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Question 1
Correct
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A 77-year-old retired engineer presents with a burning sensation around his right eye. On examination, an erythematous blistering rash can be seen in the right trigeminal distribution. Which of the following is the most likely diagnosis?
Your Answer: Herpes zoster ophthalmicus
Explanation:Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10% of case of shingles. Features include a vesicular rash around the eye, which may or may not involve the actual eye itself, and Hutchinson’s sign: a rash on the tip or side of the nose, indicating nasociliary involvement and is a strong risk factor for ocular involvement.
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This question is part of the following fields:
- Ophthalmology
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Question 2
Correct
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A 29-year-old accountant presents to the emergency department complaining of left eye pain. He has not been able to wear his contact lenses for the past 24 hours due to the pain. He describes the pain as severe and wonders whether he has 'got something stuck in his eye'. On examination, there is diffuse hyperaemia of the left eye. The left cornea appears hazy and pupillary reaction is normal. Visual acuity is reduced on the left side and a degree of photophobia is noted. A hypopyon is also seen. Which of the following is the most likely diagnosis?
Your Answer: Keratitis
Explanation:Hypopyon can be seen in anterior uveitis, however the combination of a normal pupillary reaction and contact lens use make a diagnosis of keratitis more likely. Keratitis describes inflammation of the cornea, and features include red eye with pain and erythema, photophobia, and foreign body/gritty sensation.
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This question is part of the following fields:
- Ophthalmology
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Question 3
Correct
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A 61-year-old chef with a known history of Paget's disease is noted to have irregular dark red lines radiating from the optic nerve. Which of the following is the most likely diagnosis?
Your Answer: Angioid retinal streaks
Explanation:Angioid retinal streaks are seen on fundoscopy as irregular dark red streaks radiating from the optic nerve head. They are caused by degeneration, calcification and breaks in Bruch’s membrane. They are typically associated with Paget’s disease.
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This question is part of the following fields:
- Ophthalmology
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Question 4
Correct
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A 59-year-old marketing manager presents with a persistent watery left eye for the past 4 days. On examination there is erythema and swelling of the inner canthus of the left eye. Which of the following is the most likely diagnosis?
Your Answer: Dacryocystitis
Explanation:Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac. It causes pain, redness, a watering eye (epiphora), and swelling and erythema at the inner canthus of the eye. Management is with systemic antibiotics. IV antibiotics are indicated if there is associated periorbital cellulitis.
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This question is part of the following fields:
- Ophthalmology
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Question 5
Correct
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A 30-year-old female diagnosed with rapidly progressive glomerulonephritis complains of pain and redness in the right eye. Which part of the eye is causing these symptoms in this case?
Your Answer: Sclera
Explanation:Rheumatoid Scleritis is a painful inflammatory condition of the sclera in patients with rheumatoid arthritis. It might be diffuse, nodular, or necrotizing in nature. This occurs mostly in the sixth decade of life and mostly when the rheumatoid disease is in remission. Sclera is the first ocular manifestation in a patient of rheumatoid arthritis. This inflammation might later spread to the adjacent ocular structures like the cornea, causing keratitis, the uveal tract causing uveitis and the lens causing cataracts.
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This question is part of the following fields:
- Ophthalmology
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Question 6
Correct
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A 55 year old man experiences sudden loss of vision preceded by the perception of something he describes as jagged lines or 'heat waves'. He's known to be myopic. What is the best treatment?
Your Answer: Scleral buckling
Explanation:The clinical picture is characteristic of retinal detachment, which should be treated immediately to prevent permanent loss of vision. Scleral buckling is a surgical procedure used to repair a retinal detachment, where the surgeon attaches a piece of silicone or a sponge onto the white of the eye at the spot of a retinal tear pushing the sclera toward the retinal tear or break, promoting repair. Signs of detachment include an increase in the number of eye floaters, flashes of light in the field of vision, and reduced peripheral vision.
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This question is part of the following fields:
- Ophthalmology
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Question 7
Correct
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A 70 year old female presented with a throbbing and continuous headache and loss of vision. Her ESR was elevated. Which of the following is the most appropriate management?
Your Answer: Corticosteroids
Explanation:Giant Cell Arteritis (Temporal Arteritis) is the most probable diagnosis. GCA should always be considered in the differential diagnosis of a new-onset headache in patients 50 years of age or older with an elevated erythrocyte sedimentation rate. Temporal artery biopsy remains the criterion standard for diagnosis of this granulomatous vasculitis. High-dose corticosteroid therapy is the universally accepted treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 8
Correct
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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
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Question 9
Incorrect
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A 70 year old male complained of poor vision at night which has gradually worsened with time. He has changed his glasses several times but there has been no improvement. On examination his pupils and cornea were normal. Which of the following is the most probable diagnosis?
Your Answer: Glaucoma
Correct Answer: Cataract
Explanation:Senile cataract is an age-related, vision-impairing disease characterized by gradual progressive clouding and thickening of the lens of the eye. Patients with senile cataracts often present with a history of gradual progressive visual deterioration and disturbance in night and near vision.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Correct
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A 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: 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.
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This question is part of the following fields:
- Ophthalmology
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