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  • Question 1 - A 70-year-old man experiences a sudden loss of vision in his left eye....

    Incorrect

    • A 70-year-old man experiences a sudden loss of vision in his left eye. He is later diagnosed with central retinal artery occlusion (CRAO).

      Which ONE statement about this condition is accurate?

      Your Answer: It usually presents with sudden onset painful loss of vision

      Correct Answer: The pupil on the affected side is usually poorly reactive to light with a normal consensual light reaction

      Explanation:

      Central retinal artery occlusion (CRAO) is characterized by sudden and painless loss of vision in the affected eye. It can occur due to emboli from atheromatous carotid arteries, thrombosis caused by arteriosclerosis or hypertension, or vasospasm resulting from giant cell arteritis. The pupil on the affected side typically shows poor reactivity to light, but the consensual light reaction remains normal. The typical retinal findings in CRAO include a pale retina due to edema, narrowed blood vessels, segmentation of blood columns in arteries (resembling cattle-trucking), and a cherry red spot indicating sparing of the macular center supplied by the underlying choroid. Over several weeks, optic atrophy may develop. Immediate referral to an eye specialist is necessary as CRAO is an ophthalmological emergency.

      On the other hand, central retinal vein occlusion (CRVO) leads to painless and unilateral visual loss. The retina in CRVO has a distinct appearance likened to a pizza thrown against a wall. Fundoscopic examination reveals engorged retinal veins, disc edema, multiple flame-shaped hemorrhages, and cotton wool spots.

    • This question is part of the following fields:

      • Ophthalmology
      26.3
      Seconds
  • Question 2 - A 35-year-old construction worker comes in with intense pain in his left eye...

    Correct

    • A 35-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.

      What would be the initial course of action in managing this case?

      Your Answer: Irrigate the eye with normal saline

      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.

    • This question is part of the following fields:

      • Ophthalmology
      45.3
      Seconds
  • Question 3 - A 32-year-old artist returns from a vacation in Thailand with a severely painful...

    Incorrect

    • A 32-year-old artist returns from a vacation in Thailand with a severely painful and red right eye. The symptoms appeared rapidly within a day, and the eye now has excessive mucopurulent discharge and swelling of the eyelid. During the examination, tender pre-auricular lymphadenopathy is observed on the right side. Upon further inquiry, the patient confesses to having visited a sex worker during their trip to Thailand.

      Which of the following antibiotics would be the most suitable to prescribe for this individual?

      Your Answer: Chloramphenicol

      Correct Answer: Ceftriaxone

      Explanation:

      Sexually transmitted eye infections can be quite severe and are often characterized by prolonged mucopurulent discharge. There are two main causes of these infections: Chlamydia trachomatis and Neisseria gonorrhoea. Differentiating between the two can be done by considering certain features.

      Chlamydia trachomatis infection typically presents with chronic low-grade irritation and mucous discharge that lasts for more than two weeks in sexually active individuals. It may also be accompanied by pre-auricular lymphadenopathy. This type of infection is usually unilateral but can sometimes affect both eyes.

      On the other hand, Neisseria gonorrhoea infection tends to develop rapidly, usually within 12 to 24 hours. It is characterized by copious mucopurulent discharge, eyelid swelling, and tender preauricular lymphadenopathy. This type of infection carries a higher risk of complications, such as uveitis, severe keratitis, and corneal perforation.

      Based on the patient’s symptoms, it appears that they are more consistent with a Neisseria gonorrhoea infection. The rapid onset, copious discharge, and tender preauricular lymphadenopathy are indicative of this type of infection.

      Treatment for gonococcal conjunctivitis in adults is typically based on limited research. However, a study has shown that all 12 patients responded well to a single 1 g intramuscular injection of ceftriaxone, along with a single episode of ocular lavage with saline.

      In summary, sexually transmitted eye infections can be caused by either Chlamydia trachomatis or Neisseria gonorrhoea. Differentiating between the two is important in order to provide appropriate treatment. The patient in this case exhibits symptoms that align more closely with a Neisseria gonorrhoea infection, which carries a higher risk of complications. Treatment options for gonococcal conjunctivitis are limited, but a single injection of ceftriaxone has shown positive results in previous studies.

