FRACGP AKT Opthalmology imed

A 38-year-old lady presents with pain in her left eye and mild watering. Fluorescein staining reveals an irregular pattern. Her pupils are equal, reactive to light and have a normal shape. Her visual acuity is normal.

What is the SINGLE MOST likely diagnosis? Select ONE option only.

A 7-week-old baby boy is brought in by his mother. She mentions his eyes have been watering with clear fluid for the last 3 weeks. He is otherwise well in himself. He has been growing and developing well, and was born at 38 weeks by normal vaginal delivery with no complications. On examination he looks well, his red reflex is present in both eyes, conjunctiva are normal, the cornea is clear and his sclerae are white with no discharge or eyelid swelling present.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 65-year-old lady with a past medical history of hypertension and type 2 diabetes presents with a sudden loss of vision in her left eye. Fundoscopy assessment shows the retina is pale and the fovea appears as a bright cherry red spot.

What is the MOST LIKELY diagnosis? Select ONE option only.

Which one of the following is NOT a recognised risk factor for cataracts? Select ONE option only.

A 45-year-old lady presents with decreased vision in her right eye, which started yesterday. She now has pain on eye movement and she is finding it hard to make out certain colours especially red. You suspect a diagnosis of optic neuritis.

Which ONE CONDITION listed below is a recognized cause of optic neuritis? Select ONE option only.

A 52-year-old woman presents with headache, fatigue and blurred vision in her right eye. She mentions washing and combing her hair is painful.

Which is the MOST LIKELY diagnosis? Select ONE option only.

A 54-year-old male presents with a painful red left eye. Two days ago, he noted the vision in his left eye was slightly blurred and last night he was seeing haloes around lights. On examination you note erythema around his left eye and a fixed semi-dilated pupil.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 74-year-old female presents with a painful blistering rash around her left eye. On examination you note a red blistering rash along the left trigeminal nerve distribution, the rash is also visible on the tip of her nose. You suspect Herpes zoster ophthalmicus.

What is the NAME of the CLINICAL SIGN used to describe the presence of vesicles on the tip of the nose? Select ONE option only.

A 26-year-old lady presents with a firm, localised eyelid swelling that develops slowly over several weeks. There are no other symptoms of note. On examination you note a small cyst underneath her right eye lid. You suspect she has a Meibomian cyst.

Which one of the following would be the INITIAL management option of choice? Select ONE option only.

A 24-year-old lady presents with a three-day history of sticky discharge form her right eye, the eyelids often stick together and she reports mild redness around her conjunctiva. She denies any pain or vision changes. You suspect conjunctivitis.

What is the most appropriate ADVICE listed below for the management of her condition? Select ONE option only.

A 34-year-old lady presents with pain and vision loss in her left eye. She has also had a persistent dry cough for a few months and has noted some small red tender bumps on her shins. She is reviewed by the ophthalmologist, and a chest x ray is arranged while she awaits a review from the medical team. The chest x ray shows bilateral hilar lymphadenopathy.

What is MOST LIKELY diagnosis? Select ONE option only.

A 65-year-old male comes in for some advice. He wants to know if he can take some supplements to help slow the progression of his ARMD. He remembers his ophthalmologist telling him about supplements but has forgotten most of the main points.

Which ONE of the following points about Vitamin supplementation for ARMD is correct? Select ONE option only.

A 27-year-old lady presents with an eight-week history of headache, amenorrhoea for seven months and some loss of vision from the outer parts of her visual fields. On examination you note her visual acuity in both eyes in 6/24, and bi-temporal hemianopia.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 39-year-old lady presents with a firm, localised eyelid swelling. She was seen by an out of hours doctor last week who told her it was a stye. He advised using warm compresses twice a day. She returns to see you today as she has started to loose her eye lashes on the affected eye. On examination you note she has several missing eyelashes on her upper eyelid and a slightly distorted eye lid. She appears to have a small cyst under her right upper eyelid.

Which one of the following would be the MOST APPROPRIATE MANAGEMENT option?

A 69-year-old male reports a gradual decline in his vision over the last few months. He mentions having difficulty reading, recognising faces, and watching television. On examination you note reduced visual acuity in both eyes. Fundoscopy reveals a mild opacity in his lens.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 35-year-old female presents with a three-day history of itchy eye lids which stick together in the morning. There are no symptoms of note. On examination you note some inflammation around her eye lids. You suspect blepharitis.

Which ONE of the following CONDITIONS is a known cause of blepharitis? Select ONE option only.

A 69-year male presents with blurred vision in his left eye. It started three months ago and continues to get worse. He mentions struggling with his crosswords, and he has noted that straight lines appear bent in his central vision. On examination a central scotoma is evident in his left eye.

