Week 2

Question 1

Mechanisms of ocular trauma

Answer 1

Blunt trauma
Penetrating trauma
Burns (chemical / physical)

Question 2

What can blunt trauma lead to

Answer 2

Blowout fractures
Subconjunctival haemorrhage
Globe rupture
Hyphaemia
Traumatic uveitis

Question 3

What injury mechanism can cause blowout fracture

Answer 3

Direct blow to the central orbit by fist/ ball

Question 4

What can happen as a result of blowout fracture

Answer 4

Herniation
Trapdoor fracture

Question 5

Which structure is likely to herniate in a blowout fracture

Answer 5

Inferior rectus muscle
Orbital fat

Question 6

Where does the herniates go into

Answer 6

Maxillary sinus

Question 7

Inferior rectus muscle herniation can cause

Answer 7

Diplopia
when ask the patient to look up, one eye cannot move up

But when ask the patient to look down, both eyes can

Question 8

What is subconjunctival haemorrhage

Answer 8

Rupture of blood vessels in conjunctiva, releasing the blood into the space between conjunctiva and sclera

Question 9

Besides from trauma, what else can cause subconjunctival haemorrhage

Answer 9

Heavy coughing
Strenuous exercise
Straining when constipated

Question 10

What is hyphaemia

Answer 10

Blood in anterior chamber

Question 11

What is traumatic uveitis

Answer 11

Inflammation of iris due to eye trauma

Question 12

What is the urea

Answer 12

Layer behind the conjunctiva and sclera, containing iris, choroid and ciliary body

Question 13

Why are corneal abrasions very sore

Answer 13

Due to dense sensory innervation of the cornea

Question 14

What can be used to check for corneal lacerations

Answer 14

Fluorescein stain drops

Question 15

Management of corneal laceration

Answer 15

Remove the foreign body causing it
Ocular lubricants
Analgesia
chloramphenicol if risk of infection

Question 16

What is myotonic dystrophy

Answer 16

Group of inherited conditions that show muscle weakness and myotonia

Question 17

What is myotonia

Answer 17

inability to relax after muscle contraction

Question 18

types of myotonic dystrophy

Answer 18

Classic dystrophia myotonica 1 (DM1)
Type 2 myotonic dystophy (DM2)

Question 19

Which type of myotonic dystrophy is more common

Answer 19

Classic dystrophia myotonica 1 (DM1)

Question 20

Myotonic dystrophia most commonly present at

Answer 20

20 years old

Question 21

Cause of classic dystrophia myotonic 1

Answer 21

Mutation in DMPK gene

Question 22

Presentation of myotonic dystrophia

Answer 22

Frontal balding in males
Long and thin face
Bilateral ptosis
Cataracts
Slurred speech
Loose jaw (mournful facial expression)
Muscle wasting and weakness

Question 23

What causes slurred speech in myotonic dystrophia

Answer 23

Myotonic tongue and pharyngeal muscles

Question 24

What cataracts are seen in myotonic dystrophia

Answer 24

Stellate posterior cortical cataract
Polychromatic cataract (Christmas tree)

Question 25

What physical test can be done to identify myotonic dystrophia

Answer 25

Shake the patient's hand - the patient will be unable to release their hand due to myotonia

Question 26

What is neurofibromatosis type 1

Answer 26

Genetic condition that causes tumours along the nervous system

Question 27

Cause of neurofibromatosis type 1

Answer 27

NF1 gene mutation

Question 28

Presentation of neurofibromatosis type 1

Answer 28

>6 cafe au last spots that are >5mm (pre puberty) or >15mm (post puberty) Axillary or inguinal freckling >2 neurofibromas of any type on skin Optic glioma >2 Lisch nodules

Question 29

What is optic glioma

Answer 29

slow-growing brain tumor that arises in or around the optic nerve

Question 30

What are Lisch nodules

Answer 30

Iris hamartomas (benign) that are seen as brown patches on the iris

Question 31

What can optic glioma result in

Answer 31

Afferent pupillary defect Globe proptosis (the tumour is pushing the eyeball out)

Question 32

What is afferent pupillary defect

Answer 32

pupils respond differently to light stimuli

Question 33

Which thyroid disease causes eye disease

Answer 33

Grave's - hyperthyroidism

Question 34

How does thyroid eye disease occur

Answer 34

Autoimmune disease caused by the activation of orbital fibroblasts by autoantibodies directed against thyroid receptors

Question 35

Presentation of thyroid eye disease

Answer 35

Proptosis (unilateral / bilateral) Lid retraction Red, watery eyes Optic neuropathy (as the swelling worsens and compresses the optic nerve)

Question 36

How does proptosis occur in thyroid eye disease

Answer 36

The autoantibodies target the extra ocular muscles and orbital fat which causes swelling behind the eye hence pushes the eyeball out

Question 37

What habit can worsen thyroid eye disease

Answer 37

Smoking

Question 38

Complications of thyroid eye disease

Answer 38

Optic neuropathy Exposure keratopathy Double vision

Question 39

What is exposure keratopathy

Answer 39

corneal damage and infection occurs as the patient is unable to close their eyes

Question 40

What causes double vision in thyroid eye disease

Answer 40

Fibrosis of the extra-ocular muscles limiting the gaze in certain directions