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1- A 49 year-old Caucasian man comes to the eye
casualty complaining of sudden onset of reduced vision in his right
eye. He gives a history of sudden onset loss of vision in his left eye
1year ago but he cannot remember the diagnosis. He has good general
health apart from his well-controlled hypertension and diabetes.
On examination he has visual acuities of 6/12 N10 in his right eye and
perception of light only in his left eye. He is noted to have an
indistinct disc margin inferiorly in his right eye and left disc
appears pale.
What is your differential diagnosis and management plan for this
patient?
2- A 38-year-old footballer comes to the eye clinic complaining of
floaters and distortion in his right eye for the last 4 months. More
recently he has also been aware of floaters in his left eye. On
examination his vision is 6/18, N10 in his right eye and 6/9 N5 in his
left and at the slit lamp you notice some cell in the anterior chamber
and anterior vitreous of both eye.
(a) What is your differential diagnosis and what other features would
you look for?
(b) Discuss your treatment plan and expected outcome for the patient.
3- You are asked to see a 60 year old man had undergone a right
trabeculectomy augmented with mitomycin C on the previous day. The eye
was uncomfortable overnight and he confesses that he may have rubbed
it. He complain of a foreign body sensation and that the eye is
watering excessively.
On examination the visual acuity in right eye measure 6/36 (previously
6/9).
There is dehiscence of fornix based conjunctival flap exposing the
scleral flap exposing the scleral flap which is slowly leaking
aqueous. The anterior chamber is very shallow and the IOP measure 10
mmHg.
How would you manage this patient?
4- A 37 year old man with a background of coronary artery disease and
TIA's, presented to emergency room complaining that he had vomited
blood. He is thought to have had a major GI haemorrhage.
a) What features in the history would indicate that this was a major
bleed?
b) What features on examination would indicate that this was a major
bleed?
c) What laboratory indicators would be in keeping with severe bleed?
d) What are the likely sources of major upper GI haemorrhage? What are
the likely causes of each?
e) What is the emergency management in these circumstances?
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