Opthalm

Question 1

Presentation of herpes keratitis and its complications

Answer 1

acutely painful red eye, vesicles, photophobia, reduced visual acuity, foreign body sensation

Complications - corneal scarring, meningitis, encephalitis, corneal perforation

Question 1

differentiating between episcleritis and scleritis

Answer 1

scleritis is painful, episcleritis is not

Question 2

rf of acute angle glaucoma

Answer 2

hypermetropia - long sighted
long term steroid use
fix
increasing age

Question 3

presentation of acute angle glaucoma

Answer 3

severe pain
reduced visual acuity
peripheral visual loss
fixed mid dilated pupil
dull hazy cornea
see halos around lights

Question 4

Initial rx of AAG and definitive rx

Answer 4

TAP
Timolol
Pilocarpine - reduce uveoscleral flow
Intravitreous acetozolamide

Laser iridotomy

Question 5

ix of AAG

Answer 5

tonometry (eg goldman application) and goinoscopy (slit lamp)
plus visual acuity and visual fields examination

Question 6

rf for ARMD

Answer 6

smoking
increasing age
FHX
hypertension, dyslipidaemia, diabetes

Question 7

Wet vs Dry ARMD

Answer 7

wet subacute, characterised by choroidal neovascularisation
dry more gradual. Characterised by drusen

Question 8

presentation of ARMD

Answer 8

central scotoma - may have charles bonnet hallucinations
line distortion
poor night time vision
reduced visual acuity

Question 9

Ix for ARMD

Answer 9

slit lamp/ fundoscopy
OCT

Question 10

Rx of
- dry ARMD
- wet ARMD

Answer 10

Dry - lifestyle - no smoking, control BP. Give Vitamins ACE and zinc
Wet - anti-VEGF injections. Can do laser photocoagulation but anti-VEGF preferred

Question 11

Presentation of anterior uveitis

Answer 11

acutely painful red eye
photophobia
lacrimation
small irregular pupil
hypopyon

Question 12

diseases associated with anterior uveitis

Answer 12

Crohns and UC
ankylosing spondylitis
sarcoidosis

Question 13

Rx of anterior uveitis

Answer 13

urgent referral to opthalm
steroid eye drops and dilating eye drops (cycloplegics)

Question 14

presentation of blepharitis

Answer 14

bilateral
grittiness and discomfort, particularly around the eyelid margins
eyes may be sticky in the morning
eyelid margins may be red. Swollen eyelids may be seen in staphylococcal blepharitis
styes and chalazions

Question 15

rx of blepharitis

Answer 15

hot compress
eye hygiene - cooled boiled water

Question 16

RF for cataracts

Answer 16

Smoking
Increased alcohol consumption
Trauma
Diabetes mellitus
Long-term corticosteroids
Radiation exposure

Question 17

Ix of cataracts

Answer 17

Red light reflex
fundoscopy

Question 18

Complications of phacoemulsification

Answer 18

Posterior capsule opacification (thickening of the lens capsule)
Retinal detachment
Posterior capsule rupture
Endophthalmitis:

Question 19

fundoscopy sign of central retinal artery occlusion

Answer 19

pale retina and cherry red spot

Question 20

Features of CRVO

Answer 20

painless sudden loss of vision
usually unilateral

Question 21

fundoscopy in CRVO

Answer 21

widespread hyperaemia
severe retinal haemorrhage - stormy sunset

Question 22

Rx of CRVO

Answer 22

anti VEGF or laser photocoagulation

Question 23

Rx of corneal abrasions

Answer 23

topical abx recommended to prevent infection

Question 24

Classifications of diabetic retinopathy

Answer 24

Non proliferative: - mild - micro aneurysms - moderate - micro aneurysms, blot haemorrhages, cotton wool spots, hard exudates - severe - all above + IRMA Proliferative - neovascularisation,

Question 25

Rx of diabetic retinopathy based on classification

Answer 25

All - glycemic control and BP. Regular opthalm review NPDR - regular observation. If severe pan retinal photocoagulation PDR - pan retinal photocoagulation and anti-VEGF

Question 26

Complications of pan retinal photocoagulation

Answer 26

50% notice reduction in visual fields Worsening night time vision

Question 27

causes of horners syndrome

Answer 27

stroke, syringomyelia, MS Pancoast tumours, thyroidectomy carotid artery dissection carotid artery aneurysm, cavernous sinus thrombosis cluster headaches

Question 28

Keith Wagener classification of hypertensive retinopathy

Answer 28

1 arteriolar narrowing and silver wiring 2 arteriovenous nipping 3 cotton wool exudates, flame and blot haemorrhages 4 papilloedema

Question 29

preseptal vs orbital cellulitis

Answer 29

educed visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis

Question 30

Ix of orbital cellulitis

Answer 30

CT contrast, FBC, blood culture and swabs

Question 31

rx of orbital cellulitis

Answer 31

Admission for IV antibiotics

Question 32

rx of open angle glaucoma

Answer 32

offer laser trabeculoplasty latanoprost timolol, brimonidine pilocarpine,

Question 33

how do beta blockers work in OAG what about prostaglandins and motifs

Answer 33

beta blockers - reduce aqueous production prostaglandins and miotics - increase uveosacral outflow

Question 34

2 main causes of RAPD

Answer 34

optic neuritis retinal detachment

Question 35

rf for retinal detachment

Answer 35

diabetes myopia age prev ocular surgery eye trauma eg boxing

Question 36

features of retinal detachment

Answer 36

sudden painless and progressive vision loss new onset flashes and floaters reduced visual fields rapd

Question 37

examination for a squint

Answer 37

cover test H test movements for diplopia