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Question 1
Incorrect
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A 54-year-old man presents to his General Practitioner with a three-day history of blurring of vision. He has a past medical history of hypertension, managed with amlodipine, ramipril, and indapamide, and type II diabetes mellitus, which is well controlled with metformin.
On examination, his visual acuity is 6/18 in both eyes with a reduction in colour vision. There is no relative afferent pupillary defect. On direct fundoscopy, the optic disc's margins are ill-defined and seem to be raised in both eyes. There are also some cotton-wool spots scattered around the retina in both eyes.
What is the most likely diagnosis?Your Answer: Proliferative diabetic retinopathy
Correct Answer: Hypertensive retinopathy
Explanation:Differentiating Hypertensive Retinopathy from Other Eye Conditions
Hypertensive retinopathy is a serious condition that can lead to vision loss if left untreated. A grade 4 hypertensive retinopathy, as classified by the Keith-Wagener-Barker system, is characterized by bilateral optic disc swelling and cotton-wool spots. This condition can cause a reduction in visual acuity and color vision due to optic neuropathy secondary to hypertension.
It is important to differentiate hypertensive retinopathy from other eye conditions that may present with similar symptoms. Proliferative diabetic retinopathy, for example, is unlikely if the patient’s type II diabetes is well-controlled. The presence of cotton-wool spots does not indicate diabetic retinopathy.
An intracranial space-occupying lesion is also not indicated in the patient’s history. Optic neuritis, while it can present with loss of optic nerve function, is more likely to present unilaterally and without cotton-wool spots.
Pre-proliferative diabetic retinopathy is also unlikely in this case, as the patient’s diabetes is well-controlled. In diabetic retinopathy, optic discs will not be raised.
In summary, a thorough understanding of the patient’s medical history and symptoms is necessary to accurately diagnose hypertensive retinopathy and differentiate it from other eye conditions.
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This question is part of the following fields:
- Ophthalmology
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Question 2
Incorrect
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A 16-year-old girl comes to the eye clinic with a painful red eye after a minor injury. The doctor diagnoses her with a corneal ulcer in her left eye and prescribes topical antibiotics for treatment. She asks for a prescription of the same numbing eye drops that were used during the examination to use at home. What is the most appropriate pain management for this condition?
Your Answer: Tetracaine eyedrops two times a day
Correct Answer: Oral analgesics
Explanation:It is not recommended to prescribe anaesthetic eye drops to patients with corneal ulcers as it can potentially worsen the condition by slowing down the healing process.
Understanding Corneal Ulcers
A corneal ulcer is a condition that occurs when there is a defect in the cornea, which is usually caused by an infection. It is important to note that corneal abrasions, on the other hand, are typically caused by physical trauma. There are several risk factors that can increase the likelihood of developing a corneal ulcer, including contact lens use and vitamin A deficiency, which is particularly common in developing countries.
The pathophysiology of corneal ulcers can vary depending on the underlying cause. Bacterial, fungal, and viral infections can all lead to the development of a corneal ulcer. In some cases, contact lens use can also be associated with a type of infection called Acanthamoeba keratitis.
Symptoms of a corneal ulcer typically include eye pain, sensitivity to light, and excessive tearing. Additionally, a focal fluorescein staining of the cornea may be present.
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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 67-year-old man with a history of primary open-angle glaucoma presents with sudden painless loss of vision in his left eye. Upon examination of the left eye, there are multiple flame-shaped and blot haemorrhages with a swollen optic disc. What is the probable diagnosis?
Your Answer: Occlusion of central retinal vein
Explanation:Sudden painless vision loss and severe retinal hemorrhages observed on fundoscopy are indicative of central retinal vein occlusion.
Understanding Central Retinal Vein Occlusion
Central retinal vein occlusion (CRVO) is a possible cause of sudden, painless loss of vision. It is more common in older individuals and those with hypertension, cardiovascular disease, glaucoma, or polycythemia. The condition is characterized by a sudden reduction or loss of visual acuity, usually affecting only one eye. Fundoscopy reveals widespread hyperemia and severe retinal hemorrhages, which are often described as a stormy sunset.
