SBA Ophthalmological Conditions
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A 50-year-old patient presents with a slowly growing, red, thickened area on the nasal conjunctiva that extends onto the cornea. What is the most likely diagnosis?
Answer: Pterygium
Explanation: Pterygium is a benign, fibrovascular growth of conjunctival tissue that extends onto the cornea, usually on the nasal side. It is associated with prolonged exposure to ultraviolet (UV) light and chronic irritation. Management includes advising patients to protect their eyes from UV exposure by wearing sunglasses and hats. Lubricating eye drops may alleviate irritation. Surgical excision is considered if the pterygium affects vision or causes significant discomfort.
A 40-year-old woman presents with severe eye pain, redness, and blurred vision after prolonged contact lens use. What is the most likely diagnosis?
Answer: Keratitis
Explanation: Keratitis is inflammation of the cornea, often due to infection. Prolonged contact lens wear increases the risk of bacterial keratitis. Symptoms include severe pain, redness, photophobia, and decreased vision. According to NICE guidelines, urgent referral to an ophthalmologist is essential. Treatment involves discontinuing contact lens use and initiating appropriate antimicrobial therapy, typically with intensive topical antibiotics.
A child with a recent upper respiratory infection presents with eye swelling, pain with eye movement, and a fever. What is the most likely diagnosis?
Answer: Orbital cellulitis
Explanation: Orbital cellulitis is a serious infection of the tissues behind the orbital septum. It often spreads from adjacent sinus infections. Symptoms include painful eye movements, proptosis, reduced vision, and systemic signs like fever. According to NICE guidelines, immediate hospital admission is required for intravenous antibiotics and possible surgical intervention to prevent complications such as vision loss or intracranial spread.
An elderly patient presents with gradual central vision loss. Fundoscopy reveals drusen deposits. What is the most likely diagnosis?
Answer: Macular degeneration
Explanation: Age-related macular degeneration (AMD) affects the macula, leading to central vision loss. Drusen are yellow deposits under the retina and are characteristic of dry AMD. According to NICE guidelines, management includes lifestyle modifications like smoking cessation and dietary advice. For wet AMD, treatments such as intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents are recommended.
A 70-year-old with a history of diabetes presents with blurred vision. Fundoscopy shows microaneurysms and cotton wool spots. What is the most likely diagnosis?
Answer: Diabetic retinopathy
Explanation: Diabetic retinopathy is a microvascular complication of diabetes mellitus. Microaneurysms and cotton wool spots are signs of non-proliferative diabetic retinopathy. According to NICE guidelines, management includes strict glycaemic control, blood pressure management, and regular retinal screening. Advanced cases may require laser photocoagulation, intravitreal injections, or vitrectomy surgery.
A 14-year-old boy complains of knee pain, swelling, and tenderness just below the kneecap after playing sports. What is the most likely diagnosis?
Answer: Osgood-Schlatter disease
Explanation: Osgood-Schlatter disease is an overuse injury causing inflammation of the tibial tubercle apophysis. It is common in adolescents involved in running and jumping sports. Management includes rest, activity modification, pain management with analgesics, and physiotherapy to strengthen the surrounding muscles.
A patient presents with sudden, painless loss of vision in one eye. Fundoscopy shows a cherry-red spot at the fovea. What is the most likely diagnosis?
Answer: Retinal artery occlusion
Explanation: Central retinal artery occlusion (CRAO) results from an obstruction of the central retinal artery, leading to ischemia of the retina. The cherry-red spot is due to the contrasting pale retina and the intact choroidal circulation at the fovea. CRAO is an ophthalmic emergency requiring immediate referral. Management focuses on identifying and treating underlying causes, such as carotid artery disease or cardiac emboli, and attempting to restore retinal blood flow if possible, according to clinical guidelines.
An elderly patient complains of gradually worsening vision, especially at night. Examination reveals lens opacity. What is the most likely diagnosis?
Answer: Cataract
Explanation: A cataract is a clouding of the eye's lens, leading to decreased vision. Symptoms include blurred vision, difficulty with night driving, and increased sensitivity to glare. According to NICE guidelines, cataract surgery is recommended when the patient's vision impairment affects their quality of life. The cloudy lens is replaced with an artificial intraocular lens under local anaesthesia.
A child presents with persistent, painless swelling on the upper eyelid that has been present for weeks. What is the most likely diagnosis?
Answer: Chalazion
Explanation: A chalazion is a chronic granulomatous inflammation of a meibomian gland in the eyelid. It presents as a painless, firm lump. Management includes warm compresses and gentle massage. If the chalazion persists, surgical intervention, such as incision and curettage, may be necessary.
A 55-year-old male complains of headaches, scalp tenderness, and jaw pain while chewing. What is the most likely diagnosis?
Answer: Temporal arteritis
Explanation: Temporal arteritis, also known as giant cell arteritis, is an inflammatory condition of medium and large arteries. Symptoms include headache, scalp tenderness, jaw claudication, and visual disturbances. According to NICE guidelines, immediate initiation of high-dose corticosteroids is critical to prevent permanent vision loss. Temporal artery biopsy is performed to confirm the diagnosis, and patients are monitored regularly for complications.
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