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MRCP PART 1 > Opthal > Flashcards

Opthal Flashcards

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1
Q

Primary open angle glaucoma pneuonic for symptoms and whats seen on fundoscopy? Which visual field lost first?

A

OPENs

-Optic dis atrophy
-Pressure >21mmHg -> Optic disc cupping (increased cup:disc ratio [>0.7]). Pallor also seen
-Emerging vessles from optic disc
-Nasal + superior visual fields lost first

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2
Q

Most common type of glaucoma - affects both eyes ?

A

Primary open angle glaucoma

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3
Q

Aute painful red eye. Long-sighted, episodes of blurred vision, headaches, nausea, halos around lights … which glaucoma? How does it look on exam?

A

Acute angle closure glaucoma

Semi diated with a fixed pupil, decreased acuity and may be hard on palpation

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4
Q

men or women primary angle closure glaucoma

A

women - 2:1

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5
Q

What is raised IOP cut off?

A

> 21mmHg

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6
Q

Which receptors increase secretion of aqueous humour

A

B2
[A2 inhibit]

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7
Q

Who gets screened in glaucoma

A

> 60 Screened every 2 years. >70 annually

> 40 annually with 1st degree family member with OAG

> 40 black african annually

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8
Q

Rx of open angle glaucoma

A

Open Lovers Touch Bums

Topical prostaglandin analouge - eg latanoprost [increases aqueous outflow]

Topical B blocker eg timolol [decreases aqueous humour production]

Topical carbonic anhydrase inhibitor eg Brinzolamide [decreases aqueous formation]

[Usually latanoprost then add timolol. Second line therapies include pilocarpine (cholinergic agonist) and brimonidine (A2 agonist) ]

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9
Q

First thing you do with acute angle closure glaucoma

A

Lie patient flat

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10
Q

Rx of acute angle closure glaucoma? Long term?

A

Lie down PAL

Lie patient flat
Pilocarpine eye drops
Acetazolomide (IV/PO) or Dorozolamide drops
[analgesia, antiemetic, timolol]

Peripheral Lazer irodotomy

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11
Q

Open angle glaucoma may also get laser therapy (Trabeculoplasty) or what

A

Shunt formation
[teeny lil one]

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12
Q

Inform DVLA with glaucoma

A

Dont need to if affects one eye

Do need to if affects both

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13
Q

Asymmetric diabetic retinopathy need which 2 investigations ? Why?

A

Carotid doppler
Fluorescein angiography

Raises suspicion of ocular ischemic syndrome which is usually due to atherosclerosis [usually >90% stenosed on affected side]

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14
Q

Which CN does oblique movements ? horizontal?

A

SO4 - Superior oblique = trochlear CN IV
LR6 - lateral rectus = abducens CN VI

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15
Q

If diplopia slowly gets worse through day - what needs excluded ?

A

myasthenia gravis

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16
Q

Painless sudden loss of vision in 1 eye is likely? Seen on fundoscopy / exam?

A

Central retinal artery occlusion

pale oedematous retina with ‘cherry red spot’
RAPD

[If only part of vision lost - may be branch artery occlusion]

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17
Q

Outcomes of retinal artery occulsion are poor. Even with prompt management only 1/3 of people have any improvement.
What can you do?

A

Decrease IOP - Eg IV acetazolomide / b blockers

Dilate renital artery - sublingual isosorbide dinitrate, hyperbaric oxygen

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18
Q

Chronic hyperglycaemia -> diabetic retinopathy. Sight loss is due to neovascularisation. What is the mainstay of treatment (bar addressing factors eg Glycaemic control/BP/Lipids…)

for macular oedema?
Proliferative retinopathy?

A

Focal laser therapy
Intra vitreal injection of Vascular endothelial growth factor

Pan retinal photocoagulation

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19
Q

Diabetic retinopathy
Microanneursyms, exudates, haemorrhages, sight not affected? Symptoms? Rx?

A

Background diabetic retinopathy

Asx

Annual screening
Control of factors eg glucose / lipids / BP

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20
Q

Diabetic retinopathy
widespread changes in retina - cotton wool spots, venous changes, multiple haemorrhages? Symptoms? Rx?

A

Pre-proliferative

ASx

-> routine opthal referral
-> 6 monthly check up

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21
Q

Diabetic retinopathy
Neovascularisation, vitreous haemorrhage? Symptoms?

