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Question 1
Incorrect
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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: Conjunctivitis
Correct 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.
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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 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: Surgery to retina
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 3
Incorrect
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A patient shows reduced central vision upon visual acuity test. He is advised to undergo a fundoscopy, which turns out to be normal. Which drug could be responsible for his symptoms?
Your Answer: Ethambutol
Correct Answer: Corticosteroids
Explanation:Corticosteroids are well known for their ocular complications such as glaucoma and cataracts.
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This question is part of the following fields:
- Ophthalmology
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Question 4
Correct
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A 77-year-old retired engineer presents with a burning sensation around his right eye. On examination, an erythematous blistering rash can be seen in the right trigeminal distribution. Which of the following is the most likely diagnosis?
Your Answer: Herpes zoster ophthalmicus
Explanation:Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10% of case of shingles. Features include a vesicular rash around the eye, which may or may not involve the actual eye itself, and Hutchinson’s sign: a rash on the tip or side of the nose, indicating nasociliary involvement and is a strong risk factor for ocular involvement.
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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 70-year-old female presented to her ophthalmologist with a complaint of weakening eyesight despite continued use of her corrective glasses. She also had a history of mild headaches for a few weeks. On fundoscopy, the disc had blurred margins with mild cupping and a sickle shaped scotoma in both eyes. What is the most appropriate treatment in this case?
Your Answer: Corticosteroids
Correct Answer: Pilocarpine eye drops
Explanation:Frequent change of eye glasses, scotoma, and mild cupping are suggestive of primary open angle glaucoma. This means that the anterior angle of the eye is normal but there is a problem in the trabecular meshwork, where the Schlemm’s Canal is not allowing the drainage of the aqueous humor. Pilocarpine should be given to the patient because it is a parasympathomimetic agent. It causes the ciliary muscle of the eye to contract, causing the trabecular meshwork to open up, allowing the aqueous humor to drain again.
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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 70 year old female presented with throbbing and continuous headache and loss of vision. Her ESR was elevated. Which of the following is the most appropriate management?
Your Answer: Corticosteroids
Correct Answer:
Explanation:Giant Cell Arteritis (Temporal Arteritis) is the most probable diagnosis. GCA should always be considered in the differential diagnosis of a new-onset headache in patients 50 years of age or older with an elevated erythrocyte sedimentation rate. Temporal artery biopsy remains the criterion standard for diagnosis of this granulomatous vasculitis. High-dose corticosteroid therapy is the universally accepted treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 7
Correct
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A 27-year-old female visited the OPD with a complaint of visual disturbance, eye pain, pain in the knee and hands, and a rash on her face. On examination, the rash was the shape of a butterfly, and the joints were mildly swollen. The eyes of the patient were found to be red with irregular pupils. Where do you think the problem lies?
Your Answer: Iris
Explanation:The patient’s symptoms are suggestive of ankylosing spondylitis which is often accompanied by iritis, the cause of this patient’s red eye.
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This question is part of the following fields:
- Ophthalmology
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Question 8
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: Proliferative retinopathy
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 9
Incorrect
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A 29-year-old accountant presents to the emergency department complaining of left eye pain. He has not been able to wear his contact lenses for the past 24 hours due to the pain. He describes the pain as severe and wonders whether he has 'got something stuck in his eye'. On examination, there is diffuse hyperaemia of the left eye. The left cornea appears hazy and pupillary reaction is normal. Visual acuity is reduced on the left side and a degree of photophobia is noted. A hypopyon is also seen. Which of the following is the most likely diagnosis?
Your Answer: Anterior uveitis
Correct Answer: Keratitis
Explanation:Hypopyon can be seen in anterior uveitis, however the combination of a normal pupillary reaction and contact lens use make a diagnosis of keratitis more likely. Keratitis describes inflammation of the cornea, and features include red eye with pain and erythema, photophobia, and foreign body/gritty sensation.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Incorrect
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A 40-year-old male has a 6-year history of hypertension. For two days, he has been having extreme difficulty in seeing things clearly and now complains of cloudy vision. On fundoscopy, flame-shaped haemorrhages are found in the patient's right eye. Margins of the optic disc were also found to be blurred. Which of the following conditions is this patient most likely suffering from?
Your Answer: hypertension retinopathy
Correct Answer: CRV thrombosis
Explanation:Fundoscopy reveals flame-shaped haemorrhages which are specific to central retinal vein occlusion (CRVO). In CRA thrombosis, fundoscopy would show a cherry-red spot. A patient with retinal detachment would give a characteristic history of seeing flashes of light and floaters. Background retinopathy is associated with diabetes.
