Ophthalmology

Question 1

Features of acute angle closure glaucoma

Answer 1

Severe pain (ocular or headache)
Decreased visual acuity
Symptoms worse with mydriasis
Hard, red eye
Haloes around lights
Semi dilated non reacting pupil
Corneal oedema results in dull or hazy cornea

Question 2

Acute angle closure glaucoma investigations

Answer 2

Tonometry for IOP
Gonioscopy (special slit lamp for looking at angle)

Question 3

Management of acute angle closure glaucoma

Answer 3

Pilocarpine
Timolol
Apraclonidine
IV acetazolamide

Definitive management is laser peripheral iridotomy

Question 4

Risk factors for ARMD

Answer 4

Age
Smoking
Family history

Question 5

Causes of sudden visual loss

Answer 5

Ischaemic/vascular
Vitreous haemorrhage
Retinal detachment
Retinal migraine

Question 6

Retinal vein occlusion causes

Answer 6

Glaucoma
Polycythaemia
Hypertension

Question 7

Central retinal artery occlusion features

Answer 7

Afferent pupillary defect
Cherry red spot on a pale retina

Question 8

Causes of vitreous haemorrhage

Answer 8

Diabetes
Bleeding disorders
Anticoagulants

Question 9

Vitreous haemorrhage features

Answer 9

Sudden visual loss
Dark spots

Question 10

Posterior vitreous detachment features

Answer 10

Flashes of light in periphery
Floaters in temporal central vision

Question 11

Retinal detachment features

Answer 11

Dense shadow that starts peripherally then spreads to central vision
Veil/curtain over vision
Straight lines appear curved

Question 12

Anginoid retinal streaks appearance

Answer 12

Irregular dark red streaks radiating from the optic nerve head

Question 13

Causes of anginoid retinal streaks

Answer 13

Pseudoxanthoma elasticum
Ehler-Danlos
Paget’s
Sickle cell
Acromegaly

Question 14

Classification of dry ARMD

Answer 14

90% of cases
Drusen - yellow round spots

Question 15

Classification of wet ARMD

Answer 15

Choroidal neovascularisation
Leakage of serous fluid
Worst prognosis

Question 16

Symptoms of ARMD

Answer 16

Reduction in visual acuity
Difficulties in dark adaptation
Photopsia (flickering/flashing light)
Hallucinations leading to Charles-Bonnet

Question 17

Signs of ARMD

Answer 17

Distortion of light perception
Drusen on fundoscopy
Well demarcated red patches in wet

Question 18

Management of ARMD

Answer 18

Zinc with vit A C & E
VEGF - randizumab, bevacizumab
Laser photocoagulation

Question 19

What is a relative afferent pupillary defect

Answer 19

When the affected and normal eye appear to dilate when light is shone in the affected eye

Question 20

Causes of relative afferent pupillary defect

Answer 20

Retina - detachment
Optic nerve - optic neuritis (MS)

Question 21

Causes of optic neuritis

Answer 21

MS
Diabetes
Syphilis

Question 22

Features of optic neuritis

Answer 22

Unilateral decrease in visual acuity over days
Poor discrimination of colours
Pain worse on eye movement
Relative afferent pupillary defect
Central scotoma

Question 23

Optic neuritis investigation

Answer 23

MRI of brain and orbits with gadolinium contrast

Question 24

Management of optic neuritis

Answer 24

High dose steroids

Question 25

Signs of orbital cellulitis vs pre-septal cellulitis

Answer 25

Painful eye movement Restricted eye movement Reduction in colour vision Abnormal pupillary responses to light Reduced visual acuity Reduced visual fields Chemosis

Question 26

Features of retinitis pigmentosa

Answer 26

Night blindness Tunnel vision Fundoscopy - black bone scipule-shaped pigmentation in the peripheral retina, mottling of retinal pigment epithelium

Question 27

Diseases associated with retinitis pigmentosa

Answer 27

Refsum Ushers Alports Kearns-Sayre

Question 28

Features of Horner’s syndrome

Answer 28

Miosis Ptosis Enophthalmos Anhidrosis

Question 29

Horner’s of face arm and trunk causes

Answer 29

Stroke Syringomelia MS Tumour

Question 30

Horners of face only causes

Answer 30

Pancoasts Tumour Thyroidectomy Trauma

Question 31

Horners with no anhidrosis causes

Answer 31

Carotid artery dissection Carotid aneurysm Cavernous sinus thrombosis Cluster headache

Question 32

Hypertensive retinopathy stage 1 features

Answer 32

Arteriolar rowing and tortuosity Increased light reflex Silver wiring

Question 33

Hypertensive retinopathy stage 2 features

Answer 33

Arteriovenous nipping

Question 34

Hypertensive retinopathy stage 3 features

Answer 34

Cotton wool exudates Flame and blot haemorrhages

Question 35

Hypertensive retinopathy stage 4 features

Answer 35

Papilloedema

Question 36

Holmes-Adie pupil features

Answer 36

Women Unilateral Dilated pupil Slow to accommodation Absent ankle/knee reflex

Question 37

Dacryocystitis features

Answer 37

Watering eye Swelling and erythema to inner canthus

Question 38

Dacryocystitis management

Answer 38

Systemic antibiotics

Question 39

Causes of mydriasis

Answer 39

Third nerve palsy Holmes-Adie Traumatic iridoplegia Phaeochromocytoma Congenital Atropine Cocaine/amphetamines TCA’s

Question 40

When do you get bilateral occipital lobe infarcts and what signs do you get.

Answer 40

Period of hypotension - cardiac arrest Cortical blindness with preservation of pupils reaction to light.

Question 41

Lesions at the chiasm have what signs?

Answer 41

Bitemporal hemianopia If they spread up from below the defect is worse in the upper fields (pituitary tumours) If they spread down from above the defect is worse in the lower fields (craniopharyngioma)

Question 42

Lesions before the chiasm produce what defect

Answer 42

Visual defect in the ipsilateral eye Optic nerve damage - central, asymmetrical and unilateral Acuity often affected Causes - optic neuritis, optic atrophy, glaucoma, trauma