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  • Question 1 - A 45-year-old with type 2 diabetes is found to have new vessel formation...

    Incorrect

    • A 45-year-old with type 2 diabetes is found to have new vessel formation on the optic disc on fundoscopy.
      Which of the following is the best intervention?

      Your Answer: Tighter control of HbA1c

      Correct Answer: Laser treatment

      Explanation:

      Managing Diabetic Retinopathy: Treatment Options and Risk Factors

      Diabetic retinopathy is a common complication of diabetes that can lead to blindness if left untreated. Laser photocoagulation is a non-invasive treatment option that has a high success rate and low complication rate. Focal laser photocoagulation is used to treat specific microaneurysms, while a grid pattern of laser burns is applied for non-specific leakage. Other important factors in managing diabetic retinopathy include controlling blood pressure, optimizing cholesterol levels, and maintaining HbA1c levels in the 6-7% range. Patients with diabetes should also be monitored for other ophthalmic complications, such as glaucoma and neuropathies. Risk factors for diabetic retinopathy include age at diabetes onset, serum triglyceride and total cholesterol levels, serum creatinine levels, and hypertension. Early detection and treatment of diabetic retinopathy can prevent blindness and improve long-term outcomes for patients with diabetes.

    • This question is part of the following fields:

      • Ophthalmology
      12.7
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  • Question 2 - A 62-year-old woman presents to the General Practitioner. She has a past medical...

    Incorrect

    • A 62-year-old woman presents to the General Practitioner. She has a past medical history of hypertension, diabetes mellitus type II, peripheral vascular disease and ischaemic heart disease. The patient had an episode of retinal artery occlusion (RAO) and had to go to the Eye Hospital as an emergency.
      After many investigations, the Ophthalmologist stated that the cause of her RAO is atherosclerosis of her central retinal artery (CRA). The patient is worried about her eyesight becoming worse and asks about long-term management plans for RAO.
      Which of the following is considered part of the long-term management plan for RAO?
      Select the SINGLE most appropriate management from the list below.

      Your Answer: Prophylaxis with an anticoagulation agent

      Correct Answer: Prophylaxis with an antiplatelet agent

      Explanation:

      Retinal artery occlusion is a condition that increases the risk of ischemic end-organ damage, such as stroke. Long-term management involves identifying and addressing underlying causes, reducing risk factors for atherosclerosis, and considering carotid endarterectomy if necessary. Ophthalmic follow-up and referral to low-vision-aid clinics may also be necessary. Acute treatment options include ocular massage, intra-arterial fibrinolysis, and lowering intraocular pressure with anterior chamber paracentesis. Atherosclerosis and embolism are the main causes of RAO, and prophylaxis with an antiplatelet or anticoagulation agent may be necessary for long-term management. However, even with early treatment, the prognosis is generally poor, and only about one-third of patients show any improvement.

    • This question is part of the following fields:

      • Ophthalmology
      34
      Seconds
  • Question 3 - A 28-year-old male comes to the Emergency Department complaining of a severely painful,...

    Incorrect

    • A 28-year-old male comes to the Emergency Department complaining of a severely painful, reddened right-eye that has been bothering him for the past 6 hours. He reports experiencing reduced visual acuity and seeing halos around light. The patient has a history of hypermetropia. Upon examination, the right-eye appears red with a fixed and dilated pupil and conjunctival injection. What is the most probable diagnosis?

      Your Answer: Anterior uveitis

      Correct Answer: Acute closed-angle glaucoma

      Explanation:

      The correct diagnosis is acute closed-angle glaucoma, which is characterized by an increase in intra-ocular pressure due to impaired aqueous outflow. Symptoms include a painful red eye, reduced visual acuity, and haloes around light. Risk factors include hypermetropia, pupillary dilatation, and age-related lens growth. Examination findings typically include a fixed dilated pupil with conjunctival injection. Treatment options include reducing aqueous secretions with acetazolamide and increasing pupillary constriction with topical pilocarpine.

      Anterior uveitis is an incorrect diagnosis, as it refers to inflammation of the anterior portion of the uvea and is associated with systemic inflammatory conditions. A key ophthalmoscopy finding is an irregular pupil.

      Central retinal vein occlusion is also an incorrect diagnosis, as it causes acute blindness due to thromboembolism or vasculitis in the central retinal vein. Severe retinal haemorrhages are seen on ophthalmoscopy.

