Set 1: For each patient, select the most appropriate management option.
A. Supply topical corticosteroid eye drops
B. Supply chloramphenicol and advise continuing contact lens use
C. Supportive self-care, hygiene advice and safety-netting
D. Start oral aciclovir only
E. Reassure because pain excludes serious eye disease
F. Supply lubricating eye drops only
G. Delay assessment until symptoms persist for 4 weeks
H. Same-day urgent assessment for possible microbial keratitis or corneal ulcer
1. A 23-year-old student has bilateral gritty red eyes with watery discharge after a recent cold. Vision is normal, there is no photophobia, no severe pain and he does not wear contact lenses.
Which option is most appropriate?
2. A 31-year-old woman who wears soft contact lenses has a painful red eye, photophobia, reduced vision and a small white opacity on the cornea. She slept in her lenses the night before symptoms started.
Which option is most appropriate?
Set 2: For each patient, select the most appropriate action.
A. Treat as allergic conjunctivitis
B. Supply topical antibiotic and review in 1 week
C. Reassure because red eye is usually minor
D. Emergency same-day assessment for possible acute angle-closure glaucoma
E. Supply oral antihistamine only
F. Advise the patient to buy reading glasses
G. Urgent ophthalmology assessment for possible anterior uveitis
H. Treat as dry eye only
3. A 67-year-old woman has sudden severe unilateral eye pain, blurred vision, halos around lights, headache, nausea and vomiting. The affected eye is red and the pupil appears mid-dilated.
Which option is most appropriate?
4. A 38-year-old man has a painful red eye with marked photophobia and blurred vision. The pupil is small and irregular. He has a history of ankylosing spondylitis.
Which option is most appropriate?
Set 3: For each patient, select the most appropriate referral option.
A. Urgent assessment for possible wet age-related macular degeneration
B. Emergency same-day assessment for possible retinal detachment
C. Routine optician appointment in 12 months
D. Treat with chloramphenicol eye drops
E. Supply sodium cromoglicate
F. Reassure because floaters are always benign
G. Start topical corticosteroid without review
H. Start oral antibiotics
5. A 59-year-old man reports sudden new flashes and floaters in one eye. This morning he noticed a dark curtain spreading across part of his vision. There is no pain or discharge.
Which option is most appropriate?
6. A 76-year-old woman reports new distortion of straight lines and a rapidly worsening central blurred patch in one eye. She has known dry age-related macular degeneration in both eyes.
Which option is most appropriate?
Set 4: For each patient, select the most appropriate pharmacist contribution.
A. Stop all glaucoma drops if stinging occurs
B. Use two eye drops at exactly the same time
C. Apply eye drops onto the eyelid rather than the eye
D. Store all glaucoma drops in the freezer
E. Counsel on prostaglandin analogue adverse effects and adherence
F. Query topical timolol because of asthma/bradycardia risk
G. Recommend contact lenses immediately after every eye drop
H. Use steroid eye drops long term for glaucoma
7. A 70-year-old woman is started on latanoprost for ocular hypertension. She asks why she needs to keep using it when her vision feels normal.
Which option is most appropriate?
8. A 64-year-old man with glaucoma is prescribed timolol eye drops. His records show brittle asthma, resting heart rate 48 bpm and previous hospital admission for bronchospasm.
Which option is most appropriate?
Set 5: For each patient, select the most appropriate management option.
A. Lid hygiene, warm compresses and review of contributing factors
B. Immediate irrigation and emergency assessment after chemical eye exposure
C. Supply oral fluconazole
D. Treat with oral prednisolone without review
E. Reassure and do nothing if alkali entered the eye
F. Supply chloramphenicol for all gritty eyes
G. Patch both eyes overnight
H. Lubricating eye drops, environmental advice and review of medicines contributing to dryness
9. A 58-year-old woman has chronic gritty, burning eyes that worsen during computer work. Vision is normal, there is no photophobia, no severe pain and no discharge. She recently started amitriptyline.
Which option is most appropriate?
10. A 34-year-old man splashed alkaline cleaning fluid into one eye at work 15 minutes ago. The eye is painful, red and watering.
Which option is most appropriate?
Answers and Rationale
1. C
Watery bilateral conjunctivitis after a viral illness, with normal vision and no red flags, is usually self-limiting. Hygiene advice, avoiding sharing towels and safety-netting are more appropriate than routine antibiotics or steroid drops.
2. H
Contact lens use plus pain, photophobia, reduced vision and corneal opacity suggests microbial keratitis or corneal ulcer. This is sight-threatening and requires same-day urgent assessment.
3. D
Severe unilateral eye pain, halos, headache, nausea, vomiting and a mid-dilated pupil suggest acute angle-closure glaucoma. This is an ophthalmic emergency.
4. G
Painful red eye with photophobia, blurred vision and a small irregular pupil suggests anterior uveitis. Ankylosing spondylitis is a relevant risk factor, and urgent ophthalmology assessment is needed.
5. B
New flashes and floaters with a curtain-like visual field defect suggest retinal detachment. This requires emergency same-day assessment to reduce risk of permanent sight loss.
6. A
New distortion of straight lines and rapidly worsening central vision in someone with known AMD suggests possible wet AMD. Urgent assessment is needed because early treatment can preserve vision.
7. E
Glaucoma and ocular hypertension may be asymptomatic until significant damage has occurred. Latanoprost adherence is important, and counselling should include possible iris/eyelash changes, redness and correct administration.
8. F
Topical beta-blockers such as timolol can still cause systemic effects, including bronchospasm and bradycardia. Brittle asthma and marked bradycardia make this prescription clinically concerning.
9. H
Chronic gritty, burning eyes with normal vision and no red flags is consistent with dry eye. Amitriptyline can worsen dryness, so lubricants, environmental advice and medicine review are appropriate.
10. B
Chemical eye injuries, especially alkali exposure, can rapidly damage the cornea. Immediate irrigation should not be delayed, and emergency assessment is required.
Here are 10 extended matching questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.