AKT revision

1. Which one of the following features is not consistent with acute conjunctivitis?

A. Bilateral red eyes
B. Lymphadenopathy
C. Mild photophobia
D. Papillae under an everted upper lid
E. Reduced visual acuity

Answer: E

2.A 25 year old male patient (with no significant past medical history) presents with a painful red right eye. On examination his corrected visual acuity is 6/12 in the affected eye, the redness is concentrated around the cornea and his right pupil is smaller than his left. Which of the following options represents the single most likely diagnosis?

A. Allergic Conjunctivitis
B. Glaucoma
C. Iritis
D. Marginal keratitis
E. Viral conjunctivitis

Answer: C

This is unlikely to be acute conjunctivitis because of the pattern of injection "circumlimbal", the reduction in visual acuity and the pupilary change. In this age group acute glaucoma would be unlikely - especially in the absence of any ophthalmic history.

3. A two month year old boy presents acutely with his third episode of conjunctivitis. Both he and his mother are otherwise well. What is the the single most appropriate management plan whilst awaiting swabs?

A. No antibiotic treatment
B. Oral antibiotic treatment
C. Topical antibiotic treatment
D. Both oral and topical antibiotic treatment

Answer: A

The most likely cause is naso-lacrimal duct obstruction although it is essential to exclude Ophthalmia Neonatorum (notably from Chlamydia) with this story . If swabs are negative most cases of acute conjunctivitis will resolve without treatment and if the cause of the problem is duct obstruction gentle massage of the nose (cephalo caudally whilst feeding) is said to help.

4. Which one of the following statements is true about acute sinusitis in adults?

A. Antibiotics are usually indicated in the presence of a purulent discharge
B. Decongestants have been shown to be effective
C. Plain X-Ray of the paranasal sinuses is a useful investigation in primary care
D. Sinusitis is more likely if symptoms are not preceded by an URTI
E. Sinusitis is more likely if there is pain in the teeth than if there is not

Answer: C