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Year 6 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

what is affected in Holmes-Adie pupil?

A

the ciliary ganglion

can be because of infection

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2
Q

is the pupil constricted or dilated in Holmes-Adie?

A

dilated

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3
Q

causes of dilated pupil [5]

A

Holmes-Adie
Oculomotor nerve palsy
Cocaine, Amphetamines
atropine, tropicamide
Phaeochromocytoma

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4
Q

does Horner’s cause a constricted or dilated pupil?

A

constricted

[when you are horny, you aim for the constricted hole]

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5
Q

features of optic neuritis [5]

A
  • unilateral decrease in visual acuity over hours or days
  • poor discrimination of colours, ‘red desaturation’
  • pain worse on eye movement
  • relative afferent pupillary defect
  • central scotoma

or CRAP
- central scotoma
- RAPD
- acuity loss
- painful eye movement

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6
Q

investigation for optic neuritis

A

MRI of the brain and orbits with gadolinium contrast

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7
Q

features of mild non proliferative diabetic retinopathy

A

1 or more microaneurysm

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8
Q

features of moderate non proliferative diabetic retinopathy [5]

A
  • microaneurysms
  • blot haemorrhages
  • hard exudates
  • cotton wool spots (‘soft exudates’ - represent areas of retinal infarction), - venous beading/looping
  • intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
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9
Q

features of severe non proliferative diabetic retinopathy

A
  • blot haemorrhages and microaneurysms in 4 quadrants
  • venous beading in at least 2 quadrants
  • IRMA in at least 1 quadrant
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10
Q

features of proliferative diabetic retinopathy [3]

A
  • retinal neovascularisation - may lead to vitrous haemorrhage
  • fibrous tissue forming anterior to retinal disc
  • more common in Type I DM, 50% blind in 5 years
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11
Q

treatment of maculopathy

A

VEGF inhibitors

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12
Q

treatment of proliferative diabetic retinopathy [3]

A
  • panretinal laser photocoagulation
  • VEGF inhibitors
  • vitreoretinal surgery
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13
Q

complications of retinal photocoagulation [4]

A
  • MAIN: decreased night vision (reduced rods in the periphery)
  • macular oedema
  • visual field reduction
  • decreased visual acuity
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14
Q

causes of anhidrosis of face, arms and trunk [5]

where is the lesion?

A

central lesions

Stroke
Syringomyelia
Multiple sclerosis
Tumour
Encephalitis

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15
Q

causes of anhidrosis of the face [4]three Ts

where is the lesion?

A

preganglionic lesions

Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib

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16
Q

causes of postganglionic lesions that don’t cause anhidrosis [4C]

A

Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

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17
Q

Differentiating orbital from preseptal cellulitis [3]

A
  • reduced visual acuity
  • proptosis
  • ophthalmoplegia/pain with eye movements

are NOT consistent with preseptal cellulitis

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18
Q

Main imaging for orbital cellulitis

A

CT with contrast of orbits, sinuses, brain

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19
Q

complications of orbital cellulitis [2]

A

cavernous sinus thrombosis and intracranial spread and abscess

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20
Q

what structures are affected in orbital cellulitis

A

result of an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe.

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21
Q

features of vitreous haemorrhage [3]

A
  • PAINLESS visual loss or haze (commonest)
  • red hue in the vision
  • floaters or shadows/dark spots in the vision
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22
Q

patient risk factors in vitreous haemorrhage [3]

A
  • proliferative diabetic retinopathy (over 50%)
  • posterior vitreous detachment
  • ocular trauma: the most common cause in children and young adults
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23
Q

cause of sudden vision loss in diabetics

A

vitreous haemorrhage

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24
Q

how is a squint (strabismus) detected

A

corneal light reflection test

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25
Q

how is a squint in a child managed

A

referral to ophthalmologist

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26
Q

what condition is treated with an eye patch

A

amblyopia (lazy eye)

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27
Q

key feature on fundoscopy of central retinal artery occlusion [3]

