-
Question 1
Correct
-
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.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 2
Correct
-
A 8 year old boy presented with pain and swelling around the right eye. On examination there was no proptosis or ophthalmoplegia. Which of the following is the most probable diagnosis?
Your Answer: Peri orbital cellulitis
Explanation:Infections of the superficial skin around the eyes are called periorbital, or preseptal, cellulitis. It is predominantly a paediatric disease. Erysipelas is a bacterial skin infection involving the upper dermis which extends into the superficial cutaneous lymphatics. Sinusitis is in sinuses. Orbital infections and conjunctivitis are within the eye.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 3
Incorrect
-
Which of the following is associated with heterochromia in congenital disease?
Your Answer: Argyll-Robertson pupil
Correct Answer: Horner's syndrome
Explanation:Heterochromia (difference in iris colour) is seen in congenital Horner’s syndrome, as well as anhidrosis. Other features of non-congenital Horner’s include miosis, ptosis and enophthalmos.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 4
Incorrect
-
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: Pilocarpine eyedrops
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.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 5
Correct
-
A 30-year-old female presented in the ophthalmology ward complaining of blurry vision for 4 days. Fundoscopy of both eyes revealed cotton wool spots in both the retinas. What is the most likely cause of this condition?
Your Answer: CMV infection
Explanation:Fundoscopy findings of cotton wool spots and retinal tears, accompanied by a history of blurred vision, are characteristic of retinitis. Cytomegalovirus is known to cause retinitis.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 6
Incorrect
-
A 67-year-old retired physician presents to ophthalmology clinic after seeing his optician. Raised intra-ocular pressure and decreased peripheral vision was noticed. His past medical history includes asthma and type 2 diabetes mellitus. What is the most appropriate treatment given the likely diagnosis?
Your Answer: Timolol
Correct Answer: Latanoprost
Explanation:The majority of patients with primary open-angle glaucoma are managed with eye drops. These aim to lower intra-ocular pressure which in turn has been shown to prevent progressive loss of visual field. A prostaglandin analogue should be used first-line in patients with a history of asthma.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 7
Correct
-
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 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.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 8
Incorrect
-
A 44-year-old physiotherapist with a history of rheumatoid arthritis presents with a painful, red left eye. Visual acuity is normal. Fundoscopy is also unremarkable. Which of the following is the most likely diagnosis?
Your Answer: Anterior uveitis
Correct Answer: Scleritis
Explanation:Scleritis, or inflammation of the sclera, is usually painful whereas episcleritis is not painful.
Keratoconjunctivitis sicca is usually bilateral and associated more with dryness, burning and itching.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 9
Correct
-
A 70 year old male complained of poor vision at night which has gradually worsened with time. He has changed his glasses several times but there has been no improvement. On examination his pupils and cornea were normal. Which of the following is the most probable diagnosis?
Your Answer: Cataract
Explanation:Senile cataract is an age-related, vision-impairing disease characterized by gradual progressive clouding and thickening of the lens of the eye. Patients with senile cataracts often present with a history of gradual progressive visual deterioration and disturbance in night and near vision.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 10
Correct
-
Which of the following is not a risk factor for primary open-angle glaucoma?
Your Answer: Hypermetropia
Explanation:Acute angle closure glaucoma is associated with hypermetropia, whereas primary open-angle glaucoma is associated with myopia. Glaucoma is a group of eye disorders characterised by optic neuropathy due, in the majority of patients, to raised intraocular pressure (IOP). It is now recognised that a minority of patients with raised IOP do not have glaucoma and vice versa.
-
This question is part of the following fields:
- Ophthalmology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
