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Question 1
Incorrect
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A 60-year-old man comes in with decreased vision and floaters in his right eye. Upon fundoscopy, you observe a section of sensory retina protruding towards the center of the eye. A diagnosis of retinal detachment is confirmed.
Which of the following statements about retinal detachment is correct?Your Answer: Hypermetropia is a significant risk factor
Correct Answer: A retina which remains fixed at six months post-surgical repair is unlikely to become detached again
Explanation:Retinal detachment is a condition where the retina separates from the retinal pigment epithelium, resulting in a fluid-filled space between them. This case presents a classic description of retinal detachment. Several risk factors increase the likelihood of developing this condition, including myopia, being male, having a family history of retinal detachment, previous episodes of retinal detachment, blunt ocular trauma, previous cataract surgery, diabetes mellitus (especially if proliferative retinopathy is present), glaucoma, and cataracts.
The clinical features commonly associated with retinal detachment include flashes of light, particularly at the edges of vision (known as photopsia), a dense shadow in the peripheral vision that spreads towards the center, a sensation of a curtain drawing across the eye, and central visual loss. Fundoscopy, a procedure to examine the back of the eye, reveals a sheet of sensory retina billowing towards the center of the eye. Additionally, a positive Amsler grid test, where straight lines appear curved or wavy, may indicate retinal detachment.
Other possible causes of floaters include posterior vitreous detachment, retinal tears, vitreous hemorrhage, and migraine with aura. However, in this case, the retinal appearance described is consistent with retinal detachment.
It is crucial to arrange an urgent same-day ophthalmology referral for this patient. Fortunately, approximately 90% of retinal detachments can be successfully repaired with one operation, and an additional 6% can be salvaged with subsequent procedures. If the retina remains fixed six months after surgery, the likelihood of it becoming detached again is low.
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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 one-week-old infant presents with eyelid swelling and a mucopurulent discharge from both eyes shortly after birth. The diagnosis of ophthalmia neonatorum is made. What is the most probable causative organism in this case?
Your Answer: Neisseria gonorrhoea
Correct Answer: Chlamydia trachomatis
Explanation:Ophthalmia neonatorum refers to any cause of conjunctivitis during the newborn period, regardless of the specific organism responsible.
Conjunctivitis is the most frequent occurrence of Chlamydia trachomatis infection in newborns. Chlamydia is now the leading cause, accounting for up to 40% of cases. Neisseria gonorrhoea, on the other hand, only accounts for less than 1% of reported cases. The remaining cases are caused by non-sexually transmitted bacteria like Staphylococcus, Streptococcus, Haemophilus species, and viruses.
Gonorrhoeal ophthalmia neonatorum typically presents within 1 to 5 days after birth. It is characterized by intense redness and swelling of the conjunctiva, eyelid swelling, and a severe discharge of pus. Corneal ulceration and perforation may also be present.
Chlamydial ophthalmia neonatorum, on the other hand, usually appears between 5 to 14 days after birth. It is characterized by a gradually increasing watery discharge that eventually becomes purulent. The inflammation in the eyes is usually less severe compared to gonococcal infection, and there is a lower risk of corneal ulceration and perforation.
The second most common manifestation of Chlamydia trachomatis infection in newborns is pneumonia. Approximately 5-30% of infected neonates will develop pneumonia. About half of these infants will also have a history of ophthalmia neonatorum.
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This question is part of the following fields:
- Ophthalmology
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Question 3
Incorrect
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A 40-year-old woman comes in with bitemporal hemianopia resulting from a meningioma.
Where in the visual pathway has this lesion occurred?Your Answer: Optic nerve
Correct Answer: Optic chiasm
Explanation:The optic chiasm is situated just below the hypothalamus and is in close proximity to the pituitary gland. When the pituitary gland enlarges, it can impact the functioning of the optic nerve at this location. Specifically, the fibres from the nasal half of the retina cross over at the optic chiasm to form the optic tracts. Compression at the optic chiasm primarily affects these fibres, resulting in a visual defect that affects peripheral vision in both eyes, known as bitemporal hemianopia. There are several causes of optic chiasm lesions, with the most common being a pituitary tumor. Other causes include craniopharyngioma, meningioma, optic glioma, and internal carotid artery aneurysm. The diagram below provides a summary of the different visual field defects that can occur at various points in the visual pathway.