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This question is part of the following fields:
- Ophthalmology
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Question 11
Incorrect
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A 68-year-old fashion designer presents to his GP complaining of pain in his right eye. On examination the sclera is red and the pupil is dilated with a hazy cornea. Which of the following is the most likely diagnosis?
Your Answer: Anterior uveitis
Correct Answer: Acute angle closure glaucoma
Explanation:There are many possible causes of a red eye. It is important to be able to recognise the causes which require urgent referral to an ophthalmologist. Acute angle closure glaucoma presents with severe pain, decreased visual acuity, patient seeing haloes, semi-dilated pupils, and hazy cornea. Anterior uveitis presents with acute onset pain, blurred vision and photophobia, with small, fixed oval pupils and ciliary flush.
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This question is part of the following fields:
- Ophthalmology
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Question 12
Correct
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A 54-year-old man experienced a gradual decrease in vision of one eye after being diagnosed with type 2 diabetes mellitus. Macula oedema is noted on his fundoscopy. Which of the following is the most likely diagnosis?
Your Answer: Diabetic retinopathy
Explanation:Macular disease can affect central vision at any stage of diabetic retinopathy and may be seen in type 2 diabetic patients. Diabetic retinopathy affects up to 80 percent of those who have had diabetes for 20 years or more. Macular oedema occurs when damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, which blurs vision.
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This question is part of the following fields:
- Ophthalmology
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Question 13
Correct
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A 55 year old man experiences sudden loss of vision preceded by the perception of something he describes as jagged lines or 'heat waves'. He's known to be myopic. What is the best treatment?
Your Answer: Scleral buckling
Explanation:The clinical picture is characteristic of retinal detachment, which should be treated immediately to prevent permanent loss of vision. Scleral buckling is a surgical procedure used to repair a retinal detachment, where the surgeon attaches a piece of silicone or a sponge onto the white of the eye at the spot of a retinal tear pushing the sclera toward the retinal tear or break, promoting repair. Signs of detachment include an increase in the number of eye floaters, flashes of light in the field of vision, and reduced peripheral vision.
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This question is part of the following fields:
- Ophthalmology
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Question 14
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: Iris
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 15
Incorrect
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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: Central retinal artery occlusion
Correct 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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Question 16
Correct
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A 75-year-old retired firefighter with a history of type 2 diabetes mellitus and hypertension presents due to the sensation of light flashes in his right eye. These symptoms have been present for the past 2 days and seem to occur more at the peripheral part of vision. There is no redness or pain in the affected eye. Corrected visual acuity is measured as 6/9 in both eyes. Which of the following is the most likely diagnosis?
Your Answer: Vitreous detachment
Explanation:Flashes and floaters are symptoms of vitreous detachment. The patient is at risk of retinal detachment and should be referred urgently to an ophthalmologist.
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 detachment -
This question is part of the following fields:
- Ophthalmology
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Question 17
Incorrect
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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 vein occlusion
Correct 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 18
Correct
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A 27-year-old consultant who has a family history of retinitis pigmentosa is reviewed in the ophthalmology clinic. He reports worsening vision over the past few months. During fundoscopy, which of the following findings would most support a diagnosis of retinitis pigmentosa?
Your Answer: Black bone spicule-shaped pigmentation in the peripheral retina
Explanation:Retinitis pigmentosa is a genetic disorder primarily affecting the peripheral retina resulting in tunnel vision. Night blindness is often the initial sign. Fundoscopy exam reveals black bone spicule-shaped pigmentation in the peripheral retina, and mottling of the retinal pigment epithelium.
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This question is part of the following fields:
- Ophthalmology
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Question 19
Correct
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Which of the following is associated with heterochromia in congenital disease?
Your 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.
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This question is part of the following fields:
- Ophthalmology
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Question 20
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 21
Incorrect
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A 60-year-old librarian presents for review. She has recently been diagnosed with dry age-related macular degeneration. Which of the following is the strongest risk factor for developing this condition?
Your Answer: Diabetes mellitus
Correct Answer: Smoking
Explanation:Age-related macular degeneration is the most common cause of blindness in the UK. Degeneration of the central retina (macula) is the key feature with changes usually bilateral. Smoking and genetic factors are risk factors for macular degeneration. The severity is divided into early, intermediate, and late types. The late type is additionally divided into dry and wet forms with the dry form making up 90% of cases.
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This question is part of the following fields:
- Ophthalmology
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Question 22
Incorrect
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Which of the following statements regarding macular degeneration is true?
