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Non-glaucomatous optic nerve head pathology: This visual recognition feature requires the practitioner to interpret the pathological features present at the optic nerve head.

01 The image is of the left optic nerve head of a 37-year-old man and shows:

a) Optic atrophy

b) Optic disc oedema

c) Morning glory anomaly

d) Optic nerve hypoplasia

02 Which of the following should not form part of a differential diagnosis for the above patient?

a) Papilloedema

b) Anterior ischaemic optic neuropathy

c) Optic disc pit

d) Leber hereditary optic neuropathy

03 Which of the following symptoms would be consistent with a diagnosis of papilloedema?

a) Headache, worse in the mornings

b) Slightly reduced visual acuity

c) Horizontal diplopia

d) All of these options

04 A 45-year-old woman presents with a superior 'nasal step' visual field defect, mimicking glaucoma. The image shows:

a) Optic disc drusen b) Optic neuritis c) Myelinated nerve fibres d) None of these options

05 Other conditions that may produce visual field defects mimicking glaucoma include:

a) Tilted optic disc

b) Optic disc pit

c) Optic disc coloboma

d) All of these options

06 Optical coherence tomography of the peripapillary retinal nerve fibre layer (RNFL) may show:

a) Focal RNFL thinning

b) Diffuse RNFL thinning

c) Neither focal nor diffuse RNFL thinning

d) Either focal or diffuse RNFL thinning

07 The image shows the optic nerve head of a 30-year-old woman presenting with two-day onset of a mildly painful eye and blurred vision. Which of the following should be conducted?

a) Visual field test

b) Swinging flashlight test

c) Red desaturation test

d) All of these options

08 Which of the following is the most likely diagnosis?

a) Retrobulbar neuritis

b) Papillitis

c) Non-arteritic anterior ischaemic optic neuropathy

d) Nutritional optic neuropathy

09 Over the next 15 years, the patient has an approximately 50% risk of developing:

a) Multiple sclerosis

b) Ankylosing spondylitis

c) Giant cell arteritis

d) Myotonic dystrophy

10 The image shows the right optic nerve head of a 75-year-old woman presenting with unilateral severe vision loss since last night. Which of the following should be included in differential diagnosis?

a) Arteritic anterior ischaemic optic neuropathy b) Leber hereditary optic neuropathy c) Primary optic atrophy d) All of these options

11 Which of the following non-ophthalmic symptoms should you ask about?

a) Headache b) Scalp tenderness c) Jaw pain on chewing d) All of these options

12 If the patient was diagnosed with giant cell arteritis, which of the following is correct?

a) Vision in the affected eye is likely to partially recover to around 6/12-6/18 with treatment

b) Urgent treatment is indicated to reduce the risk of fellow eye involvement

c) No treatment is available, and the fellow eye is likely to be affected within one to two weeks

d) None of these options

Dr Jonathan Denniss PhD, MOptom (Hons), MCOptom and Dr Samantha Strong PhD, BSc (Hons), AFHEA

About the authors

* Dr Jonathan Denniss is a lecturer in optometry at the University of Bradford. His research interests are in glaucoma, AMD and the measurement of visual function. His main teaching duties relate to postgraduate glaucoma modules and undergraduate clinical optometry.

* Dr Samantha Strong is a post-doctoral researcher based in the School of Optometry and Vision Science at the University of Bradford. She holds a BSc in psychology from the University of York, and a PhD in vision science from the University of Bradford. Her research involves using neuroimaging techniques to investigate perception of visual stimuli in the human brain. In addition, she is a freelance scientific illustrator.

Exam questions

Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk. Please complete online by midnight on 8 December 2017. You will be unable to submit exams after this date.

Learning objectives

* Be able to identify the clinical features of optic nerve head pathology (Group 6.1.5)

* Be able to identify cases of pathology through appropriate assessment of the optic nerve head (Group 2.1.2)

Caption: Image A Optometrists

Caption: Image B Therapeutic optometrists
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Title Annotation:VRICS
Author:Denniss, Jonathan; Strong, Samantha
Publication:Optometry Today
Date:Nov 1, 2017
Words:656
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