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FINALS: PASSMED/QUESMED > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Contact lens wearer with red painful eye?

A

Refer to opthalmology to exclude microbial keratitis

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2
Q

Management of children with squint?

A

Refer to ophthalmology

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3
Q

What is seborrhoeic dermatitis associated with?

A

Blepharitis

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4
Q

fixed dilated pupil with conjunctival injection

A

acute closed angle glaucoma

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5
Q

How to manage patient who presents with new-onset flashes or floaters?

A

Urgent referral by opthalmology for ?vitreous detachment

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6
Q

What is myopia (near-sightedness) a risk factor for?

A

Retinal detachment

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7
Q

Bacterial vs viral keratitis?

A

Viral would have contact with herpes infection or recurrent episodes triggered by stress, immunosuppression or trauma

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8
Q

central scotoma and red patches on the retina on fundoscopy in an older person?

A

Wet age-related MD

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9
Q

Mydriatic drops precipitate what?

A

Acute angle closure glaucoma

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10
Q

Metamorphopsia (wavy distortion of straight lines) is the initial symptoms of what?

A

Choroidal neovascularisation

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11
Q

Hutchinson’s sign (rash on the tip of the nose) is a predictor for what in HZO?

A

Ocular involvement

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12
Q

Ankylosing spondylitis is associated with what?

A

Anterior uveitis

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13
Q

Side effects of prostaglandin analogues e.g latanoprost?

A

increased eyelash length, iris pigmentation and periocular pigmentation

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14
Q

How does latanoprost work?

A

increasing uveoscleral outflow

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15
Q

Management of patients with organic foreign body in their eye?

A

Refer to ophthalmology for same day assessment

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16
Q

How does diabetic maculopathy present?

A

based on location rather than severity, anything is potentially serious
hard exudates and other ‘background’ changes on macula
check visual acuity
more common in Type II DM

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17
Q

How is diabetic maculopathy managed?

A

if there is a change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors

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18
Q

Management of dry MD?

A

High dose of beta-carotene, vitamins C and E, and zinc

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19
Q

Investigations for acute angle-closure glaucoma?

A

Both tonometry and gonioscopy

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20
Q

night blindness and tunnel vision?

A

Retinitis pigmentosa

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21
Q

What is Holmes-Adie pupil?

A

A benign dilated pupil seen in young women

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22
Q

How does Holmes-Adie pupil present?

A
  • Unilateral dilated pupil
  • Slow reactive to accommodation and poorly to light
  • Associated with Holmes-Adie syndrome where ankle/knee reflexes are absent
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23
Q

What is Argyll Robertson pupil?

A
  • Small irregular pupil, usually bilateral
  • No response to light
  • Responds to accommodation
  • Associated with neurosyphilis
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24
Q

What is the most common complication following laser photocoagulation?

A

Reduction of the visual field - especially night vision

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25
Q

Which eye condition is associated with IBD?

A

Anterior uveitis

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26
Q

Conjunctivitis vs orbital cellulitis?

A

Conjunctivitis would not cause any orbital swelling

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27
Q

Dense shadow that starts peripherally progresses towards the central vision/A veil or curtain over the field of vision?

A

Retinal detachment

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28
Q

Localised headache, neck pain and neuro signs e.g Horner’s suggests what?

A

Cartoid artery dissection

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29
Q

red eye, haloes, hazy cornea?

A

Acute glaucoma

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30
Q

blurred vision, haloes?

A

Acute glaucoma

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31
Q

MD vs primary open angle glaucoma?

A

MD - central visual field loss
Open angle glaucoma - peripheral visual field loss

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32
Q

What is a possible complication of corneal transplant surgery?

A

Corneal graft rejection -> requires urgent assessment by ophthalmologist with topical steroids

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33
Q

Wet vs Dry MD?

A

Wet develops over months whereas dry develops over years

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34
Q

Dendritic ulcer?