Branch retinal vein occlusion (BRVO) is a similar condition that affects a smaller area of the fundus. It occurs when a vein in the distal retinal venous system is blocked, usually at arteriovenous crossings.
Most patients with CRVO are managed conservatively, but treatment may be necessary in some cases. For instance, intravitreal anti-vascular endothelial growth factor (VEGF) agents may be used to manage macular edema, while laser photocoagulation may be necessary to treat retinal neovascularization.
Overall, understanding the risk factors, features, and management options for CRVO is essential for prompt diagnosis and appropriate treatment. Proper management can help prevent further vision loss and improve the patient’s quality of life.
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This question is part of the following fields:
- Ophthalmology
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Question 4
Correct
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In the UK, what is the primary reason for irreversible blindness in individuals over the age of 65?
Your Answer: Macular degeneration
Explanation:Common Eye Diseases and Conditions
Age-related macular degeneration, diabetic retinopathy, glaucoma, senile cataract, and corneal abrasion are some of the most common eye diseases and conditions that affect people worldwide.
Macular Degeneration
Macular degeneration is a leading cause of irreversible vision loss in developed countries. The non-exudative (dry) form of the disease is the most common, characterized by the presence of drusen in the macular region. Dry AMD progresses slowly over decades, while the exudative (wet) form can cause rapid central visual loss and distortion.
Diabetic Retinopathy
Diabetic retinopathy is a complication of diabetes that can lead to blindness. It is the most common cause of new blindness in people aged 25-64 years globally. Proliferative diabetic retinopathy is rare within the first decade of a diagnosis of type 1 diabetes mellitus, but increases with disease duration.
Glaucoma
Glaucoma is a group of eye diseases that damage the optic nerve and can cause specific visual field defects over time. Open-angle glaucoma is the most common type, and it is described as a chronic, progressive, and irreversible optic neuropathy. Glaucoma is the second leading cause of irreversible blindness in developed countries.
Senile Cataract
Senile cataract is an age-related disease that causes gradual progressive thickening of the lens of the eye. It is the world’s leading cause of treatable blindness.
Corneal Abrasion
Corneal abrasion is a common eye injury that occurs due to a disruption in the integrity of the corneal epithelium or because of physical external forces. Most people recover fully from minor corneal abrasions, but deeper scratches can cause corneal infections, erosion, or scarring, leading to long-term vision problems.
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This question is part of the following fields:
- Ophthalmology
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Question 5
Incorrect
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A 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: Hypercalcaemia
Correct 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.
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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 52-year-old woman has recently been diagnosed with raised intraocular pressure (IOP) and loss of peripheral vision. She also has diabetes.
Which of the following treatments would ophthalmology have initiated?Your Answer: Latanoprost
Explanation:Understanding Chronic Open-Angle Glaucoma and Treatment Options
Chronic open-angle glaucoma (COAG) is a progressive and irreversible optic neuropathy that can lead to significant visual loss if left untreated. It is the second leading cause of irreversible blindness in developed countries. Patients with COAG may not present with any symptoms until late in the disease course, making early detection and treatment crucial.
The first-line treatment for COAG is a prostaglandin analogue, such as latanoprost. Other options include pilocarpine, a cholinergic parasympathomimetic agent, and brinzolamide, a carbonic anhydrase inhibitor. More than one agent may be needed concurrently to achieve the target intraocular pressure (IOP).
Beta-blockers, such as timolol, may also be used as an alternative or adjuvant therapy, but should be avoided in patients with a history of asthma. Sodium cromoglicate eye drops are not effective in the management of COAG or ocular hypertension (OHT).
OHT is a major risk factor for developing COAG, but COAG can also occur without raised IOP. Age thresholds for treatment recommendations only apply when vision is currently normal and treatment is purely preventative. Patients experiencing peripheral vision loss should be evaluated for COAG regardless of age.
Early detection and appropriate treatment can help prevent significant visual loss in patients with COAG.
