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Eyes and Vision Flashcards

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1
Q

A 30-year-old woman with rheumatoid arthritis is experiencing orange staining of her soft contact lenses.

Which of the following is the SINGLE MOST likely cause?

A. Ketoprofen
B. Alcohol
C. Combined oral contraceptive
D. Sulfasalazine
E. Aspirin

A

Answer: D. Sulfasalazine
Justification: Sulfasalazine can cause orange staining of soft contact lenses. Other drugs can also affect lenses in various ways, but only sulfasalazine causes this distinct discoloration.
Resource: RCGP Learning

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2
Q

A 25-year-old man presents with a painful red right eye. Visual acuity is 6/12. Redness is pericorneal and the pupil is smaller than the other side.

What is the SINGLE MOST likely diagnosis?

A. Glaucoma
B. Iritis
C. Viral conjunctivitis
D. Marginal keratitis
E. Allergic conjunctivitis

A

Answer: B. Iritis
Justification: Circumlimbal injection, pain, reduced visual acuity, and altered pupil suggest iritis. Conjunctivitis has diffuse injection and normal pupils.
Resource: RCGP Learning

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3
Q

A 40-year-old man working in the Middle East has a hyperaemic, raised lesion on the nasal conjunctiva encroaching on the cornea.

What is the SINGLE MOST likely diagnosis?

A. Photokeratitis
B. Scleritis
C. Pterygium
D. Corneal ulcer
E. Acanthamoeba conjunctivitis

A

Answer: C. Pterygium
Justification: Pterygium is associated with UV exposure and appears on the nasal conjunctiva. May require surgical treatment if vision is affected.
Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019

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4
Q

Match the following cases to the SINGLE MOST likely diagnosis:

  1. 56F, gritty sensation, no discharge, office worker
  2. 73M smoker, missing parts when reading
  3. 35F with Raynaud’s, dry eyes/mouth
  4. 25F with weight loss, irritability, sore eyes
A

Answer:
1 – Dry eye syndrome
2 – Age-related macular degeneration
3 – Sjögren’s syndrome
4 – Graves’ disease
Justification: Dry eyes are common in dry office environments. ARMD presents with central vision loss. Sjögren’s causes dry eyes and mouth. Graves’ is associated with thyroid eye disease.
Resource: RCGP Learning

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5
Q

A 76-year-old man presents with gradual vision loss.

What is the SINGLE MOST common cause of blindness in the UK?

A. Optic atrophy
B. Diabetic retinopathy
C. Macular degeneration
D. Myopia
E. Glaucoma

A

Answer: C. Macular degeneration
Justification: Responsible for over 50% of sight loss in the UK. Affects central vision.
Resource: RCGP Learning

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6
Q

Which eye disease is MOST strongly linked to smoking?

A. Hypermetropia
B. Proptosis
C. Keratoconus
D. Age-related macular degeneration
E. Myopia

A

Answer: D. Age-related macular degeneration
Justification: Smoking increases the risk of AMD four-fold.
Resource: Khan J et al. Br J Ophthalmol 2006; 90: 75–80.

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7
Q

What is the MINIMUM visual acuity for driving a car (Group 1 licence holders)?

A. 6/5
B. 6/60
C. 6/12
D. 6/36
E. 6/18

A

Answer: C. 6/12
Justification: Group 1 drivers must have at least 6/12 vision with both eyes (or one if monocular).
Resource: DVLA. Visual disorders: assessing fitness to drive.

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8
Q

A 60-year-old woman presents with headache, scalp tenderness, jaw claudication and visual loss. ESR is pending.

What is the SINGLE MOST appropriate management?

A. Start prednisolone
B. Start aciclovir
C. Refer ophthalmology within two weeks
D. Start clopidogrel
E. Await blood results

A

Answer: A. Start prednisolone
Justification: In suspected giant cell arteritis with eye symptoms, start steroids immediately to prevent vision loss.
Resource: RCGP Learning

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9
Q

A 64-year-old man presents with painful red eye, haloes, and vomiting. Pupil is fixed and dilated.

What is the SINGLE MOST appropriate initial management?

A. Oral prednisolone + pilocarpine
B. Oral prednisolone + latanoprost
C. Oral acetazolamide + cyclopentolate
D. Oral acetazolamide + pilocarpine
E. Oral bisoprolol + chloramphenicol

A

Answer: D. Oral acetazolamide + pilocarpine
Justification: Acute angle closure glaucoma requires emergency referral; if delay, initiate treatment with acetazolamide and pilocarpine.
Resource: RCGP Learning

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10
Q

An 80-year-old woman has progressive, painless unilateral vision loss. Fundoscopy shows engorged veins and haemorrhages.

