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#passmed 2023 > Opthalmology > Flashcards

Opthalmology Flashcards

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1
Q

What condition does MS increase the risk of?

A

Optic neuritis

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2
Q

What other conditions increase risk of Optic neuritis? (3 things)

A
  1. DM
  2. MS (investigate w MRI brain)
  3. Syphilis
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3
Q

What are the CF of Optic Neuritis? (5 things)

A
  1. Unilateral visual acuity reduction (over hours / days)
  2. Central scotoma
  3. Poor colour discrimination
  4. Pain @ eye movement
  5. RAPD
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4
Q

What is a Scotoma?

A

Part of vision occluded by dark blodge

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5
Q

What is Central Scotoma assoc w?

A

Optic neuritis

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6
Q

How do you investigate for Optic Neuritis?

A

MRI of brain + orbits with contrast

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7
Q

What are the Mx options for Optic Neuritis?

A

High dose steroids
(4-6 weeks to recover)

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8
Q

What is Anterior Uveitis aka?

A

Iritis

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9
Q

What is Anterior Uveitis assoc w?

A

UC / Crohns / Ankylosing spondylitis

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10
Q

What are the CF of Ant Uveitis? (6 things)

A
  1. Pain
  2. Red eye
  3. Blurred vision
  4. Constricted oval shaped pupil
  5. Photophobia (intense)
  6. Hypopyon (pus in ant chamber, you can see fluid level in eye)
  7. Lacrimation
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11
Q

What are the Mx options for Ant Uveitis? (3 things)

A
  1. Urgent ophthalmology review
  2. Steroid eye drops
  3. Atropine (aka mydriatics to dilate pupil)
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11
Q

What are the Mx options for Ant Uveitis? (3 things)

A
  1. Urgent ophthalmology review
  2. Steroid eye drops
  3. Atropine (aka mydriatics to dilate pupil)
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12
Q

What does dilating pupil w Atropine in Ant Uveitis help reduce? (2 things)

A
  1. Pain
  2. Photophobia
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13
Q

What condition can give you Horners syndrome, but instead of Sweating you get Pain behind the eye?

A

Carotid artery dissection
(still get miosis and ptosis)

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14
Q

What is the immediate Mx of Acute CA Glaucoma? (3 things)

A
  1. Immediately admit
  2. Eye drops combo (3 things)
  3. IV acetazolamide
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15
Q

What eye drops combo can you give in Acute CA Glaucoma initial Mx? (3 things)

A
  1. Pilocarpine
  2. Beta blocker (Timolol)
  3. Alpha agonist (Apraclonidine)
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16
Q

How does Pilocarpine work in Acute CA Glaucoma initial Mx? (3 steps)

A
  1. Contracts ciliary muscle
  2. Opens trabecular meshwork
  3. Increase flow of aqueous humour
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17
Q

How do Alpha agonists, Beta blockers, and IV acetazolamide work in Acute CA Glaucoma initial Mx?

A

Decrease aqueous humour prod / secretion

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18
Q

What is the definitive Mx of Acute Glaucoma?

A

Laser peripheral iridotomy
(hole in peripheral iris –> aq humour flows to angle)

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19
Q

What are the Mx options for Primary Open-Angle glaucoma? (3 things)

A
  1. Prostaglandin analogue (PGA) eyedrop (FIRST LINE)
  2. Beta blockers / Carbonic anhydrase inhibitor / Sympathomimetic eye drops
  3. Surgery
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20
Q

How do you remember MOA of Glaucoma meds?

A
  • Any Inhibitors / Blockers / Antagonists = INHIBIT aq production
  • Any Agonists = INCREASE uveoscleral flow
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21
Q

What is an example of Carbonic anhydrase inhibitor?

A

Dorzolamide

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22
Q

What are the initial CF of OA glaucoma?