What is the single MOST LIKELY diagnosis? Select ONE option only.

A 59-year-old man presents with vision loss in his left eye which started 2 hours ago. He noted some intermittent flashes and then described a curtain descending down the lateral side of his vision.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 71-year-old lady presents with a sudden loss of vision in her right eye. Her visual acuity in the affected eye is reduced to hand movements only. Visual acuity on the left is 6/6. Fundoscopy reveals flame shaped retinal haemorrhages. Her past medical history includes poorly controlled hypertension.

Which is the SINGLE MOST likely diagnosis? Select ONE option only.

Which ONE of the following is associated with visual problems in childhood? Select ONE option only.

Which one of the following is a feature of background diabetic retinopathy? Select one option only.

A 72-year-old man with a background of atrial fibrillation attends your clinic with a sudden painless loss of vision in the left eye. On fundoscopy you note a small red spot.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 43-year-old male is referred to eye casualty, after presenting to A&E with blurred vision. A slit lamp examination in eye casualty reveals a lens dislocation.

Which ONE of the following is a recognized cause of a lens dislocation? Select ONE option only.

A 68-year-old man attends your clinic with a 6-hour history of severe pain around his left eye and vomiting. On examination the left eye is red and decreased visual acuity is noted on the Snellen chart.

What is the MOST APPROPRIATE management option ? Select ONE option only.

A 72-year-old lady with a background of glaucoma attends your clinic stating that her eye colour has changed. She states that she normally has blue eyes, but they have become a lot darker recently. On examination her sclera and conjunctiva look normal, but there appears to be a brown discolouration of the iris.

Which ONE of the following glaucoma medications is MOST LIKELY to be responsible? Select ONE option only.

A 64-year-old man attends your clinic with a one-month history of gradually worsening visual acuity. He describes blurring of the smaller words on his phone and has noticed that straight lines, such as those on the middle of the roads appear ‘curvy’. He has also started to see a grey patch in his central field of vision. On examination his visual acuity is 12/20 bilaterally. Ophthalmoscopy demonstrates choroidal neovascularisation.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 39-year-old lady is seen in clinic for her annual rheumatoid arthritis review. She is currently having some issues with her eyes.

Which ONE of the following is a recognized ocular manifestation of rheumatoid arthritis? Select ONE option only.

A 71-year-old lady presents with reduced visual acuity and blurred vision. This has been progressively getting worse over the last few months. On examination there is a central scotoma and fundoscopy reveals multiple drusen.

What is the MOST LIKELY DIAGNOSIS? Select ONE option only.

Which HLA allele is MOST likely to be associated with acute anterior uveitis? Select ONE option only.

A 25-year-old male is brought into the emergency department after he was involved in a road traffic accident. At present he has a reduced level of consciousness and you note a fixed dilated pupil.

Which NERVE is the most likely cause of his dilated pupil? Select ONE option only.

A 55-year-old man attends your clinic complaining of deteriorating vision in his left eye over the last 12 weeks. He has a chronic history of COPD and is on multiple medications for this.

Which single medication is MOST likely to have caused his visual deterioration? Select ONE option only.

A 25-year-old lady who is usually fit and well, attends your clinic with a 2-year history of a gradual decrease in her peripheral vision. On examination you note no obvious abnormality of the eyes.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 60-year-old lady with a background of COPD attends your clinic because she has noticed a streak of bright red blood in her left eye. The eye is not painful and her vision is unaffected.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 23-year-old man attends your clinic complaining of a painful, ‘gritty’ right eye. He states that the pain came on whilst he was at work this morning. On examination the eye is red but the pupil is normal and his vision is not impaired.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 13-year-old boy attends your clinic with a 2-day history of red eyes. He states that when he wakes up in the morning he has difficulty in opening his eyes because his eyelids are sealed and crusted. On examination, his conjunctiva are red, there is associated mucopurulent discharge, but the pupils are normal and reactive.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 40-year-old plumber attends your clinic with a 5-hour history of a painful and watery left eye. He also states that he has been seeing haloes. On examination, the eye looks red and the pupil is semi-dilated and fixed.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 43-year-old mechanic attends your clinic with a 2-day history of a painful right eye. He informs you that he wears contact lenses at work, but is always careful in washing them with saline before and after use. On examination of the right eye, he has marked blepharospasm and you note a white/grey patch on the cornea. The conjunctiva is red and there is a watery discharge.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 65-year-old man with a background of hypertension, night cramps and diabetes, attends your clinic with a 2-day history of impaired hearing and vision. He states that he had an episode of sudden vision loss in the left eye. On examination, his left pupil is dilated and fundoscopy shows a pale disc.

