Candidate 8 Centre: Moorfields Eye Hospital, London
Date: Feb. 2000
Indirect ophthalmoscopy with a 20D. The patient had a right macular hole.
Questions on causes of macular hole, its staging and management.
Slit-lamp examination of a middle-aged man with bilateral corneal graft. There were opacities on the recipient cornea which may be granular dystrophy. Questions on different types of stromal dystrophy and inheritance.
Slit-lamp examination of a Afro-Carribean middle-aged female. She had a right phthisical eye. The left eye had trabeculectomy. Fundal examination shows extensive peripheral chorioretinal scar. The scar looked like heavy pan-photocoagulation possibly with the old type laser like Xenon laser. Questions on anti-metabolites and their indication during trabeculectomy.
Indirect ophthalmoscopy with a 78D. The patient was a woman in her twenties. She had bilateral ectropion uvea and fundal examination revealed a right exudative retinal detachment with extensive exudates. I looked for peripheral telangiectasia (Coat's) and angioma (von-Hippel Lindau) but there were none. Questions on the possible diagnosis.
I was also asked to perform confrontational visual field test on the left eye which was normal.
Medicine / Neurology
Pupillary examination on a middle-aged woman. There were light-near dissociation and slit-lamp showed vermiform movement of the dilated left eye. She also had absent ankle jerk. The diagnosis was a Holme-Adie's pupil. Questions on possible causes and symptoms of Adie's pupil.
Examination of the hands of a patient with rheumatoid arthritis. The patient had the classical signs of ulnar deviation of the MCP joints, volar subluxation etc. He also had rheumatoid nodules at the elbow. I was asked about the ocular complications of rheumatoid arthritis including the drugs used to treat it. I was also asked to examine the cornea on the slit-lamp, there were vertical striae in both eyes. I made the diagnosis of keratoconus and was asked how I would confirm the diagnosis.
The patient was a woman in her fifties. I was asked to examine the fundus with a direct ophthalmoscope. She had a left pale disc. Questions on the possible diagnosis.
I was asked to examine the cardiovascular system and the patient's thyroid status. She had atrial fibrillation and was clinically hypothyroid (cold hands, slow pulse and delayed relaxation of the tendon reflex).
Orbital examination of a middle-aged woman with a right proptosis. The patient had an axial proptosis with paralysis of the third, fourth and sixth nerve. There were also absent corneal sensation. I gave a differential diagnosis of orbital apex syndrome and was told that the patient had an orbital apex meningioma.
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