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  • Question 1 - A 75-year-old woman complains of 'strange spots' affecting her eyesight. She has observed...

    Incorrect

    • A 75-year-old woman complains of 'strange spots' affecting her eyesight. She has observed several flashes and floaters in the visual field of her left eye over the last few days. What could be the probable diagnosis?

      Your Answer: Retinal detachment

      Correct Answer: Posterior vitreous detachment

      Explanation:

      Retinal tear is a common condition among individuals aged 65 years and above, and it is the most probable diagnosis in this case. Typically, an ophthalmologist will evaluate such patients to determine the likelihood of developing retinal detachment.

      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 arteritis), 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 arteritis 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.

    • This question is part of the following fields:

      • Ophthalmology
      28.4
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  • Question 2 - A 55-year-old man with a history of cytomegalovirus infection presented to the ED...

    Incorrect

    • A 55-year-old man with a history of cytomegalovirus infection presented to the ED complaining of blurred vision, light sensitivity, floaters, and redness in his right eye for the past two weeks. Upon fundus examination, a combination of white and red retinal lesions were observed. What is the probable diagnosis?

      Your Answer: Anterior uveitis

      Correct Answer: Chorioretinitis

      Explanation:

      Chorioretinitis can be identified through a pizza pie appearance on fundoscopy. This occurs when the choroid and retina become inflamed, typically in patients with cytomegalovirus. It is important to note that anterior uveitis will not show any fundal signs. While floaters may suggest retinal detachment, it does not present as a pizza pie appearance on fundoscopy.

      Causes of Chorioretinitis

      Chorioretinitis is a medical condition that affects the retina and choroid, which are the layers of tissue at the back of the eye. There are several causes of chorioretinitis, including syphilis, cytomegalovirus, toxoplasmosis, sarcoidosis, and tuberculosis.

      Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It can cause chorioretinitis as part of its secondary stage. Cytomegalovirus is a common virus that can cause chorioretinitis in people with weakened immune systems, such as those with HIV/AIDS. Toxoplasmosis is a parasitic infection that can be contracted from contaminated food or water, and it can cause chorioretinitis in some cases.

      Sarcoidosis is a condition that causes inflammation in various parts of the body, including the eyes. It can lead to chorioretinitis in some cases. Tuberculosis is a bacterial infection that can affect the lungs, but it can also spread to other parts of the body, including the eyes. It can cause chorioretinitis as a rare complication.

    • This question is part of the following fields:

      • Ophthalmology
      13.9
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  • Question 3 - A 68-year-old woman visits the general practice clinic with complaints of itchy eyes...

    Correct

    • A 68-year-old woman visits the general practice clinic with complaints of itchy eyes and crusting on the eyelids. During examination, the upper lids near the eyelash follicles have small flakes of skin, and the eyelids are slightly swollen.
      What is the most suitable initial treatment for this patient's condition?

      Your Answer: Warm compresses and eyelid hygiene

      Explanation:

      Treatment Options for Blepharitis

      Blepharitis is a common eye condition that causes inflammation of the eyelids. The most appropriate first-line treatment for blepharitis is self-care measures such as eyelid hygiene and warm compresses. This involves cleaning the eyelids with warm water and a diluted cleanser such as baby shampoo twice a day, and applying a warm compress to the closed eyelids for 5-10 minutes once or twice a day.

      Topical steroids are not recommended for the treatment of blepharitis, but may be used by secondary care clinicians to reduce inflammation. Topical chloramphenicol may be prescribed for anterior blepharitis if eyelid hygiene and warm compresses are ineffective, while oral tetracycline may be prescribed for posterior blepharitis with meibomian gland dysfunction and rosacea if self-care measures are ineffective.

      It is important to note that topical ketoconazole is not recommended for the treatment of blepharitis, as it is used for other conditions such as fungal skin infections and candidiasis. If self-care measures and prescribed treatments do not improve symptoms, further treatment or referral may be recommended.

    • This question is part of the following fields:

      • Ophthalmology
      22.3
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  • Question 4 - A 50-year-old man presents to the clinic with painful red eyes and blurred...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Ophthalmology
      15.4
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  • Question 5 - You are a foundation doctor working in general practice. You review a sixty-five-year-old...

    Correct

    • You are a foundation doctor working in general practice. You review a sixty-five-year-old gentleman with a facial rash. On examination you note a vesicular rash extending to the tip of the nose. Observations are unremarkable.
      What is your primary concern?

