emq 1.
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Match each clinical vignette to the most appropriate diagnosis.
Angle closure glaucoma Temporal lobe CVA Central retinal vein occlusion Acute iritis Bacterial conjunctivitis Open angle glaucoma |
Viral conjunctivits Occipital CVA Retinal detachment Central retinal artery occlusion Bacterial keratitis Parietal lobe CVA |
1. A 35 year old woman with a history of quiescent Crohn’s disease presents complaining of excessive tearing and pain to the left eye. Her visual acuity is 9/6 on the left and 5/6 on the right. On examination she has pronounced inflammation of the sclera which intensifies near the corneal border.
Answer: Acute iritis. Iritis is associated with inflammatory bowel disease, and characterised by scleral inflammation that worsens as it approaches the cornea (“perilimbic” distribution).
2. A 28 year old man with a history of active Ulcerative Colitis presents to the emergency department complaining of a painful, “grainy” left eye. His visual acuity is 9/6 on the left, corrected to 6/6 with pinhole testing. On examination he has significant scleral injection without any exudate, most pronounced at the margins of the eye.
Answer: viral conjunctivits. This patient has typical symptoms of viral conjunctivitis, which is characterised by scleral inflammation worst at the outer margins of the eye (compared with a perilimbic distribution) and a lack of exudate.
3. A 44 year old woman presents to the emergency department complaining of painless loss of vision in her left eye. She had laser surgery to correct a refractive error to the eye 2 years previously. She describes “floaters” in her vision followed by a curtain descending down across her eye. On examination she has a visual field defect in both upper quadrants as well as an afferent pupillary defect.
Answer: retinal detachment. This patient has a classic history suggesting retinal detachment, which is more common on patients who have undergone eye surgery.
4. A 60 year old patient presents to the emergency department with painless loss of vision in her right eye. She has a history of atrial fibrillation. On examination visual acuity in the eye is limited to inaccurate finger counting and there is an afferent pupillary defect. Fundoscopy reveals a pale swollen optic disc surrounded by splinter haemorrhages.
Answer: central retinal artery occlusion. CRAO is largely distinguished from CRVO on the basis of the fundoscopic findings (pale swollen disc and splinter haemorrhages versus an engorged red retina with cotton wool spots and flame haemorrhages - the “blood and thunder” appearance of CRVO)
5. A 71 year old woman with a history of atrial fibrillation presents complaining of visual disturbances. She has no pain in either eye. On examination she has a left sided homonymous hemianopia, with some macular sparing.
Answer: Occipital stroke. A homonymous hemianopia is caused by a lesion posterior to the optic chiasm. Macular sparing and a symmetrical hemianopia are associated with occipital injury.
Answer: Acute iritis. Iritis is associated with inflammatory bowel disease, and characterised by scleral inflammation that worsens as it approaches the cornea (“perilimbic” distribution).
2. A 28 year old man with a history of active Ulcerative Colitis presents to the emergency department complaining of a painful, “grainy” left eye. His visual acuity is 9/6 on the left, corrected to 6/6 with pinhole testing. On examination he has significant scleral injection without any exudate, most pronounced at the margins of the eye.
Answer: viral conjunctivits. This patient has typical symptoms of viral conjunctivitis, which is characterised by scleral inflammation worst at the outer margins of the eye (compared with a perilimbic distribution) and a lack of exudate.
3. A 44 year old woman presents to the emergency department complaining of painless loss of vision in her left eye. She had laser surgery to correct a refractive error to the eye 2 years previously. She describes “floaters” in her vision followed by a curtain descending down across her eye. On examination she has a visual field defect in both upper quadrants as well as an afferent pupillary defect.
Answer: retinal detachment. This patient has a classic history suggesting retinal detachment, which is more common on patients who have undergone eye surgery.
4. A 60 year old patient presents to the emergency department with painless loss of vision in her right eye. She has a history of atrial fibrillation. On examination visual acuity in the eye is limited to inaccurate finger counting and there is an afferent pupillary defect. Fundoscopy reveals a pale swollen optic disc surrounded by splinter haemorrhages.
Answer: central retinal artery occlusion. CRAO is largely distinguished from CRVO on the basis of the fundoscopic findings (pale swollen disc and splinter haemorrhages versus an engorged red retina with cotton wool spots and flame haemorrhages - the “blood and thunder” appearance of CRVO)
5. A 71 year old woman with a history of atrial fibrillation presents complaining of visual disturbances. She has no pain in either eye. On examination she has a left sided homonymous hemianopia, with some macular sparing.
Answer: Occipital stroke. A homonymous hemianopia is caused by a lesion posterior to the optic chiasm. Macular sparing and a symmetrical hemianopia are associated with occipital injury.