Ophthalmology Flashcards
(129 cards)
1
Q
Anti-ccp
A
Rheumatoid arthritis marker
2
Q
Rheumatoid factor
A
Rheumatoid arthritis marker
3
Q
Diclofenac
A
Nsaid
4
Q
Heberdens nodes
A
DIP joint swelling in OA
5
Q
Allopurinol
A
1st line prophylactic treatment for gout
6
Q
Methotrexate given with
A
Folic acid
7
Q
Sulfalazine
A
DMARD – good for fertile women
8
Q
Monosodium urate crystals
A
Build up in joints leads to gout
9
Q
Leflunomide
A
DMARD
10
Q
Colchicine
A
2nd line in gout if nsaids are CI becoz of renal impairment
11
Q
Hydroxychloroquine
A
DMARD
12
Q
Bouchards nodes
A
PIP joint swelling in OA
13
Q
Volar displacement
A
Displacement of the distal radius towards the palm of the hand #
14
Q
Colles fracture
A
Fracture of the head of the radius with dorsal displacement – towards back of the hand
15
Q
Weber classification
A
Classifies based on the location of distal fibula fracture relative to the syndesmosis
16
Q
Calcium pyrophosphate crystals
A
A = distal, B = at same level, C= proximal
17
Q
The 4 Rs of fractures
A
Pseudogout
18
Q
Closed reduction
A
Resuscitation, Reduction, Restriction (immobilisation), Rehabilitation
19
Q
Susceptible nerve in elbow fracture
A
Bones realigned without surgery
20
Q
Susceptible nerve in humeral neck fracture
A
Ulnar nerve
21
Q
Susceptible nerve in humeral mid shaft fracture
A
Axillary nerve
22
Q
Negatively birefringent, needle shape crystals
A
Radial nerve
23
Q
Weakly positive birefringent, rhomboid shaped crystals
A
Monosodium urate = gout
24
Q
Pre-patellar bursitis
A
Calcium pyrophosphate = pseudogout
25
5 common malignancies that spread to bone
Housemaids knee – able to flex and relatively pain free
26
Chondrocalcinosis
Thyroid, lung, breast, renal, prostate
27
Fat pad
Radiographic feature of pseudogout – calcifications in the joint space
28
Mason classification
Signe up blood and fat in the joint capsule
29
Tension band wire
Classifies radial head fracturs
30
Monteggia fracture
1=undisplaced 2 = displaced 3=comminuted
31
Galeazzi fracture
Surgical method to fix olecranon #s
32
Volar tilt
of proximal ulna with dislocation of the radial head
33
Radial inclination
of distal radius with dislocation of the distal radio-ulnar joint
34
Smith’s fracture
Normal wrist has 10 degrees volar tilt
35
Carpal bones
Normal wrist has 25 degrees radial inclination
36
FOOSH
Volar displacement of radius head
37
Clinical signs of scaphoid fracture
Bones of the wrist
38
Swan neck deformity
Scaphoid, lunate, triquetral, pisiform
39
Boutonnieres deformity
Trapezium, trapezoid, capitate, hamate
40
Z shaped thumb
Fall on out stretched hand
41
Ulnar deviation
Pain in anatomical snuff box on palpation, pain on palpation of scaphoid tubercle, pain on telescoping of the thumb
42
Garden classification
Sign of RA
43
Intertrochanteric # treatment
Hyperflexed DIPJ and hyperextended PIPJ
44
Intracapsular# treatment
Sign of RA
45
Management of hip OA
Hyperextended DIPJ and hyperflexed PIPJ
46
Commonest hip replacement
Sign of RA
47
The fibula lies on the _______ side
MCPJ flexion and IPJ extension
48
Schatzker classification
At the MCP joints
49
Ankle joint bones
Might develop to subluxation
50
Pilon #
For NOF#
51
Foot bones
1 – incomplete fracture, not displaced
52
Hallux valgus
2- complete fracture not displaced
53
Jones fracture
3 – complete fracture partially displaced
54
Odontoid peg
4- complete fracture completely displaced
55
Bamboo spine
Dynamic hip screw
56
Syndesmophytes
Cannulated screws for non-displaced fractures
57
Things that make diabetic retinopathy more likely
Long duration of diabetesType of diabetes (more common in type 1)Poor glycemic controlIncreased BPPresence of macro or microalbuminuriaIncreased serum cholesterol levelsPregnancyCigarette smokingGenetic factors
58
Screening for diabetic retinopathy
All diabetics need annual screening Children screened after five years if have type 1Increased checks if pregnantPhotographs taken - 2 photos of each eye. Disc centred and macula centred, Slit lamps used
59
Why can diabetes lead to blindness
MaculopathyNew vessel formation CataractsCVA with field loss
60
Stages of diabetic eye disease0123
0- no retinopathy 1- microaneurysms, any exudate, venous loops2- any microvascular changes, venous beading, multiple blot haemorrhage 3- proliferative disease
61
What is glaucoma
Chronic progressive optic neuropathyThinning of neuroretinal rim of the optic disc results in characteristic cupping of optic nerve head and visual field loss
62
Risks for primary open angle glaucoma
AgeIOPraceFamily history High myopiaCorneal thicknessDiabetes Vascular factors eg CV disease, vasospasms, systemic hypotension
63
Normal intraocular pressure
10-21 mmHg15.5 average
64
Optic changes in glaucoma
Enlargement of optic cupLoss of disc rimVascular changesPeripappillary atrophy
65
Treatment of primary open angle glaucoma
Control the IOPOptions:Prostaglandin analogues eg latanoprost. These increase outflow Beta blockers eg timolol. Decrease productionCarbonic anyhydrase inhibitors eg dorzolamide. Decrease productionAlpha agonists decrease production Cholinergic agonists eg pilocarpine. Increase trabecular outflow.