A

Herpes simplex keratitis

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35
Q

AV nipping ?

A

Hypertensive retinopathy

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36
Q

What is Keratoconjunctivitis sicca a complication of?

A

Bells palsy

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37
Q

What should not be affected in conjunctivitis?

A

Visual acuity

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38
Q

Which organisms cause conjunctivitis?

A

Viral - adenoviruses, herpes
Bacterial - staph aureus, h influenzae, staph epidermidis

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39
Q

What can occur after facial trauma?

A

Orbital blow out fractures

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40
Q

When treating acute glaucoma, what should be treated?

A

BOTH eyes

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41
Q

A 56-year-old patient presents complaining of a red eye. On examination, you notice that the patient’s left conjunctiva is severely injected and that the left eye is displaced forwards. Additionally, when you ask the patient to look left you notice that only right eye is able to do so

A

Carotid cavernous fistula - complication of conjunctivitis/trauma

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42
Q

What is an complication of CRVO?

A

Neovascular gaucoma -> develops over a few months

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43
Q

painful red eye, blurring of vision and photophobia with hypopyon?

A

Anterior uveitis

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44
Q

First line treatment for chronic glaucoma?

A

Prostaglandin analogues e.g. latanoprost

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45
Q

Lid lag is a sign of?

A

Thyroid eye disease

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46
Q

How enlarged should the optic disc: cup ratio be to diagnose open angle glaucoma?

A

> 0.7

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47
Q

Complication of untreated squint?

A

Amblyopia- lazy eye

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48
Q

Most common risk factor for CRVO?

A

HTN

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49
Q

What should be given for corneal abrasion?

A

Topical Abx

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50
Q

Elderly female with painless loss of vision with scalp tenderness/headaches/jaw claudication?

A

Think arthritic ischaemic optic neuropathy caused by GCA

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51
Q

Long sightedness is a risk factor for what?

A

Acute glaucoma - smaller eyeball therefore iris-cornea angle is smaller

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52
Q

Orbital vs preorbital cellulitis?

A

Preorbital will have no proptosis, no pain on eye movements, no swelling on conjunctiva and normal optic nerve function

53
Q

What are examination findings for cataracts?

A
  • Clouding of lens
  • Absent red reflex
54
Q

What is the name of cataract surgery?

A

Phacoemulsification

55
Q

What is an early and late complication of cataract surgery?

A

Early - posterior capsule rupture
Late - posterior capsule opacification

56
Q

What is used to measure intraocular pressure and what is the normal upper limit?

A

Tonometry - 21

57
Q

What is gonioscopy?

A

Measurement of the iridocorneal angle -> distinguishes between open-angle and closed-angle

58
Q

What investigations should be done when suspecting macular degeneration?

A

Amsler chart, fundoscopy, OCT, fluorescein angiography

59
Q

What are the management options for wet ARMD?

A
  • Photodynamic therpay
  • Laser photocoagulation
  • anti-VEGF
60
Q

What causes the blurred vision in acute closed angle glaucoma?

A

Corneal oedema

61
Q

What can cause resolution of acute glaucoma symptoms upon going to bed?

A

Pupil constricts which pulls iris out of the angle

62
Q

What is the immediate management of central retinal artery occulsion?

A

High dose steroids

63
Q

What agent is used to visualise any ulceration of the cornea?

A

Fluorescein

64
Q

What should be examined in the eye in someone with ophthalmic shingles?

A

Corneal sensation due to risk of corneal ulceration

65
Q

Contact lens wearer who swims?

A

Acanthanoeibc keratitis

66
Q

What are Amsler grids and Snellen charts used for?

A

Amsler - tests for distortion of line perceptions
Snellen - tests visual acuity

67
Q

What are signs of orbital compartment syndrome?

A
  • Blood in anterior chamber
  • Proptosis
  • Stiff eyelid
  • RAPD
68
Q

How should orbital compartment syndrome be managed?

