Ophthalmology

Question 1

P Uvea=

Answer 1

iris + ciliary body + choroid

Question 2

Production and flow of aqueous humour

Answer 2

Produced by posterior ciliary body, travels through pupil to anterior chamber. Trabeculum and Cansl of Schlemm take back to venous system.
Maintain 10-21mmHg normal pressure on the eye

Question 3

Differentials for painful loss of vision

Answer 3

GCA, unveitis, keratitis, conjunctivitis, acute angle glaucoma

Question 4

Differentials for painless loss of vision

Answer 4

Retinal detachment, vitreous haemorrhage, retinal artery occlusion, anterior ischemic optic neuropathy

Question 5

Red flags for visual loss

Answer 5

Headache (do an ESR if over 50)
Eye movements painful (optic neuritis)
Lights or flashes preceding visual loss (retinal detachment)
“like a curtain descending” (amaurosis fungax, preceding peripheral vision loss)
Poorly controlled DM (virtuous haemorrhage)

Question 6

Central retinal artery occlusion appearance on fundoscop

Answer 6

Pale retina, macula has cherry red spot. Attenuated blood vessels.

Question 7

Sudden painless loss of vision, fundoscopy shows many flame haemorrhages in all quadrants: Diagnosis?

Answer 7

Central retinal vein occlusion

Question 8

Risks for retinal detachment

Answer 8

pathological myopia
Trauma
Previous retinal detachment
Intraocular surgery

Question 9

Unilateral swelling of optic disc differentials

Answer 9

NIGHT TIC
Neuritis
Infectious
Granulomatous
Hereditary
Toxic

Traumatic
Infiltrative
Compressive

Question 10

Papilloedema differentials

Answer 10

=see bilateral swelling of optic disc specifically due to raised ICP
Space occupying lesion
Idiopathic intracranial hypertension
Obstructive hydrocephalus
Venous sinus thrombosis

Question 11

Differentials for gradual loss of vision

Answer 11

glaucoma
AMD
cataracts
Diabetic and hypertensive retinopathy

Question 12

open angle glaucoma

Answer 12

increased resistance to aqueous outflow leads to slow and Insidious rise in intraocular pressure. May have decreased visual fields and acuity.
Fingins: High IOP
Incteased cup to disc ratio
Scotoma, peripheral field loss, Central sparing

Question 13

Management of open angle glaucoma

Answer 13

Prostaglandin analogues (reduce aqueous humor production)
Beta blockers

Question 14

Acute angle glaucoma

Answer 14

Lens pushes against iris, closed angle blocks aqueous drainage. Acute rise in intraocular pressure -> red, painful eye, photophobia, N&V, red haloes
Cloudy cornea and middilated sluggish pupils

Question 15

Risks for acute angle glaucoma

Answer 15

Hypermetropia
DM
Trauma
Indian ethnicity

Question 16

Management of acute angle glaucoma

Answer 16

Urgently reduce IOP: IV acetazolamide, pilocarpine and beta blocker
Then laser iridotomy

Question 17

Age-related macular degeneration fundoscopy

Answer 17

Yellow spots around macular = drusen, dry AMD, build up of deposits between retinal pigment epithelium and Brooke’s membrane
If haemorrhagic look = wet AMD

Question 18

Symptoms of AMD

Answer 18

Metamorphopsia, blurred vision, Central scotoma, visual fluctuation
Most common cause of irreversible visual loss on developed world

Question 19

Risk factors for AMD

Answer 19

Age
Smoking
Cardiovascular disease
Cataract surgery
Caucasian ethnicity
Family history

Question 20

Cataracts presentation

Answer 20

clouding of lens in different layers, leads to gradual painless loss of vision, glare

Question 21

Stage I Keith Wagener classification of hypertensive retinopathy

Answer 21

Arteriolar narrowing and tortuosity. Incr light reflex - silver wiring

Question 22

Stage II Keith Wagener classification of hypertensive retinopathy

Answer 22

Arterio-venous nipping

Question 23

Stage III Keith Wagener classification of hypertensive retinopathy

Answer 23

Cotton wool exudates
Flame and blot haemorrhages

Question 24

Stage IV Keith Wagener classification of hypertensive retinopathy

Answer 24

Papilloedema

Question 25

Fearures of anterior uveitis

Answer 25

Acute onset Ocular discomfort and pain (may incr w use) Pupil may be small and possibly irregular due to sphincter muscle contraction Photophobia Lacrimation Red eye Blurred vision Ciliary flush (ring of red spreading out) Hypopyon (pus and inflammatory cells in anterior chamber, often visible fluid level) Visual acuity initially normal but becomes impaired

Question 26

Anterior uveitis associations

Answer 26

Ankylosing spondylitis Reactive arthritis IBD Behcet's disease Sarcoidosis

Question 27

Management of anterior uveitis

Answer 27

Cycloplegics to dilate pupil, eg atropine Steroid eye drops

Question 28

Pathophysiology of diabetic retinopathy

Answer 28

Hyperglycemia leads to increased retinal blood flow, abnormal metabolism in vessel walls. Therefore there is damage to the endothelial cells and pericytes, so increased vascular permeability and formation of exudates; retinal ischaemia and so neovascularisation; pericyte dysfunction and so micrpaneurysms

Question 29

Mild non proliferative diabetic retinopathy

Answer 29

1+ microaneurysm

Question 30

Moderate non proliferative diabetic retinopathy

Answer 30

Microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous beading/looping

Question 31

Severe non proliferative diabetic retinopathy

Answer 31

Blot hemorrhages and microaneirysms in four quadrants Venous bleedijg in at least 2 quadrants Intraretinal microvasculature abnormal in at least 1 quadrant

Question 32

Proliferative diabetic retinopathy

Answer 32

Retinal neovascularisarion (may lead to vitreous haemorrhage) Fibrous tissue anterior to retinal disc More common in DM 1 30% blind in 5 years

Question 33

Maculopathy

Answer 33

Located in the macula so any pathology is more serious Hard exudates and other background change Check visual acuity More common in DM2

Question 34

Management of non proliferative diabetic retinopathy

Answer 34

Optimize glycaemic control Control BP Control hypelipidaemia Regular ophthalmology review If severe consider panretinal laser photocoagulation

Question 35

Management of proliferative diabetic retinopathy

Answer 35

Optimize glycaemic control Control BP Control hypelipidaemia Regular ophthalmology review Panretinal lazer photocoagulatiom VEGF inhibitor

Question 36

Pilocarpine in acute angle glaucoma

Answer 36

Direct parasympathomimetic Increases vitreous outflow

Question 37

Timolol in acute angle glaucoma

Answer 37

Beta Blocker Decreases aqueous humor production

Question 38

Apraclonidine in acute angle glaucoma

Answer 38

Alpha2 agonist

Question 39

Blepharitis

Answer 39

Inflammation of eyelid margins, causes red eye

Question 40

Entropion and ectropion

Answer 40

EN= inturned eyelids EC= outturned eyelids