      Your Answer: Possible involvement of the cornea

      Explanation:

      The presence of vesicles extending to the tip of the nose, known as Hutchinson’s sign, is strongly linked to shingles affecting the eyes. This is because the trigeminal nerve branch that supplies the cornea and nasal tip is affected. While pneumonia can be associated with herpes, this patient does not exhibit any respiratory symptoms. Despite the potential for post-herpetic neuralgia from the painful rash of shingles, the primary concern for this patient is the ocular involvement indicated by Hutchinson’s sign.

      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.

    • This question is part of the following fields:

      • Ophthalmology
      29.1
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  • Question 6 - You assess a patient in the Emergency Department who was admitted after a...

    Incorrect

    • You assess a patient in the Emergency Department who was admitted after a motorcycle accident. He is a diabetic patient, with multiple recent hospitalizations due to non-adherence to insulin therapy. Both of his pupils are small, responsive to accommodation, but unresponsive to light.
      What is the most appropriate description of this situation?

      Your Answer: Adie pupil

      Correct Answer: Argyll-Robertson pupil

      Explanation:

      – Adie pupil: A condition where the pupil is constantly dilated and reacts slowly to light, but responds better to accommodation. It is caused by damage to the parasympathetic innervation of the eye due to viral or bacterial infection. It is more commonly seen in females and is often accompanied by absent knee or ankle jerks.
      – Marcus-Gunn pupil: A relative afferent pupillary defect that is observed during the swinging light examination of pupil response. The pupils constrict less and appear to dilate when a light is swung from the unaffected to the affected eye. This condition is most commonly caused by damage to the optic nerve or severe retinal disease.
      – Horner’s syndrome: A condition characterized by miosis (pupillary constriction), ptosis (droopy eyelid), apparent enophthalmos (inset eyeball), with or without anhidrosis (decreased sweating) occurring on one side. It is caused by damage to the sympathetic trunk on the same side as the symptoms, due to trauma, compression, infection, ischaemia, or other causes.
      – Hutchinson’s pupil: A condition where the pupil on one side is unilaterally dilated and unresponsive to light. It is caused by compression of the occulomotor nerve on the same side, usually by an intracranial mass such as a tumor or hematoma.

      Argyll-Robertson Pupil: A Classic Pupillary Syndrome

      The Argyll-Robertson Pupil (ARP) is a classic pupillary syndrome that is sometimes observed in neurosyphilis. It is characterized by small, irregular pupils that do not respond to light but do respond to accommodation. A useful mnemonic for remembering this syndrome is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA).

      The ARP can be caused by various factors, including diabetes mellitus and syphilis. It is important to note that the presence of an ARP may indicate underlying neurological or systemic disease and should prompt further evaluation and management. Proper diagnosis and treatment of the underlying condition can help prevent further complications and improve patient outcomes.

    • This question is part of the following fields:

      • Ophthalmology
      27.1
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  • Question 7 - A 25-year-old man, who is typically healthy, arrives at the Emergency Department with...

    Correct

    • A 25-year-old man, who is typically healthy, arrives at the Emergency Department with a three-day history of a red, itchy eye that is only slightly painful when touched over the redness. He had previously visited his General Practitioner and was given chloramphenicol ointment to apply to his eyes four times daily. However, he noticed no improvement in his red eye.
      During the examination, his visual acuities are 6/6 in both eyes. His affected eye displays a red spot on the medial side of the eyeball. After administering phenylephrine 10% eye drops, the redness appeared to have improved.
      What is the most probable diagnosis?

      Your Answer: Episcleritis

      Explanation:

      Differentiating Eye Inflammations: Symptoms and Characteristics

      Episcleritis is a mild inflammation that causes grittiness and tenderness on palpation, with sectorial redness that is deeper than conjunctivitis. Scleritis, on the other hand, causes severe pain, tenderness, and blueish-red tinge due to deeper inflamed vessels in the sclera. Conjunctivitis presents with superficial inflammation and is not tender to palpation. Iritis causes acute pain, photophobia, and circumcorneal redness, while keratitis also causes acute pain and circumcorneal redness, with fluorescein staining indicating corneal epithelial defect. Knowing these symptoms and characteristics can help in accurately diagnosing and treating eye inflammations.

