Question Easy:
A 25-year-old woman comes to the GP complaining of itchy, watery eyes and a runny nose. It often happens during springtime and is worse outdoors in the afternoon. Which of the following is the most likely diagnosis?
A) Bacterial conjunctivitis
B) Viral conjunctivitis
C) Allergic rhinitis
D) Acute sinusitis
E) Chronic dacryocystitis
Explanations & Answers:
Question Easy Answer: C) Allergic rhinitis
Question Easy Explanation: Allergic rhinitis, commonly known as hay fever, is characterised by symptoms such as itchy, watery eyes and a runny nose, especially during pollen season. NICE guidelines recommend recognising these seasonal variations that coincide with specific allergen exposures, like pollen in the spring.
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Question Medium:
A 40-year-old man presents with a sudden onset of severe, deep eye pain, accompanied by nausea and seeing halos around lights. On examination, his right eye appears red and the pupil is mid-dilated and sluggish. What is the most probable diagnosis?
A) Closed-angle glaucoma
B) Open-angle glaucoma
C) Optical migraine
D) Retinal detachment
E) Central retinal artery occlusion
Explanations & Answers:
Question Medium Answer: A) Closed-angle glaucoma
Question Medium Explanation: This patient exhibits classic signs of acute closed-angle glaucoma, including sudden eye pain, redness, nausea, and visual disturbances such as halos. According to NICE guidelines, this is an ophthalmic emergency requiring immediate referral to ophthalmology for intervention to prevent vision loss.
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Question Hard:
A 30-year-old woman reports persistent changes in her vision over several months. She notes difficulty distinguishing between red and green colours. She also mentions transient episodes of vision loss in her right eye and feels that her vision is deteriorating. What is the underlying condition that could explain her symptoms?
A) Optic neuritis
B) Age-related macular degeneration
C) Retinitis pigmentosa
D) Diabetic retinopathy
E) Papilledema
Explanations & Answers:
Question Hard Answer: A) Optic neuritis
Question Hard Explanation: Optic neuritis often presents with vision changes such as difficulty distinguishing colours (dyschromatopsia) and episodes of vision loss, especially related to multiple sclerosis. Episodes of loss are consistent with optic neuritis where inflammation of the optic nerve can cause these specific symptoms, aligning with NHS clinical practice guidelines for diagnosing and managing potential neurological conditions.
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Medical fact of the day: Out of all the senses, smell is most closely linked to memory. This is likely due to the olfactory bulb’s location, which is closely connected to the amygdala and hippocampus, brain regions involved in emotion and memory formation.
Quote of the day: “In the symphony of healthcare, each note of compassion we play contributes to the harmony of healing.”