A

Proliferative

Floaters, blurred vision

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22
Q

Diabetic retinopathy
Retinopathy in the macular region? Symptoms?

A

Diabetic maculopathy

Blurred vision with darkened / distorted vision

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23
Q

What is the earliest clinical sign of diabetic retinopathy? How do they appear?

A

Microaneurysms

small red dots in superficial layers

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24
Q

Cotton wool spots are? When might these affect vision ?

A

Arteriole occlusion

If in fovea

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25
Who gets diabetic retinopathy screening
All with diabetes > 12
26
What are aflibercept and ranibizumab?
VEGF inhibitors
27
What is triamcinolone
Intra vitreal Steroid used in proliferative retinopathy / macular oedema
28
Surgical rx of proliferative retinopathy? Macular oedema
Proliferative - pan-retinal photocoagulation Macular - focal laser therapy
29
Surgical Rx if lots of blood in vitreous/aggressive proliferative retinopathy? Why? What is it?
Vitrectomy - reduce risk of retinal detachment Cloudy vitreous is replaced with saline -Often day case under local anaesthetic
30
What does a posterior communicating artery aneurysm lead to?
CN III palsy (Fixed dilated pupil facing down and out) +/- SAH
31
CNIII palsy but painless and sparing of the pupil?
Diabetic/hypertensive microangiopathy. [Due to pupillary fibres on the peripheral surface of nerve and having own vascular supply]
32
Why aye abduction in CN III palsy?
due to unopposed action of Lateral rectus
33
How does vitreous haemorrhage present? How does it appear on fundoscopy? What is needed?
Loss of vision Hazy/limited fundal view US scan to check for retinal detachment
34
The usual cause of CRVO vs BRVO? How does it look on fundoscopy?
Central - thrombus Branch - compression from an adjacent artery Retinal haemorrhages, cotton wool spots, dilated vessels/tortuosity. Swollen optic disc
35
Rx of RVO? if macular oedema ?
VEGF inhibitors - aflibercept / ranibizumab intravitreal steroids focal laser coagulation *if macular oedema in BRVO*
36
Which eye condition usually in sarcoidosis ? Usual sarcoid presentation?
Anterior uveitis Bihalar lymphadenopathy and erythema nodosum [+ fever, arthalgia]
37
What eye condition might be associated with complete heart block and a gradual reduction in eye movements + poor night vision
Retinitis pigmentosa
38
Rx of thyroid eye disease
High dose IV steroids Surgical decompression may be required
39
Optic neuropathy (eg in thyroid eye disease) typically presents with....
loss of colour vision and reduced acuity
40
When do you see cells in the anterior chamber?
Uveitis or inflamation
41
CMV eye infection looks like?
'brush fire' (rapidly spreading outwards) Vasculitis and haemorrhages
42
VZV and HSV eye infections cause
Actute retinal necrosis
43
Arteriole narrowing, Arterovenous nipping, hard exudates and flame haemorrhages?
Hypertensive retinopathy
44
Rosacea. What seen in eye
keratitis
45
Why would patient with rosecea end up getting cataracts
Secondly to steroid treatment for keratitis
46
Vitamin deficiency -> keratitis
Vit A
47
What gives a dendritic ulcer
HSV keratitis
48
Contact use then swimming -> which protozoal infection
Acathamoeba
49
Key thing to not give people with bacterial / viral keratosis
Topical corticosteroids
50
Diabetic + unilateral painless visual loss -> with vitreous haemorrhage on fundoscopy. Whats happened
Neovascularisation -> haemorrhage (proliferative diabetic retinopathy)
51
What is supranuclear gaze palsy?
Doll's eye [dont follow movements up but will continue to focus on object despite head turning] [Due to a leision between cortex and ocular motor nuclei]
52
Eye feels firm - IE increased IOP. It can be due to many things such as trauma which may cause hyphema (bleeding in iris). First line RX to reduce the pressure
Carbonic anhydrase inhibitor (acetazolamide) [or topical B blockers]
53
Most common side effect of carbonic anhydrase inhibitor eg. cetazolamide, methazolamide, dorzolamide, brinzolamide
Finger tingling
54
