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Question 1
Incorrect
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A 60-year-old woman presents with a complaint of seeing an 'arc of white light and some cobwebs' in her vision for the past week. She reports no pain or recent trauma. The patient has a history of myopia in both eyes. Upon examination, her vision is 6/9 in both eyes and the anterior segments appear normal. Dilated fundoscopy reveals no horseshoe tear in either eye. What is the most probable diagnosis?
Your Answer: Cataract
Correct Answer: Posterior vitreous detachment
Explanation:Understanding Eye Conditions: Posterior Vitreous Detachment and Other Possibilities
Posterior vitreous detachment is a common condition that occurs with age, particularly in myopic patients. It happens when the vitreous becomes more liquid and separates from the retina, causing symptoms like flashes and floaters. However, it’s important to rule out any retinal tears or breaks that could lead to retinal detachment. Cataracts, on the other hand, are unlikely to cause these symptoms. Exudative retinal detachment is rare and usually associated with underlying pathologies. Rhegmatogenous retinal detachment is the most common type but not evident in the fundoscopy result. Tractional retinal detachment is uncommon and often linked to diseases like diabetes. However, there’s no indication of diabetes or retinal detachment in this case.
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This question is part of the following fields:
- Ophthalmology
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Question 2
Correct
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Which of the following does not predispose to cataract formation?
Your Answer: Hypercalcaemia
Explanation:Cataract formation is more likely to occur due to hypocalcaemia rather than hypercalcaemia.
Understanding Cataracts: Causes, Symptoms, and Management
A cataract is a common eye condition that affects the lens of the eye, causing it to become cloudy and reducing the amount of light that reaches the retina. This can lead to blurred or reduced vision, making it difficult to see clearly. Cataracts are more common in women and tend to increase in incidence with age. While the normal ageing process is the most common cause, other factors such as smoking, alcohol consumption, trauma, diabetes, and long-term corticosteroid use can also contribute to the development of cataracts.
Symptoms of cataracts include reduced vision, faded colour vision, glare, and halos around lights. A defect in the red reflex is also a sign of cataracts. Diagnosis is typically made through ophthalmoscopy and slit-lamp examination, which can reveal the presence of a visible cataract.
In the early stages, age-related cataracts can be managed conservatively with stronger glasses or contact lenses and brighter lighting. However, surgery is the only effective treatment for cataracts and involves removing the cloudy lens and replacing it with an artificial one. Referral for surgery should be based on the presence of visual impairment, impact on quality of life, and patient choice. Complications following surgery can include posterior capsule opacification, retinal detachment, posterior capsule rupture, and endophthalmitis.
Overall, cataracts are a common and treatable eye condition that can significantly impact a person’s vision. Understanding the causes, symptoms, and management options can help individuals make informed decisions about their eye health.
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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 75-year-old man comes to the General Practitioner (GP) complaining of painless sudden vision loss in his eyes. Upon examination, the GP observes a right homonymous hemianopia with macular sparing. Where is the lesion located that is responsible for this visual field defect?
Your Answer: Left temporal lobe optic radiation
Correct Answer: Left occipital visual cortex
Explanation:Lesions and their corresponding visual field defects
Lesions in different areas of the visual pathway can cause specific visual field defects. A lesion in the left occipital visual cortex can result in a right homonymous hemianopia with macular sparing. This is because the visual cortex typically presents with macular sparing. On the other hand, a lesion in the left temporal lobe optic radiation can cause a right superior quadrantanopia. An optic chiasm lesion can lead to bitemporal hemianopia, while a right optic tract lesion can cause a left homonymous hemianopia. Finally, a right parietal lobe optic radiation lesion can result in a left inferior quadrantanopia. Understanding these different visual field defects can aid in localizing the site of a lesion in the visual pathway.
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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 29-year-old man visits his General Practitioner (GP) with complaints of painful red eye on one side. Upon examination, the GP observes reduced visual acuity, photophobia, eye watering, and a poorly reactive pupil. The patient is suspected to have uveitis. What is the most suitable course of action for managing this patient?
Your Answer: Chloramphenicol
Correct Answer: Same-day referral to an Ophthalmologist
Explanation:Management of Acutely Painful Red Eye with Suspected Uveitis
Explanation:
When a patient presents with an acutely painful red eye and suspected uveitis, it is crucial to refer them for same-day assessment by an Ophthalmologist. A slit-lamp examination is necessary to confirm the diagnosis, which cannot be performed by a GP. Non-infective anterior uveitis is treated with a combination of steroids and cycloplegics to reduce inflammation and ciliary spasm. In cases of infective uveitis, antimicrobials are also added.Chloramphenicol is used in the treatment of conjunctivitis, but it is not appropriate for uveitis. Conservative management with pain relief alone is not sufficient for this condition. Topical steroids are required to reduce inflammation, along with a cycloplegic such as atropine to reduce ciliary spasm. However, topical steroids should not be initiated in primary care, and patients require urgent assessment in secondary care.
Referral within two weeks is not appropriate for a patient with an acutely painful red eye and suspected uveitis. Any delay in treatment can result in adhesions within the eye and long-term damage. Therefore, same-day referral to an Ophthalmologist is necessary for prompt diagnosis and treatment.
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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 28-year-old woman comes to the Eye Casualty complaining of a painful decrease in vision in her left eye that has been occurring over the past six hours. She reports no other symptoms.
During the examination, her right eye has a visual acuity of 6/6, while her left eye has a visual acuity of 6/36. The left eye has reduced color vision. Eye movements do not show any double vision, but the pain intensifies. The swinging torch test is performed, and it is discovered that the left pupil dilates when the torch light is moved from the right eye to the left. Dilated fundoscopy reveals a swollen optic disc and exudates that align like a star at the macula in the left eye.
What is the most probable diagnosis?Your Answer: Papillitis
Correct Answer: Neuroretinitis
Explanation:Differentiating Subtypes of Optic Neuritis
Optic neuritis is a condition that involves inflammation of the optic nerve, which can cause vision loss and other symptoms. However, there are several subtypes of optic neuritis that can present differently.
Neuroretinitis is a subtype of optic neuritis that involves both the retina and optic disc. A macular star pattern of lipid exudates may be present in the macula.
Papillitis is another subtype of optic neuritis that is characterized by swelling of the optic disc.
Papilloedema, on the other hand, is optic disc swelling that is typically caused by increased intracranial pressure.
Post-viral demyelination is a subtype of optic neuritis that can occur after a viral illness.
Retrobulbar neuritis is a subtype of optic neuritis where the optic disc is not affected.
It is important to differentiate between these subtypes of optic neuritis in order to determine the appropriate treatment and management plan.
