Ophthalmology
1. Slit-lamp examination of the anterior and posterior segment of a
black patient.
The slit-lamp showed bilateral shallow anterior
chamber with peripheral iridotomies.
Fundoscopy with 90D revealed bilateral ischaemic
changes of the retina with sea-fan
neovascularization in the periphery.
Diagnosis: previous acute angle closure glaucoma
and sickle cell retinopathy.
Questions on the ocular presentation of sickle cell
anaemia.
2. Fundoscopy of the retina with a 78D lens. The macula showed a macular
mass with
haemorrhage and pigment epithelium detachment. Questions
on the differential diagnosis.
3. Slit-lamp examination of the anterior and posterior segment. The
patient had an inferior
peripheral iridotomies and some silicone oil in
the superior anterior chamber. Fundal
examination revealed an inferior retinal detachment.
Diagnosis: silicone oil in a patient with retinal
detachment.
Questions: the effects of silicone oil on the ocular
structures and on biometry.
4. Slit-lamp examination of the anterior segment of a white patient.
The patient had bilateral
vortex keratopathy.
In addition, there is an increased skin pigmentation.
I diagnosed amiodarone-induced vortex
keratopathy and mentioned that I would like to perform
a cardiovascular examination for
cardiac rhythm abnormalities.
5. Anterior segment examination with a slit-lamp. The patient had a
right stellate keratitic
precipitates with some posterior subcapsular cataract.
I could not detect any obvious
heterochromic iridis. I gave a differential diagnosis
including Fuch's heterochromic cyclitis.
Questions on the effect of Fuch's heterochromic
cyclitis on glaucoma and cataract extraction.
6. Fundal examination with a 78D. The patient has multiple microaneurysms
in the macula.
Questions on the definitions of clinically significant
macular oedema in diabetes mellitus.
Medicine and Neurology
1. Orbital examination of a patient with obvious thyroid eye disease.
I was asked about the triad of Graves' eye diseases
(eye signs, pretibial myxoedema and
acropachy).
2. Cranial examination of a patient with expressionless facies. There
were bilateral facial
muscle paralysis with sixth cranial nerve palsies
and wasting of the tongue.
Diagnosis: Moebius's syndrome.
3. Direct ophthalmoscopy of the retina. The patient had bilateral angioid
streaks. I examined
the patient's skin and found changes in the skin
and axillary regions.
Diagnosis: pseudoxanthoma elasticum.
4. Viva on the investigation of a patient with optic neuritis. The controversy
of steroid treatment.
Ocular manifestation of multiple sclerosis.
5. Viva on the management of a patient with suspected eye disease. The
effects of smoking
and radioactive iodine on thyroid eye disease. The
indication for orbital decompressions.
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