    • This question is part of the following fields:

      • Ophthalmology
      16.4
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  • Question 8 - A 35-year-old woman presents with a gradual loss of night vision over the...

    Incorrect

    • A 35-year-old woman presents with a gradual loss of night vision over the past few months. On examination, she has also lost peripheral vision. She reports that her mother had a similar problem and became blind in her early 40s.
      What is the most probable diagnosis? Choose ONE answer only.

      Your Answer: Multiple sclerosis

      Correct Answer: Retinitis pigmentosa

      Explanation:

      Retinitis pigmentosa (RP) is a group of inherited disorders that cause progressive peripheral vision loss and difficulty seeing in low light, which can eventually lead to central vision loss. RP is often diagnosed based on the hallmark symptom of night blindness, and can be inherited in different ways. While there is no cure for RP, patients can receive low-vision evaluations and medications such as vitamins and calcium-channel blockers to help manage their symptoms. Glaucoma is another eye disease that can cause vision loss, particularly in older adults, but the patient’s symptoms and age do not suggest a diagnosis of primary open-angle glaucoma. Leber’s congenital amaurosis is a rare eye disorder that affects infants and young children, and is characterized by severe visual impairment, photophobia, and nystagmus, which is not consistent with the patient’s symptoms. Multiple sclerosis is an immune-mediated disease that can cause optic neuritis, but the patient’s symptoms do not match those typically associated with this condition. Vitreous hemorrhage is a condition where blood leaks into the vitreous body of the eye, causing visual disturbances such as floaters and cloudy vision, but the patient’s symptoms do not suggest this diagnosis either.

    • This question is part of the following fields:

      • Ophthalmology
      23
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  • Question 9 - A 72-year-old retired teacher visits the doctor with a painless gradual loss of...

    Incorrect

    • A 72-year-old retired teacher visits the doctor with a painless gradual loss of vision. She reports difficulty reading as the words on the page are becoming harder to see. Additionally, she notices that straight lines in her artwork are appearing distorted, which is confirmed by Amsler grid testing. What is the probable diagnosis?

      Your Answer: Wet age-related macular degeneration

      Correct Answer: Dry age-related macular degeneration

      Explanation:

      The most likely diagnosis for this patient’s gradual central loss of vision and difficulty reading is dry age-related macular degeneration. This subtype accounts for the majority of cases of macular degeneration and typically presents with a gradual loss of vision. Glaucoma and retinal detachment are unlikely diagnoses as they present with different symptoms such as peripheral vision loss and sudden vision loss with flashes and floaters, respectively.

      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.

    • This question is part of the following fields:

      • Ophthalmology
      15.3
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  • Question 10 - A 28-year-old woman visits her GP complaining of a red left eye. She...

    Correct

    • A 28-year-old woman visits her GP complaining of a red left eye. She experiences a gritty sensation and feels the need to blink frequently to clear her vision. There is no pain or photophobia, and her pupil size is normal. She reports a significant amount of discharge from the affected eye and recently had a cold. What is the probable diagnosis?

      Your Answer: Conjunctivitis

      Explanation:

      Conjunctivitis is a common condition that can be identified by symptoms such as redness in the eye, a gritty sensation, swollen conjunctivae, and discharge that crusts the eyelashes. However, if a patient presents with severe eye pain, photophobia, a small or abnormal shaped pupil, or blurred vision, it may indicate iritis and require urgent referral to an ophthalmologist. Similarly, acute glaucoma can cause severe eye pain, halos, blurred vision, nausea, and vomiting, while keratitis can cause a painful, red eye with tearing, discharge, and decreased vision, particularly in contact lens wearers.

      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.

    • This question is part of the following fields:

      • Ophthalmology
      18.8
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  • Question 11 - A 57-year-old man presents with papilloedema during examination. What could be the possible...

    Incorrect

    • A 57-year-old man presents with papilloedema during examination. What could be the possible cause?

      Your Answer: Hypercalcaemia

      Correct Answer: Hypercapnia

      Explanation:

      In emergency situations, inducing hypocapnia through hyperventilation may be employed as a means to decrease intracranial pressure.

      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.

    • This question is part of the following fields:

      • Ophthalmology
      26.1
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  • Question 12 - A 26-year-old man presents to the emergency department with complaints of left eye...

