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Finals 2024 > Opthalomology Finals > Flashcards

Opthalomology Finals Flashcards

1
Q

How does vitreous haemorrhage present?

A

Painless vision loss

Red Hue in Vision

Floaters/dark spots in vision

Decreased visual acuity

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2
Q

Main cause of vitreous haemorrhage

A

Proliferative Diabetic Retinopathy

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3
Q

What investigations and findings for Vitreous Haemorrhage (3)

A

dilated fundoscopy: may show haemorrhage in the vitreous cavity

slit-lamp examination: red blood cells in the anterior vitreous

fluorescein angiography: to identify neovascularization

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4
Q

Retinal Detachment Signs/Symptoms

A

new onset floaters/flashes

sudden onset, painless vision loss - like a curtain

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5
Q

Mx of retinal detachment

A

Same day emergency referral - there laser therapy

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6
Q

Risk Factors for retinal detachment

A

Diabetes

Myopia (nearsightedness)

Age

Previous surgery for cataracts

Eye trauma - boxing

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7
Q

4 main causes of PAINFUL Red Eye

Hint - ASA

A

A - Anterior Uveitis

S - Scleritis

A - Acute Angle Closure Gluaocoma

BONUS:

Corneal abrasions or ulceration
Keratitis
Foreign body

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8
Q

Features of Anterior Uveitis (Get 5 at least)

A

Hypopyon

Painful Red Eye - DULL ACHE

Ciliary Flush

Abnormally shaped pupils

Photophobia

Lacrimation

Blurred vision

Reduced visual acuity

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9
Q

Causes of Painless Red eye

A

subconjunctival haemorrhage

episcleritis

Conjuncitivitis

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10
Q

Associated Conditions with Anterior Uveitis

A

Ankylosing spondylitis (and other seronegative spondylos)

IBD

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11
Q

Mx of anterior uveitis

A

Urgent referral to opthalmology

Steroid eye drops

Atropine/cyclopentolate

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12
Q

When should screening for glaucoma be done for those with a FHx

A

From age 40, annually

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13
Q

Primary Open Angle Glaucoma features

A

Peripheral vision loss (Think of the ‘O’ as a tunnel)

Optic disc cupping

Decreased visual acuity

Fluctuating pain - headaches sometimes

Halos

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14
Q

Dx of Open Angle Glaucoma (2)

A

Goldmann applanation tonometry for the intraocular pressure

Slit lamp assessment for the cup-disk ratio and optic nerve health

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15
Q

Management of Open Angle Glaucoma

Also 3 medications that can help - (ABCD)

A

360° selective laser trabeculoplasty

Meds:

A - Prostaglandin Analogue - Latanoprost - Increases uveoscleral outflow

B - BB - BLOCKS aqueous production

C - Carbonic anhydrase inhibitor eye drops - (e.g. Dorzolamide) - reduces aqueous production

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16
Q

What is Anisocoria

A

This is uneven pupil size

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17
Q

What is Holme’s Adie Pupil

A

Benign condition, where usually ONE pupil does not constrict - remains dilated

Homer Simpson Lazy

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18
Q

What is Argyll-Robertson pupil (ARP)

A

Accomodation Reflex Present (ARP)

Both pupils do not directly respond to light, but respond when light is shone in OTHER eye

Presents as small, irregular pupils

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19
Q

What is Hutchinson’s sign? What is is caused by?

A

HS - vesicles extending to the tip of the nose.

Caused by Varicella Zoster Virus reactivation (Shingles)

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20
Q

What does Hutchinson’s sign indicate and what are patients at risk of?

A

It indicates ocular involvement (inflammation can spread ‘ocular-ly’).

These patients are at risk of anterior uveitis

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21
Q

2 side effects of Latanoprost (Prostaglandin analogue)

A

‘TAN’ - Brown pigmentation of iris

PR - (PRETTY) Increased eyelash length

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22
Q

Features of MILD NPDR

MOD NPDR (4)

A

MILD - Just micro-aneurysms

MOD - microaneurysms

blot haemorrhages

hard exudates

cotton wool spots (‘soft exudates’ - represent areas of retinal infarction)

venous beading/looping

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23
Q

SEVERE NPDR features (2)

