opth

Question 1

AMD treatment

Answer 1

Wet = anti VEGF injections, Dry = zinc

Question 2

blepharitis Mx

Answer 2

eye hygiene and warm compress

Question 3

hypertensive retinopathy grades

Answer 3

Question 4

A 73 year old male presents with recurrent episodes of pain around their right eye. The eye is not red but there is some redness medial to the right canthus. He complains of some blurring of his vision due to tearing but he has no vision loss, floaters or flashes. This is his third episode.
What is the most appropriate management plan?

Answer 4

Dacrystorhinostomy
This patient has features of dacrocystitis which is an infection of the lacrimal sac due to gram-positive bacteria. It typically occurs due to nasal-lacrimal duct obstruction leading to stagnation of tears which then gets infected. Management of recurrent cases requires surgical fixation of the duct obstruction.

Question 5

A 76 year old man presents 4 days after cataract surgery to his right eye with a painful red right eye.
On examination he has a severely injected conjunctiva and a white fluid level in the anterior chamber.
What is the most likely diagnosis?

Answer 5

A red eye post-surgery should prompt the diagnosis of endophthalmitis, which is infection inside the patient’s eye. This patient also has a hypopyon, described in the stem as a ‘white fluid level’, which is a collection of pus in the anterior chamber and indicates intraocular inflammation

Question 6

CRAO doesn’t usually have

Answer 6

floaters

Question 7

A patient who presents with sudden visual loss, floaters, and a curtain falling over the vision with a history of poorly controlled diabetes is likely experiencing a

Answer 7

vitreous haemorrhage. The inability to visualise the fundus on ophthalmoscopy due to dense opacities further supports this.

Question 8

Vitreous haemorrhage presents and is associated with

Answer 8

sudden, painless loss of vision. However, it is typically associated with the use of anticoagulants and a history of diabetes. Rather than floaters and flashes of light, “dark spots” are often described by patients, referring to moderate bleeds.

Question 9

Retinal detachment features - sudden, painless loss of vision occurs.

Answer 9

Often preceded by symptoms of posterior vitreous detachment: flashes of light and the presence of floaters.

Question 10

risk factors and Mx of retinal detachment

Answer 10

Severe myopia is a risk factor, as is previous cataract surgery. Urgent referral to the ophthalmology team is warranted for consideration of surgery.

Question 11

jaw claudication and weight loss support

Answer 11

GCA diagnosis

Question 12

Redness, blurred vision, pain and mild photophobia in a patient that wears contact lenses and is an alcoholic should raise a strong suspicion of

Answer 12

bacterial keratitis. His social history suggests that he may often fall asleep before removing his lenses, increasing his risk. A broad spectrum topical antibiotic, such as gatifloxacin, should be commenced and an urgent referral made to the ophthalmologist. The patient should stop wearing contact lenses until advised otherwise by an ophthalmologist.

Question 13

penetrating foreign body looking for injury Ix

Answer 13

CT orbit

Question 14

B USS used to detect

Answer 14

retinal detachment

Question 15

gonococcal conjunctivitis features

Answer 15

usually within 3 days of birth, mother would not have tender inguinal lump (this occurs with chalmydia, onset of this conjunctivitis neonatorum is 4-28 days )

Question 16

anti phospholipid syndrome causing CRAO test with

Answer 16

anti-cardiolipin antibodies

Question 17

treatment for acute progression acute progression of dry ARDM to wet ARMD

Answer 17

Intra-vitreal anti-vascular endothelial growth factor (VEGF) injection
This patient is presenting with acute progression of dry ARDM to wet ARMD. When treating wet ARMD, prevention of further neovascularisation is essential. This is achieved through anti-VEGF agents such as Bevacizumab, which can be injected directly into the vitreous to increase its bioavailability to the choroid

Question 18

An 86 year old woman attends eye casualty. She has a background of type 2 diabetes mellitus, Grave’s disease, hypertension, angina and atrial fibrillation for which she takes warfarin. She complains of floaters and dark streaks across her visual field which came on suddenly one day ago

Answer 18

vitreous haemorrhage - DM

Question 19

A 27 year old man attends A&E. He presented with a 2 day history of sudden onset vision loss in his right eye. On moving his right eye, he experiences pain behind his eye. He has a relative afferent pupillary defect of his right eye and a loss of his central visual field. His ability to distinguish between colours, particularly red, is diminished. Fundoscopy reveals a unilateral right sided papilloedema.
Given the likely diagnosis, what is the single best investigation?

Answer 19

MRI head
This patient is suffering from optic neuritis – an inflammatory demyelinating condition of the optic nerve. An MRI head is an important investigation to investigate for any further demyelinating plaques in the CNS that may suggest multiple sclerosis. 40-70% of optic neuritis cases will have, or go on to develop multiple sclerosis

Question 20

A rapidly growing, well differentiated lesion on eyelid that is “dome shaped” in appearance is descriptive of

Answer 20

keratoacanthoma. It is considered to be a well differentiated form of squamous cell carcinoma

Question 21

A 45-year-old man presents to the emergency department with acute weakness of the right side of his face. He is unable to to raise his eyebrow on the right and he notes difficulty in chewing. He also has a dry right eye. Upper and lower neurological examination is unremarkable, as is examination of the tympanic membrane.
Which of the following is a likely complication from the underlying diagnosis?

Answer 21

Keratoconjunctivitis sicca
Bell’s palsy can result in failure of the eyelids to close properly, which can cause the affected eye(s) to dry and sustain damage. This can lead to keratoconjunctivitis sicca

Question 22

A 50 year old female presents to the GP Practice complaining of a painful left eye. She reports onset of pain this morning which has worsened over several hours. She also mentions that bright lights exacerbate the pain and her vision has become blurred.
On examination, you note hyperaemia and an irregularly shaped pupil.
Which of the following is the most appropriate management option?

