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Neuro and int med
1.Description of INO asked where lesion is and what side rt MLF and
causes if it were a young female (MS) and old person (CVA tumour)
2.Pic with anisocoria to say what is most obvious finding. Possible
causes - given scenario if tested in light and dark. Tests for
horner's and adies including doses of drops
3. Pic with swollen disc, 80y male with headache - most likely cause:
GCA. Give other symptoms and investigations and treatment. Side
effects of steroids, dosing of steroids and what other drugs to give
with steroids to prevent these complications. Definitive investigation
temp art biopsy. If biopsy negative will u still treat: yes bc of skip
lesions.
4. Known epileptic with seizure- call for help check abc, left lat
decubitus, o2, protect airway, treat precipitating causes eghypoglyc,
alcoholism with thiamine. Lorazepam 2-4mg and if no help arrives yet
do phenytoin incision. Check diascan anticonvulsant levels and
toxicology
5. Needle stick. What infections concerned about HIV hep b and c. What
to do - encourage bleeding, take blood samples from you and patient,
inform infection control, if high risk then start PEP. For how long: 4
weeks. How many drugs: 3. What test to do immediately
6. Right and left VFT with sup temp quadrantanopia - where is lesion,
what symptoms, investigations
Ophthalmic med
1. Amaurosisfugax list causes: emoblic and artherotic and
migraine.Investigations for sources of emboli and also artherotic
including temp art biopsy.
2. Pic with cicatrizing eye disease to list causes to state eye
findings and how to treat specifically eye findings.
3. Pt with papillae in palp conj - possible causes - akc, vkc,
glaucoma gtt ?Which, giant papillary conj.write a prescription for
treatment, if it were an old man possible diag: floppy eyelid and a
young girl what would u advise - no contacts but then if she is not
happy with her vision without contacts when what would u think:
keratoconus
4. Picture with corneal dystrophy ? Granules how to treat types if
surgery
5. Pt with IOP 28 - what are the immediate thoughts - glaucoma
suspect. What investigations - disc, pachy, VFT, gonio
Opthalmic surgery and pathology
1. Pic with ectropion, ptosis, medial canthus cutaneous horn. Types of
ectropion which is most likely this case- senile.Surgical options.
Would u be worried about cutaneous horn - yes bc of risk of squamous
cell ca in this age group ( older man)
2. Post cataract patient with inf alt scotoma and floaters - RD. Ways
to treat and how to counsel patient
3. Pic of Pterygium and ways to decrease recurrence
4. Post op refractive surprise - possible causes, treatment and
protection of endothelium by dispersive viscoelastic and to give an
example
5. Retrobulbar hg pic, give diagnosis and treatment
Neuro
1.Pupil exam female pt
Left RAPD
Slit lamp for nerves - rt temporal pallor but left complete pallor -
most likely cause in a young patient optic neuritis
2. Old man with right exodeviation
Motility exam
Only Able to do elevation and depression on abduction. Most likely
cause CN 3 palsy partial. What else to look for:
Look for ptosis and pupil
Pupil mid dilated but not fully and fixed - most likely cause :
vascular
Oculoplastics
1. Bilateral ptosis R>>L
Ptosis exam and measurements
Other obvious finding - dermatochalasis both upper and lower lids-
causes of ptosis
most likely cause: aponeurotic
2. Young boy with diagonal right corneal scar and opacification and
vascularization
Most likely trauma
What else? ? Ptosis
Use torch to look at reflexes - ? Phthysical.
What is the difference between phthisical and enophthalmos
Which does this patient have.
How to proceed, Pt is NLP:
Counsel poor prognosis. Use contact lenses ? What else
Ant seg
1. Right looks like correctopia, with IOL ant capsular fibrosis, sup
scar with vasc and crystal like opacities. Left with same iris defect
but ectropion uvea and not much else
Diag: iris colobomas.
Congenital or aquired? Congenital bc it bilateral and inf nasal
position
What type of surgery - ecce bc of size of wound and suture marks.
Adv and disadvantage of scleral ecce wound vs corneal - axis and astig
2. Man with endothelial dusting, pigment on ant capsule, and bulging
of inf temp sclera- coloboma from ruptured globe avoid this by doing
peritomy and looking for scleral rupture. Most likely site for rupture
- just post to insertion of recti
3. Young boy with temp corneal scar, inf old hyphaema,
fibrovascularmemb over lens, lens dislocated, tube shunt sup nasally.
Most likeu traumatic glaucoma
Post seg
1. Man with right macular exudates, prp scars, dot n blot hgs and left
periph pre retinal hg.
List differentials - DM htn BRVO radiation, anaemia
Why can prpbe done in one area only- sectoralprp for BRVO
Why do prp for BRVO - BVOS study
2. Young man with nvd, tortuous vessels fibrosis at sup temp disc and
ERM - most likely cause sup tmp BRVO. Acute or chronic? - chronic.
What findings would he have in the acute stage. What is ERM most likey
due to - long standing macula oedema
Suppose he had a complete vit hg what to do? B scan to rule out RRD,
then anti vegf if no traction. monitor how often? Monthly, then prp
after view clears.
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