      Infective conjunctivitis is another incorrect diagnosis, as it is characterized by sore, red eyes with discharge. Bacterial causes typically result in purulent discharge, while viral cases often have serous discharge.

      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
      22.1
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  • Question 4 - A 40-year-old man comes to the clinic complaining of visual difficulties. He reports...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Ophthalmology
      25.2
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  • Question 5 - A 27-year-old female patient complains of a painful and red left eye that...

    Incorrect

    • A 27-year-old female patient complains of a painful and red left eye that has been bothering her for a day. She reports continuous tearing from the affected eye and experiences photophobia. Upon examination, fluorescein staining reveals a small, feathery area of abnormal uptake. However, her visual acuity is 6/6 in both eyes. What is the best course of action for management?

      Your Answer: Topical aciclovir and review in 2 days

      Correct Answer: Refer immediately to ophthalmology

      Explanation:

      The patient’s symptoms suggest the possibility of a corneal abrasion or dendritic corneal ulcer, with photophobia being a key indicator. However, the feathery pattern observed is more indicative of herpes simplex keratitis. Urgent review by an ophthalmologist is necessary, and caution should be exercised in prescribing topical steroids as they may exacerbate the infection.

      Understanding Herpes Simplex Keratitis

      Herpes simplex keratitis is a condition that affects the cornea of the eye and is caused by the herpes simplex virus. The most common symptom of this condition is a dendritic corneal ulcer, which can cause a red, painful eye, photophobia, and epiphora. In some cases, visual acuity may also be decreased. Fluorescein staining may show an epithelial ulcer, which can help with diagnosis. One common treatment for this condition is topical aciclovir, which can help to reduce the severity of symptoms and prevent further damage to the cornea.

    • This question is part of the following fields:

      • Ophthalmology
      30
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  • Question 6 - A young patient presents with a painful red eye.
    Which of the following findings...

    Correct

    • A young patient presents with a painful red eye.
      Which of the following findings is more suggestive of acute conjunctivitis than anterior uveitis?

      Your Answer: Profuse discharge

      Explanation:

      Understanding the Symptoms of Acutely Painful Red Eye

      A red eye can be a sign of various eye conditions, including conjunctivitis, anterior uveitis, scleritis, and more. One of the most common symptoms of conjunctivitis is profuse discharge, which can cause the eyelids to stick together on waking. On the other hand, anterior uveitis can cause blurred vision, small pupil, and photophobia. Scleritis, an inflammatory disease that affects the sclera, can cause severe pain that worsens with eye movement and may radiate to the forehead or jaw. It’s essential to seek medical attention promptly if you experience any of these symptoms, as they can indicate a serious underlying condition.

    • This question is part of the following fields:

      • Ophthalmology
      15.4
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  • Question 7 - A 75-year-old patient with a history of hypertensive retinopathy comes in for an...

    Correct

    • A 75-year-old patient with a history of hypertensive retinopathy comes in for an eye examination. Upon fundoscopy, only retinal arteriole tortuosity is observed without any other abnormalities. Based on the Keith-Wagener classification, what grade of hypertensive retinopathy is most likely represented in this case?

      Your Answer: Grade 1

      Explanation:

      Grade 1 hypertensive retinopathy is characterized by tortuosity and silver wiring on fundoscopy, while Grade 0 would show no abnormal findings despite a diagnosis of hypertension.

      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.

    • This question is part of the following fields:

      • Ophthalmology
      12.6
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  • Question 8 - A 78-year-old woman visits her GP complaining of a gradual loss of vision...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ophthalmology
      24.7
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  • Question 9 - A 82-year-old man comes to the clinic complaining of sudden loss of vision...

    Correct

    • A 82-year-old man comes to the clinic complaining of sudden loss of vision in his left eye since this morning. He denies any associated eye pain or headaches and is otherwise feeling well. His medical history includes ischaemic heart disease. Upon examination, the patient has no vision in his left eye. The left pupil shows poor response to light, but the consensual light reaction is normal. Fundoscopy reveals a red spot over a pale and opaque retina. What is the most probable diagnosis?