What is the SINGLE MOST likely diagnosis?

A. Retinal detachment
B. Central retinal vein occlusion
C. COAG
D. Central retinal artery occlusion
E. Dry macular degeneration

A

Answer: B. Central retinal vein occlusion
Justification: CRVO presents with sudden painless vision loss, retinal haemorrhages and vein engorgement.
Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019

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11
Q

A 27-year-old man has a corneal abrasion from a gardening injury.

What is the SINGLE MOST appropriate treatment?

A. Topical chloramphenicol
B. Topical lidocaine
C. Topical tropicamide
D. Topical tetracaine
E. Eye patch

A

Answer: A. Topical chloramphenicol
Justification: Prevents secondary infection. Anaesthetic drops delay healing and increase ulcer risk; patches are not recommended.
Resource: Syed S, Harrison N. InnovAiT 2013; 6(9): 551–554.

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12
Q

A 58-year-old man with MS has transient vision loss lasting 45 minutes. Visual fields are abnormal.

What is the SINGLE MOST likely diagnosis?

A. Acute glaucoma
B. Optic neuritis
C. Retinal artery thrombosis
D. Retinal detachment
E. Transient ischaemic attack

A

Answer: E. Transient ischaemic attack
Justification: MS relapses must last >24 hours. Sudden transient vision loss is likely a TIA.
Resource: RCGP Learning

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13
Q

A 4-year-old is being assessed for squint. Which test is NOT indicated?

A. Ocular movements
B. Visual acuity
C. Swinging light test
D. Corneal light reflex
E. Cover test

A

Answer: C. Swinging light test
Justification: Used for afferent pupillary defects, not squint. All others help assess ocular alignment.
Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019

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14
Q

A 2-month-old has persistent watery eye since birth. When should referral be made?

A. 3 months
B. 6 months
C. 9 months
D. 12 months
E. 15 months

A

Answer: D. 12 months
Justification: Nasolacrimal duct obstruction usually resolves in the first year. Refer if persisting beyond 12 months.
Resource: RCGP Learning

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15
Q

A 61-year-old woman calls with painful, red eye, blurred vision, nausea, headache.

What is the SINGLE MOST likely diagnosis?

A. Episcleritis
B. Anterior uveitis
C. Ocular migraine
D. Acute angle closure glaucoma
E. Retinal detachment

A

Answer: D. Acute angle closure glaucoma
Justification: Typical presentation includes pain, mid-dilated pupil, nausea, and blurred vision.
Resource: RCGP Learning

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16
Q

A 40-year-old woman walks into door frames. She has bitemporal hemianopia.

What is the SINGLE MOST likely diagnosis?

A. Pituitary adenoma
B. Iritis
C. Multiple sclerosis
D. Retinitis pigmentosa
E. Glaucoma

A

Answer: A. Pituitary adenoma
Justification: Bitemporal hemianopia results from optic chiasm compression, most commonly from a pituitary tumour.
Resource: RCGP Learning

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17
Q

An 82-year-old woman presents with sudden, painless unilateral vision loss. Fundoscopy shows haemorrhages.

What is the SINGLE MOST likely diagnosis?

A. Central retinal vein occlusion
B. Diabetic retinopathy
C. Central retinal artery occlusion
D. Branch retinal vein occlusion
E. Branch retinal artery occlusion

A

Answer: A. Central retinal vein occlusion
Justification: Sudden, painless visual loss with retinal haemorrhages and engorgement indicates CRVO.
Resource: RCGP Learning

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18
Q

Match the following painful red eye cases with diagnoses:

  1. 26M, contact lens pain, fluorescein stains cornea
  2. 78F, demented, eye pain, vomiting, fixed pupil
  3. 32F with RA, boring eye pain, deep redness
A

Answer:
1 – Keratitis
2 – Acute closed-angle glaucoma
3 – Scleritis
Justification: Keratitis = corneal ulcer; Glaucoma = fixed pupil, systemic symptoms; Scleritis = deep pain, RA association.
Resource: RCGP Learning

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19
Q

A 65-year-old diabetic man has 1 week of flashes and floaters with a grey shadow in vision.

What is the MOST likely diagnosis?

A. Macular degeneration
B. Uveitis
C. Retinal detachment
D. Amaurosis fugax
E. Glaucoma

A

Answer: C. Retinal detachment
Justification: Symptoms of floaters, flashes, grey curtain = classic for detachment.
Resource: Holliday L, Wilde C. InnovAiT 2019; 12(12): 720-724.

