ophthalmology

Question 1

first line management for pt with AAU (new presentations of and recurrent acute anterior uveitis)

Answer 1

urgent referral to ophthalmologists within 24hrs
then afterwards may be given prednisolone eyedrops and cylcoplegic eyedrops to dilate the pupil eg atropine

Question 2

epislceritis vs scleritis

Answer 2

episcleritis
- inflammation of episclera which is the outer layer of the sclera
- painless, doesnt affect vision
- episcleral vessels are mobile in response to phenylephrine drops

scleritis
- pain, photophobia and reduced vision
- the vessels in the eye are not moveable and will show no response to phenylephrine drops

Question 3

what is the name for the condition which causes inflammation at the eyelid margins / base of eyelashes

Answer 3

blepharitis

Question 4

tx for blepharitis

Answer 4

there is no cure, just do conservative management eg cleaning the area

Question 5

painful red eye
pain is worse when moves eye
photophobia
PMH of RA
diagnosis?

Answer 5

scleritis

Question 6

what is chemosis

Answer 6

swelling of conjunctiva

Question 7

which 3 features point to a diagnosis of orbital cellulitis over periorbital cellulitis

Answer 7

opthalmoplegia
pain with eye movements
proptosis

Question 8

effect of hydroxychloroquine on the eye

Answer 8

bulls eye maculopathy - irreversible damage to macula

Question 9

which medication can cause raised IOP (intraocular pressure)

Answer 9

steroids

Question 10

what is corneal arcus

Answer 10

a white, blue or grey opaque ring around edge of iris

Question 11

gradual visual loss tat affects the peripheral visual fields at first
diagnosis

Answer 11

retinitis pigmentosa
hereditary
black pigmentaion on the retina

Question 12

in which condition are bright yellow deposits (called “drusen” - deposits of protein) seen on the macula / retina

Answer 12

Dry age related macular degeneration (Dry AMD)

Question 13

nausea
headaches
servere ocular pain
blurred vision
haloes around lights
pupil in fixed dilated position
diagnosis

Answer 13

acute angle closure glaucoma

Question 14

He reports seeing bright flashing lights and a curtain in his right visual field
diagnosis

Answer 14

retinal detachment

Question 15

what are new onset flashers and floaters followed by loss of vision indicative of

Answer 15

retinal detachment

Question 16

Her headaches are worse in the morning and worse when she lays down to go to sleep at night.
what is this indicative of

Answer 16

raised inter cranial pressure

Question 16

what is used to treat raised intracranial hypertension secondary to intracerebral malignancy

Answer 16

dexamethasone

Question 17

which 2 medications are used in emergency only for acutely raised intercranial pressure, due to their risk of causing electrolyte disturbances

Answer 17

mannitol
hypertonic saline

Question 18

which medication can be used to relieve idiopathic intracranial hypertension

Answer 18

acetazolamide (+weight loss, lifestyle adjustments, optic nerve fenestration if vision is threatened and ventriculo-peritoneal shunting if headaches are refractory to medical management)

Question 19

which med causes red coloration of secretions

Answer 19

rifampicin

Question 20

what is the main side effect of ethambutol

Answer 20

optic neuropathy

Question 21

initial Tx for GCA to minimise permanent visual loss

Answer 21

no vision loss: high-dose steroids such as oral prednisolone
vision loss: IV methylprednisolone

Question 22

elderly female presenting with sudden, painless, monocular loss of vision usually on a background of scalp tenderness, headaches, or jaw claudication
diagnosis?

Answer 22

GCA

Question 23

what are cyclopentolate or cycloplegc eyes drops used for

Answer 23

uveitis

Question 24

gradual history of unilateral blurred vision, haloes around light sources loss of the red light reflex worse vision at night myopic shift (patient becomes more short sighted due to the increased refractive index of the cataract) suggests a diagnosis of what?

Answer 24

cataracts

Question 25

definitive mx of cataracts

Answer 25

surgical removal of the cloudy lens and replacement with an artificial one

Question 26

main modifiable risk factor for age related macular degeneration

Answer 26

smoking

Question 27

what does central visual loss (straight lines appear wavy) , esp in dim light (night blindness) indicate

Answer 27

age related macular degeneration

Question 28

what is a gonioscopy

Answer 28

an eye test that checks for signs of glaucoma

Question 29

vision loss reduced visual acuity peri orbital pain, exacerbated by eye movements colour desaturation RAPD diagnosis?

Answer 29

optic neuritis

Question 30

what is the main cause of corneal arcus

Answer 30

hyperlipidaemia

Question 31

which examination can confirm a diagnosis of refractive error?