Your Answer: Male sex is a risk factor
Correct Answer: Wet macular degeneration carries the worst prognosis
Explanation:Traditionally two forms of macular degeneration are seen:
– Dry (geographic atrophy) macular degeneration is characterized by drusen – yellow round spots in Bruch’s membrane.
– Wet (exudative, neovascular) macular degeneration is characterized by choroidal neovascularization. Leakage of serous fluid and blood can subsequently result in a rapid loss of vision. This carries the worst prognosis. -
This question is part of the following fields:
- Ophthalmology
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Question 23
Incorrect
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A 62 year old patient presents to the ophthalmology OPD with progressive deterioration of vision and dazzling of view in well lit environments. Which of the following is the most likely diagnosis leading to this presentation?
Your Answer: Acute iritis
Correct Answer:
Explanation:Cataract is a condition characterized by clouding of the lens of the eye. This condition most frequently occurs due to age-related degenerative processes in the lens, but can also be associated with ocular trauma, metabolic disorders, side-effects of drugs, or congenital infections. The clouding causes distortion of light, as it passes through the lens, resulting in visual impairment and glare. Initially, a cataract presents discretely and may even go unnoticed, but the visual impairment worsens as the cataract grows larger.
Diagnosis is typically established on the basis of a thorough history and direct visualization of the cataract (by means of slit-lamp microscopy). Surgery is indicated with significant visual impairment and involves lens extraction and implantation of an artificial lens. Untreated cataracts eventually lead to complete blindness.
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This question is part of the following fields:
- Ophthalmology
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Question 24
Correct
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An 87-year-old woman presents with 'funny spots' affecting her vision. Over the past week she has noticed a number of flashes and floaters in the visual field of the right eye. Which of the following is the most likely diagnosis?
Your Answer: Posterior vitreous detachment
Explanation:Posterior vitreous detachment is thought to occur in up to 50-75% of the population over 65 years and is the most likely diagnosis here. Patients should be reviewed by an ophthalmologist to assess the risk of progressing to retinal detachment. Flashes of light (photopsia) occur in the peripheral field of vision while floaters often occur on the temporal side of the central vision.
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This question is part of the following fields:
- Ophthalmology
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Question 25
Incorrect
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A 59-year-old marketing manager presents with a persistent watery left eye for the past 4 days. On examination there is erythema and swelling of the inner canthus of the left eye. Which of the following is the most likely diagnosis?
Your Answer: Blepharitis
Correct Answer: Dacryocystitis
Explanation:Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac. It causes pain, redness, a watering eye (epiphora), and swelling and erythema at the inner canthus of the eye. Management is with systemic antibiotics. IV antibiotics are indicated if there is associated periorbital cellulitis.
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This question is part of the following fields:
- Ophthalmology
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Question 26
Incorrect
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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: Cryptosporidium
Correct 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.
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This question is part of the following fields:
- Ophthalmology
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Question 27
Incorrect
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A 40-year-old male patient, who is otherwise healthy and without a significant family history, presents with a history of early morning headache and visual field defects, When asked, he said that he has been having these complaints for three months now. What is the most possible diagnosis?
Your Answer: Temporal arteritis
Correct Answer: Pituitary tumour
Explanation:The most possible diagnosis is a pituitary tumour. Pituitary tumours compress the optic chiasm inferiorly and can cause visual field defects (bitemporal hemianopia or quadrantanopia). Temporal arteritis usually develops in older people and acute glaucoma usually requires a family history. Amaurosis fugax is classed as a stroke and usually leads to reversible unilateral vision loss. A subconjunctival haemorrhage does not typically produce the symptoms described.
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This question is part of the following fields:
- Ophthalmology
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Question 28
Correct
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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: 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.
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This question is part of the following fields:
- Ophthalmology
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Question 29
Incorrect
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A 38-year-old chef is brought into the emergency department by her husband. He reports that she has been confused for the last 3 days. She has a long-standing history of severe psoriasis but no other past medical history. Basic observations are all within normal range and a CT head is unremarkable. A fundoscopy exam reveals bilateral papilledema. Which of the following is the most likely cause?
Your Answer: Encephalitis
Correct Answer: Vitamin A toxicity
Explanation:Vitamin A toxicity is a rare cause of papilledema. In this case, the patient is likely to have been taking retinoids for psoriasis.
Encephalitis does not usually present with papilledema. Brain abscess, brain tumour and hydrocephalus are all less likely with a normal CT head.
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This question is part of the following fields:
- Ophthalmology
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Question 30
Correct
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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: 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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