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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 54-year-old female with a history of rheumatoid arthritis visited her GP complaining of redness in her right eye. She mentioned experiencing mild discomfort and irritation with occasional watering of the eye. However, she denied any dryness or significant pain. The examination of her pupils revealed no abnormalities, and she did not experience any discomfort when exposed to light. What is the probable diagnosis?
Your Answer: Corneal ulceration
Correct Answer: Episcleritis
Explanation:Rheumatoid Arthritis and Its Effects on the Eyes
Rheumatoid arthritis is a chronic autoimmune disease that affects various parts of the body, including the eyes. In fact, ocular manifestations of rheumatoid arthritis are quite common, with approximately 25% of patients experiencing eye problems. These eye problems can range from mild to severe and can significantly impact a patient’s quality of life.
The most common ocular manifestation of rheumatoid arthritis is keratoconjunctivitis sicca, also known as dry eye syndrome. This condition occurs when the eyes do not produce enough tears, leading to discomfort, redness, and irritation. Other ocular manifestations of rheumatoid arthritis include episcleritis, scleritis, corneal ulceration, and keratitis. Episcleritis and scleritis both cause redness in the eyes, with scleritis also causing pain. Corneal ulceration and keratitis both affect the cornea, with corneal ulceration being a more severe condition that can lead to vision loss.
In addition to these conditions, patients with rheumatoid arthritis may also experience iatrogenic ocular manifestations. These are side effects of medications used to treat the disease. For example, steroid use can lead to cataracts, while the use of chloroquine can cause retinopathy.
Overall, it is important for patients with rheumatoid arthritis to be aware of the potential ocular manifestations of the disease and to seek prompt medical attention if they experience any eye-related symptoms. Early diagnosis and treatment can help prevent vision loss and improve overall quality of life.
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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 70-year-old man comes to the emergency department complaining of severe headache and visual disturbance. He states that he experienced sudden onset pain while watching TV last night with the lights off. Painkillers have been ineffective, and he has vomited twice since the pain started. He has no notable medical history and wears glasses for reading.
What medication should be administered as part of the initial treatment?Your Answer: Oral oxybutynin
Correct Answer: Intravenous (IV) acetazolamide
Explanation:IV acetazolamide is the appropriate initial emergency medical treatment for acute angle-closure glaucoma, in addition to eye drops. This diagnosis is suggested by the patient’s symptoms of severe headache, visual disturbance, and vomiting, as well as the presence of mydriasis and hypermetropia. Oral amitriptyline and oxybutynin should not be used in the management of acute angle-closure glaucoma as they can worsen the condition. Topical dorzolamide is typically used for primary open-angle glaucoma.
Glaucoma is a group of disorders that cause optic neuropathy due to increased intraocular pressure (IOP). However, not all patients with raised IOP have glaucoma, and vice versa. Acute angle-closure glaucoma (AACG) is a type of glaucoma where there is a rise in IOP due to impaired aqueous outflow. Factors that increase the risk of AACG include hypermetropia, pupillary dilation, and lens growth associated with age. Symptoms of AACG include severe pain, decreased visual acuity, halos around lights, and a hard, red-eye. Management of AACG is an emergency and requires urgent referral to an ophthalmologist. Emergency medical treatment is necessary to lower the IOP, followed by definitive surgical treatment once the acute attack has subsided.
There are no specific guidelines for the initial medical treatment of AACG, but a combination of eye drops may be used, including a direct parasympathomimetic, a beta-blocker, and an alpha-2 agonist. Intravenous acetazolamide may also be administered to reduce aqueous secretions. Definitive management of AACG involves laser peripheral iridotomy, which creates a small hole in the peripheral iris to allow aqueous humour to flow to the angle. It is important to seek medical attention immediately if symptoms of AACG are present to prevent permanent vision loss.
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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 72-year-old myopic man with a history of hypertension arrives at the clinic complaining of a sudden, painless decrease in his vision. He reports a dense shadow obstructing his left eye, which began in the periphery and has advanced towards the center of his vision.
During the examination, he can only perceive hand movements in his left eye, while his right eye has a visual acuity of 6/6. What is the probable reason for the vision loss?Your Answer: Vitreous hemorrhage
Correct Answer: Retinal detachment
Explanation:Retinal detachment is a condition that can cause sudden and painless loss of vision. It is characterized by a dense shadow that starts from the periphery and progresses towards the center of the visual field.
Central retinal artery occlusion, on the other hand, is caused by a blockage of blood flow due to thromboembolism or arthritis. This condition can also cause sudden and painless loss of vision, but it does not typically present with a peripheral-to-central progression. Instead, it is characterized by an afferent pupillary defect and a cherry red spot on a pale retina.
Central retinal vein occlusion is more common than arterial occlusion and is often seen in older patients, particularly those with glaucoma. This condition can also cause sudden and painless loss of vision, but it can affect any venous territory and is associated with severe retinal hemorrhages.
Retinal detachment is often seen in people with myopia and can be preceded by flashes and floaters. It typically presents with a shadow in the visual field that starts from the periphery and progresses towards the center.
Optic neuritis can also cause sudden visual loss, but this is usually temporary and is often accompanied by painful eye movement.
Vitreous hemorrhage, on the other hand, causes a dark spot in the visual field where the hemorrhage is located, rather than a shadow that progresses towards the center.
Sudden loss of vision can be a scary symptom for patients, as it may indicate a serious issue or only be temporary. Transient monocular visual loss (TMVL) is a term used to describe a sudden, brief loss of vision that lasts less than 24 hours. The most common causes of sudden, painless loss of vision include ischaemic/vascular issues (such as thrombosis, embolism, and temporal arthritis), vitreous haemorrhage, retinal detachment, and retinal migraine.
Ischaemic/vascular issues, also known as ‘amaurosis fugax’, have a wide range of potential causes, including large artery disease, small artery occlusive disease, venous disease, and hypoperfusion. Altitudinal field defects are often seen, and ischaemic optic neuropathy can occur due to occlusion of the short posterior ciliary arteries. Central retinal vein occlusion is more common than arterial occlusion and can be caused by glaucoma, polycythaemia, or hypertension. Central retinal artery occlusion is typically caused by thromboembolism or arthritis and may present with an afferent pupillary defect and a ‘cherry red’ spot on a pale retina.
Vitreous haemorrhage can be caused by diabetes, bleeding disorders, or anticoagulants and may present with sudden visual loss and dark spots. Retinal detachment may be preceded by flashes of light or floaters, which are also common in posterior vitreous detachment. Differentiating between posterior vitreous detachment, retinal detachment, and vitreous haemorrhage can be challenging, but each has distinct features such as photopsia and floaters for posterior vitreous detachment, a dense shadow that progresses towards central vision for retinal detachment, and large bleeds causing sudden visual loss for vitreous haemorrhage.