    • This question is part of the following fields:

      • Ophthalmology
      37.1
      Seconds
  • Question 4 - A 35-year-old traveler returns from a trip to Thailand with a painful, red...

    Incorrect

    • A 35-year-old traveler returns from a trip to Thailand with a painful, red right eye. The eye has been bothering him for the past two and a half weeks, and the onset of the irritation has been gradual. There has been mild mucopurulent discharge present in the eye for the past two weeks, and he states that he has to clean the eye regularly. On examination, you note the presence of right-sided, nontender pre-auricular lymphadenopathy. On further questioning, he admits to visiting a sex worker during his visit to Thailand.
      Which of the following antibiotics would be most appropriate to prescribe for this patient?

      Your Answer: Flucloxacillin

      Correct Answer: Doxycycline

      Explanation:

      Sexually transmitted eye infections can be quite severe and are often characterized by prolonged mucopurulent discharge. The two main causes of these infections are Chlamydia trachomatis and Neisseria gonorrhoea. Differentiating between the two can be done by considering certain features.

      Chlamydia trachomatis infection typically presents with chronic low-grade irritation and mucous discharge that lasts for more than two weeks in sexually active individuals. Pre-auricular lymphadenopathy, or swelling of the lymph nodes in front of the ear, may also be present. Most cases of this infection are unilateral, affecting only one eye, but there is a possibility of it being bilateral, affecting both eyes.

      On the other hand, Neisseria gonorrhoea infection tends to develop rapidly, usually within 12 to 24 hours. It is characterized by copious mucopurulent discharge, swelling of the eyelids, and tender preauricular lymphadenopathy. This type of infection carries a higher risk of complications, such as uveitis, severe keratitis, and corneal perforation.

      Based on the patient’s symptoms, it appears that they are more consistent with a Chlamydia trachomatis infection, especially considering the slower and more gradual onset of their symptoms.

      There is ongoing debate regarding the most effective antibiotic treatment for these infections. Some options include topical tetracycline ointment to be applied four times a day for six weeks, oral doxycycline to be taken twice a day for one to two weeks, oral azithromycin with a single dose of 1 gram followed by 500 mg orally for two days, or oral erythromycin to be taken four times a day for one week.

    • This question is part of the following fields:

      • Ophthalmology
      13.6
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  • Question 5 - A 25-year-old patient comes in with a painful and red left eye. Upon...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ophthalmology
      38.6
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  • Question 6 - You evaluate the pupillary light reflex in a patient with a cranial nerve...

    Correct

    • You evaluate the pupillary light reflex in a patient with a cranial nerve impairment. When the light is directed into the left eye, there is no alteration in pupil size in either the left or right eye. However, when the light is directed into the right eye, both the left and right pupils constrict.
      What is the location of the lesion in this scenario?

      Your Answer: Left optic nerve

      Explanation:

      The pupillary light reflex is a reflex that regulates the size of the pupil in response to the intensity of light that reaches the retina. It consists of two separate pathways, the afferent pathway and the efferent pathway.

      The afferent pathway begins with light entering the pupil and stimulating the retinal ganglion cells in the retina. These cells then transmit the light signal to the optic nerve. At the optic chiasm, the nasal retinal fibers cross to the opposite optic tract, while the temporal retinal fibers remain in the same optic tract. The fibers from the optic tracts then project and synapse in the pretectal nuclei in the dorsal midbrain. From there, the pretectal nuclei send fibers to the ipsilateral Edinger-Westphal nucleus via the posterior commissure.

      On the other hand, the efferent pathway starts with the Edinger-Westphal nucleus projecting preganglionic parasympathetic fibers. These fibers exit the midbrain and travel along the oculomotor nerve. They then synapse on post-ganglionic parasympathetic fibers in the ciliary ganglion. The post-ganglionic fibers, known as the short ciliary nerves, innervate the sphincter muscle of the pupils, causing them to constrict.

