other

Question 1

lobes and lesions

Answer 1

A lesion in the temporal lobe would cause contralateral homonymous superior (upper) quadrantanopia
A lesion in the parietal lobe would cause contralateral homonymous inferior (lower) quadrantanopia
A lesion in the occipital lobe would cause contralateral homonymous hemianopia

Question 2

high prolactin what we thinkign what other sx

Answer 2

prolactinoma
pituitary gladn tumour most common compressing optic chiasm where the temproal fibres of the optic nerve decussate so lead to biteporal hemianopia

Question 3

A 45 year old female presents to Accident & Emergency complaining of a painful right eye. She reports onset of a dull aching pain over the space of hours associated with a severe headache and nausea. She has no medical history and wears reading glasses.

On examination, you note a red eye with a fixed dilated pupil.

Which of the following is the most likely diagnosis?

Answer 3

Acute angle closure glaucoma

Acute angle closure glaucoma often presents with headache and nausea, while visual symptoms may not always be present. A fixed dilated pupil is classic of this diagnosis and an important clue in the stem is that the patient wears reading glasses – hypermetropia being a risk factor for acute angle closure glaucoma

Question 4

Which of the following clinical features suggests a diagnosis of ischaemic optic neuropathy?

Answer 4

Swollen optic disc

A swollen optic disc is a common finding in patients with acute ischaemic optic neuropathy. In the chronic phase, the optic disc may atrophy and appear pale

Question 5

trochelar palsy what would you seee explain

hypertropia - up
hypermetropia
exotropia -out
esotropia - in
hypotropia - down

all types of strabismus - squints

Answer 5

The trochlear nerve supplies the superior oblique muscle which functions to depress the eye when the eye is held in adduction and to intort the eye when the eye is held in primary gaze. As a result of the unopposed action of the muscles to elevate the eye (the superior rectus and inferior oblique) a trochlear palsy causes the affected eye to sit higher within the orbit compared to the contralateral eye. This is termed hypertropia

Question 6

abducens palsy

Answer 6

CN VI innervates the lateral rectus muscle. The inability of an eye to turn outward results in a convergent strabismus or esotropia(in) which causes diplopia in which the two images appear side by side – a horizontal diplopia. Diplopia is also increased on looking to the affected side.

Question 7

scarrign alopecia

Answer 7

Folliculitis decalvans

This is the only option that causes a scarring alopecia. Folliculitis decalvans causes a scarring alopecia with peri-follicular pustules and multiple hairs originating from a single follicle

Alopecia areata

Alopecia areata does cause patches of hair loss, but this is non-scarring

Telogen effluvium causes diffuse hair loss after severe physiological stress eg childbirth, illness, surgery.

Androgenic alopecia causes male- or female-pattern balding. In males it presents with a receding hairline and loss of hair on the vertex of the scalp. In females it presents with thinning of the hair.

Nutritional deficiencies and thyroid dysfunction may also cause non-scarring alopecia.

Question 8

A 69-year-old gentleman presents to the emergency department with a suspected stroke. On examination there is unilateral hemiparesis of the right upper limb as well as significant dysphasia of speech and hemispatial neglect on visual examination. Which of the following is the correct classification of this stroke?

Answer 8

PACI

Contralateral hemiplegia or hemiparesis, AND
Contralateral homonymous hemianopia, AND
Higher cerebral dysfunction (e.g. aphasia, neglect) A TACI involves the anterior AND middle cerebral arteries on the affected side.
A partial anterior circulation infarct (PACI) is defined by:

2 of the above, OR
Higher cerebral dysfunction alone.
A PACI involves the anterior OR middle cerebral artery on the affected side.

Question 9

A 69-year-old gentleman presents to the emergency department with a suspected stroke. On examination there is unilateral hemiparesis of the right upper limb as well as significant dysphasia of speech and hemispatial neglect on visual examination. Which of the following is the correct classification of this stroke?