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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 7-year-old boy comes to your clinic with his mother. He reports that for the past year, he has been experiencing intermittent episodes of red, itchy eyelids. These episodes usually resolve on their own, but the current flare has been ongoing for over a month. The boy has not experienced any changes in his vision.
During the examination, the boy is cheerful and cooperative. His eyelids appear slightly red, and there is some foamy discharge on the lid margins with matting of the eyelashes. On the superior lid of his right eye, there is a small, tender, red lump in the medial canthus. However, his eye is not painful or red, and he has no fever.
What is the best initial management option for this 7-year-old boy?Your Answer: Topical dexamethasone drops to both eyes
Correct Answer: Hot compresses to both eyes
Explanation:The initial treatment for blepharitis involves the use of hot compresses. Blepharitis is a common inflammatory condition that affects the margins of the eyelids. Symptoms of this condition include burning, itching, and crusting of the eyelids, which are often worse in the mornings and aggravated by makeup and wind. Both eyelids are typically affected, and patients may experience recurrent hordeolum or styes, as well as intolerance to contact lenses. While blepharitis cannot be cured, hot compresses and eyelid hygiene measures should be used twice daily to reduce the frequency and severity of relapses. Oral antibiotics are only used as a secondary option for patients who have not responded to hygiene measures and who have meibomian gland dysfunction and rosacea. If hygiene measures are ineffective, topical antibiotics like chloramphenicol may be prescribed. However, topical steroids such as dexamethasone drops are not recommended for the treatment of blepharitis.
Blepharitis is a condition where the eyelid margins become inflamed. This can be caused by dysfunction of the meibomian glands (posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (anterior blepharitis). It is more common in patients with rosacea. The meibomian glands secrete oil to prevent rapid evaporation of the tear film, so any problem affecting these glands can cause dryness and irritation of the eyes. Symptoms of blepharitis are usually bilateral and include grittiness, discomfort around the eyelid margins, sticky eyes in the morning, and redness of the eyelid margins. Styes and chalazions are also more common in patients with blepharitis, and secondary conjunctivitis may occur.
Management of blepharitis involves softening the lid margin with hot compresses twice a day and practicing lid hygiene to remove debris from the lid margins. This can be done using cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo or sodium bicarbonate in cooled boiled water. Artificial tears may also be given for symptom relief in people with dry eyes or an abnormal tear film.
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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 concerned mother brings her 8-month-old baby boy who has been experiencing recurrent eye problems. The baby has been having persistent sticky discharge and the mother has tried various drops and cleaning methods without success. Upon examination, the baby's pupils are equal and reactive, the conjunctiva shows no signs of inflammation, the sclera is white, and the eyelids appear healthy. The baby has a normal gaze, a normal red reflex, and tracks objects in their visual field appropriately.
Based on the probable diagnosis, what is the best advice to offer the mother?Your Answer: The condition requires ongoing chloramphenicol eye drops
Correct Answer: The condition usually self-resolves by 1 year
Explanation:Understanding Nasolacrimal Duct Obstruction in Infants
Nasolacrimal duct obstruction is a common condition that affects around 10% of infants at one month of age. It is characterized by a persistent watery eye caused by an imperforate membrane, usually located at the lower end of the lacrimal duct. Fortunately, symptoms usually resolve on their own by the age of one year in 95% of cases.
To manage this condition, parents can be taught to massage the lacrimal duct to help clear any blockages. However, if symptoms persist beyond one year, it is recommended to seek the advice of an ophthalmologist. In such cases, probing may be considered, which is a procedure done under a light general anaesthetic. By understanding the causes and management of nasolacrimal duct obstruction, parents can take the necessary steps to ensure their child’s eye health and comfort.
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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 22-year-old woman comes to the General Practitioner (GP) complaining of redness, watering, and burning in both eyes for the past week. Upon examination, her vision is 6/6 in both eyes, but the conjunctivae are diffusely injected. Tender preauricular lymphadenopathy is noticeable when the face and neck are palpated. Further questioning reveals that she also has a sore throat and a stuffy nose. What is the initial treatment for this patient's eye issue?
Your Answer: Topical prednisolone eye drops
Correct Answer: Supportive measures with cool compresses and artificial tears
Explanation:Treatment Options for Viral Conjunctivitis
Viral conjunctivitis, also known as pink eye, is a common condition that can cause redness, itching, and discharge in the eyes. While there is no cure for viral conjunctivitis, there are several treatment options available to help manage the symptoms.
The first-line treatment for viral conjunctivitis is supportive care, which typically involves using cool compresses and artificial tears to soothe the eyes. These measures can help reduce inflammation and relieve discomfort, and the condition will usually resolve on its own over time.
While an eye shield is not typically necessary for viral conjunctivitis, some doctors may recommend using topical chloramphenicol eye drops to prevent secondary bacterial infections. However, this is not a first-line treatment and is not always necessary.
Topical steroids, such as prednisolone and dexamethasone eye drops, are not recommended for the treatment of viral conjunctivitis. While these medications can help reduce inflammation, they can also increase the risk of complications and should only be used under the guidance of a healthcare professional.
In summary, the best course of action for treating viral conjunctivitis is to focus on supportive care with cool compresses and artificial tears. If necessary, your doctor may recommend additional treatments to help manage your symptoms and prevent complications.
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This question is part of the following fields:
- Ophthalmology
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Question 12
Incorrect
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A 50-year-old woman with uncontrolled diabetes visits her doctor reporting sudden vision loss in her right eye without any pain. She also mentions seeing flashes of light in the periphery of her vision. What could be the possible diagnosis?
Your Answer: Optic neuritis
Correct Answer: Retinal detachment
Explanation:The patient’s symptoms suggest retinal detachment, which is characterized by a painless loss of vision over several hours and the presence of flashes and floaters. Acute closed-angle glaucoma, optic neuritis, diabetic retinopathy, and central retinal artery occlusion are less likely causes as they do not fit the patient’s presentation or symptoms.
Sudden loss of vision can be a scary symptom for patients, as it may indicate a serious issue or only be temporary. Transient monocular visual loss (TMVL) is a term used to describe a sudden, brief loss of vision that lasts less than 24 hours. The most common causes of sudden, painless loss of vision include ischaemic/vascular issues (such as thrombosis, embolism, and temporal arthritis), vitreous haemorrhage, retinal detachment, and retinal migraine.
Ischaemic/vascular issues, also known as ‘amaurosis fugax’, have a wide range of potential causes, including large artery disease, small artery occlusive disease, venous disease, and hypoperfusion. Altitudinal field defects are often seen, and ischaemic optic neuropathy can occur due to occlusion of the short posterior ciliary arteries. Central retinal vein occlusion is more common than arterial occlusion and can be caused by glaucoma, polycythaemia, or hypertension. Central retinal artery occlusion is typically caused by thromboembolism or arthritis and may present with an afferent pupillary defect and a ‘cherry red’ spot on a pale retina.
