Candidate 48                                                  Centre: York
MRCOphth (Failed)                                                          Date: March, 2004

1) Viva: discussion on neonatal conjunctivitis; micrograph of rubeosis and posterior synechiae with vitreous haemorrhage asked about the likely diagnosis in a 75 year old, I mentioned central retinal vein occlusion. Histology of a lipogranulomatous lesion and the diagnosis was chalazion.

2) Toxoplasma.

3) Late endophthalmitis: Discussion of likely pathogens (propiobacterium acne), signs and treatment.

4) A histology slide of either lymphoma or benign reactive hyperplasia but I thought it looked like a non-caseating granuloma and wrongly diagnosed it as sarcoid granuloma.

5) Retinoblastoma (poor quality micrograph).

Clinical OSCE

1) Communication skill:

  • ARMD, discussion and explanation and consent for FFA

2) Ophthalmology and medicine: 

  • Psoriasis with non-granulamatous uveitis and sarcoid with granulomatous uveitis
  • Carotid artery occlusion: asked to listen for carotid bruit and feel the pulse for any irregularity. Discussion on the possibility of temporal arteritis.

3) Posterior segment:

  • choroidal lesion. Possibilities of choroidal naevus vs melanoma. Went through B-scan findings.
  • disciform scar from subretinal neovascular membrane.

  • 4) Glaucoma and Cataract: 

    • bilateral blebs with pale cupped discs. Discussion on augmented trabeculectomies (5-Fu and mitomycin) including the age, race and complications.
    • Hudson-Stanli's line but could not see any other abnormalities.

    5) Neurology/strabismus:

    • combined 3rd and 4th nerve palsy post-traumatic without pupil involvement.
    • bilateral pale discs and possible causes
    • visual field examination: right eye has no light perception and the left has temporal visual field defect. Possible causes: chiasmal lesion? junctional scotoma?

    6) Anterior segment: 

    • conjunctival lesion: ? pseudopterygium
    • Fuch's endothelial dystrophy
    • unilateral scared cornea with bullae.
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