Which drug has MOST LIKELY caused this side effect? Select ONE option only.

A 60-year-old man attends your clinic complaining of a single episode of sudden vision loss in his right eye that lasted a few minutes. He states that he can now see with both his eyes. On examination his visual acuity is normal. You note from his records that he has a background of atrial fibrillation.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 35-year-old male presents with a dull ache over his left eye, which has started to get worse over the last four days. He finds relief by wearing sunglasses all of the time. On examination the left conjunctiva is red, he has some watery discharge, and his pupil is fixed and irregular. Visual acuity is 6/6 in both eyes.

What is the SINGLE MOST likely diagnosis? Select ONE option only.

A 77-year-old lady is referred to an ophthalmologist by her GP, after her optician wrote a letter saying her sight is now severely impaired, but her visual fields were normal.

What VISUAL ACUITY level is needed before this lady can be registered as severely sight impaired? Select ONE option only.

A 31-year-old lady presents with a two-week history of a swelling above her left upper eyelid. On examination you note a firm, non-tender slightly fluctuant lump measuring about 0.5 cm. There are no other signs noted.

What would be the SINGLE MOST appropriate MANAGEMENT option? Select ONE option only.

A 46-year-old male presents with pain in his left eye which is worse on moments. On examination he appears to have reduced colour vision, a slow light reflex and a relative afferent pupillary defect in his left eye. His visual acuity is normal.

What is the MOST likely diagnosis? Select ONE option only.

A 28-year-old female presents with a small painless lump on her left upper eyelid. It has developed slowly over the last three weeks. She does not have any other symptoms of note. She goes onto mention that she has been travelling in Asia and then south America and she returned three weeks ago.

What is the MOST LIKELY cause of her symptom? Select ONE option only.

A 54-year-old female presents with headache and double vision. On examination you note the left pupil is larger than the right and there is a left sided ptosis present. The diplopia is only present when both of her eyes are open. You suspect a third nerve palsy.

Which ONE of the following is a known cause of a third nerve palsy? Select ONE option only.

A 65-year-old male is referred to eye casualty after he initially noted some flashes and floaters in his left eye, and this morning he lost his vision completely in his left eye. After a fundoscopy and slit lamp assessment he is diagnosed with a retinal detachment, and is placed on the emergency surgery list.

Which ONE of the following is NOT a risk factor for retinal detachment? Select ONE option only.

A 6-week-old girl presents to her GP for the fourth time. Her mother said her infection has not cleared despite two courses of chloramphenicol ointment given by one of your colleagues. Her main symptom is recurrent watery discharge from both eyes. The girl is otherwise well. Her examination today is unremarkable.

What is the SINGLE MOST appropriate management plan? Select ONE option only.

A 57-year-old lady comes to see you for some advice. She has Sjogren’s syndrome and has been using the same ocular lubricant for 6 months for her dry eyes. Unfortunately, it has not been very helpful. She currently wears soft contact lenses. She asks you if you can recommend some better drops to help her dry eyes.

Which ONE of the following ocular drops would be the MOST APPROPRIATE for this lady? Select ONE option only.

A 55-year-old lady presents with a painful left eye, headaches and describes seeing haloes around bright lights. She has also had some abdominal pain and vomiting this morning. On examination she has a fixed and dilated left pupil and her eye is red.

What is the MOST LIKELY diagnosis? Select ONE option only.

The mother of a one-year old girl comes into see her GP. She is concerned due to excessive watering of her daughters left eye. On examination you note that the left eye seems to be larger than the right eye and there is opacification of the left pupil which does not respond to light stimuli.

What is the MOST LIKELY diagnosis? Select ONE option only.

The mother of a new born baby boy comes in for some advice. After a reviewing a family photo taken yesterday she noted he had a white pupil in his right eye and the left pupil was red. On examination you note a white pupil in the right eye and a red reflex in the left eye.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 27-year-old lawyer attends your clinic with a 2-day history of a painful and watery right eye that is sensitive to light. On examination, the right eye looks red and the pupil is irregularly shaped.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 41-year-old man who has had asthma for 20 years, presents with decreased vision in his left eye. He complains of a glare especially during the night.

What single medication is most likely to cause his visual deterioration? Select one option only.

A 53-year-old woman attends your clinic for a routine eye check-up. She has Type 2 Diabetes and Hypertension. Her fundoscopy shows neovascularization of the retina.

What is the single most appropriate management? Select ONE option only.

