypertension (previous features + optic disc swelling)
34
Stages of diabetic retinopathy (4 stages)
35
Label the retinal quadrants (top image shows a left eye)
36
Macula pathology - name 3 findings
- Hard exudates - *yellow lesions associated with diabetic retinopathy, hypertensive retinopathy, and vein occlusions* - Drusen - *yellow flecks caused by AMD* - Cherry red spot - *central retinal artery occlusion*
37
What is used to dilate the pupil in a fundoscopy exam + how does it work?
Tropicamide 1% - *short-acting mydriatic drops* (relaxes the pupillary sphincter muscle)
38
Spot diagnosis + conditions seen in
Macula star - *ring of exudate on macula* - severe hypertensive retinopathy - papilloedema - ischaemic optic neuropathy
39
Spot diagnosis
Retinal detachment
40

Module 3C - Neuro / Ophthal (13 decks)

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