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Sudden painless loss of vision

Clinical Discipline(s)/Organ System(s)
Progress Test Topic(s)
A 74 year old South African male presents with sudden painless loss of vision in his right eye. This occurred shortly after waking. He has no associated symptoms and no past ocular history of note. His medical history includes hypertension, atrial fibrillation, and he is a smoker. On examination, the best visual acuity was measured at 'count fingers only' in the right eye and 6/9 in the left eye. There was a right relative afferent pupillary defect. On ophthalmoscopy of the right eye, there was narrowing of the retinal arterioles, whitening of the retina and a cherry-red spot at the macula.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy and physiology of the retina, the retinal vascular supply, the optic nerve and the visual tracts within the brain
   - Common pathologies of the retina, the retinal vascular supply and the optic nerve
   - Pathogenesis of central and branch retinal artery and vein occlusions
   - Definition and mechanism of amaurosis fugax
Clinical and Communication Skills 
   - Elicit a relevant history of visual loss and its associated features
   - Elicit a relevant past medical history, medication history, and systems review to identify risk factors for central retinal artery occlusion
   - Differential diagnosis of visual loss
   - Relevance of giant cell arteritis (temporal arteritis) to central retinal artery occlusion
   - Clinical features of retinal detachment
   - Perform a focused ophthalmic examination including measurement of visual acuity, pupil reactions, colour vision, visual field testing to confrontation, slit lamp examination and ophthalmoscopy examination of the optic nerve and retina
   - Perform a relevant cardiac and neurologic examination, including measurement of blood pressure, assessment for murmurs and carotid bruits
   - Interpret FBC with differential, erythrocyte sedimentation rate (ESR) , C-reactive protein (CRP), lipid profile, and other relevant blood test results, carotid artery evaluation (Doppler ultrasound) and cardiac investigations
Personal and Professional Skills 
   - Empathic approach with a distressing presentation
   - Team work: interaction with relevant specialists (GP, ophthalmology, cardiology, neurology)
Hauora Māori 
   - Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
Population Health 
   - Cardiovascular risk factors - elevated blood pressure, diabetes, hyperlipidaemia
Conditions to be considered relating to this scenario
central or branch retinal artery occlusion, cerebrovascular accident (stroke), central or branch retinal vein occlusion, anterior ischaemic optic neuropathy (arteritic (giant cell arteritis) and non-arteritic), retinal detachment, vitreous hemorrhage, optic neuritis, exudative (wet) age-related macular degeneration