Candidate 39                                      Centre: Dundee
MRCOphth                                                        Date: September 2003

Pathology Viva
  • Retinoblastoma. A whole globe was shown and asked about the stains used and describe what can be seen. Asked to give a differential diagnosis. Question on optic nerve extension whether it is more common in retinoblastoma or melanoma.

  • Picture of Flexner-Winterstein rosettes. Questions on why they form, what sort of cells the retinoblastoma cells would normally differentiate into ie. photoreceptor cells and the degree of differentiation.

  • Definition of metaplasia. What would you interpret from a report that says squamous cell metaplasia.

  •  Retinoblastoma again. How would it present, investigations and what are the typical histology features. Chlamydial conjunctivitis: its presentation, treatment and differential diagnosis.

  • Sarcoidosis. Investigations and differential diagnosis.
Clinical Cases

Communication skills:

  • Counselling a 50 year old librarian for cataract surgery. The patient is myopic with refraction of RE -15.00D (operating eye) and LE -14D (6/9). Biometry aim to leave at -3.00D. Questions asked by examiners: 
  • What would be her risk for retinal detachment? 
  • Questions asked by patient: 
  • Can she be left to wear glasses in the distance but read unaided?
  • Why does she need to have the other eye done despite the good vision? 
  • Discussion on anisometropia. 
  • Can she have a general anaesthesia as she is scared or sedation?

  • Anterior segment: 

    • Elderly lady with Fuchs' endothelial dystrophy and cataract. Discussion regarding whether cataract surgery is indicated (vision is 6/180, risk of cataract surgery. Methods of reducing risk of corneal oedema and treatment of corneal oedema. 
    • Young man with Crohn's disease and acne rosacea. Discussion about acne rosacea and ocular features: blepharitis, peripheral corneal thinning and neovascularization. Causes of peripheral corneal thinning.

    Orbit and Neuroophthalmology: 

    • Elderly lady with obvious right proptosis and diplopia in right lateral gaze. Examination of face and head. Description only was asked? The patient has 2 burr holes on the forehead due to previous neurosurgical procedure. Examination of ocular movements. Asked causes of axial and non-axial proptosis.
    • Examination of pupils on a young girl of about 20. Right relative afferent pupillary defect. What else would I look for? asked the examiner Causes of RAPD. Visual field examination on the vision shows no vision in the right eye and hemifield defect in the the left. Asked possible causes of field defects. Methods of differentiating a pituitary from craniopharyngioma on the visual fields.

    Medical examination:

    • Fundal examination: old central retinal vein occlusion with pan-photocoagulation and collaterals. Discussion about investigation in young man (<40) with central retinal vein occlusion. What treatment would I start the him on? Aspirin or warfarin and why? If he presented at 6/12 with deep vein thrombosis and what would I do? How long would I treat DVT with warfarin and what is the ideal INR?
    • Examination of a tremor. What are the features of a tremor. What are the different types of treatment? Examine this lady's tremor. She was hyperthyroid with a flap tremor. What bedside investigations would you do to see if there were any cardiovascular feature? (ECG and pulse for atrial fibrillation)

    Posterior segment: 

    • Hemivein occlusion with sector panphotocoagulation. Also new vessels. Asked about management.
    • Trauma to eye 10 to 15 years earlier. Subluxated lens (laterally) with cataract and total retinal detachment. Options for treatment of lens and retina. What is the most likely cause for these feature? (I was not told at the beginning that the patient has trauma so I gave a differential diagnosis). What are the causes of retinal detachment (rhegmatogenous and non-rhegmatogenous)? How would you repair the retinal detachment and visual prognosis?


    • Pigment dispersion syndrome. What medical treatment and the reason for each alternative? What is medical treatment fail?
    • Normal tension glaucoma. What investigations would I perform? The need for phasing and when is IOP the highest?
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