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Quiz: Flashes and Shadows in a Middle-Aged Woman

Test your understanding of this case with 10 questions.

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Case Information
Review the case details while answering questions

PATIENT DEMOGRAPHICS

46-year-old female

PRESENTING COMPLAINT

Multiple episodes of transient flashes of light in the right eye over the past 3 months, each lasting 10-15 seconds. Episodes are followed by temporary dark spots in the central vision that resolve after 20-30 minutes. No headache, nausea, or neurological symptoms accompanying the visual disturbances.

EXAMINATION FINDINGS

Visual Acuity: OD: 6/9, OS: 6/6

Pupils: Equal, reactive, no RAPD

Fundus: OD: Multiple cotton wool spots and small retinal hemorrhages in the posterior pole. OS: Normal retinal appearance with clear optic disc

INVESTIGATIONS

Fundus Photography: Right eye shows multiple cotton wool spots and small flame-shaped hemorrhages scattered throughout the posterior pole, consistent with embolic retinal events. Left eye shows normal retinal vasculature.

Fluorescein Angiography: Multiple areas of capillary non-perfusion and delayed filling in branch arterioles in the right eye, suggesting embolic occlusion.

Echocardiogram: Large left atrial mass (4.2cm) attached to the interatrial septum, consistent with atrial myxoma.

Carotid Doppler: No significant stenosis. Normal flow patterns bilaterally.

Question 1 of 10

What is the most likely source of the embolic events in this patient?

Question 2 of 10

Photopsias followed by scotomas in a young patient should always be attributed to migraine.

Question 3 of 10

Which investigation was most crucial for establishing the diagnosis?

Question 4 of 10

What is the most likely diagnosis?

Question 5 of 10

The following is an appropriate management step: Urgent cardiothoracic surgery referral for myxoma resection

Question 6 of 10

What did the fluorescein angiography findings in the right eye demonstrate?

Question 7 of 10

The left eye was entirely normal on examination while the right eye showed multiple embolic events. Which of the following best explains this unilateral pattern?

Question 8 of 10

If the atrial myxoma is not surgically resected, what is the most serious systemic risk to this patient beyond further retinal events?

Question 9 of 10

What is the most likely diagnosis?

Question 10 of 10

The following is an appropriate management step: Urgent cardiothoracic surgery referral for myxoma resection