Candidate 10 Centre: Glasgow
Date: Sept., 2000
OphthalmologyCase one
Slit-lamp examination of the anterior segment. The patient had bilateral obliteration of caruncles and shallowing of the inferior fornix. I made the diagnosis of ocular cicatrical pemphigoid. I was asked to give a differential diagnosis and the confirmatory diagnosis for pemphigoid.Case two
Ocular motility examination of a patient with exotropia. The tropia was constant and the deviated eye did not take up fixation. I was asked to examine the fundus of the affected eye with a direct ophthalmoscope. Unfortunately, the pupil had become constricted and all that I could find were cataract and possible fibrosis. I repeated the examination with a 20D lens and again the view was poor. However, the examiner said that he could see the view very well through the small pupil!Case three
I was asked to demonstrate pupillary examination in a patient with dilated pupils. As both eyes were dilated with mydriatic, there were no reaction to light or accommodation. It seemed that the examiner just wanted to see how I can perform the test proficiently.
On the same patient, I was asked to examine the fundus with a 78D. There were subtle macular changes in the right and I gave a differential diagnosis of early macular hole or cystoid macular oedema.Case four
Slit-lamp examination of a patient with peripheral corneal thinning. There was pannus and lipid deposition. I made the diagnosis of herpetic stroma disease.
Medical ophthalmology
Case one
Take a history from this patient.
Patient was a woman in her 60s. History revealed four year history of foreign body sensation and dry mouth.
Patient had Sjogren's syndrome and questions on treatment, diagnosis (blood tests) and causes (primary and secondary) of Sjogren's syndrome. Also risk of lymphomaCase two
Spot diagnosis. The patient was male and had a significant stiff posture. He had a stiff lumbar vertebrate. The diagnosis was ankylosing spondylitis.
Questions how the patient may present to the ophthalmologist apart from uveitis. The answer that the examiner after was difficult in looking straight due to the problem with the spine. I was asked what optical treatment is available for this problem and I mentioned vertical prisms which appeared to satisfy the examiner.
Further questions on the management of rheumatological conditions focusing mainly on the adverse effect of steroid (osteoporosis and bone density measurement) and immunosuppressants (methotrexate, cyclosporine and azathioprine)Case three
Examination of a patient's face. There were changes diagnostic of acne rosacea. I was asked to examine the anterior segment through a slit-lamp. There were bilateral inferior corneal pannus and posterior blepharitis. Questions on the ocular complications of acne rosacea and management of the skin and eye problems.Case four
Instead of patients the examiners asked questions on the medical management of surgical patient. I was given a scenario of a diabetic patient who developed shortness of breath after vitrectomy and how I would manage the patient. The answers were focused on the management of diabetic patients pre and post-operation and also the diagnosis and management of diabetic ketoacidosis (rehydration and insulin).