      Your Answer: Central retinal artery occlusion

      Explanation:

      Central Retinal Artery Occlusion: A Rare Cause of Sudden Vision Loss

      Central retinal artery occlusion is a rare condition that can cause sudden, painless loss of vision in one eye. It is typically caused by a blood clot or inflammation in the artery that supplies blood to the retina. This can be due to atherosclerosis or arteritis, such as temporal arteritis. Symptoms may include a relative afferent pupillary defect and a cherry red spot on a pale retina. Unfortunately, the prognosis for this condition is poor, and management can be difficult. Treatment may involve identifying and addressing any underlying conditions, such as intravenous steroids for temporal arteritis. In some cases, intraarterial thrombolysis may be attempted, but the results of this treatment are mixed. Overall, central retinal artery occlusion is a serious condition that requires prompt medical attention.

    • This question is part of the following fields:

      • Ophthalmology
      33.9
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  • Question 10 - A 78-year-old man comes to the clinic complaining of a swollen left upper...

    Correct

    • 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.

    • This question is part of the following fields:

      • Ophthalmology
      79.5
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  • Question 11 - A 48-year-old woman presents to the emergency department with complaints of facial and...

    Incorrect

    • A 48-year-old woman presents to the emergency department with complaints of facial and eye pain. She has been experiencing a severe upper respiratory tract infection for the past two weeks, with purulent nasal discharge and fever. Upon examination, there is noticeable proptosis of the left eye, accompanied by ophthalmoplegia. The palpebra is red and swollen. Her temperature is 39.2 ºC and she appears unwell. She has a medical history of well-controlled type 1 diabetes mellitus. What is the immediate management plan for the most likely diagnosis?

      Your Answer: Refer for an urgent contrast CT head

      Correct Answer: Admit for intravenous antibiotics

      Explanation:

      Patients diagnosed with orbital cellulitis should be admitted to the hospital for intravenous antibiotics due to the potential risk of cavernous sinus thrombosis and intracranial spread. This condition is characterized by symptoms such as proptosis, ophthalmoplegia, fever, and eyelid swelling and redness, which are specific to orbital cellulitis and absent in preseptal cellulitis. Oral antibiotics or discharge with oral antibiotics are not appropriate treatment options for orbital cellulitis, as they are reserved for preseptal cellulitis. Referring the patient for an urgent contrast CT head is not the immediate management priority, as empirical IV antibiotics should be initiated promptly to prevent further spread of the infection.

      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.

    • This question is part of the following fields:

      • Ophthalmology
      22.7
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  • Question 12 - A 75-year-old man presents to his GP with a decline in his vision....

    Correct

    • A 75-year-old man presents to his GP with a decline in his vision. He describes a gradual onset of dark floaters in his vision over the past few months and has recently experienced some episodes of flashing lights when outside in bright sunlight. The patient has a history of hypertension, which is managed with 5mg ramipril daily. He has a smoking history of 45 pack-years, does not consume alcohol, and is able to perform his daily activities independently. What is the most probable diagnosis for this patient's vision changes?

      Your Answer: Vitreous detachment

      Explanation:

      The patient has flashers and floaters associated with vitreous detachment, which can lead to retinal detachment. This is not central retinal artery occlusion, ischaemic optic neuropathy, macular degeneration, or temporal arteritis.

      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
      34.3
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  • Question 13 - An 80-year-old woman presents with complaints of dry, gritty, and painful eyes bilaterally....

    Correct

    • An 80-year-old woman presents with complaints of dry, gritty, and painful eyes bilaterally. She has been experiencing these symptoms for a few years and has found little relief with frequent use of lubricating eye drops. Upon examination, both eyelids were crusted and had irregular margins. The meibomian orifices on both lids were obstructed with oily material. What is the underlying cause of this woman's dry eye condition?

      Your Answer: Meibomian blepharitis

      Explanation:

      When the tarsal glands are chronically infected, they can hinder the production of the precorneal tear film, which is responsible for slowing down the evaporation of tears. This can ultimately lead to dry eyes.

      The tarsal glands, also known as Meibomian glands, produce an oily substance that forms the outer layer of the precorneal tear film. This oily substance helps to prevent tear evaporation, while also improving tear stability and spreading. However, when Meibomian blepharitis occurs, the production of this oil is reduced, causing excessive water from the tear film to evaporate and resulting in dry eyes. None of the other options listed are relevant to this issue, as they do not involve dysfunction of the Meibomian glands.