      The result of these pathways is that when light is shone in one eye, both the direct pupillary light reflex (ipsilateral eye) and the consensual pupillary light reflex (contralateral eye) occur.

      Lesions affecting the pupillary light reflex can be identified by comparing the direct and consensual reactions to light in both eyes. If the optic nerve of the first eye is damaged, both the direct and consensual reflexes in the second eye will be lost. However, when light is shone into the second eye, the pupil of the first eye will still constrict. If the optic nerve of the second eye is damaged, the second eye will constrict consensually when light is shone into the unaffected first eye. If the oculomotor nerve of the first eye is damaged, the first eye will have no direct light reflex, but the second eye will still constrict consensually. Finally, if the oculomotor nerve of the second eye is damaged, there will be no consensual constriction of the second eye when light is shone into the unaffected first eye.

    • This question is part of the following fields:

      • Ophthalmology
      19.9
      Seconds
  • Question 7 - A 60-year-old woman comes in with intense left eye pain and vision loss...

    Incorrect

    • A 60-year-old woman comes in with intense left eye pain and vision loss in the left eye. She has experienced multiple episodes of vomiting. During the examination, there is noticeable redness around the left side of the cornea, and the left pupil is dilated and does not react to light.

      What is the SINGLE most probable diagnosis?

      Your Answer: Vitreous detachment

      Correct Answer: Closed-angle glaucoma

      Explanation:

      Acute closed-angle glaucoma is a serious eye condition that requires immediate medical attention. It occurs when the iris pushes forward and blocks the fluid from reaching the trabecular meshwork, which is responsible for draining the eye. This blockage leads to increased pressure inside the eye and can cause damage to the optic nerve.

      The main symptoms of acute closed-angle glaucoma include severe eye pain, vision loss or decreased visual acuity, redness and congestion around the cornea, swelling of the cornea, a fixed semi-dilated pupil, and nausea and vomiting. Some individuals may also experience episodes of blurred vision or seeing haloes before the onset of these symptoms.

      On the other hand, chronic open-angle glaucoma is a more common form of the condition. It affects about 1 in 50 people over the age of 40 and 1 in 10 people over the age of 75. In this type of glaucoma, there is a partial blockage in the trabecular meshwork, which gradually restricts the drainage of fluid from the eye. As a result, the pressure inside the eye gradually increases, leading to optic nerve damage. Unlike acute closed-angle glaucoma, chronic open-angle glaucoma does not cause eye pain or redness. Instead, it presents slowly with a gradual loss of peripheral vision, while central vision is relatively preserved.

      It is important to seek medical attention if you experience any symptoms of glaucoma, as early diagnosis and treatment can help prevent further vision loss.

    • This question is part of the following fields:

      • Ophthalmology
      15.1
      Seconds
  • Question 8 - A 3-year-old boy is brought in by his father with a red and...

    Incorrect

    • A 3-year-old boy is brought in by his father with a red and itchy right eye. On examination, there is mild redness of the conjunctiva, and small bumps are visible on the inside of the eyelid. The eyelid is swollen, and there are a few small red spots on the white part of the eye. The eye is watery, and there is no pus. He recently had a mild cold. You diagnose him with viral conjunctivitis.
      According to the current NICE guidance, which of the following should NOT be included in the management of this patient?

      Your Answer: They should be encouraged to wash their hands frequently

      Correct Answer: The child should be excluded from school until the infection has resolved

      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.

    • This question is part of the following fields:

      • Ophthalmology
      20.6
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  • Question 9 - A 60-year-old woman comes in with intense pain and vision loss in her...

    Incorrect

    • A 60-year-old woman comes in with intense pain and vision loss in her left eye. She has experienced multiple episodes of vomiting. Upon examination, there is noticeable redness around the left side of the cornea, and the left pupil is dilated and unresponsive to light.
      What is the most suitable initial treatment for this patient?

      Your Answer: Topical chloramphenicol

      Correct Answer: Intravenous acetazolamide

      Explanation:

      This patient has presented with acute closed-angle glaucoma, which is a serious eye condition requiring immediate medical attention. It occurs when the iris pushes forward and blocks the fluid access to the trabecular meshwork, leading to increased pressure within the eye and damage to the optic nerve.

