Medicine Tips 3

Question 1

Common causes of a sudden painless loss of vision

Answer 1

Ischaemic optic neuropathy (temporal arteritis, atherosclerosis), occlusion of central retinal vein, occlusion of central retinal artery, vitreous haemorrhage, retinal detachment

Question 2

Ischaemic optic neuropathy

Answer 2

Due to arteritis (temporal arteritis) or atherosclerosis (hypertensive, diabetic older patient)
Occlusion of the short posterior ciliary arteries, causing damage to the optic nerve
Altitudinal field defects

Question 3

Central retinal vein occlusion

Answer 3

Risk increases with age, more common than arterial occlusion
Causes - glaucoma, polycythaemia, hypertension
Severe retinal haemorrhages seen on fundoscopy

Question 4

Central retinal artery occlusion

Answer 4

Due to thromboembolism (from atherosclerosis) or arteritis (temporal arteritis)
Features include afferent pupillary defect, ‘cherry red’ spot on a pale retina

Question 5

Vitreous haemorrhage

Answer 5

Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters
Causes - diabetes, bleeding disorders

Question 6

Retinal detachment

Answer 6

Features of vitreous detachment, which may precede retinal detachment, include flashes of light or floaters
Dense shadow that starts peripherally and progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss

Question 7

Posterior vitreous detachment

Answer 7

Flashes of light (photopsia) in the peripheral field of vision
Floaters on the temporal side of the central vision

Question 8

Hypertensive retinopathy classification

Answer 8

Keith-Wagener classification

Question 9

Hypertensive retinopathy stage I

Answer 9

Arteriolar narrowing and tortuosity

Increased light reflex - silver wiring

Question 10

Hypertensive retinopathy stage II

Answer 10

Arteriovenous nipping

Question 11

Hypertensive retinopathy stage III

Answer 11

Cotton-wool exudates

Flame and blot haemorrhages

Question 12

Hypertensive retinopathy stage IV

Answer 12

Papilloedema

Question 13

Holmes-Adie pupil

Answer 13

Dilated pupil (80% unilateral)
Slowly reactive to accommodation but very poorly to light

Question 14

What indicates orbital cellulitis over periorbital cellulitis?

Answer 14

Reduced visual acuity, proptosis and pain with eye movements

Question 15

Anterior uveitis

Answer 15

Acute onset, pain, blurred vision and photophobia

Small, fixed oval pupil, ciliary flush

Question 16

Scleritis

Answer 16

Severe pain (worse on movement) and tenderness
Underlying autoimmune disease (RA)

Question 17

Conjunctivitis

Answer 17

Purulent discharge - bacterial

Clear discharge - viral

Question 18

Subconjunctival haemorrhage

Answer 18

History of trauma or coughing bouts