Ophthalmology

Question 1

What effect can improving diabetic control have on diabetic retinopathy?

Answer 1

Initial worsening, this will wear off

Question 2

What are the four stages of diabetic retinopathy?

Answer 2

Mild non proliferative
Moderate non proliferative
Severe non proliferative
Proliferative

Question 3

What is seen in mild non proliferative diabetic retinopathy?

Answer 3

Microaneurysms

Question 4

What is seen in moderate non proliferative diabetic retinopathy?

Answer 4

Mild +
Hard exudates
Flame shaped haemorrhages

Question 5

What is seen in severe non proliferative diabetic retinopathy?

Answer 5

Microaneurysms + one of:
- >4 per quadrantt dot + blot haemorrhages
- >2 quadrants with venous changes
- IRMA

Question 6

What does IRMA stand for?

Answer 6

Intra-retinal microvascular abnormalities

Question 7

What characterises proliferative diabetic retinopathy?

Answer 7

Neovascularisation

Question 8

What is the leading cause of blindness in diabetics?

Answer 8

Diabetic macular oedema (DME)

Question 9

When is treatment done for DME?

Answer 9

When vision is reduced

Question 10

What are the treatment options for DME?

Answer 10

Anti-VEGF injections
Focal laser

Question 11

When is management done for diabetic retinopathy?

Answer 11

If proliferative

Question 12

What is the management for proliferative diabetic retinopathy?

Answer 12

Panretinal photocoagulation

Question 13

What causes glaucoma?

Answer 13

Blockage of aqueous outflow across the trabecular meshwork

Question 14

Name three signs of glaucoma

Answer 14

Raised IOP
Visual field defects
Optic disc cupping

Question 15

How can you assess someones IOP in glaucoma?

Answer 15

Applanation tonometry

Question 16

How do most cases of primary open angle glaucoma present?

Answer 16

Incidental finding at routine optician appointments

Question 17

How do prostaglandins work in glaucoma?

Answer 17

Open up the meshwork to increase uveoscleral outflow

Question 18

Name a prostaglandin that may be used in glaucoma

Answer 18

Xalatan

Question 19

What are some possible side effects of prostaglandins in glaucoma?

Answer 19

Increased pigmentation of the irises
Lengthened eyelashes

Question 20

What is the first line management of glaucoma?

Answer 20

Prostaglandins

Question 21

Name a parasympathominetic used for glaucoma

Answer 21

Pilocarpine

Question 22

What side effect can pilocarpine have?

Answer 22

Pupillary constriction = can be painful and can cause dimmed vision

Question 23

State the order of treatments for glaucoma

Answer 23

1st line = prostaglandin
2nd line = add a beta blocker or carbonic anhydrase inhibitor
3rd line = laser treatment
4th line = ANS influencing drugs
5th line = surgery

Question 24

What surgery can be done for glaucoma?

Answer 24

Trabeculectomy

Question 25

How does optic neuritis present?

Answer 25

Loss of colour vision Dull ache on eye movements

Question 26

What is the most common cause of optic neuritis and what investigation should be offered in the first episode?

Answer 26

Multiple sclerosis Offer an MRI

Question 27

What is the concern when patients have bilateral optic disc swelling?

Answer 27

Papilloedema

Question 28

What is the direct pupillary response?

Answer 28

Constriction of the pupil light is being shone on

Question 29

What is the consensual pupillary response?

Answer 29

Constriction of the pupil the light is not being shone on

Question 30

What is the accommodation response?

Answer 30

Constriction of the pupil when looking at an object up close

Question 31

What is Horner's syndrome?

Answer 31

Paralysis of the sympathetic supply to the eye

Question 32

How does Horner's syndrome present?

Answer 32

Mild ptosis Constricted pupil Reduced sweating