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This question is part of the following fields:
- Ophthalmology
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Question 4
Incorrect
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A 30-year-old construction worker comes in with intense pain in his left eye following an incident at the job site where a significant amount of cement dust entered his left eye.
Which of the following long-term complications is the LEAST probable to develop?Your Answer: Keratitis sicca
Correct Answer: Open-angle glaucoma
Explanation:Cement contains lime, which is a powerful alkali, and this can cause a serious eye emergency that requires immediate treatment. Alkaline chemicals, such as oven cleaner, ammonia, household bleach, drain cleaner, oven cleaner, and plaster, can also cause damage to the eyes. They lead to colliquative necrosis, which is a type of tissue death that results in liquefaction. On the other hand, acids cause damage through coagulative necrosis. Common acids that can harm the eyes include toilet cleaners, certain household cleaning products, and battery fluid.
The initial management of a patient with cement or alkali exposure to the eyes should be as follows:
1. Irrigate the eye with a large amount of normal saline for 20-30 minutes.
2. Administer local anaesthetic drops every 5 minutes to help keep the eye open and alleviate pain.
3. Monitor the pH every 5 minutes until a neutral pH (7.0-7.5) is achieved. Briefly pause irrigation to test the fluid from the forniceal space using litmus paper.After the initial management, a thorough examination should be conducted, which includes the following steps:
1. Examine the eye directly and with a slit lamp.
2. Remove any remaining cement debris from the surface of the eye.
3. Evert the eyelids to check for hidden cement debris.
4. Administer fluorescein drops and check for corneal abrasion.
5. Assess visual acuity, which may be reduced.
6. Perform fundoscopy to check for retinal necrosis if the alkali has penetrated the sclera.
7. Measure intraocular pressure through tonometry to detect secondary glaucoma.Once the eye’s pH has returned to normal, irrigation can be stopped, and the patient should be promptly referred to an ophthalmology specialist for further evaluation.
Potential long-term complications of cement or alkali exposure to the eyes include closed-angle glaucoma, cataract formation, entropion, keratitis sicca, and permanent vision loss.
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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 25-year-old patient complains of a red and painful right eye. Upon examination, you observe conjunctival erythema. There is also mucopurulent discharge and lid crusting present in the eye. Based on the current NICE guidance, what is the recommended first-line antibiotic for treating bacterial conjunctivitis?
Your Answer: Chloramphenicol 1% ointment
Explanation:When it comes to managing bacterial conjunctivitis, NICE provides some helpful guidance. It is important to inform the patient that most cases of bacterial conjunctivitis will resolve on their own within 5-7 days without any treatment. However, in severe cases or situations where a quick resolution is necessary, topical antibiotics may be necessary. In some cases, it may be appropriate to delay treatment and advise the patient to start using topical antibiotics if their symptoms have not improved within 3 days.
There are a few options for topical antibiotics that can be used. One option is Chloramphenicol 0.5% drops, which should be applied every 2 hours for 2 days and then 4 times daily for 5 days. Another option is Chloramphenicol 1% ointment, which should be applied four times daily for 2 days and then twice daily for 5 days. Fusidic acid 1% eye drops can also be used as a second-line treatment and should be applied twice daily for 7 days.
By following these guidelines, healthcare professionals can effectively manage bacterial conjunctivitis and provide appropriate treatment options for their patients.
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This question is part of the following fields:
- Ophthalmology
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Question 6
Incorrect
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A child who was diagnosed with viral conjunctivitis ten days ago presents with persistent symptoms of painful, red eyes. During their previous visit, they were reassured and given advice on general measures, but no antibiotics were prescribed. The symptoms have now worsened, and the eye is extremely sticky and crusted.
