Step 2

Ophthalmology 3

A 26-year-old woman presents to her primary care physician for evaluation of her vision, which has deteriorated over the last year. She has noticed increasing difficulty driving at night, especially in reading signs and detecting cars on her left or right. She has had no associated eye pain or headache. Past medical history is significant for anxiety, which is managed with counseling. Family history is significant for progressive blindness in the patient’s biological father by the age of 40. She takes no medications. Vitals are significant for a BMI of 21 kg/m2 and a blood pressure of 118/76 mm Hg. Physical examination reveals moderate, bilateral peripheral field deficits and decreased visual acuity compared to previous testing.

Which of the following findings is most likely present on fundoscopy?

  • A) Arteriovenous nicking, silver wiring, and flame hemorrhages
  • B) Bony spicule pigmentation with pallor of the optic disc
  • C) Hard exudates with capillary microaneurysms
  • D) Retinal whitening with a cherry red spot at the macula
  • E) Scattered diffuse hemorrhages with swelling of the optic disc


Alexandra Conway


Dr. Ted O'Connell