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phase 3b > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What is cataract

A

any opacity in the lens

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2
Q

cataract risk factors

A

age
db
smoking
alcohol

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3
Q

Presentation of cataract

A

blurred vision

unilateral - unnoticed but depth perception affected

bilateral - gradual painless loss of vision ±glare with bright lights, ±monocular diplopia, haloes, faded colours

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4
Q

cataracts management

A

mydriatic drops
sunglasses
surgery - phacoemulsification

day case with local anaesthetic

  • incision -> phacoemulsion-> artifical lens
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5
Q

Types of uveitis

A

anterior - iritis

posterior - choroiditis

intermediate - vitrous

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6
Q

What is subconjunctival haemorrage, who is it common in?

A

harmless pool of blood behind conjunctiva from small bleed

common in elderly women

ask about anti-coags

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7
Q

Presentation of conjunctivitis

A

itchy, burning, watering eyes

sticky discharge causes eyes to stick

conjunctiva red and inflamed

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8
Q

conjunctivitis management

A

symptomatic - artificial tears and antihistamines (emedastine)
topical abx used in bacterial to reduce length and transmission risk

Abx if ?sexual, contact lens, immunocomp
(chloramphenicol or fusidic acid)

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9
Q

Investigations for red eye

A

Gonioscopy - evalutaed internal drainage system ?glaucoma

Slit lamp - see leucocytes in anterior chamber if iritis

?culture if suspected sexual cause or recurrent unresponsive conjunctivitis

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10
Q

Iritis presentation

A

pain, blurred vision, photophobia, non sticky discharge, red eye

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11
Q

iritis management

A

refer

prednisolone drops to reduce inflam

cyclopentolate - keeps pupils dilated to prevent adhesions between lens and iris and also to relieve spasms of ciliary body

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12
Q

Acute closed angle glaucoma presentation

A

onset hours/days

  • blurred vision, haloes
  • painful red eye
  • generally unwell
  • N&V
  • headache
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13
Q

Management of acute closed angle glaucoma

A

B Blockers triad (supress aqueous production)
-timolol, pilocarpine, IV acetazolamide

Monitor IOP

peripheral iridectomy once IOP under control - removal of piece of iris

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14
Q

Episcleritis Presentation

A

Inflammatory nodule

Blue sclera below cone shaped wedge of engored vessels

dull acbe in eyes, tender

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15
Q

Episcleritis managemtn

A

Symptomatic relief - artificial tears and topical/systemic NSAIDs

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16
Q

Scleritis presentation

A

constant severe dull ache that bores into eye

painful ocular movements

?headache and photophobia

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17
Q

scleritis management

A

referral

anterior: NSAIDs ± oral pred
posterior: more aggressive

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18
Q

Ketatitis causes

A

bacterial: pseduomonas aeruginsoa, staph
fungal: aspergillus, candida
viral: HSV

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19
Q

Keratitis presentation

A

PAIN, photophobia, decreased visual acuity

discharge

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20
Q

Keratitis management

A

treat causative organism

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21
Q

How would a patient with open angle glaucoma present?

A

asymptomatic until visual fields badly impaired

loss of vision peripherally -> tunnel vision

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22
Q

Why is there a need for screening high risk groups for open angle glaucoma?

A

doesnt present until visual fields are badly impaired

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23
Q

What are high risk groups for open angle glaucoma

A

+ve FH

Diabetic

thyroid eye disease

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24
Q

How would you confirm a diagnosis of open angle glaucoma?

A

Tonometry: pressure >21

Central corneal thickness measurement

gonioscopy: ant chambre assessment

Visual fields

Optic nerve

25
Medical management of OAG
1) prostaglandin analogues: increase uveoscleral outflow 2) B blockers: decrease production of aqueous 3) Alpha adrenergic agonists: decrease production of aqueous and increase uveoscleral outflow 4) carbonic anhydrase inhibs: decrease aqueous production 5) miotics: decrease resistance to aqueous outflow
26
Examples and SE of prostaglandin analogues
latanoprost, travoprost * Eyelash growth * iris colour change * Red eye
27
Examples and SE of B blockers for use in open angle glaucoma
Timolol, betaxolol * dry eyes * corneal anaesthesia * \*asthmatics \*HF
28
Exampes and side effects of alpha adrenergic agonists
Dorzolaminde, brimonidine * fatigue * dyspepsia
29
side effects and examples of miotics
pilocarpine * decreased acuity * brow ache (ciliary muscle spasm)
30
Surgical option for open angle glaucoma
trabeculectomy
31
Synonyms for squint
strabismus, tropia
32
types of squint
esotropia - inward (convergence) exotropia - outward (divergent) hypertropia - upwards hypotropia - downwards
33
How do you diagnose a squint
cover test - movement of uncovered (bad) eye to correct fixation when good eye is covered corneal reflection - reflection from bright light falls asymmetrically on cornea
34
Management of squint
glasses patch/drops(atropine) in good eye to encourage use of bad eye Operation: resection and recession of rectus muscles
35
What would the eye look like in a 3rd nerve palsy?
down and out
36
what woudl the eye look like in a 4th nerve palsy?
up pt might tilt head
37
what would the eye look like in a 6th nerve palsy?
diplopia in horizontal plane medial deviation eye cant move laterally from horizontal plane
38
What is amblyopia
reduction in visual acuity due to problem in focussing in early childhood - brain isnt stimulated to develop correctly
39
list 3 causes of amyblyopia
\*squint refractive defects congential cataracts
40
how would you diagnose amblyopia?
snellen chart lack of red reflex
41
How would you manage amblyopia?
strabismus: patch and drops refractive error: glasses congential cataracts: surgery
42
Causes of CRAO
atherosclerosis embolism inflammation thrombophilic disorders
43
How would a patient with CRAO present?
sudden painless unilateral visual loss
44
What would you expect to find on examination of a patient with suspected CRAO
pale retina with cherry red spot afferent pupil defect ?carotid auscultation for bruits, murmers, radial pulse for AF
45
How would you manage a patient with CRAO
occular massge with in 100mins of onset surgical removal of aqueous acetazolamide (intraocular hypotensive)
46
What long term management would you advise for patient with CRAO
opthalmolmic follow up low vision aid clinic carotid endarterectomy DVLA notification
47
How would optic neuritis present?
1) unilateral reduced vision 2) eye pain 3) impared colour vision
48
What would you expect to find on examination of a patient with optic neuritis?
* reduced vision * decreased pupillary light reaction in affected eye * abnormal sensitivity and colour vision * papillitis * scotoma
49
How would you manage optic neuritis
corticosteroids in acute phase methylprednisolone speeds up visual recovery in acute phase
50
what is drusen?
lipid deposit under retina - yellow appearance
51
what are the types of macular degeneration?
wet - choroidal neovascularization dry- geographic atrophy
52
how would wet macula degen present?
blurred vision metamorphopsia poor night vision central vision loss
53
what would u find on examination of pt with wet macular degen
macular drusen XS vessels (fluorescein angiography) haemorrhage Amsler grid shows waving lines
54
How woudl u manage wet macular degen
anti-VEGF injections
55
how would dry macular degen present?
gradual visual loss - difficulty reading central scotoma
56
what would you expect to find OE in dry macular degen
macular drusen retinal pigment epithelium clumping or atrophy
57
how would you manage dry macular degen
zinc, vit A/C/E
58

phase 3b (15 decks)

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