Ophthal

Question 1

What screening should take place for patients with a family history of glaucoma?

Answer 1

Annual screening from the age of 40

Question 2

What are the risk factors for POAG?

Answer 2

Genetics A-C Myopia HTN DM Steroids

Question 3

What are the features of POAG?

Answer 3

Peripheral visual loss Reduced acuity Disc cupping +-pallor

Question 4

How would you investigate for POAG?

Answer 4

Automated perimetry Slit lamp with dilatation Tonometry Central corneal thickness measurement Gonioscopy (measures peripheral anterior chamber configuration and depth)

Question 5

What are the fundoscopic features of ARMD?

Answer 5

Drusen - yellow areas of pigment deposition in and around the macula In wet ARMD, well demarcated red patches may be seen representing haemorrhages

Question 6

What is the typical presentation of ARMD?

Answer 6

Subacute vision loss with: Reduced acuity Difficulties in dark adaptation Fluctuations day to day Photopsia

Question 7

What are the key risk factors for ARMD?

Answer 7

Age>75 Smoking FHx HTN DM

Question 8

What is the first and second line management of allergic conjunctivitis?

Answer 8

1st - topical or systemic antihistamines 2nd - topical mast cell stabilisers e.g. sodium cromoglicate

Question 9

What is the management of ARMD?

Answer 9

Vit ACE for dry reduce progression VEGF useful in wet Laser photogoaculation is beneficial but risks acute visual loss

Question 10

Whatis the goal of treatment in pOAG and what drugs are used?

Answer 10

To reduce IOP Beta blockers e.g. timolol PG analogues e.g. latanoprost Sympathomimetics e.g. brimonidine Carb anhydrase inhibitors - Dorzolamide Miotics e.g. pilocarpine

Question 11

What are the different grades of hypertensive retinopathy, and name the grading system used?

Answer 11

Keith-Wagener classification 1 - Tortous vessels with silver wiring 2 - 1+ AV nipping 3 - 2+ Cotton wool exudates and flame/blot haemorrhages 4- 3+ papilloedema

Question 12

What is seen on fundoscopy of papilloedema?

Answer 12

Venous engorgement Loss of venous pulsation Blurring of optic disc margin Elevation of optic disc

Question 13

What are the causes of papilloedema?

Answer 13

SOL Malignant HTN IIH Hydrocephalus Hypercapnia

Question 14

What are the features of an Argyll Robertson pupil?

Answer 14

Small irregular pupils which accomodate but do not respond to light

Question 15

What is a Hutchinson’s pupil?

Answer 15

Unilaterally dilated pupil which is unresponsive to light. A result of compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma)

Question 16

What are the commonest causes of sudden painless vision loss?

Answer 16

Ischaemic/vascular (amaurosis fugax) Vitreous haemorrhage Retinal detachment Retinal migraine

Question 17

What are the causes of vitreous haemorrhage?

Answer 17

DM bleeding diatheses Anticoagulation

Question 18

What might patients with retinal detachment describe?

Answer 18

Dense shadowing that starts peripherally and progresses towards the centre Like a veil or curtein over the field of vision Straight lines may appear curved

Question 19

What is the management of herpes zoster ophthalmicus?

Answer 19

Oral aciclovir

Question 20

What are the two aims of treatment of acute glaucoma and how is this achieved?

Answer 20

Reduce aqueous secretion - acetazolomide Induce papillary constriction - topical pilocarpine

Question 21

What are the features of acute closed angle glaucoma?

Answer 21

Severe pain Reduced acuity symptoms worse with mydriasis Hard red eye Haloing Non-reactive pupil Corneal oedema N/V +- abdo pain

Question 22

What is seen on fundoscopy of central retinal artery occlusion?

Answer 22

Cherry red macula on a pale retina

Question 23

What ist he management of a stye?

Answer 23

Analgesia and hot compress

Question 24

What distinguishes between non-proliferative and proliferative DMR?

Answer 24

Non-proliferative DMR shows microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous bleeding et/ Proliferative DMR also shows neovascularisation +-viteous haemorrhage

Question 25

What conditions are associated with anterior uveitis?

Answer 25

Ank spon Reactive arthritis UC/Crohns Behcets Sarcoid

Question 26

What is the management of anterior uveitis?

Answer 26

Urgent review Cycloplegics - dilate the pupil for pain relief (e.g. Atropine) Steroid drops

Question 27

What are the classical features of ret pig?

Answer 27

Night blindness initially Tunnel vision

Question 28

What is the strongest risk factor for subcapsular cataracts?

Answer 28

Steroids

Question 29

What are the risk factors for cataracts?

Answer 29

Smoking EtOH Trauma DM Steroids Radiation Myotonic dystrophy Hypocalcaemia

Question 30

Flashers and floaters indicate?

Answer 30

Vitreous/retinal detachment

Question 31

Amaurosis fugax is transient or permanent?

Answer 31

Transient

Question 32

What is the most common cause of vitreous haemorrhage?