A

blot haemorrhages and micro-aneurysms in 4 quadrants

venous beading in at least 2 quadrants

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24
Q

Features of PDR

A

retinal neovascularisation - may lead to vitrous haemorrhage

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25
Q

Management of NPDR

A

regular observation
if severe/very severe consider PRP

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26
Q

Management of Diabetic Maculopathy

A

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

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27
Q

CMV retinitis sign

A

PIZZA PIE APPEARANCE

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28
Q

CRVO features

A

Stormy sunset appearance - this represents vitreous haemorrhage

Sudden painless loss of vision

Retinal oedema

Cotton wool spots

Hard exudates

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29
Q

Why does a branch retinal vein occlusion (BRVO) occur

A

thought to occur due to blockage of retinal veins at arteriovenous crossings. It results in a more limited area of the fundus being affected.

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30
Q

Risk factors of CRVO

A

increasing age
hypertension
cardiovascular disease
glaucoma
polycythaemia

31
Q

Side effects of PRP

A

Decreased visual fields

Decreased night vision

32
Q

Management of CRVO

A

mainly conservative

macular oedema - intravitreal anti-vascular endothelial growth factor (VEGF) agents

retinal neovascularization - laser photocoagulation

33
Q

Features of Wet Macular Degeneration

A

Characterised by choroidal neovascularisation - red patches

Gradual loss of central vision - scotoma

Crooked or wavy appearance to straight lines (metamorphopsia)

34
Q

Features of Dry Macular Degeneration

A

characterised by drusen - yellow/amber round spots in Bruch’s membrane

Gradual loss of central vision - scotoma

Crooked or wavy appearance to straight lines (metamorphopsia)

35
Q

Investigations of macular degeneration

A

Slit lamp examination gives a detailed view of the retina and macula

fluorescein angiography is utilised if neovascular ARMD is suspected

36
Q

Mx of DRY Macular degeneration

Mx of WET Macular degeneration

A

combination of zinc with anti-oxidant vitamins A,C and E

Anti-vascular endothelial growth factor (VEGF) - ranibizumab, bevacizumab and pegaptanib,. The agents are usually administered by 4 weekly injection.

37
Q

Causes of Central Scotoma

A

Age related macular degeneration - painless

Optic neuritis - Painful

38
Q

Causes of “colour changes” in vision (2)

A

Optic Neuritis - poor colour discrimination (red desaturation)

Cataracts - Faded Colour vision - HARDER to distinguish

39
Q

Causes of “RAPD”

A

Ocular trauma

CRAO

Optic Neuritis

40
Q

Ocular Trauma signs

A

eye pain/swelling
proptosis
‘rock hard’ eyelids
relevant afferent pupillary defect
hx of trauma

41
Q

Ocular trauma management

A

opthlamic emergency - urgent lateral canthotomy

42
Q

Associated conditions w/scleritis (3)

A

rheumatoid arthritis: the most commonly associated condition

systemic lupus erythematosus

sarcoidosis

43
Q

Scleritis mx

A

Painful red eye - so same day emergency referral

Oral NSAIDS first line

Oral glucocorticoids if more severe

44
Q

Episcleritis asx conditions

A

Rheumatoid Arthritis

Inflammatory bowel disease

45
Q

how to differentiate between scleritis and episcleritis?

A

phenylephrine drops may be used to differentiate - conjunctival and episcleral vessels but not the scleral vessels

if the eye redness improves after phenylephrine a diagnosis of episcleritis can be made

46
Q

What group is PDR more common in

A

T1DM

47
Q

Horner’s syndrome

A

miosis (small pupil)
ptosis
enophthalmos* (sunken eye) (may have)
anhidrosis (loss of sweating one side)

48
Q

Causes of Horner’s

(4S, 4T, 4C)

A

4S - Central (cause anhidrosis of face AND body)

S – Stroke
S – Multiple Sclerosis
S – Swelling (tumours)
S – Syringomyelia (cyst in the spinal cord)

4T - Pre-ganglionic (cause anhidrosis of face)

T – Tumour (Pancoast tumour)
T – Trauma
T – Thyroidectomy
T – Top rib (a cervical rib growing above the first rib and clavicle)

4C’s - Post-Ganglionic - no anhidrosis

Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

49
Q

Signs of congenital Horner’s syndrome

A

heterochromia

50
Q

How to dx Horner’s

A

Cocaine eye drops

51
Q

Squint mx

A

referal to secondary care

Also eye patches to help bad eye develop

52
Q

Investigation for Acute Angle closure glaucoma

A

tonometry to assess for elevated IOP

gonioscopy (literally looking, oscopy, at the angle, gonio): a special lens for the slit lamp that allows visualisation of the angle

53
Q

mx of Acute Angle Closure Glaucoma

A

Same day emergency referral

In community -
Lying the patient on their back without a pillow

Pilocarpine eye drops (2% for blue and 4% for brown eyes) - miotic agent, opens pathway for aqeuous humour to leave

Acetazolamide 500 mg orally - reduces aqueous humour

Laser iridotomy is usually required as a definitive treatment.