    Incorrect

    • A 26-year-old man presents to the emergency department with complaints of left eye pain. He has been unable to wear his contact lenses for the past day due to the severity of the pain. He describes the pain as intense and wonders if there is something lodged in his eye. Upon examination, diffuse hyperemia is observed in the left eye. The left cornea appears hazy, and there is a hypopyon present. Pupillary reaction is normal, but visual acuity is reduced on the left side, and the patient experiences some photophobia. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Keratitis

      Explanation:

      A hypopyon in anterior uveitis can be seen, but a normal pupillary reaction and contact lens use suggest a diagnosis of keratitis.

      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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 13 - A 45-year-old woman presents to the Ophthalmology department with a 3-day history of...

    Incorrect

    • A 45-year-old woman presents to the Ophthalmology department with a 3-day history of an increasingly painful and swollen left eye. She complains of blurring of vision and pain, especially with eye movements.
      On examination, visual acuity is 6/24 in the left and 6/6 in the right. The periorbital area of the left eye is very swollen and erythematous. The eye itself is red and proptosed. The conjunctiva is chemosed. Eye movements in the left eye are quite restricted in all directions. There is relative afferent pupillary defect on the left. Fundoscopy shows a swollen optic disc in the left eye. Vital observations are as follows:
      Blood pressure 130/80 mmHg
      Heart rate 80 bpm
      Respiratory rate 20 per minute
      Oxygen saturation 97% on air
      Temperature 38.2 °C
      Computed tomography (CT) scan shows some opacities in the ethmoid sinuses.
      What is the definitive treatment for this eye problem?

      Your Answer:

      Correct Answer: Drainage of the ethmoid sinuses

      Explanation:

      Treatment Options for Ethmoidal Sinusitis and Orbital Cellulitis

      Ethmoidal sinusitis is a common cause of orbital cellulitis, which requires prompt treatment to prevent complications. The most effective treatment for ethmoidal sinusitis is surgical drainage of the sinuses to remove the pus and debris. Antibiotics are also necessary to aid recovery, but they should be administered after the drainage procedure.

      While there are several antibiotics that can be used to treat orbital cellulitis, such as cefuroxime, metronidazole, co-amoxiclav, and Tazocin®, they are not sufficient to address the underlying cause of the condition. Therefore, drainage of the ethmoid sinuses is the definitive treatment for ethmoidal sinusitis and orbital cellulitis.

      In summary, the treatment options for ethmoidal sinusitis and orbital cellulitis include surgical drainage of the sinuses followed by antibiotics. Antibiotics alone are not enough to treat the condition, and the choice of antibiotic may vary depending on the patient’s age and other factors.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 14 - A 55-year-old female patient arrived at the emergency department complaining of intense pain...

    Incorrect

    • A 55-year-old female patient arrived at the emergency department complaining of intense pain in her left eye, along with redness and sensitivity to light. Upon examination, her intraocular pressure was found to be elevated at 30 mmHg, and her pupil was mid-dilated. After diagnosing her with acute angle closure glaucoma, you promptly administered IV acetazolamide and topical pilocarpine. What is the definitive treatment for this condition?

      Your Answer:

      Correct Answer: Laser peripheral iridotomy in both eyes

      Explanation:

      The definitive treatment for acute angle-closure glaucoma is laser peripheral iridotomy, which creates an additional pathway in the iris for aqueous to flow from the posterior chamber to the anterior chamber and be drained into the angle. While topical beta blockers, alpha agonists, prostaglandin analogues, and carbonic anhydrase inhibitors can all help control intraocular pressure in glaucoma patients, they are not considered definitive treatments for AACG.

      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 dilatation, and lens growth associated with age. Symptoms of AACG include severe pain, decreased visual acuity, haloes 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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 15 - In people aged 45-64, what is the most frequent cause of blindness? Choose...

    Incorrect

    • In people aged 45-64, what is the most frequent cause of blindness? Choose ONE option from the list provided.

      Your Answer:

      Correct Answer: Diabetic retinopathy

      Explanation:

      Common Eye Conditions: Causes and Prevalence

      Diabetes can lead to various ophthalmic complications, including glaucoma, cataracts, and neuropathies, but the most common and potentially blinding is diabetic retinopathy. This condition accounts for 12% of all new cases of blindness in developed countries and is the leading cause of new blindness in people aged 25-64 years. Glaucoma, a group of eye diseases that damage the optic nerve, is more prevalent in the aging population, with up to 15% affected by the seventh decade of life. Age-related macular degeneration (AMD) is the most common cause of irreversible vision loss in the developed world, with non-exudative (dry) AMD comprising more than 90% of patients diagnosed with AMD. Optic atrophy, a sign of many disease processes, can cause changes in the color and structure of the optic disc associated with variable degrees of visual dysfunction. Finally, corneal abrasion, caused by a disruption in the integrity of the corneal epithelium or physical external forces, is the most common eye injury. While most people recover fully from minor corneal abrasions, deeper scratches can cause long-term vision problems if not treated properly.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 16 - A 30-year-old male with a history of ankylosing spondylitis presents to his GP...

