Candidate 21                                                            Date: March, 2002
                                                                                 Centre: Sheffield
Pathology viva:

Microbiology for corneal scrapes- the details re gram stain and plates. Chlamydia tests e.g. Giema, PCR, ELISA and the details of how to perform each one! Retinoblastoma- prognostic factors for life (they rubbished the Reese-Ellsworth classification), genetics. Corneal pathology ?granular dystrophy

Medicine & Neurology

Case 1: 
Take a history from patient who had unilateral gradual non specific visual loss. Asked to examine the patient as if I was in clinic: positive RAPD, centrocaecal scotoma, pale optic disc (direct ophthalmoscope, undilated pupil). Differential diagnosis. Investigation and management of meningioma.

Case 2. 
Young man: asked to examine his gait and proceed. Ataxic gait, positive Rombergs. No cerebellar signs, intact reflexes, upgoing planters, normal power, diminished proprioception, mild bilateral facial weakness. Most signs difficult to elicit since patient had jeans on (I did ask to have them removed without success) Asked to put everything together. I couldn’t. The examiner said they couldn’t either -?mitochondrial disease

Case 3: 
Middle age man with one side of glasses frosted. Asked to take a history- strange history of intermittent malaise, generalised small joint pain and swelling, complete heart block, nasal discharge, painful eye. I offered Wegeners and SLE as differential diagnosis. Exam of eye showed scleromalacia perforans. Asked to explain his general symptoms and asked about eye manifestations of Wegeners, including exudative RD and optic nerve involvement. Discussed treatment, including side effects of cyclophosphamide.


Case 1: 
Congenital glaucoma, pendular nystagmus, bilateral aphakia, one side hazy corneal. Discussed causes, long term complications, and possibility of secondary lens implant etc.

Case 2: 
Bilateral high myope, unilateral pseudophakia and YAG. Right previous RD surgery. Left prophylactic cryo. Talked about considerations when doing his other cataract.

Case 3:
Young man gives history of progressive night blindness and constricted visual fields. asked for differential diagnosis. Exam showed bilateral aphakia, RP changes, glaucomatous optic discs, unilateral epiretinal membrane. Asked to long term management.

Case 4: 
Middle aged woman came into the room on crutches. Asked to exam eye movements. Abnormal head posture, L exotropia on cover test. small palpebral fissure on L. Limited abduction more than adduction. A pattern exo. No INO,RAPD. Asked for differential diagnosis. Offered aberrant regeneration of 3rd, MG, demyelination and Duanes. Turned out to be MS.

Case 5: 
Middle aged woman with unilateral lipid keratopathy and neovascularisation. Asked for differential diagnosis. Offered HSV as most likely cause.

Return to the main page