      Understanding Dry Eye Syndrome

      Dry eye syndrome is a condition that causes discomfort in both eyes, with symptoms such as dryness, grittiness, and soreness that worsen throughout the day. Exposure to wind can also cause watering of the eyes. People with Meibomian gland dysfunction may experience symptoms that are worse upon waking, with eyelids sticking together and redness of the eyelids. In some cases, dry eye syndrome can lead to complications such as conjunctivitis or corneal ulceration, which can cause severe pain, photophobia, redness, and loss of visual acuity.

      Although there may be no abnormalities on examination, eyelid hygiene is the most appropriate management step for dry eye syndrome. This can help control blepharitis, which is a common condition associated with dry eye syndrome. By understanding the symptoms and appropriate management steps, individuals with dry eye syndrome can find relief and improve their overall eye health.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 14 - You assess a patient in the Emergency Department who was admitted after a...

    Correct

    • 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: 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
      17.1
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  • Question 15 - An 80-year-old man presents to you with a complaint of blurred vision that...

    Incorrect

    • An 80-year-old man presents to you with a complaint of blurred vision that has been worsening over the past 3 months. He has a medical history of type 2 diabetes and takes metformin. During the examination, you observe a shadow in the red reflex. What is the most probable diagnosis?

      Your Answer: Retinitis pigmentosa

      Correct Answer: Cataract

      Explanation:

      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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 16 - A 35-year-old woman came to your GP clinic with a cold sore and...

    Correct

    • A 35-year-old woman came to your GP clinic with a cold sore and left eye discomfort. She reported experiencing a red, painful eye with watering and sensitivity to light for the past 3 days. During fluorescein examination, you observed a dendritic ulcer on the cornea that was stained with fluorescein.

      What is the primary treatment for this condition?

      Your Answer: Topical aciclovir drops

      Explanation:

      The appropriate treatment for herpes simplex keratitis is the use of topical aciclovir. Antibiotics are ineffective against viral infections and should not be used. The use of steroids can worsen the condition and should be avoided. If the patient is already using topical steroids for another eye condition, the dosage should be decreased.

      Understanding Herpes Simplex Keratitis

      Herpes simplex keratitis is a condition that affects the cornea of the eye and is caused by the herpes simplex virus. The most common symptom of this condition is a dendritic corneal ulcer, which can cause a red, painful eye, photophobia, and epiphora. In some cases, visual acuity may also be decreased. Fluorescein staining may show an epithelial ulcer, which can help with diagnosis. One common treatment for this condition is topical aciclovir, which can help to reduce the severity of symptoms and prevent further damage to the cornea.

    • This question is part of the following fields:

      • Ophthalmology
      2.4
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  • Question 17 - 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
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  • Question 18 - A 35-year-old Arabic woman visits the GP clinic complaining of vision issues. She...

    Correct

    • A 35-year-old Arabic woman visits the GP clinic complaining of vision issues. She reports experiencing increasing haziness in both eyes for the past 2 years. Upon further inquiry, she discloses a history of recurrent tetany and seizures. During fundoscopy, you observe a lack of red reflex in both eyes. Additionally, both Chvostek sign and Trousseau sign are positive. She has no significant medical history and is not taking any medications. Her blood test results are as follows:
      HbA1c 40 mmol/mol
      What is the probable cause of her visual problem?

      Your Answer: Hypocalcaemia

      Explanation:

      The positive Chvostek and Trousseau signs, along with a history of tetany and convulsions, suggest that the patient is suffering from hypocalcaemia. This condition can lead to cataracts, which may explain the patient’s vision problems. It is unlikely that the cataracts are related to age, as the patient is still young. Hypercalcaemia is not a common cause of cataracts, and the patient is not taking steroids, which can also cause cataracts. Additionally, the patient’s normal HbA1c indicates that she does not have diabetes mellitus.

      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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 19 - During your FY2 rotation in General Practice, you saw a 76-year-old man in...

    Incorrect

    • During your FY2 rotation in General Practice, you saw a 76-year-old man in your GP clinic who had been experiencing blurring of vision in his right eye for the past 5 months. He finally decided to seek medical attention because he felt his vision was becoming increasingly distorted. Upon examination, there were no signs of inflammation in either eye, and both corneas were clear with no fluorescein uptake. However, on dilated fundoscopy, you noticed yellowish deposits in the center of the macula in his right eye. What is the curative treatment for this condition?