Answer 9

PACI

Contralateral hemiplegia or hemiparesis, AND
Contralateral homonymous hemianopia, AND
Higher cerebral dysfunction (e.g. aphasia, neglect) A TACI involves the anterior AND middle cerebral arteries on the affected side.
A partial anterior circulation infarct (PACI) is defined by:

2 of the above, OR
Higher cerebral dysfunction alone.
A PACI involves the anterior OR middle cerebral artery on the affected side.

Question 10

what things can damage the cornea causing a refractive error

Answer 10

Refractive error means that the shape of your eye does not bend light correctly, resulting in a blurred image. The main types of refractive errors are myopia (nearsightedness), hyperopia (farsightedness), presbyopia (loss of near vision with age), and astigmatism.

Question 11

This patient has had a central retinal artery occlusion (CRAO) which presents with a profound and painless loss of vision with a pale retina and a ‘cherry red’ spot in the macula.

Given her young age, her history of miscarriages and her rash, known as livedo reticularis, she should be investigated for

Answer 11

anticardiolipin- antiphospholipid syndrome

Question 12

Which of the following is the correct explanation for the purpose of a fluorescein eye drop test?

Answer 12

To identify any defects in the corneal epithelium

Fluorescein is an orange/yellow eye drop which turns green with stimulation by blue light. The fluorescein accumulates in defects in the corneal epithelium and thus these areas of damage are more apparent when blue light is shone on to the cornea

Question 13

retinits pigementosa sx and what is affected

Answer 13

Patients often present at a young age with ‘tunnel vision’ due to damage to the peripheral retina from pigment deposits.

As rod cells are primarily affected in most types, patients also classically complain of reduced visual acuity in dim light.

Question 14

Any cause of reduced visual stimulation in one eye can cause

Answer 14

Amblyopia - A visual impairment resulting from abnormal visual stimulation during early childhood

Question 15

differnce between central and branch retinal artery occlusion

Answer 15

branch you would have half of it most commonly temporal

Question 16

dendritic ucler caused by

Answer 16

virus

Question 17

A 23-year-old female patient presents to the Emergency Eye Clinic complaining of a 3 day history of pain and reduced vision in her left eye. On examination, the visual acuity in the left eye was 6/12 and scored 3 out of 38 on the Ishihara plate test. She had a left-sided relative afferent pupillary defect and fundoscopy showed optic disc oedema, consistent with a diagnosis of optic neuritis. Examination of the right eye was unremarkable. On reviewing her record, her doctor notes that she presented with a similar complaint 6 months ago in her right eye, which self resolved over the course of three weeks.

Which of the following investigation findings is likely to be found in this patient?

Answer 17

Oligoclonal bands in a cerebrospinal fluid sample

The presence of relative afferent pupillary defect, colour blindness and optic disc oedema localises the pathology to the optic nerve. Pain suggests the pathology is optic neuritis, especially given the demographics of the patient. The past ocular history shows two neurological events disseminated in time and space (as both eyes have now been affected). This diagnosis is likely to be multiple sclerosis (MS). Oligoclonal bands are IgG clones produced in the CSF as a result of the T-cell mediated inflammation that defines Multiple Sclerosis. They can be identified by electrophoresis of CSF. Note that Oligoclonal bands are not required for the diagnosis but are suggestive

Question 18

argyll robertson pupil - what is it and linked to what disease

Answer 18

Argyll-Robertson pupil refers to bilaterally small pupils that constrict on convergence but do not constrict in response to light.

They are highly specific for neurosyphilis.

Question 19

Corneal arcus

Answer 19

high lipids

Question 20

A single, well demarcated white ulcer

A dendritic ulcer

Multiple, poorly demarcated, fluffy white lesions with satellite lesions

match up these with specifc keratitis

Answer 20

bacterial keratitis

herpes simplex keratitis

fungal keratitis

Question 21

complciation of bacterial keratitis after bells palsy

Answer 21

Exposure keratopathy

Bell’s palsy is an idiopathic facial nerve palsy. Paralysis of the orbicularis oculi muscle attenuates eyelid closure (lagophthalmos) thus increasing the exposure of the cornea and tear layer to the environment. This increases the risk of damage to the corneal epithelium (exposure keratopathy) which may become infected leading to sight-threatening keratitis

Question 22

A 51 year old female patient attends A&E complaining of a red right eye. She reports that her red eye started suddenly, and she can hear a ‘whooshing noise’. She also reports diplopia, a headache and loss of vision.