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20
Q

A 70-year-old diabetic man has blurred central vision 8 weeks post cataract surgery.

What is the SINGLE MOST likely cause?

A. Suprachoroidal haemorrhage
B. Intra-ocular lens error
C. Cystoid macular oedema
D. Endophthalmitis
E. Posterior capsular thickening

A

Answer: C. Cystoid macular oedema
Justification: Occurs 2–4 months post-op, causes central vision loss. Pain = uncommon.
Resource: Royal College of Ophthalmologists. Cataract Services Quality Standards. 2021

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21
Q

A 40-year-old man, working in the Middle-East, presents with a hyperaemic lesion on the nasal conjunctiva encroaching on the cornea.
What is the SINGLE MOST likely diagnosis?
A. Pterygium
B. Acantamoeba conjunctivitis
C. Photokeratitis
D. Corneal ulcer
E. Scleritis

A

Answer: A. Pterygium
Justification: Pterygium is a benign growth associated with wind, sunlight, and sand exposure. It commonly appears on the nasal conjunctiva and may require surgical treatment if symptomatic or obstructing vision.
Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2024.

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22
Q

A 67-year-old man with reduced peripheral vision in all directions and visual acuity of 6/9 bilaterally.
What is the SINGLE MOST likely diagnosis?
A. Retinal detachment
B. Diabetic retinopathy
C. Cataract formation
D. Primary open-angle glaucoma
E. Macular degeneration

A

Answer: D. Primary open-angle glaucoma
Justification: POAG causes painless, gradual peripheral visual field loss leading to tunnel vision. It is asymptomatic until significant optic nerve damage has occurred.
Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.

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23
Q

Which is the SINGLE MOST likely eye disease associated with smoking?
A. Keratoconus
B. Myopia
C. Age-related macular degeneration
D. Proptosis
E. Hypermetropia

A

Answer: C. Age-related macular degeneration
Justification: Smoking is a major risk factor for AMD, increasing the risk by four times.
Resource: Khan J et al. Br J Ophthalmol 2006; 90: 75–80.

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24
Q

A 33-year-old contact lens wearer has a gritty, red eye with no discharge.
Which condition would fluorescein staining reveal?
A. Keratitis
B. Bacterial conjunctivitis
C. Iritis
D. Gonococcal conjunctivitis
E. Anterior uveitis

A

Answer: A. Keratitis
Justification: Fluorescein highlights corneal epithelial defects, typical in keratitis, especially among contact lens users.
Resource: RCGP Learning.