      Your Answer: Intravitreal anti-VEGF injection

      Correct Answer: None

      Explanation:

      Dry age-related macular degeneration, characterized by yellowish drusen deposits, currently has no cure. However, high doses of beta-carotene, vitamins C and E, and zinc can be administered to slow down the progression of visual loss. On the other hand, wet AMD can be treated with intravitreal anti-VEGF injections, laser photocoagulation, and photodynamic therapy.

      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
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  • Question 20 - A 62-year-old female presents with a red eye on one side that is...

    Incorrect

    • A 62-year-old female presents with a red eye on one side that is watering but not causing any pain. She has a history of well-managed Crohn's disease and reports feeling generally healthy. Her vital signs are normal. Upon examination, a small area of redness is observed, but there is no vision impairment, and the patient does not display any sensitivity to light. Eye drops are given, resulting in a brief whitening of the blood vessels. What is the probable diagnosis?

      Your Answer: Retrobulbar haemorrhage

      Correct Answer: Episcleritis

      Explanation:

      Episcleritis is a condition that can cause redness in the eye, but it is typically not accompanied by pain.

      Both episcleritis and scleritis can cause unilateral redness in the eye, tearing, and no sensitivity to light. However, a key difference between the two is that the use of phenylephrine or neosynephrine eye drops will cause the blood vessels in episcleritis to become pale, while this will not occur in scleritis.

      In contrast, closed-angle glaucoma often presents with a painful, red eye that is unilateral. The cornea may appear hazy, and the pupil may be mid-dilated. Patients may also experience nausea, vomiting, and see halos around lights.

      A stye, or hordeolum, is a bacterial infection of one of the glands in the eyelid. This can cause a tender, red bump on the edge of the eyelid.

      Retrobulbar hemorrhage can occur due to various factors, such as AV malformation, trauma, or increased venous pressure. Symptoms include a painful, red eye that may protrude, particularly at night. Patients may also experience reduced vision, nausea, vomiting, and double vision.

      Understanding Episcleritis

      Episcleritis is a condition that involves the sudden onset of inflammation in the episclera of one or both eyes. While the majority of cases are idiopathic, there are some associated conditions such as inflammatory bowel disease and rheumatoid arthritis. Symptoms of episcleritis include a red eye, mild pain or irritation, watering, and mild photophobia. However, unlike scleritis, episcleritis is typically not painful.

      One way to differentiate between the two conditions is by applying gentle pressure on the sclera. If the injected vessels are mobile, it is likely episcleritis. In contrast, scleritis involves deeper vessels that do not move. Phenylephrine drops may also be used to distinguish between the two conditions. If the eye redness improves after phenylephrine, a diagnosis of episcleritis can be made.

      Approximately 50% of cases of episcleritis are bilateral. Treatment for episcleritis is typically conservative, with artificial tears sometimes being used. Understanding the symptoms and differences between episcleritis and scleritis can help individuals seek appropriate treatment and management for their eye condition.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 21 - A 28-year-old pregnant woman came to your GP clinic complaining of mild pain...

    Incorrect

    • A 28-year-old pregnant woman came to your GP clinic complaining of mild pain and redness in both eyes that had been present for a week. During the examination, you noticed diffuse conjunctival injection with some purulent discharges and crusted eyelids. What is the ONE treatment you should initiate for this patient?

      Your Answer: Watch and wait

      Correct Answer: Fusidic acid eye drops

      Explanation:

      Pregnant women with bacterial conjunctivitis should use topical fusidic acid eye drops for treatment. It is not recommended to use chloramphenicol ointment or eye drops in pregnant patients. Oral antibiotics are typically unnecessary for treating bacterial conjunctivitis, and steroid eye drops are not effective. While viral conjunctivitis can be monitored without treatment, bacterial conjunctivitis requires prompt treatment with topical antibiotics to prevent a secondary bacterial infection.

      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
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  • Question 22 - A 75-year-old woman with age-related macular degeneration (AMD) presented to the emergency department...

    Incorrect

    • A 75-year-old woman with age-related macular degeneration (AMD) presented to the emergency department with a painless bloodshot right eye. She was very worried about her condition. The previous day, she had received an intravitreal injection for the treatment of AMD. Upon examination, her visual acuity had not decreased further, but there was bleeding under the conjunctiva around the injection site. What is the probable diagnosis?