      The main symptoms of acute closed-angle glaucoma include severe eye pain, decreased vision, redness around the cornea, swelling of the cornea, a fixed semi-dilated pupil, nausea, vomiting, and episodes of blurred vision or seeing haloes.

      To confirm the diagnosis, tonometry is performed to measure the intraocular pressure. Normal pressure ranges from 10 to 21 mmHg, but in acute closed-angle glaucoma, it is often higher than 30 mmHg. Goldmann’s applanation tonometer is commonly used in hospitals for this purpose.

      Management of acute closed-angle glaucoma involves providing pain relief, such as morphine, and antiemetics if the patient is experiencing vomiting. Intravenous acetazolamide is administered to reduce intraocular pressure. Additionally, a topical miotic medication like pilocarpine is started about an hour after initiating other treatments to help constrict the pupil, as it may initially be paralyzed and unresponsive.

      Overall, acute closed-angle glaucoma is a medical emergency that requires prompt intervention to alleviate symptoms and prevent further damage to the eye.

    • This question is part of the following fields:

      • Ophthalmology
      18.4
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  • Question 10 - A 60-year-old woman with uncontrolled hypertension experiences a sudden loss of vision in...

    Incorrect

    • 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 artery occlusion

      Correct 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.

    • This question is part of the following fields:

      • Ophthalmology
      22.9
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  • Question 11 - A 42-year-old male patient comes in with a pituitary tumor that has resulted...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ophthalmology
      8.3
      Seconds
  • Question 12 - A 45-year-old woman has been diagnosed with a brain tumor. Visual field testing...

    Incorrect

    • A 45-year-old woman has been diagnosed with a brain tumor. Visual field testing shows that she has a left-sided superior homonymous quadrantanopia.

      Where in the visual pathway has this lesion occurred?

      Your Answer: Optic chiasm

      Correct Answer: Lower optic radiation

      Explanation:

      Homonymous quadrantanopias 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 quadrantanopias, while lesions in the parietal lobe can cause inferior homonymous quadrantanopias. The diagram below provides a summary of the different visual field defects resulting from lesions at various points in the visual pathway.

    • This question is part of the following fields:

      • Ophthalmology
      131.1
      Seconds
  • Question 13 - A 60-year-old man presents with decreased visual acuity and 'floaters' in his right...

    Incorrect

    • A 60-year-old man presents with decreased visual acuity and 'floaters' in his right eye. You conduct a fundoscopy and observe a sheet of sensory retina bulging towards the center of the eye. A diagnosis of retinal detachment is made.
      Which of the following statements about retinal detachment is NOT true?

      Your Answer: The success rate for initial surgical repair is approximately 90%

      Correct Answer: Hypermetropia is a significant risk factor

      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.

    • This question is part of the following fields:

      • Ophthalmology
      25.7
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  • Question 14 - A 42-year-old woman comes in with a suddenly painful right eye and sensitivity...

    Incorrect

    • 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: Fusidic acid ointment

      Correct 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.

    • This question is part of the following fields:

      • Ophthalmology
      16.8
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  • Question 15 - A one-week-old infant presents with eyelid swelling and a mucopurulent discharge from both...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Ophthalmology
      15.5
      Seconds
  • Question 16 - A 32-year-old woman comes in with a painful, red left eye. She is...

    Incorrect

    • A 32-year-old woman comes in with a painful, red left eye. She is also experiencing bilateral knee discomfort. Her medical history includes frequent and recurring mouth and genital ulcers. Upon examination of her eye, there is circumlimbal redness and a hypopyon is visible. Her left pupil has a poor reaction to light.

      What is the SINGLE most probable diagnosis?

