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Question 1
Correct
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Which one of the following features is not present in pre-proliferative retinopathy in elderly diabetic patients?
Your Answer: Neovascularisation
Explanation:Proliferative retinopathy is characterized by the presence of retinal neovascularization.
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 non-proliferative 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 non-proliferative 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 2
Incorrect
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A 40-year-old man comes to the clinic complaining of visual difficulties. He reports having poor vision in low light conditions for a while, but now he is concerned as he is experiencing tunnel vision. He mentions that his grandfather had a similar issue and was declared blind when he was in his 50s. What is the probable diagnosis?
Your Answer: Leber's congenital amaurosis
Correct Answer: Retinitis pigmentosa
Explanation:Understanding Retinitis Pigmentosa
Retinitis pigmentosa is a condition that primarily affects the peripheral retina, leading to tunnel vision. The initial sign of this condition is often night blindness, which can progress to a loss of peripheral vision. Fundoscopy, a diagnostic test, reveals black bone spicule-shaped pigmentation in the peripheral retina and mottling of the retinal pigment epithelium. Retinitis pigmentosa is often associated with other diseases such as Refsum disease, Usher syndrome, abetalipoproteinemia, Lawrence-Moon-Biedl syndrome, Kearns-Sayre syndrome, and Alport’s syndrome.
To better understand retinitis pigmentosa, it is important to know that it is a genetic disorder that affects the retina’s ability to respond to light. This condition can lead to the death of photoreceptor cells in the retina, which are responsible for detecting light and transmitting visual information to the brain. As a result, individuals with retinitis pigmentosa may experience difficulty seeing in low light conditions, loss of peripheral vision, and, in severe cases, complete blindness.
In summary, retinitis pigmentosa is a genetic condition that primarily affects the peripheral retina, leading to tunnel vision. It is often associated with other diseases and can cause night blindness, loss of peripheral vision, and, in severe cases, complete blindness. Early diagnosis and management are crucial in preventing further vision loss.
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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 56-year-old woman visits the emergency GP service with a red and painful eye that has been bothering her for a few hours. Upon examination, the doctor notices a dilated pupil and a significant decrease in vision.
What is the most probable diagnosis?Your Answer: Acute angle-closure glaucoma
Explanation:Common Eye Conditions: Symptoms and Characteristics
Acute angle-closure glaucoma, Conjunctivitis, Foreign body, Optic neuritis, and Uveitis are some of the most common eye conditions that individuals may experience. Each condition has its own set of symptoms and characteristics that can help in identifying the underlying cause.
Acute angle-closure glaucoma is characterized by sudden onset symptoms such as blurred vision, seeing haloes around lights, red eye, pain, headache, and nausea and vomiting. It is an ophthalmic emergency that requires urgent specialist assessment to prevent blindness.
Conjunctivitis is one of the most common non-traumatic eye complaints resulting in presentation to A&E. It is characterized by redness, profuse discharge, irritation, and rarely photophobia. Most causes are benign, with a self-limited process.
Foreign body in the cornea is characterized by pain, foreign body sensation, photophobia, tearing, and red eye. A visible foreign body may be present on physical examination.
Optic neuritis is characterized by rapidly developing impairment of vision in one eye, dyschromatopsia, retro-orbital or ocular pain, Uhthoff’s phenomenon, and Pulfrich’s phenomenon. It often occurs in association with multiple sclerosis (MS) and neuromyelitis optica (NMO).
Uveitis is characterized by inflammation of the uveal tract or adjacent ocular structures. It is often autoimmune in nature, and the aetiology remains elusive in most cases. Symptoms vary depending on the location of the inflammation, with acute anterior uveitis being the most common form of intraocular inflammation, causing a painful red eye.
Understanding the symptoms and characteristics of these common eye conditions can help in identifying the underlying cause and seeking appropriate treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 4
Correct
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A 78-year-old man comes to the clinic complaining of a swollen left upper eyelid that has been bothering him for the past 3 months. He recalls noticing a bump on the eyelid that was uncomfortable at first, but it gradually grew into a hard lump. He denies any pain at present and has not experienced any vision problems. Upon examination, the eye appears to be in good health. What is the probable diagnosis?
Your Answer: Chalazion
Explanation:A painless, firm lump in the eyelid is indicative of a chalazion or Meibomian cyst. This occurs when the Meibomian gland becomes blocked, resulting in the formation of a cyst. It is often a consequence of an internal stye (hordeolum internum). Although cysts may resolve on their own, they may require topical antibiotics if they become infected. The absence of pain and the prolonged history suggest that it is not an internal or external stye. Blepharitis and ectropion are unlikely to cause a lump in the eyelid.
Eyelid problems are quite common and can include a variety of issues. One such issue is blepharitis, which is inflammation of the eyelid margins that can cause redness in the eye. Another problem is a stye, which is an infection of the glands in the eyelids. Chalazion, also known as Meibomian cyst, is another eyelid problem that can occur. Entropion is when the eyelids turn inward, while ectropion is when they turn outward.
Styes can come in different forms, such as external or internal. An external stye is an infection of the glands that produce sebum or sweat, while an internal stye is an infection of the Meibomian glands. Treatment for styes typically involves hot compresses and pain relief, with topical antibiotics only being recommended if there is also conjunctivitis present. A chalazion, on the other hand, is a painless lump that can form in the eyelid due to a retention cyst of the Meibomian gland. While most cases will resolve on their own, some may require surgical drainage.
