passmed

Question 1

A 54-year-old man is noted to have papilloedema on examination. Which one of the following may be responsible?

Answer 1

hypercapnia

Question 2

wha is papilloedema

Answer 2

optic disc swelling that is caused by increased intracranial pressure. It is almost always bilateral.

Question 3

what are the features of papilloedema on fundoscopy

Answer 3

venous engorgement: usually the first sign
loss of venous pulsation: although many normal patients do not have normal pulsation
blurring of the optic disc margin
elevation of optic disc
loss of the optic cup
Paton’s lines: concentric/radial retinal lines cascading from the optic disc

Question 4

what are causes of papilloedema

Answer 4

space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia

Question 5

what are the rare causes of papilloedema

Answer 5

hypoparathyroidism and hypocalcaemia
vitamin A toxicity

Question 6

A 47-year-old woman presents to the emergency department with a painful red left eye, which came on suddenly this morning. Visual acuity is significantly reduced in the left eye compared to the right. On slit-lamp examination, you notice the presence of pus within the anterior chamber.

Given the likely diagnosis, what is the most appropriate treatment?

Answer 6

anterior uveitis

steroid eye drops plus cycloplegic (mydriatic drops)

Question 7

what are the features of anterior uveitis

Answer 7

acutely painful red-eye
reduced visual acuity.

complain of photophobia.

On examination, the affected pupil is likely to be small, and there may be pus in the anterior chamber.

Question 8

features of anterior uveitis

Answer 8

acute onset
ocular discomfort & pain (may increase with use)
pupil may be small +/- irregular due to sphincter muscle contraction
photophobia (often intense)
blurred vision
red eye
lacrimation
ciliary flush: a ring of red spreading outwards
hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
visual acuity initially normal → impaired

Question 9

what are the associated conditions of anterior uveitis

Answer 9

ankylosing spondylitis
reactive arthritis
ulcerative colitis, Crohn’s disease
Behcet’s disease
sarcoidosis: bilateral disease may be seen

Question 10

describe the management of anterior uveitis

Answer 10

urgent review by ophthalmology
cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate.
steroid eye drops

Question 11

what is anterior uveitis

Answer 11

Anterior uveitis describes inflammation of the anterior portion of the uvea - iris and ciliary body. It is associated with HLA-B27 and may be seen in association with other HLA-B27 linked conditions