      Your Answer: Ankylosing spondylitis

      Correct Answer: Behçet’s syndrome

      Explanation:

      Behçet’s syndrome is a systemic vasculitis that is mediated by the immune system. It is characterized by various symptoms, including polyarthritis, which primarily affects large joints. Additionally, patients with Behçet’s syndrome often experience recurrent oral and genital ulcers. Ocular disease is also common, with manifestations such as uveitis, hypopyon, and iridocyclitis. Furthermore, neurological involvement can occur, leading to demyelination, parkinsonism, and dementia. In this particular case, the patient’s eye examination reveals features consistent with anterior uveitis and the presence of a hypopyon. While several conditions can cause anterior uveitis, the patient’s history of joint pain in large joints and recurrent oral and genital ulcers strongly suggest Behçet’s syndrome as the most likely diagnosis.

    • This question is part of the following fields:

      • Ophthalmology
      19.6
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  • Question 17 - A 65-year-old man has experienced a stroke affecting the blood vessels in his...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Ophthalmology
      14.8
      Seconds
  • Question 18 - A 70-year-old diabetic woman presents with a history of a shadow passing across...

    Correct

    • A 70-year-old diabetic woman presents with a history of a shadow passing across her left eye 'like a curtain being drawn'. For the two weeks before this occurring, she had experienced flashing lights and floaters in the periphery of her vision in the eye. The floaters were most prominent to the nasal side of her central vision in the left eye. She has a feeling of 'heaviness in the eye' but no eye pain. She normally wears glasses for myopia, and her visual acuity in the left has been reduced to counting fingers.

      What is the SINGLE most likely diagnosis?

      Your Answer: Retinal detachment

      Explanation:

      This patient has presented with a history consistent with retinal detachment preceded by posterior vitreous detachment.

      Posterior vitreous detachment occurs when the vitreous membrane separates from the retina. There are several risk factors for posterior vitreous detachment, including myopia, recent cataract surgery, diabetes mellitus, increasing age, and eye trauma.

      The main clinical features of posterior vitreous detachment include flashes of light (photopsia), increased numbers of floaters, a ring of floaters to the temporal side of central vision, and a feeling of heaviness in the eye. Another characteristic is Weiss’ ring, which is an irregular ring of translucent floating material in the vitreous.

      It is important to note that there is a small associated risk of retinal detachment in the 6-12 weeks following a posterior vitreous detachment. Retinal detachment can be distinguished from posterior vitreous detachment by the presence of a dense shadow in the periphery that spreads centrally, a curtain drawing across the eye, straight lines suddenly appearing curved (positive Amsler grid test), and central visual loss with decreased visual acuity.

      Given the patient’s presentation, an urgent referral to ophthalmology is necessary. In most cases of retinal detachment, surgical repair will be required.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 19 - A 7-year-old girl presents with a 4-day history of blurred vision in her...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 20 - A 22-year-old individual comes in with a painful, itchy, red left eye. During...

    Correct

    • 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 ears

      Features 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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 21 - A 45-year-old woman comes in with a temporary vision loss in her right...

    Correct

    • A 45-year-old woman comes in with a temporary vision loss in her right eye half an hour after a yoga session. She had observed flickering lights in the eye before the incident and also experienced a headache that persisted for a few hours. Her visual symptoms disappeared after 45 minutes, but she still experiences slight nausea.

      What is the SINGLE most probable diagnosis?

      Your Answer: Migraine

      Explanation:

      The presentation, in this instance, is consistent with retinal (ocular) migraine. As per the International Headache Society, the primary clinical features of retinal migraine include an expanding blind-spot in the center of vision, flickering or flashing lights, temporary loss of vision in one eye lasting less than an hour, headache lasting anywhere from 4 to 72 hours (often affecting only one side of the head), nausea and vomiting, sensitivity to light and sound, and a prodrome present in 50-60% of cases. Retinal migraine is relatively uncommon, affecting only 1 in 200 individuals with migraines, and is believed to occur due to the narrowing of blood vessels in the choroidal or retinal arteries. Factors that can trigger retinal migraine include recent intense exercise, changes in posture, and the use of oral contraceptives.

      Acute optic neuritis typically presents with unilateral vision loss that worsens over a couple of weeks and then spontaneously improves within three weeks. This condition is more commonly seen in individuals under the age of 45 and is often accompanied by pain around the eyes that worsens with eye movement. A relative afferent pupillary defect and pallor of the optic disc, visible 4-6 weeks after the onset, are frequently observed. The most common cause of optic neuritis in this age group is acute demyelination.

