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  • Question 1 - A 40-year-old male has a 6-year history of hypertension. For two days, he...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ophthalmology
      7.1
      Seconds

  • Question 2 - A 62-year-old laboratory technician presents to the ophthalmology emergency department with sudden onset...

    Incorrect

    • 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: Vitreous haemorrhage

      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 detachment

      Retinal 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
      4
      Seconds

  • Question 3 - A 54-year-old man experienced a gradual decrease in vision of one eye after...

    Correct

    • 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.

    • This question is part of the following fields:

      • Ophthalmology
      8.2
      Seconds

  • Question 4 - A 62 year old patient presents to the ophthalmology OPD with progressive deterioration...

    Incorrect

    • 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: Viral conjunctivitis

      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.

    • This question is part of the following fields:

      • Ophthalmology
      3
      Seconds

  • Question 5 - A 45-year-old patient presents with a red, watering eye, complaining of a severe...

    Correct

    • A 45-year-old patient presents with a red, watering eye, complaining of a severe left sided headache and vision distortion with coloured haloes. What would be the next best step in management of this patient?

      Your Answer: Measure Intraocular pressure

      Explanation:

      Acute angle closure glaucoma can manifests itself with severe headache, nausea or vomiting, very blurry or hazy vision, seeing rainbows or halos around lights and redness in the white part of the affected eye. It is caused by a rapid or sudden increase in pressure inside the eye – intraocular pressure (IOP). In order to establish the diagnosis and start treatment immediately, IOP should first be measured.

    • This question is part of the following fields:

      • Ophthalmology
      0.3
      Seconds

  • Question 6 - A 77-year-old retired engineer presents with a burning sensation around his right eye....

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 7 - An 88-year-old retired firefighter presents with loss of vision in his left eye...

    Incorrect

    • 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:

      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
      0
      Seconds

  • Question 8 - A 75-year-old retired firefighter with a history of type 2 diabetes mellitus and...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 9 - An 87-year-old woman presents with 'funny spots' affecting her vision. Over the past...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 10 - A 70-year-old female presented to her ophthalmologist with a complaint of weakening eyesight...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 11 - A 59-year-old marketing manager presents with a persistent watery left eye for the...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 12 - A 70 year old male complained of poor vision at night which has...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds

  • Question 13 - A 49-year-old woman suddenly experienced complete loss of vision in her right eye....

    Incorrect

    • A 49-year-old woman suddenly experienced complete loss of vision in her right eye. Fundoscopy results show a pale retina, and a cherry red spot on the macular region. She also experienced right sided headaches aggravated by chewing. What caused her vision loss?

      Your Answer:

      Correct Answer: CRAO

      Explanation:

      Central retinal artery occlusion (CRAO) is a disease of the eye where the flow of blood through the central retinal artery is blocked (occluded). There are several different causes of this occlusion; the most common is carotid artery atherosclerosis. It causes sudden vision loss in one eye. Fundoscopic exam will show a red lesion, called a cherry red spot, with surrounding pale retina (the pale colour is caused by ischemia of the retina)

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 14 - A 30-year-old female diagnosed with rapidly progressive glomerulonephritis complains of pain and redness...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 15 - A 27-year-old female visited the OPD with a complaint of visual disturbance, eye...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 16 - A 68-year-old fashion designer presents to his GP complaining of pain in his...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 17 - A 45-year-old pharmacist with a history of rheumatoid arthritis presents with a two...

    Incorrect

    • A 45-year-old pharmacist with a history of rheumatoid arthritis presents with a two day history of a red right eye. There is no itch or pain. Pupils are 3mm, equal and reactive to light. Visual acuity is 6/5 in both eyes. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Episcleritis

      Explanation:

      Ocular manifestations of rheumatoid arthritis are common, with 25% of patients having eye problems. These manifestations include keratoconjunctivitis sicca (most common), episcleritis (erythema), scleritis (erythema and pain), corneal ulceration, and keratitis.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 18 - Which of the following is associated with heterochromia in congenital disease? ...

    Incorrect

    • Which of the following is associated with heterochromia in congenital disease?

      Your Answer:

      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
      0
      Seconds

  • Question 19 - A 44-year-old physiotherapist with a history of rheumatoid arthritis presents with a painful,...

    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:

      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
      0
      Seconds

  • Question 20 - A 27-year-old consultant who has a family history of retinitis pigmentosa is reviewed...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 21 - A 67-year-old retired physician presents to ophthalmology clinic after seeing his optician. Raised...

    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:

      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
      0
      Seconds

  • Question 22 - A 61-year-old chef with a known history of Paget's disease is noted to...

    Incorrect

    • A 61-year-old chef with a known history of Paget's disease is noted to have irregular dark red lines radiating from the optic nerve. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Angioid retinal streaks

      Explanation:

      Angioid retinal streaks are seen on fundoscopy as irregular dark red streaks radiating from the optic nerve head. They are caused by degeneration, calcification and breaks in Bruch’s membrane. They are typically associated with Paget’s disease.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 23 - A 42-year-old man presents with a watery eye and some purulent discharge. Mucoid...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 24 - A 20-year-old man presents with a history of sticky greenish discharge, accompanied by...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 25 - A 60-year-old librarian presents for review. She has recently been diagnosed with dry...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 26 - A 76-year-old retired store owner presents with severe pain around his right eye...

    Incorrect

    • A 76-year-old retired store owner presents with severe pain around his right eye and vomiting. On examination, the right eye is red and decreased visual acuity is noted. Which of the following options is the most appropriate initial treatment?

      Your Answer:

      Correct Answer: Topical pilocarpine + intravenous acetazolamide

      Explanation:

      In acute angle closure glaucoma (AACG) there is a rise in IOP secondary to an impairment of aqueous outflow. Management options include reducing aqueous secretions with acetazolamide and inducing pupillary constriction with topical pilocarpine.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 27 - A 69-year-old retired veterinarian with type 2 diabetes mellitus presents as she has...

    Incorrect

    • 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:

      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

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 28 - A 30-year-old female presented in the ophthalmology ward complaining of blurry vision for...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 29 - A 60-year old female suddenly started seeing a curtain-like shadow in her field...

    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:

      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
      0
      Seconds

  • Question 30 - A 34-year-old woman has had progressive reduction of visual acuity over the past...

    Incorrect

    • 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:

      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
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Ophthalmology (2/5) 40%
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