Question Easy:
A 56-year-old man presents with sudden onset of painless vision loss in his right eye. On examination, there is a ‘cherry red spot’ at the macula and a pale retina. What is the most likely diagnosis?
A) Central retinal artery occlusion
B) Retinal detachment
C) Vitreous hemorrhage
D) Age-related macular degeneration
E) Diabetic retinopathy
Explanations & Answers:
Question Easy Answer: A
Question Easy Explanation: Central retinal artery occlusion (CRAO) is typically characterized by sudden, painless vision loss often associated with a ‘cherry red spot’ at the macula due to retinal ischemia. This condition demands urgent referral to ophthalmology. Retinal detachment, vitreous hemorrhage, age-related macular degeneration, and diabetic retinopathy present differently and are usually distinguished by their unique clinical features and patient histories.
Question Medium:
A 25-year-old woman complains of episodes of vertigo, unilateral tinnitus, and hearing loss. She reports that these episodes last from 20 minutes to a few hours and are accompanied by a sensation of fullness in the affected ear. What is the most likely diagnosis?
A) Benign paroxysmal positional vertigo (BPPV)
B) Vestibular neuritis
C) Meniere’s disease
D) Acoustic neuroma
E) Labyrinthitis
Explanations & Answers:
Question Medium Answer: C
Question Medium Explanation: Meniere’s disease is characterized by episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness or pressure in the ear. These episodes can last from minutes to hours and are due to the buildup of fluid in the inner ear. This is distinct from BPPV, which is characterized by brief episodes of vertigo related to changes in head position, and other conditions such as vestibular neuritis, acoustic neuroma, and labyrinthitis which have differing clinical features.
Question Hard:
A 65-year-old woman with a long history of untreated hypertension presents with sudden onset painless monocular vision loss. Fundoscopy reveals diffuse retinal hemorrhages, cotton wool spots, and swollen optic disc. What is the most likely diagnosis?
A) Central retinal artery occlusion
B) Central retinal vein occlusion
C) Anterior ischemic optic neuropathy
D) Retinal detachment
E) Optic neuritis
Explanations & Answers:
Question Hard Answer: B
Question Hard Explanation: Central retinal vein occlusion (CRVO) typically presents with sudden, painless vision loss and is associated with fundoscopic findings of diffuse retinal hemorrhages, cotton wool spots, and optic disc swelling due to venous stasis. In contrast, central retinal artery occlusion presents with a pale retina and a cherry red spot, anterior ischemic optic neuropathy often includes a visible swollen optic disc but differs in etiology and associated systemic symptoms, and retinal detachment and optic neuritis have distinct clinical and ophthalmoscopic appearances.
Medical fact of the day: Approximately 130,000 people in the UK are visually impaired due to age-related macular degeneration, making it the leading cause of blindness in older adults in the UK.
Quote of the day: “In the practice of medicine, small acts of kindness can make a world of difference. Keep touching lives with compassion.” 🌼