      Retinal hemorrhage leads to painless vision loss, while acute glaucoma and amaurosis fugax are unlikely to occur in individuals of this age group.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 22 - A 9-year-old girl comes in with a painful, red, swollen right eye. She...

    Incorrect

    • A 9-year-old girl comes in with a painful, red, swollen right eye. She recently had a sinus infection but has no other significant medical history. Her temperature is 38.2°C. She experiences pain when moving her eye and complains of seeing double.
      What ONE clinical feature would be most helpful in differentiating between orbital and peri-orbital cellulitis?

      Your Answer: Conjunctival injection

      Correct Answer: Red desaturation

      Explanation:

      Peri-orbital cellulitis, also known as preseptal cellulitis, is an infection that affects the eyelid and the skin surrounding the eye in front of the orbital septal. On the other hand, orbital cellulitis is a medical emergency that occurs when there is an infection in the tissues of the eye located behind the orbital septum.

      The most common organisms that cause these infections include Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus influenzae.

      Peri-orbital cellulitis may present with various symptoms, such as swelling of the eyelid, redness around the eye, discharge, difficulty closing the eye, conjunctival injection, mild fever, teary eyes, and discomfort.

      To distinguish orbital cellulitis from peri-orbital cellulitis, it is important to look out for additional symptoms, including pain when moving the eye, protrusion of the eye (proptosis), redness of the eye (red desaturation), vision loss, eye muscle paralysis (ophthalmoplegia), double vision (diplopia), and optic nerve damage (optic neuropathy). These symptoms indicate a more severe condition that requires immediate medical attention.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 23 - A 3-year-old boy is brought in by his father with a red and...

    Incorrect

    • A 3-year-old boy is brought in by his father with a red and painful right eye. On examination, you note the presence of conjunctival erythema. There is also mucopurulent discharge and lid crusting evident in the eye. You make a diagnosis of bacterial conjunctivitis.
      With reference to the current NICE guidance, which of the following should NOT be included in your management plan for this patient?

      Your Answer: Advise that no school exclusion is necessary

      Correct Answer: Topical antibiotics should be prescribed routinely

      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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 24 - A 60-year-old man comes in with decreased visual acuity and 'floaters' in his...

    Correct

    • A 60-year-old man comes in with decreased visual acuity and 'floaters' in his right eye. Upon conducting fundoscopy, you observe a sheet of sensory retina bulging towards the center of the eye.
      What is the MOST LIKELY diagnosis?

      Your Answer: Retinal detachment

      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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 25 - A 60-year-old woman presents with intense pain in her left eye and sudden...

    Correct

    • A 60-year-old woman presents with intense pain in her left eye and sudden vision loss in the same eye. She has experienced multiple episodes of vomiting. After conducting a comprehensive examination and measuring the intraocular pressure, you diagnose her with acute closed-angle glaucoma. You provide analgesics and administer IV acetazolamide as the initial treatment.
      What other treatment option could potentially benefit this patient?

      Your Answer: Topical pilocarpine

      Explanation:

      This patient has presented with acute closed-angle glaucoma, which is a serious eye condition requiring immediate medical attention. It occurs when the iris pushes forward and blocks the fluid access to the trabecular meshwork, leading to increased pressure within the eye and damage to the optic nerve.

      The main symptoms of acute closed-angle glaucoma include severe eye pain, decreased vision, redness around the cornea, swelling of the cornea, a fixed semi-dilated pupil, nausea, vomiting, and episodes of blurred vision or seeing haloes.

      To confirm the diagnosis, tonometry is performed to measure the intraocular pressure. Normal pressure ranges from 10 to 21 mmHg, but in acute closed-angle glaucoma, it is often higher than 30 mmHg. Goldmann’s applanation tonometer is commonly used in hospitals for this purpose.

      Management of acute closed-angle glaucoma involves providing pain relief, such as morphine, and antiemetics if the patient is experiencing vomiting. Intravenous acetazolamide is administered to reduce intraocular pressure. Additionally, a topical miotic medication like pilocarpine is started about an hour after initiating other treatments to help constrict the pupil, as it may initially be paralyzed and unresponsive.

