Candidate 33                                      Centre: Edinburgh
MRCSEd                                                          Date: March, 2003

Ophthalmology Clinical

Case 1
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 segment cleavage 

Case 2
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.

Case 3
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.

Case 4
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

Case 1 
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.

Case 2
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.

Case 3
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. Mentioned autonomic 
neuropathy. This was followed by a brief discussion on DCCT and UKPDS.

Case 4
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 
walk patient.
Was asked about treatment of anaphylaxis in the setting of FFAs.

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