Answers for Medical Finals Quiz May 2006

Below are the author's answers and teaching points for this Quiz.

Question 1

A 72 year old lady presents to the ophthalmology department after sudden blindness in her right eye. The following fundal appearance is noted.

Retina
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Which of the following most accurately describes the fundus?

(a) Central retinal vein occlusion
(b) Central retinal artery occlusion
(c) Papilloedema
(d) Cholesterol embolus
(e) Age related macular degeneration
Answer: (b) Central retinal artery occlusion

This demonstrates a cherry red spot and is diagnostic of a central retinal artery occlusion.

Question 2

You are the ophthalmology SHO.

What is your immediate management?

(a) Aspirin
(b) Anti-coagulation
(c) MRI brain
(d) Ocular massage
(e) Carotid dopplers
Answer: (d) Ocular massage

Immediate management is ocular massage to try and dislodge the embolus.

Question 3

On further questioning this lady alludes to having had severe headaches prior to the onset of sudden blindness.

What investigation would you like to perform?

(a) CT brain
(b) MRI brain
(c) Carotid dopplers
(d) Lumbar puncture
(e) ESR
Answer: (e) ESR

An ESR would be most helpful in this context as the clinical history is highly suspicious of temporal arteritis.

Question 4

You have the result of the above investigation to hand.

What is your next step in her management?

(a) Temporal artery biopsy
(b) Low dose steroids
(c) High dose steroids
(d) Aspirin
(e) Anticoagulation
Answer: (c) High dose steroids

She must be immediately commenced on high dose immunosuppression with oral prednisolone. A temporal artery biopsy is advised to confirm the diagnosis. Treatment with steroids in the interim will not alter the biopsy result significantly.

Question 5

An x-ray of the wrist is shown below.

Wrist x-ray
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Which of the carpal bones is labelled 'a'?

(a) Hamate
(b) Capitate
(c) Lunate
(d) Scaphoid
(e) Pisiform
Answer: (d) Scaphoid

Wrist x-ray
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There are 2 rows of carpal bones in the wrist - the proximal and distal.

Distal Row:

d = Hamate
c = Capitate (the largest)
e = Trapezoid
f = Trapezium ('to the thumb')

Proximal Row:

g = Pisiform
h = Triquetral
b = Lunate
a = Scaphoid (in the anatomical snuff box clinically)

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