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Question 1
Correct
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A 40-year-old woman who has recently been diagnosed with multiple sclerosis presents to her General Practitioner (GP) with blurring of her vision and pain on eye movement. The GP suspects that she may have optic neuritis.
Which of the following signs is most likely to be present on examination?Your Answer: Reduced colour vision
Explanation:Signs and Symptoms of Optic Neuritis
Optic neuritis is a condition characterized by inflammation of the optic nerve, often associated with demyelinating diseases like multiple sclerosis. One of the signs of optic neuritis is reduced color vision in the affected eye. Other symptoms may include decreased pupillary light reaction, relative afferent pupillary defect, reduced visual acuity, visual field defects, swollen optic disc, and pain on eye movements. However, optic neuritis is not associated with increased intraocular pressure, erythema, or vesicles around the affected eye. It is important to differentiate optic neuritis from other eye conditions to provide appropriate treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 2
Correct
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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 superior quadrantanopia. Where is the lesion located that is responsible for this visual field defect?
Your Answer: Left temporal lobe optic radiation
Explanation:Lesions and their corresponding visual field defects
Visual field defects can be caused by lesions in various parts of the visual pathway. Here are some examples:
Left temporal lobe optic radiation
Lesion in this area can cause a left superior quadrantanopia.Optic chiasm
A lesion in the optic chiasm can cause a bitemporal hemianopia.Left occipital visual cortex
A lesion in the left occipital visual cortex can cause a right homonymous hemianopia with macular sparing.Right optic tract
A lesion in the right optic tract can cause a left homonymous hemianopia.Right parietal lobe optic radiation
A lesion in the right parietal lobe optic radiation can cause a left inferior quadrantanopia.Understanding the location of the lesion and its corresponding visual field defect can aid in diagnosis and treatment of visual impairments.
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This question is part of the following fields:
- Ophthalmology
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Question 3
Correct
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A 70-year-old man with a lengthy history of hypertension is undergoing an eye examination. He has been experiencing deteriorating headaches and reduced visual acuity over the past few weeks. Upon fundoscopy, he displays flame haemorrhages, cotton wool spots, arteriovenous nipping, and papilloedema. What level of hypertensive retinopathy does this correspond to?
Your Answer: Grade IV
Explanation:Grade IV hypertensive retinopathy is indicated by papilloedema, which is a severe manifestation that requires immediate attention due to its association with high morbidity and mortality. The various grades of hypertensive retinopathy have distinct characteristics, which are outlined below.
Understanding Hypertensive Retinopathy: Keith-Wagener Classification
Hypertensive retinopathy is a condition that affects the eyes due to high blood pressure. The Keith-Wagener classification is a system used to categorize the different stages of hypertensive retinopathy. Stage I is characterized by narrowing and twisting of the blood vessels in the eyes, as well as an increased reflection of light known as silver wiring. In stage II, the blood vessels become compressed where they cross over veins, leading to arteriovenous nipping. Stage III is marked by the appearance of cotton-wool exudates, which are white patches on the retina caused by blocked blood vessels. Additionally, there may be flame and blot hemorrhages that can collect around the fovea, resulting in a ‘macular star.’ Finally, stage IV is the most severe stage and is characterized by papilloedema, which is swelling of the optic disc at the back of the eye. Understanding the Keith-Wagener classification can help healthcare professionals diagnose and manage hypertensive retinopathy.
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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 36-year-old swim instructor arrives at the Emergency Department complaining of severe pain in his right eye and feeling like there is something foreign in it, even though he has already removed his contact lenses. Upon examination, the right eye shows conjunctival injection, and the patient experiences photophobia, tearing, and discharge. His visual acuity is 6/6 in the left eye and 6/12 in the right eye, with intact ocular reflexes. A slit lamp inspection reveals mild, regular ulceration in the right eye. What is the most probable diagnosis?
Your Answer: Herpes simplex virus keratitis
Correct Answer: Acanthamoeba keratitis
Explanation:Wearing contact lenses increases the risk of acanthamoeba infection, which can cause keratitis. This is especially true for individuals who are frequently exposed to bodies of water, such as swimmers and lifeguards. Symptoms of acanthamoeba keratitis include eye pain, reduced visual acuity, redness, photophobia, and discharge. Treatment typically involves a combination of antiamoebic medications such as biguanides and diamidines. Anterior uveitis, conjunctivitis, and herpes simplex virus keratitis are less likely causes of the patient’s symptoms, given the history of contact lens use and occupation as a lifeguard.
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 5
Incorrect
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A 65-year-old woman was referred to ophthalmology with a vesicular rash around her left lower eyelid. The left eye is swollen and itchy. What is the recommended treatment for this condition?
Your Answer: Topical corticosteroids + acyclovir eye drops
Correct Answer: Oral acyclovir
Explanation:Herpes Zoster Ophthalmicus: Symptoms, Treatment, and Complications
Herpes zoster ophthalmicus (HZO) is a condition that occurs when the varicella-zoster virus reactivates in the area supplied by the ophthalmic division of the trigeminal nerve. It is responsible for approximately 10% of shingles cases. The main symptom of HZO is a vesicular rash around the eye, which may or may not involve the eye itself. Hutchinson’s sign, a rash on the tip or side of the nose, is a strong indicator of nasociliary involvement and increases the risk of ocular involvement.
Treatment for HZO involves oral antiviral medication for 7-10 days, ideally started within 72 hours of symptom onset. Intravenous antivirals may be necessary for severe infections or immunocompromised patients. Topical antiviral treatment is not recommended for HZO, but topical corticosteroids may be used to treat any secondary inflammation of the eye. Ocular involvement requires urgent ophthalmology review to prevent complications such as conjunctivitis, keratitis, episcleritis, anterior uveitis, ptosis, and post-herpetic neuralgia.
