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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 orreproduced 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 beaccepted by PasTest Ltd.

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Ophthalmology

PasTest Ltd

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 quadrantsOptic 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

PasTest Ltd

- Hypertensive retinopathy Narrowing of arteries

AV nipping

CWS, flame shaped haemorrhages, exudates

Disc swelling, macular star

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Ophthalmology

PasTest Ltd

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

retinitis pigmentosa

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Ophthalmology

PasTest Ltd

3) OPTIC DISCCupping 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

PasTest Ltd

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 pseudoxanthomaelasticum)

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Ophthalmology

PasTest Ltd