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This question is part of the following fields:
- Ophthalmology
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Question 7
Incorrect
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A 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: Retinitis pigmentosa
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%.
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This question is part of the following fields:
- Ophthalmology
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Question 8
Incorrect
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A 65-year-old man with a history of type 2 diabetes mellitus complains of deteriorating vision. Upon examination with mydriatic drops, pre-proliferative diabetic retinopathy is discovered. The patient is referred to an ophthalmologist. However, later that evening while driving home, he experiences reduced visual acuity and pain in his left eye. What is the probable diagnosis?
Your Answer: Vitreous haemorrhage
Correct Answer: Acute angle closure glaucoma
Explanation:Although mydriatic drops can cause acute angle closure glaucoma, this situation is more frequently encountered in exams than in actual medical practice.
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.
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This question is part of the following fields:
- Ophthalmology
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Question 9
Incorrect
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An 80-year-old man presents to ophthalmology with complaints of progressive vision loss over the past few months, which has worsened suddenly in the last week. On visual field testing, a central scotoma is noted, and fundoscopy reveals well-defined red patches on the retina. What is the most probable diagnosis?
Your Answer: Dry age-related macular degeneration
Correct Answer: Wet age-related macular degeneration
Explanation:If a patient experiences a gradual decline in vision over several months, along with metamorphopsia and a central scotoma, it is highly likely that they have wet age-related macular degeneration (ARMD). This condition is characterized by a sudden deterioration in vision, red patches on the retina during fundoscopy, and leakage of serous fluid and blood. Acute angle-closure glaucoma, on the other hand, presents with severe headaches, vomiting, and mid-dilated or irregularly shaped pupils. Dry ARMD also causes a slow decline in vision, but it does not result in sudden deterioration or red patches on the retina. Retinal detachment causes a painless loss of vision that starts peripherally and progresses centrally, while vitreous hemorrhage is a common cause of sudden visual loss in diabetics, characterized by dark spots in the vision and a hemorrhage within the vitreous cavity during fundoscopy.
Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by the degeneration of the central retina (macula) and the formation of drusen. It is more prevalent in females and is strongly associated with advancing age, smoking, family history, and conditions that increase the risk of ischaemic cardiovascular disease. ARMD can be classified into two forms: dry and wet. Dry ARMD is more common and is characterized by drusen, while wet ARMD is characterized by choroidal neovascularisation and carries a worse prognosis. Clinical features of ARMD include subacute onset of visual loss, difficulties in dark adaptation, and visual disturbances such as photopsia and glare.
To diagnose ARMD, slit-lamp microscopy and color fundus photography are used to identify any pigmentary, exudative, or haemorrhagic changes affecting the retina. Fluorescein angiography and indocyanine green angiography may also be used to visualize changes in the choroidal circulation. Treatment for dry ARMD involves a combination of zinc with anti-oxidant vitamins A, C, and E, which has been shown to reduce disease progression by around one third. For wet ARMD, anti-VEGF agents such as ranibizumab, bevacizumab, and pegaptanib are used to limit disease progression and stabilize or reverse visual loss. Laser photocoagulation may also be used to slow progression, but anti-VEGF therapies are usually preferred due to the risk of acute visual loss after treatment.
In summary, ARMD is a common cause of blindness in the UK that is strongly associated with advancing age, smoking, and family history. It can be classified into dry and wet forms, with wet ARMD carrying a worse prognosis. Diagnosis involves the use of various imaging techniques, and treatment options include a combination of zinc and anti-oxidant vitamins for dry ARMD and anti-VEGF agents or laser photocoagulation for wet ARMD.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Incorrect
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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: Cefuroxime intravenously (IV)
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.
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This question is part of the following fields:
- Ophthalmology
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Question 11
Correct
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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: 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.
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This question is part of the following fields:
- Ophthalmology
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Question 12
Correct
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A 67-year-old man with a 14 year history of type 2 diabetes mellitus presents with complaints of blurred vision and poor eyesight. Upon examination using a Snellen chart, his visual acuity is found to be reduced to 6/12 in the left eye and 6/18 in the right eye. Fundoscopy reveals the presence of yellow deposits in the right eye, consistent with drusen formation, albeit to a lesser extent. Similar changes are observed in the left eye. What is the most probable diagnosis?