A 50-year-old lady who presented with an acute episode of headache associated with vomiting, with was started on Latanoprost by the eye casualty because of raised intraocular pressure.

What is the mechanism of action of this drug? Select one option only.

A 26-year-old female presents with a red and painful left eye and some blurring of her vision which started yesterday. She tells you she has been suffering with persistent back pain and morning stiffness for the last year, and she takes Ibuprofen as needed which does help.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 32-year-old male attends your clinic complaining of slow onset, reduced vision and left eye pain, especially exaggerated during eye movements. On further examination the optic disc appears swollen and pale. The patient has also been complaining of left leg muscle weakness for the past two weeks.

What is the most likely diagnosis? Select one option only.

A 39-year-old man with a background of depression attends your clinic with a 2-day history of tiredness, headaches, left eye pain, blurry vision and nausea. You note from his records that he has recently been started on sertraline.

What is the most appropriate next step in management? Select one option only.

A 28-year-old man attends your clinic with a 7-month history of gradual vision loss of his peripheral vision in both eyes. He states the problem seems to be particularly bad when he is driving in the dark. His father had a similar problem also and is now partially sighted.

What is the most likely diagnosis? Select one option only.

A 20-year-old lorry driver attends your clinic with a 6-month history of gradual vision loss of his peripheral vision in both eyes. The problem is worse at night and he remembers his mother having a similar problem, before she eventually had to use a white cane.

What is the MOST APPROPRIATE management? Select ONE option only.

Which one of the following drug classes would be considered first line for the treatment of primary open angle glaucoma (POAG)? Select one option only.

A 54-year-old man with a background of diabetes attends your clinic with a 2-day history of floaters and intermittent flashes in his left eye. He denies any pain. On examination he has 6/6 vision in his right eye but 6/12 in the left eye.

What is the most likely diagnosis? Choose one option only.

A 28-year-old man attends your clinic with a 3-week history of ‘gritty’, itchy, dry eyes. A recent opticians report states that he had a positive Schirmer’s test. On examination of his eyes today you note no abnormalities and his Snellen’s chart is normal.

What is the most appropriate management? Choose one option only.

A 7-year-old boy is brought to your clinic with a 2-day history of a red swelling of his right upper eye lid. On examination the right upper eye lid is red, swollen and tender. His temperature is 38.9 degrees Celsius.

What is the most likely diagnosis? Choose one option only.

A 5-year-old girl is brought to your clinic with a 1-day history of a tiredness associated with swelling and redness on her left upper eye lid. On examination her left upper eye lid is warm to touch and appears swollen. Her temperature is 39.1 degrees Celsius.

What is the most appropriate management? Choose one option only.

A 27-year-old lady attends your clinic with a 2-day history of pain behind her left eye, which is worse when she looks around. She states that her vision in her left eye seems to have got worse with time also. On examination of the left eye you note dilation of the left pupil when light is moved from the right eye to the left eye.

What is the most appropriate management? Choose one option only.

A 65-year-old diabetic lady attends your clinic with concerns about the vision in her right eye. She states it has felt as if a dark curtain has been encroaching in on her vision over the last 3 days. There is no pain associated and the symptoms started suddenly.

What is the most appropriate management? Choose one option only.

A 55-year-old expatriate attends your clinic for a routine health check, following his return from Vietnam. On fundoscopy you note that he has evidence of silver wiring.

What is the most likely diagnosis? Choose one option only.

A 34-year-old male is diagnosed with a retinal detachment after being examined by the ophthalmologist in eye casualty. He had presented with a sudden onset of floaters and then noted a progressive visual field loss in his left eye.

Which ONE of the following is NOT a risk factor for retinal detachment? Select ONE option only.

A 55-year-old women presents with pain in her left eye, a headache, blurring of vision with lights seen surrounded by halos, and recurrent vomiting for the last 12 hours. On examination you note reduced visual acuity, a tender and hard eye, ciliary injection and a fixed and mid-dilated pupil which is unresponsive to bright light.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 56-year-old lady successfully undergoes surgery after being referred to eye casualty by her GP. A few weeks later she returns to ask her GP about the risk factors of developing this condition, as she is worried it may happen again.

Which ONE of the following is a RISK FACTOR for developing retinal detachment? Select ONE option only.

A 56-year-old male is referred urgently to eye casualty by his GP with suspected giant cell arteritis. After presenting with a severe left temporal headache, jaw claudication and some mild disturbance to the vision in his left eye. You decide to start him on Prednisolone after reviewing the current NICE guidance on suspected giant cell arteritis.

What is the MOST APPROPRIATE dose of Prednisolone you should issue for suspected giant cell arteritis? Select ONE option only.