Vitreous haemorrhage can be caused by diabetes, bleeding disorders, or anticoagulants and may present with sudden visual loss and dark spots. Retinal detachment may be preceded by flashes of light or floaters, which are also common in posterior vitreous detachment. Differentiating between posterior vitreous detachment, retinal detachment, and vitreous haemorrhage can be challenging, but each has distinct features such as photopsia and floaters for posterior vitreous detachment, a dense shadow that progresses towards central vision for retinal detachment, and large bleeds causing sudden visual loss for vitreous haemorrhage.
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This question is part of the following fields:
- Ophthalmology
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Question 13
Incorrect
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A 60-year-old man presents to the Emergency Department with a 1-day history of sudden loss of vision in the left eye. He complains of recent new-onset headache, particularly painful when combing his hair in the morning. He also has pain in his jaw when eating his meals.
His past medical history includes polymyalgia rheumatica, hypertension and type 2 diabetes mellitus.
On examination, his vision is 6/9 in the right eye, 6/60 in the left eye. Palpation of the temporal arteries reveals that they are non-pulsatile. The left pupil, on swinging torch test, dilates when the light is swung from the right to the left. On dilated fundoscopy, a swollen optic disc and some surrounding disc haemorrhages in the left can be seen. The rest of the retina looks normal bilaterally.
What is the most likely diagnosis?Your Answer: Optic neuritis
Correct Answer: Anterior ischaemic optic neuropathy
Explanation:Differentiating Optic Nerve Conditions: A Brief Overview
When it comes to optic nerve conditions, it’s important to differentiate between them in order to provide the appropriate treatment. Here are some key differences between a few common conditions:
– Arteritic anterior ischaemic optic neuropathy: This condition is caused by giant-cell arthritis and presents with unilateral vision loss.
– Amaurosis fugax: This is a transient loss of vision that typically lasts a few minutes and resolves on its own.
– Optic neuritis: Patients with optic neuritis may experience retrobulbar pain, but not the headache, scalp tenderness, or jaw claudication mentioned in the history.
– Papilloedema: This condition is characterized by bilateral optic disc swelling due to raised intracranial pressure, which is not present in the history.
– Retinal detachment: Flashes and floaters are typically present in retinal detachment, which is not mentioned in the history. Additionally, this condition does not present with headache.By understanding the unique features of each condition, healthcare providers can make a more accurate diagnosis and provide appropriate treatment.
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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 32-year-old individual who wears contact lenses presents to the emergency department complaining of pain in their left eye. They describe a sensation of having something gritty stuck in their eye. The eye appears red all over and they have difficulty looking at bright lights. Upon examination with a slit-lamp, there is a hypopyon and focal white infiltrates on the cornea. What is the probable causative organism?
Your Answer: Acanthamoeba
Correct Answer: Pseudomonas aeruginosa
Explanation:Pseudomonas aeruginosa is the likely cause of bacterial keratitis in contact lens wearers. Symptoms include a foreign body sensation, conjunctival injection, and hypopyon on slit-lamp examination. Staphylococci and streptococci are also common causes, but pseudomonas is particularly prevalent in this population. Neisseria gonorrhoeae, Acanthamoeba, and herpes simplex are less likely causes.
Understanding Keratitis: Inflammation of the Cornea
Keratitis is a condition that refers to the inflammation of the cornea. While conjunctivitis is a common eye infection that is not usually serious, microbial keratitis can be sight-threatening and requires urgent evaluation and treatment. The causes of keratitis can vary, with bacterial infections typically caused by Staphylococcus aureus and Pseudomonas aeruginosa commonly seen in contact lens wearers. Fungal and amoebic infections can also cause keratitis, with acanthamoebic keratitis accounting for around 5% of cases. Parasitic infections such as onchocercal keratitis can also cause inflammation of the cornea.
Other factors that can cause keratitis include viral infections such as herpes simplex keratitis, environmental factors like photokeratitis (e.g. welder’s arc eye), and exposure keratitis. Clinical features of keratitis include a red eye with pain and erythema, photophobia, a foreign body sensation, and the presence of hypopyon. Referral is necessary for contact lens wearers who present with a painful red eye, as an accurate diagnosis can only be made with a slit-lamp examination.
Management of keratitis involves stopping the use of contact lenses until symptoms have fully resolved, as well as the use of topical antibiotics such as quinolones. Cycloplegic agents like cyclopentolate can also be used for pain relief. Complications of keratitis can include corneal scarring, perforation, endophthalmitis, and visual loss. Understanding the causes and symptoms of keratitis is important for prompt diagnosis and treatment to prevent serious complications.
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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 9-year-old boy comes to his General Practitioner complaining of redness around his left eye and pain when moving his eye since waking up this morning. He has been experiencing symptoms of a cold for a few days. Upon examination of his left eye, there is redness around the eye, proptosis, limited and painful eye movements, and decreased visual acuity. The examination of his right eye is normal.
What is the most probable diagnosis?Your Answer: Preseptal cellulitis
Correct Answer: Orbital cellulitis
Explanation:Orbital cellulitis is a serious eye infection that can cause redness around the eye, pain when moving the eye, limited eye movement, bulging of the eye, and decreased vision. It is more commonly seen in children and is caused by an infection behind the orbital septum. This infection can spread from the sinuses, trauma to the eye, or from preseptal cellulitis. On the other hand, a chalazion, which is a small cyst in the eyelid, would not cause these symptoms. Optic neuritis, which is inflammation of the optic nerve, is often associated with multiple sclerosis and can cause vision problems and abnormal color vision. Preseptal cellulitis, which is an infection in front of the orbital septum, can cause eyelid swelling and drooping, but does not cause the same symptoms as orbital cellulitis. Sinusitis, which is inflammation of the sinuses, can lead to orbital cellulitis, but it does not fully explain the patient’s symptoms.
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This question is part of the following fields:
- Ophthalmology
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Question 16
Incorrect
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A 35-year-old female accountant comes to the emergency eye clinic with a painful red eye on the right side. She reports a burning sensation around the eye, sensitivity to light, and excessive tearing. Fluorescein staining reveals a linear, branching epithelial defect. She has no history of wearing contact lenses and no significant medical history. What is the best course of action for management?
Your Answer: Oral corticosteroids
Correct Answer: Topical acyclovir
Explanation:Topical acyclovir is the treatment for herpes simplex keratitis, which presents with a painful red eye, photophobia, and abnormal fluorescein staining. Artificial tears are used for dry eyes, while topical chloramphenicol is used for bacterial conjunctivitis.