Your Answer: Dry age-related macular degeneration
Explanation:Dry macular degeneration is characterized by the presence of drusen.
Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by the degeneration of the central retina (macula) and the formation of drusen. It is more prevalent in females and is strongly associated with advancing age, smoking, family history, and conditions that increase the risk of ischaemic cardiovascular disease. ARMD can be classified into two forms: dry and wet. Dry ARMD is more common and is characterized by drusen, while wet ARMD is characterized by choroidal neovascularisation and carries a worse prognosis. Clinical features of ARMD include subacute onset of visual loss, difficulties in dark adaptation, and visual disturbances such as photopsia and glare.
To diagnose ARMD, slit-lamp microscopy and color fundus photography are used to identify any pigmentary, exudative, or haemorrhagic changes affecting the retina. Fluorescein angiography and indocyanine green angiography may also be used to visualize changes in the choroidal circulation. Treatment for dry ARMD involves a combination of zinc with anti-oxidant vitamins A, C, and E, which has been shown to reduce disease progression by around one third. For wet ARMD, anti-VEGF agents such as ranibizumab, bevacizumab, and pegaptanib are used to limit disease progression and stabilize or reverse visual loss. Laser photocoagulation may also be used to slow progression, but anti-VEGF therapies are usually preferred due to the risk of acute visual loss after treatment.
In summary, ARMD is a common cause of blindness in the UK that is strongly associated with advancing age, smoking, and family history. It can be classified into dry and wet forms, with wet ARMD carrying a worse prognosis. Diagnosis involves the use of various imaging techniques, and treatment options include a combination of zinc and anti-oxidant vitamins for dry ARMD and anti-VEGF agents or laser photocoagulation for wet ARMD.
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This question is part of the following fields:
- Ophthalmology
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Question 13
Incorrect
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A 28-year-old male with a history of Marfan's syndrome arrives at the emergency department reporting a sudden, painless loss of vision in his left eye. He did not experience any symptoms beforehand and did not sustain any injuries.
What is the probable diagnosis?Your Answer: Retinal detachment
Correct Answer: Lens dislocation
Explanation:In Marfan’s syndrome, painless loss of vision in one eye may be caused by lens dislocation, which is a common ocular symptom of the condition. The dislocation usually occurs in the upper outer part of the eye and can affect one or both eyes. While retinal detachment can also cause sudden vision loss without pain, it is less common than lens dislocation and is often preceded by visual disturbances such as flashes, floaters, or blind spots.
Causes of Lens Dislocation
Lens dislocation can occur due to various reasons. One of the most common causes is Marfan’s syndrome, which causes the lens to dislocate upwards. Homocystinuria is another condition that can lead to lens dislocation, but in this case, the lens dislocates downwards. Ehlers-Danlos syndrome is also a known cause of lens dislocation. Trauma, such as a blow to the eye, can also cause the lens to dislocate. Uveal tumors and autosomal recessive ectopia lentis are other potential causes of lens dislocation. It is important to identify the underlying cause of lens dislocation to determine the appropriate treatment plan. Proper diagnosis and management can help prevent complications and improve outcomes for patients.
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This question is part of the following fields:
- Ophthalmology
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Question 14
Incorrect
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A 75-year-old man came to the clinic with painless, blurry vision in his right eye. He reported no other ocular symptoms and had a history of bilateral cataract surgery five years ago. What is the most probable reason for his vision impairment?
Your Answer: Recurrence of cataract
Correct Answer: Posterior capsule opacification
Explanation:Blurred vision years after cataract surgery may be caused by posterior capsule opacification, which can occur even after the cataract has been removed and an artificial lens has been implanted.
