Ophthalmology

Question 1

Meaning of amblyopia, anisocoria, miosis, mydriasis, myopia, hyperopia?

Answer 1

Amblyopia = “lazy eye”
Anisocoria = difference in pupil size
Miosis = small pupil
Mydriasis = large pupil
Myopia = short sighted
Hyperopia = far sighted

Question 2

Nervous control of extraocular muscles?

Answer 2

Lateral rectus (CN VI)
Superior oblique (CN IV)
Superior rectus, inferior rectus, medial rectus, inferior oblique, levator palpebrae superioris (CN III)

Question 3

Homonymous hemianopia lesion sites?

Answer 3

Occipital lobe
Optic tract
Optic radiations

Question 4

Bitemporal hemianopia lesion site?

Answer 4

Optic chiasm

Question 5

Homonymous quadrantanopia lesion site?

Answer 5

Superior quadrantanopia = inferior optic radiation (temporal lobe)
Inferior quadrantanopia = superior optic radition (parietal lobe)

Question 6

Features and main cause of CN III palsy?

Answer 6

Eye “down and out”
Ptosis
Mydriasis
Main cause = cranial aneurysm
N.B. painful CN III palsy is indicative of a posterior communicating artery aneurysm

Question 7

Features and main cause of CN IV palsy?

Answer 7

Eye “up and in”
Vertical diplopia
Head tilt to compensate
Main cause = trauma

Question 8

Features and main cause of CN VI palsy?

Answer 8

Eye turned inwards
Horizontal diplopia
Main cause = raised ICP

Question 9

Classification of strabismus?

Answer 9

Direction of deviation:
→ nasally = esotropia
→ temporal = exotropia
→ superiorly = hypertropia
→ inferiorly = hypotropia

Question 10

Investigation and management of strabismus (squint)?

Answer 10

Corneal light reflection test
Management = ophthalmology referral, eye patch to prevent amblyopia

Question 11

Features and management of infective conjunctivitis?

Answer 11

Sore, itchy, red eyes
Excessive discharge
No change in visual acuity
Management = usually self-resolving, chloramphenicol (non-pregnant), fusidic acid (pregnant)

Question 12

Red flag in suspected conjunctivitis and why?

Answer 12

Photophobia (suggests corneal involvement)

Question 13

Features and management of allergic conjunctivitis?

Answer 13

Sore, itchy, red eyes
Eyelid involvement
Seasonal symptoms
PMH atopy e.g. eczema
Management = antihistamines (1st line), mast cell stabilisers (2nd line)

Question 14

Most common cause of keratitis in contact lens wearers vs non-contact lens wearers?

Answer 14

Wearers = pseudomonas auerginosa
Non-wearers = staphylococcus aureus

Question 15

Keratitis organism in soil or contaminated water?

Answer 15

Acanthomoeba

Question 16

Features and management of keratitis?

Answer 16

Acute red eye
Gritty sensation
Loss of visual acuity
Photophobia
Hypopyon, corneal ulcer
Anterior chamber reaction (cells and flare)
Management = topical quinolone + cycloplegic drops

Question 17

Main cause of a corneal ulcer?

Answer 17

Infection e.g. keratitis

Question 18

HSV keratitis feature and management?

Answer 18

Dendritic ulcer on fluorescein stain
Management = topical aciclovir

Question 19

Most common condition associated with scleritis vs episcleritis?

Answer 19

Scleritis = rheumatoid arthritis
Episcleritis = IBD

Question 20

Features and management of episcleritis?

Answer 20

Acute red eye
Classically not painful
Increased lacrimation
Management = supportive e.g. artifical tears

Question 21

Features and management of scleritis?

Answer 21

Acute red eye
Classically painful
Increased lacrimation
Loss of visual acuity
Management = NSAID (1st line), steroid (2nd line)

Question 22

Test to differentiate scleritis from episcleritis and explain?

Answer 22

Phenylephrine eye drops
→ blanches conjunctival and episcleral vessels but not scleral
→ if redness improves, episcleritis diagnosed

Question 23

Most common causes of blepharitis?

Answer 23

Meibomian gland dysfunction
Seborrhoeic dermatitis
Staphylococcal infection

Question 24

Features and management of blepharitis?

Answer 24

Gritty, sore eyes
Eyes stuck together on waking
Styes and chalazions
Management = hot compress + lid hygeiene

Question 25

Features and management of anterior uveitis (iritis)?