Answer 22

urgent specialist referral due to anterior uveitis

Question 23

washing contact lenses in sink can cause

Answer 23

Acanthamoeba is a serious parasitic infection with the main risk factor being contact lens use. Inadequate lens hygiene, such as washing lenses in the sink rather than with a sterile solution increases the risk of infection - red painful eye with reduced VA and hypopyon

Question 24

painful, red, watery eye with foreign body sensation, and green dendritic ulcer on staining indicative of

Answer 24

The dendritic ulcer described is characteristic of herpes simplex keratitis.

Question 25

infective endocarditis eye sign

Answer 25

Roth spots- retinal haemorrhage with white centre

Question 26

A 49-year-old woman presents to her general practitioner with difficulty driving at night due to ‘excessive glare’, blurring and double-vision. She has a background of type 1 diabetes mellitus and ulcerative colitis for which she has required 2 courses of steroids this year. She drinks 5-8 units of alcohol a week and smokes 10 cigarettes a day. On examination, there is reduced red reflex in the left eye and reduced acuity in the left eye. Eye movements, visual fields pupillary reflexes are normal. The patient’s double vision improves when the left eye is covered.
What is the most likely diagnosis?

Answer 26

Cataracts
Although the majority of cataracts occur in older patients over the age of 60, this patient has key risk factors that increase her risk of cataracts - a history of diabetes, smoking and steroid use. She has the typical symptoms of progressive loss and blurring of vision, difficulty in driving at night due to glare and monocular diplopia.

Question 27

GCA can lead to

Answer 27

anterior ischaemic optic neuropathy

Question 28

Fundoscopy reveals a pale retina with a red spot in the macula.
Which of the following is the next best investigation to evaluate the underlying cause of her condition?

Answer 28

CRAO- carotid artery doppler (carotid atherosclerosis is most common cause)

Question 29

virtuous haemorrhage in T2DM definitive treatment

Answer 29

vitrectomy

Question 30

long and short sightedness are RF for

Answer 30

Hypermetropia (longsightedness), not myopia, is a risk factor for acute angle closure glaucoma as patients usually have decreased axial length of the eyeball and a shallow anterior chamber. Myopia is a risk factor for chronic open angle glaucoma.

Question 31

anterior uveitis treatment

Answer 31

Topical cyclopentolate and topical corticosteroids

Question 32

Difficulty in reading text and recognising faces, and problems with vision in dim light are typical features of

Answer 32

dry AMD.

Question 33

hypopyon with recent cataract surgery

Answer 33

endopthalmitis most likely, rather than anterior uveitis

Question 34

The emergency management of acute angle closure glaucoma is with

Answer 34

IOP-lowering agents such as IV acetazolamide, pilocarpine or beta blockers.

Question 35

Zinc and antioxidant vitamin supplementation can

Answer 35

slow the progression of dry age-related macular degeneration but does not reverse existing damage.

Question 36

In individuals with age-related macular degeneration and acute onset of central vision loss,
what is first line

Answer 36

intravitreal VEGF inhibitor injections represent first-line treatment according to NICE guidelines.

Question 37

Atropine use can precipitate

Answer 37

acute angle closure glaucoma by causing mydriasis and narrowing the iridocorneal angle, obstructing aqueous outflow.

Question 38

Thyroid eye disease, often associated with Graves’ disease, may require

Answer 38

oral corticosteroids like prednisolone.

Question 39

Photopsia (flashes of light) is reported by some patients during a

Answer 39

posterior vitreous detachment.

Question 40

Suspected bacterial keratitis requires

Answer 40

urgent specialist referral, as it is sight-threatening.

Question 41

Oligoclonal bands in cerebrospinal fluid suggest

Answer 41

multiple sclerosis, particularly in patients with recurrent optic neuritis.

Question 42

Retinal detachment occurs when the retina separates from the back of the eye, leading to visual disturbances like

Answer 42

field impairment, flashes of light, or a curtain-like shadow over vision.

Question 43

Scleritis presents with

Answer 43

severe eye pain, redness, and photophobia, often worsening with eye movement, and may be linked to systemic inflammatory diseases.

Question 44

A patient with severe ocular pain, redness, tenderness on eye movement, photophobia, and reduced visual acuity, along with a tender eye that worsens with motion and an abnormal pupil reaction to light, may be suffering from

Answer 44

scleritis, which is a sight-threatening condition often associated with systemic autoimmune disorders.

Question 45

Post-operative or traumatic bacterial inoculation into the eye can lead to

Answer 45

endophthalmitis, a sight-threatening condition that requires urgent ophthalmological referral and intravitreal antibiotics.

Question 46

Adult East Asian women presenting with sudden-onset headache, nausea, blurred vision, and redness in one eye, accompanied by a recent history of taking antimuscarinic medication, may indicate

Answer 46

acute angle closure glaucoma. Initial treatment includes intravenous Acetazolamide and topical Timolol, along with urgent ophthalmology referral.

Question 47

Atropine sulfate eye drops is used to

Answer 47

dilate the pupil before eye exams.

Question 48

AACG management initially

Answer 48

Question 49

when IV steroids in GCA

Answer 49

if eye involvement, if not then oral

Question 50

surfers ear appearance and investigation

Answer 50

ear canal stenosis, CT head

Question 51

hypothyroid is associated with

Answer 51

blepharitis due to meibomian gland dysfunction