In summary, HZO is a condition caused by the reactivation of the varicella-zoster virus in the ophthalmic division of the trigeminal nerve. It presents with a vesicular rash around the eye and may involve the eye itself. Treatment involves oral antiviral medication and urgent ophthalmology review is necessary for ocular involvement. Complications of HZO include various eye conditions, ptosis, and post-herpetic neuralgia.
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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 72-year-old woman arrives at the emergency department reporting a sudden loss of vision in her left eye that occurred three hours ago and lasted for approximately 3 minutes. She explains the episode as a 'black-out' of her vision in that eye, without associated pain or nausea, and denies any other symptoms. The patient has a medical history of hypertension, hypercholesterolaemia, and depression, and is currently taking amlodipine, ramipril, simvastatin, and citalopram. What is the best description of this patient's symptoms?
Your Answer: Giant cell arthritis
Correct Answer: Amaurosis fugax
Explanation:The patient’s symptom of painless, temporary blindness in one eye, accompanied by the sensation of a black curtain coming down, is indicative of amaurosis fugax. While advanced age and sudden vision loss may suggest giant cell arthritis, this condition typically causes pain and other symptoms such as scalp tenderness, headache, and jaw claudication. Acute closed-angle glaucoma is also unlikely as it is typically painful and causes redness and increased tearing. None of the medications the patient is taking are known to cause transient visual loss. A TIA of the posterior circulation is unlikely as the visual loss occurred in both eyes. Amaurosis fugax is the most likely cause, which is characterized by painless, temporary vision loss in one or both eyes, often due to retinal ischemia from an embolic or thrombotic event, which is consistent with the patient’s medical history. Reference: Wilkinson & Longmore, Oxford Handbook of Clinical Medicine (10th Ed.), p. 476.
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 7
Incorrect
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A 5-year-old girl is referred to the optometrist by her GP due to her mother's concern about a squint. The optometrist diagnoses her with exotropia and offers treatment options, including intermittent eye patching. However, before any treatment can be started, the family moves to a different area and misses their follow-up appointments. The mother does not seek further attention for her daughter's exotropia.
What potential future health risks may this child be more susceptible to due to the lack of treatment for her exotropia?Your Answer: Hypermetropia
Correct Answer: Amblyopia
Explanation:If childhood squints are not corrected, it may result in amblyopia, also known as ‘lazy eye’. This condition is more likely to occur if the child has exotropia, where one eye deviates outward. However, it can be treated with patching. There is no increased risk of developing esotropia, hypermetropia, hypertropia, or hypotropia due to non-compliance with exotropia treatment, as these are different forms of squint.
Squint, also known as strabismus, is a condition where the visual axes are misaligned. There are two types of squints: concomitant and paralytic. Concomitant squints are more common and are caused by an imbalance in the extraocular muscles. On the other hand, paralytic squints are rare and are caused by the paralysis of extraocular muscles. It is important to detect squints early on as they can lead to amblyopia, where the brain fails to process inputs from one eye and favours the other eye over time.
To detect a squint, a corneal light reflection test can be performed by holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils. The cover test is also used to identify the nature of the squint. This involves asking the child to focus on an object, covering one eye, and observing the movement of the uncovered eye. The test is then repeated with the other eye covered.
If a squint is detected, it is important to refer the child to secondary care. Eye patches may also be used to help prevent amblyopia.
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This question is part of the following fields:
- Ophthalmology
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Question 8
Correct
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A 55-year-old man visits his optometrist for a check-up. He has hyperopia and his current prescription is +3/+3.25 without any astigmatism or myopia. What is the primary eye condition that this patient is susceptible to with his present eye condition?
Your Answer: Acute angle-closure glaucoma
Explanation:Hypermetropia is linked to acute angle-closure glaucoma, while myopia is associated with primary open-angle glaucoma. This is because those with hypermetropia have smaller eyes, shallower anterior chambers, and narrower angles. The connection between myopia and primary open-angle glaucoma is not as clear, but it may be due to the optic nerve head being more vulnerable to damage from increased intraocular pressure. Cataracts are commonly linked to aging and severe short-sightedness, while central retinal artery occlusion is associated with aneurysms, arterial disease, and emboli.
Glaucoma is a condition where the optic nerve is damaged due to increased pressure in the eye. Primary open-angle glaucoma (POAG) is a type of glaucoma where the peripheral iris is clear of the trabecular meshwork, which is important in draining aqueous humour from the eye. POAG is more common in older individuals and those with a family history of the condition. It may present insidiously with symptoms such as peripheral visual field loss, decreased visual acuity, and optic disc cupping. Diagnosis is made through a series of investigations including automated perimetry, slit lamp examination, applanation tonometry, central corneal thickness measurement, and gonioscopy. It is important to assess the risk of future visual impairment based on factors such as IOP, CCT, family history, and life expectancy. Referral to an ophthalmologist is typically done through a GP.
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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 60-year-old man comes to the clinic complaining of a gradual onset of weakness in his legs, arms, neck, and face. He notices that his muscle strength improves after some exercise.
During the examination, the doctor observes weakness in all limbs, particularly in the proximal arms and legs, and ptosis in both eyelids. The patient has a history of heavy smoking for 45 pack-years and was recently diagnosed with lung cancer.
What is the probable diagnosis?Your Answer: Myasthenia gravis
Correct Answer: Lambert–Eaton myasthenic syndrome
Explanation:Possible Diagnoses for a Patient with Bilateral Ptosis and Limb Weakness
The patient’s symptoms of bilateral ptosis and limb weakness suggest several possible diagnoses. However, the most likely diagnosis is Lambert–Eaton myasthenic syndrome, a disorder of the presynaptic calcium channels that impairs the release of acetylcholine. This condition is often associated with lung cancer.
