Ophthalmology

Question 1

A patient presents with red, sore, inflamed eyes for several weeks, and complains of agonising pain when you go to have a look with the ophthalmoscope/slit lamp. Chloramphenicol drops for presumed bacterial conjunctivitis haven’t worked, and she looks guilty when you ask about her contact lens habits. What’s the treatment?

Answer 1

keratitis
- patients need admission for hourly ofloxacin antibiotic drops

Question 2

A patient presents with sudden painless loss of vision in one eye. Fundoscopy reveals a ‘cherry red’ spot on a pale retina. What condition is most likely?

Answer 2

central retinal artery occlusion

Question 3

A patient presents with sudden visual loss. On fundoscopy the retina cannot be visualised. The patient reports peripheral flashes of light (photopsia) and floaters on the temporal side. What is the most likely diagnosis?

Answer 3

posterior vitreous detachment

Question 4

A patient presents with sudden visual loss. On fundoscopy the retina cannot be visualised. They describe a ‘dense shadow’ that started peripherally and progressed towards the central vision, and how straight lines appeared curved. What is the most likely diagnosis?

Answer 4

retinal detachment

Question 5

A patient presents with sudden visual loss. On fundoscopy the retina cannot be visualised. They describe seeing numerous dark spots and floaters. Medical history includes diabetes and CVD. What is the most likely diagnosis?

Answer 5

vitreous haemorrhage

Question 6

A patient with an extremely red and painful eye, nausea and vomiting, sluggish and mid-dilated pupil, seeing halos around lights, and hazy cornea has what condition?

Answer 6

closed-angle glaucoma

Question 7

Closed-angle glaucoma is associated with hypermetropia/myopia?

Answer 7

hypermetropia

Question 8

how do you treat dendritic ulcers

Answer 8

topical antiviral eg acyclovir

Question 9

What dermatological condition is associated with posterior blepharitis?

Answer 9

acne rosacea

Question 10

What drugs can help relieve the pain of anterior uveitis?

Answer 10

cycloplegics- dilates pupil and helps to relieve photophobia and pain eg atropine, cyclopentalone

Question 11

What is a chalazion?

Answer 11

granulomatous, inflammation of the meibomion gland. not painful, but can become infected

Question 12

What is amaurosis fugax?

Answer 12

transient central retinal artery occlusion (‘ministroke’)
‘like a curtain coming down’- lasts 5 mins will full recovery

Question 13

What is RAPD and what does it mean?

Answer 13

relevant afferent pupillary defect
- swinging light test
- pupil contracts when you shine light on the other eye (as it should!) but not when you shine light on it directly

Question 14

What test can confirm ocular dryness?

Answer 14

schirmers test

Question 15

Which is worse, episcleritis or scleritis?

Answer 15

scleritis- extremely serious, requires NSAIDs/steroids
episcleritis- mild, clears up in a week without treatment

Question 16

Anti-VEGF drugs can be used in dry AMD, true or false?

Answer 16

FALSE - only in wet AMD

Question 17

Brain swelling can cause compression of which nerve controlling eye movement against the petrous tip

Answer 17

CN VI

Question 18

Cover test

You see downward movement of eye =

Answer 18

hypertropia

Question 19

Cover test

You see inward movement of eye =

Answer 19

exotropia

Question 20

Cover test

You see outward movement of eye =

Answer 20

esotropia

Question 21

Cover test You see upward movement of eye =

Answer 21

hypotropia

Question 22

If a patient is tilting their head to see straight, which nerve controlling eye movement is likely affected?

Answer 22

CN IV - superior oblique

Question 23

Palsy of which nerve controlling eye movement is associated with papilloedema?

Answer 23

CN VI

Question 24

Papilloedema can result from raised intracranial pressure because of continuation of which anatomical space between the brain and optic nerve

Answer 24

the subarachnoid space

Question 25

Visual deterioration in dry AMD is usually gradual, true or false?

Answer 25

true

Question 26

Visual deterioration in wet AMD is always gradual, true or false?

Answer 26

FALSE Visual deterioration may develop quickly (suddenly become unable to read, drive, or see fine detail), and may suddenly develop to profound central visual loss in the event of a bleed. This may be preceded or accompanied by a shower of floaters

Question 27

Glaucoma preferentially affects peripheral/central vision?

Answer 27

peripheral- usually presents late for this reason

Question 28

Visual fields - bitemporal hemianopia, where's the defect?

Answer 28

optic chiasm

Question 28

Visual fields - whole left eye affected, where's the defect?

Answer 28

left optic nerve

Question 29

blurred, swollen optic disc?

Answer 29

papilloedema

Question 30

What diagnosis would you suspect in an elderly patient with a long history of diabetes, previous steroid use, unilateral blurry vision, and halos surrounding light sources?

Answer 30

cataract

Question 31

What is the first-line treatment for a patient with ocular hypertension?

Answer 31

If OHT >24 mmHg, give latanoprost as first-line treatment. Prostaglandin analogue

Question 32

What is the most likely cause of CNIII palsy?

Answer 32

In exams at least, aneurysms

Question 33

What is the most likely cause of CNIV nerve palsy?