      Overall, acute closed-angle glaucoma is a medical emergency that requires prompt intervention to alleviate symptoms and prevent further damage to the eye.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 26 - A one-month-old infant develops eyelid swelling and a mucopurulent discharge from both of...

    Incorrect

    • A one-month-old infant develops eyelid swelling and a mucopurulent discharge from both of his eyes approximately two weeks after birth. His mother is currently being treated for a chlamydia infection.
      What is the baby's highest risk of complications?

      Your Answer: Corneal ulcer

      Correct Answer: Pneumonia

      Explanation:

      Conjunctivitis is the most frequent occurrence of Chlamydia trachomatis infection in newborns. Ophthalmia neonatorum refers to any cause of conjunctivitis during the newborn period, regardless of the specific organism responsible. 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.

    • This question is part of the following fields:

      • Ophthalmology
      17
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  • Question 27 - A 40-year-old man with a history of multiple sclerosis presents with loss of...

    Correct

    • A 40-year-old man with a history of multiple sclerosis presents with loss of vision in his right eye due to an episode of optic neuritis.

      At which point in the visual pathway has this lesion occurred?

      Your Answer: Optic nerve

      Explanation:

      Lesions that occur in the optic nerve, specifically those that are located outside of the optic chiasm, result in visual loss in only one eye on the same side as the lesion. There are several factors that can cause these optic nerve lesions, including optic neuritis which is often associated with multiple sclerosis. Other causes include compression of the optic nerve due to tumors in the eye, toxicity from substances like ethambutol or methanol, and trauma to the optic nerve such as fractures in the orbital bone. The diagram provided below illustrates the different types of visual field defects that can occur depending on the location of the lesion along the visual pathway.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 28 - A 42-year-old woman comes in with a suddenly painful right eye and sensitivity...

    Incorrect

    • A 42-year-old woman comes in with a suddenly painful right eye and sensitivity to light. The eye feels sandy and is visibly watery. The patient has been experiencing a mild cold for the past few days. You administer fluorescein drops to her eye, and this exposes the existence of a dendritic ulcer.
      What is the PRIMARY probable causative organism?

      Your Answer: Adenovirus

      Correct Answer: Herpes simplex virus (type 1)

      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 aciclovir 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.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 29 - A 12-year-old boy presents to the eye clinic with a sudden onset of...

    Incorrect

    • A 12-year-old boy presents to the eye clinic with a sudden onset of acute follicular conjunctivitis in his right eye. He complains of severe eye pain and has blurred vision with a lot of watery discharge. During the examination, pseudomembrane formation is observed in his eye, and he has preauricular lymphadenopathy on the right side. The doctor informs him that he has been diagnosed with 'epidemic keratoconjunctivitis'.
      What is the SINGLE most likely causative organism in this case?

      Your Answer: Streptococcus pneumoniae

      Correct Answer: Adenovirus

      Explanation:

      Epidemic keratoconjunctivitis is a type of viral conjunctivitis that is primarily caused by adenoviruses. This highly contagious condition tends to occur in outbreaks. It is a common cause of acute conjunctivitis and has distinct clinical features. These include the sudden onset of acute follicular conjunctivitis, severe pain in the affected eye, a significant amount of watery discharge, the presence of subconjunctival hemorrhages, potential visual changes, hyperemia and chemosis, and the possibility of membranes and pseudomembranes forming. Additionally, ipsilateral preauricular lymphadenopathy may be observed.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 30 - A 30-year-old construction worker comes in with intense pain in his right eye...

    Correct

    • A 30-year-old construction worker comes in with intense pain in his right eye following an incident at the job site where a significant amount of cement dust entered his right eye.
      What is the potential pathological condition that this patient's eye may be susceptible to?

      Your Answer: Colliquative necrosis

      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.

    • This question is part of the following fields:

      • Ophthalmology
      19.5
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SESSION STATS - PERFORMANCE PER SPECIALTY

Ophthalmology (12/30) 40%
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