Slit lamp examination.
LE residual lens matter, no lens. some KP. asked for ddx. I said ant.
uveitis, or Fuch's uveitis. Asked about signs of Fuch's heterochromic cyclitis.
Asked whether the comment of no posterior synechiae is valid, I said
no, because there was no lens.
Fundus with bilateral indirect ophthalmoscopy of an old lady.
I saw a scar at macular. Not allowed to exam further, asked me what
will I put
down in my clinical notes. I said disciform scar examiner was happy.
Then looked at the other fundus, a big big patch of chorioretinal atrophy
at inferotemp. region. asked me to give some ddx. I said toxoplasma,
chorioretinal coloboma.... then told me that this lady got previous radiotherapy
to her eye. it was a scar of intraocular tumour after radiotherapy.
Pupil exam of an old man.
Anisocoria, LE smaller which became exaggerated in darkness.
Asked me which side is the pathology, LE. Continue to examine, also got
RE RAPD. examiner happy
already. no further question on it. Then was asked what are the ddx
of a large abn pupil.Ask me what simple history I would like to take if
there is large abn pupil, I said eye drop and trauma. then on the way to
the next case, he asked me
how to dx an adie's pupil.
Asked me to take a history from a man of 50 yr old.
Photophobia since 20 yrs old. bilateral. night vision is completely
normal. family hx +++. asked me what is the possible diagnosis. I said
cones dystrophy. Then asked me to use 90D to see fundus. I said I can't
see a bull's eye maculopathy. Examiner laughed and said 'neither do I'
but the patient got a bit of temporal disc pallor. Asked about ERG.
A middle age woman with left esotropia.
Perform extraocular movement, left abduction deficit. Asked me what
else I want to do, I did duction. still the same. then I said may be it's
a 6th nerve palsy. but examiner not satisfied. Patient has no diplopia.
anyway, I was led to the next case. (may be she has chronic eso, with muscle
fibrosis, but I wasn't given a chance to say that.
Old lady with a left ptosis and frontalis over action.
Asked what I would like to do. I said check pupil. Asked again what
else. i said EOM and jaw winking. was asked whether jaw winking is
likely, i said no. was asked whether jaw winking can occur in patient without
marcus jaw winking syn. I didn't know.... then I went back to examine pupil.
it was a Horner's. Was asked what is the first thing I ask the patient.
I said I like to know if the patient is on pilocarpine causing the small
pupil. examiner was happy.
Slit lamp examination of an old man.
He got posterior chamber IOL and trabeculectomy. Asked me to
look at the other eye, same findings. asked me to use 90D look at the
disc, it was an increased CDR. He has glaucoma and cataract. that's all
the examiner wanted
Slit lamp again of an old lady.
Easily seen ACIOL. was lightly scolded... 'could u examine in a more
systematic way?' I started from the lid, conj, cornea and saw
a white patch at 9 o'clock. Asked me what was that. I said vogt's limbal
girdle, examiner frowned, i
then say it maybe early band keratopathy. he asked what does band k
looked like, i said interpalpebral. He was happy. went on to look at the
other eye, also
ACIOL. Asked me why she has bilateral. ACIOL, just a postulation. i
said she has previous ICCE before the days of ECCE. Examiner nodded. Was
asked why should one examine the anterior segment start from temporal side
rather than nasal side... I was blank. then I guess it's for patient's
comfort as the light shines on the nasal retina rather than macula first,
Ophthalmology in relation to medicine and neurology
Just some dots blots at macula, no clinically significant macular oedema.
me what is that. I said diabetic retinopathy asked how to classify
and what is the patient diabetic retinopathy status. Asked what other illness
or condition will cause progression of the retinopathy, I said hypertension,
pregnancy. lastly, asked me what is the type of DM. (some candidates got
questions like what is the
action of ACE inhibitors and why it is good for DMR....quite difficult
questions that would have been for me)
Look at the hands of an old lady.
Rheumatoid arthritic hands, point out the deformities one by one. then
look at the elbow got rheumatoid nodules. look at the palm, got palmar
erythema. then examiner asked me to look at the face. Other than some telangiectasia,
i saw nothing. Was asked about ocular features, regurgitated again. Examiner
satisfied. was asked about drug tx of RA. I counted NSAIDs, hydroxychloroquine,
azathioprine.....then he asked me what have I left out..... I didn't
know I left out STEROID, he looked annoyed!!!! I saw I got a 5 for
this case. looking back, I think I missed a moon face (Note: avoid using
Moon face or buffalo hump in the exam use the term Cushingoid features
instead to avoid upsetting the patient), as told by other candidates.
Look at a woman's facial feature. She had got facial asymmetry.
I volunteered to test for 7th nerve. She also has a tarrsoraphy. was
asked why. other than tarsorrhaphy, what else can be done to protect cornea.
lubrication, BCL, botox. examiner was happy. then I said I wanna test
other nerves. 5 and 8 are affected too. Was asked where is the pathology.
i said cerebello-ponting angle.
Asked what to do, refer to neurosurgeon and CT scan. Examiner nodded.
Exam an old man's eyes with a torch.
I can see IOL in both eyes and trabeculectomies. Use direct ophthalmoscope
to look at disc. BE disc pallor and CDR 0.6-0.8. was asked whether glaucoma
alone cause this picture. I said no, the disc won't be that pale. Then
asked me what other ddx to consider. then i just regurgitate a whole list
of bilateral disc pallor ddx.
examiner looked happy as I went on and on with the possiblities. He
told me this man is from a very poor family and has poor diet. What is
the cause? I said vitamin deficiency causing optic disc atrophy and the
90D indirect ophthalmoscopy.
Both discs got some ?new vessels ?collaterals. nothing else in the
fundus. asked me the differential diagnosis for new vessels and differential
diagnosis for collaterals. asked what to do to differentiate. I said FFA.
examiner agreed, and said the
FFA showed no leakage. So it's collaterals. He asked me what are the
risks for CRVO, just regurgitated from the books. Before we left, he asked
the patient whether he has hypertension, the patient said yes, examiner
nodded to me.