CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Ophthalmology – OPH002

You can self-report this CPD/PDP activity by logging it online with the RACGP/ACRRM. The activity has been allocated 1 hour (0.5 hour EA and 0.5 hour RP). Certificates are not available for this CPD.

Test your clinical knowledge by taking the 6 quizzes below. If you select the wrong answer, have another go — you can try as many times as you like.

RACGP Activity Number: OPH002

ACRRM Activity Number: OPH002

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1. What's causing this swollen eyelid?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Nigel is a 53-year-old restauranteur who presents with sudden swelling of the left lower eyelid. This developed very rapidly, after he forcefully blew his nose. Nigel has no other symptoms of note and is usually very fit and well. He reports he had a low-speed collision with a tree on his electric skateboard earlier in the morning, which involved a ‘minor face plant’ into the tree trunk. He was wearing a helmet (no visor) and travelling at about 20km/hr. He has felt well since, apart from slight facial discomfort. Examination of the eye reveals a haematoma affecting the left inferior orbital rim with palpable crepitus. Multiple small vesiculae are visible on the temporal bulbar conjunctiva (pictured). Visual acuity, pupillary reflexes and extraocular movements are all intact. Examination is otherwise unremarkable.</strong></p></p> <ul> <li>a. Chemosis</li> <li>b. Subconjunctival emphysema</li> <li>c. Amelanotic neoplasia</li> <li>d. Subcutaneous crepitation due to infection</li> </ul> </section> <p></p>Photo: Reproduced from Emergency Medicine Journal, Schuur D, et al, 39:9-29; 2022 with permission from BMJ Publishing Group Ltd.

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

2. What’s causing the ‘black hole’ in this patient’s vision?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Sara is a 33-year-old office manager who is fitted in urgently for review of sudden right-sided visual disturbance. This came on during a squats and burpees superset in a gym class that morning. She reports the vision in her right eye initially appeared “pixelated”, after which she developed a “black hole” in the centre of her vision. She has a history of migraine with aura, but these features are not her typical aura, nor has there been any migraine progression. She has no other medical history of note. On examination, vital signs are normal, pupils are equal and reactive, visual acuity is counting fingers on the right and 6/5 on the left, uncorrected. Fundal findings on the right are pictured.</strong></p></p> <ul> <li>a. Valsalva retinopathy</li> <li>b. Acute migrainous infarction</li> <li>c. Hypertensive retinopathy</li> <li>d. Retinal detachment</li> </ul> </section> <p></p>Photo: Reproduced from Ng J K Y, et al. Sudden loss of vision at the gym; BMJ 2021

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

3. Can you suss out this salmon-pink eye patch?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jeanette, a 55-year-old bookkeeper, presents with a two-month history of an enlarging lump under her left eyelid. She has noticed an associated salmon-coloured patch, extending towards her iris (pictured). She has tried warm compresses, eyelid hygiene, ocular lubricants and topical antibiotics. There is no preceding history of injury or associated epiphora, discharge, pain or systemic symptoms. Jeanette is typically well, with well-controlled hypertension only. The contralateral eye is unaffected. Examination reveals a soft, salmon-pink conjunctival mass (pictured). Pathology — including FBC, autoimmune markers and bacterial swabs — are unremarkable.</strong></p></p> <ul> <li>a. Pterygium</li> <li>b. Subconjuctival haemorrhage</li> <li>c. Nodular scleritis</li> <li>d. Conjunctival malignancy</li> </ul> </section> <p></p>Photo: BMJ 2021

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

4. What caused this boy’s suddenly blurred vision?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Evan is an 11-year-old regular patient of the practice who presents with blurry vision in his left eye. He has a background of Stickler syndrome — a genetic connective-tissue disorder — with associated hearing loss, joint hypermobility and high myopia, which is corrected with glasses. Evan was playing with his younger brother in the backyard when the vision in his left eye suddenly became blurry. There was no preceding trauma or injury and no associated discomfort. Evan is able to count fingers only. He is sent urgently to ED for paediatric ophthalmology review, and the retinal findings on ultrawide field laser scanning are shown.</strong></p></p> <ul> <li>a. Retinal haemangioma</li> <li>b. Optic neuritis</li> <li>c. Retinal detachment</li> <li>d. Central retinal vein occlusion</li> </ul> </section> <p> </p> <p></p>Photo: BMJ 2021

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

5. Is this sore eye a post-op complication?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Claire, a 55-year-old fashion designer, presents for her routine ophthalmology follow-up appointment a few weeks after having a therapeutic penetrating keratoplasty. Currently, she is experiencing mild pain and reduced vision. She was diagnosed with Fuchs’ dystrophy a decade ago and had this surgery because the medical management became ineffective, resulting in worsening corneal dystrophy. Aside from the above, she has no significant medical history.</strong></p></p> <ul> <li>a. Tyrosinemia</li> <li>b. Multiple myeloma</li> <li>c. Schnyder crystalline corneal dystrophy</li> <li>d. Infectious crystalline keratopathy</li> </ul> </section> <p></p>Photo: EyeRounds.org, University of Iowa

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

6. Can you diagnose this decorative disorder?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Nicholas, a healthy 80-year-old retired dentist, attends for a routine checkup with his optician. It has been three years since his last review, and he has been keeping well. His only medication is ramipril 2.5mg daily for hypertension, with no other significant medical history. He mentions that his GP recently carried out some bloods, and the only abnormality identified was a slightly raised glucose level. The GP has arranged for further investigations as well as a follow-up with Nicholas. His unaided visual acuity is 6/7.5 bilaterally. He feels that his vision has remained essentially unchanged since his last visit. The slit-lamp image is of his right eye.</strong></p></p> <ul> <li>a. Dendritic ulcer</li> <li>b. Corneal abrasion</li> <li>c. Polychromatic cataract</li> <li>d. Foreign body</li> </ul> </section> <p></p>Photo: EyeRounds.org, University of Iowa

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

References on request from kate.kelso@adg.com.au