Post on 15-Jan-2017
Embed Size (px)
Opthalmology QuizSian Chivers
Question 1Whats This?
Name 3 Causes?
What Symptoms may a person complain of?
How is it Treated
Answer 1CataractCausesSenile (Commonest)Diabetes, Recurrent Uveitis, Previous ocular surgeryDrugs steroids, phenothiazinesTrauma and foreign bodiesIonising radiation Xray, UVCongenitalInherited Myotonic Dystrophy, Marfans, Lowes, Rubella, high myopiaSymptomsReduced acuity, Glare in sunshine, Distortion of lines, Diplopia, Altered coloursMydriatic drops, sunshades and sunglasses. Surgery Phacoemulsification and Lens implant (US breaks up lens)
Question 2What is this?
What investigation is being carried out?
What is the causative organism?
What are the clinical features?
What is the treatment?
Answer 2Dendritic ulcerEye examination under fluorescein stainHerpes Simplex virusIrritable red eye, watering, photophobicRefer to an opthalmologist, Aciclovir 3% eye ointment 5x daily
Question 3What is this?
Name 3 pathological features shown in the picture and describe how they occur?
Name 2 complications of this eye condition?
How can this eye condition be treated and what would you see when you looked at the retina post procedure?
Answer 4 Background Diabetic retinopathyMicroaneurysms outpouching of retinal caps
Cotton wool spot microinfarct of retinal nerve fibre layerRetinal oedema and exudate leakage of serum into the neural retina and lipid accumulationNeovascularisation (proliferative) new vessels grow outside the retina along posterior surface of vitreousComplications blindness, vitreous haemorrhage and retinal detachment. Cataract as part of DM
Answer 4 ContTreatment
Good Glycaemic control prevents complications
Laser photocoagulation indicated for proliferative DR via argon laser
Vitrectomy vitreous is removed via a trans-pars incision to clear vitreous haemorrhage, to relieve retinal traction and to treat diffuse macular oedema
Question 5What abnormality is seen here?
Name 3 causes?
What may be seen when examining the pupils?
Answer 5Optic AtrophyCausesHereditary Autosomal dominant/recessive, Lebers hereditaryRetinal Dystrophy Cone Dystrophy, retinitis pigmentosaVascular central retinal artery occlusionNutritional VitB12 deficiency, tobacco, alcohol, drugs ethambutol chloramphenicolInflammatory Sarcoid, PANDemyelination (common)Compressive (glioma or meningioma)Relative afferent pupillary defect
Question 6This patient has AIDS
What is shown in fig 1What organism cause thisWhat other organisms commonly infect the retina of a patient with AIDS
What is shown in fig 2Would you expect lesions elsewhereWhat other infections affect the lids and conjunctiva of a patient with AIDS
Answer 6CMV retinitisMillions CMV, EBV, Toxoplasmosis, Syphilis, Cryptococcus, M.TB, M.aviumintracellulare, Candida, Aspergillus, histoplasmosis
Kaposi SarcomaYesTrichomegaly (long eyelashes), molluscum contagiosum, conjunctivitis, conjunctival granulomas , SCC assoc w HPV, herpes zoster opthalmitis
Question 7What intervention has been carried out here
What underlying condition does this patient have
What symptoms may the patient have experienced in the acute phase
What signs may have been apparent on examination
What is the treatment for the acute phase of the illness?
Answer 7 A peripheral iridotomyGlaucoma. Iridotomy is the intervention of choice to prevent angle closure glaucoma or after an attack has been broken by medical treatmentSymps sudden onset, severely painful red eye, blurred vision, halos around lights, headache, nausea and vomitingSigns reduced visual acuity, brick red eye, hazy cornea, vertically mid-dilated fixed pupil, high IOPTreatment Pilocarpine 2-4% 2h, acetazolamide 500mg iv stat then 250mg/8h, mannitol 20% by ivi. Topical steroids and antihypertensive drops may be used
Question 8What is shown here?
What symptoms may the patient complain of?
What associated condition may the patient have
What signs are found on examination?
What is the management?
Answer 8Anterior UveitisPainful red eye, photophobia, blurred vision or floatersAutoimmune disease ank spond, inflam bowel disease, sarcoidosisSigns ciliary injection, reduced visual acutiy, sluggish or irregular pupil, hazy iris details, high IOP refer to opthalmologist, reducing regimen of topical steroid (dexamethosone 0.1%) and cycloplegic and dilating drops (cyclopentolate 1%)Cataract in recurrent or chronic cases
Name to following
DiagnosisInherited underlying condition that may predisposeOther features of that condition
Answer 10Central retinal vein occlusionSigns afferent pupillary defect common, retinal haemorrhages, optic disc swelling, venous dilatation and tortuosity, cotton wool spotsUp to 33% are ischaemic assoc with rubeosis iridis or neovascularisation of discDetect any underlying systemic disease and treat, check IOP, screen for new vessels, treaat cv risk factors, laser new vessels.
Lens dislocationMarfans syndromeAortic dissection or dilatation, dural ectasia, arachnodactly, armspan greater than height, pectus deformity, pes planus, scoliosis high arched palate, mitral valve prolapse, joint hypermobility.
Well done, thats enough opthalmology for now!!