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25
A 72-year-old man has sudden visual loss, afferent pupillary defect, and pale retina. What is the SINGLE MOST likely diagnosis? A. Temporal arteritis B. Retinal artery occlusion C. Keratitis D. Orbital cellulitis E. Acute glaucoma
Answer: B. Retinal artery occlusion Justification: CRAO causes painless vision loss, pale retina, and vessel attenuation. Urgent treatment is needed to prevent permanent loss. Resource: RCGP Learning.
26
A 72-year-old with gradual unilateral visual loss and obliterated red reflex. What is the SINGLE MOST likely diagnosis? A. Age-related macular degeneration B. Cataract C. Refractive error D. Corneal ulcer E. Retinal detachment
Answer: B. Cataract Justification: Cataracts cause progressive, painless vision loss with a reduced red reflex due to lens opacification. Resource: RCGP Learning.
27
A 6-month-old boy with intermittent outward eye deviation. Red reflex present bilaterally. What is the SINGLE MOST appropriate management? A. Refer to ophthalmologist B. Refer to orthoptic service C. Refer to paediatrician D. Refer to health visitor E. Advice and reassurance
Answer: B. Refer to orthoptic service Justification: Strabismus beyond 3 months of age requires referral to eye services to prevent amblyopia. Resource: NICE CKS. Squint in children. 2021.
28
A 68-year-old with bilateral red, itchy, watery eyes and mild gritty sensation. No discharge. What is the SINGLE MOST likely diagnosis? A. Bacterial conjunctivitis B. Blepharitis C. Infectious keratitis D. Viral conjunctivitis E. Anterior uveitis
Answer: D. Viral conjunctivitis Justification: Viral conjunctivitis is bilateral, with serous discharge and mild symptoms. Resource: RCGP Learning.
29
Match the following cases of red, painful eyes: 1. 26M, contact lens, photophobia, fluorescein staining 2. 78F with dementia, eye pain, vomiting, fixed pupil 3. 32F with RA, boring pain, redness, no staining
Answer: 1 – Keratitis 2 – Acute closed-angle glaucoma 3 – Scleritis Justification: Keratitis = corneal ulcer, Glaucoma = fixed pupil and nausea, Scleritis = deep, boring pain, RA-related. Resource: RCGP Curriculum Topic Guides: eyes and vision. 2019.
30
A 4-year-old girl is assessed for suspected squint. Which examination technique is NOT indicated? A. Ocular movements B. Visual acuity C. Cover test D. Swinging light test E. Corneal light reflex
Answer: D. Swinging light test Justification: Swinging light test is used for afferent pupillary defect, not strabismus. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
31
A 62-year-old woman presents with sudden unilateral visual loss. Fundoscopy shows widespread haemorrhages. What is the SINGLE MOST likely diagnosis? A. Central retinal vein occlusion B. Glaucoma C. Central retinal artery occlusion D. Vitreous haemorrhage E. Amaurosis fugax
Answer: A. Central retinal vein occlusion Justification: CRVO presents with multiple haemorrhages and cotton wool spots due to venous thrombosis. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
32
A 60-year-old woman has blurred vision, headache, jaw claudication, and temporal tenderness. What is the SINGLE MOST appropriate management? A. Start aciclovir B. Initiate clopidogrel C. Start prednisolone D. Refer to ophthalmology within two weeks E. Await blood results
Answer: C. Start prednisolone Justification: GCA with visual involvement requires urgent steroid initiation before test results. Resource: NICE CKS. Giant cell arteritis. 2024.
33
An 80-year-old man with weight loss, jaw claudication, and headache. Which complication is MOST likely prevented by early treatment? A. Central retinal vein occlusion B. Episcleritis C. Iritis D. Retinal detachment E. Ischaemic optic neuropathy
Answer: E. Ischaemic optic neuropathy Justification: GCA can cause irreversible vision loss through optic nerve infarction. Resources: BSR & BHPR GCA Guidelines; NICE CKS. Giant cell arteritis. 2024.
34
A 42-year-old man with rash to tip of nose, red eye, and vision loss. What is the SINGLE MOST appropriate treatment? A. Topical sodium cromoglicate B. Topical timolol C. Oral flucloxacillin D. Topical daktacort E. Oral aciclovir
Answer: E. Oral aciclovir Justification: Herpes zoster ophthalmicus with eye symptoms requires systemic antivirals within 72 hours. Resource: RCGP Learning.
35
A woman with non-epileptic seizures reports visual loss. Which feature suggests functional visual loss? A. Expanding visual fields B. Tubular visual fields C. Constant blurring D. Worse function in daily life E. Gradual onset
Answer: B. Tubular visual fields Justification: Functional loss may show field restriction regardless of testing distance, unlike organic vision loss. Resource: RCGP Learning.
36
