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Opthalmology Flashcards

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1
Q

RAPD

A

Relative afferent pupillary defect (RAPD) or Marcus Gunn pupil Light directed in the affected eye will cause only mild constriction of both pupils (due to decreased response to light from the afferent defect), while light in the unaffected eye will cause a normal constriction of both pupils (due to an intact efferent path, and an intact consensual pupillary reflex).

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2
Q

Swinging flashlight test

A
  1. Swing a light back and forth in front of the two pupils 2. When light reaches a pupil there should be a normal direct and consensual response. 3. An RAPD is diagnosed by observing paradoxical dilatation when light is directly shone in the affected pupil after being shown in the healthy pupil indicating disease in the optic nerve or severe retinal disease
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3
Q

Mechanism of RAPD

A

Damage to: 1. optic nerve 2. severe retinal disease.

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4
Q

Differentiate between decreased vision from an ocular problem such as cataract or from a defect of the optic nerve

A

Swinging flashlight test

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5
Q

The pathway for pupillary constriction begins at the _ nucleus near the occulomotor nerve nucleus. The fibers enter the orbit with CN _ nerve fibers and synapse at the _ ganglion.

A

The pathway for pupillary constriction begins at the Edinger-Westphal nucleus near the occulomotor nerve nucleus. The fibers enter the orbit with CN III nerve fibers and ultimately synapse at the cilliary ganglion.

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6
Q

_ innervation leads to pupillary constriction performed by sphincter pupillae. The pathway begins at the Edinger-Westphal nucleus near the occulomotor nerve nucleus. The fibers enter the orbit with CN III to synapse at the cilliary ganglion.

A

Parasympathetic innervation leads to pupillary constriction performed by sphincter pupillae. The pathway begins at the Edinger-Westphal nucleus near the occulomotor nerve nucleus. The fibers enter the orbit with CN III to synapse at the cilliary ganglion.

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7
Q

__ stimulation causes pupillary dilation, performed by dilator pupillae. Pathway begins at the cortex with the first synapse at the __ center. Post synaptic neurons travel through the brain stem and exit through the __ __ chain and the superior cervical ganglion. They synapse at the superior cervical ganglion where third-order neurons travel through the _ plexus and enter into the orbit through the first division of the _ nerve.

A

Sympathetic stimulation causes pupillary dilation, performed by dilator pupillae. Pathway begins at the cortex with the first synapse at the cilliospinal center. Post synaptic neurons travel through the brain stem and exit through the cervical sympathetic chain and the superior cervical ganglion. They synapse at the superior cervical ganglion where third-order neurons travel through the carotid plexus and enter into the orbit through the first division of the trigeminal nerve.

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8
Q

Innervation of the pupil

A

https://upload.wikimedia.org/wikipedia/commons/a/a5/Gray840.png

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9
Q

Most effective monotherapy for lowering IOP

A

latanoprost

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10
Q

Sympathetic connections of the ciliary and superior cervical ganglia.

A

https://upload.wikimedia.org/wikipedia/commons/a/a5/Gray840.png

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11
Q

The cause of uveitis is typically:

A

idiopathic

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12
Q

Causes of uveitis

A

Idiopathic Sarcoidosis B-27 associated spondyloarthropathies

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13
Q

Hazy cornea, fixed dilated pupil

A

Acute angle closure glaucoma

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14
Q

Uvea

A

iris, ciliary body, choroid

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15
Q

Floaters, flashing lights, shadow

A

Retinal detachment

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16
Q

is a type of distorted vision in which grid of straight lines appears wavy and parts of the grid may appear blank. People with this condition often first notice this when looking at mini-blinds in their home.

