Candidate 39
Date: February, 2005 Centre: Dundee
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OSE
1. Calculate the AC/A ratio in a patient who has 25PD of esotropia for near without glasses and with +3D lens esotropia is 5PD at 1/3 meter. Ans : 6.6PD of AC/1D of accommodation.
Ans: 9.8D
Ans: Hess chart was showing the muscle sequale of R 3rd Cranial nerve palsy.Principle- I wrote Hering’s and Sherrington’s law. 7. CT scan:
Ans(I am not sure): CT scan of the skull and orbit (axial view) showing echodense bony hyperostosis at the medial wing of the sphenoid bone involving the orbital apex (R).---probably due to sphenoidal meningioma involving the medial aspect. 8. Visual Field Test:
Ans: Binocular Esterman Visual fields showing R homonymous inferior quadrantinopia extending upto fixation. The lesion is located in Left parietal lobe.
Station 1:
Station 2: Slit-lamp—asked to examine left eye of a patient—Relatively clear cornea with trabeculectomy bleb superiorly. AC was uniformly shallow with convex iris configuration and mid dilated fixed pupil with post synechiae and total cataract.---asked about the diagnosis—later examiner gave me a pentorch and asked to demonstrate visual fields in the left eye of the same patient—Before checking VF by confrontation, I tested perception of light---patient had projection of light only inferotemporally—then asked to correlate. Visual Fields-- Asked to
do confrontation test in LE of a wheel chair bound gentleman.
Station 3: Pupil—patient had right RAPD—Near reflex appeared normal, however it was difficult to appreciate the reaction---asked causes/site of lesion for RAPD. Ocular motility—asked to examine the ocular motility of a middle aged patient and to answer while testing—mild right exotropia in primary position—cover test showed elevation & mild abduction of the ‘covered’ eye with no movement of the fixing eye, there was no changes in the palpebral fissure—answered as bilateral DVD---then ocular movements showed limitation of abduction, laevoelevation and laevodepression---Examiner persistently asked to correlate the findings but I couldn’t {right exo + elevation & abduction of the covered eye(bilateral) + limitation of abduction in the left eye}—asked in whom the DVD is common?? [Some answered it as bilateral Duane’s, Bilateral 4th nerve palsy. Some said there was also limitation of adduction in the left eye. I am not sure of the exact diagnosis, but there was a definite DVD] Station 4: Direct Ophthalmoscopy—asked
to examine the left eye of a young patient—the media was clear with distant
direct ophthalmoscopy—near direct examination showed normal disc and retinal
vessels at the post pole, entire macula revealed plenty of yellowish lesions
involving the fovea in the deeper retinal plane with glistening retinal
surface,??associated focal serous detachment which needs confirmation by
slit-lamp biomicroscopy---asked about the diagnosis---probable Best’s /
adult vitelliform dystrophy.
Indirect Ophthalmoscopy—of
left eye—optic disc normal, macula showing diffuse areas of depigmentation
with central elevated yellowish white fibrous tissue with pigmentation,
no evidence of serous detachment or haemorrhage, rest of the fundus being
normal---Wet ARMD, disciform stage---asked to write the diagram on retinal
chart---asked what will be the expected pathology in contralateral
eye—may be dursen / dryARMD / wet ARMD---what are the causes of drusen---what
is the pathology of drusen and exact microscopic location of the drusen—answered.
REFRACTION: 20 year old student—short
history—vision test, 6/36 ph 6/9 in RE, 6/36 ph 6/6 in LE—cover test showed
exophoria---measured IPD—ret using only spheres—wrote power cross---VA
with objective refraction, 6/9 RE, 6/6 LE---best sphere—cross cylinder---duochrome
test (uniocular and binocular)---1D blur test ---tested near vision with
distant correction---then cover test---examiner intervened and asked to
proceed with muscle balance using Maddox rod---tested for horizontal imbalance
only---revealed exophoria---did not use prisms to correct—measured BVD
-3.0 / -0.75 80 RE---6/6,
N5
IPD—67 mm
Examiner pointed about a
mistake in Maddox rod testing. Then asked to leave—still 3 mts left.
Some Tips: 1. MCQ—Studying between the
alphabets!! of Elkington text book and chua book with this excellent web
is suffice to answer most of them.
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