A 70-year-old woman has headache and unilateral vision loss. Tender temples. What is the SINGLE MOST important treatment? A. Diclofenac B. Aspirin C. Co-codamol D. Sumatriptan E. Prednisolone 60 mg orally
Answer: E. Prednisolone 60 mg orally Justification: Suspected GCA requires immediate steroids to prevent further visual loss. Resource: RCGP Learning.
37
A 76-year-old man reports progressive visual decline. What is the SINGLE MOST common cause of blindness in the UK? A. Myopia B. Optic atrophy C. Diabetic retinopathy D. Macular degeneration E. Glaucoma
Answer: D. Macular degeneration Justification: AMD causes central vision loss and accounts for over 50% of blindness in the UK. Resource: RCGP Learning.
38
Which patient requires URGENT ophthalmology referral? A. Drusen B. Retinal haemorrhage with neovascularisation C. Disciform scar D. Background diabetic retinopathy E. None of the above
Answer: B. Retinal haemorrhage with neovascularisation Justification: Wet macular degeneration is sight-threatening and needs urgent therapy. Resource: RCGP Learning.
39
A 78-year-old woman does not meet driving vision standards. What is the MINIMUM acuity required for driving (with correction if needed)? A. 6/60 B. 6/36 C. 6/18 D. 6/5 E. 6/12
Answer: E. 6/12 Justification: Group 1 drivers must read a number plate at 20 metres (approx. 6/12). Resource: DVLA. Visual disorders: assessing fitness to drive.
40
What is the MINIMUM Snellen visual acuity required to drive? A. 6/6 B. 6/9 C. 6/12 D. 6/24 E. 6/18
Answer: C. 6/12 Justification: Must be able to read number plate at 20 metres with corrective lenses if worn. Resource: DVLA guidance: fitness to drive.
41
A 24-year-old woman attends with a swelling in her right lower eyelid. It has been slowly enlarging over the past three weeks. On examination, you note a soft, slightly fluctuant lump about 1 cm in diameter and is non-tender. There is no associated erythema. What would be the SINGLE MOST appropriate treatment at this stage? A. Heat and massage B. Intralesional triamcinolone C. Topical chloramphenicol ointment D. Oral flucloxacillin E. Incision and curettage
Answer: A. Heat and massage Justification: A meibomian cyst (chalazion) is painless and often self-limiting. Early treatment with heat and massage leads to faster resolution. Incision and curettage or intralesional triamcinolone are second line. Resource: Arbabi E, Kelly R, Carrim Z. Chalazion. BMJ 2010; 341: c4044.
42
A 60-year-old woman with Sjögren's syndrome has dry eyes and finds that her current ocular lubricant is not helping. She wears soft contact lenses. Which preparation is LIKELY to be the MOST SUITABLE? A. Pilocarpine hydrochloride 0.5% preservative-free eye drops B. Acetylcysteine 5% eye drops C. Hypromellose 0.3% eye drops D. Carbomer 980 preservative-free single dose liquid eye gel E. Lacri-Lube eye ointment
Answer: D. Carbomer 980 preservative-free single dose liquid eye gel Justification: Preservative-free single-dose gels are best for contact lens wearers and those needing frequent drops. Resource: NICE. Dry eye syndrome; Roberts D. InnovAiT 2015; 8(7): 412–417.
43
A 76-year-old man complains of worsening eyesight and is the main carer for his disabled wife. He has age-related macular degeneration. Which health professional can register a patient as ‘partially-sightedʼ or ‘blindʼ? A. General practitioner B. Occupational therapist C. Ophthalmologist D. Optometrist E. Social worker
Answer: C. Ophthalmologist Justification: Only a consultant ophthalmologist can complete the Certificate of Vision Impairment. Resource: RNIB. The criteria for certification.
44
A 40-year-old woman walks into door frames. Examination shows bitemporal hemianopia. What is the SINGLE MOST likely diagnosis? A. Pituitary adenoma B. Iritis C. Retinitis pigmentosa D. Multiple sclerosis E. Glaucoma
Answer: A. Pituitary adenoma Justification: Compression of the optic chiasm by a pituitary tumour causes bitemporal hemianopia. Resource: RCGP Learning
45
A 67-year-old motorcyclist is advised by his optician to notify the DVLA of a new eye condition. Which condition requires DVLA notification? A. Unilateral macular degeneration B. Unilateral diabetic retinopathy C. Bilateral glaucoma D. Colour blindness E. Bilateral conjunctivitis
Answer: C. Bilateral glaucoma Justification: DVLA must be informed if a person has bilateral glaucoma. Resource: DVLA. Assessing fitness to drive.
46
A 48-year-old woman has a 24-hour history of painful red eye, photophobia and blurred vision. Fluorescein shows a central irregular patch. What is the SINGLE MOST likely diagnosis? A. Dendritic corneal ulcer B. Bacterial conjunctivitis C. Blepharitis D. Episcleritis E. Acute iritis
Answer: A. Dendritic corneal ulcer Justification: Herpes simplex causes dendritic ulcers seen with fluorescein staining. Requires urgent ophthalmology referral. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
47
