Candidate 139

Final FRCS

Centre:    Muscat

   Date:    Feb 2010


1- A 49 year-old Caucasian man comes to the eye casualty complaining of sudden onset of reduced vision in his right eye. He gives a history of sudden onset loss of vision in his left eye 1year ago but he cannot remember the diagnosis. He has good general health apart from his well-controlled hypertension and diabetes.
On examination he has visual acuities of 6/12 N10 in his right eye and perception of light only in his left eye. He is noted to have an indistinct disc margin inferiorly in his right eye and left disc appears pale.
What is your differential diagnosis and management plan for this patient?

2- A 38-year-old footballer comes to the eye clinic complaining of floaters and distortion in his right eye for the last 4 months. More recently he has also been aware of floaters in his left eye. On examination his vision is 6/18, N10 in his right eye and 6/9 N5 in his left and at the slit lamp you notice some cell in the anterior chamber and anterior vitreous of both eye.
(a) What is your differential diagnosis and what other features would you look for?
(b) Discuss your treatment plan and expected outcome for the patient.

3- You are asked to see a 60 year old man had undergone a right trabeculectomy augmented with mitomycin C on the previous day. The eye was uncomfortable overnight and he confesses that he may have rubbed it. He complain of a foreign body sensation and that the eye is watering excessively.
On examination the visual acuity in right eye measure 6/36 (previously 6/9).
There is dehiscence of fornix based conjunctival flap exposing the scleral flap exposing the scleral flap which is slowly leaking aqueous. The anterior chamber is very shallow and the IOP measure 10 mmHg.
How would you manage this patient?

4- A 37 year old man with a background of coronary artery disease and TIA's, presented to emergency room complaining that he had vomited blood. He is thought to have had a major GI haemorrhage.
a) What features in the history would indicate that this was a major bleed?
b) What features on examination would indicate that this was a major bleed?
c) What laboratory indicators would be in keeping with severe bleed?
d) What are the likely sources of major upper GI haemorrhage? What are the likely causes of each?
e) What is the emergency management in these circumstances?



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