MISCELLANEOUS FACTS FROM PASSMED Flashcards
A 35-year-old man presents with visual problems. He has had very poor vision in the dark for a long time but is now worried as he is developing ‘tunnel vision’. He states his grandfather had a similar problem and was registered blind in his 50’s. What is the most likely diagnosis?
Leber’s congenital amaurosis
Vitelliform macular dystrophy
Central serous retinopathy
Primary open angle glaucoma
Retinitis pigmentosa
Retinitis pigmentosa
What are the clinical features of retinitis pigmentosa?
Night blindness is often the initial sign
Funnel vision (the preferred term for tunnel vision)
Fundoscopy:
Black bone spicule-shaped pigmentation in the peripheral retina
Mottling of the retinal pigment epithelium
A 19-year-old female presents complaining of visual disturbance. Examination reveals a bitemporal hemianopia with predominately the lower quadrants being affected. What is the most likely lesion?
Brainstem lesion
Craniopharyngioma
Frontal lobe lesion
Pituitary macroadenoma
Right occipital lesion
Craniopharyngioma
A 64-year-old woman presents with bilateral sore eyelids. She also complains of her eyes being dry all the time. On examination her eyelid margins are erythematous at the margins but are not swollen. Of the given options, what is the most appropriate initial management?
Topical chloramphenicol + mechanical removal of lid debris
Hot compresses + topical steroids
Topical chloramphenicol + topical steroids
Hot compresses + mechanical removal of lid debris
Topical chloramphenicol + hot compresses
Hot compresses + mechanical removal of lid debris
A 67-year-old man presents as he has developed a painful blistering rash around his right eye. On examination a vesicular rash covering the right trigeminal nerve dermatome is seen. Currently he has no eye symptoms or signs. Which one of the following is most likely to predict future eye involvement?
Presence of the rash on the tip of his nose
Smoking history
Increasing age
Previous courses of corticosteroids
Presence of the rash in the ear canal
Presence of rash on the tip of his nose
This is the Hutchinson’s sign which is strongly predictive for ocular involvement.
What is Herpes zoster ophthalmicus?
Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve.
What proportion of shingles is herpes zoster ophthalmicus?
10%
What are the features of herpes zoster ophthalmicus?
Blistering vesicular rash around the eye - may involve eye itself
Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
How do we manage herpes zoster ophthalmicus?
Ocular involvement requires urgent ophthalmology review
Oral antiviral treatment for 7-10 days, ideally started within 72 hours. Topical antiviral treatment is not given in HZO
Oral corticosteroids may reduce the duration of pain but do not reduce the incidence of post-herpetic neuralgia
What are the complications of herpes zoster ophthalmicus?
Conjunctivitis
Keratitis
Episcleritis
Anterior uveitis
Ptosis
Post-herpetic neuralgia
A 54-year-old woman presents with a persistent watery left eye for the past 4 days. On examination there is erythema and swelling of the inner canthus of the left eye. What is the most likely diagnosis?
Blepharitis
Acute angle closure glaucoma
Meibomian cyst
Dacryocystitis
Pinguecula
Dacryocystitis
Dacryocystitis is infection of the lacrimal sac
Features:
- Watering eye (epiphora)
- Swelling and erythema at the inner canthus of the eye
Following an uneventful pregnancy, a 19 year old woman delivers a male child vaginally. At assessment one week later the child is noted to have purulent discharge and crusting of the eyelids. What is the next step in management of the child?
Advise that this is normal in infants
Prescribe erythromycin ophthalmic ointment empirically
Take urgent swabs of the discharge for microbiological investigation
Prescribe oral erythromycin immediately
Prescribe cloramphenicol if not improved in 48 hours
Take urgent swabs of the discharge for microbiological investigation
Although minor conjunctivitis with encrusting of the eyelids is common and often benign, a purulent discharge may indicate the presence of a serious infection (for example, with chlamydia or gonococcus).In babies with a purulent eye discharge swab samples should be taken urgently for microbiological investigation, using methods that can detect chlamydia and gonococcus. While the guidance is to start systemic antibiotic treatment for possible gonococcal infection while awaiting the swab microbiology results, swabs must be taken first.
A 24-year-old man presents to the emergency department complaining of left eye pain. He has not been able to wear his contact lenses for the past 24 hours due to the pain. He describes the pain as severe and wonders whether he has ‘got something stuck in his eye’. On examination there is diffuse hyperaemia of the left eye. The left cornea appears hazy and pupillary reaction is normal. Visual acuity is reduced on the left side and a degree of photophobia is noted. A hypopyon is also seen. What is the most likely diagnosis?
Acute angle closure glaucoma
Viral conjunctivitis
Keratitis
Episcleritis
Anterior uveitis
Keratitis
Whilst a hypopyon can of course be seen in anterior uveitis the combination of a normal pupillary reaction and contact lens use make a diagnosis of keratitis more likely.
A 54-year-old man is noted to have papilloedema on examination. Which one of the following may be responsible?
Vitamin D toxicity
Hypercapnia
Hyperkalaemia
Hypercalcaemia
Hypoglycaemia
Hypercapnia
Hyperventilation to induce hypocapnia may be used in the emergency setting to reduce intracranial pressure
A 23-year-old female presents with recurrent headaches. Examination of her cranial nerves reveals the right pupil is 3 mm whilst the left pupil is 5 mm. The right pupil constricts to light but the left pupil is sluggish. Peripheral neurological examination is unremarkable apart from difficult to elicit knee and ankle reflexes. What is the most likely diagnosis?
Acute angle closure glaucoma
Migraine
Multiple sclerosis
Holmes-Adie syndrome
Argyll-Roberson syndrome
Holmes-Adie syndrome:
- Unilateral in 80% of cases
- Dilated pupil
- Once the pupil has constricted it remains small for an abnormally long time
- Slowly reactive to accommodation but very poorly (if at all) to light
- Association with absent ankle/knee reflexes
