OE
OphthalmoEducate
Back to Case

Quiz: The Stressed Coder's Blood Pressure Crisis

Test your understanding of this case with 10 questions.

Progress0 / 10 completed
Case Information
Review the case details while answering questions

PATIENT DEMOGRAPHICS

30-year-old male

PRESENTING COMPLAINT

Blurring of vision in the right eye, headaches, and loss of energy. Recent stress following father's death from motor neurone disease.

EXAMINATION FINDINGS

Visual Acuity: OD: 6/7.5, OS: 6/6

Pupils: Equal, reactive, no RAPD

Fundus: OD: Optic disc oedema with blurred margins, cotton wool spots, flame-shaped hemorrhages. OS: Comparatively normal appearance

INVESTIGATIONS

Right posterior pole showing cotton wool spots and retinal hemorrhages consistent with hypertensive retinopathy

Right posterior pole showing cotton wool spots and retinal hemorrhages consistent with hypertensive retinopathy

Right optic disc demonstrating significant swelling with blurred disc margins

Right optic disc demonstrating significant swelling with blurred disc margins

Left posterior pole showing relatively normal retinal appearance

Left posterior pole showing relatively normal retinal appearance

Left optic disc showing minimal changes compared to the right eye

Left optic disc showing minimal changes compared to the right eye

Fundus Photography: Right eye shows optic disc swelling with blurred disc margins, cotton wool spots, and flame-shaped hemorrhages in the posterior pole. Left eye demonstrates comparatively normal optic disc appearance with minimal retinal changes.

OCT left macula showing normal retinal architecture

OCT left macula showing normal retinal architecture

OCT left optic disc demonstrating minimal changes with preserved nerve fiber layer

OCT left optic disc demonstrating minimal changes with preserved nerve fiber layer

OCT right optic disc showing significant swelling and nerve fiber layer thickening

OCT right optic disc showing significant swelling and nerve fiber layer thickening

OCT right macula revealing mild retinal thickening secondary to hypertensive changes

OCT right macula revealing mild retinal thickening secondary to hypertensive changes

OCT Optic Disc and Macula: Right eye shows significant optic disc swelling with peripapillary fluid and retinal nerve fiber layer thickening. Macular OCT reveals mild retinal thickening. Left eye shows minimal optic disc changes with normal macular architecture, confirming the asymmetric nature of the hypertensive damage.

Blood Pressure Measurement: 220/145 mmHg - Consistent with hypertensive emergency. Repeat measurements confirmed sustained severe elevation.

Renal Function and Electrolytes: Mild elevation in creatinine suggesting early kidney involvement. No significant electrolyte abnormalities.

Echocardiogram: Left ventricular hypertrophy consistent with longstanding hypertension. Normal systolic function. No structural abnormalities.

Renal Artery Doppler: No evidence of renal artery stenosis. Normal flow patterns bilaterally.

24-hour Urine Catecholamines: Normal levels, excluding phaeochromocytoma as a secondary cause of hypertension.

Question 1 of 10

The patient's father died of motor neurone disease, and there is a strong family history of MND. What is the most accurate interpretation of this history in the context of his presentation?

Question 2 of 10

Which examination finding most directly reflects acute end-organ damage from this hypertensive crisis, as opposed to chronic change or the diagnostic criterion itself?

Question 3 of 10

Full, pain-free eye movements in both eyes make which diagnosis less likely?

Question 4 of 10

Which OCT finding best supports a diagnosis of unilateral (right-sided) hypertensive optic neuropathy in this case?

Question 5 of 10

What is the most likely diagnosis?

Question 6 of 10

Optic disc swelling in malignant hypertension results from disruption of axoplasmic flow at which anatomical level?

Question 7 of 10

In malignant hypertension, blood pressure should be lowered rapidly to prevent further organ damage.

Question 8 of 10

Secondary causes of hypertension should be investigated in young adults presenting with malignant hypertension.

Question 9 of 10

Which finding, if present, would be a red flag requiring urgent neuroimaging and escalation beyond routine outpatient BP management?

Question 10 of 10

At the bedside, before any investigation results, what single feature best distinguishes hypertensive optic neuropathy from papilloedema due to raised intracranial pressure?