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2009 Series -  December 1, 2009 Lecture 5 of 52  NEXT»

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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.



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