What is the most suitable course of action for managing this patient?Your Answer: Send swabs for viral PCR alone and prescribe empirical topical antibiotics
Correct Answer: Send swabs for viral PCR and bacterial culture and prescribe empirical topical antibiotics
Explanation:When it comes to managing viral conjunctivitis, it’s important to reassure the patient that most cases are self-limiting and don’t require antimicrobial treatment. In fact, viral conjunctivitis usually resolves on its own within one to two weeks. However, there are some self-care measures that can help ease symptoms. These include cleaning the eyelids with cotton wool soaked in sterile saline or boiled and cooled water, applying cool compresses around the eye area, and using lubricating drops or artificial tears. It’s also important to avoid prescribing antibiotics if possible.
It’s crucial to inform the person that infective conjunctivitis is contagious and they should take steps to prevent spreading the infection to their other eye and other people. This includes washing hands frequently with soap and water, using separate towels and flannels, and avoiding close contact with others, especially if they are a healthcare professional or child-care provider. It’s worth noting that the infection can be contagious for up to 14 days from onset.
According to Public Health England, there is no recommended exclusion period from school, nursery, or childminders unless there is an outbreak or cluster of cases. It’s important to provide written information to the patient, explain the red flags for an urgent review, and advise them to seek further help if symptoms persist beyond 7 days. If the person returns with symptoms of conjunctivitis, it may be necessary to consider sending swabs for viral PCR and bacterial culture, as well as prescribing empirical topical antibiotics if they haven’t already been prescribed. If symptoms persist for more than 7-10 days after initiating treatment, it may be necessary to discuss with or refer to ophthalmology.
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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 60-year-old woman with uncontrolled hypertension experiences a sudden loss of vision in her left eye. The visual acuity in her left eye is reduced to hand movements only, while her right eye has a visual acuity of 6/6. Upon examining her fundi, you observe engorged retinal veins, disc edema, numerous flame-shaped hemorrhages, and cotton wool spots scattered throughout the entire retina.
What is the SINGLE most probable diagnosis?Your Answer: Central retinal vein occlusion
Explanation:Central retinal vein occlusion (CRVO) typically results in painless, one-sided vision loss. On fundoscopic examination, the retina displays a distinct appearance resembling a ‘pizza thrown against a wall’. This includes engorged retinal veins, swelling of the optic disc, multiple flame-shaped hemorrhages, and cotton wool spots. Hypertension is present in about 65% of CRVO patients, and it is more common in individuals over 65 years old.
In contrast, central retinal artery occlusion (CRAO) also causes sudden, painless, one-sided vision loss. However, the retina’s appearance in CRAO is different from CRVO. It appears pale, with narrowed blood vessels. A notable feature is the presence of a ‘cherry-red spot’ at the center of the macula, which is supplied by the underlying choroid. Examination often reveals an afferent pupillary defect.
Vitreous hemorrhage occurs when there is bleeding into the middle chamber of the eye, known as the vitreous. This can be caused by conditions such as proliferative diabetic retinopathy, trauma, or retinal detachment. The appearance of vitreous hemorrhage is described as ‘blood within a bloodless gel’, resulting in a diffuse red appearance of the retina. Unlike CRVO, there are no focal flame-shaped hemorrhages.
Diabetic maculopathy refers to the presence of diabetic eye disease within a one-disc diameter of the macula.
Wet age-related macular degeneration (ARMD) causes vision loss due to choroidal neovascularization, which leads to leakage of blood and protein beneath the macula. While there may be hemorrhages visible on the retina, the overall appearance does not match the description provided in the question.
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This question is part of the following fields:
- Ophthalmology
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Question 8
Correct
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A 6-year-old boy is brought in by his father with an itchy, red and watery right eye. On examination, there is mild erythema of palpebral conjunctiva, and follicles are visible on eversion of the eyelid. Lid oedema is evident, and you can also see a few petechial subconjunctival haemorrhages. The eye appears watery, and there is no purulent discharge. He has recently recovered from a mild upper respiratory tract infection. You make a diagnosis of viral conjunctivitis.