A 23-year-old male presents with a small swelling above his left eye lid. On examination you confirm the presence of a meibomian cyst. He tells you this is the fifth episode in the last 6 months.

Which ONE of the following is a RISK FACTOR for developing Meibomian cysts? Select ONE option only.

A 23-year-old male presents with a small swelling above his left eye lid. On examination you confirm the presence of a Meibomian cyst. He tells you this is the fifth episode in the last 6 months.

Which ONE of the following is a RISK FACTOR for developing Meibomian cysts? Select ONE option only.

A 32-year-old lady presenting with a headache is reviewed. Her fundoscopy findings are shown below.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 65-year-old female complains of deterioration in her vision over the last few weeks. Her fundoscopy findings are shown below.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 32-year-old lady asks you to have a look at her eye. She has noticed it this morning. She denies any trauma and is otherwise well. Her blood pressure is 119/78. Her eye examination finding is shown below.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 74-year-old lady attends your clinic for a review of her vision, following cataract surgery. She has no symptoms of note. On fundoscopy you note the following.

What is the MOST likely diagnosis? Select ONE option only.

A 65-year-old man attends your clinic following a deterioration in his vision. On fundoscopy you note the following.

What is the MOST likely diagnosis? Select ONE option only.

A 65-year-old man attends your clinic following a deterioration in his vision. On fundoscopy you note the following.

What is the MOST likely diagnosis? Select ONE option only.

A 65-year-old lady with a background of hypertension and diabetes attends your clinic following an acute deterioration in her vision. On fundoscopy, you note the following. What is the MOST likely diagnosis? Select ONE option only.

A 60-year-old lady attends your clinic following an acute deterioration in her vision. On fundoscopy you note the following. What is the MOST likely diagnosis? Select ONE option only.

A 50-year-old man attends your clinic following a slow deterioration in his vision. On fundoscopy you note the following. What is the MOST likely diagnosis? Select ONE option only.

A 65-year-old man with known age-related macular degeneration (AMD) attends your clinic. On fundoscopy, you note the following (see below). What feature of AMD is present here? Select ONE option only.

A 25-year-old female is referred to eye casualty after presenting with pain and redness in her right eye. She also reports watering of the right eye. Assessment in eye casualty reveals a hazy cornea and slit lamp examination with Fluorescein staining is shown below. What is the MOST LIKELY diagnosis? Select ONE option only.

A 25-year-old male presents with decreased vision, pain and mild ciliary injection in both eyes. On examination, his visual acuity is 6/60 in both eyes. His past medical history includes HIV for which he is currently taking anti-retroviral therapy (ARV). His fundoscopy findings are shown below: What is the MOST LIKELY diagnosis? Select ONE option only.

A 55-year-old male presents to A&E after losing vision in his right eye. He said it all happened very quickly. He denies any trauma. On examination, you note an afferent pupil defect. On fundoscopy, you note the following. What is the MOST LIKELY diagnosis? Select ONE option only.

A 51-year-old male is seen in A&E with a painful blistering rash (shown below) which has gotten significantly worse over the last 24 hours. You diagnose him with herpes zoster ophthalmicus. Which NERVE is affected in this condition? Select ONE option only.

A 65-year-old man with known age-related macular degeneration (AMD) attends your clinic. On fundoscopy, you note the following (see below). What feature of AMD is present here? Select ONE option only.

A 48-year-old man with known type 1 diabetes Mellitus attends your clinic. On fundoscopy, you note the following (see below). What feature of diabetic retinopathy is present here (labelled with yellow arrows)? Select ONE option only.

A 19-year-old male presents with recurrent fatigue, jaundice, mood changes, and ataxia and his mum says he appears very clumsy. On examination, you note the following in his eyes. What is the MOST LIKELY diagnosis? Select ONE option only.

A 48-year-old man attends your clinic with a 5-week history of a lump under his left eye, despite using warm compresses regularly. He complains that it feels uncomfortable and is keen to get it resolved. On examination, you note the following: What is the most appropriate next step in management? Select one option only.

A 62-year-old man with a background of hypertension attends your clinic with a 24-hour history of a painless, left-sided, red eye. He states his vision is unaffected and he otherwise feels well. On examination, his blood pressure is 110/72. You note from his records that he normally takes amlodipine. What is the most appropriate next step in management? Select one option only.

A 49-year-old homeless man attends your clinic for some ongoing intermittent headaches. He states he also feels very anxious most of the time and drinks 4 cans of larger every evening. On examination, his blood pressure is 152/93 and his fundoscopy is as below. What is the most likely diagnosis? Choose one option only.