Pathology
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preoperative preparation of cataract, questioned me about antibiotic in
irrigation fluid (she was not in favour)
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endophthalmitis -> diagnosis, organisms, treatment
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giant cell arteritis, anatomy of artery (asked to draw it) treatment of
GCA
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photo of section of globe with retrolental opacity (i think it was PPHV)
Ophthalmology
1. Fuch's heterochromic cyclitis, B/L and aphakic asked about
complication and why is she
aphakic (done 20 years back)
2. A patient with few haemorrhages on superior part of fundus, with
collateral vessels at disc
questioned about vein occlusion history from a pt
with right central visual disturbance not
changing since 7 years. Fundus showed a oval shaped
pigmented lesion in right maculae, it
looked like a CHRPE, no resemblance to toxo. We
discussed CHRPE and Intestinal
poliosis and Gardners' Syndrome and about screening
family as it is an autosomal
dominant condition.
3. Pupil examination. The examiner asked me to exam the pupils, I used
an indirect, There was an
obvious anisocoria but no lid abnormality, the reaction
to light was very sluggish on both sides.
I almost started to panic, he asked me what I needed
to check next, I said pharmacological
test, he asked what I would do before that and after
a brief silence i checked for near response
which was intact. He briefly went into causes of
light near dissociation.
4. I was asked to see a patient with indirect, he had an operculated
tear with laser around it,
asked about PVD.
5. There was another middle aged lady who had a whitish lesion on her
supertemporal cornea, it
looked raised, I gave a differential diagnosis of
Salzman, old scar, and Bowens disease of
cornea, he seemed to be more happy with Bowens disease,
but i was not sure what it was
Medicine and Neurology
1. Asked to take a history from a young man, who had a history of a
stroke 1 year back, I was
asked to do cerebellar function which were abnormal,
then they made me do reflexes of upper
limb, which were brisk on the side opposite the
hemiplegia, they also asked me to do finger
reflexes which surprisingly was elicited nicely.
There was a family history of hypertension and
renal mass. He then started giving clues and asking
me to tell him what the problem was. He
mentioned pheochromocytoma and asked how to diagnosis,
which i said VMA but apparently
this is no longer used. The the diagnosis came to
my mind it was VKH with cerebellar
haemangioblastoma.
2. Then came the hands, there were classical changes of rheumatoid defomity
which I was
asked what types are they, she also had nail fold
infarcts and I already saw her right eye
which was red, and mentioned I would like to examine
the eyes, which had scleritis, they asked
me some other ocular complications of rheumatoid
arthritis.
3. I was asked to look at another pair of hands, which were coarse dry,
he mentioned the pt has
bitemporal hemi anopia, I started looking for acromegaly
but it did not fit into that diagnosis,
and I was thinking of hypothyroid as there was temporal
loss of eye brow coarse facial feature
and mild peri orbital swelling and dry skin but
I mentioned both and said there was no
prognathism or any dental problems
Medical emergency
He gave me a scenario of a 58yr man with recent 3rd nerve with pupil
sparing and mild headache. I said I would do a full neurological exam and
check his BP and urine and do routine bloods, including FBC, ESR and U&E..
Then I would give him a patch for the deviated eye or put a tape on his
glasses and ask to see him again in 1wk or earlier if any deterioration.
He said the man came back after 6 days with pupil involvement and headache.
I said I would arrange an urgent MRA, he said the pt went for scanning
and collapsed, the examiner wanted me to contact neurosurgery before sending
him for scanning. He then briefly asked me about MRA and angiography.
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