Candidate 70                                                  Centre: Southampton 
Final MRCOphth                                                             Date: September, 2005
Posterior Segment

Case 1
Ask to use indirect followed by slit lamp. Patient had bilateral sub foveal CNV scars. Right eye had small angioid streaks. Asked to link up together, and systemic associations of angiod streaks

Case 2
Slit lamp examination of diabetic retinopathy and PRP treament. Asked on NVD and whether they were active or not. Mentioned that signs were unilateral and possible causes. Mentioned ocular ischaemic syndrome and examiners pointed to neck scar with previous surgery for carotid endartrectomy. Asked about possible tests, mentioned CVS risk factors
and thrombosis screen. 

Glaucoma and Cataract

Case 1
Patient with bilateral pseudophakic. Distance between IOL and posterior capsule in one eye very deep. Asked why. Turned out that patient had 2 IOL inserted due to refractive problems

Case 2
Patient with PXF and asked about signs and glaucoma risks and risks in cataract operation.
Asked to go through Visual Fields 24-2. Asked about field of vision tested and false negative, false positive etc meant.


Asked to talk to patient with regards to initial diagnosis of POAG, importance of drops, complicance, small visual field defect, risks of driving, whether "laser by Boots" could cure POAG, and Side effects of b-blockers.

Anterior Segment

Case 1
Patient with corneal scar and vascularization. Asked about possible aetiology and mentioned herpes keratitis. Asked about disciform keratitis and management. Asked about prophylaxis and mentioned HEDS.

Case 2
Patient with heterochromia and evidence of KPs. DDx. Mentioned Fuch's heterochromic cyclitis

Case 3
Patient with Bilateral Fuch's endothelial dystrophy. One eye with guttata and asked to examine other eye. Other eye pseudophakic with evidence of bullous keratopathy. Almost missed contact lens, but spotted it before bell rang. Asked about purpose, and mentioned for comfort.

Neurophthalmology and Ocular Motility

Case 1
Asked to perform visual fields. Took a while, patient had bitemporal hemianopia, worse on Left than right, and Right Superior worse than inferior. Asked about location of lesion. Mentioned parasellar tumours and probably came from inferior due to worse defect superiorly. Asked about other eye signs, but wasn't too sure what examiner wanted.

Case 2
Asked to examine patient with seventh nerve palsy. Comment on facial features, Asked about whether UMN or LMN lesion. forehead not spared thus LMN lesion. Asked to examine relavant cranial nerves. Looked for CN 5,6,7,8. signs. Asked about possible diagnosis, mentioned cerebellopontine angle lesions.

Medicine and Ophthalmology

2 very sound examiners : )

Case 1
Asked to examine lids of patient, who had a left ptosis. Measure MRD, IPD and levator function, which the latter was very poor. Very faint scars noted, which suggested lid surgery. Asked which most likely, and mentioned brow suspension. Asked for differentials of bilateral
ptosis. Mentioned myasthenia gravis, myotonic dystrophy and Kearns-Sayers. Asked about features of first two.

Case 2
Next patient young girl in 30's with NVD and PRP. Asked about diabetic control, mentioned glucose, HBA1c and significant level. Asked what would be good BP control. what agents to use for BP control. Mentioned ACE inhibitors, beta blockers and diuretics. Asked about management of patient that had gone to party for few drinks and collapsed. Mentioned ABCs and glucose required. Asked about whether if ketoacidosis
required glucose. Wasn't sure. Examiners told me yes.

Told that final patient had signs of papillodema and headache. Asked for differential. Mentioned had to rule out Benign Intercranial Hypertension. Asked to describe type of headache typical of this, mentioned textbook answer, nausea and vomiting etc. Examiners seemed satisfied. Asked if they presented to optician first, what would they complain about. Paused to think, and bell rang. Examiners said "that's fine...thank you"

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