MRCSI (Ophth) Written cheat sheet

Afferent pupillary defect: a relative afferent pupillary defect indicates optic nerve or severe retinal disease; it is detected with the swinging flashlight test and is absent in purely media-opacity or isolated efferent lesions.

Acute angle-closure glaucoma: mid-dilated fixed pupil, hazy cornea, hard globe, nausea and halos; immediate lowering of intraocular pressure with topical and systemic agents plus definitive laser peripheral iridotomy.

Central retinal artery occlusion: sudden painless monocular loss with a cherry-red fovea and attenuated vessels; it is an ocular emergency linked to embolic carotid or cardiac sources.

Giant cell arteritis: age over 50, headache, scalp tenderness, jaw claudication and raised ESR/CRP; give high-dose corticosteroids immediately before temporal artery biopsy to protect the fellow eye.

Retinal detachment: flashes, floaters and a curtain-like field defect; macula-on detachments require urgent surgical repair to preserve central vision.

Endophthalmitis after intraocular surgery: pain, hypopyon and marked vision loss within days; obtain vitreous/aqueous samples and give intravitreal antibiotics urgently.

Optic neuritis: painful monocular loss worsened by eye movement, color desaturation and an afferent pupillary defect; it is strongly associated with multiple sclerosis.

Corneal foreign body and abrasion: assess with fluorescein and cobalt-blue light, evert the eyelid to exclude subtarsal bodies, and avoid topical anesthetics for ongoing pain relief.

Hypertensive and diabetic retinopathy: diabetic changes are classified as non-proliferative versus proliferative, with macular edema being the commonest cause of vision loss regardless of stage.

Acute appendicitis: migration of pain to the right iliac fossa with localized peritonism; Alvarado scoring combines symptoms, signs and leukocytosis to stratify need for imaging or surgery.

Bowel obstruction: colicky pain, vomiting, distension and absolute constipation; supine and erect abdominal films show dilated loops and air-fluid levels, and strangulation signs mandate urgent surgery.

Acute mesenteric ischemia: pain out of proportion to examination findings in an elderly or atrial fibrillation patient; early CT angiography and revascularization improve survival.

Hernia: an irreducible, tender hernia with systemic upset suggests strangulation and requires emergency operation; inguinal hernia is the commonest groin hernia in men.

Trauma primary survey follows ABCDE, with massive hemorrhage control and permissive hypotension until surgical control; FAST detects free intraperitoneal fluid.

Thyroid surgery risks recurrent laryngeal nerve injury (hoarseness) and hypocalcemia from parathyroid devascularization; postoperative neck swelling with stridor suggests hematoma requiring opening of the wound.

Breast cancer: triple assessment combines clinical examination, imaging and tissue sampling; axillary nodal status is the strongest prognostic factor.

Perianal sepsis: perianal abscess requires prompt incision and drainage; a fistula-in-ano is managed according to the relationship of its tract to the sphincter complex.

Postoperative fever: consider atelectasis, urinary and wound infection, and deep vein thrombosis; wound dehiscence with evisceration is a surgical emergency requiring theater.