How long does Public Health England recommend that he should be excluded from school?Your Answer: No school exclusion is necessary
Explanation:According to Public Health England, there is no recommended exclusion period for viral or bacterial conjunctivitis from school, nursery, or childminders, unless there is an outbreak or cluster of cases.
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This question is part of the following fields:
- Ophthalmology
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Question 9
Incorrect
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A 42-year-old male patient comes in with a pituitary tumor that has resulted in a visual field defect.
What type of visual field defect is he most likely experiencing?Your Answer: Contralateral homonymous hemianopia
Correct Answer: Bitemporal hemianopia
Explanation:The optic chiasm is situated just below the hypothalamus and is in close proximity to the pituitary gland. When the pituitary gland enlarges, it can impact the functioning of the optic nerve at this location. Specifically, the fibres from the nasal half of the retina cross over at the optic chiasm to form the optic tracts. Compression at the optic chiasm primarily affects these fibres, resulting in a visual defect that affects peripheral vision in both eyes, known as bitemporal hemianopia. There are several causes of optic chiasm lesions, with the most common being a pituitary tumor. Other causes include craniopharyngioma, meningioma, optic glioma, and internal carotid artery aneurysm. The diagram below provides a summary of the different visual field defects that can occur at various points in the visual pathway.
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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 35-year-old man is diagnosed with anterior uveitis.
Which SINGLE statement regarding this condition is FALSE?Your Answer: Cataract is a recognized complication
Correct Answer: It most commonly involves the posterior chamber
Explanation:Anterior uveitis refers to the inflammation of the iris and is characterized by a painful and red eye. It is often accompanied by symptoms such as sensitivity to light, excessive tearing, and a decrease in visual clarity. In less than 10% of cases, the inflammation may extend to the posterior chamber. The condition can also lead to the formation of adhesions between the iris and the lens or cornea, resulting in an irregularly shaped pupil known as synechia. In severe cases, pus may accumulate in the front part of the eye, specifically the anterior chamber, causing a condition called hypopyon.
There are various factors that can cause anterior uveitis, including idiopathic cases where no specific cause can be identified. Other causes include trauma, chronic joint diseases like spondyloarthropathies and juvenile chronic arthritis, ankylosing spondylitis, inflammatory bowel disease, psoriasis, sarcoidosis, and infections such as Lyme disease, tuberculosis, leptospirosis, herpes simplex virus (HSV), and varicella-zoster virus (VZV). It is worth noting that approximately 50% of patients with anterior uveitis have a strong association with the HLA-B27 genotype.
Complications that can arise from uveitis include the development of cataracts, glaucoma, band keratopathy (a condition where calcium deposits form on the cornea), and even blindness.
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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 22-year-old individual comes in with a painful, itchy, red left eye. During the examination, there is noticeable redness in the conjunctiva, and follicles are observed on the inner eyelid when it is turned inside out. They recently had a mild and short-lived upper respiratory tract infection, but there are no other significant medical history.
What is the MOST LIKELY diagnosis for this patient?Your Answer: Viral conjunctivitis
Explanation:Conjunctivitis is the most common reason for red eyes, accounting for about 35% of all eye problems seen in general practice. It occurs when the conjunctiva, the thin layer covering the white part of the eye, becomes inflamed. Conjunctivitis can be caused by an infection or an allergic reaction.
Infective conjunctivitis is inflammation of the conjunctiva caused by a viral, bacterial, or parasitic infection. The most common type of infective conjunctivitis is viral, with adenoviruses being the main culprits. Bacterial conjunctivitis is also common and is usually caused by Streptococcus pneumoniae, Staphylococcus aureus, or Haemophilus influenzae.
The symptoms of infective conjunctivitis include sudden redness of the conjunctiva, discomfort described as a gritty or burning sensation, watering of the eyes, and discharge that may temporarily blurry vision. It can be challenging to differentiate between viral and bacterial conjunctivitis based on symptoms alone.
