Passmed Qs Flashcards
Inferior homonymous quadrantanopia, where is the most likely site of lesion?
Superior optic radiation in parietal lobe
(PITS - parietal-inferior visual field / temporal-superior visual field)
Sudden visual loss in diabetics, most likely cause?
Vitreous haemorrhage
If clopidogrel (75mg OD) is contraindicated or not tolerated in a pt following an ischaemic stroke, what should be given instead?
Aspirin
Type of scotoma seen in MS
Central scotoma - feature of optic neuritis
Fall/collapse + associated muscle weakness triggered by strong emotions (laughter/anger/surprise) –>
Cataplexy - often associated with narcolepsy
Erythema/swelling around the right eye + pain on eye movements. What is the appropriate management?
IV antibiotics
- orbital cellulitis (risk of cavernous sinus thrombosis and intracranial spread)
What tool/score is used to assess stroke symptoms in an acute setting (ED)?
ROSIER
Headache + fever + focal neurology –>
Brain abscess
Case:
- Progressive weakness in legs following a GI illness 3 weeks ago
- Has noticed he is tripping while walking
- O/E: symmetrical weakness + diminished reflexes in lower limbs, while sensation remains intact
Guillain-Barre syndrome
- worsening lower limb weakness following gastroenteritis
- tripping while walking –> foot drop
Case:
- 37yo hypertensive woman presents to ED with a 1-hour history of sudden onset headache and nausea and vomiting
- since arriving, she complains of new onset facial pain over her right maxilla
- Blood tests show a raised D-dimer
What is the diagnosis + what scan is gold-standard for investigating this potential diagnosis?
Venous sinus thrombosis –> MR venogram
- her age is within typical ranges for women presenting with this condition
- sudden-onset headache + features of increased ICP (nausea and vomiting) + raised D-dimer
Case:
- 2 day hx of drooping of his right eyelid and double vision + mild, persistent headache
- O/E: right-sided ptosis, dilated pupil, and impaired adduction, elevation, and depression of the right eye
- visual acuity intact, no proptosis or conjunctival injection
What is the most likely cause of his symptoms?
Posterior communicating artery aneurysm
- painful third nerve palsy = PCOM aneurysm
- dilated pupil –> due to compression of the parasympathetic fibres that run superficially on the nerve
Case:
- gradual loss of visual acuity in her left eye, painful eye movements, relative afferent pupillary defect, and evidence of a central scotoma
- no black spots or curtain-like sensations in her vision
What is likely diagnosis and what type of vision is affected in this condition?
Optic neuritis –> colour vision (‘red desaturation’) is affected in optic neuritis
Case:
- 45yo woman presents to ED with blurring of vision in right eye over the last 2 days
- there is deep pain behind her eye which is worse on eye movement
- O/E: visual acuity is 6/60, large central visual field defect is present in right eye, and hwne shining light into left eye, both puils constrict, however, when moving the light to the right eye, both pupils dilate
What is likely diagnosis + most appropriate next step in her management?
Optic neuritis –> IM corticosteroids + MRI of the brain and orbits
- subacute unilateral visual loss, eye pain worse on movements –> ?optic neuritis
- IM corticosteroids –> reduce optic nerve inflammation and damage
- MRI brain –> to look for white matter lesions in the brain due to ON’s association with MS
- MRI orbits –> may show signs of inflammation that support a diagnosis of ON (optic nerve swelling and white matter lesions)
Case:
- 62yo woman presents with occasional blurriness in her vision and has noticed periheral vision loss
- O/E: intraocular pressure (IOP) is 26 mmHg in both eyes
- PMH: well-controlled hypertension
- FH: mother has glaucoma
What is the most appropriate next step in terms of management?
360° selective laser trabeculoplasty (SLT) –> 1st-line if the IOP is ≥ 24 mmHg
- the diagnosis is primary open-angle glaucoma –> elevated IOP, peripheral vision loss, and FH of glaucoma
