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Fire Through Finals > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are the causes of sudden painful visual loss?

How do you differentiate them clinically

A

Closed angle glaucoma: Red eye, hazy cornea, dilated pupil

Anterior uveitis: flush, iris pus, fixed oval pupil

Optic neuritis: central loss, colour loss, RAPD, worse on movement

Giant cell arteritis: Painful jaw/ scalp

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2
Q

What are causes of painless sudden visual loss?

How do you distinguish them?

A

Amaurosis fugax: ‘curtain coming down’,

Central retinal artery occlusion: RAPD, ‘cherry red’ spot on pale retina

Central retinal vein occlusion: retinal haemorrhages

Vitreous haemorrhage: Dark spots, diabetics, anticoagulants

Posterior vitreous detachment: Flashes and floaters

Retinal detachment: Dense shadows peripheral to central; curtain over visual field

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3
Q

Name and distinguish the causes of gradual visual loss?

A

Cataracts: ‘starbursts’ at night, red reflex loss

ARMD: central field loss, wavy appearance to straight lines

Diabetic retinopathy: blurred, blotched vision, ‘cotton wool’ spots

Chronic open angle glaucoma: peripheral loss, halos, can be painful

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4
Q

How do you manage acute angle closure glaucoma?

A

Urgent referral to ophtho

Improve flow: pilocarpine and apraclonidine

Reduce secretions: B-blocker IV acetazolamide

*Blockers/inhibitors block production, agonists improve flow, a–agonists do both)

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5
Q

How do you manage anterior uveitis

A

Urgent Ophtho review

Dilate eye with atropine, cyclopentate

Steroid eye drops for inflammation

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6
Q

How do you manage optic neuritis

A

Give high dose steroids

MRI for white matter lesions (>3 measns 50% MS risk in 5 yrs)

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7
Q

How do you treat giant cell arteritis?

A

Give high dose glucocorticoids (IV methylprednisilone if evolving changes prior to pred)

Optho review same day

Artery biopsy

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8
Q

How do you treat amaurosis fugax?

A

Aspirin 300mg as per stroke

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9
Q

How do you manage

CRVO

A

CRVO

Macular oedema: Anti-VEGF

Neovascularisation: Lasering

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10
Q

How are vitreous haemorrahge and retinal detachment managed?

A

Urgent Ophtho review

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11
Q

How are cataracts managed?

A

If visual impairment, QOL and patient choice are fitting, lens replacement

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12
Q

How is age related macular degeneration investigated and managed?

A

Investigations

1st: Slit lamp

+ fluoreiscin angiography if neovascular suspected

Management

vitamins A, C, E

VEGF if wet/neovascular

+ laser photocoagulation to slow progression

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13
Q

How is diabetic retinopathy categorised?

A

Non-proliferative

Mild: >=1 microaneurysm

Moderate: Cotton wool spots, hard exudates

Severe: Blot haemorrhages in 4 quadrants, venous bleeds in 2

Proliferative

neovascularisation

Maculopathy

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14
Q

How do you manage diabetic retinopathy?

A

All: Optimise cardiac risk factors, regular review

Non-proliferative: Observe, laser photocoag if severe

Proliferative: laser coagulation

Maculopathy: VEGF if visual acuity change

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15
Q

How do you investigate primary open angle glaucoma?

A

Fundoscopy: cup/disc 0.7 pallor and bayonetting of vessels

Slit lamp, tonometry to confirm

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16
Q

How do you tell the difference between keratitis and conjunctivitis?

A

Keratitis // Conjuncitvitis

hypopyon, contact lense // discharge if infective, seasonal, atopic history if allergic

17
Q

How do you manage keratitis?

A

Refer to Ophtho same day for slit lamp

Stop contact lenses

Quinilone antibiotics

Cycloplegics for pain

18
Q

How do you investigate and treat herpes simplex keratitis?

A

Immediate referral to Ophtho

Fluoreiscin staining shows corneal ulcer

give oral aciclovir

19
Q

What organism is responsible for keratitis that is

Bacterial

Fungal

Viral

A

Bacterial: S. aureus, P. aeringuosa (contacts)

Fungal: Acanthomoebic (soil, contaminated water)

Viral: Herpes simplex

20
Q

How do viral, bacterial and allergic conjunctivitis differ

Demographic

Symptoms

Treatment

Pathogen

A

Viral // Bacterial // allergic

Adults // Children // equal

Watery discharge, URTI // Thick discharge // watery discharge, itch

Self-limiting 1-2w // if 5-7d, chloramphenicol // antihistamine –> mast cell stabilisers

adeno, HSV // S. aureus, chlamydia, gonorrhea // NA

21
Q

What is the difference between esophoric and exophoric ambylopia?

How are they managed

A

Eso: Inward, Exo: Outwards

Covering good eye causes other to move opposite way

Refer for Ophtho

Specs/patch good eye/corrective surgery

*tropia if all the time, phoria if sometimes*

22
Q

Which ophtho meds cause

brown pigmentation, eyelash growing

Hyperaemia, adversity in MAOIs or TCAs

Headaches, blurred vision

A

PGE analogues (lantaprost)

sympathomimetics (brimonidine)

pilocarpine

23
Q

What nerve damage causes the following

Down + out eye, dilated eye

Up and outward rotation, vertical diplopia

Eye cannot abduct

A

3rd nerve (oculomotor)

4th nerve (superior oblique)

6th nerve (abducens)

24
Q

What is the difference between a Holmes-Adie pupil and Argyll-Robertson?

A

HA: Unilateral dilation, slow dilation following constriction; will get smaller over time. +/- ankle and knee reflex loss

AR: Constricted pupil that accomodates but does not react. Neurosyphilis.

25
Q

Name the location of the lesion and the associated pathologies

A
  1. Optic nerve: ipsilateral loss (neuritis, ischaemia, trauma)
  2. Optic chiasm central: bitemporal hemianopia (adenoma, suprasellar aneurysm)
  3. Optic chiasm lateral: ipsilateral monocular hemianopia (3rd ventricle distension, IC/PCA atheroma)

4. Optic tract: contralateral homonymous hemianopia (MCA stroke and tumours)

5. Occipital cortex: contralateral homonymous hemianopia with macular sparing (PCA stroke, trauma)

26
Q

Contralateral homonymous quandrantopia is associated with

A

MCA stroke, tumour and trauma

27
Q

What’s this?

A

Normal retina

28
Q

Whats this?

A

Central retinal artery occlusion

29
Q

Whats this

A

Central retinal vein occlusion

30
Q

Whats this?

A

Maculopathy

Advanced diabetic retinopathy

31
Q

Whats this?

A

ARMD

32
Q
A

Fire Through Finals (32 decks)

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