Review Question - QID 106755

Action	Numeric Key	Letter Key	Function Key
Choose 1	1
Choose 2	2
Choose 3	3
Choose 4	4
Choose 5	5
Submit Response			Enter
Previous Question			Left Arrow
Next Question		N	Right Arrow
Open/Close Bookmode		C
Open Image			Spacebar

Retinal Artery Occlusion / Amaurosis Fugax Pathophysiology Cholesterol embolism is the most common cause QID: 106755 (M2.OP.15.75)

QID 106755 (Type "106755" in App Search)

A 67-year-old woman presents to the emergency department complaining of right eye blindness. She states she first noticed the vision loss when she woke up this morning. She denies any pain or other associated symptoms. Review of systems is notable for passive suicidal ideation as the patient's husband died in the ICU last night. Her temperature is 98.3°F (36.8°C), blood pressure is 174/104 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for the patient being unable to see out of her right eye with normal vision in her left eye. Her cranial nerves are otherwise intact and she has normal strength and sensation in her upper and lower extremities. A fundoscopic examination is performed and the results are demonstrated in Figure A. Which of the following is the most likely etiology of this patient's symptoms?

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Arterial embolization

26%

18/70

Detachment of the retina

1/70

Emotional stress

3/70

Increased intraocular pressure

51%

36/70

Ischemia of the brain

13%

9/70

Select Answer to see Preferred Response

Review TC In New Tab

The patient presents with central retinal artery occlusion, characterized by sudden, painless blindness and a pale retina with a cherry-red macula on funduscopic evaluation.

Central retinal artery occlusion (CRAO) is an eye condition where the flow of blood through the central retinal artery is occluded. It is often associated with carotid artery atherosclerosis and a carotid bruit will often be found on physical exam. CRAO often presents with acute, painless monocular vision loss. Retinal whitening with a cherry-red spot is observed on funduscopic exam. Treatment consists of ocular massage, increasing CO2 levels (for vasodilation), and an ophthalmology consultation.

Figure/Illustration A demonstrates retinal whitening with a cherry-red spot (red arrow) as is commonly seen in CRAO.

Incorrect Answers:
Answer 2: Detachment of the retina presents with loss of vision like a "curtain is coming down over the eye" and presents with a free flap on ultrasound. Treatment may involve positioning of the head, injection of gas, and cryoretinopexy.

Answer 3: Emotional stress can cause conversion disorder where the patient has sudden-onset neurologic symptoms after a life stressor. Typically, the patient is indifferent to these symptoms or not overly concerned (La belle Indifference) and the patient's neurologic deficits will not cause the patient harm (meaning even if claiming they are blind, they will not trip over objects). This patient's pallor on fundoscopy suggests against this diagnosis.

Answer 4: Increased intraocular pressure describes glaucoma which can present with unilateral vision loss as well as a rock hard eye and a steamy pupil with an elevated intraocular pressure.

Answer 5: Ischemia of the brain describes an ischemic stroke which would present with focal neurologic deficits in the distribution of a vascular territory. Isolated vision loss with pallor on fundoscopy suggests against this diagnosis.

Bullet Summary:
Central retinal artery occlusion presents with sudden, monocular vision loss and pallor on fundoscopy.

ILLUSTRATIONS:

Rating

Please Rate Question Quality

5.0

(7)