Ophthal

Question 1

HPC of an eye history

Answer 1

Site: whole eye, lid, localised, wear contacts
Onset: gradual, sudden
Character: Foreign body sensation, headache
Radiation: behind eye, midline, head, side of face, ear, jawline
Associated symptoms: nausea/vom, headache
Time: Constant/intermittent
Exac/relieve
Severity.

Question 2

Why is it importance to ask about illicit drugs?

Answer 2

Poppers - loss of central vision

Question 3

Importance factors in social history:

Answer 3

Driving.
Home situation.
Smoking (macula degen, cataracts, diabetic retinopathy, thyroid eye disease, healing)

Question 4

Vision questions

Answer 4

How is your vision? Compared to other eye? What was it like before? Anything missing?

Question 5

What condition can cause a brow ache?

Answer 5

Glaucoma - feel bruise pain of bone

Question 6

What symptom presents with pressure?

Answer 6

Scleritis

Question 7

Curtain?

Answer 7

TIA

Question 8

How can a detached retina present?

Answer 8

Curtain, flashes and floaters

Question 9

What is the likely differential if the patent has sudden, painful visual loss?

Answer 9

Vascular

Question 10

What underlying cause if pain for days-weeks compared to hours

Answer 10

infection - inflammatory for less time

Question 11

How does a piece of metal look on close inspection of the eye?

Answer 11

Circular lesion on cornea, often brown with a yellow halo

Question 12

What condition occurs as a result of the iris and lens blocking the angle through the trabecular meshwork causing sudden severe symptoms?

Answer 12

Angle closure glaucoma.

Intense eye pain, red eye, headache, halos, blurred, nausea

Question 13

What are the risk factors of AC glaucoma?

Answer 13

HLA-B27. Dry eyes. Sjogren’s. RA. Scleritis. Rheumatoid arthritis.

Question 14

Define Entropion

Answer 14

Lid rolled in, lashes scratch eye - ulcers

Question 15

What are signs of allergic disease of conjunctiva?

Answer 15

Follicular, both eyes. Sticky coating on eye lashes, itchy and watering

Question 16

What is the term for a constricted pupil?

Answer 16

Miosis

Question 17

What condition is suggested by gradual onset of blurred hazy vision with associated glare, halos and monocular diplopia? What other signs would be present?

Answer 17

Cataracts - opacification of lens:

Reduced acuity, red reflex and poor fundus view.

Question 18

What is glaucoma? How does it present?

Signs present on optic disk?

Answer 18

Degenerative disease of the option nerve, eye drainage canals become blocked over time. At end stage - peripheral field loss (nasal defect first). Linked to raised intraocular pressure. 
Optic disk:
Cupping 
Pallor
Splinter haemorrhage

Question 19

Red flags of Giant Cell Arteritis?

Answer 19

Weight loss
Headache
Malaise
Pain on chewing 
Scalp Tenderness

Question 20

Red flags of retinal tear or detachment?

Answer 20

Flashing lights
Floaters
Shadow over vision

Question 21

Red flags of double vision?

Answer 21

Headache.
Vomiting.
(would indicate intracranial pathology)

Question 22

Red flags with eye pain? Excluding AC Glaucoma

Answer 22

Haloes

Triggered by low illumination

Question 23

When would you get painful visual loss?

Answer 23

Secondary to inflammatory events: uveitis, AC glaucoma, keratitis, neurtis

Question 24

When would you get painless visual loss?

Answer 24

Secondary to vascular events: vitreous haemorrhage, occlsions, artertic, ARMD

Question 25

Would visual loss with vascular events, retinal detachment, and angle closure glaucoma be gradual or sudden?

Answer 25

Sudden

Question 26

Would visual loss with cataracts, ARMD, uveitis and keratitis be gradual or sudden?

Answer 26

Gradual

Question 27

Term for long sightedness

Answer 27

Hypermetropia

Question 28

Discharge and conjuctivitis - likely causes. 1. purulent - yellow and sticky 2. Mucoid - white and stringy 3. Serous-Watery

Answer 28

1. Bacterial chlamydial 2. Allergic 3. Viral/toxic

Question 29

What does pain from shining a light in good eye or asking patient to follow a target suggest?

Answer 29

Iris inflammation (iritis or anterior uveitis)

Question 30

Signs of acute glaucoma?

Answer 30

Severe pain. Fixed, mid-dilated pupil. Hazy view of iris.

Question 31

How can anterior uveitis present?

Answer 31

Miosis (constricted pupil). irregular pupils due to iris and pupil adhesions

Question 32

Does papilloedema occur unilaterally or bilaterally?

Answer 32

Bilateral

Question 33

What is giant cell arteritis and how is it treated?

Answer 33

Inflammation of medium and large arteries in head and neck. | Urgent treatment with steroids and temporal biopsy within one week of commencing steroids.

Question 34

What chemicals cause more damage to the eye? How are they treated?

Answer 34

Alkali - can penetrate more rapidly (lipophilic) | Restore pH with irrigation. Recover corneal epithelium.

Question 35

How is scleritis treated?

Answer 35

Urgent referral, NSAID, immunosuppressants required.

Question 36

Is posterior vitreous detachment common? What symptoms does it cause?

Answer 36

Yes occurs in 75% of those of 65. | Floaters & flashing lights.

Question 37

When may a patient experience cobweb effect of floaters?

Answer 37

Retinal detachment | Flashes of light, black curtain

Question 38

What is a severe complication of retinal detachment?

Answer 38

Blindness due to the lack of blood supply. URGENT

Question 39

What condition occurs when retinal blood vessels are atherosclerosed?

Answer 39

Amaurosis fugax

Question 40

What is the difference between dry macular degeneration and wet?

Answer 40

Dry is damage caused by build up deposit - drusen. | Wet is damage from the abnormal formation of blood vessels underneath the macula.

Question 41

Is wet or dry AMD more serious?

Answer 41

Wet: vision can deteriorate over days.

Question 42

What condition causes central vision loss?

Answer 42

Macula degeneration

Question 43

What are the symptoms of optic neuritis?

Answer 43

Painful eye movements and dull ache behind the eye. Unilateral temporary visual loss. Loss of colour vision and visual fields.

Question 44

What may indicate a painful third nerve palsy? Why is it important to CT?

Answer 44

Pain. Ptosis Eye lateral and downwards Diplopia. Sign of a berry aneurym

Question 45

What is the concern with painful horner's syndrome?

Answer 45

Carotid dissection until proven otherwise

Question 46

What is the term for near-sightedness? What do they have difficulty seeing?

Answer 46

Myopia Distant objects Correct with concave lens

Question 47

Term for lazy eye.

Answer 47

Amblyopia

Question 48

Types of squint:

Answer 48

Esotropia: eye turning inwards Exotropia: eye turning outwards Hypertropia: eye turning upwards Hypotropia: eye turning downwards