Other possible diagnoses include myasthenia gravis, which typically causes weakness and fatigability of skeletal muscles, but the patient’s muscle strength increased with exercise, which is more typical of Lambert–Eaton myasthenic syndrome. Thymoma, not lung cancer, is associated with myasthenia gravis.
Central Horner syndrome and postganglionic Horner syndrome are unlikely because they do not typically cause bilateral ptosis accompanied by limb weakness. Preganglionic Horner syndrome is also unlikely for the same reason.
In summary, the patient’s symptoms suggest Lambert–Eaton myasthenic syndrome as the most likely diagnosis, but further testing and evaluation are necessary to confirm the diagnosis and determine the appropriate treatment plan.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Incorrect
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An 82-year-old woman arrives at the emergency department complaining of sudden vision loss in her right eye. She reports experiencing painless vision loss without prior symptoms two hours ago, which has not improved. The left eye has a visual acuity of 6/12 (corrected with a pinhole), while the right eye has undetectable visual acuity. Upon fundoscopic examination, prominent retinal haemorrhages are observed. What is the probable diagnosis?
Your Answer: Optic neuritis
Correct Answer: Central retinal vein occlusion
Explanation:A sudden painless loss of vision with severe retinal haemorrhages on fundoscopy is indicative of central retinal vein occlusion. This is a common cause of monocular vision loss seen in emergency departments. Acute glaucoma, on the other hand, presents with a painful eye, fixed pupil, hazy cornea, and increased ocular pressures. Central retinal artery occlusion can be difficult to distinguish from venous occlusion, but a ‘cherry red spot’ in the macula is often seen on fundoscopy. However, the absence of this finding and the presence of retinal haemorrhages suggest that arterial occlusion is less likely in this case. Optic neuritis, which presents with eye pain and pain on eye movements, is another possible cause of vision loss.
Understanding Central Retinal Vein Occlusion
Central retinal vein occlusion (CRVO) is a possible cause of sudden, painless loss of vision. It is more common in older individuals and those with hypertension, cardiovascular disease, glaucoma, or polycythemia. The condition is characterized by a sudden reduction or loss of visual acuity, usually affecting only one eye. Fundoscopy reveals widespread hyperemia and severe retinal hemorrhages, which are often described as a stormy sunset.
Branch retinal vein occlusion (BRVO) is a similar condition that affects a smaller area of the fundus. It occurs when a vein in the distal retinal venous system is blocked, usually at arteriovenous crossings.
Most patients with CRVO are managed conservatively, but treatment may be necessary in some cases. For instance, intravitreal anti-vascular endothelial growth factor (VEGF) agents may be used to manage macular edema, while laser photocoagulation may be necessary to treat retinal neovascularization.
Overall, understanding the risk factors, features, and management options for CRVO is essential for prompt diagnosis and appropriate treatment. Proper management can help prevent further vision loss and improve the patient’s quality of life.
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This question is part of the following fields:
- Ophthalmology
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Question 11
Correct
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A 49-year-old man comes to the emergency department complaining of sudden painless loss of vision on the left side. He reports experiencing dark 'floaters' in his vision and a 'red hue' before losing vision completely on the affected side. The symptoms were most severe when lying flat. The patient has a medical history of poorly controlled type 1 diabetes, proliferative diabetic retinopathy, hypertension, and a metallic aortic valve for which he takes warfarin. What is the probable diagnosis?
Your Answer: Vitreous haemorrhage
Explanation:Vitreous haemorrhage should be considered as a possible cause of sudden visual loss in diabetic patients. This patient’s symptoms, including painless loss of vision with floaters and a red hue, are typical of vitreous haemorrhage. The worsening of symptoms when lying flat is also consistent with this diagnosis. The patient has several risk factors for vitreous haemorrhage, such as proliferative retinal disease, hypertension, and anticoagulant use.
Acute angle-closure glaucoma, which presents with painful loss of vision, red-eye, halos around lights, and a semi-dilated non-reactive pupil, is less likely in this case as the patient denies pain and there is no mention of a red eye.
Central retinal vein occlusion is unlikely as it does not typically present with floaters and a red hue preceding sudden loss of vision. Additionally, symptoms would not worsen when lying flat.
Posterior vitreous detachment, which presents with flashes of light and floaters in the peripheral field of vision, does not cause loss of sight.
Understanding Vitreous Haemorrhage
Vitreous haemorrhage is a condition where there is bleeding into the vitreous humour, which can cause sudden painless loss of vision. This disruption to vision can range from floaters to complete visual loss. The bleeding can come from any vessel in the retina or extend through the retina from other areas. Once the bleeding stops, the blood is typically cleared from the retina at a rate of approximately 1% per day.
The incidence of spontaneous vitreous haemorrhage is around 7 cases per 100,000 patient-years. The incidence by age and sex varies according to the underlying causes. The most common causes, which collectively account for 90% of cases, include proliferative diabetic retinopathy, posterior vitreous detachment, and ocular trauma (which is the most common cause in children and young adults).
Patients with vitreous haemorrhage typically present with an acute or subacute onset of painless visual loss or haze, a red hue in the vision, or floaters or shadows/dark spots in the vision. Signs of the condition include decreased visual acuity (depending on the location, size, and degree of vitreous haemorrhage) and visual field defects if the haemorrhage is severe.