Answer 33

Congenital or trauma

Question 34

What is the most likely cause of CNVI palsy?

Answer 34

raised intracranial pressure

Question 35

What is the second-line treatment for a patient with ocular hypertension?

Answer 35

If latanoprost isn't doing the job or isn't tolerated, can substitute or add timolol (beta blocker). After that, you're looking at carbonic anhydrase inhibitors.

Question 36

What is the threshold for cup-to-disk ratio to suggest glaucoma?

Answer 36

0.7

Question 37

What nerve travels within the cavernous sinus, not the wall?

Answer 37

CN VI

Question 38

What stain can be used to assist ophtho examination?

Answer 38

Fluorescein

Question 39

What toxicity can cause acute bilateral vision loss?

Answer 39

bilateral optic nerve damage- methanol poisoning

Question 40

What would you suspect in a patient with bilaterally small pupils that reduce in size on a near object (ie, accommodate), but do not constrict when exposed to bright light?

Answer 40

In exams, Argyll Robertson pupils -> neurosyphillis 'Prostitute's pupil': accomodates, but doesn't react

Question 41

What would you suspect in this patient who has rapidly deteriorating vision with distortion in their visual field (Amsler grid)?

Answer 41

wet AMD

Question 42

what is the most common cause of persistent watery eye (without other symptoms) in an infant, especially if unilateral?

Answer 42

nasolacrimal duct obstruction

Question 43

what test refers to the use of fluorescein to identify a full-thickness penetrating trauma to the cornea - it will show aqueous humour leaking from the defect and dilution of tear film

Answer 43

siedels test

Question 44

a patient with pupil dilation likely has what syndrome due to loss of parasympathetic control?

Answer 44

adies syndrome

Question 45

a patient with adies syndrome has pupil dilation/constriction due to loss of sympathetic/parasympathetic control

Answer 45

dilation parasympathetic

Question 46

acute allergic conjunctivitis is an example of a type _ hypersensitivity reaction

Answer 46

type I

Question 47

Adie's pupil is a cause of pupil constriction and is most common in men, true or false?

Answer 47

false causes dilation; more common in women opposite of Horners syndrome

Question 47

Anterior blepharitis can present as inflammation, pus, and scale around what structure

Answer 47

the eyelashes

Question 48

Autoimmune corneal melting is an example of a type _ hypersensitivity

Answer 48

type III

Question 49

Bacterial conjunctivitis is particularly associated with enlargement of the preauricular lymph nodes, true or false?

Answer 49

false- that's viral conjunctivitis

Question 50

Blood supply to the eye is provided by central retinal and anterior ciliary arteries, true or false?

Answer 50

false- central retinal artery and posterior ciliary arteries

Question 51

Corneal graft rejection is an example of a type _ hypersensitivity

Answer 51

type IV

Question 52

Flame and blot haemorrhages suggest stage _ hypertensive retinopathy

Answer 52

stage III

Question 53

Arteriolar narrowing and tortuosity suggests stage _ hypertensive retinopathy

Answer 53

stage I

Question 54

How do you tell the difference between episcleritis and scleritis?

Answer 54

pain much worse with scleritis phenylephrine will not blanch vessels in scleritis

Question 55

Hypertensive retinopathy tends to affect only older patients, true or false?

Answer 55

false can be very severe in young patients

Question 56

If you are giving a patient eye drops, what can you advise them to do to limit systemic absorption?

Answer 56

hands on eyes

Question 57

In eye pharmacology, prednisolone acetate is useful in inflamed/uninflamed corneas?

Answer 57

uninflamed- used post-operatively

Question 58

In ophthalmology, a pachymeter is used to ...

Answer 58

measure the thickness of the cornea

Question 59

In ophthalmology, a perimeter is used to ...

Answer 59

plot fields of vision

Question 60

In ophthalmology, anisocoria means ...

Answer 60

the pupils differ in size

Question 61

Individuals with a positive family history of glaucoma should be screened annually from age

Answer 61

35-40 years

Question 62

Optometrists will refer patients for assessment of open-angle glaucoma if their intraocular pressure is >... mmHg

Answer 62

24- or any evidence of optic nerve head damage, or peripheral visual field defect

Question 63

Orbital cellulitis is defined as inflammation in what specific anatomical region?

Answer 63

behind the orbital septum

Question 64

Papilloedema suggests stage _ hypertensive retinopathy

Answer 64

stage IV

Question 64

The cornea is thickest in its centre, true or false?

Answer 64

false- thickest peripherally

Question 65

What distinguishes anterior from posterior blepharitis?

Answer 65

is the eyelid margin redder/more inflamed than the deeper part of the lid yes- anterior no- posterior

Question 66

What examination findings help distinguish anterior uveitis from other causes of painful red eye? Name three

Answer 66

hypopyon small or irregular pupil cells, flare, precipitates in anterior chamber

Question 67

What genetic condition would you suspect in a patient who presents with progressive night blindness and tunnel vision? On fundoscopy, you see discolouration of the retina.

Answer 67

retinitis pigmentosa