Understanding Central Vision Loss in Older Adults – A UKMLA/PLAB Question Analysis
Decode Complex Exam Style Questions for UKMLA and PLAB Success
This article dissects a tricky exam-style question, focusing on a common yet challenging condition: age-related macular degeneration (AMD). As the leading cause of central vision loss in older adults, AMD tests clinical reasoning and diagnostic skills, making it a crucial topic for medical exams like the UKMLA, PLAB, and USMLE.
PLAB Exam Style Case Scenario: A 75-year-old man presents with difficulty recognizing faces and reading, which has gradually worsened over the past year. He reports that straight lines appear wavy. On examination, there is a loss of central vision in both eyes.
What is the most likely diagnosis?
- A) Glaucoma
- B) Diabetic retinopathy
- C) Age-related macular degeneration
- D) Cataracts
- E) Retinal detachment
Answer with an explanation is provided below.
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More about the UKMLA or PLAB exam:
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Explanation of the above PLAB / UKMLA exam question
Correct Answer: C) Age-Related Macular Degeneration (AMD)
Why Age-Related Macular Degeneration (AMD) is the Most Likely Diagnosis
Symptoms Match AMD: AMD is the leading cause of central vision loss in older adults and is associated with difficulty reading and recognising faces due to the involvement of the macula.
Metamorphopsia: The symptom of wavy lines is characteristic of wet AMD, where fluid or blood accumulates under the retina, distorting vision.
Bilateral Presentation: AMD typically affects both eyes, though not necessarily symmetrically, which fits this patient’s findings.
Why Other Options are Less Likely:
A) Glaucoma: Glaucoma primarily causes peripheral vision loss, not central vision loss. It progresses silently and does not typically cause metamorphopsia or distorted vision.
B) Diabetic Retinopathy: Diabetic retinopathy causes vision loss due to retinal haemorrhages, macular oedema, or detachment, but it is usually associated with a history of diabetes. This is not mentioned in the scenario.
D) Cataracts: Cataracts cause blurred vision, glare, and difficulty seeing at night. However, they do not typically cause wavy lines or central vision loss, as seen in this case.
E) Retinal Detachment: Retinal detachment presents acutely with symptoms like a sudden curtain-like shadow, flashes of light, and floaters, which are not present here. It does not typically cause progressive central vision loss over a year.
Management and Follow-Up:
Confirm Diagnosis: Refer the patient to an ophthalmologist for further evaluation, including optical coherence tomography (OCT) and fundoscopy to confirm AMD and differentiate between the dry and wet types.
Treatment:
Dry AMD: Focuses on lifestyle modifications, such as smoking cessation, dietary supplements (e.g., antioxidants), and vision aids.
Wet AMD: Requires treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (e.g., ranibizumab or aflibercept) to reduce fluid accumulation and slow progression.
Monitoring: Regular follow-up with an ophthalmologist is necessary to monitor disease progression and response to treatment.
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Reference:
NICE Guidelines: Urinary Tract Infection in Children and Young People.
Remember: This blog post is for educational purposes only and should not be considered medical advice.
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