Here are some key features that can help distinguish between viral and bacterial conjunctivitis:
Features suggestive of viral conjunctivitis:
– Mild to moderate redness of the conjunctiva
– Presence of follicles on the inner surface of the eyelids
– Swelling of the eyelids
– Small, pinpoint bleeding under the conjunctiva
– Pseudomembranes (thin layers of tissue) may form on the inner surface of the eyelids in severe cases, often caused by adenovirus
– Less discharge (usually watery) compared to bacterial conjunctivitis
– Mild to moderate itching
– Symptoms of upper respiratory tract infection and swollen lymph nodes in front of the earsFeatures suggestive of bacterial conjunctivitis:
– Purulent or mucopurulent discharge with crusting of the eyelids, which may cause them to stick together upon waking
– Mild or no itching
– Swollen lymph nodes in front of the ears, which are often present in severe bacterial conjunctivitis
– If the discharge is copious and mucopurulent, infection with Neisseria gonorrhoeae should be considered.By considering these distinguishing features, healthcare professionals can better diagnose and manage cases of conjunctivitis.
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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 child who was diagnosed with bacterial conjunctivitis seven days ago presents with ongoing symptoms. During their last visit, they were reassured and given advice on general measures, but no antibiotics were prescribed. The symptoms have now worsened, and the eye is extremely sticky and crusted.
What is the most suitable course of action in managing this child's condition?Your Answer: Send swabs for viral PCR and bacterial culture and prescribe empirical topical antibiotics
Explanation:Here is a revised version of the guidance on the management of bacterial conjunctivitis:
– It is important to inform the patient that most cases of bacterial conjunctivitis will resolve on their own within 5-7 days without any treatment.
– However, if the condition is severe or if there is a need for rapid resolution, topical antibiotics may be prescribed. In some cases, a delayed treatment strategy may be appropriate, and the patient should be advised to start using topical antibiotics if their symptoms have not improved within 3 days.
– There are several options for topical antibiotics, including Chloramphenicol 0.5% drops (to be applied every 2 hours for 2 days, then 4 times daily for 5 days) and Chloramphenicol 1% ointment (to be applied four times daily for 2 days, then twice daily for 5 days). Fusidic acid 1% eye drops can also be used as a second-line treatment, to be applied twice daily for 7 days.
– It is important to note that there is no recommended exclusion period from school, nursery, or childminders for isolated cases of bacterial conjunctivitis. However, some institutions may have their own exclusion policies.
– Provide the patient with written information and explain the red flags that indicate the need for an urgent review.
– Arrange a follow-up appointment to confirm the diagnosis and ensure that the symptoms have resolved.
– If the patient returns with ongoing symptoms, it may be necessary to send swabs for viral PCR (to test for adenovirus and Herpes simplex) and bacterial culture. Empirical topical antibiotics may also be prescribed if they have not been previously given.
– Consider referring the patient to ophthalmology if the symptoms persist for more than 7 to 10 days after initiating treatment.For more information, you can refer to the NICE Clinical Knowledge Summary on Infective Conjunctivitis.
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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 45-year-old woman comes in with a painful red eye accompanied by sensitivity to light, excessive tearing, and reduced vision. The on-call ophthalmology team is consulted, and they diagnose her with anterior uveitis.
Which of the following is the SINGLE LEAST probable underlying cause?Your Answer: Inflammatory bowel disease
Correct Answer: Lymphoma
Explanation:Anterior uveitis refers to the inflammation of the iris and is characterized by a painful and red eye. It is often accompanied by symptoms such as sensitivity to light, excessive tearing, and a decrease in visual clarity. In less than 10% of cases, the inflammation may extend to the posterior chamber. The condition can also lead to the formation of adhesions between the iris and the lens or cornea, resulting in an irregularly shaped pupil known as synechia. In severe cases, pus may accumulate in the front part of the eye, specifically the anterior chamber, causing a condition called hypopyon.
