Examine the anterior segments
Axenfeld-Rieger’s with pseudopolycoria.
One eye looked smaller - offered to measure but examiner declined.
This was followed by discussion
on the treatment of glaucoma. Was asked about the embryology of anterior
Examine left eye with indirect ophthalmoscope.
Patient had tractional RD with traction on the disc. Patient was elderly
and also had pendular
nystagmus. Requested to look at other eye – was no allowed.
Asked for the causes. Offered the typical causes and suggested ROP
as the cause for the patient.
Examiners then asked about the guidelines for screening and treatment
options for ROP. Was
also asked about the nystagmus and if I had heard of the 2-4-6 rule
with regards to nystagmus
development due to poor VA at birth and what it meant.
Examine the anterior segment both eyes.
Unilateral aniridia with conjunctivalisation of the cornea and a drainage
tube in site. Limbal
autografts were also seen. Other eye was normal but had limbal scars
due to the autograft.
Was asked for the cause – offered iatrogenic for tumours or epithelial
in-growth or trauma.
Examiner said it was iatrogenic and asked if I could think of a cause.
I guessed epithelial in-growth
due to the tube. Examiner agreed and told me IOP is well controlled.
Then asked if I thought the
limbal transplant had succeeded – said no. He wanted to know what else
could be done for the
cornea – I said limbal allograft but he still wanted some other options.
I did not know anymore but
the examiner did not push me.
Examine the posterior segment with 90D
Macroaneurysm that had bled superiorly. There was subretinal haemorrhage
and was only just
outside the fovea. Discussion on treatment of macros. Examiner asked
what the most imminent threat
to the patient’s VA was – mentioned that the subretinal haemorrhage
was very close to the fovea.
Medicine and neurology
Examine the patient’s pupils.
RAPD was found and was asked about RAPD. The patient was blind due
to NAION. Asked
about blind eyes with RAPD – can you have a dilated pupil? No. Asked
to explain why –
consensual of other eye keeps them equal. Asked for the light pathway.
Examine this patient as appropriate.
Patient was acromegalic. I looked at his hands – there were scars for
carpal tunnel in one hand.
Proceeded to do a quick test for carpal tunnel. Then tested VF – bitemporal
was present. Look
at tongue and got him to check mouth closure. Then mentioned about
CVS examination – was
asked to examine precordium only – has pacemaker and also what I thought
to be a pan-systolic
murmur (not sure) but is systolic.
Finally was asked what else I would check – offered BP and glucose
and urine. Examiner seemed
satisfied with this.
Examine this patients macula with direct ophthalmoscope.
Was diabetic with mild NPDR.
Then asked to examine the foot. Had ulcer and peripheral neuropathy.
Examiner mentioned that
the patient feels dizzy when standing up and would like to know why.
neuropathy. This was followed by a brief discussion on DCCT and UKPDS.
Examine this patients eye movements
Patient had INO evident on testing the saccades. Mentioned I would
like to test for other cerebellar
signs as patient was unsteady when entering the room and was young.
There was disdiadochokinesis and pass pointing but no speech abnormality.
Was not allowed to
Was asked about treatment of anaphylaxis in the setting of FFAs.