Answer 31

Pinhole-aided visual acuity

Question 32

retinal oedema, retinal pigment epithelium detachment and macular exudates is this dry or wet age-related macular degeneration

Answer 32

wet

Question 33

drusen, chorioretinal atrophy is this dry or wet age-related macular degeneration

Answer 33

dry

Question 34

what symptoms does diabetic macular oedema cause

Answer 34

reduced visual acuity straight lines appear wavy

Question 35

what is a myopic shift

Answer 35

patient becomes more short sighted due to the increased refractive index of the cataract

Question 36

classic triad of Horners syndrome

Answer 36

mitosis partial ptosis anhidrosis

Question 37

what is posterior synechiae and which condition can it be seen in

Answer 37

adhesions between the lens and iris causing an irregularly shaped pupil this occurs in anterior uveitis

Question 38

which type of uveitis can cause exudative retinal detachment

Answer 38

posterior uveitis

Question 39

in which type of uveitis can vitreous cells be visualised

Answer 39

intermediate uveitis

Question 40

sudden painless vision loss in ONE eye optic disc swelling RAPD TIAs of visual loss prior to the sudden visual loss RFs = age, htn, dm, sleep apnoea diagnosis

Answer 40

ischaemic optic neuropathy (ION)

Question 41

what eye manifestation is associated with infective endocarditis

Answer 41

Roth spots

Question 42

which vision field is affected first in glaucoma

Answer 42

peripheral

Question 43

what is cupping of the optic disc a feature of

Answer 43

glaucoma

Question 44

what is AV nipping a feature of

Answer 44

hypertensive retinopathy

Question 45

what is cherry red spot a feature of

Answer 45

central retinal artery occlusion

Question 46

Retinal hyperaemia and haemorrhages, sometimes called the ‘stormy sunset’ appearance what is this a typical fundoscopy appearance of

Answer 46

central retinal vein occlusion

Question 46

what is photopsia

Answer 46

flashers

Question 47

pain on eye movement and visual loss diagnosis

Answer 47

optic neuritis (scleritis and orbital cellulitis don't present with visual loss)

Question 48

what is the cause of Horners syndrome

Answer 48

loss of innervation of the sympathetic chain

Question 49

what eye position does fourth cranial nerve palsy cause

Answer 49

up and in

Question 50

what eye position does third cranial nerve palsy cause

Answer 50

down and out

Question 51

what eye position does sixth cranial nerve palsy cause

Answer 51

abduction - double vision

Question 52

what is a central scotoma

Answer 52

blind spot in the middle of your vision

Question 53

what are the 4 signs of acute optic neuropathy

Answer 53

monocular visual field defect - usually central scotoma reduced colour vision RAPD optic disc swelling, or if chronic, atrophy of optic nerve fibres --> pale optic disc

Question 54

what are latanoprost eye drops used for

Answer 54

treat high pressure in the eye , and treat glaucoma

Question 55

which eye condition is associated with RA

Answer 55

scleritis

Question 56

which eye condition is associated with MS

Answer 56

optic neuritis

Question 57

blurry vision difficulty driving at night due to glare from street lights diagnosis?

Answer 57

cataracts

Question 58

if child has an eye that drifts to the side they look forwards, what complication could this lead to if not treated

Answer 58

amblyopia

Question 59

what is entropion

Answer 59

the eyelid turns inwards with the lashes against the eyeball, subsequently causing corneal damage and ulceration

Question 60

what is keratitis sicca

Answer 60

"dry eyes" - chronic, bilateral desiccation of the conjunctiva and cornea due to an inadequate tear film.

Question 61

what is entropion and ectropion

Answer 61

entropion- inward curling of the eyelid ectropion - outward turning of the eyelid

Question 62

which peripheral facial neuropathy is caused by varicella zoster virus

Answer 62

Ramsay hunt syndrome

Question 63

how does a sub conjunctival haemorrhage present

Answer 63

bright red eye common causes include sneezing, coughing, eye trauma no pain

Question 64

what are Lid retraction (Dalrymple's sign) and lid lag on down gaze (Von Graefe's sign) classic signs of

Answer 64

thyroid eye disease

Question 65

what condition are Anti-acetylcholine receptor antibodies tested to check for

Answer 65

myasthenia gravis

Question 66

what is posterior lens capsule opacification

Answer 66

relatively common complication of cataract surgery that usually occurs a few weeks following the operation patient complains of blurry vision as if their cataract has returned, and a white opacity may be visible on observation