There are various factors that can cause anterior uveitis, including idiopathic cases where no specific cause can be identified. Other causes include trauma, chronic joint diseases like spondyloarthropathies and juvenile chronic arthritis, ankylosing spondylitis, inflammatory bowel disease, psoriasis, sarcoidosis, and infections such as Lyme disease, tuberculosis, leptospirosis, herpes simplex virus (HSV), and varicella-zoster virus (VZV). It is worth noting that approximately 50% of patients with anterior uveitis have a strong association with the HLA-B27 genotype.
Complications that can arise from uveitis include the development of cataracts, glaucoma, band keratopathy (a condition where calcium deposits form on the cornea), and even blindness.
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This question is part of the following fields:
- Ophthalmology
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Question 14
Correct
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A 42-year-old woman comes in with a suddenly painful right eye and sensitivity to light. She describes her eye as feeling gritty and it is noticeably watery. The patient has been experiencing a mild cold for the past few days. You administer fluorescein drops to her eye, which reveal the presence of a dendritic ulcer.
What is the most suitable treatment for this patient?Your Answer: Acyclovir ointment
Explanation:There are two types of infectious agents that can lead to the development of a dendritic ulcer. The majority of cases (80%) are caused by the herpes simplex virus (type I), while the remaining cases (20%) are caused by the herpes zoster virus. To effectively treat this condition, the patient should follow a specific treatment plan. This includes applying acyclovir ointment topically five times a day for a duration of 10 days. Additionally, prednisolone 0.5% drops should be used 2-4 times daily. It is also recommended to take oral high dose vitamin C, as it has been shown to reduce the healing time of dendritic ulcers.
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This question is part of the following fields:
- Ophthalmology
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Question 15
Correct
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A 35-year-old woman comes in with a painful, red right eye. She has a history of ankylosing spondylitis (AS).
What is the MOST frequently occurring eye complication associated with AS?Your Answer: Uveitis
Explanation:Uveitis is the most prevalent eye complication that arises in individuals with ankylosing spondylitis (AS). Approximately one out of every three patients with AS will experience uveitis at some stage. The symptoms of uveitis include a red and painful eye, along with photophobia and blurred vision. Additionally, patients may notice the presence of floaters. The primary treatment for uveitis involves the use of corticosteroids, and it is crucial for patients to seek immediate attention from an ophthalmologist.
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This question is part of the following fields:
- Ophthalmology
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Question 16
Incorrect
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A 7-year-old girl presents with a 4-day history of blurred vision in her left eye. She is also experiencing eye pain and fatigue. On examination, her temperature is 38.0°C, but her other vital signs are normal. There is significant redness in the conjunctiva, and a collection of pus (hypopyon) is present in her left eye. Her visual acuity in that eye is reduced to counting fingers. She recently received a kitten as a pet from her parents.
What is the SINGLE most likely causative organism?Your Answer: Pasteurella canis
Correct Answer: Toxocara canis
Explanation:Toxocariasis is a rare infection caused by the parasitic roundworm Toxocara canis. The main way it spreads to humans is through contact with dog feces. However, practicing good hand hygiene can help prevent transmission. While most people who come into contact with Toxocara canis don’t show any symptoms, a small number may experience a mild flu-like illness.
The most common presentation of toxocariasis is in children, who may experience unilateral visual loss. This loss of vision is typically caused by conditions such as vitritis, macular edema, and tractional retinal detachment. It is believed that these lesions occur due to a toxic or immunoallergic reaction to the larval antigens.
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This question is part of the following fields:
- Ophthalmology
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Question 17
Incorrect
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A 12-year-old boy presents with double vision. He is holding his head tilted to the left-hand side. On examination of his eye movements, you note that both eyes can look normally to the right, but on looking to the left, his left eye cannot turn outwards past the midline. The right eye is unaffected when looking to the left.