Which condition always gets optic neuritis in questions? Which type of optic neuritis
MS Retrobulbar neuritis
55
How long is the presentation of optic neuritis
Usually few days - 2 weeks. IE sub acute
56
Optic neuritis presents how?
Pain Decreased acuity Colour desaturation [USUALLY RED] RAPD
57
Main investigation in optic neuritis
Gadolinium enhanced MRI
58
Acute optic neuritis management
High dose Mpred Eg 1000mg IV for 3 days
59
Heavy smoker with unilateral ptosis and constricted pupil? What is this describing? why?
Horners syndrome - Ptsosis (drooping eyelid), miosis (constricted pupil) and anhydrosis (decreased sweating) Pancoast tumour
60
The location of anhydrosis lets you work out where the lesion causing horners syndrome is. Face arm and trunk? [1st order] Face only? [2nd order] No anhydrosis? [3rd order]
Face arm and trunk = MS / encephalitis / brain tumours...1st order [central] Face only - Thoracic/thyroid carcinomas including Pancoast, Thoracic AAA, Trauma ... 2nd order [pre ganglionic] No anhydrosis - cluster headache, carotid dissection/aneursym, cavenous sinus thrombosis. 3rd order [post ganglionic]
61
finding only in congenital horners syndrome?
Heterochromia iridis [Different coloured bits of iris. ie one blue one brown eye or just in a section]
62
Cocaine test in horners?
Cocaine drops in the eye -> block the reuptake of NA which makes pupil dilate -In horners lack of NA causes a failure of the pupil to dilate (remains constricted) [Can also use apraclonidine hydrochloride / adrenaline (beta adrenic receptor test) - this test the affected pupil is the one to dilate)
63
How to differentiate between a 3rd order (post ganglionic horners and a 1st/2nd] other than the lack of anhydrosis
Hydroxyamphetamine test If pupil dilation occurs it is a 1st/2nd order no dilation is a 3rd
64
NF type 1. Seen in the eye?
lisch nodules on iris
65
Who gets ash leaf spots on trunk
Tuberous sclerosis
66
Best test to look for diabetic retinopathy
Fluorescein angiography [ to visualise the micro aneurysms
67
Visual field defects with lesions : Before chiasm At chiasm After chiasm Biltemporal hemaniopia from below? Above? Homonymous superior quadrantanopia Top right/left quarter? Homonymous inferior quadrantanopia?
Before chiasm - Ipsilateral eye At chiasm - bitemporal homonymous hemaniopia [lateral fibres cross] After chiasm - Homonymous contralateral Eg right occipital = left side of both eyes Biltemporal hemaniopia from below = cause from above Eg Pit tumour Above = lesion from below eg Craniopharyngioma Homonymous upper quadratic? Temporal lesion Homonymous inferior quadratic? Parietal
68
Older person with neovascularisation and leakage at macula only on fundoscopy =? 3 key risks factors? which is most important?
Wet macular degeneration Smoking - most important Hypertension Cataract surgery
69
Which macular degeneration is there a Rx for?
Wet VGEF inhibitors
70
Differentiate wet and dry macular degeneration? What do they both have
Both have Drussen: Protein/lipid under retinal pigement epithelium (RPE) RPE - hypo/hyperpigmentation Only wet has neovascularisation and exudate / haemorrhages
71
Early, intermediate and advanced macular degeneration
Early - numerous drussen / mild RPE abnormalities Intermediate - drussen >125um -Geographic atrophy NOT involving fovea Advanced - Atrophy involving fovea Neovascularisation
72
What do drussen look like ? What does geographical atrophy look like?
Yellow deposits in retina Hypopigmentation of retina
73
What test is required for diagnosis of wet AMD and for monitoring treatment
Ocular coherence tomography
74
Intermediate AMD usual therapy
Vitamin supplements Control of risk factors
75
Painful 3rd nerve palsy age 50. Most likely cause
PCA Aneurysm [MS would present earlier]
76
Aortic regurg and Aphakic glassess = ? What eye thing?
Marfans Ectopia lentis [dislocation of lens] -Aphakia means not having a lens inside your eye. The glasses are big jam jar ones which do the work of the lens
77
Hereditary ectopia lentis. What Ix?
homocysteine levels
78
Same day review by opthal in?
Corneal ulcer Acute glaucoma Endopthalmitis Foreign body stuck Trauma / chemical injury