A

Immediate canthotomy to reduce pressure then can do imaging like CT

69
Q

What is the finding of a RAPD?

A

Affected and normal eye dilated when light is shone on the affected -> usually optic nerve/retina affected

70
Q

What is papilledema?

A

Blurring of the optic disc margin on fundoscopy

71
Q

What screening test can be done for squints in children?

A

Hirschberg test - corneal light reflection test

72
Q

red-tinged vision along with dark spots

A

Vitreous haemorrhage

73
Q

What are risk factors for vitreous haemorrhage?

A
  • Diabetes
  • Trauma
  • Anticoag/coagulation disorders
74
Q

What is the management of vitreous haemorrhage?

A
  • Laser photocoagulation
  • Anti VEGF injections
  • Vitrectomy
75
Q

Main causes of tunnel vision

A
  • Papilloedema
  • Glaucoma
  • Choroidoretinits
76
Q

Management of proliferative diabetic retinopathy?

A

Intravitreal VEGF injections + pan retinal photocoagulation laser

77
Q

Congruous vs Incongruous loss of vision?

A

Congruous - complete/symmetrical visual field loss -> optic radiation lesion/occipital cortex
Incongruous - incomplete/asymmetrical visual field loss -> optic tract lesion

78
Q

Initial management of glaucoma?

A
  1. Direct parasympathomimetic e.g. pilocarpine (increase AH outflow)
  2. Beta blocker e.g timolol (decrease AH production)
  3. alpha-2 agonist e.g Apraclonidine (decrease AH production + improve outflow)
  4. IV Acetazolamide (reduce secretions)
79
Q

Proliferative vs Non proliferative diabetic retinopathy on fundoscopy?

A

Proliferative - new vessel formation/haemorrhages

80
Q

Untreated Proliferative vs treated proliferative diabetic retinopathy?

A

Treated - dark circular scars around peripheries -> pan retinal photocoagulation / yellow spots/holes all over the fundus -> laser therapy

81
Q

Mild vs Moderate vs Severe NPDR?

A

Mild - microaneurysms
Moderate - blot haemorrhages, hard exudates, cotton wool spots
Severe - venous beading, blot haemorrhages and microaneurysms in all 4 quadrants

82
Q

What metabolic disorder can cause cataracts?

A

Hypocalcaemia

83
Q

What is associated with subcapsular cataracts?

A

Steroids

84
Q

Painful red eye with photophobia + watery eye?

A

Herpes keratitis

85
Q

HTN retinopathy vs DM retinopathy?

A

DM will have choroidal neovascularisation

86
Q

Acute vs chronic glaucoma

A

Acute - hypermetropia (far sightedness)
Chronic - myopia (near sightedness)

87
Q

What can cause worsening of eye disease in Graves?

A

Radioiodine treatment

88
Q

Cotton wool spots represent what?

A

Area of pre capillary arteriolar occlusion/infarction

89
Q

What mineral can cause band keratopathy?

A

Calcium

90
Q

What does superior rectus do?

A

Move eye up and out + inward rotation

91
Q

Green central disc with spoke like projections?

A

Wilsons disease

92
Q

What is the earliest feature which can be seen in anterior uveitis?

A

Aqueous flare

93
Q

What does inferior oblique move eye in?

A

Down, in and outward

94
Q

Risk factors for AAG

A
  • Hypermetropia
  • Shallow anterior chamber
  • Thicker lens
  • Smaller corneal diameter
95
Q

Care advice for someone with bacterial conjunctivitis?

A
  • Avoid touching eyes
  • Avoid sharing towels
  • Wash hands using drops
  • Return if persists
96
Q

Allergic vs bacterial conjunctivitis

A

Allergic will have itchy eyes, watery discharge

97
Q

What are risk factors for cataracts?

A
  • Age
  • Sunlight
  • Eye trauma
  • Recurrent uveitis
  • Steroid use
98
Q

Which dermatome is affected in herpes zoster opthalmicus?

