-
Question 1
Incorrect
-
A 27-year-old female visited the OPD with a complaint of visual disturbance, eye pain, pain in the knee and hands, and a rash on her face. On examination, the rash was the shape of a butterfly, and the joints were mildly swollen. The eyes of the patient were found to be red with irregular pupils. Where do you think the problem lies?
Your Answer: Ciliary body
Correct Answer: Iris
Explanation:The patient’s symptoms are suggestive of ankylosing spondylitis which is often accompanied by iritis, the cause of this patient’s red eye.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 2
Incorrect
-
An 84-year-old retired police officer presents to the neurology clinic with double vision and unsteadiness whilst walking. He has a past medical history of hypertension, hypercholesterolemia and type 2 diabetes. On examination, you notice a right partial ptosis and miosis. The patient also has notable right facial loss of pain and temperature sensation with left sided truncal sensory loss contralateral to the face. In the clinic, apraclonidine eye drops are added to the affected eye, which causes a dilatation, whilst in the opposite eye, a pupil constriction occurs. After the eye drops have been eliminated from the body, 1% hydroxyamphetamine eye drops are then instilled. One hour after instillation, both pupils dilate. Which order of neurons is most likely affected in the sympathetic pathway?
Your Answer: Second order
Correct Answer: First order
Explanation:Apraclonidine eye drops are initially used to confirm a Horner’s pupil. Apraclonidine stimulates both alpha-1 and alpha-2 receptors. When added to the affected eye, it causes pupil dilation by >2mm because of the relative super sensitivity of this pupil to alpha-1 receptor activity. In a normal pupil, however, it causes constriction due to the more potent activity at the alpha-2 receptor which triggers re-uptake of noradrenaline in the synaptic cleft.
Hydroxy amphetamine is then used to distinguish between first/second or third order neurones. In other words, it will distinguish either a lesion in the brainstem, cervical cord, chest or neck and one affecting above the superior cervical ganglion at the carotid bifurcation. In a normal pupil or a first/second order Horner’s, the pupil will dilate secondary to increased levels of noradrenaline released from the post-synaptic neurones. In a third order neurone, this will not occur. There is no fourth or fifth order neurone.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 3
Incorrect
-
A 38-year-old chef is brought into the emergency department by her husband. He reports that she has been confused for the last 3 days. She has a long-standing history of severe psoriasis but no other past medical history. Basic observations are all within normal range and a CT head is unremarkable. A fundoscopy exam reveals bilateral papilledema. Which of the following is the most likely cause?
Your Answer: Hydrocephalus
Correct Answer: Vitamin A toxicity
Explanation:Vitamin A toxicity is a rare cause of papilledema. In this case, the patient is likely to have been taking retinoids for psoriasis.
Encephalitis does not usually present with papilledema. Brain abscess, brain tumour and hydrocephalus are all less likely with a normal CT head.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 4
Correct
-
A 54-year-old man experienced a gradual decrease in vision of one eye after being diagnosed with type 2 diabetes mellitus. Macula oedema is noted on his fundoscopy. Which of the following is the most likely diagnosis?
Your Answer: Diabetic retinopathy
Explanation:Macular disease can affect central vision at any stage of diabetic retinopathy and may be seen in type 2 diabetic patients. Diabetic retinopathy affects up to 80 percent of those who have had diabetes for 20 years or more. Macular oedema occurs when damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, which blurs vision.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 5
Correct
-
Which of the following statements regarding macular degeneration is true?
Your Answer: Wet macular degeneration carries the worst prognosis
Explanation:Traditionally two forms of macular degeneration are seen:
– Dry (geographic atrophy) macular degeneration is characterized by drusen – yellow round spots in Bruch’s membrane.
– Wet (exudative, neovascular) macular degeneration is characterized by choroidal neovascularization. Leakage of serous fluid and blood can subsequently result in a rapid loss of vision. This carries the worst prognosis. -
This question is part of the following fields:
- Ophthalmology
-
-
Question 6
Incorrect
-
A 30-year-old female presented in the ophthalmology ward complaining of blurry vision for 4 days. Fundoscopy of both eyes revealed cotton wool spots in both the retinas. What is the most likely cause of this condition?
Your Answer: Cryptococcal infection
Correct Answer: CMV infection
Explanation:Fundoscopy findings of cotton wool spots and retinal tears, accompanied by a history of blurred vision, are characteristic of retinitis. Cytomegalovirus is known to cause retinitis.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 7
Incorrect
-
A 44-year-old physiotherapist with a history of rheumatoid arthritis presents with a painful, red left eye. Visual acuity is normal. Fundoscopy is also unremarkable. Which of the following is the most likely diagnosis?
Your Answer: Keratoconjunctivitis sicca
Correct Answer: Scleritis
Explanation:Scleritis, or inflammation of the sclera, is usually painful whereas episcleritis is not painful.
Keratoconjunctivitis sicca is usually bilateral and associated more with dryness, burning and itching.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 8
Incorrect
-
A 39-year-old professor presents with visual problems. He has had very poor vision in the dark for a long time but is now worried as he is developing 'tunnel vision'. He states his grandfather had a similar problem and went blind in his 50's. Which of the following is the most likely diagnosis?
Your Answer: Primary open angle glaucoma
Correct Answer: Retinitis pigmentosa
Explanation:Retinitis pigmentosa primarily affects the peripheral retina resulting in tunnel vision. Night blindness is often the initial sign. Tunnel vision occurs due to loss of the peripheral retina (occasionally referred to as funnel vision).
Fundoscopy exam reveals black bone spicule-shaped pigmentation in the peripheral retina, and mottling of the retinal pigment epithelium. -
This question is part of the following fields:
- Ophthalmology
-
-
Question 9
Correct
-
A 49-year-old woman suddenly experienced complete loss of vision in her right eye. Fundoscopy results show a pale retina, and a cherry red spot on the macular region. She also experienced right sided headaches aggravated by chewing. What caused her vision loss?
Your Answer: CRAO
Explanation:Central retinal artery occlusion (CRAO) is a disease of the eye where the flow of blood through the central retinal artery is blocked (occluded). There are several different causes of this occlusion; the most common is carotid artery atherosclerosis. It causes sudden vision loss in one eye. Fundoscopic exam will show a red lesion, called a cherry red spot, with surrounding pale retina (the pale colour is caused by ischemia of the retina)
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 10
Incorrect
-
An 87-year-old woman presents with 'funny spots' affecting her vision. Over the past week she has noticed a number of flashes and floaters in the visual field of the right eye. Which of the following is the most likely diagnosis?
Your Answer: Retinal detachment
Correct Answer: Posterior vitreous detachment
Explanation:Posterior vitreous detachment is thought to occur in up to 50-75% of the population over 65 years and is the most likely diagnosis here. Patients should be reviewed by an ophthalmologist to assess the risk of progressing to retinal detachment. Flashes of light (photopsia) occur in the peripheral field of vision while floaters often occur on the temporal side of the central vision.
-
This question is part of the following fields:
- Ophthalmology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
