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EGERTON COURT, PARKGATE ESTATE, KNUTSFORD, CHESHIRE WA16 8DX, ENGLAND TELEPHONE: 01565 752000 FAX: 01565 650264

MRCP 2 PACES CLINICAL COURSE

OPHTHALMOLOGY STATION

HOW TO APPROACH A FUNDAL EXAMINATION: DO NOT PANIC!

Copyright 2008 PasTest Ltd The material in the folder is strictly copyright 2008 by PasTest Ltd. Under no circumstances may this material be photocopied or reproduced by any means whatsoever without the prior permission of PasTest Ltd. The information contained within this binder was obtained from reliable sources. However, while every effort has been made to ensure its accuracy, no responsibility for loss, damage or injury occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by PasTest Ltd.

Ophthalmology

1) PICTURE AS A WHOLE - Diabetes: Microaneurisms, Exudates, Venous beading, IRMA (intraretinal micro vascular abnormalities) New vessels on the disc New vessels elsewhere

- CRVO :

Diffuse haemorrhages 4 quadrants Optic disc swollen in severe cases Think causes for thrombosis: HT, diabetes, hyperviscosity etc

- CRAO:

Doctors sees nothing, patient sees nothing pale fundus cherry red spot during first few months missing arteries Think causes for occlusion: GCA, carotid stenosis etc

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Ophthalmology

- Hypertensive retinopathy Narrowing of arteries AV nipping CWS, flame shaped haemorrhages, exudates Disc swelling, macular star

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Ophthalmology

2) RETINAL PERIPHERY - Black spots laser scars (diabetes, CRVO)

retinitis pigmentosa

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Ophthalmology

3) OPTIC DISC Cupping glaucoma (MRCOphth not MRCP) Contour disc swelling: disc hyperemia, fluffy nerve fibers, disc haemorrhages One disc swollen: optic neuritis GCA AION CRVO, HT retinopathy, TED, neuro-retinitis (rare!) Lebers optic neuropathy (mitochondrial, rare!) Both swollen: SOL brain Idiopathic intracranial hypertension (IIH) Meningitis Cavernous sinus thrombosis Beware of drusen (pseudo-swelling)

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Ophthalmology

Colour

Pale

After swelling (optic neuritis, GCA, TED, Lebers) Compressive (meningioma, leukaemia) Toxicity (ethambutol, isoniazide, amiodarone, lead ethylene glycol (anti-freeze fluid) vit B deficiency in alcoholics aka tobacco-alcohol amblyopia Ischemia (AION) Post-trauma Infective (syphilis, neuro-retinitis) Granulomatous disease (sarcoidosis)

4) MACULA

Oedema

Diabetes (circinnate)

Scarring

Chorio-retinitis (toxoplasma, sarcoid) ARMD (grayish membrane, extensive scarring) Angioid streaks (assoc. with pseudoxanthoma elasticum)

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Ophthalmology

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