A

Reduced peripheral vision

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23
Q

What are the side fx of Prostaglandin analogue (PGA) eyedrops used in Primary open-angle glaucoma? (2 things)

A
  1. Increased eye lash length
  2. Iris + Periocular pigmentation
    (Prostaglandins make you Pretty n Pigmented)
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24
What is the difference in RF for CA vs OA Glaucoma?
* Hypermetropia (long sightedness) --> CA * Myopia (short sightedness) --> OA
25
What are some CF of Retinal detachment that you didn’t know? (3 things)
1. Flashes in peripheral field, followed by… 2. Sudden painless LOV 3. Loss of Red Reflex
26
What are the RF for Retinal detachment? (5 things)
1. DM 2. Myopia (short sightedness) 3. Age (40+) 4. Previous cataract surgery 5. Trauma
27
What are the CF / investigation results of Chronic open-angle glaucoma? (4 things)
1. Slow onset peripheral LOV (patient barely even notices it) 2. NORMAL intraocular pressure 3. NORMAL gonioscopy (drainage test) 4. Increased cup-to-disc ratio
28
What is the most common cause of Flashers and Floaters?
Posterior vitreous detachment
29
What does Posterior vitreous detachment happen with?
Normal with ageing (75% ppl over 65)
30
Is any Tx required for Posterior vitreous detachment?
No
31
If you don’t correct a childhood squint (aka exotropia), what can the child develop?
Amblyopia (aka lazy eye)
32
How can you prevent Exotropia (aka squint) from developing into Amblyopia (aka lazy eye)?
Eye patches
33
How do you differentiate between Episcleritis and Scleritis?
* Epi = Painless // Scleritis = painful * Epi = vessels are mobile @ gentle pressure // Scleritis = vessels deeper so immobile * Epi = redness improves with Phenylephrine
34
What are the Mx options for Episcleritis? (2 things)
1. Conservative 2. Artificial tears (sometimes)
35
What are the Mx options for Scleritis? (2 things)
1. Refer for same day ophthalmology assessment 2. NSAIDs (first line)
36
What are the complication of Scleritis? (5 things)
1. Perforation of the globe (in severe necrotising scleritis) 2. Glaucoma (bc Raised IO pressure) 3. Cataracts 4. Retinal detachment 5. Uveitis
37
What are the RF for Cataract development? (6 things)
1. DM 2. Long term steroids 3. HypOcalcaemia 4. Smoking / alcohol 5. Downs syndrome 6. Scleritis
38
What are the types of ARMD? (2 things)
1. Dry ARMD 2. Wet ARMD
39
What are the CF of ARMD? (2 things)
1. Straight lines appear wavy 2. Colours less strong
40
What CF suggest Dry ARMD is progressing to Wet ARMD? (2 things)
1. Central vision loss (esp nearby objects) 2. Flashing lights
41
What would fundoscopy show if Dry ARMD is progressing to Wet ARMD?
Choroidal neovascularisation
42
What fundoscopy findings can you find in both Dry AND Wet ARMD
Drusen (yellow deposits)
43
What are the Tx options for Dry / Wet ARMD?
* Dry = nothing * Wet = regular anti-VEGF inj (to stop neovasc)
44
What are the CF of Keratitis? (3 things)
1. Painful red eye 2. Photophobia 3. Gritty sensation
45
What should you do with Contact lens wearers who present w Painful red eye + gritty?
Refer for same day ophthalmology assessment (to exclude Microbial keratitis)
46
What are the CF of Herpes Simplex Keratitis? (3 things)
1. Painful red eye 2. Photophobia 3. Dendritic corneal ulcer @ exam
47
What are the RF for Herpes Simplex Keratitis?
Recent course of steroids
48
What is the Tx for Herpes Simplex Keratitis?
Topical antivirals (e.g aciclovir)
49
What investigation tells you if a person has a Refractive error, as their cause of blurred vision?
Pinhole occluder (if vision improves with occluder = they have a refractive error)
50