Investigations for vitreous haemorrhage include dilated fundoscopy, slit-lamp examination, ultrasound (useful to rule out retinal tear/detachment and if haemorrhage obscures the retina), fluorescein angiography (to identify neovascularization), and orbital CT (used if open globe injury is suspected).
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This question is part of the following fields:
- Ophthalmology
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Question 12
Incorrect
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Please rewrite the question while maintaining the paragraph structure.
Your Answer: Right monocular anopia – right occipital cortex tip injury
Correct 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 13
Correct
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A 27-year-old woman visits her GP with complaints of itchy eyes. She reports a sensation of grittiness in both eyes and observes that they stick together in the morning. The grittiness is most severe upon waking up. She denies experiencing any other symptoms.
What is the probable diagnosis based on her presentation?Your Answer: Blepharitis
Explanation:The patient is experiencing bilateral grittiness that is worse in the mornings and sticking eyelids, which is a classic symptom of blepharitis. Dry eye syndrome, which is more common in the elderly, can also cause a bilateral gritty feeling, but symptoms are typically worse at the end of the day and may be associated with pain. Cellulitis, on the other hand, would present with redness, inflammation, tenderness, and signs of infection such as fever or discharge. A basal cell carcinoma (BCC) of the eyelid may cause a gritty feeling in the eye, but it would be unilateral, not bilateral. Allergic rhinitis (hay fever) may also cause itchy eyes, but other symptoms such as sneezing, a runny nose, and an itchy nose are typically present.
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 14
Incorrect
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A 55-year-old man visited his GP complaining of a gradual blurring of vision in his right eye. He underwent cataract surgery on the same eye five years ago. Despite wearing reading glasses, he noticed no improvement. During the examination, his left eye had a visual acuity of 6/18, while his right eye had a visual acuity of 6/9. What possible diagnosis could explain his symptoms in the right eye?
Your Answer: Anterior capsule opacification
Correct Answer: Posterior capsule opacification
Explanation:Understanding Common Eye Conditions and Refraction
Posterior Capsule Opacification
Posterior capsule opacification is a common complication after cataract surgery. It can cause blurring of vision, but is harmless and can be treated with a laser procedure called YAG laser capsulotomy.Anterior Capsule Opacification
Anterior capsule opacification does not occur after cataract surgery as most of the anterior capsule would have been removed during the procedure.Hypermetropia and Myopia
Hypermetropia, also known as long-sightedness, and myopia, also known as short-sightedness, can cause blurring of vision if spectacles of the correct refraction were not prescribed. Hypermetropia requires a convex spectacle lens, while myopia requires a concave spectacle lens.Presbyopia
Presbyopia is the normal loss of near focusing ability that occurs with age. However, if wearing reading glasses does not improve blurring of vision, presbyopia may not be the correct diagnosis. -
This question is part of the following fields:
- Ophthalmology
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Question 15
Incorrect
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A parent brings her daughter in for surgery suspecting a squint. She believes her left eye is 'turned inwards'. You conduct a cover test to gather more information. What result would indicate a left esotropia?
Your Answer: On covering the right eye the left eye moves medially to take up fixation
Correct Answer: On covering the left eye the right eye moves laterally to take up fixation
Explanation:Squints can be categorized based on the direction in which the eye deviates. If the eye turns towards the nose, it is called esotropia. If it turns towards the temporal side, it is called exotropia. If it turns upwards, it is called hypertropia, and if it turns downwards, it is called hypotropia. For instance, when the left eye is covered, the right eye may move laterally from its esotropic position towards the center to focus on an object.
Squint, also known as strabismus, is a condition where the visual axes are misaligned. There are two types of squints: concomitant and paralytic. Concomitant squints are more common and are caused by an imbalance in the extraocular muscles. On the other hand, paralytic squints are rare and are caused by the paralysis of extraocular muscles. It is important to detect squints early on as they can lead to amblyopia, where the brain fails to process inputs from one eye and favours the other eye over time.
To detect a squint, a corneal light reflection test can be performed by holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils. The cover test is also used to identify the nature of the squint. This involves asking the child to focus on an object, covering one eye, and observing the movement of the uncovered eye. The test is then repeated with the other eye covered.
If a squint is detected, it is important to refer the child to secondary care. Eye patches may also be used to help prevent amblyopia.
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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 68-year-old woman presents to eye casualty with a painful, red eye and blurred vision. She reports that the pain started suddenly this morning. On examination, there is swelling of the eyelid and a small hypopyon is present. Her vision is blurry in the affected eye and she can only see moving fingers at a distance of one meter. Fundoscopy reveals periphlebitis. The patient has no significant medical history except for cataract surgery performed 3 days ago. What is the probable diagnosis?
Your Answer: Keratitis
Correct Answer: Endophthalmitis
Explanation:Endophthalmitis is a rare but serious complication of cataract surgery that requires urgent treatment. This patient is experiencing a painful and red eye after undergoing cataract surgery, which is a common symptom of endophthalmitis. The condition occurs when microbial organisms are introduced into the eye during surgery, either from the patient’s normal flora or contaminated instruments. Symptoms include retinal periphlebitis, pain, redness, ocular discharge, and worsening vision. Treatment involves prompt administration of intravitreal or systemic antibiotics. Blepharitis, infective conjunctivitis, and keratitis are other ocular conditions that do not fit the symptoms presented by this patient.
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 17
Correct
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Which eye sign is correctly matched with its corresponding condition from the following options?
Your Answer: Ehlers–Danlos syndrome and blue sclerae
Explanation:Ocular Signs and Systemic Diseases: A Brief Overview
Various systemic diseases can manifest ocular signs that can aid in their diagnosis. Here are some examples:
Ehlers–Danlos syndrome and blue sclerae: This genetic disorder affects collagen production and can cause the sclerae to have a blue tint.