66
Ocular muscles and innervation
Medial rectus- adduction. Third cranial nerveLateral rectus- abduction. Fourth cranial nerveSuperior rectus- up. ThirdInferior rectus- down. ThirdSuperior oblique- fourthInferior oblique- third
67
Horizontal Diplopia cause
Sixth nerve palsy as lateral rectus not working - could be trauma, neoplasms, ischamia, demyelination. Autoimmune disorders
68
Vertical diplopia
Fourth or third cranial nerve palsy- superior oblique or superior rectus
69
Causes of a mechanical restriction in eye movement
Trauma leading to orbital floor fracture leading to vertical Diplopia usuallyThyroid eye disease
70
How to test for RAPD
Swinging light testDetects if there is paradoxical dilatation of the pupil when light is shone into it due to an afferent defectDetects an optic neuritis
71
Causes of optic neuritis
MS or neuromyelitis optica
72
Blindness by age group16-6465-7475-84 85+
16-64 diabetic retinopathy, macular disorders, optic atrophy, hereditary 65-74 AMD75-84 glaucoma 85+ cataracts
73
What eye diseases is smoking linked to?
Cataracts Macular degenerationThyroid eye diseaseRetinal vein occlusionRetinal artery occlusion
74
How do you perform a visual acuity test?
Corrective lenses should be wornTest each eye individually Should be 6m away with snellen or 3m with a 3m snellenNumber on chart says distance at which most people can read itRecord as distance from chart over number on chart Test near vision and colour vision
75
Charts to measure visual acuity
SnellenLogmar
76
Eye symptoms history questions
Has vision been affected When did it startSudden or gradualAre the eyes uncomfortable Pain?Grittiness, dryness, feel tired- dryness problemSharp or stabbing pain- ocular surface problems Dull ache- uveitis, raised IOP, scleritisRednessPrevious eye history or surgeryFHsmoking, alcohol, job, driver
77
Total blindness of right eye- where is lesion
Right optic nerve
78
Bitemporal hemianopia- where lesion
Optic chiasm- think pituitary tumour
79
Left visual field loss
Right occipital lobe- could be posterior circulation stroke
80
Peripheral field loss- what’s the problem
Could be glaucoma
81
Left homonymous inferior quadrantanopia
Right parietal lobe lesion or stroke
82
Right homonymous superior quadrantanopia
Left temporal lobe lesion or stroke
83
What are you looking for on optic disc
CupColour- should be orange with pale centre. Can be pale in optic atrophy eg optic neuritis advanced glaucomaContour- circle should be well defined, if not then could be papilloedema
84
Cataracts
Common cause of visual loss in the elderlyGradual blurring of distant then near vision If cataracts is posterior in the lens then they experience glare and vision is better out of sunlight Correct with surgery and intraocular implant
85
Younger patients with cataracts
Diabetes, steroid use, chronic uveitis, FH
86
Primary open angle glaucoma How does it presentWho is at risk
Progressive painless visual field lossRisk factor include Afro Caribbean, family history, hypertensionOften picked up by opticians or at glaucoma screening
87
What are changes in ARMD?
Central visionReading, faces and fine detail affected. Colour is also affected
88
Dilating agents
TropicamideCyclopentolatePhenylephrine
89
Absent red reflex
Cataracts Retinoblastoma (rare)
90
Drusen
Lipid deposits Think ARMD
91
Flat retina- means not
Not glaucoma as this causes cupping
92
Retinal haemorrhages
Hypertension Retinal vein occlusion Diabetes In baby could be shaken baby
93
Retinal elevation
Retinal detachment
94
Dry ARMD
Gradual loss of central visionRisk factors- female, smoking, HTN, previous cataracts surgery
95
Side effects of latanoprost
Blurred vision, stinging, long eyelashes, foreign body sensation, hyperaemia
96
Eyes and the DVLAAcuityGlaucoma ARMDCataractsOptic neuritis Diplopia
Must have at least 6/12 vision If glaucoma need to inform DVLA so they can do tests to see if safeMacular degeneration- inform if both eyes affectedCataracts- don’t need to tell DVLA if still over 6/12Optic neuritis- tell DVLA Diplopia- can drive once adaptations of once settled. HGV drivers can’t even with prisms
97
What is wet macular degeneration
Fluid and or blood develops in the retinaSudden loss of central vision Needs instant referral for anti VEGFV injections
98
Blurred vision Red eye Nausea and vomiting Headache Differential?
