Archives: MRCGP AKT

AKT-2110

An 80-year-old lady came to the clinic complaining of a one day history of right temporal headache, jaw claudication, fever and reduced appetite. She stated that her vision had not worsened.
Upon examination, there was tenderness on palpation of the right scalp at the temporal region and the right temporal artery was palpable and hard. The patient’s visual acuity was 6/6 on both eyes according to the Snellen chart.
What would be the most appropriate next step in managing this patient’s condition?

AKT-2094

You are seeing a 54-year-old gentleman for his diabetic annual review appointment. He has type 1 diabetes which was diagnosed when he was 12-years-old. He tells you that over the last 72 hours he has noticed new onset flashers and floaters in his right eye. Today he has felt that the vision in his right eye has become ‘extremely blurry’.

You can see that his last diabetic retinopathy screening was performed just over a month ago and the report you have states that the retinal photographs taken showed ‘pre-proliferative retinopathy’ in his left eye and ‘proliferative retinopathy’ in the right eye. Following this the screening service has referred him for outpatient ophthalmological assessment at the local hospital, which is pending.

On examination there is a loss of the red reflex in the right eye and right eye visual acuity is reduced to ‘hand movements’.

What is the most appropriate management?

AKT-2095

A 35-year-old builder with type 1 diabetes presents with a typical history of tension headache.

During the course of the examination, you look to exclude papilloedema and incidentally note a few diabetic changes.

Which of the following fundoscopy findings would warrant an urgent referral to the ophthalmologist?

AKT-2096

An 81-year-old man presents with sudden loss of vision in his left eye. On further questioning, he complains of a left-sided headache over the past few weeks, associated with tenderness of his head when he brushes his hair. On examination, his vision is reduced to counting fingers in the left eye. A left relative afferent pupillary defect is present. Fundoscopy reveals a pale, swollen left optic disc with some adjacent flame-shaped haemorrhages. The right eye is entirely normal. An urgent erythrocyte sedimentation rate (ESR) is elevated at 92 mm/h.
What is the most important initial course of action?

AKT-2097

A 29-year-old man visits his General Practitioner with a complaint of discomfort in his right eye following the use of a rotary saw to cut bricks. Despite washing the eye, he still experiences discomfort. He reports no changes in his vision. Upon examination, there are no foreign objects on the cornea or under the lower lid. Fluorescein staining reveals linear abrasions on the cornea. What is the most probable diagnosis? Choose only ONE option.

AKT-2098

A 30-year-old teacher presents to the out-of-hours General Practice with complaints of conjunctivitis. She wears contact lenses. She has been using over-the-counter Brolene® drops for the last two days to try to treat the problem herself, but now finds her vision blurred in the affected eye. On examination, she has florid keratoconjunctivitis and visual acuity of 6/36 in her affected eye. Fluorescein stain is taken up centrally.
What is the most likely diagnosis?

AKT-2099

A 52-year-old woman presents with sudden-onset, painless visual loss affecting her left eye. She awoke from sleep to find that she could only perceive light and dark and was unable to drive to work because of this.
She has a history of recurrent miscarriage, although she has gone on to have one healthy child. Her medical history is otherwise unremarkable. She is anxious and has a blood pressure of 154/89 mmHg; her heart rate is 78 bpm and regular.
A picture of her left retina is shown below:
Which of the following is the most useful investigation?

AKT-2100

A 77-year-old woman presents with a complaint of distorted vision and difficulty reading with her right eye. She reports seeing straight lines as bent and her peripheral vision is unaffected. Upon fundoscopy, yellow spots are observed around the macular region.
What is the most probable diagnosis?

AKT-2091

Which of the following statements about conditions that affect the eyelids is true?

AKT-2092

A 65-year-old woman has been experiencing a shift in her eyesight in recent weeks. She is unable to read small text, even with her regular reading glasses. There is a constant slight blurriness in the center, and lines always appear distorted instead of straight.
Which retinal indication is most likely linked to this condition? Choose ONE option only.