Understanding Herpes Simplex Keratitis
Herpes simplex keratitis is a condition that affects the cornea of the eye and is caused by the herpes simplex virus. The most common symptom of this condition is a dendritic corneal ulcer, which can cause a red, painful eye, photophobia, and epiphora. In some cases, visual acuity may also be decreased. Fluorescein staining may show an epithelial ulcer, which can help with diagnosis. One common treatment for this condition is topical acyclovir, which can help to reduce the severity of symptoms and prevent further damage to the cornea.
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This question is part of the following fields:
- Ophthalmology
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Question 17
Incorrect
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A client of yours has been diagnosed with Horner's syndrome. What is the most probable symptom that will be observed?
Your Answer: Mydriasis + anhydrosis on the affected side of the face
Correct Answer: Miosis + ptosis + enophthalmos
Explanation:Horner’s syndrome is a medical condition that is characterized by a set of symptoms including a small pupil (miosis), drooping of the upper eyelid (ptosis), sunken eye (enophthalmos), and loss of sweating on one side of the face (anhidrosis). The presence of heterochromia, or a difference in iris color, is often seen in cases of congenital Horner’s syndrome. Anhidrosis is also a distinguishing feature that can help differentiate between central, Preganglionic, and postganglionic lesions. Pharmacologic tests, such as the use of apraclonidine drops, can be helpful in confirming the diagnosis of Horner’s syndrome and localizing the lesion.
Central lesions, Preganglionic lesions, and postganglionic lesions can all cause Horner’s syndrome, with each type of lesion presenting with different symptoms. Central lesions can result in anhidrosis of the face, arm, and trunk, while Preganglionic lesions can cause anhidrosis of the face only. postganglionic lesions, on the other hand, do not typically result in anhidrosis.
There are many potential causes of Horner’s syndrome, including stroke, syringomyelia, multiple sclerosis, tumors, encephalitis, thyroidectomy, trauma, cervical rib, carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, and cluster headache. It is important to identify the underlying cause of Horner’s syndrome in order to determine the appropriate treatment plan.
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This question is part of the following fields:
- Ophthalmology
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Question 18
Incorrect
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A 43-year-old man presents to the emergency department with complaints of a headache on the right side of his head, localized at the eye, and neck pain. He reports that the pain started suddenly over an hour. The patient has a medical history of hypertension and a 20-year pack history of smoking. He appears to be in significant pain, with sweat on his forehead.
Observations reveal a heart rate of 102 bpm, blood pressure of 158/89 mmHg, and a Glasgow coma scale of 15/15. On examination, the right pupil is small, and the eyelid is drooping. The sclera is white, and there is no swelling of the eyelid. The left eye appears normal.
What is the most probable cause of these symptoms?Your Answer: Syringomyelia
Correct Answer: Carotid artery dissection
Explanation:A localised headache, neck pain, and neurological signs such as Horner’s syndrome are indicative of carotid artery dissection. This is a crucial diagnosis to consider when dealing with such symptoms. The presence of a localised headache, neck pain, and Horner’s syndrome suggest carotid artery dissection. The patient’s right eye is showing signs of loss of sympathetic innervation, such as a small pupil and drooping eyelid. The presence of sweat on the forehead indicates that the lesion causing Horner’s syndrome is postganglionic. A carotid artery dissection is the most likely cause of these symptoms, given the patient’s risk factors of smoking and hypertension. Cluster headache, encephalitis, and subarachnoid haemorrhage are less likely diagnoses, as they do not fit with the patient’s symptoms and presentation.
Horner’s syndrome is a medical condition that is characterized by a set of symptoms including a small pupil (miosis), drooping of the upper eyelid (ptosis), sunken eye (enophthalmos), and loss of sweating on one side of the face (anhidrosis). The presence of heterochromia, or a difference in iris color, is often seen in cases of congenital Horner’s syndrome. Anhidrosis is also a distinguishing feature that can help differentiate between central, Preganglionic, and postganglionic lesions. Pharmacologic tests, such as the use of apraclonidine drops, can be helpful in confirming the diagnosis of Horner’s syndrome and localizing the lesion.
Central lesions, Preganglionic lesions, and postganglionic lesions can all cause Horner’s syndrome, with each type of lesion presenting with different symptoms. Central lesions can result in anhidrosis of the face, arm, and trunk, while Preganglionic lesions can cause anhidrosis of the face only. postganglionic lesions, on the other hand, do not typically result in anhidrosis.
There are many potential causes of Horner’s syndrome, including stroke, syringomyelia, multiple sclerosis, tumors, encephalitis, thyroidectomy, trauma, cervical rib, carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, and cluster headache. It is important to identify the underlying cause of Horner’s syndrome in order to determine the appropriate treatment plan.
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This question is part of the following fields:
- Ophthalmology
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Question 19
Correct
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An 80-year-old man visits his primary care physician, reporting difficulty watching television. He has a medical history of hypertension, but no other significant issues.
Tests:
Fasting plasma glucose: 6.5 mmol/l
Fundoscopy: Bilateral drusen affecting the fovea
Visual field testing: Bilateral central visual field loss
Fluorescein angiography: Bilateral retinal neovascularisation and exudates present
What is the most appropriate diagnosis for this patient's symptoms and test results?Your Answer: Age-related macular degeneration (AMD)
Explanation:Understanding Age-Related Macular Degeneration (AMD)
Age-related macular degeneration (AMD) is a common condition among individuals aged 75 years and above. It is characterized by the presence of yellow spots called drusen, which are waste products from the retinal pigment epithelium. Gradual loss of central vision, as well as the presence of foveal drusen on retinal examination, are typical signs of AMD. There are two types of AMD: wet (neovascular) and dry (non-neovascular). Dry AMD progresses slowly and has no known treatment, although stopping smoking can reduce its rate of progression. Wet AMD, on the other hand, arises when there is choroidal neovascularization and can be treated with laser treatment or anti-VEGF intravitreal injections to reduce new vessel formation.
Other eye conditions that may cause vision loss include diabetic maculopathy, proliferative retinopathy (PR), hypertensive retinopathy, diabetic retinopathy, retinitis pigmentosa, and chronic angle closure glaucoma. However, the patient’s symptoms and retinal examination findings suggest that AMD is the most likely diagnosis. It is important to understand the different eye conditions and their respective treatments to provide appropriate care and management for patients.
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This question is part of the following fields:
- Ophthalmology
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Question 20
Correct
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A 19-year-old male patient visits his general practitioner with a complaint of sore eyes. He reports experiencing stickiness in his eyes upon waking up and a gritty sensation when he blinks. Dry eyes are not a concern. Upon examination, the only notable finding is slightly red eyelid margins. What is the most suitable treatment for the probable diagnosis?