A

Ophthalmic division of trigeminal nerve

99
Q

What are risk factors for scleritis?

A
  • SLE
  • Sarcoidosis
  • TB
  • Syphilis
  • Trauma
  • RA
100
Q

What are examination findings for scleritis?

A
  • Inflammation involving full thickness of sclera
  • Anterior uveitis
  • Scleral thinning
  • Corneal thinning
101
Q

Episcleritis vs Scleritis?

A

Episcleritis - fast onset, no pain, superficial inflammation, self limiting
Scleritis - gradual, painful, watery discharge, visual disturbances, topical steroids to treat

102
Q

Risk factors for orbital cellulitis?

A
  • URTI
  • Retained foreign body
  • Post surgery
  • Systemic infection
103
Q

Recurrent watery/sticky eye in neonates?

A

Tear duct obstruction -> self resolves by 1 year

104
Q

What is the prognosis of herpes zoster opthalmicus?

A

Complete resolution with no complications

105
Q

Causes of lack of red reflex

A
  • Retinoblastoma
  • Cataracts
  • Retinal dysplasia
  • Corneal opacity
106
Q

What are the 2 layers of retina?

A
  • Neurosensory layer which has ganglion cells and photoreceptors
  • Retinal pigment epithelium
107
Q

Timolol (beta blockers) is C/I when?

A
  • Asthma and heart block
108
Q

What is leukocoria?

A

White pupillary reflex - absence of red reflex -retinoblastoma

109
Q

What is ophthalmia neonatorum?

A

Neonatal conjunctivitis contracted within the first 28 days of birth
Commonly gonococcal in first 5 days and chlamydia after 5 days

110
Q

What are the 4 stages of HTN retinopathy?

A

1 - silver wiring, arteriolar narrowing
2 - AV nipping
3 - Cotton wool spots, flame haemorrhages
4 - Papilledema

111
Q

Scleritis vs anterior uveitis

A

Scleritis would not have any pupillary signs i.e. irregularly shaped pupil

112
Q

What is the fluorescein eye drop test used for?

A

Identify any defects in the corneal epithelium

113
Q

What is the management of endophthalmitis?

A

Intravitreal Abx
Vitrectomy in severe cases

114
Q

dense shadow that starts peripherally and moves to the patient’s central vision on a background of new onset floaters and flashes

A

Retinal detachment

115
Q

What is the name given to blood in the anterior chamber of the eye following trauma?

A

Hyphema

116
Q

What should be done when thinking about any corneal abrasions?

A

Fluorescein staining

117
Q

Blunt ocular trauma with associated hyphema

A

High risk for raised IOP -> secondary glaucoma?

118
Q

Herpes zoster opthalmicus is caused by what?

A

Varicella zoster

119
Q

What is a carotid cavernous fistula?

A

Abnormal communication between carotid artery and the cavernous sinus

120
Q

What causes carotid cavernous fistulas?

A

Secondary to trauma e.g. head injuries, surgery

121
Q

How does carotid cavernous fistulas present?

A
  • Pulsatile proptosis
  • Bruit
  • Severe conjunctivitis
  • Cranial nerve involvement
122
Q

What is the gold standard for carotid cavernous fistulas?

A
  • Cerebral Angiography
123
Q

How is carotid cavernous fistulas managed?

A

Coil embolization or balloon occlusion

124
Q

Which cranial nerves are in cavernous sinus?

A

3,4,6,5 - opthalmic and maxillary

125
Q

“pizza pie” appearance on fundoscopy?

A

CMV retinitis -> HIV patient

126
Q

Horners is loss of innervation to what?

A

Sympathetic chain

127
Q

How to tell right vs left 4th nerve palsies?

A

Vision improves when head tilts towards the unaffected side

128
Q
A

FINALS: PASSMED/QUESMED (22 decks)

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