A
  • cherry red spot at fovea
  • atheromatous plaques
  • globally pale retina
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28
Q

differential for sudden painless loss of vision [6] NEEDS EDIT

A

CRVO
CRAO
vitreous haemorrhage
retinal detachement
ischaemic optic neuropathy
occipital stroke

ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery
vitreous haemorrhage
retinal detachment
retinal migraine

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29
Q

how long does amaurosis fugax last

A

resolves spontaneously in minutes

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30
Q

features on fundoscopy in central retinal vein occlusion [6]

A

ischaemic:
* extensive, severe flame haemorrhages- ‘stormy sunset’
* cotton wool spots
* widespread hyperaemia
* tortuous dilated vessels
* retinal oedema
* hard exudates

non-ischaemic
* haemorrhage in all 4 quadrants

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31
Q

MoA of prostaglandin analogues e.g. latanoprost in the treatment of glaucoma

A

increases uveoscleral outflow

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32
Q

MoA of beta blockers in the treatment of glaucoma

A

reduces aqueous production

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33
Q

MoA of carbonic anhydrase inhibitors in the treatment of glaucoma

A

Reduces aqueous production

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34
Q

MoA of sympathomimetics e.g brimonidine in the treatment of glaucoma

A

Reduces aqueous production and increases outflow

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35
Q

MoA of miotics e.g. pilocarpine in the treatment of glaucoma

A

Increases uveoscleral outflow

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36
Q

first line treatment for glaucoma with an IOP of ≥ 24 mmHg

A

360° selective laser trabeculoplasty (SLT

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37
Q

2nd line treatment of primary open angle glaucoma

A

prostaglandin analogues e.g. latanoprost

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38
Q

3rd line treatment of primary open angle glaucoma [3]

A

beta-blocker eye drops
carbonic anhydrase inhibitor eye drops
sympathomimetic eye drops

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39
Q

treatment of refractory glaucoma

A

trabeculectomy

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40
Q

example of sympathomimetic

MoA

A

brimonidine

alpha2-adrenoceptor agonist

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41
Q

example of Prostaglandin analogue

A

latanoprost

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42
Q

example of carbonic anhydrase inhibitor [2]

A
  • Dorzolamide
  • Acetozolamide
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43
Q

example of miotic

MoA

A

pilocarpine

muscarinic agonist

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44
Q

which part of the visual field does glaucoma affect most

A

peripheral

leads to tunnel vision

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45
Q

what eyesight is at risk of primary open angle glaucoma

A

myopia

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46
Q

what happens to the optic disc in primary open angle glaucoma [2]

A

optic disc cupping and pallor

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47
Q

what sort of eyesight is at risk of retinal detachment

A

myopia

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48
Q

how should a patient with a new onset of flashers and floaters be managed

A

referred urgently (<24 hours) to an ophthalmologist for assessment with a slit lamp and indirect ophthalmoscopy for pigment cells and vitreous haemorrhage

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49
Q

what does Amsler grid testing show in age related macular degeneration

A

distortion of line perception

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50
Q

compare the reduction of visual acuity in the two types of age related macular degeneration

A

gradual in dry ARMD, fluctuating quality of vision

subacute in wet ARMD

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51
Q

key feature in dry ARMD

A

drusen (yellow spots under the retinaantioxidant)

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52
Q

key feature in wet ARMD

A

neovascularisation

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53
Q

difference in symptoms between scleritis and episcleritis

A

no pain in episcleritis

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54
Q

treatment of acute angle-closure glaucoma [4]

A
  • a direct parasympathomimetic (e.g. pilocarpine, causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)
  • a beta-blocker (e.g. timolol, decreases aqueous humour production)
  • an alpha-2 agonist (e.g. apraclonidine, dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)
  • intravenous acetazolamide
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55
Q

definitive treatment of acute angle-closure glaucoma

A

laser peripheral iridotomy

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56
Q

causative agent in contact lens keratitis

A

Pseudomonas

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57
Q

causative agent in keratitis

A

staph aureus

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58
Q

amoebic cause of keratitis

A

acanthamoebic keratitis

increased incidence if eye exposure to soil or contaminated water

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59
Q

4 features of keratitis [4]