Down syndrome and Bitot’s spots: Children with Down syndrome may have small white or greyish/brown spots on the iris called Brushfield spots. Bitot’s spots, on the other hand, are a sign of vitamin A deficiency and are collections of keratin on the anterior conjunctiva.
Haemochromatosis and Kayser–Fleischer rings: Wilson’s disease, an autosomal recessive disease in which copper accumulates in tissues, can cause a brown ring around the periphery of the cornea called Kayser–Fleischer ring.
Hypocalcaemia and band keratopathy: Hypercalcaemia can cause band keratopathy, which is visualised as bands across the centre of the cornea.
Tuberous sclerosis and Lisch nodules: Retinal hamartomas are associated with tuberous sclerosis, while Lisch nodules, pigmented nodules affecting the iris, are a sign of neurofibromatosis type 1.
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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 65-year-old man visits the clinic with complaints of vision problems that have persisted for the past month. He reports difficulty reading words in books and blurry vision. The patient's visual acuity is 20/30 in both eyes upon examination. He currently takes amlodipine and ramipril for hypertension and smokes 30 cigarettes per day. The patient is concerned about losing his vision, as his father experienced a similar issue.
During fundoscopy, amber material deposits are observed under the retinal pigment epithelium in both eyes, without neovascularisation present. What is the most appropriate next step in diagnosing the patient's condition?Your Answer: Slit lamp examination of the anterior chamber
Correct Answer: Test with Amsler grid
Explanation:The Amsler grid test is a useful tool for assessing patients suspected of having age-related macular degeneration (AMD) as it checks for distortion of line perception. In this case, the patient has dry AMD, which is confirmed by the presence of drusen on fundoscopy. Patients with AMD typically see distorted lines instead of straight ones. Fluorescein angiography would not be appropriate for this patient as it assesses the vascular supply to the retina and choroid, which is not relevant in this case. Measuring intraocular pressure is also not useful in diagnosing AMD as it is associated with glaucoma. Similarly, a slit lamp examination of the anterior chamber is not relevant in diagnosing AMD as it is used to diagnose other eye conditions such as injuries, corneal infections, or cataracts.
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 19
Incorrect
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A 68-year-old man with elevated intraocular pressure is prescribed dorzolamide eye drops. What is the mechanism of action of this medication?
Your Answer: Alpha2-adrenoceptor agonist
Correct Answer: Carbonic anhydrase inhibitor
Explanation:Dorzolamide is a type of medication that works as a carbonic anhydrase inhibitor.
Glaucoma is a condition where the optic nerve is damaged due to increased pressure in the eye. Primary open-angle glaucoma is a type where the iris is clear of the trabecular meshwork, which is responsible for draining aqueous humour from the eye. This results in increased resistance to outflow and raised intraocular pressure. The condition affects 0.5% of people over 40 years old and increases with age. Genetics also play a role, with first-degree relatives having a 16% chance of developing the disease. Symptoms are usually absent, and diagnosis is made through routine eye examinations. Investigations include visual field tests, tonometry, and slit lamp examinations. Treatment involves eye drops to lower intraocular pressure, with prostaglandin analogues being the first line of treatment. Surgery may be considered in refractory cases. Regular reassessment is necessary to monitor progression and prevent visual field loss.
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This question is part of the following fields:
- Ophthalmology
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Question 20
Incorrect
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A 47-year-old man presents to his GP complaining of facial swelling and pain following a recent upper respiratory tract infection. Upon examination, the right eye is surrounded by erythema and swelling, and there is discomfort when moving the eye. The patient's left eye has a visual acuity of 6/6, while the right eye has a visual acuity of 6/24.
What would be the best course of action in this case?Your Answer: Prescribe high-dose oral steroids and refer urgently to Rheumatology
Correct Answer: Admit to hospital for IV antibiotics
Explanation:Patients who exhibit symptoms of orbital cellulitis should be admitted to the hospital for IV antibiotics due to the potential risks of cavernous sinus thrombosis and intracranial spread. Prescribing high-dose oral steroids and checking thyroid function is not the appropriate course of action, as these symptoms are more indicative of orbital cellulitis resulting from the spread of infection from the upper respiratory tract. Referring to Rheumatology and prescribing high-dose oral steroids is also not recommended, as this would be more appropriate for suspected giant cell arthritis, which is rare in patients under 65 years old. Supportive management and nasal decongestants are not recommended at this stage, as the facial pain and swelling with painful eye movements suggest that the condition has progressed to orbital cellulitis and requires IV antibiotics.
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 21
Correct
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A 22-year-old woman, a known type 1 diabetic, visited the GP clinic.
Your GP placement supervisor requested you to conduct a dilated direct fundoscopy on her eyes. During the examination, you observed a few dot haemorrhages and hard exudates.
What is the probable diagnosis of the patient's eye condition?Your Answer: Background diabetic retinopathy
Explanation:Understanding the Different Stages of Diabetic Retinopathy
Diabetic retinopathy is a condition that affects the eyes of people with diabetes. It is important to understand the different stages of diabetic retinopathy to ensure timely diagnosis and treatment.
Background diabetic retinopathy is the earliest stage, characterized by a few dot haemorrhages and microaneurysms. Pre-proliferative diabetic retinopathy is marked by intraretinal microvascular abnormalities, venous beading or loops, large blot haemorrhages, and cotton-wool spots.
Diabetic maculopathy occurs when these features affect the macula, which is responsible for central vision. Proliferative diabetic retinopathy is a more advanced stage, with new vessels forming at the disc or elsewhere in the retina.