Answer 32

Proliferative DMR

Question 33

What is the commonest cause of persistent watery eye in an infant, andhow is it managed?

Answer 33

Nasolacrimal duct obstruction manabed by teaching lacrimal duct massage - 95% of cases will resolve by 1 year

Question 34

What are the side effects of prostaglandin inhibitors such as Latanoprost?

Answer 34

Increased eyelash length Iris pigmentation Periocular pigmentation

Question 35

What investigations are used in ARMD?

Answer 35

Slit lamp microscopy initially Fluorsecein angiography if neovascular disease is suspected Ocular coherence tomography if needed

Question 36

True or false - optic neuritis is associated with Marcus Gunn pupil?

Answer 36

True

Question 37

What should be done for babies with a purulent eye dischagre?

Answer 37

Urgent swabs looking for chlamydia and gonogoccus

Question 38

What are some complications of zoster ophthalmicus

Answer 38

Ant uveitis (commonest) Conjunctivitis Keratitis Episcleritis Ptosis Post herpetic neuralgia

Question 39

Myopia and hypermetropia relevance to glaucoma?

Answer 39

Acute closed angle glaucoma is assocaited with hypermetropia Primary open angle glaucoma is associated with myopia

Question 40

Does hyper or hypocalcaemia predispose to cataracts?

Answer 40

Hypocalcaemia

Question 41

What is the strongest predictor of ocular involvement in zoster ophthlalmicus?

Answer 41

Hytchinson's sign

Question 42

When would you see a dendritic ulcer on fluorescein eye staining?

Answer 42

Herpes simplex keratitis

Question 43

A 79-year-old gentleman presents with a 3 months history of a red swollen left upper eyelid. He remembers initially developing a bump on the eyelid which was uncomfortable but then got bigger forming a hard lump. He reports no pain currently and has not noted any problems with his vision and the eye itself appears healthy.

Answer 43

Chalazion/Meibomian cyst, which occurs after the progression of an internal stye (hordeolum intermum)

Question 44

What is the classical presentation of optic neuritis?

Answer 44

Vision loss Eye pain 'behind the eye' Red desaturation

Question 45

What type of scan would you do to assess the posterior spread of infection in orbital cellulitis?

Answer 45

Contrast CT of the orbits, sinuses and brain

Question 46

What is a contraindication to vitamin/antioxidant therapy for ARMD?

Answer 46

Smoking - because beta carotene increases risk of lung cancer

Question 47

Bilateral grittiness worse first thing in the morning indicates?

Answer 47

Blepharitis

Question 48

What are the classical features of central retinal vein occlusion?

Answer 48

Sudden painless loss of vision with severe retinal haemorrhaging on fundoscopy

Question 49

What should be done for young children with a squint?

Answer 49

Ophthal referral

Question 50

Which medication causes brown pigmentation of the iris?

Answer 50

Latanoprost

Question 51

What is the first line glaucoma treatment for patients with heart block?

Answer 51

Latanoprost

Question 52

What drug causes pupillary copnstriction, blurred vision and headahces?

Answer 52

Pilocarpine

Question 53

What conditions cause tunnel vision?

Answer 53

Papilloedema Glaucoma Ret Pig Choroidretinitis Optic atrophy

Question 54

What type of eyedrop might cause a corneal ulceration?\>

Answer 54

Steroids - through fungal infection

Question 55

What are the features of episcleritis?

Answer 55

Red eye classically not painful Watering +- mild photophobia Phenylephrine induced blanching of the vessels (not the case in scleritis)

Question 56

How does latanoprost work in the management of POAG?

Answer 56

Increases uveoscleral outflow

Question 57

Stormy sunset appearance?

Answer 57

Central retinal vein occlusion

Question 58

What clinical feature differentiates scleritis from episcleritis?

Answer 58

Pain only seen in scleritis

Question 59

What clinical test may be used to detect a strabismus?

Answer 59

orneal light reflection test, where a light source is held 30cm from the child's face to assess reflection symmetry on the pupils

Question 60

What is the MOA of dorzolamide?

Answer 60

Carbonic anhydrase inhibitor

Question 61

What type of visual impairment does POAG cause?

Answer 61

Peripheral visual field impairment

Question 62

Long hx of diabetes in an elderly patient presenting with unilateral blurring and halos is strongly indicative of?

Answer 62

Cataracts

Question 63

Answer 63

Treated diabetic retinopathy

Question 64

Answer 64

Age related macular disease

Question 65

Answer 65

Papilloedema

Question 66

Answer 66

Age related macular degeneration

Question 67

Answer 67

Retinal detachment

Question 68

Answer 68

Central retinal artery occlusion

Question 69

Answer 69

Proliferative retinopathy

Question 70

Answer 70

Retinitis pigmentosa

Question 71

Answer 71

Treated diabetic retinopathy

Question 72

Answer 72

Entropion

Question 73

Answer 73

Ectropion

Question 74

Answer 74

Retinal detachment

Question 75

Answer 75

Age related macular degeneration

Question 76

Answer 76

Central retinal vein occlusion