Understanding Cataracts: Causes, Symptoms, and Management
A cataract is a common eye condition that affects the lens of the eye, causing it to become cloudy and reducing the amount of light that reaches the retina. This can lead to blurred or reduced vision, making it difficult to see clearly. Cataracts are more common in women and tend to increase in incidence with age. While the normal ageing process is the most common cause, other factors such as smoking, alcohol consumption, trauma, diabetes, and long-term corticosteroid use can also contribute to the development of cataracts.
Symptoms of cataracts include reduced vision, faded colour vision, glare, and halos around lights. A defect in the red reflex is also a sign of cataracts. Diagnosis is typically made through ophthalmoscopy and slit-lamp examination, which can reveal the presence of a visible cataract.
In the early stages, age-related cataracts can be managed conservatively with stronger glasses or contact lenses and brighter lighting. However, surgery is the only effective treatment for cataracts and involves removing the cloudy lens and replacing it with an artificial one. Referral for surgery should be based on the presence of visual impairment, impact on quality of life, and patient choice. Complications following surgery can include posterior capsule opacification, retinal detachment, posterior capsule rupture, and endophthalmitis.
Overall, cataracts are a common and treatable eye condition that can significantly impact a person’s vision. Understanding the causes, symptoms, and management options can help individuals make informed decisions about their eye health.
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This question is part of the following fields:
- Ophthalmology
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Question 15
Incorrect
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A 62-year-old man presents to the Ophthalmology Clinic with elevated intraocular pressure and peripheral vision loss. He also has a history of asthma. What is the most suitable course of treatment to begin in this scenario?
Your Answer: Brinzolamide
Correct Answer: Latanoprost
Explanation:Medications for Glaucoma: Uses and Contraindications
Glaucoma is a condition that can lead to vision loss if left untreated. The primary goal of treatment is to lower intraocular pressure. Here are some common medications used for glaucoma and their uses and contraindications:
1. Latanoprost: This prostaglandin analogue increases scleral permeability to aqueous fluid, reducing intraocular pressure. It is safe to use in asthmatics and is recommended as a first-line medication.
2. Brinzolamide: This carbonic anhydrase inhibitor also lowers intraocular pressure but is not a first-line medication for glaucoma. It is safe to use in those with concurrent asthma.
3. Pilocarpine: This muscarinic receptor agonist improves the flow rate of aqueous humour but is not a first-line medication. It is cautioned against use in asthmatics as it can increase bronchial secretions and airway resistance.
4. Sodium cromoglicate: This mast-cell stabiliser is not usually used in glaucoma but is commonly used in conditions such as allergic rhinitis.
5. Timolol: This beta-receptor antagonist is contraindicated in asthmatics as it can lead to increased airway resistance through bronchospasm.
It is important to consult with a healthcare provider to determine the best medication for individual cases of glaucoma, taking into consideration any contraindications or potential side effects.
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This question is part of the following fields:
- Ophthalmology
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Question 16
Correct
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A 38-year-old male patient visits the GP clinic complaining of redness in his left eye for the past week. During the examination, a tender papule is observed at the margin of the lower eyelid on the left side. Additionally, the conjunctiva of the left eye appears red. What is the best course of action for this patient?
Your Answer: Warm compress, analgesia and topical antibiotic
Explanation:If there is conjunctivitis present with the stye, topical antibiotics are recommended along with warm compress and pain relief. Cold compress should not be used. Oral antibiotics should only be considered if the infection persists despite topical treatment.
Eyelid problems are quite common and can include a variety of issues. One such issue is blepharitis, which is inflammation of the eyelid margins that can cause redness in the eye. Another problem is a stye, which is an infection of the glands in the eyelids. Chalazion, also known as Meibomian cyst, is another eyelid problem that can occur. Entropion is when the eyelids turn inward, while ectropion is when they turn outward.
Styes can come in different forms, such as external or internal. An external stye is an infection of the glands that produce sebum or sweat, while an internal stye is an infection of the Meibomian glands. Treatment for styes typically involves hot compresses and pain relief, with topical antibiotics only being recommended if there is also conjunctivitis present. A chalazion, on the other hand, is a painless lump that can form in the eyelid due to a retention cyst of the Meibomian gland. While most cases will resolve on their own, some may require surgical drainage.