Answer 25

Acute red eye Photophobia Ciliary flush Small, oval pupils Hypopyon Loss of visual acuity HLA-B27 associations Anterior chamber reaction (cells and flare) Management = steroid + cycloplegic drops

Question 26

Features and management of periorbital cellulitis?

Answer 26

Generally unwell e.g. fever Red and swollen eye Ptosis Management = admission + oral antibiotics

Question 27

Features and management of orbital cellulitis?

Answer 27

Generally unwell e.g. fever Red and swollen eye Proptosis Pain on eye movement Management = admission + IV antibiotics

Question 28

Investigation for suspected orbital cellulitis?

Answer 28

Contrast CT head

Question 29

What are glaucomas?

Answer 29

Optic neuropathies associated with raised ICP

Question 30

Features, investigations and management of acute angle-closure glaucoma?

Answer 30

Acute, severe pain Loss of visual acuity Haloes around lights Nausea and vomiting Dilated, nonreactive pupil Investigations = tonometry (IOP), gonioscopy Management = timolol + pilocarpine + acetazolamide (acute), laser peripheral iridotomy (definitive)

Question 31

Features and management of primary open-angle glaucoma?

Answer 31

Insidious onset Peripheral visual loss Loss of visual acuity Optic disc cupping Management = treat if IOP ≥24 mmHg, SLT surgery (1st line), medication (2nd line)

Question 32

Normal cup-to-disc ratio?

Answer 32

0.4-0.7

Question 33

Mechanism of action of latanoprost vs pilocarpine vs acetazolamide vs timolol?

Answer 33

Latanoprost, pilocarpine = increases uveoscleral outflow Acetazolamide, timolol = reduced aqueous humour production

Question 34

Features and management of central retinal artery occlusion?

Answer 34

Sudden painless vision loss "Cherry red" spot on a pale retina Management = treat underlying cause

Question 35

Features and management of central retinal vein occlusion?

Answer 35

Sudden painless vision loss Widespread hyperaemia Severe retinal haemorrhages "Stormy sunset" appearance Management = supportive

Question 36

Most common cause of blindness in the UK?

Answer 36

Age-related macular degeneration

Question 37

Features and management of dry vs wet macular degeneration?

Answer 37

Dry = gradual visual loss, drusen → zinc + vitamin A, C and E Wet = subacute visual loss, neovascularisation, haemorrhages → anti-VEGF

Question 38

Tool used to assess line distortion in macular degeneration?

Answer 38

Amsler grids

Question 39

Features and management of cataracts?

Answer 39

Gradual visual loss Haloes around lights Glare from lights Loss of red reflex Management = cataract surgery

Question 40

Serious complication of cataract surgery and management?

Answer 40

Endophthlamitis Management = intravitreal vancomycin

Question 41

Investigation to differentiate refractive error vs other pathology causing blurred vision?

Answer 41

Pinhole occluders when reading Snellen chart → improvement indicates refractive error

Question 42

Pathwway of pupillary light reflex?

Answer 42

Afferent = retina → CN II → lateral geniculate body → midbrain Efferent = Edinger-Westphal nucleus (midbrain) → CN III

Question 43

RAPD clinical finding and causes?

Answer 43

Affected and normal eye dilate when light is shone on the affected → retinal pathology e.g. detachment → CN II pathology e.g. optic neuritis

Question 44

Features, investigation and management of optic neuritis?

Answer 44

Loss of visual acuity Poor colour discrimination Pain on eye movement Central scotoma Investigation = MRI with gadolinium contrast Management = IV methylprednisolone

Question 45

Classification of diabetic retinopathy?

Answer 45

Non-proliferative diabetic retinopathy (NPDR) Proliferative diabetic retinopathy (PDR) Maculopathy

Question 46

Features and management of NPDR vs PDR?

Answer 46

NPDR = microaneurysms, blot haemorrhages, hard exudates, cotton wool spots Management = observation PDR = as above + neovascularisation Management = panretinal laser photocoagulation + anti-VEGF

Question 47

Staging of hypertensive retinopathy?

Answer 47

I = arteriole narrowing, silver wiring II = arteriovenous nipping III = cotton wool spots, flame and blot haemorrhages IV = papilloedema

Question 48

Features of posterior vitreous detachment?

Answer 48

Sudden flashes floaters Loss of visual acuity

Question 49

Features of retinal detachment?

Answer 49

Shadow peripheral → central "Curtain" over visual field Flashes and floaters Loss of visual acuity

Question 50

Features of vitreous haemorrhage?

Answer 50

Multiple dark spots Floaters Red hue Loss of visual acuity