54
Q

Features of Bacterial Conjunctivitis

A

Purulent discharge

Eyes “stuck” together

Highly Contagious

55
Q

Management of bacterial conjunctivitis

A

Self-limiting usually

Hygiene measures - stay away from peeps and do not share THINGS. School exclusion not necessary tho

Chloramphenicol or fusidic acid (for pregnant women) eye drops

56
Q

Features of Viral Conjunctivitis

A

Watery discharge
Recent URTI
Preauricular lymph nodes

57
Q

Allergic Conjunctivitis Features

A

Bilateral symptoms conjunctival erythema, conjunctival swelling (chemosis)
Itchy
swollen eyelids
May be a history of atopy
May be seasonal (due to pollen) or perennial (due to dust mite, washing powder or other allergens)

58
Q

Keratitis vs conjunctivitis

A

Conjuncitivits - whites of eyes (conjunctiva) - painless red eye

Keratitis - Cornea (colour) - painful red eye

59
Q

Keratitis features

A

red eye: pain and erythema
photophobia
foreign body, gritty sensation
hypopyon may be seen

60
Q

Causes of bacterial Keratitis and mx

A

typically Staphylococcus aureus

Pseudomonas aeruginosa is seen in contact lens wearers

stop using contact lens until the symptoms have fully resolved
topical antibiotics
typically quinolones are used first-line
cycloplegic for pain relief
e.g. cyclopentolate

61
Q

Causes of Loss of Red Reflex (2)

A

Cataracts

CRAO

62
Q

Features of acanthamoebic keratitis

A

increased incidence if eye exposure to soil or contaminated water

associated with contact lenses

pain is classically out of proportion to the findings

63
Q

Dx of Keratitis

A

slit-lamp

64
Q

mx of keratitis

A

Management
stop using contact lens until the symptoms have fully resolved
topical antibiotics
typically quinolones are used first-line
cycloplegic for pain relief
e.g. cyclopentolate

65
Q

Corneal Abrasion Features

A

RED eye pain
lacrimation
photophobia
foreign body sensation
decreased visual acuity in the affected eye

KEY: fluorescein staining
examination typically reveals a yellow-stained abrasion

66
Q

Herpes Simplex Keratitis (due to HSV mostly) Features

A

KEY: DENDRITIC ULCER ON SLIT LAMP
red, painful eye
photophobia
visual acuity decreased

67
Q

Keith Wagener Staging (SAFE)

A

S - Slim (mild narrowing of aterioles) - STAGE 1

A - AV nicking - STAGE 2

F - Flame - haemorrhages - STAGE 3 (+COTTON WOOL SPOTS)

E - Oedema - Papilloedema

68
Q

Mx of Hypertensive retinopathy

A

managing BP, risk factors

69
Q

Dx of Optic neuritis

A

MRI of the brain and orbits with gadolinium contrast

70
Q

How to tell Pre-orbital and orbital cellulitis apart

mx for orbital

A

Using a CT

mx for orbital - Oral/IV abx

71
Q

Features of a 3rd nerve palsy?

A

“down and out appearance of eye”
dilated and fixed pupil
ptosis

72
Q

Causes of a 3rd nerve palsy

A

diabetes mellitus
vasculitis e.g. temporal arteritis, SLE
Aneurysm

73
Q

Features of 6th nerve palsy

A

This will result in a cross eyed look

74
Q

Features of a fourth nerve palsy

A

vertical diplopia (think of 4 and the number 2)
classically noticed when reading a book or going downstairs
subjective tilting of objects (torsional diplopia)
the patient may develop a head tilt, which they may or may not be aware of - they do this to avoid the vertical diplopia

Finals 2024 (8 decks)

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