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This question is part of the following fields:
- Ophthalmology
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Question 17
Correct
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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
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.
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This question is part of the following fields:
- Ophthalmology
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Question 18
Correct
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Which one of the following features is not present in pre-proliferative retinopathy in elderly diabetic patients?
Your Answer: Neovascularisation
Explanation:Proliferative retinopathy is characterized by the presence of retinal neovascularization.
Understanding Diabetic Retinopathy
Diabetic retinopathy is a leading cause of blindness among adults aged 35-65 years old. The condition is caused by hyperglycemia, which leads to abnormal metabolism in the retinal vessel walls and damage to endothelial cells and pericytes. This damage causes increased vascular permeability, resulting in exudates seen on fundoscopy. Pericyte dysfunction predisposes to the formation of microaneurysms, while neovascularization is caused by the production of growth factors in response to retinal ischemia.
Patients with diabetic retinopathy are classified into those with non-proliferative diabetic retinopathy (NPDR), proliferative retinopathy (PDR), and maculopathy. NPDR is further classified into mild, moderate, and severe, depending on the presence of microaneurysms, blot hemorrhages, hard exudates, cotton wool spots, venous beading/looping, and intraretinal microvascular abnormalities. PDR is characterized by retinal neovascularization, which may lead to vitreous hemorrhage, and fibrous tissue forming anterior to the retinal disc. Maculopathy is based on location rather than severity and is more common in Type II DM.
Management of diabetic retinopathy involves optimizing glycaemic control, blood pressure, and hyperlipidemia, as well as regular review by ophthalmology. Treatment options include intravitreal vascular endothelial growth factor (VEGF) inhibitors for maculopathy, regular observation for non-proliferative retinopathy, and panretinal laser photocoagulation and intravitreal VEGF inhibitors for proliferative retinopathy. Vitreoretinal surgery may be necessary in cases of severe or vitreous hemorrhage.
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This question is part of the following fields:
- Ophthalmology
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Question 19
Correct
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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.
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This question is part of the following fields:
- Ophthalmology
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Question 20
Incorrect
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A 56-year-old woman visits the emergency GP service with a red and painful eye that has been bothering her for a few hours. Upon examination, the doctor notices a dilated pupil and a significant decrease in vision.
What is the most probable diagnosis?Your Answer: Optic neuritis
Correct Answer: Acute angle-closure glaucoma
Explanation:Common Eye Conditions: Symptoms and Characteristics
Acute angle-closure glaucoma, Conjunctivitis, Foreign body, Optic neuritis, and Uveitis are some of the most common eye conditions that individuals may experience. Each condition has its own set of symptoms and characteristics that can help in identifying the underlying cause.
Acute angle-closure glaucoma is characterized by sudden onset symptoms such as blurred vision, seeing haloes around lights, red eye, pain, headache, and nausea and vomiting. It is an ophthalmic emergency that requires urgent specialist assessment to prevent blindness.
Conjunctivitis is one of the most common non-traumatic eye complaints resulting in presentation to A&E. It is characterized by redness, profuse discharge, irritation, and rarely photophobia. Most causes are benign, with a self-limited process.
Foreign body in the cornea is characterized by pain, foreign body sensation, photophobia, tearing, and red eye. A visible foreign body may be present on physical examination.
Optic neuritis is characterized by rapidly developing impairment of vision in one eye, dyschromatopsia, retro-orbital or ocular pain, Uhthoff’s phenomenon, and Pulfrich’s phenomenon. It often occurs in association with multiple sclerosis (MS) and neuromyelitis optica (NMO).
Uveitis is characterized by inflammation of the uveal tract or adjacent ocular structures. It is often autoimmune in nature, and the aetiology remains elusive in most cases. Symptoms vary depending on the location of the inflammation, with acute anterior uveitis being the most common form of intraocular inflammation, causing a painful red eye.
Understanding the symptoms and characteristics of these common eye conditions can help in identifying the underlying cause and seeking appropriate treatment.
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This question is part of the following fields:
- Ophthalmology
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