A 70-year-old diabetic man complains of blurred central vision 8 weeks after cataract surgery. What is the SINGLE MOST likely cause? A. Posterior capsular thickening B. Suprachoroidal haemorrhage C. Hypopyon D. Endophthalmitis E. Intra-ocular lens error
Answer: A. Posterior capsular thickening Justification: The most common post-cataract surgery complication. Resource: Terveen D et al. J Ophthalmol 2022; 2022: 8653476.
48
A 60-year-old woman uses bimatoprost/timolol eye drops for glaucoma and experiences mild conjunctival irritation. Which side-effect may also commonly occur? A. Ulceration of cornea B. Thickening of eyelashes C. Lightening of iris colour D. Staining of cornea E. Thinning of eyelashes
Answer: B. Thickening of eyelashes Justification: Prostaglandin analogues can cause thickening and lengthening of eyelashes. Resource: RCGP Curriculum Guide; BNF. Bimatoprost.
49
A 30-year-old woman with rheumatoid arthritis complains of orange staining of her soft contact lenses. What is the SINGLE MOST likely cause? A. Sulfasalazine B. Aspirin C. Combined oral contraceptive D. Alcohol E. Ketoprofen
Answer: A. Sulfasalazine Justification: Sulfasalazine causes characteristic orange staining of soft contact lenses. Resource: RCGP Learning
50
A 58-year-old man had transient visual loss in his right eye for 45 minutes, now resolved. What is the SINGLE MOST likely diagnosis? A. Acute glaucoma B. Optic neuritis C. Retinal artery thrombosis D. Retinal detachment E. Amaurosis fugax
Answer: E. Amaurosis fugax Justification: Transient monocular vision loss suggests TIA; urgent referral is needed. Resource: NICE CKS. Stroke and TIA – Diagnosis
51
A 33-year-old woman is diagnosed with blepharitis. What is the SINGLE MOST appropriate initial treatment? A. Oral flucloxacillin B. Eyelid hygiene: wet cloth or cotton bud with cleanser C. Topical fusidic acid D. Topical chloramphenicol E. Topical steroids
Answer: B. Eyelid hygiene: wet cloth or cotton bud with cleanser Justification: First-line management for blepharitis includes warm compresses, lid massage, and lid cleansing. Resource: NICE CKS. Blepharitis. 2024.
52
A 26-year-old nurse presents with right eye pain and visual loss. Suspected optic neuritis. What finding indicates a relative afferent pupillary defect? A. Right pupil dilates when light is shone into left eye B. Left pupil constricts when light is shone into right eye C. Left pupil dilates when light is shone into it D. Right pupil constricts when light is shone into it E. Right pupil dilates when light is shone into it
Answer: E. Right pupil dilates when light is shone into it Justification: Classic finding in optic neuritis with a Marcus Gunn pupil on swinging light test. Resource: RCGP Learning
53
A 30-year-old woman has a dull ache in her right eye for 3 days, photophobia, and redness at the limbus. What is the SINGLE MOST likely diagnosis? A. Anterior uveitis B. Episcleritis C. Acute angle closure glaucoma D. Allergic conjunctivitis E. Bacterial conjunctivitis
Answer: A. Anterior uveitis Justification: Unilateral eye pain with photophobia and redness at the limbus suggests anterior uveitis (iritis). Resource: RCGP Learning
54
A 68-year-old man has painful unilateral red eye, blurred vision, and a mid-dilated pupil. What is the SINGLE MOST likely diagnosis? A. Acute angle closure glaucoma B. Iritis C. Anterior uveitis D. Conjunctivitis E. Giant cell arteritis
Answer: A. Acute angle closure glaucoma Justification: Acute angle closure presents with red eye, mid-dilated fixed pupil, and severe pain. Resource: RCGP Learning
55
A two-year-old boy has bilateral red eyes with green discharge after an upper respiratory tract infection. What is the SINGLE MOST appropriate INITIAL management step? A. Topical chloramphenicol B. OTC Brolene drops C. Bathe eyelids with lukewarm water D. Topical fucithalmic E. Advise not to touch eyes
Answer: C. Bathe eyelids with lukewarm water Justification: Most cases of infective conjunctivitis are self-limiting and managed with hygiene. Resource: NICE CKS. Conjunctivitis – infective. 2022.
56
A 61-year-old woman has a red, painful eye with headache and nausea. Mid-dilated fixed pupil noted. What is the SINGLE MOST likely diagnosis? A. Retinal detachment B. Acute angle closure glaucoma C. Episcleritis D. Ocular migraine E. Anterior uveitis
Answer: B. Acute angle closure glaucoma Justification: Classic features of AACG – red eye, pain, nausea, fixed mid-dilated pupil. Resource: RCGP Learning
57
A 24-year-old man with back pain and ulcerative colitis presents with recurrent painful red eye and photophobia. What is the SINGLE MOST likely diagnosis? A. Iritis B. Conjunctivitis C. Retinal vein occlusion D. Acute glaucoma E. Corneal ulcer
Answer: A. Iritis Justification: Iritis is associated with seronegative spondyloarthropathies and inflammatory bowel disease. Resource: RCGP Learning