A

Metamorphopsia

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17
Q

Metamorphopsia: sign of

A

Age related macular degeneration

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18
Q

Rx: age related macular degeneration

A

Bevacizumab

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19
Q

Rx: tractional retinal detachment, persistent vitreous hemorrhage

A

Vitrectomy

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20
Q

Grid of horizontal and vertical lines used to monitor central visual field; visual disturbances caused by changes in the retina, particularly the macula (e.g. macular degeneration, Epiretinal membrane), as well as the optic nerve

A

Amsler grid

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21
Q

Non-invasive imaging test that uses light waves to take cross-section pictures of retina

A

Ocular coherence tomography

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22
Q

Humphrey visual field testing is used to:

A

Monitor glaucoma Peripheral vision testing

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23
Q

How can you stop bradycardia with timolol?

A

Punctal occlusion

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24
Q

Brimonidine

A

topical alpha agonist increases outflow decreases production of aqueous humor rx glaucoma

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25
Latanoprost
rx glaucoma topical prostaglanding analog increases outflow
26
Dorzolamide
rx glaucoma decreases production topical carbonic anhydrase inhibitor
27
Pilocarpine
rx glaucoma Topical parasympathomimetic increases outflow Side-effects: retinal detachment, brow ache
28
Gradual decrease in visual acuity + problems with glare
Cataracts Blurred vision, glare difficulty with night driving Myopic shift in prescription
29
Small yellow areas of localized extra-cellular deposits on fundoscopy
Drusen
30
[Associated with macular degeneration](http://upload.wikimedia.org/wikipedia/commons/thumb/5/57/Macular_Soft_Drusen.jpg/800px-Macular_Soft_Drusen.jpg)
Drusen
31
Rx: blepharitis
Warm compresses, baby shampoo cleansing of eye-lashes
32
Blepharitis: complications
Chalazion Stye
33
Rx: WPW + irregularly irregular stable WCAT
Procainamide
34
Why are nodal blocking agents (verapamil, adenosine, beta blockers, digoxin) contra-indicated in WPW+atrial fibrillation with RVR (a rare condition)?
They can cause preferential conduction through the accessory pathway causing death.
35
Indication for cataract surgery
1. Functional impairment 2. ADL impairment Snellen's alone is not helpful predictor of dysfunction
36
Commonest anesthesia in cataract surgery
Topical + intra-ocular GA is rare
37
Cataract surgery pre-op
1. Surgery performed through peripheral clear cornea using topical or intraocular (intracameral) anesthesia allows patients to remain on warfarin or aspirin through cataract surgery 2. IV sedation usually required for surgery, but 3. Preoperative testing in otherwise healthy patients is NOT needed
38
39
The optic disk is __ to the fovea.
The optic disk is *nasal* to the fovea.
40
Cx: Gradual visual loss
1. Cataract 2. Primary open angle glaucoma 3. Age related macular degeneration 4. Narrow angle glaucoma 5. Diabetic retinopathy
41
Cx: Classification parameter acute visual loss
Time course: 1. Transient (Amaurosis Fugax) 1. Emboli (cholesterol plaques, cardiac myxoma, clot) 2. Vasospasm (migraine, subarachnoid hemorrhage, hypertensive crisis) 2. Sustained 1. Optic neuritis (MS, lupus, sarcoidosis) 1. Anterior ischemic optic neuropathy 2. Arteritic: GCA 2. Nonarteritic—associated with advancing age, hypertension 3. Hemorrhage (neovascular AMD, vitreous hemorrhage in diabetes) 4. Occipital infarct 5. AMD, MS
42
Leading cause of legal blindness in patients age 55 years and older in the United States
AMD
43
Deposits of material in the macula that probably represent deposition by-products of photoreceptor metabolism. On ophthalmoscopy, they appear as small, bright yellow objects.
Drusen Signify: dry AMD
44
Describe abnormalities
Dry yellow bodies: Drusen Non-neovascular age-related macular degeneration.
45
Forms of AMD, frequency
1. Dry: 90% 2. Wet: 10%