What is the SINGLE most likely nerve to be involved in this case?Your Answer: Left trochlear nerve
Correct Answer: Right abducens nerve
Explanation:This patient is experiencing a condition called right-sided abducens nerve palsy, which means that their sixth cranial nerve is paralyzed. As a result, the lateral rectus muscle, which is responsible for moving the eye outward, is also paralyzed. This means that the patient’s right eye is unable to turn outward. This can lead to a condition called convergent strabismus, where the eyes are not aligned properly, and diplopia, which is double vision. To compensate for the double vision, patients often tilt their head towards the side of the paralyzed muscle.
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This question is part of the following fields:
- Ophthalmology
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Question 18
Incorrect
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A 25-year-old patient comes in with a painful and red left eye. Upon examination, you observe conjunctival erythema and the presence of mucopurulent discharge and lid crusting. Based on these findings, you diagnose the patient with bacterial conjunctivitis. However, the patient cannot use the first-line treatment due to a previous reaction. According to the current NICE guidance, what is the recommended second-line antibiotic for managing bacterial conjunctivitis?
Your Answer: Fusidic acid 1% ointment
Correct Answer: Fusidic acid 1% drops
Explanation:When it comes to managing bacterial conjunctivitis, NICE provides some helpful guidance. It is important to inform the patient that most cases of bacterial conjunctivitis will resolve on their own within 5-7 days without any treatment. However, in severe cases or situations where a quick resolution is necessary, topical antibiotics may be necessary. In some cases, it may be appropriate to delay treatment and advise the patient to start using topical antibiotics if their symptoms have not improved within 3 days.
There are a few options for topical antibiotics that can be used. One option is Chloramphenicol 0.5% drops, which should be applied every 2 hours for 2 days and then 4 times daily for 5 days. Another option is Chloramphenicol 1% ointment, which should be applied four times daily for 2 days and then twice daily for 5 days. Fusidic acid 1% eye drops can also be used as a second-line treatment and should be applied twice daily for 7 days.
By following these guidelines, healthcare professionals can effectively manage bacterial conjunctivitis and provide appropriate treatment options for their patients.
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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 70-year-old woman experiences a sudden onset of vision loss in her left eye. She is later diagnosed with central retinal vein occlusion (CRVO).
Your Answer: Chronic glaucoma is a recognised risk factor
Explanation:Central retinal vein occlusion (CRVO) typically leads to painless, one-sided vision loss. When examining the retina, it may appear similar to a ‘pizza thrown against a wall’, with swollen retinal veins, swelling of the optic disc, multiple flame-shaped hemorrhages, and cotton wool spots. Hypertension is present in about 65% of CRVO patients, and it is more common in individuals over the age of 65. Other known risk factors include being elderly, having chronic glaucoma, arteriosclerosis, and polycythemia.
In contrast, central retinal artery occlusion (CRAO) is characterized by a pale retina and a ‘cherry-red spot’ in the macula’s center, which is spared due to its blood supply from the underlying choroid. It is important to differentiate between CRVO and CRAO based on these distinct features.
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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 65-year-old man has experienced a stroke affecting the blood vessels in his brain. Testing of his visual field reveals that he has a quadrantanopia in the lower left side of his vision.
Where in the visual pathway has this injury occurred?Your Answer:
Correct Answer: Upper optic radiation
Explanation:Homonymous quadrantanopia occur when there are lesions in the optic radiation. The optic tract passes through the posterolateral angle of the optic chiasm, running alongside the cerebral peduncle and inside the uncus of the temporal lobe. Eventually, it reaches the lateral geniculate body (LGN) in the thalamus. Acting as a relay center, the LGN sends axons through the optic radiation to the primary visual cortex in the occipital lobe. The upper optic radiation carries fibers from the superior retinal quadrants (which corresponds to the lower half of the visual field) and travels through the parietal lobe. On the other hand, the lower optic radiation carries fibers from the inferior retinal quadrants (which corresponds to the upper half of the visual field) and travels through the temporal lobe. Consequently, lesions in the temporal lobe can lead to superior homonymous quadrantanopia, while lesions in the parietal lobe can cause inferior homonymous quadrantanopia. The diagram below provides a summary of the different visual field defects resulting from lesions at various points in the visual pathway.
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This question is part of the following fields:
- Ophthalmology
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