other Flashcards
lobes and lesions
A lesion in the temporal lobe would cause contralateral homonymous superior (upper) quadrantanopia
A lesion in the parietal lobe would cause contralateral homonymous inferior (lower) quadrantanopia
A lesion in the occipital lobe would cause contralateral homonymous hemianopia
high prolactin what we thinkign what other sx
prolactinoma
pituitary gladn tumour most common compressing optic chiasm where the temproal fibres of the optic nerve decussate so lead to biteporal hemianopia
A 45 year old female presents to Accident & Emergency complaining of a painful right eye. She reports onset of a dull aching pain over the space of hours associated with a severe headache and nausea. She has no medical history and wears reading glasses.
On examination, you note a red eye with a fixed dilated pupil.
Which of the following is the most likely diagnosis?
Acute angle closure glaucoma
Acute angle closure glaucoma often presents with headache and nausea, while visual symptoms may not always be present. A fixed dilated pupil is classic of this diagnosis and an important clue in the stem is that the patient wears reading glasses – hypermetropia being a risk factor for acute angle closure glaucoma
Which of the following clinical features suggests a diagnosis of ischaemic optic neuropathy?
Swollen optic disc
A swollen optic disc is a common finding in patients with acute ischaemic optic neuropathy. In the chronic phase, the optic disc may atrophy and appear pale
trochelar palsy what would you seee explain
hypertropia - up
hypermetropia
exotropia -out
esotropia - in
hypotropia - down
all types of strabismus - squints
The trochlear nerve supplies the superior oblique muscle which functions to depress the eye when the eye is held in adduction and to intort the eye when the eye is held in primary gaze. As a result of the unopposed action of the muscles to elevate the eye (the superior rectus and inferior oblique) a trochlear palsy causes the affected eye to sit higher within the orbit compared to the contralateral eye. This is termed hypertropia
abducens palsy
CN VI innervates the lateral rectus muscle. The inability of an eye to turn outward results in a convergent strabismus or esotropia(in) which causes diplopia in which the two images appear side by side – a horizontal diplopia. Diplopia is also increased on looking to the affected side.
scarrign alopecia
Folliculitis decalvans
This is the only option that causes a scarring alopecia. Folliculitis decalvans causes a scarring alopecia with peri-follicular pustules and multiple hairs originating from a single follicle
Alopecia areata
Alopecia areata does cause patches of hair loss, but this is non-scarring
Telogen effluvium causes diffuse hair loss after severe physiological stress eg childbirth, illness, surgery.
Androgenic alopecia causes male- or female-pattern balding. In males it presents with a receding hairline and loss of hair on the vertex of the scalp. In females it presents with thinning of the hair.
Nutritional deficiencies and thyroid dysfunction may also cause non-scarring alopecia.
A 69-year-old gentleman presents to the emergency department with a suspected stroke. On examination there is unilateral hemiparesis of the right upper limb as well as significant dysphasia of speech and hemispatial neglect on visual examination. Which of the following is the correct classification of this stroke?
PACI
Contralateral hemiplegia or hemiparesis, AND
Contralateral homonymous hemianopia, AND
Higher cerebral dysfunction (e.g. aphasia, neglect) A TACI involves the anterior AND middle cerebral arteries on the affected side.
A partial anterior circulation infarct (PACI) is defined by:
2 of the above, OR
Higher cerebral dysfunction alone.
A PACI involves the anterior OR middle cerebral artery on the affected side.
A 69-year-old gentleman presents to the emergency department with a suspected stroke. On examination there is unilateral hemiparesis of the right upper limb as well as significant dysphasia of speech and hemispatial neglect on visual examination. Which of the following is the correct classification of this stroke?
PACI
Contralateral hemiplegia or hemiparesis, AND
Contralateral homonymous hemianopia, AND
Higher cerebral dysfunction (e.g. aphasia, neglect) A TACI involves the anterior AND middle cerebral arteries on the affected side.
A partial anterior circulation infarct (PACI) is defined by:
2 of the above, OR
Higher cerebral dysfunction alone.