Your Answer: Hot compresses
Explanation:The primary treatment for blepharitis is hot compresses. This is the most likely diagnosis for the patient, who is experiencing discomfort and grittiness in both eyes, along with redness of the eyelid margins and stickiness in the morning. While artificial tears may be used for dry eyes, this is not necessary in this case. Topical chloramphenicol is only necessary if there is secondary conjunctivitis present. Topical sodium cromoglicate is typically used for allergic conjunctivitis, which presents with itchiness and is often associated with hayfever.
Blepharitis is a condition where the eyelid margins become inflamed. This can be caused by dysfunction of the meibomian glands (posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (anterior blepharitis). It is more common in patients with rosacea. The meibomian glands secrete oil to prevent rapid evaporation of the tear film, so any problem affecting these glands can cause dryness and irritation of the eyes. Symptoms of blepharitis are usually bilateral and include grittiness, discomfort around the eyelid margins, sticky eyes in the morning, and redness of the eyelid margins. Styes and chalazions are also more common in patients with blepharitis, and secondary conjunctivitis may occur.
Management of blepharitis involves softening the lid margin with hot compresses twice a day and practicing lid hygiene to remove debris from the lid margins. This can be done using cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo or sodium bicarbonate in cooled boiled water. Artificial tears may also be given for symptom relief in people with dry eyes or an abnormal tear film.
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This question is part of the following fields:
- Ophthalmology
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Question 21
Correct
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A 59-year-old man presents to the ophthalmology clinic with progressive bilateral visual loss. Despite feeling well, he is worried about his ability to drive and grade his students' math assignments. He has no medical history but has a smoking history of 25 packs per year and does not drink alcohol. During the examination, drusen is observed and visual acuity is reduced. What is the best course of action for this patient?
Your Answer: High-dose beta-carotene and vitamins C and E
Explanation:The use of high-dose corticosteroids is not recommended for the treatment of wet or dry AMD due to their anti-inflammatory properties, which are not effective in managing the disease. Additionally, these drugs can cause side effects such as cataracts and glaucoma. High-dose vitamin D and omegas 3 and 6 are also not associated with the treatment of dry AMD. Antioxidants such as beta-carotene, vitamins C and E, and zinc have been shown to slow the progression of dry AMD by approximately 25 percent. Intravitreal anti-VEGF agents are used to manage wet AMD, which is characterized by rapid onset and the growth of abnormal, leaky vessels in the subretinal space. The goal of intravitreal treatment is to slow the progression of the disease, but it is not indicated for the management of dry AMD.
Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by the degeneration of the central retina (macula) and the formation of drusen. It is more prevalent in females and is strongly associated with advancing age, smoking, family history, and conditions that increase the risk of ischaemic cardiovascular disease. ARMD can be classified into two forms: dry and wet. Dry ARMD is more common and is characterized by drusen, while wet ARMD is characterized by choroidal neovascularisation and carries a worse prognosis. Clinical features of ARMD include subacute onset of visual loss, difficulties in dark adaptation, and visual disturbances such as photopsia and glare.
To diagnose ARMD, slit-lamp microscopy and color fundus photography are used to identify any pigmentary, exudative, or haemorrhagic changes affecting the retina. Fluorescein angiography and indocyanine green angiography may also be used to visualize changes in the choroidal circulation. Treatment for dry ARMD involves a combination of zinc with antioxidant vitamins A, C, and E, which has been shown to reduce disease progression by around one third. For wet ARMD, anti-VEGF agents such as ranibizumab, bevacizumab, and pegaptanib are used to limit disease progression and stabilize or reverse visual loss. Laser photocoagulation may also be used to slow progression, but anti-VEGF therapies are usually preferred due to the risk of acute visual loss after treatment.
In summary, ARMD is a common cause of blindness in the UK that is strongly associated with advancing age, smoking, and family history. It can be classified into dry and wet forms, with wet ARMD carrying a worse prognosis. Diagnosis involves the use of various imaging techniques, and treatment options include a combination of zinc and antioxidant vitamins for dry ARMD and anti-VEGF agents or laser photocoagulation for wet ARMD.
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This question is part of the following fields:
- Ophthalmology
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Question 22
Incorrect
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A 70-year-old man comes to the Emergency Department complaining of double vision that occurs when both eyes are open. He has a medical history of hypertension and type 2 diabetes mellitus.
During the examination, his visual acuity is measured at 6/9 in both eyes. The patient has complete drooping of his left eyelid. The size of his left pupil is the same as the right. His left eye is turned outward and slightly downward when looking straight ahead. The patient's left eye movements are limited in most directions except for outward movement.
What is the next step in investigating this condition?Your Answer: Orthoptic review with Hess charts
Correct Answer: Blood tests including full blood count (FBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lipids and blood glucose
Explanation:Investigations for Third-Nerve Palsy: What to Consider
When presented with a third-nerve palsy, it is important to investigate the potential causes and determine the appropriate course of action. A pupil-sparing complete palsy may suggest a medical cause, such as hypertension or diabetes, which can be assessed through blood tests including FBC, ESR, CRP, lipids, and blood glucose. Once all causes have been investigated and treated, an orthoptic review with Hess charts can help resolve diplopia. CSF testing for oligoclonal bands is not necessary unless a demyelinating cause is suspected. In cases of severe symptoms, an MRI head with MRA is the correct option to rule out a posterior-communicating artery aneurysm. A non-contrast CT head is only necessary if an acute intracranial or subarachnoid bleed is suspected.
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This question is part of the following fields:
- Ophthalmology
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Question 23
Incorrect
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A 6-year-old girl presents to the hospital with a 3 days history of painful swelling in the right eye.
On examination, the girl appears agitated and is crying continuously. Her temperature is 38.5°C and other vital signs are within normal limits. On examination of the affected eye, the eyelid is swollen and red. Proptosis of the right eye is observed, and there seems to be limited ocular movement as well. The globe is unaffected, and the other eye is normal. There are no signs of systemic involvement.
What imaging modality should be performed to confirm the most probable diagnosis and assess for potential complications?Your Answer: Ultrasound scan of the affected eye and orbit
Correct Answer: Contrast enhanced-CT scan of the orbits, sinuses and brain
Explanation:If there is suspicion of orbital cellulitis, a CT scan with contrast should be conducted to evaluate the potential spread of infection to the posterior region. The presence of symptoms such as limited ocular movement and proptosis indicates a higher likelihood of orbital cellulitis rather than periorbital cellulitis. In cases where orbital cellulitis is suspected, a contrast-enhanced CT scan of the sinuses, brain, and orbits should be considered to confirm the diagnosis and identify any potential complications, such as abscesses that may require surgical drainage. Plain skull X-rays are typically used to detect facial bone fractures or metallic foreign bodies in trauma cases. Optical coherence tomography (OCT) is not relevant in this scenario as it is a non-invasive imaging test used to take cross-sectional images of the retina. Ultrasound scans of the eye and orbit are commonly used in cases of eye area injury or trauma. CT venography is performed when cavernous sinus thrombosis is suspected.