Finally, proliferative diabetic retinopathy with maculopathy combines the features of pre-proliferative retinopathy, new vessel formation, and diabetic maculopathy. By understanding these stages, individuals with diabetes can work with their healthcare providers to manage their condition and prevent vision loss.
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This question is part of the following fields:
- Ophthalmology
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Question 22
Incorrect
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An 8-year-old boy comes to the clinic 2 days after injuring his right upper eyelid. He has a fever and feels generally sick. Upon examination, the eyelid is visibly swollen, red, and tender to the touch. The boy also has ptosis, but no pain when moving his eyes or visual impairment. What is the most probable diagnosis?
Your Answer: Viral conjunctivitis
Correct Answer: Periorbital cellulitis
Explanation:Periorbital (preseptal) cellulitis can be distinguished from orbital cellulitis by the absence of painful eye movements, double vision, and visual impairment. These symptoms are indicative of orbital cellulitis, which is more severe and involves infection of the orbit. Children are more susceptible to both types of cellulitis. Dry eyes, or keratoconjunctivitis sicca, typically presents as a painful, gritty feeling in the eye with redness of the conjunctiva, similar to viral conjunctivitis.
Understanding Preseptal Cellulitis
Preseptal cellulitis, also known as periorbital cellulitis, is an infection that affects the soft tissues in front of the orbital septum. This includes the skin, eyelids, and subcutaneous tissue of the face, but not the contents of the orbit. Unlike orbital cellulitis, which is a more severe infection that affects the soft tissues behind the orbital septum, preseptal cellulitis is less serious. The infection typically spreads from nearby sites, such as breaks in the skin or local infections like sinusitis or respiratory tract infections. Common causative organisms include Staph. aureus, Staph. epidermidis, streptococci, and anaerobic bacteria.
Preseptal cellulitis is most commonly seen in children, with 80% of patients under the age of 10 and a median age of presentation at 21 months. It is more prevalent in the winter due to the increased incidence of respiratory tract infections. Symptoms of preseptal cellulitis include a sudden onset of a red, swollen, and painful eye, often accompanied by fever.
Clinical signs of preseptal cellulitis include erythema and edema of the eyelids, which can spread to the surrounding skin, as well as partial or complete ptosis of the eye due to swelling. It is important to note that orbital signs, such as pain on eye movement, restriction of eye movements, proptosis, visual disturbance, chemosis, and relative afferent pupillary defect (RAPD), should be absent in preseptal cellulitis. If these signs are present, it may indicate orbital cellulitis.
Diagnosis of preseptal cellulitis is typically made based on clinical presentation and blood tests showing raised inflammatory markers. A swab of any discharge present may also be taken. A contrast CT of the orbit may be performed to differentiate between preseptal and orbital cellulitis.
Management of preseptal cellulitis involves referral to secondary care for assessment. Oral antibiotics, such as co-amoxiclav, are often sufficient for treatment. Children may require admission for observation. If left untreated, bacterial infection may spread into the orbit and evolve into orbital cellulitis.
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This question is part of the following fields:
- Ophthalmology
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Question 23
Correct
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A 16-year-old male comes to the clinic complaining of an itchy eye with watery discharge on one side. The patient reports feeling generally healthy, without changes to their vision or fever symptoms. They wear contact lenses but have not had an optician appointment recently.
During the examination, the patient's right eye shows injected conjunctiva, but there is no noticeable swelling or redness around the eye. The application of topical fluorescein does not reveal any corneal staining.
What would be the best course of action for managing this patient's symptoms?Your Answer: Advise she should not wear contact lenses for the duration of her symptoms
Explanation:During an episode of conjunctivitis, contact lenses should not be worn. In this case, the 15-year-old is likely experiencing viral conjunctivitis and should refrain from wearing contact lenses until symptoms have subsided. It is important to note that not having seen an optician recently may affect the patient’s lens prescription, but it does not increase their susceptibility to infection or more severe conditions.
While warm compresses can be helpful for styes or chalazion, they are not as effective for viral conjunctivitis. In this case, the fluorescein test did not show any corneal stains, indicating that the patient does not require a referral to ophthalmology. However, if a contact lens wearer with these symptoms had corneal staining, they would need to visit eye casualty as this would suggest a corneal injury.
Although topical antihistamine eye drops may be appropriate for allergic conjunctivitis, the unilateral nature of the patient’s symptoms makes this diagnosis less likely. Topical chloramphenicol is the preferred treatment for bacterial conjunctivitis, but the watery discharge in this case suggests viral conjunctivitis instead.
Conjunctivitis is a common eye problem that is often seen in primary care. It is characterized by red, sore eyes with a sticky discharge. There are two types of infective conjunctivitis: bacterial and viral. Bacterial conjunctivitis is identified by a purulent discharge and eyes that may be stuck together in the morning. On the other hand, viral conjunctivitis is characterized by a serous discharge and recent upper respiratory tract infection, as well as preauricular lymph nodes.
In most cases, infective conjunctivitis is a self-limiting condition that resolves without treatment within one to two weeks. However, topical antibiotic therapy is often offered to patients, such as Chloramphenicol drops given every two to three hours initially or Chloramphenicol ointment given four times a day initially. Alternatively, topical fusidic acid can be used, especially for pregnant women, and treatment is twice daily.
For contact lens users, topical fluoresceins should be used to identify any corneal staining, and treatment should be the same as above. During an episode of conjunctivitis, contact lenses should not be worn, and patients should be advised not to share towels. School exclusion is not necessary.