79
Drug causes of closed angle glaucoma
A's Antidepresents (tricyclics) Antipsychotics Antihistamine Anti-parkinsons (sulphonamides)
80
What is hypopyon. Symptoms associated
'level' of inflammatory cells in anterior chamber. Seen in inflammation Eg anterior uveitis Pain + photophobia + reduced acuity [IBD...]
81
Ehlers-danlos sudden painless loss of vision in 1 eye. Normal anterior chamber. What has happened?
Retinal detachement [Anterior chamber would not be normal if lens dislocation]
82
Superior homonymous hemianopia
Temporal lobe lesion
83
Right eye superior visual field loss
Branch retinal artery / vein occulsion
84
Cough, sore lesions on face with facial swelling. Facial palsy. CSF high protein? If there was uveitis and fever?
Neurosarcoid Heerfordt-waldenstrom syndrome [Parotid enlargement, uveitis, fever, cranial nerve palsies]- type of neuro sarcoid
85
seizing 10 mins with 2x 10mg rectal diazepam. What next?
IV phenytoin loading
86
Essential tremor. 1st line 2 options? Second line and key side effect
Propranolol / topiramate Primidone - drowsiness [Deep brain stimulation can also be used]
87
Most common cause of viral meningitis ? CSF findings
Enterovirus (echovirus/coxsakie) Mild raised protein, Normal glucose, lymphocytosis
88
When is CSF glucose very low? (2)
TB Fungal
89
Myasthenia gravis which receptor
Nicotinic Ach 90% MuSK - 10% [Muscle specific tyrosine kinase]
90
What is key assoc with myasthenia gravis
Thymus abnormalities 75% (10% thymus Ca)
91
Myasthenic crisis Rx
IV Ig Plasmapheresis +/- ventilate
92
Myasthenia gene risks. Which is specific for ocular
HLA DR3 / B8 HLA DR1 - specific for ocular myasthenia
93
Myasthenia crisis triggered by infection or which class of drug? Other classes to avoid generally
Amino-glycosides - gentamicin, neomycin other -mycin types -cyclines B blockers Antipsychotics
94
Bedside test with 90% sensitivity in MG
Ice test -Ice in glove. Put on ptosis and it will improve temporary
95
Bar Anti-Ach what tests for MG
Anti-MuSK TFTs EMG CT/MRI brain / thymus
96
Why is the edrophonium test no longer done? other name?
Tensilon test for MG No longer done due to severe brady / arrest
97
Rx MG usual drug? What else initially? Which -mab? Surgical
Pyridostigmine - cholinesterase inhibitor Steroids (+ steroid sparing) Rituximab (think Thymus and T cell driven attack) Thymectomy
98
Differentiate L5 and S1 lesions. Movement
L5 Largest of 5 - dorsiflexion - dorsiflex foot and it will have big toe at top S1 - Small 1 Plantar flex and lil toe will be bottom
99
Impaired adduction and contralateral nystagmus. Normal accommodation. Where is lesion
Medial longitudinal fasiculus [If R sided adduction issues its on R side]
100
Ipsilateral horners. Facial numbess, horse voice and contralateral limb numbness. [May get nystagmus / limb ataxia] Called? Lesion is where?
Wallenberg syndrome Lateral medulla
101
Most common type of nystagmus in kids ? Direction
Sensory deprivation nystagmus (90%) Bi - horizontal
102
Vertical nystagmus Upwards - lesion in
Medulla (stroke often)
103
Vertical downbeat nystagmus in?
Arnold-chiari malformation - lesion in foramen magnum
104
Acute vs chronic horizontal nystagmus
Acute - away from lesion Chronic - towards lesion
105
Nystagmus with hearing loss / tinitus =
Usually peripheral cause -Trauma -Menniers -CN8 lesion
106
Nystagmus that varies with head position
BPPV
107
partial dislocation of lens (ectopia lentis), quivering (iridodonesis) of (iris), nearsightedness (myopia). Long arms and legs
Cyststhione beta synthase deficiency (Hereditary homocystineuria)
108
Unilateral visual loss and pain with RAPD
Optic neuritis
109
GCA causes anterior ischemic optic neuritis. What is most common thing seen on fundoscopy
Optic disk swelling [occlusive vasculitis -> ischemia of optic nerve which then manifests as swelling visible on exam]
110
Amiodarone deposits in eye sometimes termed?
cornea verticillata vortex keratopathy
111
What are Band keratopathy? Hudson -stahli lines?
band - Calcium deposition due to chronic hyper Ca Hudson - iron deposition in normal ageing

MRCP PART 1 (22 decks)

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