Acute angle closure glaucoma
99
Why blurred vision in AACG
IOP increases leading to oedema of cornea and it becomes cloudy Therefore affects vision
100
Who does AACG affect
Long sighted Female
101
Treatment of acute angle closure glaucoma
Reduce pressure with drops- acetazolamidePeripheral iridotomy to restore aqueous flow Treat other eye prophylactically
102
Cherry red spot with pale retina
Central retinal artery occlusion
103
Why does central retinal artery occlusion happen
Non inflammatory vascular problems Raised cholesterol, HTN, atherosclerosis, diabetesAlongside angina and TIAGet smoking Hx, CV exam, routine bloods
104
Sudden onset of floaters
Most likely to be retinal detachment
105
Risk factors for retinal detachment
Trauma eg high velocity Myopia is also a risk
106
Treatment for retinal detachment
Surgery! Vitreous removed. Flatten retina with gas or oil
107
Child with eye pain, oedema, erythema, chemosis (swelling of conjunctiva), restricted eye movement, systemically unwell
Orbital cellulitis!
108
Once identified or suspected orbital cellulitis, what is next step
True emergency! Get senior! May need referral to oculoplastic team or ENT.Investigation- blood cultures, swabs, orbital scan, FBCCephalosporins or penicillin IV. If abscess present may need surgery Check obs and visual acuity hourly
109
Common organisms causing orbital cellulitis
Usually a bacterial infection spread from paranasal sinuses. Commonly staphylococcus aureus, strep pneumoniae, h influenzae. Could be fungal in severely immunosuppressed.
110
What is a hypopyon?
Red eye, fluid level in anterior chamber of the eye, this indicates an accumulation of WBCCan be a sign of bacterial keratitis. Leads to a risk of corneal perforationTreat with broad spec antibiotics
111
Red eye, pain and reduced vision
Refer!
112
Questions with query conjunctivitis
Contact lensesSexually active (could be chlamydial) URTI recently (indicates probably viral cause)Any contact with people with red eyesAllergies
113
Symptoms of conjunctivitis
Redness of conjunctivaNormal visual acuityReactive pupilsMucoid discharge
114
Tests in conjunctivitis
Swabs- bacterial, viral, chlamydial
115
Treatment of conjunctivitis
Usually bacterial usually self limiting. 60% resolve in five days without treatment. Chloramphenicol drops. Ointments and gel provide a higher concentration for longer periods than drops but daytime use is limited because of blurred vision. Cold compressesLubricantsIf allergic conjunctivitis then remove trigger. Antihistamines.
116
If conjunctivitis does not go away after chloramphenicol...
PCR may be required as more likely to be viral or chlamydial
117
Fluoroscein eye drops would help reveal..
Corneal abrasion, dendritic ulcers and microbial keratitis
118
Dendritic ulcers
When herpes simplex infects corneal epithelium Treat with Aciclovir drops
119
Young male with red eye
Conjunctivitis? Anterior uveitis? Ask about back painAsk about IBD
120
Investigation into Diplopia
HistoryTests to measure squintAssess range of eye movements Use Hess chartDo bloods and head scans to determine cause of eye palsy (could be aneurysm, SOL, could be microvascular infarcts)
121
Treatment of eye palsy
80% of palsies due to microvascular infarct resolve in 6 months. Therefore symptom treatment eg temporary plastic prism can be fitted to patients glasses then Botox into medial rectus muscle to reduce size of squint
122
Ptosis, eye divergent and depressed. Large pupil
The pupil involvement suggests pressure on nerve rather than microvascular cause
123
Causes of Diplopia
Poor blood supply, direct pressure on nerve (aneurysm), tumour, head injury, inflammation near nerve
124
Presence of large pupil as well as nerve palsy, treatment
Indicates Pressure on nerve. Therefore is a medical emergency! This could be dangerous swelling of blood supply in the brain (posterior communicating artery). Imaging required! Go from there.
125
Trauma to eye area
Could lead to inferior orbital floor fracture. Orbital fat and muscle can get stuck in fracture and lead to diplopia. Get max fax involved, prescribe broad spec antibiotic. Do not blow nose! Ask about loss of sensation below orbit
126
Variable or progressive weakness of eyelid and ocular muscle
Think myasthenia gravis
127
Symptoms of optic neuritis
Sudden vision lossDecreased contrast and colour sensitivity Pain with eye movement RAPD
128
Child with white pupil
Retinoblastoma!Congenital cataracts
129
Retinopathy of prematurity
Underdeveloped Retina. The retina is susceptible to the high oxygen that premature babies are often exposed to.Babies born on or before 31 weeks gestation, under 1500g. Laser photocoagulation is the treatment of choice.