58
A patient on amiodarone presents with night glare while driving. What is the SINGLE MOST likely eye-related side effect? A. Glaucoma B. Retinal detachment C. Blepharitis D. Retinopathy E. Corneal microdeposits
Answer: E. Corneal microdeposits Justification: Amiodarone causes corneal deposits leading to glare and halos, especially at night. Resource: Dovie JM, Gurwood AS. Optometry 2006; 77(2): 76–81.
59
Which THREE of the following are TRUE about registration for blindness? 1. CVI can be completed by GP 2. Glaucoma is the most common cause of blindness 3. Visual field is assessed 4. Free sight tests for blind patients 5. Tax benefits available
Answer: Statements 3, 4, and 5 are correct Justification: CVI must be completed by an ophthalmologist; AMD is the leading cause of blindness in the UK. Resource: RNIB; HMRC Blind Person’s Allowance; NHS sight test eligibility.
60
A 60-year-old man with COPD is found to have raised intraocular pressure. Which of his medications is MOST likely to be responsible? A. Salmeterol B. Aspirin C. Carbocysteine D. Fluticasone propionate E. Aminophylline
Answer: D. Fluticasone propionate Justification: Inhaled corticosteroids can raise intraocular pressure and cause glaucoma. Resource: BNF. Fluticasone; RCGP Curriculum Topic Guide.
61
A two-week-old baby boy presents with a red, inflamed conjunctiva and purulent discharge in the right eye. What is the SINGLE MOST appropriate management plan? A. Refer immediately to an ophthalmology unit B. Prescribe chloramphenicol eye drops C. Prescribe erythromycin eye ointment D. Prescribe fucithalmic eye drops E. Advise saline washes
Answer: A. Refer immediately to an ophthalmology unit Justification: Ophthalmia neonatorum requires urgent ophthalmology referral due to risk of severe infection and systemic involvement. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
62
A 73-year-old woman reports gradual visual loss. Exam reveals bilateral cloudy lenses and obliterated red reflex. What is the SINGLE MOST appropriate management option? A. Foreign body removal B. Chloramphenicol eye drops C. Advise eye exam by optometrist D. Urgent neurology referral E. Urgent ophthalmology referral
Answer: C. Advise eye exam by optometrist Justification: Suspected cataracts should be evaluated by an optometrist before referral for surgery. Resource: Machin A. Cataracts. InnovAiT 2018; 11(11): 634–638.
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A young child presents with a white pupil ('cat's eye' reflex). What is the SINGLE MOST likely diagnosis? A. Holmes–Adie Pupil B. Heterotropia C. Concomitant strabismus D. Retinoblastoma E. Paralytic strabismus
Answer: D. Retinoblastoma Justification: Common in children <5 years, presents with leukocoria. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
64
Match the eyelid lesions to their diagnosis: 1. Slightly painful upper lid lesion (2 weeks) 2. Slowly enlarging lower lid lesion (months) 3. Yellow plaques on upper eyelid
Answer: 1 – Chalazion 2 – Basal cell carcinoma 3 – Xanthelasma Justification: Typical presentations of chalazion, BCC, and xanthelasma. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
65
Which of the following is the SINGLE MOST likely cause of secondary glaucoma? A. Age-related macular degeneration B. Conjunctivitis C. Optic neuritis D. Retinitis pigmentosa E. Uveitis
Answer: E. Uveitis Justification: Uveitis, trauma, steroids, and cataracts can all cause secondary glaucoma. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
66
A 65-year-old man reports flashes and floaters in lateral visual field, with grey area in vision. What is the MOST likely diagnosis? A. Glaucoma B. Amaurosis fugax C. Uveitis D. Retinal detachment E. Macular degeneration
Answer: D. Retinal detachment Justification: Flashes, floaters, and grey shadow are classic for detachment. Resource: Holliday L, Wilde C. InnovAiT 2019; 12(12): 720–724.
67
A 32-year-old with eye pain and visible fluid level in inferior anterior chamber. What is the SINGLE MOST likely diagnosis? A. Scleritis B. Keratitis C. Conjunctivitis D. Uveitis E. Episcleritis
Answer: D. Uveitis Justification: Hypopyon in anterior chamber indicates severe anterior uveitis or endophthalmitis. Resource: Kanani S, Mechrgui M. InnovAiT 2022; 15(12): 687–692.
68
A 29-year-old woman with painful red eyelid, no fever or visual impairment. What is the SINGLE MOST appropriate treatment for preseptal cellulitis? A. Vancomycin B. Ciprofloxacin C. Co-amoxiclav D. Metronidazole E. Erythromycin
Answer: C. Co-amoxiclav Justification: First-line treatment for preseptal cellulitis includes flucloxacillin or co-amoxiclav. Resource: Iftakhar R. InnovAiT 2021; 14(4): 241–245.
69
A 27-year-old man has painless, smooth swelling on inside of eyelid for 3 weeks. What is the SINGLE MOST likely diagnosis? A. Meibomian cyst B. Stye C. SCC D. Sebaceous cyst E. Trachoma