Understanding Orbital Cellulitis: Causes, Symptoms, and Management
Orbital cellulitis is a serious infection that affects the fat and muscles behind the orbital septum within the orbit, but not the globe. It is commonly caused by upper respiratory tract infections that spread from the sinuses and can lead to a high mortality rate. On the other hand, periorbital cellulitis is a less severe infection that occurs in the superficial tissues anterior to the orbital septum. However, it can progress to orbital cellulitis if left untreated.
Risk factors for orbital cellulitis include childhood, previous sinus infections, lack of Haemophilus influenzae type b (Hib) vaccination, recent eyelid infections or insect bites, and ear or facial infections. Symptoms of orbital cellulitis include redness and swelling around the eye, severe ocular pain, visual disturbance, proptosis, ophthalmoplegia, eyelid edema, and ptosis. In rare cases, meningeal involvement can cause drowsiness, nausea, and vomiting.
To differentiate between orbital and preseptal cellulitis, doctors look for reduced visual acuity, proptosis, and ophthalmoplegia, which are not consistent with preseptal cellulitis. Full blood count and clinical examination involving complete ophthalmological assessment are necessary to determine the severity of the infection. CT with contrast can also help identify inflammation of the orbital tissues deep to the septum and sinusitis. Blood culture and microbiological swab are also necessary to determine the organism causing the infection.
Management of orbital cellulitis requires hospital admission for IV antibiotics. It is a medical emergency that requires urgent senior review. Early diagnosis and treatment are crucial to prevent complications and reduce the risk of mortality.
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This question is part of the following fields:
- Ophthalmology
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Question 24
Correct
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Please rewrite the question while maintaining the paragraph structure.
Your Answer: Left homonymous scotoma – right occipital cortex
Explanation:Understanding Visual Field Defects and their Corresponding Brain Lesions
Visual field defects can occur due to various brain lesions. The location of the lesion determines the type of visual field defect. Here are some examples:
– Left homonymous scotoma – right occipital cortex: If the tip of the occipital cortex is affected, it can cause a contralateral scotoma, affecting the central vision. However, if the whole occipital lobe is affected, it will cause a homonymous hemianopia.
– Bitemporal hemianopia – optic chiasm: Bitemporal hemianopia occurs with a lesion of the optic chiasm, not the occipital cortex.
– Right superior homonymous quadrantanopia – left temporal cortex: Superior quadrantanopia occurs with temporal lesions, not parietal lesions.
– Left inferior homonymous quadrantanopia – right parietal cortex: Inferior quadrantanopia occurs with parietal lesions, not temporal lesions.
– Right monocular anopia – right optic nerve injury: Monocular anopia occurs with damage to the optic nerve on that same side, rather than damage to the occipital cortex.Understanding the relationship between visual field defects and their corresponding brain lesions can aid in diagnosis and treatment of neurological conditions affecting 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 54-year-old woman presents with a sudden onset of severe pain and redness in her right eye. She denies any history of foreign body injury and has not experienced any cold-like symptoms. The patient has a medical history of systemic lupus erythematosus, which is currently being managed with hydroxychloroquine. She has no fever and upon examination, her sclera is erythematous and injected with a bluish hue. Her pupils are equal and reactive, and her visual acuity is normal in both eyes. There is no significant discharge present. What is the most likely diagnosis in this case?
Your Answer: Foreign body injury
Correct Answer: Scleritis
Explanation:The patient’s autoimmune history, painful red-eye, and bluish hue suggest scleritis, which is a medical emergency requiring urgent ophthalmology review. Episcleritis, which is not painful and presents with a different type of redness, is unlikely. Acute angle closure glaucoma and foreign body injury are also possible differentials, but the patient’s clear and reactive pupils and lack of eye discharge make these less likely. In any case, intraocular pressure should be checked to rule out acute glaucoma.
Understanding Scleritis: Causes, Symptoms, and Treatment
Scleritis is a condition that involves inflammation of the sclera, which is the white outer layer of the eye. This condition is typically non-infectious and can cause a red, painful eye. The most common risk factor associated with scleritis is rheumatoid arthritis, but it can also be linked to other conditions such as systemic lupus erythematosus, sarcoidosis, and granulomatosis with polyangiitis.
Symptoms of scleritis include a red eye, which is often accompanied by pain and discomfort. Patients may also experience watering and photophobia, as well as a gradual decrease in vision.
Treatment for scleritis typically involves the use of oral NSAIDs as a first-line treatment. In more severe cases, oral glucocorticoids may be used. For resistant cases, immunosuppressive drugs may be necessary, especially if there is an underlying associated disease. With proper treatment, most patients with scleritis can achieve relief from their symptoms and prevent further complications.
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This question is part of the following fields:
- Ophthalmology
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Question 26
Correct
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A 67-year-old man visits his doctor with a complaint of double vision. He reports that he has developed a squint and his left eye seems to be turning inwards towards his nose. During the examination, the doctor observes that the patient is unable to move his left eye to the left and diagnoses him with a lateral rectus palsy. Which cranial nerve lesion is the most probable cause of his symptoms?
Your Answer: Abducens nerve
Explanation:Overview of Cranial Nerves and Their Functions
The human body has 12 pairs of cranial nerves that originate from the brain and control various functions of the head and neck. Here are brief explanations of some of the cranial nerves and their functions:
Abducens nerve: This nerve controls the lateral rectus muscle, which moves the eye outward. Damage to this nerve can cause double vision and an inability to move the eye outward.
Oculomotor nerve: This nerve controls several muscles of the eye, including those responsible for moving the eye up, down, and inward. It also controls the size of the pupil and the ability to focus. Damage to this nerve can cause the eye to be positioned downward and outward, loss of accommodation, and a dilated pupil.
Optic nerve: This nerve transmits visual information from the retina to the brain. Damage to this nerve can cause visual loss and abnormal pupillary reflexes.
Trigeminal nerve: This nerve provides sensation to the face and controls the muscles of mastication. It has three branches that control different areas of the face. Damage to this nerve can cause sensory loss or changes.
Trochlear nerve: This nerve controls the superior oblique muscle, which allows the eye to look down and in. Damage to this nerve can cause double vision, especially when looking down.
Understanding the functions of the cranial nerves can help diagnose and treat various neurological conditions.
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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 72-year-old man comes to the clinic complaining of a gradual decline in his vision. He mentions difficulty driving at night due to glare from headlights. He does not experience any pain in his eyes. The physician suspects that he may have developed cataracts.
What are the typical examination findings for cataract formation?Your Answer: Cotton wool spots
Correct Answer: Absent red reflex
Explanation:Common Ophthalmic Findings and Their Significance
Red reflex absence, increased ocular pressure, cotton wool spots, positive Schirmer’s test, and reduced visual acuity are common ophthalmic findings that can indicate various eye conditions.