    Incorrect

    • A 30-year-old male with a history of ankylosing spondylitis presents to his GP with complaints of eye pain and sensitivity to light. He wears glasses for nearsightedness and this is his first occurrence, affecting only his right eye. Upon examination, his right eye has a visual acuity of 6/6 while his left eye is corrected to 6/18. The left pupil is misshapen and the eye is red, but the cornea appears clear. What is the most likely diagnosis for this patient?

      Your Answer:

      Correct Answer: Anterior uveitis

      Explanation:

      Ankylosing spondylitis is commonly associated with anterior uveitis, which presents with symptoms such as a misshapen pupil, red eye, and reduced vision. This condition involves both eyes and is more likely than other eye conditions. Retinal detachment does not cause eye pain.

      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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 17 - A 25-year-old female patient complains of red, itchy, and sore eyelids with crusts...

    Incorrect

    • A 25-year-old female patient complains of red, itchy, and sore eyelids with crusts on the eyelashes and a gritty feeling in both eyes. What is the primary treatment for this condition?

      Your Answer:

      Correct Answer: Eyelid hygiene with warm compresses, lid massage and lid margin cleaning

      Explanation:

      The initial step in treating blepharitis is to apply hot compresses to the affected area. This is followed by eyelid hygiene, which involves cleaning the lid margins and massaging them. If this does not work, chloramphenicol eye drops and oral antibiotics may be prescribed. Oily tear eye drops can be used to prevent rapid evaporation of tears caused by blepharitis. While an omega-3 rich diet may help improve the condition, it is not considered a first-line treatment.

      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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 18 - A 42-year-old woman presents with a sudden onset of vision loss in her...

    Incorrect

    • A 42-year-old woman presents with a sudden onset of vision loss in her left eye. She reports experiencing pain with eye movement and a decrease in colour vision. She has no significant medical history and is not taking any medications.

      During the examination, her left eye has a visual acuity of 6/6 while her right eye has a visual acuity of 6/24. A relative afferent pupillary defect is observed in her left eye, and visual field testing reveals a central scotoma in the left eye.

      What is the most probable cause of her symptoms?

      Your Answer:

      Correct Answer: Optic neuritis

      Explanation:

      A central scotoma is a common feature of optic neuritis, along with visual loss, periocular pain, and dyschromatopsia (change in colour perception). Other classic signs on examination include a relative afferent pupillary defect. Unlike open-angle glaucoma, which typically causes painless, gradual loss of peripheral vision, optic neuritis often affects the central vision. Anterior ischaemic optic neuropathy, on the other hand, causes sudden, painless loss of vision and is more common in people over 50. Optic nerve glioma, which is rare after age 20 and may be associated with neurofibromatosis, can cause visual defects and headaches but is not typically associated with eye movement pain or colour desaturation.

      Optic neuritis is a condition that can be caused by multiple sclerosis, diabetes, or syphilis. It is characterized by a decrease in visual acuity in one eye over a period of hours or days, as well as poor color discrimination and pain that worsens with eye movement. Other symptoms include a relative afferent pupillary defect and a central scotoma. The condition can be diagnosed through an MRI of the brain and orbits with gadolinium contrast. Treatment typically involves high-dose steroids, and recovery usually takes 4-6 weeks. If an MRI shows more than three white-matter lesions, the risk of developing multiple sclerosis within five years is approximately 50%.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 19 - A 62-year-old man presents to the Ophthalmology Clinic with elevated intraocular pressure and...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 20 - A 68-year-old man complains of a burning sensation around his left eye. Upon...

    Incorrect

    • A 68-year-old man complains of a burning sensation around his left eye. Upon examination, a rash with erythematous blisters is visible in the left trigeminal distribution. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Herpes zoster ophthalmicus

      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.

    • This question is part of the following fields:

      • Ophthalmology
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