January 4, 2025

50-year-old man with abnormal funduscopic examination

By Med-Challenger · 1 minute read

A 50-year-old man with no prior medical history presents to you for an annual physical examination. He does not have any symptoms and does not take any medications.

Vitals are: blood pressure 120/80 mm Hg, pulse 80 beats/minute, respiratory rate 14 breaths/minute, oxygen saturation 100% on room air, and temperature 99 °F.

Findings on general physical and neurologic examinations are within normal limits. However, you notice something abnormal on funduscopic examination (see Figure).

image (53)

Based on these findings, what is the next best step in the management of this patient's condition?

Check glycated hemoglobin.
Check lipid profile.
Perform HIV and rapid plasma reagin testing.
Check erythrocyte sedimentation rate and C-reactive protein level.

The correct answer is:

Check lipid profile.

The next best step in this case would be to obtain a lipid profile, because the results from this panel are likely to indicate hypertriglyceridemia.

The findings in the Figure indicate that he has lipemia retinalis, which causes a creamy white appearance to the retinal arteries and veins. The condition is associated with severe hypertriglyceridemia.

Reference:

Baron RB. Lipid disorders. >In: Papadakis MA, McPhee SJ, Rabow MW, eds, et al. Current Medical Diagnosis & Treatment. 2016.

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