Red Reflex Absence: This finding is often seen in patients with cataracts, where the lens becomes opaque and prevents light from reaching the retina. A slit-lamp examination can confirm the opacity of the lens.
Increased Ocular Pressure: This finding is associated with glaucoma, where patients may experience reduced peripheral vision and headaches in addition to problems with glare.
Cotton Wool Spots: These white patches on the retina are often seen in patients with diabetic retinopathy and hypertension, caused by ischaemia of the nerve fibres supplying the retina.
Positive Schirmer’s Test: This test is used to diagnose dry eyes or Sjögren syndrome by measuring tear production using litmus paper placed on the lower eyelid.
Reduced Visual Acuity: While this finding is not specific to any particular condition, it is often reported by patients with cataracts as a gradual progressive visual loss.
Overall, these ophthalmic findings can provide important clues to help diagnose and manage various eye conditions.
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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 26-year-old woman comes to the clinic complaining of a headache and blurred vision that have been present for 2 days. Upon fundoscopy, it is discovered that she has optic neuritis on the right side. She had a previous episode of arm weakness 5 months ago that was also accompanied by blurred vision. What is the most probable diagnostic test for this patient?
Your Answer: MRI brain
Explanation:High dose steroids are the recommended treatment for acute optic neuritis, which is the likely cause of this woman’s symptoms. However, her symptoms suggest a possible diagnosis of multiple sclerosis (MS) as they are spread out over both space and time.
Optic neuritis is a condition that can be caused by multiple sclerosis, diabetes, or syphilis. It is characterized by a decrease in visual acuity in one eye over a period of hours or days, as well as poor color discrimination and pain that worsens with eye movement. Other symptoms include a relative afferent pupillary defect and a central scotoma. The condition can be diagnosed through an MRI of the brain and orbits with gadolinium contrast. Treatment typically involves high-dose steroids, and recovery usually takes 4-6 weeks. If an MRI shows more than three white-matter lesions, the risk of developing multiple sclerosis within five years is approximately 50%.
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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 45-year-old man comes to the eye clinic complaining of bilateral redness around the corneal limbus. He has been experiencing this for one day and is in a lot of pain, particularly when reading the newspaper. He also reports sensitivity to light and blurry vision. Additionally, he has a headache that is affecting his entire head and back pain that is more severe in the morning but improves throughout the day.
During the examination, the patient's pupils are fixed and small, with an oval shape. There is no hypopyon, but his eyes are very watery.
What is the most appropriate course of action for managing this patient's symptoms?Your Answer: Sodium cromoglicate eye drops
Correct Answer: Steroid and cycloplegic eye drops
Explanation:The recommended treatment for anterior uveitis is a combination of steroid and cycloplegic (mydriatic) eye drops. This patient exhibits typical symptoms of anterior uveitis, which may be caused by a systemic condition like ankylosing spondylitis. The patient experiences pain, redness, watering, blurry vision, and small, fixed, oval-shaped pupils in both eyes around the corneal limbus. Although hypopyon may not always be present, the patient’s back pain that improves throughout the day may suggest ankylosing spondylitis. Steroid and cycloplegic eye drops are the appropriate treatment options. Cyclopentolate helps relieve pain caused by muscle spasms controlling the pupil and prevents the formation of synechiae that may affect the pupils function. Steroids help treat the underlying inflammation. Bilateral laser iridotomy is not suitable for this patient, as it is most appropriate for acute closed-angle glaucoma. High flow oxygen and sumatriptan may seem like a possible treatment for cluster headaches due to the patient’s lacrimation, red eyes, and headache, but this presentation is more consistent with anterior uveitis. Topical sodium cromoglicate is not appropriate for this patient, as it is used to treat allergic conjunctivitis, which typically presents with watery, red, itchy eyes in patients with a history of atopy.
Anterior uveitis, also known as iritis, is a type of inflammation that affects the iris and ciliary body in the front part of the uvea. It is a common cause of red eye and is associated with HLA-B27, which may also be linked to other conditions. Symptoms of anterior uveitis include sudden onset of eye discomfort and pain, small or irregular pupils, intense sensitivity to light, blurred vision, redness, tearing, and the presence of pus and inflammatory cells in the front part of the eye. This condition may be associated with ankylosing spondylitis, reactive arthritis, ulcerative colitis, Crohn’s disease, Behcet’s disease, and sarcoidosis. Urgent review by an ophthalmologist is necessary, and treatment may involve the use of cycloplegics and steroid eye drops.
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This question is part of the following fields:
- Ophthalmology
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Question 30
Incorrect
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A 50-year-old male visits his GP complaining of bilateral sore eyes that feel gritty. He has tried using over-the-counter eye drops, but the symptoms returned the next day. During the examination, the doctor notices erythematosus eyelid margins and a small stye on the right side. The patient has no known allergies. What is the initial management that should be taken?
Your Answer:
Correct Answer: Hot compress and mechanical removal of debris
Explanation:The patient is displaying symptoms that are typical of blepharitis, such as bilateral grittiness. This condition is caused by inflammation of the eyelid margins due to meibomian gland dysfunction, seborrhoeic dermatitis, or infection. Common symptoms include sticky eyes, erythematosus eyelid margins, and an increased risk of styes, chalazions, and secondary conjunctivitis.
To manage blepharitis, hot compresses should be applied to soften the eyelid margin, and debris should be removed with cotton buds dipped in cooled boiled water. Artificial tears may also be used if the patient reports dry eyes.
If the patient were suffering from allergic conjunctivitis, topical sodium cromoglycate would be appropriate. This condition would present with bilateral red eyes, itchiness, swelling, rhinitis, and clear discharge. On the other hand, if the patient had anterior uveitis, topical steroids would be indicated. This condition would present with rapid onset blurred vision, photosensitivity, floaters, eye pain, and redness in one or both eyes.
Blepharitis is a condition where the eyelid margins become inflamed. This can be caused by dysfunction of the meibomian glands (posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (anterior blepharitis). It is more common in patients with rosacea. The meibomian glands secrete oil to prevent rapid evaporation of the tear film, so any problem affecting these glands can cause dryness and irritation of the eyes. Symptoms of blepharitis are usually bilateral and include grittiness, discomfort around the eyelid margins, sticky eyes in the morning, and redness of the eyelid margins. Styes and chalazions are also more common in patients with blepharitis, and secondary conjunctivitis may occur.
Management of blepharitis involves softening the lid margin with hot compresses twice a day and practicing lid hygiene to remove debris from the lid margins. This can be done using cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo or sodium bicarbonate in cooled boiled water. Artificial tears may also be given for symptom relief in people with dry eyes or an abnormal tear film.
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This question is part of the following fields:
- Ophthalmology
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