A

red eye: pain and erythema
photophobia
foreign body, gritty sensation
hypopyon may be seen

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60
Q

management of keratitis [3]

A
  • stop using contact lens until the symptoms have fully resolved
  • topical antibiotics: typically quinolones are used first-line
  • cycloplegic for pain relief e.g. cyclopentolate
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61
Q

Mydriatic drops are a known precipitant of…

A

acute angle-closure glaucoma

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62
Q

cause of flashers and floater [2]

A

vitreous haemorrhage
vitreous detachment (which often precedes retinal detachment)

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63
Q

cause of central scotoma

A

optic neuritis

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64
Q

metabolic cause of cataract

A

hypocalcaemia

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65
Q

what eye sight is at risk of acute angle closure glaucoma

A

hypermetropia

66
Q

what happens to the cup to disc ration in chronic open angle glaucoma

A

increased

67
Q

which eye drops put you at risk of corneal ulcer

A

steroid

68
Q

what is seen on fundoscopy in CRVO

A

widespread haemorrhages, well demarcated red patches

69
Q

are vein occlusions associated with flashes and floaters

A

NO

70
Q

triad of Horner’s syndrome

A

miosis (small pupil)
ptosis (right lid lag)
enophthalmos (a sunken eye appearance due to narrowing of the palpebral fissure)

+/- anhydrosis

71
Q

what MSK symptom can a Pancoast tumour present with

A

shoulder pain

72
Q

bilateral grittiness cause

A

blepharitis

73
Q

management of blepharitis

A
  • softening of the lid margin using hot compresses twice a day
  • ‘lid hygiene’ - mechanical removal of the debris from lid margins
  • cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used
  • an alternative is sodium bicarbonate, a teaspoonful in a cup of cooled water that has recently been boiled
  • artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film
74
Q

what is Hutchinson’s sign and what is it predictive of

A

rash on the tip or side of the nose.

Indicates nasociliary involvement and is a strong risk factor for ocular involvement

75
Q

Herpes zoster ophthalmicus complications [3]

A

ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
ptosis
post-herpetic neuralgia

76
Q

treatment of HZO

A

oral antiviral treatment for 7-10 days
ideally started within 72 hours
intravenous antivirals may be given for very severe infection or if the patient is immunocompromised
review by ENT if ocular involvement

77
Q

what is an entropion

A

in turning of eye lid

78
Q

what is an ectropion

A

out turning of eye lid

79
Q

adverse effect of prostaglandin analogues [2]

A

brown iris pigmentation
eye lash elongation

80
Q

which patients should avoid taking sympathomimetics [2]

A

Avoid if taking MAOI or tricyclic antidepressants

adverse effect includes hyperaemia

81
Q

adverse effects of miotics like pilocarpine [3]

A

Adverse effects included a constricted pupil, headache and blurred vision

82
Q

Keith-Wagener classification of hypertensive retinopathy: stage 1

A

Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring

83
Q

Keith-Wagener classification of hypertensive retinopathy: stage 2

A

Arteriovenous nipping

84
Q

Keith-Wagener classification of hypertensive retinopathy: stage 3 [3]

A

Cotton-wool exudates
Flame and blot haemorrhages
These may collect around the fovea resulting in a ‘macular star’

85
Q

Keith-Wagener classification of hypertensive retinopathy: stage 4

A

Papilloedema

86
Q

what is seen in Marcus Gunn pupil (RAPD)

A

the affected and normal eye appears to dilate when light is shone on the affected

87
Q

where is the lesion in RAPD

A

anterior to optic chiasm i.e. optic nerve or retina

88
Q

what is a Holmes Adie Pupil associated with [2]

A

most commonly seen in women

reduced lower limb reflexes

89
Q

3 causes of RAPD

A

optic neuritis
optic atrophy
retinal disease

90
Q

cause of afferent pupil defect

A

optic nerve lesion

91
Q

cause of efferent pupil defect

A

3rd nerve palsy

92
Q

causes of fixed and dilated pupil [4]

A

acute glaucoma
surgical third nerve palsy
iris trauma
mydriatics e.g. tropicamide

