Opthalmology

Question 1

Most common form of blindness worldwide?

Answer 1

Cataracts

Question 2

3rd most common form of blindness worldwide?

Answer 2

Age related macular degeneration

Question 3

What aspect of vision does ARMD affect?

Answer 3

Central

Question 4

What aspect of vision does Glaucoma affect?

Answer 4

Peripheral

Question 5

3 features of dry ARMD

Answer 5

1) Drusen - waste products from pigment eipthelium
2) Atrophy of retinal pigment eipthelium
3) Slowly progressing
4) Less dramatic

Question 6

3 features of wet ARMD

Answer 6

1) Fluid build up 2’ o neovascularisation from pigment epithelium
2) Haemorrhages, scarring, swelling
3) Dramatic

Question 7

Presentation of ARMD

Answer 7

Central vision affected, difficulty reading fine print and recognising faces

Question 8

Signs of ARMD of fundoscopy

Answer 8

Drusen, atrophy, haemorrhages, scarring, pigmentation

Question 9

Risk factors of ARMD

Answer 9

Smoking, sun exposure, age, poor diet + alcohol

Question 10

What is the 2nd leading cause of blindness worldwide

Answer 10

Glaucoma

Question 11

Glaucoma presentation

Answer 11

Usually no symptoms until end stage - bumping into things, missing object in peripheries.
VA unaffected until end stage

Question 12

Signs of glaucoma on fundoscopy

Answer 12

Cupping, pallor, splinter haemorrhages in optic disk.

Usually raised IOP + RAPD is asymmetric advanced glaucoma

Question 13

Pathology in AACG

Answer 13

Physically obstructed anterior chamber angle stops outflow of aqueous humour - rise in IOP

Question 14

What produces the aqueous humour and where does it drain?

Answer 14

Produces - Ciliary body

Drains - Trabecular meshwork

Question 15

ACAG presentation

Answer 15

Severe and rapid onset of pain

Blurred vision, coloured haloes, systemic malaise

Question 16

Signs of ACAG

Answer 16

Red eye caused by ciliary flush

Raised IOP, shallow anterior chamber, corneal epithelial oedema

Question 17

ACAG treatment

Answer 17

Medical - B-blockers, steroids, IV Acetazolamide - if no response then systemic hyperosmotics
Surgical:
- Peripheral iridotomy - 2 holes in iris with laser
- Surgical iridotomy - more invasive when PI not
possible
- Lensectomy - if cataract swollen to precipitate
ACAG

Question 18

What is GCA

Answer 18

Systemic immune mediated vaculitis affecting medium and large arteries

Question 19

Presentation of GCA

Answer 19

Recent temporal headache, myalgia, fever, malaise.

Sudden bilateral vision loss in the elderly due to inflammation of the opthalmic artery

Question 20

Investigations of GCA

Answer 20

Temporal artery biopsy within 2 wks of starting steroids

Question 21

Treatment of GCA

Answer 21

High dose corticosteroids immediately

Add low dose aspirin

Question 22

Pathophysiology of conjunctivitis

Answer 22

Inflammation of the conjunctiva

Question 23

Non infectious causes of conjunctivitis

Answer 23

Mechanical, toxic, immune mediated and neoplastic

Question 24

Presentation of conjunctivits

Answer 24

1) Dilated conjunctival vessels
2) Follicles - round collections of lymphocytes - nodules
3) Papillae - Cobblestone appearance of flattened nodules, red surface and pale base.

Question 25

Bacterial causes of conjunctivitis

Answer 25

Staph/ strep pneu. h/flu, chlamydial

Question 26

Viral causes of conjunctivitis

Answer 26

Adenovirus, HSV, HZV, Molluscum

Question 27

Conjunctivitis treatment

Answer 27

Allergic - Prevent release of mediators and avoid triggers - mast cell stabilisers/ ati-histamines Infective - Most are self limiting - good hygeine

Question 28

Presentation of a corneal ulcer

Answer 28

Severe discomfort, red and watering eye, cant keep eye open

Question 29

Red flags of corneal ulcer

Answer 29

Deep lid laceration, subconjunctival haemorrhage, pupil, iris or fundal abnormalities

Question 30

Corneal ulcer treatment

Answer 30

Analgesia, remove abrasion and rust ring, photokeratitis, eye patch for 24 hrs

Question 31

What is Uveitis

Answer 31

Inflammation of the uveal tract - pigmented layer that consists of the iris, ciliary body and choroid

Question 32

Different forms of uveitis

Answer 32

Anterior - iris (most common) Intermediate - vitreous and posterior ciliary body Posterior choroid

Question 33

Causes of uveitis

Answer 33

Inflammation, infection, infiltration 2' to neoplasm, trauma, iatrogenic, idiopathic or ischaemic

Question 34

Presentation of A I and P Uveitis

Answer 34

A - Unilateral pain, redness, blurred vision, headache I - Painless floaters P - Bilateral gradual visual loss, blurred vision, photophobia

Question 35

Uveitis treatment

Answer 35

Trying to control inflammation, prevent visual loss and minimise complications - Cycloplegic drugs to paralyse the ciliary body and relieve pain and adhesions - Topical corticosteroids.