Ophthalmology

Question 1

When are nuclear and subcapsular cataracts common?

Answer 1

Nuclear: old age
Subcapsular: steroid use

Question 2

Cataracts presentation?

Answer 2

Increasing myopia (nearsightedness)
Blurred vision
Halos
Glare
Red reflex defect

Question 3

Cataracts investigations

Answer 3

Ophthalmoscopy: darkened red reflex
Slit-lamp: visible cataract

Question 4

Cataracts management

Answer 4

Conservative
Medical: mydriatic eye drops
Surgical (dependent on impact on patient)

Question 5

Central retinal artery occlusion cause

Answer 5

Thromboembolism or arteritis

Question 6

Central retinal artery occlusion presentation and fundoscopy

Answer 6

Sudden, painless unilateral vision loss (if partial, it’s branch not central)
RAPD
Cherry red spot on pale retina

Question 7

Central retinal vein occlusion fundoscopy

Answer 7

Widespread hyperaemia
Sever retinal haemorrhages (stormy sunset)

Question 8

Central retinal vein occlusion treatment

Answer 8

Conservative
Can consider anti-VEGF or laser photocoagulation

Question 9

Presentation of ischaemic vs non-ischaemic central retinal vein occlusion vs branch

Answer 9

Ischaemic - total vision loss
Non-ischaemic - mild loss of vision
Branch - asymptomatic unless macula involved

Question 10

Central retinal artery occlusion management

Answer 10

Eyeball massage
Carbogen therapy

Question 11

Viral vs bacterial vs allergic conjunctivitis presentation

Answer 11

Viral: serous discharge, unilateral
Bacterial: purulent discharge, unilateral
Allergic: pruritic, bilateral

Question 12

Infective conjuncitivitis management (including contact lens users)

Answer 12

Settles without treatment in 1-2 weeks
Can use 1) chloramphenicol drops 2) fusidic acid

Contact lens users: remove lens, same-day ophthalmologist review (topical fluoresceins to check staining)

Question 13

Acute angle-closure glaucoma features

Answer 13

Ocular pain or headache
Hard, red eye
Halos
Semi-dilated non-reacting pupil

Question 14

Acute angle-closure glaucoma investigation

Answer 14

Gonioscopy with slit lamp

Question 15

Acute angle-closure glaucoma management

Answer 15

Urgent ophthalmologist referral to lower the pressure, then definitive surgical treatment

Eye drops:
Parasympathomimetic e.g. pilocarpine (for outflow)
Beta-blocker (decreased AH production)
Alpha-2 agonst (both actions)

Laser peripheral iridotomy

Question 16

Primary open-angle glaucoma presentation

Answer 16

Peripheral visual field loss
Similar to acute but slower

Question 17

Condition with optic disc cupping and bayonetting of vessels?

Answer 17

Primary open-angle glaucoma

Question 18

What is keratitis?

Answer 18

Inflammation of cornea

Question 19

Keratitis features

Answer 19

Red eye
White corneal opacity
Gritty sensation

Question 20

Bacterial cause of keratitis in contact-lens users

Answer 20

P. aerigunosa

Question 21

When to refer in keratitis

Answer 21

Visual loss
Contact-lens user

Question 22

Keratitis slit-lamp finding

Answer 22

Green fluorescein staining

Question 23

Keratitis management

Answer 23

Topical quinolones/acyclovir
Cycloplegic (pain relief)
Stop using contact-lens until symptoms resolve

Question 24

Most common cause of blindness in the UK

Answer 24

Age-related macular degeneration

Question 25

Age-related macular degeneration presentation

Answer 25

Central visual loss
Fluctuating visual disturbance
Flickering light and glare
Visual hallucinations
Poorer night vision

Question 26

Difference between dry and wet macular degeneration seen on the retina

Answer 26

Dry (most common): drusen (yellow round spots in Bruch’s membrane)
Wet: choroidal neovascularisation

Question 27

What can be used to identify distortion of line perception in age-related macular degeneration?

Answer 27

Amsler grid testing

Question 28

What is an important investigation in age-related macular degeneration to visualise the retina in 3D?

Answer 28

Ocular coherence tomography

Question 29

Dry age-related macular degeneration treatment

Answer 29

Zinc + anti-oxidant vitamins A, C, E

Question 30

Wet age-related macular degeneration treatment

Answer 30

Anti-VEGF

Question 31

Orbital cellulitis presentation

Answer 31

Redness and swelling around the eye
Pain with/without eye movements
Proptosis
Reduced visual acuity

Question 32

Orbital cellulitis imaging

Answer 32

CT with contrast

Question 33

Orbital cellulitis management

Answer 33

Admission for IV cefuroxime

Question 34

Retinal detatchment presentation

Answer 34

Floaters or flashes
Painless
Progressive visual field loss from periphery to centre

Question 35

Retinal detachment on fundoscopy

Answer 35

Lost red reflex
Pale, opaque, wrinkled retinal folds
May appear normal if small

Question 36

Retinal detachment management

Answer 36

Urgent referral for surgery

Question 37

Difference between concomitant and paralytic strabismus

Answer 37

Concomitant - imbalance of extraocular muscles (convergent more common)
Paralytic - paralysis of extraocular muscles (CN III, IV, VI palsy)

Question 38

Tests for strabismus

Answer 38

Corneal light reflection
Cover test

Question 39

Anterior uveitis features

Answer 39

Hypopyon (pus in anterior chamber)
Small and irregular pupil
Intense photophobia
Pain
Red eye

Question 40

Anterior uveitis management

Answer 40

Urgent ophthalmology review
Steroid drops
Cycloplegic drops (pain and photophobia)

Question 41

Vitreous haemorrhage presentation

Answer 41

Sudden painless loss of vision or haze
Red hue
Floaters or dark spots

Question 42

Vitreous haemorrhage management

Answer 42

Small: spontaneous reabsorption
Larget: vitrectomy