Candidate 18                                                                Date: Sep, 2001
                                                                                  Centre: Manchester

1. Slit-lamp examination of the anterior and posterior segment of a black patient.
    The slit-lamp showed bilateral shallow anterior chamber with peripheral iridotomies. 
    Fundoscopy with 90D revealed bilateral ischaemic changes of the retina with sea-fan 
    neovascularization in the periphery. 
    Diagnosis: previous acute angle closure glaucoma and sickle cell retinopathy.
    Questions on the ocular presentation of sickle cell anaemia.

2. Fundoscopy of the retina with a 78D lens. The macula showed a macular mass with 
    haemorrhage and pigment epithelium detachment. Questions on the differential diagnosis.

3. Slit-lamp examination of the anterior and posterior segment. The patient had an inferior 
    peripheral iridotomies and some silicone oil in the superior anterior chamber. Fundal 
    examination revealed an inferior retinal detachment.
    Diagnosis: silicone oil in a patient with retinal detachment.
    Questions: the effects of silicone oil on the ocular structures and on biometry.

4. Slit-lamp examination of the anterior segment of a white patient. The patient had bilateral 
    vortex keratopathy. 
    In addition, there is an increased skin pigmentation. I diagnosed amiodarone-induced vortex 
    keratopathy and mentioned that I would like to perform a cardiovascular examination for 
    cardiac rhythm abnormalities.

5. Anterior segment examination with a slit-lamp. The patient had a right stellate keratitic 
    precipitates with some posterior subcapsular cataract. I could not detect any obvious 
    heterochromic iridis. I gave a differential diagnosis including Fuch's heterochromic cyclitis.
    Questions on the effect of Fuch's heterochromic cyclitis on glaucoma and cataract extraction.

6. Fundal examination with a 78D. The patient has multiple microaneurysms in the macula. 
    Questions on the definitions of clinically significant macular oedema in diabetes mellitus.

Medicine and Neurology

1. Orbital examination of a patient with obvious thyroid eye disease.
    I was asked about the triad of Graves' eye diseases (eye signs, pretibial myxoedema and 

2. Cranial examination of a patient with expressionless facies. There were bilateral facial 
    muscle paralysis with sixth cranial nerve palsies and wasting of the tongue.
    Diagnosis: Moebius's syndrome.

3. Direct ophthalmoscopy of the retina. The patient had bilateral angioid streaks. I examined
    the patient's skin and found changes in the skin and axillary regions.
    Diagnosis: pseudoxanthoma elasticum.

4. Viva on the investigation of a patient with optic neuritis. The controversy of steroid treatment.
     Ocular manifestation of multiple sclerosis.

5. Viva on the management of a patient with suspected eye disease. The effects of smoking 
    and radioactive iodine on thyroid eye disease. The indication for orbital decompressions.

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