      Your Answer: Endophthalmitis

      Correct Answer: Subconjunctival haemorrhage

      Explanation:

      It is important to inform patients about the possibility of developing subconjunctival haemorrhage after receiving intravitreal injections, as it is a common iatrogenic complication. This condition causes a red eye but is not painful and typically resolves within a couple of weeks.

      Understanding Subconjunctival Haemorrhage

      Subconjunctival haemorrhage occurs when blood vessels bleed into the subconjunctival space, usually those that supply the conjunctiva or episclera. Trauma is the most common cause, followed by spontaneous idiopathic cases, Valsalva manoeuvres, and several systemic diseases. Although subconjunctival haemorrhages can look alarming, they are rarely an indicator of anything sinister.

      Subconjunctival haemorrhages are more common in women than in men when there has been no history of trauma. The annual incidence of non-traumatic subconjunctival haemorrhages is 0.6%, and the risk increases with age as the risk factors are more common in elderly patients. Newborns are also more susceptible. The incidence of both traumatic and non-traumatic subconjunctival haemorrhages is 2.6%.

      The most common causes of subconjunctival haemorrhages are trauma and contact lens usage, which are often the sole risk factor in younger patients. Other risk factors include idiopathic causes, Valsalva manoeuvre, hypertension, bleeding disorders, drugs such as aspirin, NSAIDs and anticoagulants, diabetes, arterial disease, and hyperlipidaemia.

      Subconjunctival haemorrhages are mostly asymptomatic, but patients may experience mild irritation. The main sign is a flat, red patch on the conjunctiva with well-defined edges and normal conjunctiva surrounding it. Traumatic haemorrhages are most common in the temporal region, with the inferior conjunctiva as the next most commonly affected area. Vision should be normal, including acuity, visual fields, and range of eye movements. On examination, the fundus should be normal.

      The diagnosis of a subconjunctival haemorrhage is a clinical one. If there is no obvious traumatic cause, check the patient’s blood pressure. If raised, refer the patient appropriately. If the patient is taking warfarin, check the INR. If raised, refer for appropriate adjustments to the dose to bring the INR back into the target range. Recurrent or spontaneous, bilateral subconjunctival haemorrhages warrant investigations for bleeding disorders or other pathology.

      Reassure the patient that subconjunctival haemorrhage is a benign condition that will resolve on its own in 2 to

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 23 - A 65-year-old man presents to the ophthalmology clinic with a complaint of gradual...

    Incorrect

    • A 65-year-old man presents to the ophthalmology clinic with a complaint of gradual vision loss. During tonometry, his intraocular pressure is found to be 26mmHg and optic disc cupping is observed on fundoscopy. Visual field examination reveals peripheral visual loss. The physician prescribes timolol eye drops to be used twice daily. What is the mechanism of action of this medication?

      Your Answer: Decrease production of aqueous fluid and increase uveoscleral outflow

      Correct Answer: Decrease production of aqueous fluid

      Explanation:

      Timolol, a beta blocker, is effective in treating primary open-angle glaucoma by reducing the production of aqueous fluid. This condition is characterized by increased intraocular pressure due to inefficient drainage of fluid in the eye’s trabecular meshwork. Symptoms include gradual loss of vision, particularly in the peripheral fields. Brimonidine, an alpha-adrenergic agonist, also reduces aqueous fluid production and increases uveoscleral outflow. However, drugs that decrease uveoscleral outflow or increase aqueous fluid production would worsen the patient’s condition. Glucocorticoids can cause reduced drainage of aqueous humour and are implicated in causing open-angle glaucoma. Latanoprost, a prostaglandin analogue, increases uveoscleral outflow.

      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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 24 - A 25-year-old man comes to you complaining of severe, stabbing pain in his...

    Incorrect

    • A 25-year-old man comes to you complaining of severe, stabbing pain in his right eye that has been occurring once a day for the past few weeks. The pain lasts for about 30 minutes and he is often seen pacing around and shouting during these episodes. His wife reports that his right eye appears red and he has clear nasal discharge during the episodes. Based on this presentation, what advice would you give the patient to prevent further episodes?

