Candidate 17                                                              Date: March, 2001
                                                                                  Centre: Cardiff
  • preoperative preparation of cataract, questioned me about antibiotic in irrigation fluid (she was not in favour) 
  • endophthalmitis ->  diagnosis, organisms, treatment 
  • giant cell arteritis, anatomy of artery (asked to draw it) treatment of GCA 
  • photo of section of globe with retrolental opacity (i think it was PPHV) 


1. Fuch's heterochromic cyclitis,  B/L and aphakic asked about complication and why is she 
    aphakic (done 20 years back) 

2. A patient with few haemorrhages on superior part of fundus, with collateral vessels at disc 
    questioned about vein occlusion history from a pt with right central visual disturbance not 
    changing since 7 years. Fundus showed a oval shaped pigmented lesion in right maculae, it 
    looked like a CHRPE, no resemblance to toxo. We discussed CHRPE and Intestinal 
    poliosis and Gardners' Syndrome and about screening family as it is an autosomal 
    dominant condition. 

3. Pupil examination. The examiner asked me to exam the pupils, I used an indirect, There was an 
    obvious anisocoria but no lid abnormality, the reaction to light was very sluggish on both sides. 
    I almost started to panic, he asked me what I needed to check next, I said pharmacological 
    test, he asked what I would do before that and after a brief silence i checked for near response 
    which was intact. He briefly went into causes of light near dissociation. 

4. I was asked to see a patient with indirect, he had an operculated tear with laser around it, 
    asked about PVD. 

5. There was another middle aged lady who had a whitish lesion on her supertemporal cornea, it 
    looked raised, I gave a differential diagnosis of Salzman, old scar, and Bowens disease of
    cornea, he seemed to be more happy with Bowens disease, but i was not sure what it was 

Medicine and Neurology

1. Asked to take a history from a young man, who had a history of a stroke 1 year back, I was 
    asked to do cerebellar function which were abnormal, then they made me do reflexes of upper 
    limb, which were brisk on the side opposite the hemiplegia, they also asked me to do finger 
    reflexes which surprisingly was elicited nicely. There was a family history of hypertension and 
    renal mass. He then started giving clues and asking me to tell him what the problem was. He 
    mentioned pheochromocytoma and asked how to diagnosis, which i said VMA but apparently 
    this is no longer used. The the diagnosis came to my mind it was VKH with cerebellar 

2. Then came the hands, there were classical changes of rheumatoid defomity which I was 
    asked what types are they, she also had nail fold infarcts and I already saw her right eye 
    which was red, and mentioned I would like to examine the eyes, which had scleritis, they asked 
    me some other ocular complications of rheumatoid arthritis. 

3. I was asked to look at another pair of hands, which were coarse dry, he mentioned the pt has 
    bitemporal hemi anopia, I started looking for acromegaly but it did not fit into that diagnosis, 
    and I was thinking of hypothyroid as there was temporal loss of eye brow coarse facial feature 
    and mild peri orbital swelling and dry skin but I mentioned both and said there was no 
    prognathism or any dental problems 

Medical emergency

He gave me a scenario of a 58yr man with recent 3rd nerve with pupil sparing and mild headache. I said I would do a full neurological exam and check his BP and urine and do routine bloods, including FBC, ESR and U&E.. Then I would give him a patch for the deviated eye or put a tape on his glasses and ask to see him again in 1wk or earlier if any deterioration. 

He said the man came back after 6 days with pupil involvement and headache. I said I would arrange an urgent MRA, he said the pt went for scanning and collapsed, the examiner wanted me to contact neurosurgery before sending him for scanning. He then briefly asked me about MRA and angiography. 

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