Candidate 4 (Passed) Centre: Sunderland
Date : Nov. 2000
Visual field examination. Patient was in her early 40s and field examination revealed bilateral symmetrical reduction of the visual field. I was asked about the possible diagnosis and as the patient was relatively young, I decided on retinitis pigmentosa.
Ocular motility with cover/uncover tests. There was mild exophoria for distance and there was reduction in elevation in adduction which was mechanical. I diagnosed Brown's syndrome.
Direct ophthalmoscopy. The patient was an elderly woman and she had bilateral cupped pale optic discs. I was about the differential diagnosis and the most likely cause to which I said primary open angle glaucoma. I was asked about all the filters on the direct ophthalmoscopy and how to examine the anterior segment with a direct ie. increasing the positive power of the lenses.
Indirect ophthalmoscopy with 20D. Patient was seated and I asked for the patient to lie down. She had new and old laser scars in the right eye in one quadrant only. I diagnosed possible branch retinal vein occlusion with new vessels elsewhere and hence the sectorial pan-photocoagulation. I was also asked about the different lenses used in indirect ophthalmoscopy.
Pupillary examination. Initially I thought there was anisocoria and I diagnosed a left Horner's syndrome. I was about the pharmacological tests for Horner's syndrome. I was also asked to re-examine for an afferent pupillary defect and in fact the patient had a small left relative afferent pupillary defect. I was asked where the lesion might be and I said the likely location is in the anterior visual pathway up to the pre-tectal nucleus.
Slit-lamp examination of the anterior and posterior segment (90D). The anterior segment was normal and the posterior segment had a cellophane maculopathy with a strand of fibrous tissue from the optic disc going inferonasally. I was not asked to examine the peripheral retina. I was asked about the possible diagnosis and also the different lenses used in slit-lamp examination (90, 78 and Hruby lens, including the optics of the latter).
Focimeter on a pair of bifocal glasses.
Keratometry using the Javal-Schiøtz's keratometer on a patient. Questions on the optics of keratometer ie. the Purkinje's images.
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