46
Thin, highly vascularized and pigmented tissue under the sensory retina that forms the posterior portion of the uveal tract (the iris, ciliary body, and \_.
Choroid
47
The inner boundary of the choroid is Bruch's membrane (BrM) on which the retinal pigment epithelium (RPE) lies. This vasculature has three layers: the anterior choriocapillaris; Sattler's layer of intermediate vessels in the middle; and the outermost Haller's layer with large vessels.
choriocapillaris
48
Differences between wet and dry AMD
Frequency Progression Wet 10% Rapid Dry 90% Slow
49
[Distortion of straight lines may be an early presenting complaint](http://upload.wikimedia.org/wikipedia/commons/5/56/Amslergrid_patientAMD.gif)
AMD | (Amsler grid)
50
Rx: reduce the risk of progression from moderate to severe AMD,
zinc + vitamins C and E + beta-carotene
51
Anti–vascular endothelial growth factor (VEGF) agents (\_\_, \_) injected intraocularly (usually monthly) can stabilize neovascular AMD and often improve vision.
bevacizumab, ranibizumab
52
Rx: neovascular AMD
1. Anti-VEGF (bevacizumab, ranibizumab) 2. Laser (photocoagulation, photodynamic)
53
Second leading cause of blindness in Americans
Primary Open angle glaucoma
54
Leading cause of blindness in African Americans
Primary open angle glaucoma
55
Pathogenesis: open angle glaucoma
Trabecular meshwork is blocked by excess glycosaminoglycan production, decreasing aqueous outflow, but not clinically visible.
56
Why is POAG hard to diagnose?
Asymptomatic till much later: measurement of visual acuity alone not adequate. ## Footnote Dx: tonometry, automated visual field, imaging study of optic nerve
57
Is headache common in POAG?
Rarely causes headache unless IOP is extremely high
58
Screening age for POAG in African Americans
40
59
Rx: POAG
1. Drugs: Prostaglanding analog, beta blocker, alpha agonist, cholinergic agonist. 2. Laser trabeculoplasty: may be temporary 3. Surgery
60
Differentiate POAG and narrow angle glaucoma
Narrow angle: acute, headache, nausea, painful red eye
61
Why is glcyemic control important in diabetic retinopathy?
Degree of glucose control is a better predictor of progression than duration of disease.
62
Among diabetics older than 40 years of age, prevalence of: diabetic retinopathy: _ % sight-threatening retinopathy: _ %
40, 8
63
\_ dilated funduscopic examination.
Yearly
64
Types or stages
1. Non-proliferative (background or pre-proliferative) 2. Proliferative
65
the retina, optic disc, macula, fovea, and posterior pole.
Fundus
66
Cotton-wool spots, microaneurysms, intraretinal hemorrhages, lipid (“hard”) exudates, retinal edema, venous beading, and intraretinal microvascular abnormalities
Non-proliferative diabetic retinopathy
67
Differences between non-proliferative and proliferative
Proliferative = Non-proliferative + neovascularization
68
Locate macula, fovea, disc, cup
disk is pale pink, approximately 1.5 mm in diameter, with sharp, flat margins. The physiologic cup is located within the disk and usually measures less than six-tenths the disk diameter.
69
Describe features
Hemorrhage subretinal neovascularization Age-Related Macular Degeneration: Hemorrhage seen beneath the retina + subretinal neovascularization.
70
Describe abnormalities
Linear collection of yellow lipid deposits with sharp margins in macula. Hard Exudates
71
Describe what you see
Multiple white centred haemorrhages Roth's spots: retinal hemorrhages with white or pale centers, composed of clot, inflammatory infiltrate, infectious organisms, or neoplastic cells. In this case: Multiple retinal haemorrhages (decompression retinopathy) following paracentesis for macular branch artery occlusion
72
Grid _ \_ more effective than intraocular corticosteroids for leaking vessels causing macular edema.
Grid laser photocoagulation more effective than intraocular corticosteroids for leaking vessels causing macular edema
73
Treatment overview
1. Laser photocoagulation: grid and pan-retinal 2. Intravitreal injections of VEGF antagonists 3. Surgery
74
Causes
1. Conjunctivitis (allergic, bacterial, viral) 2. Corneal ulcer 3. Anterior uveitis 4. Acute glaucoma 5. Anterior scleritis