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This question is part of the following fields:
- Ophthalmology
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Question 24
Incorrect
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An 80-year-old man presents to the clinic with an 8-month history of uncorrectable poor vision. He has a medical history of hypertension, allergic conjunctivitis, and type 1 diabetes mellitus, and has been a heavy smoker for the past 20 years. On examination, his right eye has a visual acuity of 6/30 while the left eye is normal. Fundoscopy reveals increased retinal blood vessels, blot haemorrhages, and hard exudates in the nasal upper quadrant of the right eye. He denies any sudden visual loss or ocular trauma. What is the most likely diagnosis?
Your Answer: Wet age-related macular degeneration
Correct Answer: Proliferative diabetic retinopathy
Explanation:The most likely diagnosis for this patient is proliferative diabetic retinopathy, as evidenced by the presence of neovascularisation, microaneurysms, and hard exudates on fundoscopy. This condition is more common in type 1 diabetes mellitus. Dry age-related macular degeneration and hypertensive retinopathy are less likely diagnoses, as they do not explain all of the patient’s symptoms and findings.
Understanding Diabetic Retinopathy
Diabetic retinopathy is a leading cause of blindness among adults aged 35-65 years old. The condition is caused by hyperglycemia, which leads to abnormal metabolism in the retinal vessel walls and damage to endothelial cells and pericytes. This damage causes increased vascular permeability, resulting in exudates seen on fundoscopy. Pericyte dysfunction predisposes to the formation of microaneurysms, while neovascularization is caused by the production of growth factors in response to retinal ischemia.
Patients with diabetic retinopathy are classified into those with nonproliferative diabetic retinopathy (NPDR), proliferative retinopathy (PDR), and maculopathy. NPDR is further classified into mild, moderate, and severe, depending on the presence of microaneurysms, blot hemorrhages, hard exudates, cotton wool spots, venous beading/looping, and intraretinal microvascular abnormalities. PDR is characterized by retinal neovascularization, which may lead to vitreous hemorrhage, and fibrous tissue forming anterior to the retinal disc. Maculopathy is based on location rather than severity and is more common in Type II DM.
Management of diabetic retinopathy involves optimizing glycaemic control, blood pressure, and hyperlipidemia, as well as regular review by ophthalmology. Treatment options include intravitreal vascular endothelial growth factor (VEGF) inhibitors for maculopathy, regular observation for nonproliferative retinopathy, and panretinal laser photocoagulation and intravitreal VEGF inhibitors for proliferative retinopathy. Vitreoretinal surgery may be necessary in cases of severe or vitreous hemorrhage.
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This question is part of the following fields:
- Ophthalmology
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Question 25
Incorrect
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Sarah is a 35-year-old woman who presents with a red eye and significant nausea. She has noticed that her right eye was red when she woke up from sleep. She also has a concurrent headache with this and her vision is blurry. When asked, she feels that she can see rings around lights as well. She remains otherwise well.
Examination reveals significant conjunctival injection around the right eye. Sarah is very photophobic when testing her right eye. The pupil appears to be dilated at 5 mm and does not respond to light. Her left eye has a pupil size of 3mm and is reactive to light.
What is the likely cause for her symptoms?Your Answer: Primary open angle glaucoma
Correct Answer: Acute closed angle glaucoma
Explanation:Acute closed-angle glaucoma is a rare but serious condition that can lead to vision loss if left untreated. It is more likely to occur in individuals who are long-sighted, have a shallow anterior chamber, or are female. Symptoms include sudden visual loss, a red eye, pain when moving the eye, and the appearance of halos around light. The pupil will be fixed and dilated, and the cornea may appear hazy. Treatment involves reducing intraocular pressure with topical drops.
Anterior uveitis is another possible cause of an acutely red eye with visual loss, but it is not typically associated with halos. The pupil will be normal-sized or small, and there may be precipitates or a hypopyon visible on slit-lamp examination. Uveitis may be a sign of an underlying inflammatory or autoimmune condition.
Primary open-angle glaucoma has a more gradual onset and is often asymptomatic, but may cause peripheral vision loss. Pupillary changes are not typically seen.
Cluster headaches can cause a severe headache, conjunctival injection, and blurry vision, but should not cause any pupillary defects.
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 26
Incorrect
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A 23-year-old female who is overweight visits her doctor complaining of daily headaches that have been ongoing for two weeks. The headaches are felt on both sides of her forehead, persist throughout the day, and intensify when she bends over. She does not experience any aura with the headaches. During a fundoscopy, the doctor notices blurring of the optic disc. What is the probable diagnosis?
Your Answer: Sinus headache
Correct Answer: Idiopathic intracranial hypertension
Explanation:Idiopathic intracranial hypertension is a possible diagnosis for a young woman with a high BMI, headache, and visual symptoms, as it is associated with papilloedema. Cluster headaches, migraines, and sinus headaches do not account for papilloedema and have different characteristics.
Understanding Papilloedema: Optic Disc Swelling Caused by Increased Intracranial Pressure
Papilloedema is a condition characterized by swelling of the optic disc due to increased pressure within the skull. This condition is typically bilateral and can be identified through fundoscopy. During this examination, venous engorgement is usually the first sign observed, followed by loss of venous pulsation, blurring of the optic disc margin, elevation of the optic disc, loss of the optic cup, and the presence of Paton’s lines, which are concentric or radial retinal lines cascading from the optic disc.
There are several potential causes of papilloedema, including space-occupying lesions such as tumors or vascular abnormalities, malignant hypertension, idiopathic intracranial hypertension, hydrocephalus, and hypercapnia. In rare cases, papilloedema may also be caused by hypoparathyroidism and hypocalcaemia, or vitamin A toxicity.
Overall, understanding papilloedema is important for identifying potential underlying conditions and providing appropriate treatment to prevent further complications.