In addition to anti-VEGF, what can you use to treat Proliferative Diabetic Retinopathy?
Panretinal laser photocoagulation
51
What is the Dx of a painful lump at edge of eyelid?
Stye (pus filled abscess)
52
What is a Stye?
Infection of glands of eyelids
53
What are the Mx options for Stye?
Warm steaming / soaking with warm flannel (don’t need to drain this abscess)
54
What is the classical presentation of Blepharitis? (2 things)
1. Bilateral grittiness 2. Eyes stuck together in morning
55
What are the CF of Central Retinal Vein occlusion? (2 things)
1. Sudden painless LOV 2. Severe retinal haemorrhages @ fundoscopy
56
What are the CF of Orbital cellulitis? (3 things)
1. Eye erythema 2. Pain 3. Pain @ eye movements
57
What is special about Orbital cellulitis?
Medical emergency
58
Why is Orbital cellulitis a Medical emergency? (2 things)
Risk of: 1. Cavernous sinus thrombosis 2. Intracranial spread
59
What is the Mx for Orbital cellulitis?
Hospital admission for IV abx
60
What is a CI for Lumbar puncture?
Raised ICP (aka papilloedema @ fundoscopy)
61
What are the causes of Tunnel vision? (4 things)
1. Papilloedema 2. Glaucoma 3. Retinitis pigmentosa 4. Hysteria
62
What is the Dx?
Macular degeneration (drusen seen around macula)
63
What drops can lead to Corneal ulcers
Steroid drops --> fungal infections --> Corneal ulcer
64
What is the Dx of swollen gritty eye, and whats the Tx?
1. Blepharitis 2. Compress and clean
65
What are Mydriatic drops a risk factor for?
Acute CA glaucoma
66
What happens to the optic disc in Primary OA glaucoma?
Cupping, due to chronic raised IOP
67
What is the Dx of this, they had sudden painless LOV?
Central retinal vein occlusion (looks like exploding sun / cheese n tomato pizza)
68
What is the Dx of this, they had sudden painless LOV?
Branch retinal vein occlusion (haemorrhage confined to limited area of retina like a patch)
69
What are the CF or common picture of Idiopathic Intracranial HTN? (5 things)
1. Optic disc blurring 2. Young woman 3. High BMI 4. Headache 5. Visual symptoms worse @ bending over
70
If someone on the phone has new flashers / floaters what should you do?
Same day ophthalmology assessment bc could be retinal detachment
71
What is route of administration for Tx of Orbital cellulitis?
IV abx (admit them) bc risk of cavernous sinus + intracranial spread
72
What are Argyll-Robertson pupils? (3 things)
1. Small pupils bilaterally 2. They accommodate 3. But don’t constrict to light (Robinson never saw the light)
73
What is a RF for Subconjunctival haemorrhage?
Constipation | pressure min al ja3ba laman 3iyoonak takub dam
74
What is the cause of painful red eye and reduced vision after eye surgery?
Endopthalmitits
75
What is the cause of painful red eye and reduced vision after eye surgery?
Endopthalmitits
76
What condition has ciliary flush?
Ant uveitis
77
How do you differentiate between CA glaucoma and Ant uveitis?
* Ant uveitis: Small pupil * CA glaucoma: fixed dilated pupil
78
What is an eye manifestation of RA, that presents with PAINFUL red eye?
Scleritis (remember that Scl antibody thing in rheumatology?)
79
What is an eye manifestation of RA, that presents with PAINLESS red eye?
Episcleritis (remember that Scl antibody thing in rheumatology?)
80
What Dx gives you pale retina?
Central retinal Artery occlusion (pAle retina = Artery occlusion)
81
What are the CF of Central retinal artery occlusion? (4 things)
1. Sudden painless LOV 2. RAPD 3. Cherry red spot 4. Pale retina
82
What are the Dx for Central vs Peripheral LOV?
* **M**iddle loss = **M**acula degeneration *** P**eripheral loss = **P**rimary glaucoma

#passmed 2023 (39 decks)

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