93
Q

which pupillary defect has a sluggish accomodation

A

Holmes Adie

94
Q

which pupillary defect is seen in syphilis and DM

A

argyll-robertson

95
Q

which ocular muscles are innervated by CNVI and CNIV

A

SO4

LR6

96
Q

red flag symptoms for red eyes [4]

A

photophobia
poor vision
fluorescein staining
abnormal pupil

97
Q

treatment of anterior uveitis [2]

A

urgent review by ophthalmology

prednisolone and cyclopentolate

98
Q

treatment of scleritis

A

urgent referral <24 hours

oral NSAIDs are typically used first-line
oral glucocorticoids may be used for more severe presentations
immunosuppressive drugs for resistant cases (and also to treat any underlying associated diseases)

99
Q

differential for sudden vision loss [5]

A
  • anterior ischaemic optic neuropathy
  • optic neuritis
  • vitreous haemorrhage
  • retinal detachment
  • retinal vessel occlusion
100
Q

what causes anterior ischaemic optic neuropathy

A

optic nerve damage due to posterior ciliary artery blockage

101
Q

3 features of AION

A

visual loss
RAPD
visual field defect

102
Q

3 features on fundoscopy in AION

A

pale
swollen optic disc
peripheral microaneurysm

103
Q

management of optic neuritis

A

methylprednisolone IV 72 hours

104
Q

investigation of vitreous haemorrhage

A

B-scan US

105
Q

treatment of large vitreous haemorrhage

A

victrectomy

smaller ones–> spontaneous reabsorption

106
Q

main risk factor for vitreous haemorrhage

A

diabetes

107
Q

aetiology of retinal detachment

A

holes in the retinal allow fluid to separate the retina from the pigmented epithelium

108
Q

3 causes of retinal detachment

A

Diabetes
cataract surgery
trauma

109
Q

4 signs of retinal detachment

A
  • flashers
  • floaters
  • field loss (veil down)
  • fall in acuity

all painless

110
Q

fundoscopy features in retinal detachment

A

grey, opalescent retina

balloons forward

111
Q

difference in visual loss between central retinal artery and branch retinal artery occlusion [2]

A

total vs partial loss of vision

RAPD +ve vs RAPD -ve

112
Q

management of arterial retinal occlusion

A

eyeball massage

113
Q

aetiology of venous retinal vessel occlusion [4]

A

diabetes
hypertension
hypercoaguable state
glaucoma

114
Q

different between central retinal vein and branch retinal vein occlusion

A

total/moderate loss of vision +/- RAPD

vs

asymptomatic unless macula involved, vision loss in affected area only

115
Q

investigation of venous retinal vessel occlusion

A

fluorescein angiography

116
Q

common and rare causes of gradual loss of vision

A

common:
diabetes
open-angle glaucoma
ARMD
cataracts

rare:
retinitis pigments
hypertension
optic atrophy

116
Q

investigations of ARMD

A

Amsler grid and fundoscopy looking for neovascularisation
slit lamp microscopy upon referral
fluoroscein angio for wet ARM
optic coherence tomography

117
Q

management of ARMD [3]

A

photodynamic therapy
VEGF inhibitors
anti-oxidant vitamins and zinc

118
Q

management of wet ARMD

A

anti VEGF
laser photocoagulation does slow progression of ARMD

119
Q

management of dry ARMD

A

zinc+ vitamin A,C,E, beta-carotene supplementation (antioxidant)

120
Q

how to best slow progression of ARMD

A

stop smoking

121
Q

drugs that reduce aqueous production

A

BAC
- beta blocker
- alpha 2 agonists
- carbon anhydrase inhibit

122
Q

drugs that increase uveoscleral outflow

A

Ps
- pilocarpine
- prostaglandin analouges

123
Q

management of proliferative retinopathy

A

pan-retinal photocoagulation

124
Q

management of maculopathy

A

grid/focal retinal photocoagulation

125
Q

causes of cataracts [4]

