MRCP 2 Masterclass – Ophthalmology

A 38-year-old woman presents with blurring of vision in her right eye that has developed over the last 3 days. She says that she can now see very little out of it, and acuity is reduced to counting fingers. The optic fundus is shown below:

What is the diagnosis?

A 60-year-old man with type 2 diabetes mellitus reported that when watching television ‘something went wrong with his vision’. The optic fundus of his right eye is shown below: –

What is the diagnosis?

A 48-year-old man with diabetes finds that the vision in one eye is blurred when he reads, but not at other times.

The most likely diagnosis is:

A 50-year-old diabetic woman with ischaemic heart disease complains of a problem with the vision in her left eye.

To get a good view of the ocular fundi for diagnostic purposes the best agent to dilate her pupils with is:

Study the Goldmann visual field test below.

Where is the pathological lesion?

The surgical registrar calls you at 11pm to see a 72-year-old Chinese lady. She is under the general surgeons, being investigated for possible bowel obstruction because of severe nausea and vomiting. She is vomiting every half-hour and complains of progressive visual loss in the right eye during the course of the evening as well as redness and pain. She noticed that for the preceding few days she has seen halos round street lamps. She does not smoke, only drinks rarely and lives on her own except that recently she has purchased a cat.

You do not have a Snellen or a Jaeger chart but on using a magazine, her acuity is better in the left than in the right eye. On inspection there is a shallow anterior chamber, a semidilated, fixed pupil and the appearance is shown below. There is a little clear discharge.

Her blood results were:

Which of the following two statements are true?

A 65-year-oldoverweight Asian lady was referredto Ophthalmology Outpatients with general malaise and a gradual reduction in vision of 3 months’ duration, affecting both eyes. 

Aided Snellen visual acuity was recorded as 6/18 right eye, 6/12 left eye, both eyes improving to 6/9 with a pinhole. Dilated examination revealed bilateral, moderate nuclear sclerosis, and widespread retinal changes as shown below.

Her lipids were checked by her CP 4 months before:

Which of the following is the most likely underlying diagnosis?

A 65-year-oldmanpresents to A&E with reduced vision in the right eye, noticed while taking a photograph.

On examination he has a right afferent pupillary defect and the following appearance on fundoscopy.

Which two of the following should be undertaken soon?

A 64-year-old male presented with reduced visual acuity. He had a long history of hypertension.

What is the ophthalmological diagnosis?

A 38-year-old male with HIV presented with confusion and ataxia and reduced visual acuity in the left eye. A brain MRI scan is shown –

What is the diagnosis?