A PACI involves the anterior OR middle cerebral artery on the affected side.
what things can damage the cornea causing a refractive error
Refractive error means that the shape of your eye does not bend light correctly, resulting in a blurred image. The main types of refractive errors are myopia (nearsightedness), hyperopia (farsightedness), presbyopia (loss of near vision with age), and astigmatism.
This patient has had a central retinal artery occlusion (CRAO) which presents with a profound and painless loss of vision with a pale retina and a ‘cherry red’ spot in the macula.
Given her young age, her history of miscarriages and her rash, known as livedo reticularis, she should be investigated for
anticardiolipin- antiphospholipid syndrome
Which of the following is the correct explanation for the purpose of a fluorescein eye drop test?
To identify any defects in the corneal epithelium
Fluorescein is an orange/yellow eye drop which turns green with stimulation by blue light. The fluorescein accumulates in defects in the corneal epithelium and thus these areas of damage are more apparent when blue light is shone on to the cornea
retinits pigementosa sx and what is affected
Patients often present at a young age with ‘tunnel vision’ due to damage to the peripheral retina from pigment deposits.
As rod cells are primarily affected in most types, patients also classically complain of reduced visual acuity in dim light.
Any cause of reduced visual stimulation in one eye can cause
Amblyopia - A visual impairment resulting from abnormal visual stimulation during early childhood
differnce between central and branch retinal artery occlusion
branch you would have half of it most commonly temporal
dendritic ucler caused by
virus
A 23-year-old female patient presents to the Emergency Eye Clinic complaining of a 3 day history of pain and reduced vision in her left eye. On examination, the visual acuity in the left eye was 6/12 and scored 3 out of 38 on the Ishihara plate test. She had a left-sided relative afferent pupillary defect and fundoscopy showed optic disc oedema, consistent with a diagnosis of optic neuritis. Examination of the right eye was unremarkable. On reviewing her record, her doctor notes that she presented with a similar complaint 6 months ago in her right eye, which self resolved over the course of three weeks.
Which of the following investigation findings is likely to be found in this patient?
Oligoclonal bands in a cerebrospinal fluid sample
The presence of relative afferent pupillary defect, colour blindness and optic disc oedema localises the pathology to the optic nerve. Pain suggests the pathology is optic neuritis, especially given the demographics of the patient. The past ocular history shows two neurological events disseminated in time and space (as both eyes have now been affected). This diagnosis is likely to be multiple sclerosis (MS). Oligoclonal bands are IgG clones produced in the CSF as a result of the T-cell mediated inflammation that defines Multiple Sclerosis. They can be identified by electrophoresis of CSF. Note that Oligoclonal bands are not required for the diagnosis but are suggestive
argyll robertson pupil - what is it and linked to what disease
Argyll-Robertson pupil refers to bilaterally small pupils that constrict on convergence but do not constrict in response to light.
They are highly specific for neurosyphilis.
Corneal arcus
high lipids
A single, well demarcated white ulcer
A dendritic ulcer
Multiple, poorly demarcated, fluffy white lesions with satellite lesions
match up these with specifc keratitis
bacterial keratitis
herpes simplex keratitis
fungal keratitis
complciation of bacterial keratitis after bells palsy
Exposure keratopathy
Bell’s palsy is an idiopathic facial nerve palsy. Paralysis of the orbicularis oculi muscle attenuates eyelid closure (lagophthalmos) thus increasing the exposure of the cornea and tear layer to the environment. This increases the risk of damage to the corneal epithelium (exposure keratopathy) which may become infected leading to sight-threatening keratitis
A 51 year old female patient attends A&E complaining of a red right eye. She reports that her red eye started suddenly, and she can hear a ‘whooshing noise’. She also reports diplopia, a headache and loss of vision.
On examination her visual acuity is 1/60 in her right eye. Her conjunctiva is injected, and she has a restriction in her right eye movements in all direction. The eye is severely proptosed and pulsatile.
What is the most likely diagnosis?
Carotid-cavernous fistula
what is a carotid cavernous fistula
what CN affected
This a communication between the carotid artery and the cavernous sinus.
III, IV, V1, V2 and VI
The eye is usually proptosed with an injected conjunctiva and may be pulsatile
Photopsia
flash of light
seen in post vitreous detachment