Question 67

what condition does cupping of the optic disc indicate

Answer 67

chronic open angle glaucoma

Question 68

what condition does bone spicule pigmentation indicate

Answer 68

retinal defect found in patients with retinitis pigmentosa

Question 69

what condition is eczema on the eyelids seen in

Answer 69

allergic conjunctivitis

Question 70

what condition is pre-auricular lymph nodes, watery, gritty eyes, symptoms of an upper respiratory tract infection associated with

Answer 70

viral conjunctivitis

Question 71

what visual field loss is caused by left optic neuritis affecting left optic nerve

Answer 71

left monocular blindness

Question 72

what visual field loss is caused by a right-sided optic tract lesion

Answer 72

Left homonymous hemianopia

Question 73

what visual field loss is caused by a left-sided optic tract lesion

Answer 73

Right homonymous hemianopia

Question 74

progressive loss of vision over past few days central vision worse trouble reading retinal oedema / grey-green macula diagnosis

Answer 74

wet age-related macular degeneration

Question 75

tx for wet age-related macular degeneration

Answer 75

anti VEGF injections

Question 76

what is sumatriptan used to treat

Answer 76

migraines

Question 77

what condition is associated with poor contact lens hygiene

Answer 77

microbial keratitis

Question 78

what is microbial keratitis

Answer 78

infection of the cornea painful photophobia sticky discharge hypoyon (pus in anterior chamber)

Question 79

main risk factors for developing cataracts

Answer 79

age smoking diabetes systemic corticosteroid use

Question 80

mx of cataracts

Answer 80

surgical intervention called "pseudophakia" removal of affected lens by using "phacoemulsification" then replacing it w an artificial lens

Question 81

2 main complications of cataract surgery

Answer 81

endophthalmitis - pain, vision loss, red, within DAYS, emergency posterior lens capsule opacification - blurry vision, white opacity, within WEEKS

Question 82

Ix for cataract

Answer 82

slit-lamp biomicroscopy reveals a brown/white appearance of the lens

Question 83

cataract signs and symptoms

Answer 83

difficulty seeing at light halos around lights esp at night blurred vision difficulty reading and recognising faces gradual PAINLESS Visual loss loss of red reflex brown/white lens on slit-lamp bio microscopy

Question 84

what is ptosis

Answer 84

eyelid drooping

Question 85

proptosis severe pain restricted eye mouvements rapid deterioration in vision all following trauma diagnosis?

Answer 85

retrobulbar haemorrhage - requires urgent lateral canthotomy

Question 86

night blinds and tunnel vision are indicative of what

Answer 86

retinitis pigmentosa

Question 87

what do flashers and floater suggest

Answer 87

retinal detachment

Question 88

what does visual fluctuations suggest

Answer 88

Age related macular degeneration

Question 89

what does glare from bright light

Answer 89

cataracts

Question 90

what is hypermetropia

Answer 90

long-sightedness

Question 91

what is myopia

Answer 91

short-sightedness

Question 92

what is enopthalmos

Answer 92

eyes sinking deeper into socket

Question 93

what treat meant is C/I in thyroid eye disease

Answer 93

radioactive iodine ablation therapy

Question 94

immediate next step after suspicion of temporal arteritis

Answer 94

high dose steroids, confirm w temporal artery biopsy later

Question 95

what could cause bilateral central field of visual loss

Answer 95

retinal disease eg AMD or diabetic maculopathy

Question 96

fundoscopy appearance of central retinal artery vs being occlusion

Answer 96

central retinal artery occlusion - pale retina with cherry red spot on macula central retinal vein occlusion - stormy sunset appearance

Question 97

what does crusting at eyelid margins suggest

Answer 97

blepharitis

Question 98

what does purulent discharge suggest

Answer 98

bacterial conjunctivitis

Question 99

what do pupils which constrict on convergence but do not constrict in response to light suggest

Answer 99

argyll-roberston pupil - suggests neurosyphilis

Question 100

tx for scleritis

Answer 100

URGENT REFERRAL 1) NSAIDs 2) systemic glucocorticosteroids 3) azathioprine / methotrexate

Question 101

tx for uveitis

Answer 101

URGENT REFERRAL corticosteroid eye drops eg prednisolone cycloplegic eye drops eg atropine

Question 102

tx for optic neuritis

Answer 102

high dose prednisolone

Question 103

peri orbital cellulitis mx

Answer 103

oral co-amoxiclav secondary career referral

Question 104

orbital cellulitis

Answer 104

IV vancomycin + cefotaxime hospital admission