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2009 Series : December 1, 2009

December 29, 2009  |  December 22, 2009  |  December 15, 2009  |  December 8, 2009  |  December 1, 2009  |  November 24, 2009  |  November 17, 2009  |  November 10, 2009  |  November 3, 2009  |  October 27, 2009  |  October 20, 2009  |  October 13, 2009  |  October 6, 2009  |  September 29, 2009  |  September 22, 2009  |  September 15, 2009  |  September 8, 2009  |  September 1, 2009  |  August 25, 2009  |  August 18, 2009  |  August 11, 2009  |  August 4, 2009  |  July 28, 2009  |  July 21, 2009  |  July 14, 2009  |  July 7, 2009  |  June 30, 2009  |  June 23, 2009  |  June 16, 2009  |  June 9, 2009  |  June 2, 2009  |  May 26, 2009  |  May 19, 2009  |  May 12, 2009  |  May 5, 2009  |  April 28, 2009  |  April 21, 2009  |  April 14, 2009  |  April 7, 2009  |  March 31, 2009  |  March 24, 2009  |  March 17, 2009  |  March 10, 2009  |  March 3, 2009  |  February 24, 2009  |  February 17, 2009  |  February 10, 2009  |  February 3, 2009  |  January 27, 2009  |  January 20, 2009  |  January 13, 2009  |  January 6, 2009

To see views enlarged, click on the individual pictures...

QOW120109_2A

QOW120109_2B

QOW120109_1A QOW120109_1B

A 12-year-old male of Eastern European descent gave a 10-day history of central blurred vision in the right eye. He was otherwise fit and well but had a history of a "post-viral illness" one year ago. There was no recent travel history. He had 6D myopia affecting both eyes and no previous ocular history. On examination, right visual acuity (VA) was 6/36 with spectacles and 6/24 with pinhole. Left VA was 6/5 with spectacles and 6/5 with pinhole. No relative afferent pupillary defect (RAPD) was elicited and anterior segments were white and quiet. Humphrey visual fields and fundus photos are shown above.

1. Which of the following would be the least informative test?

a. fundus fluorescein angiography (FFA)
b. electroretinogram (ERG)
c. treponemal serology
d. Hb electrophoresis
e. lumbar puncture

2. The differential diagnosis includes:

a. serpiginous choroiditis
b. acute multi-focal placoid pigment epitheliopathy (AMPPE)
c. choroidal tuberculosis
d. presumed ocular histoplasmosis syndrome (POHS)
e. all of the above

3. Which of the following is/are true?
a. If this case is thought to be acute posterior multifocal placoid pigment epitheliopathy (APMPPE), the patient should be told that the prognosis is guarded.
b. If this case is thought to be serpiginous choroidopathy, the patient can be reassured that spontaneous recovery is the norm.
c. Around 90% of cases of birdshot retinopathy are HLA-A29 positive.
d. Multiple evanescent white-dot syndrome (MEWDS) tends to have a male preponderance.
e. Punctate inner choroidopathy (PIC) can clinically simulate presumed ocular histoplasmosis syndrome (POHS).
f. (c) and (e)

For answers to the above, click here on or after December 8, 2009.