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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 68-year-old man is referred to Ophthalmology with bilateral cataracts. He reports gradual worsening of his vision over many years and struggles with night-time driving due to glare. He is put on the waiting list for surgical repair.
What structure in the eye is affected by cataract formation?Your Answer: Retina
Correct Answer: Lens
Explanation:Anatomy of the Eye: Understanding the Different Parts and Their Disorders
The eye is a complex organ that allows us to see the world around us. It is made up of several parts, each with its own function. Understanding the anatomy of the eye and the disorders that can affect it is important for maintaining good eye health.
Lens: The lens is a transparent structure located behind the pupil and iris. It helps to focus light onto the retina. Cataracts occur when the lens becomes cloudy or opaque, causing vision problems.
Cornea: The cornea is the clear dome-shaped surface of the eye that sits over the iris. It plays a role in refracting light. Damage to the cornea can cause pain and light sensitivity.
Iris: The iris is the colored part of the eye. It can be affected by disorders such as uveitis, which causes inflammation of the uvea (iris, ciliary body, and choroid).
Retina: The retina is located at the back of the eye and contains rods and cones that process incoming light. Disorders of the retina include retinitis pigmentosa, diabetic retinopathy, and retinal detachment.
Sclera: The sclera is the white part of the eye. Disorders of the sclera include scleritis, which causes redness, pain, and reduced visual acuity. It can be associated with rheumatoid arthritis.
Understanding the different parts of the eye and their functions can help you identify potential problems and seek treatment early. Regular eye exams are important for maintaining good eye health and preventing vision loss.
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This question is part of the following fields:
- Ophthalmology
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Question 28
Incorrect
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After an uncomplicated pregnancy, a 20-year-old woman gives birth to a baby boy through vaginal delivery. During the one-week check-up, the infant is observed to have crusting and purulent discharge in the eyes. What should be the next course of action for the baby's care?
Your Answer: Prescribe erythromycin ophthalmic ointment empirically
Correct Answer: Take urgent swabs of the discharge for microbiological investigation
Explanation:While minor conjunctivitis with encrusting of the eyelids is usually harmless, a purulent discharge could be a sign of a severe infection such as chlamydia or gonococcus. In infants with a purulent eye discharge, it is crucial to take swab samples immediately for microbiological testing that can detect chlamydia and gonococcus. Although it is recommended to begin systemic antibiotic treatment for potential gonococcal infection while waiting for the swab results, the swabs must be taken first.
Conjunctivitis is a common eye problem that is often seen in primary care. It is characterized by red, sore eyes with a sticky discharge. There are two types of infective conjunctivitis: bacterial and viral. Bacterial conjunctivitis is identified by a purulent discharge and eyes that may be stuck together in the morning. On the other hand, viral conjunctivitis is characterized by a serous discharge and recent upper respiratory tract infection, as well as preauricular lymph nodes.
In most cases, infective conjunctivitis is a self-limiting condition that resolves without treatment within one to two weeks. However, topical antibiotic therapy is often offered to patients, such as Chloramphenicol drops given every two to three hours initially or Chloramphenicol ointment given four times a day initially. Alternatively, topical fusidic acid can be used, especially for pregnant women, and treatment is twice daily.
For contact lens users, topical fluoresceins should be used to identify any corneal staining, and treatment should be the same as above. During an episode of conjunctivitis, contact lenses should not be worn, and patients should be advised not to share towels. School exclusion is not necessary.
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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 50-year-old woman presents to the eye emergency department with complaints of blurred vision and sensitivity to bright lights. She has a medical history of asthma, polymyalgia rheumatica, and gout. During the examination, the ophthalmologist identifies a subcapsular cataract in her left eye, located just beneath the lens in the visual axis.
What is the most significant risk factor for subcapsular cataracts?Your Answer:
Correct Answer: Steroids
Explanation:Steroid use may be linked to the development of subcapsular cataracts, which are located behind the capsule in the visual axis and have a rapid progression. These cataracts are often accompanied by glare from bright lights and appear as a central granular lens opacity during examination. Dot cataracts are associated with myotonic dystrophy, while nuclear cataracts are linked to myopia. Nuclear cataracts with a stellate morphology are typically associated with ocular trauma, but this depends on the mechanism of the injury.
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 30
Incorrect
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An older woman presents with an intermittent frontal headache associated with pain around her right eye which looks slightly red. She describes episodes occurring while she watches television in the evening, during which she sees halos around lights in the room. On examination, there is no tenderness around her temporal artery and her eye appears normal. She has normal visual acuity.
What is the most likely diagnosis?Your Answer:
Correct Answer: Closed angle glaucoma
Explanation:Differential Diagnosis for a Painful Red Eye with Headache and Visual Symptoms
When a patient presents with a painful red eye, headache, and visual symptoms, several conditions should be considered. One possible diagnosis is primary closed angle glaucoma, which can present as latent, subacute, or acute. Subacute closed angle glaucoma causes intermittent attacks with blurring of vision and halos around light sources, while acute glaucoma is more severe and requires urgent reduction in intraocular pressure. Another possible diagnosis is anterior uveitis, which presents with a persistent painful red eye and photophobia but does not cause headaches or halos in the vision.
Migraine is also an important differential, as its symptoms can be mistaken for acute glaucoma. Tension headaches are less likely, as they are not associated with visual symptoms. Finally, giant cell arthritis should be considered, especially if the patient has symptoms of claudication such as temporal headache and jaw pain when chewing food, as well as scalp tenderness and pulseless beaded temporal arteries on examination.
In summary, a painful red eye with headache and visual symptoms can have several possible causes, and a thorough differential diagnosis is necessary to determine the appropriate treatment.
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This question is part of the following fields:
- Ophthalmology
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