Candidate 11 Centre: Glasgow
I was asked to take a history from an elderly woman. She had an of acute angle-closure glaucoma in her left eye.
Slit-lamp examination revealed bilateral peripheral iridectomies and trabeculectomies. She also had bilateral pseudophakia. Questions on the management of acute angle closure glaucoma.
Examination of the fundi with 90D lens. The patient had a right disciform scar in the right macula and in the left macula there was pigment epithelium detachment. Questions on investigation including the advantages of ICG over FFA and possible treatment modalities including PDT (photodynamic therapy).
The next patient was a woman in her 50s. Her right eye was dilated and the examiner asked me to examine the macula with a direct ophthalmoscope. The fundus showed myopic disc with Foster-Fuch's spots. Then, I was asked to examine the left eye with a slit-lamp. She had had a left LASIK procedure.
The last patient was a 65 year-old woman with a right esotropia. She wore glasses for her high hypermetropia. Cover/uncover tests revealed esotropia for near and distance with and without glasses. The bell went before I had time to complete her ocular motility.
The first patient was a tall (more than 6') young woman and I immediately suspected this to be a Marfan's syndrome. Sure enough her anterior segment examination revealed bilateral contact lens wear for aphakia in both eyes.
I was asked to look for other signs of Marfan's syndrome in her. She had arachnodactyly, high arch palate, arm span longer than height. I also mentioned that I would like to carry out a cardiovascular examination. The examiner asked me what medication would I give to Marfan's patient with cardiovascular problems (the answer was beta blocker).
This was visual field examination using confrontation method. I wanted to start the test by presenting finger(s) in different quadrants but the examiner stopped me and asked me to test the field with a white pin. There was bitemporal superior quadrinopia.
I was asked about the systemic manifestation of pituitary problems ie. galactorrhea, loss of hair and libido in men and infertility in women.
The patient had bilateral prominent eyes suggestive of thyroid eye disease. The examiners wanted me to examine the patient as if she was first seen in the consultation clinic. There were especially interested to know how I would test the optic nerve function (afferent pupillary defect, visual field, colour vision and direct visualization of the disc), the type of thyroid function tests and antibodies I would order. There was also a brief discussion of differential diagnosis of proptosis.
I was asked to examine the fundi of a patient with an instrument of my choice. I opted for slit-lamp using the 90D. In the right eye, there was extensive pan-photocoagulation with new vessels elsewhere. Some of the scars were white suggesting recent fill-in laser. The left fundus cannot be visualized due to vitreous haemorrhage. The examiners asked me for the differential diagnosis of vitreous haemorrhage (posterior vitreous detachment, trauma, macroaneurysm, new vessels from retinal occlusive diseases)
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