A

age
steroids
diabetes
smoking

126
Q

investigations for cataracts

A

tonometry
fundoscopy shows darkened red reflex
acuity test
BMs

127
Q

complication after cataracts surgery

A

posterior capsular opacification

treated with laser surgery

128
Q

conditions with blurred optic disc margin

A

optic neuritis and papilloedema

129
Q

inheritance of the most common form of retinitis pigmentosa

which has the best prognosis and the worst prognosis

A

AR

best: AD
worst: x-linked

130
Q

features of retinitis pigmentosa

A

night blindness
tunnel vision
blind by mid-30s
Friedrichs ataxia

131
Q

features of retinoblastoma

A

strabismus
leukocoria (white eye with no red reflex)

131
Q

management of retinoblastoma

A

depending on size:
- enucleation
- chemo
- radio

132
Q

where is the abscess in chalazion

A

Meibomian gland

132
Q

what makes a ptosis a true ptosis

A

LPS weakness

133
Q

causes of blepharitis

A

seborrhoeic dermatitis
staphylococcus

134
Q

causes of bilateral ptosis

A

MG
congenital
myotonic dystrophy
senile

135
Q

what is lagopthalmos

A

difficulty closing lid over the globe leading to exposure keratitis

treat with lubrication and tarsorrhaphy

136
Q

what is pinguecula

A

yellow vascular nodules on either side of the cornea

136
Q

what is pterygium

A

yellow vascular nodes the grow over the cornea affecting vision

137
Q

management of orbital cellulitis

A

urgent referal
IV abx e.g. cefuroxime

138
Q

3 causes of exopthalmos

A

Graves
orbital cellulits
trauma

138
Q

2 types of strabismus

A

Concomitant (common) – imbalance in extraocular muscles

Paralytic (rare) – paralysis of extraocular muscles

138
Q

what is a carotid cavernous fistula

A

carotid aneurysm rupture leading to reflux of blood into cavernous sinus

leads to eye bruit, pulsate exophthalmos

treated with endovascular repair

139
Q

what direction diplopia does a CN IV palsy cause

A

downwords

140
Q

what direction diplopia does CN VI cause

A

horizontal

mx: botulinum toxin

141
Q

most common type of squint in children

A

esotropia/convergent

cause: hypermetropia

142
Q

haloes + eye pain

A

acute glaucoma

143
Q

causes of haloes [3]

A

cataract
corneal oedema
acute glaucoma

144
Q

1st line treatment of allergic conjunctivitis

2nd line

A

antihistamine

2nd: topical cromoglycate (mast cell stabiliser)

145
Q

treatment of trachoma

A

tetracycline

146
Q

treatment of onchocerciasis (river blindness)

A

ivermectin

147
Q

treatment of xerophthalmia and keratomalacia

A

vitamin A

this Vit A def

148
Q

anti muscarinic drugs

examples [2]

what effects do they have

A

tropicamide (3 hr)
cyclopentolate (24 hr, paeds)

all are mydriatics, cycloplegics paralyse the iris in order to dilate.

effects:
- pupil dilatation
- loss of light reflex
- blurred vision

149
Q

features of scleritis

A

red eye
classically painful (in comparison to episcleritis), but sometimes only mild pain/discomfort is present
watering and photophobia are common
gradual decrease in vision

150
Q

conditions associated with scleritis

A

RA and SLE

151
Q

what is anterior uveitis the inflammation of

A

iris and ciliary body (anterior portion of the uvea)

152
Q

what is blepharitis

A

inflammation of the eyelid margins. It may due to either meibomian gland dysfunction

153
Q

features of anterior uveitis

A

acute onset
ocular discomfort & pain (may increase with use)
pupil may be small +/- irregular due to sphincter muscle contraction
photophobia (often intense)
blurred vision
red eye
lacrimation
ciliary flush: a ring of red spreading outwards
hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
visual acuity initially normal → impaired

154
Q

treatment of central retinal artery occlusion

A

Management is difficult and the prognosis is poor
any underlying conditions should be identified and treated (e.g. intravenous steroids for temporal arteritis)
if a patient presents acutely then Intraarterial thrombolysis may be attempted but currently, trials show mixed results.

155
Q

Red eye - glaucoma or uveitis?

A

glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush

156
Q
A

Year 6 (19 decks)

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