Ophthalmology

Question 1

Your patient awoke with this in the morning. It is painless. What is it, and what are 3 risk factors?

Answer 1

Sub-conjunctival haemorrhage

Sneeze, cough

hypertension

anticoagulants

Question 2

What is this?

Answer 2

Hyphema

Haemorrhage of the anterior chamber - blood vessels at iris root

Question 3

What is this? How would you assess any damage?

Answer 3

A foreign body - examine the pretarsal sulcus by everting the upper eyelid.

Remove with cotton applicator.

Apply fluorescein - an orange dye used with a blue light to visualise any abrasions

If there are abrasions - topical antibiotic?

Question 4

What is this? List three things that might have caused it

Answer 4

Ptosis

Congenital - poor development of Levator palpabrae superioris

Acquired - Eyelid mass

neurological condition (Mysasthenia gravis, ophthalmoplegia, Horner’s (superior tarsal muscle) or third nerve paralysis)

Question 5

What is this - be specific!

Answer 5

A horizontal strabismus - Right sided exotropia

Question 6

What are the subtypes of strabismus?

Answer 6

Exotropia, esotropia, hypotropia, hypertropia

Question 7

What is this? Be specific!

Answer 7

A horizontal stabismus - esotropia

Question 8

Name two anti-muscarinic eyedrops

Answer 8

Cyclopentolate (think uveitis)

Tropicamide (best for reg eye exam)

Question 9

What is this? If unilateral, what might be be due to?

Answer 9

Papilloedema

Raised ICP

Idiopathic intracranial hypertension

Question 10

What is this?

Answer 10

Optic disc oedema - the 4 Is

Inflammation

Infiltration (cancers)

ICP

Infarction

Question 11

What is this?

Answer 11

Arterio-venous nicking

Hardened arteries due to chronic hypertension mean they distort the more pliant veins where they cross

Question 12

What is this?

Answer 12

Copper wiring

Sign of chronic hypertension

due to fibrosis of intima and subintima

Question 13

What is this?

Answer 13

Obliterative retinal vasculopathy

A thrombus has totally occluded this vessel - now looks like a pipe cleaner!

Question 14

What is this?

Answer 14

A Hollenhorst spot - a platelet-fibrin-cholesterol embolus

it is likely to have originated at an artheroma of the carotid bifurcation

Question 15

What is this?

Answer 15

Segemental retinal infarction resulting from Hollenhorst plaque - patient would report cloudy vision pertaining to this area of the retina

Question 16

What is this?

Answer 16

Retinal vasculitis - ‘sheathing’ due to lympocytic infiltrates

MS

Sarcoidosis

Question 17

What is this?

Answer 17

Myelinated nerve fibres

a congenital issue, does not affect the vision

Question 18

What is this?

Answer 18

Cotton wool spots

(ischaemic bursting of axons in the nerve fibre layer)

Microinfarcts in the retinal nerve fibre layer

Hundereds of causes!

Diabetes, hypertension, hypercoagulable states, HIV, connective tissue diseases

Question 19

What is this?

What is their ‘classic’ cause?

Answer 19

Roth spots

It’s a cotton wool spot (ischaemic bursting of axons in the nerve fibre layer) surrounded by haemorrhage (ischaemic bursting of pre-capillary arterioles)

Sub-acute bacterial endocarditis

Question 20

What is this?

Answer 20

Hard exudates

lipid leakage from damaged capillaries

diabetes!

von Hippel-Lindau

retinal vein occlusion

Question 21

What is this?

Answer 21

Retinal drusen

Remains of dead retinal pigment epithelial cells

age-related macular degeneration

biggest issue with be submacular neovascularisation

Question 22

What is this?

Answer 22

Retinal neovascularisation

risk is they bleed easily or with minimal trauma

leads to retinal detachment eventually

near the optic disk? - retinal vein occlusion or, DIABETES!

near the extremities? Think sickle cell

Question 23

What is this?

Answer 23

Boat haemorrhage

due to rupture of large superficial retinal veins between the retina and the vitreous

aka - subhyaloid haemorrhage OR pre-retinal haemorrhage. In practise, v difficult to tell the two apart

Question 24

What is this?

Answer 24

Dot haemorrhage

Rupture of deep capillary

Diabetes!

Question 25

What is this?

Answer 25

Flame haemorrhage Rupture of superficial pre-capillary arterioles Hypertension

Question 26

What is this?

Answer 26

A sub-retinal haemorrhage - note the normal vessels above it

Question 27

Label the arrows from left to right - top row then bottom of this normal fundus

Answer 27

Physiologic cup Fovea Neuroretinal rim Retinal vein Retinal arteriole Macula

Question 28

Diagnosis?

Answer 28

Phlyctenular conjunctivitis - senstization of the conjunctiva to an endogenous allergen A sign of: Primary TB or more likely, S aureus

Question 29

Retinopathies as a result of essential hypertension. What are they, in roughly the order that they might be seen

Answer 29

Copper wiring **I** Silver wiring **I** AV nicking **II** Flame haem, cotton wool spots **III** Papilloedema **IV**

Question 30

Where, in terms of eye layers would you find drusen. What are they?

Answer 30

Between Bruch's membrane and the retinal pigment epithelium (or within Bruch's membrane. Lipid deposits

Question 31

What is the classic lesion seen with internucelar ophthalmoplegia?

Answer 31

Failure of adduction in each eye during horizontal gaze (signal, which goes from cortex to VI nuclei THEN III, via the medial longitudinal fasciculus, doesn't get there as a result of a lesion in the MLF, and thus the medial rectus doesn't adduct the eye. Abducting eye also shows nystagmus Convergence is NOT affected!!