On examination her visual acuity is 1/60 in her right eye. Her conjunctiva is injected, and she has a restriction in her right eye movements in all direction. The eye is severely proptosed and pulsatile.

What is the most likely diagnosis?

Answer 22

Carotid-cavernous fistula

Question 23

what is a carotid cavernous fistula

what CN affected

Answer 23

This a communication between the carotid artery and the cavernous sinus.
III, IV, V1, V2 and VI

The eye is usually proptosed with an injected conjunctiva and may be pulsatile

Question 24

Photopsia

Answer 24

flash of light

seen in post vitreous detachment

Question 25

infective endocarditis eyes what do you see

Answer 25

roth spots - Roth spots refer to retinal haemorrhages with a white centre.

caused by septic emboli minor Duke criteria for infective endocarditis.
They represent micro-abscess formation on the retina (in the same way that septic emboli can also cause larger intra-cerebral abscesses)

Question 26

infective endocarditis eyes what do you see

Answer 26

roth spots - Roth spots refer to retinal haemorrhages with a white centre. They are caused by septic emboli and thus are one of the minor Duke criteria for infective endocarditis. They represent micro-abscess formation on the retina (in the same way that septic emboli can also cause larger intra-cerebral abscesses)

Question 27

pain behind the eye , RAPD, on moving hurts , loss of colour vision

Answer 27

optic neuritis

Question 28

object in eye investgiation

Answer 28

CT orbits need to see if it has penetrated

Question 29

wilsons disease levels off copper in urine and serum
high or low

Answer 29

high urinary copper and low serum ceruloplasmin is seen.

Plasma free copper is paradoxically low, reflecting its rapid deposition in the central nervous system and liver. Treatment is with copper chelators such as Penicillamine or Trientine Hydrochloride

Question 30

sx arise from what nerve in cluster headahce

Answer 30

but the symptoms arise from hyperactivity of the nociception fibers of the ophthalmic division of the trigeminal nerve (gi

Question 31

Small, pink nodules with a central umbilication

Answer 31

molluscum

Question 32

central field loss
associated with what condition

Answer 32

macular degeneration

Question 33

A 71-year-old man presents with severe pain around his right eye and vomiting. On examination the right eye is red and decreased visual acuity is noted. Which one of the following options is the most appropriate initial management?

Answer 33

refer to hospital

this is glaucoma

Question 34

A 68-year-old man presents to the emergency department due to a painless loss of visual acuity in his left eye for the last three days.

He reports progressive central visual loss over the last eighteen months.

He has a 40-pack-year smoking history.

On examination, his visual acuity is 6/48 in his left eye, and 6/18 in his right eye. A scotoma is present in the left eye. When the patient looks at an Amsler grid, the straight lines in the centre appear wavy. On fundoscopy, intra-retinal and sub-retinal haemorrhages are visualised in the left eye.

What is associated with his condition?

Answer 34

choriodal neovascularisation

wet MRD

Question 35

A 74-year-old retired artist attends the GP with a long-standing painless loss of vision. She complains of a gradual loss of vision affecting reading as she is finding the words on the page more difficult to see. She also complains that straight lines in her paintings are starting to appear wonky and this is also picked up with Amsler grid testing.

What is the most likely diagnosis?

Answer 35

dry

Wet age-related macular degeneration is incorrect. Macular degeneration is correct as the symptoms described are consistent with a macular degeneration diagnosis. 90% of cases of macular degeneration are the dry subtype so the correct answer is dry age-related macular degeneration. Wet ARMD also usually presents with a faster loss of vision than dry ARMD.

Question 36

characterisitic sx of belpharitis

Answer 36

Burning, itching and/or crusting of the eyelids;
Worse in the mornings, exacerbated by makeup and/or wind;
Involvement of both eyelids;
Recurrent hordeolum (commonly called a ‘stye’), which is a blockage of the sweat glands;
Intolerance to contact lenses