[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient has complained of blurred vision.  Please examine their pupillary responses.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/144967673″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has a relative afferent pupillary defect.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]The relative afferent pupillary defect – also known as a Marcus Gunn pupil is a medical sign identified by swinging a torch between the patient’s eyes.  The eye affected by the RAPD is able to sense the light and produces constriction to a modest degree.

To test for an RAPD a light is alternately shone in each eye, typically for around a second in each position.  A normal response elicits constriction of both pupils symmetrically – irrespective of which eye the light is shining into.  However, in pathological states when the light is shone into the affected eye this response is blunted.  However, when the light is shone into the unaffected eye both pupils constrict normally.

In the MRCP PACES examination a RAPD must be differentiated from a second cranial nerve palsy by the fact that an optic nerve palsy would produce no response to light at all.

A RAPD is often encountered in the context of optic neuritis and multiple sclerosis.  In a young patient this is often the leading differential diagnosis.  In older patients a compressive optic neuropathy may be more likely due to a growing space occupying lesion, severe glaucoma.

Other differentials include:

  • Traumatic optic neuropathy
  • Giant cell arteritis
  • Radiation optic nerve damage.

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has a relative afferent pupillary defect.  I would like to investigate further by taking a thorough history.  It may be necessary to investigate for causes such as demyelination with an MRI head scan.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]