Answer: A. Meibomian cyst Justification: Chalazion is a painless cyst from blocked meibomian gland. Resource: Shaheen T et al. InnovAiT 2020; 13(9): 543–549.
70
A 15-year-old boy has reduced distance vision but reads fine up close. VA is 6/20. What is the MOST likely diagnosis? A. Astigmatism B. Amblyopia C. Myopia D. Hypermetropia E. Presbyopia
Answer: C. Myopia Justification: Near vision normal, distant vision reduced. Myopia occurs in youth and causes image focus in front of retina. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
71
An 82-year-old woman notices distortion in vision and difficulty reading. Drusen are seen. What is the SINGLE MOST likely diagnosis? A. Uveitis B. Cataract C. Diabetic retinopathy D. Age-related macular degeneration E. Chronic simple glaucoma
Answer: D. Age-related macular degeneration Justification: Presents with central distortion and drusen; commonest cause of blindness in UK. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
72
Which is the SINGLE MOST appropriate initial treatment for chronic open-angle glaucoma (COAG)? A. Brimonidine tartrate B. Brinzolamide C. Latanoprost D. Levobunolol E. Timolol
Answer: C. Latanoprost Justification: Prostaglandin analogues like latanoprost are first-line for COAG. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
73
A 55-year-old man has sore, itchy eyelids with crusting at lash base. What is the SINGLE MOST appropriate primary management? A. Sodium cromoglycate B. Latanoprost C. Lid hygiene D. Oral flucloxacillin E. Intraocular chloramphenicol
Answer: C. Lid hygiene Justification: Blepharitis is managed with hot compresses, massage and cleaning. Resource: Shaheen T et al. InnovAiT 2020; 13(9): 543–549.
74
A painless red eye with subconjunctival haemorrhage is noted. What is the SINGLE MOST appropriate examination? A. Clotting screen B. Fundoscopy C. Blood pressure check D. Fluorescein staining E. Full blood count
Answer: C. Blood pressure check Justification: BP should be checked as hypertension is a common cause of subconjunctival haemorrhage. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
75
Which eye drop REDUCES intraocular pressure by increasing uveoscleral outflow? A. Carmellose sodium B. Brinzolamide C. Latanoprost D. Levobunolol E. Timolol
Answer: C. Latanoprost Justification: Latanoprost is a prostaglandin analogue that increases uveoscleral outflow. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
76
A 22-year-old with seasonal rhinitis has bilateral red watery eyes in spring. What is the SINGLE MOST appropriate treatment? A. Chloramphenicol B. Pilocarpine C. Cyclopentolate D. Fluorescein E. Sodium cromoglicate
Answer: E. Sodium cromoglicate Justification: First-line treatment for allergic conjunctivitis is topical mast cell stabilisers. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
77
A two-month-old boy has recurrent sticky eyes but is otherwise well. What is the SINGLE MOST appropriate management while awaiting swabs? A. Oral antibiotic B. No antibiotic treatment C. Oral and topical antibiotics D. Refer to paediatrician E. Topical antibiotic treatment
Answer: B. No antibiotic treatment Justification: Likely nasolacrimal duct obstruction; manage conservatively unless infection confirmed. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
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A 43-year-old presents with severe right eye pain, headache, and fixed oval pupil. What is the SINGLE MOST likely diagnosis? A. Conjunctivitis B. Episcleritis C. Acute angle closure glaucoma D. Giant cell arteritis E. Retinal detachment
Answer: C. Acute angle closure glaucoma Justification: Presents with painful red eye, nausea, and oval fixed pupil. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
79
An 80-year-old woman woke with painless reduced vision in left eye. Fundoscopy shows engorged veins and haemorrhages. What is the SINGLE MOST likely diagnosis? A. Dry macular degeneration B. Central retinal artery occlusion C. Retinal detachment D. Central retinal vein occlusion E. Chronic open angle glaucoma
Answer: D. Central retinal vein occlusion Justification: CRVO causes painless loss of vision with haemorrhages and engorged veins. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.
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Which feature is NOT consistent with acute conjunctivitis? A. Bilateral red eyes B. Lymphadenopathy C. Reduced visual acuity D. Mild photophobia E. Papillae under everted lid
Answer: C. Reduced visual acuity Justification: Persistent reduction in visual acuity suggests serious pathology (e.g. keratitis, uveitis), not conjunctivitis. Resource: RCGP. Curriculum Topic Guides: eyes and vision. 2019.

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