75
Aetiological types
1. Allergic 2. Bacterial 3. Viral
76
Red eye differential diagnosis parameters
1. Vision: 2. Pruiritus: \<+, -\> 3. Photophobia: \<+, -\> 4. Discharge: 5. Pain: 6. Pupillary size 7. Pupillary response 8. Redness distribution
77
+ pain worse at night
Anterior scleritis
78
Red eye + ciliary flush
1. anterior uveitis 2. Acute glaucoma
79
Anterior uveitis: mx
1. Topical corticosteroids 2. Cycloplegic 3. Systemic workup
80
Corneal abnormality shown
Dendritic pattern after fluorescein staining
81
1. CD4 count \< 50 cells/mm3 2. Floaters, flashing lights, blind spots 3. no pain, discharge, or redness
CMV retinitis
82
Rx
Oral valganciclovir (IV foscarnet if resistance or intolerance)
83
CMV retinitis: local rx
Systemic: Oral valganciclovir Local: 1. Ganciclovir implant + oral valganciclovir 2. ntravitreous ganciclovir or foscarnet injections
84
Syndrome of uveitis, vitreitis, macular edema, and epiretinal membrane formation in HIV+ on HAART
“Immune recovery uveitis” (IRU) ## Footnote Exp: occurs in minority of eyes with CMV retinitis in patients responsive to HAART
85
Reactivation of _ \_ virus residing within the ophthalmic nerve; subtype of shingles.
Herpes zoster ophthalmicus (HZO) : reactivation of varicella zoster virus residing within the ophthalmic nerve; subtype of shingles.
86
Bacterial conjunctivitis: bugs
S. aureus, S. pneumoniae, H. influenzae
87
Internal _ : Infection of meibomian gland
hordeolum ## Footnote Internal hordeolum: Infection of meibomian gland on the conjunctival side of the eyelid External hordeolum (stye): Infection of gland and eyelash follicle on skin side of the lid
88
Focal, noninfectious blockage of meibomian gland
Chalazion
89
Chalazion: Rx
Warm compresses; incision and drainage
90
Ring of injection around limbus
Ciliary flush ## Footnote Exp: feature of uveitis, others Pain Redness Photophobia
91
A 36-year-old woman is referred back to you by her ophthalmologist, who states that she has evidence of uveitis. She was begun on topical corticosteroids with some improvement. She says that her ophthalmologist wanted you to do a systemic evaluation. She has no complaints and no abnormalities on physical examination. Which of the following tests is an appropriate component of her evaluation? Chest x-ray Magnetic resonance imaging (MRI) of the head Purified protein derivative (PPD) test Herpes simplex virus (HSV) serology
CXR ## Footnote The most common disorders associated with uveitis include JRA, seronegative spondyloarthropathies, Behçet syndrome, and sarcoidosis. Therefore, a chest x-ray to assess for lymphadenopathy from sarcoidosis would be the best answer.
92
Which of the following medications increases the risk of open-angle glaucoma? Anticholinergics α-Adrenergic agents β-Blockers Corticosteroids
Corticosteroids Explanation: Corticosteroids in any form can cause elevations in intraocular pressure without any visible changes
93
A 44-year-old woman with rheumatoid arthritis complains of severe right-sided ocular pain for 3 days that radiates into “the back of my head.” She denies decreased vision, halos, or tearing. External examination shows normally reactive pupils. There is a localized area of intense redness over the temporal sclera that is very sensitive to touch. Superiorly, there is an area of bluish discoloration to the sclera. The cornea appears normal. She has no other medical problems. The most reasonable treatment at this point would be which of the following? Topical corticosteroids Oral corticosteroids Oral hydroxychloroquine Oral nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs ## Footnote The patient has classic features of anterior scleritis. The area of bluish discoloration suggests previous scleritis that has resolved. RA is the most common underlying disease associated with scleritis. Scleritis does not usually respond to topical therapy. Oral NSAIDs are the first line of therapy; prescription NSAIDs such as flurbiprofen or indomethacin are preferred Oral corticosteroids are second-line therapy. DMARDs are not effective in the treatment of scleritis.
94

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