MRCS (Passed) Date: April, 2004
|Clinical General Ophthalmology
I only saw 4 cases.
Case 1: Fuch's endothelial dystrophy.
Case 2: Inferior and inferotemporal chorioretinal atrophy with
dome shaped indentation.
Case 3: Alternating exotropia with V pattern in young boy
Case 4: Keratoconus
Clinical Neurology and General Medicine
Case 1: Elderly woman asked to perform VF. I asked her whether she can
see whole of my face with either eye covered and she said yes. Patient
is not co-operative and keep moving her eyes on confrontation. I then asked
her to cover her eyes in turn again and ask her whether there is any part
of my face missing and she said yes this time!! Her description was compatible
with left homonymous hemianopia. The examiner then ask me since the patient
is not too co-operative, what would I do next. I mention about wringling
fingers for peripheral fields but I think he wants me to compare colour
differences between red bottles. He then ask me to use a red pin. Since
I have only 1 red pin, I then tried to map her blind spot and look for
central scotoma. The examiner was not happy but he asked me to look at
Case 2: Middle age man with left lid retraction and right partial ptosis with prominent lid crease. Ask to inspect. I confirmed proptosis by looking from behind and above. I then did the cornea light reflex and it looks quite symmetrical. I proceed to EOM and there was some limitation on abduction and adduction for both eyes but he patient said he has no diplopia. I was asked about differential and I mentioned thyroid. I was asked why he has ptosis on one eye and lid retraction on the other. I mentioned the ptosis could be due to levator dehiscence. I was then led to another case.
Case 3: Middle age lady with burnt out PDR with fibrosis along vascular arcades and laser marks at peripheral. I was then ask what stage of DMR is that. (examine with superfield lens)
Case 4: Young man told to have unilateral visual loss and pain. Asked to check VA. There was no letter charts in the room and his worse eye could see the picture on opposite way but he mentioned it was blurred. Can not test colour desaturation because there is no red target. I asked to perform pupils exam and there was L RAPD. I asked to see optic disc and there was optic atrophy. I was then asked about differential. I said MS. I was asked about management and Ix (MRI).
Case 5: Young man with unilateral visual loss after trauma. Told to exam VA. The left eye could see objects on opposite wall but could not read the letters from the tissue box (that was the only target available). I said I would like to exam his pupils. There was L RAPD and sluggish direct light response. The examiner ask me what I want to do and I mention to look at the optic disc and there was optic disc pallor. So it was a case of traumatic optic neuropathy.
Case 6: Ask to perform general inspection. The patient has Apert's syndrome with all the facial features and also syndactyly.
Case 7: Strange case. Middle age man. Ask to observe and then proceed. there was AXT on inspection. Confirmed with cover test. EOM showed limitation on adduction and ataxic nystagmus. However, on covering one eye, the adduction returns!! I mentioned about INO and would like to check other signs of MS such as cerebellar signs. The examiner then ask me what will I think it he tells me this case was like than since young. I couldn't think of anything else. I mention AXT with congenital nystagmus, knowing that this would not be the right answer. I don't know the real answer in the end.
Case 8: Told to inspect a young man. Saw a right exotropia. No ptosis. I ask to check for anisocoria. The examiner ask why. I said I want to rule out 3rd nerve palsy. Then the bell rang! Save by the bell...