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Question 1
Incorrect
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A 30-year-old female diagnosed with rapidly progressive glomerulonephritis complains of pain and redness in the right eye. Which part of the eye is causing these symptoms in this case?
Your Answer: Conjunctivitis
Correct Answer: Sclera
Explanation:Rheumatoid Scleritis is a painful inflammatory condition of the sclera in patients with rheumatoid arthritis. It might be diffuse, nodular, or necrotizing in nature. This occurs mostly in the sixth decade of life and mostly when the rheumatoid disease is in remission. Sclera is the first ocular manifestation in a patient of rheumatoid arthritis. This inflammation might later spread to the adjacent ocular structures like the cornea, causing keratitis, the uveal tract causing uveitis and the lens causing cataracts.
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This question is part of the following fields:
- Ophthalmology
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Question 2
Incorrect
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A 23 year old girl presented with complaints of diplopia on looking towards her right side. Which of the nerves will be effected?
Your Answer: Left abducens
Correct Answer: Right abducens
Explanation:This patient has complaints of diplopia in the right eye, when looking towards the right. Eyeball movements towards the right side are controlled by right lateral rectus muscle which is supplied by the abducent nerve.
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This question is part of the following fields:
- Ophthalmology
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Question 3
Correct
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A 20-year-old man presents with a history of sticky greenish discharge, accompanied by redness of the eyes, and difficulty opening his eyes in the morning. What is the single most likely cause of these symptoms?
Your Answer: Conjunctivitis
Explanation:Redness of the eyes can present in all of the conditions. However, the green sticky discharge that causes the eyelids to stick together overnight is characteristic of bacterial conjunctivitis. Bacterial conjunctivitis is an inflammatory condition of the conjunctiva in which bacteria commonly Staphylococcus Aureus invade the conjunctiva. The person experiences a foreign body feeling in the eye and mucopurulent or purulent discharge.
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This question is part of the following fields:
- Ophthalmology
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Question 4
Incorrect
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A 69-year-old retired veterinarian with type 2 diabetes mellitus presents as she has started to bump into things since this morning. Over the previous two days, she had noticed some 'floating spots in her eyes'. Examination reveals she has no vision in her right eye. The red reflex on the right side is difficult to elicit and you are unable to visualise the retina on the right side during fundoscopy. Examination of the left fundus reveals changes consistent with pre-proliferative diabetic retinopathy. Which of the following is the most likely diagnosis?
Your Answer: Retinal detachment
Correct Answer: Vitreous haemorrhage
Explanation:The history of diabetes, complete loss of vision in the affected eye and inability to visualise the retina, suggest a diagnosis of vitreous haemorrhage (VH). 3 conditions cause 59 to 88.5% of VH cases: proliferative diabetic retinopathy, posterior vitreous detachment (PVD), and ocular trauma
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This question is part of the following fields:
- Ophthalmology
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Question 5
Incorrect
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A 42-year-old man presents with a watery eye and some purulent discharge. Mucoid discharge can be expressed from the lacrimal punctum. His eye is painful and red while the nasal end of his lower eyelid is swollen. The redness extends further to reach the nasal peri-orbital area. What is the most likely diagnosis?
Your Answer: Acute conjunctivitis
Correct Answer: Acute dacryocystitis
Explanation:Acute dacryocystitis presents as inflammation of the lacrimal sac and is typically caused by infection. Symptoms of acute dacryocystitis can be pain, redness of the eye and swelling of the nasal aspect of the eye. The eye is usually watery and discharge can be expressed through the lacrimal punctum which is generally mucoid but can also be purulent. Patient can also present with fever.
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This question is part of the following fields:
- Ophthalmology
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Question 6
Incorrect
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A 60-year old female suddenly started seeing a curtain-like shadow in her field of vision with flashes of lights and subsequent loss of vision, which prompted her to visit her ophthalmologist. What do you think is the most appropriate treatment in this case?
Your Answer: Corticosteroids
Correct Answer:
Explanation:Flashes of light, presence of floaters and loss of vision (often described as a black curtain closing in on the visual field) are symptoms that strongly indicate retinal detachment. The fundoscopy findings of retinal tears support this diagnosis. Therefore, surgery of retina must be done to treat this patient.
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This question is part of the following fields:
- Ophthalmology
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Question 7
Incorrect
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A 27 year old female has been taken to A&E from a cinema after complaining of sudden severe pain in the eyes. This is followed by seeing coloured halos and vomiting. She has a history of reoccurring headaches which used to resolve themselves. She is examined and is found to have a fixed, dilated ovoid pupil. Choose the most appropriate first investigation from the list.
Your Answer: Toxicology screen
Correct Answer: Applanation tonometry
Explanation:The darkness of the cinema room will have caused halfway dilation of the pupil. This can cause an acute attack of angle closure glaucoma. The appropriate test to diagnose this is applanation tonometry.
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This question is part of the following fields:
- Ophthalmology
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Question 8
Correct
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An 88-year-old retired firefighter presents with loss of vision in his left eye since this morning. He is otherwise asymptomatic and of note has had no associated eye pain or headaches. His past medical history includes ischaemic heart disease but he is otherwise well. On examination he has no vision in his left eye. The left pupil responds poorly to light but the consensual light reaction is normal. Fundoscopy reveals a red spot over a pale and opaque retina. Which of the following is the most likely diagnosis?
Your Answer: Central retinal artery occlusion
Explanation:The most common causes of a sudden painless loss of vision are:
– ischaemic optic neuropathy
– occlusion of central retinal vein or artery
– vitreous haemorrhage
– retinal detachment.
Central retinal artery occlusion is due to thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis). Features include afferent pupillary defects, and a ‘cherry red’ spot on a pale retina. -
This question is part of the following fields:
- Ophthalmology
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Question 9
Incorrect
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A 34-year-old woman has had progressive reduction of visual acuity over the past 3 years. She has now almost lost all of her vision. What is the diagnosis?
Your Answer: Macular degeneration
Correct Answer: Retinitis pigmentosa
Explanation:Retinitis pigmentosa is a genetic disorder of the eyes that causes loss of vision. Symptoms include trouble seeing at night and decreased peripheral vision. Onset of symptoms is generally gradual.
– In keratitis, there will be pain, redness and photophobia but vision is not affected
– In macular degeneration, near blindness does not occur rather the inability to identify faces or read small print
– Cataracts are more common in elderly
– It is not angle closure glaucoma as angle closure glaucoma occurs usually after the age of 50; In open angle glaucoma visual loss is not gradual but rather occurs suddenly following progression -
This question is part of the following fields:
- Ophthalmology
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Question 10
Correct
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A 62-year-old laboratory technician presents to the ophthalmology emergency department with sudden onset painless loss of vision in the right eye. He describes it as having a dense shadow over his vision, progressing from the periphery to the centre. He has no past medical history of note. Which of the following is the most likely diagnosis?
Your Answer: Retinal detachment
Explanation:The most common causes of a sudden painless loss of vision are as follows:
– Ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis)
– Occlusion of central retinal vein
– Occlusion of central retinal artery
– Vitreous haemorrhage
– Retinal detachmentRetinal detachment is a cause of sudden painless loss of vision. It is characterised by a dense shadow starting peripherally and progressing centrally.
Vitreous haemorrhage usually presents with dark spots.
Central retinal artery and central retinal vein occlusion do not usually present with progressing dense shadow.
This man’s lack of ischaemic risk factors makes ischaemic optic neuropathy less likely.
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This question is part of the following fields:
- Ophthalmology
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