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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 62-year-old man presents to the Ophthalmology Clinic with elevated intraocular pressure and peripheral vision loss. He also has a history of asthma. What is the most suitable course of treatment to begin in this scenario?
Your Answer: Pilocarpine
Correct Answer: Latanoprost
Explanation:Medications for Glaucoma: Uses and Contraindications
Glaucoma is a condition that can lead to vision loss if left untreated. The primary goal of treatment is to lower intraocular pressure. Here are some common medications used for glaucoma and their uses and contraindications:
1. Latanoprost: This prostaglandin analogue increases scleral permeability to aqueous fluid, reducing intraocular pressure. It is safe to use in asthmatics and is recommended as a first-line medication.
2. Brinzolamide: This carbonic anhydrase inhibitor also lowers intraocular pressure but is not a first-line medication for glaucoma. It is safe to use in those with concurrent asthma.
3. Pilocarpine: This muscarinic receptor agonist improves the flow rate of aqueous humour but is not a first-line medication. It is cautioned against use in asthmatics as it can increase bronchial secretions and airway resistance.
4. Sodium cromoglicate: This mast-cell stabiliser is not usually used in glaucoma but is commonly used in conditions such as allergic rhinitis.
5. Timolol: This beta-receptor antagonist is contraindicated in asthmatics as it can lead to increased airway resistance through bronchospasm.
It is important to consult with a healthcare provider to determine the best medication for individual cases of glaucoma, taking into consideration any contraindications or potential side effects.
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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 75-year-old man came to the clinic with painless, blurry vision in his right eye. He reported no other ocular symptoms and had a history of bilateral cataract surgery five years ago. What is the most probable reason for his vision impairment?
Your Answer: Recurrence of cataract
Correct Answer: Posterior capsule opacification
Explanation:Blurred vision years after cataract surgery may be caused by posterior capsule opacification, which can occur even after the cataract has been removed and an artificial lens has been implanted.
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 7
Incorrect
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A 78-year-old woman visits her GP complaining of a gradual loss of vision over the past 2 years. She reports difficulty seeing objects up close, particularly at dusk and in the early morning when walking her dog. Amsler grid testing reveals distorted line perception. The patient has a history of osteoarthritis in her knees, which she treats with paracetamol as needed. What is the probable observation on fundoscopy?
Your Answer: Cupping of the optic disc
Correct Answer: Drusen
Explanation:The patient’s symptoms and clinical findings suggest a diagnosis of dry macular degeneration, which is characterized by the presence of drusen – small yellowish deposits of lipids under the retina. The patient is experiencing a gradual loss of central vision, difficulty seeing in the dark, and distorted line perception on Amsler grid testing.
Hypertensive retinopathy can cause AV nicking, which is visible on fundoscopy, but it is unlikely to be the cause of this patient’s symptoms. Cotton wool spots, which are associated with hypertensive and diabetic retinopathy, are also an unlikely cause as the patient has no history of hypertension or diabetes, and these spots do not typically cause changes in vision. Cupping of the optic disc, seen in glaucoma, is also an unlikely diagnosis as the patient’s symptoms do not match those typically seen in glaucoma.
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 anti-oxidant 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 anti-oxidant 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 8
Incorrect
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A 50-year-old man presents to the clinic with painful red eyes and blurred vision. Upon examination, the eye appears red and tender with decreased visual acuity. There is no inflammation or discharge from the eyelids, and the anterior chamber is normal. The patient has a history of rheumatoid arthritis but is currently not receiving treatment. What is the probable diagnosis?
Your Answer: Anterior uveitis
Correct Answer: Scleritis
Explanation:Blepharitis is a condition characterized by inflammation of the margins of the eyelids, typically caused by the growth of eyelashes inwards. Symptoms include discomfort, redness, and dryness of the eyes, but no visual impairment. Urgent referral to ophthalmology is necessary if suspected. Treatment involves conservative measures such as regular eye care using warm compresses.
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 9
Correct
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A 28-year-old man with ankylosing spondylitis (AS) comes in with photophobia and a painful red eye.
What is the most probable diagnosis?Your Answer: Uveitis
Explanation:Understanding Eye Conditions Associated with Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a chronic inflammatory disorder that primarily affects the sacroiliac joints and axial skeleton. However, it can also lead to various eye conditions. Uveitis, also known as iritis or iridocyclitis, is the most common extra-articular manifestation of AS, occurring in 20-30% of patients. Acute anterior uveitis is often unilateral and presents with symptoms such as a painful red eye, photophobia, and blurred vision. Patients with uveitis may also have or develop other spondyloarthropathies, including reactive arthritis, undifferentiated spondyloarthropathy, and psoriatic arthritis.
Acute angle-closure glaucoma, on the other hand, is not associated with AS. It is a medical emergency that needs immediate treatment to prevent vision loss. Conjunctivitis, which is responsible for approximately 30% of all eye complaints, is usually benign and self-limited. Herpes zoster ophthalmicus and keratoconus are also not associated with AS.
It is important for patients with AS to be aware of these potential eye conditions and seek urgent ophthalmological assessment if they experience any symptoms. Early diagnosis and treatment can prevent vision loss and improve outcomes.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Correct
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A 42-year-old patient with ankylosing spondylitis complains of sudden pain in the right eye and blurry vision. During examination, you observe redness around the cornea and a constricted pupil. Ophthalmoscopy reveals difficulty in visualizing the retina due to the patient's intolerance to bright light, but you do notice a fluid level at the front of the eye. What is the probable diagnosis?
Your Answer: Anterior uveitis
Explanation: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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