      Your Answer: Sunlight

      Correct Answer: Alcohol

      Explanation:

      Cluster headaches are often triggered by alcohol, and they typically affect individuals of a certain age and gender.

      Cluster headaches are a type of headache that is known to be extremely painful. They are called cluster headaches because they tend to occur in clusters that last for several weeks, usually once a year. These headaches are more common in men and smokers, and alcohol and sleep patterns may trigger an attack. The pain typically occurs once or twice a day, lasting between 15 minutes to 2 hours. The pain is intense and sharp, usually around one eye, and is accompanied by redness, lacrimation, lid swelling, and nasal stuffiness. Some patients may also experience miosis and ptosis.

      To manage cluster headaches, 100% oxygen or subcutaneous triptan can be used for acute treatment, with response rates of 80% and 75% respectively within 15 minutes. Verapamil is the drug of choice for prophylaxis, and a tapering dose of prednisolone may also be effective. It is recommended to seek specialist advice from a neurologist if a patient develops cluster headaches, especially with respect to neuroimaging. Some neurologists use the term trigeminal autonomic cephalgia to group a number of conditions including cluster headache, paroxysmal hemicrania, and short-lived unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). Patients with these conditions should be referred for specialist assessment as specific treatment may be required, such as indomethacin for paroxysmal hemicrania.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 25 - 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
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  • Question 26 - A 30-year-old woman with type 1 diabetes mellitus arrives at the emergency department...

    Correct

    • A 30-year-old woman with type 1 diabetes mellitus arrives at the emergency department complaining of blurry vision in her left eye. She reports her vision in that eye as 'hazy and faded' which started a few hours ago. She also experiences pain that worsens with eye movement. There are no visible signs of trauma or infection on her eyes, and her recent HbA1c and capillary blood glucose levels are normal. What clinical manifestation is linked to the suspected diagnosis?

      Your Answer: Relative afferent pupillary defect (RAPD)

      Explanation:

      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 27 - 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: Glaucoma

      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 28 - A 45-year-old man with a chronic history of back pain visits his GP...

    Correct

    • A 45-year-old man with a chronic history of back pain visits his GP with complaints of left eye pain and sensitivity to light. Upon examination, the pupil appears small and oval-shaped, accompanied by ciliary congestion. What is the probable diagnosis?

      Your Answer: Anterior uveitis

      Explanation:

      It is possible that his chronic back pain is related to HLA-B27, which is often associated with anterior uveitis. As for his red eye, it could be indicative of either glaucoma or uveitis. Glaucoma typically presents with severe pain, haloes, and a semi-dilated pupil, while uveitis is characterized by a small, fixed oval pupil and ciliary flush.

      Understanding the Causes of Red Eye

      Red eye is a common condition that can be caused by various factors. It is important to identify the underlying cause of red eye to determine the appropriate treatment. In some cases, urgent referral to an ophthalmologist may be necessary. Here are some of the key distinguishing features of the different causes of red eye:

      Acute angle closure glaucoma is characterized by severe pain, decreased visual acuity, and haloes. The pupil may also be semi-dilated and the cornea hazy.

      Anterior uveitis presents with acute onset, pain, blurred vision, and photophobia. The pupil is small and fixed, and there may be ciliary flush.

      Scleritis is characterized by severe pain and tenderness, which may worsen with movement. It may also be associated with underlying autoimmune diseases such as rheumatoid arthritis.

      Conjunctivitis may be bacterial or viral, with purulent or clear discharge, respectively.

      Subconjunctival haemorrhage may be caused by trauma or coughing bouts.

      Endophthalmitis typically occurs after intraocular surgery and presents with red eye, pain, and visual loss.

      By understanding the different causes of red eye and their distinguishing features, healthcare professionals can provide appropriate management and referral when necessary.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 29 - A 68-year-old man complains of a burning sensation around his left eye. Upon...

    Correct

    • 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: 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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  • Question 30 - A 62-year-old man is referred to Ophthalmology with bilateral cataracts. He reports a...

    Correct

    • A 62-year-old man is referred to Ophthalmology with bilateral cataracts. He reports a gradual decline in his vision over the past few years and has difficulty reading small print. He is placed on the surgical waiting list.
      Which eye structure is most likely to be impacted by this ailment?

      Your 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.

    • This question is part of the following fields:

      • Ophthalmology
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