Candidate six Date: Nov, 1999
Indirect ophthalmoscopy of both fundi with a 20D lens. The patient had extensive bilateral pan-photocoagulation, the right macula had a dense macular pucker. The patient had obvious diabetic retinopathy but the examiner asked me for a list of causes which can give rise to peripheral neovascularisation.
Indirect ophthalmoscopy of the right fundus with a 20 D lens. The patient has a pigmented choroidal lesion in the right supero-temporal quadrant. I was asked questions on the differential diagnosis and the possible treatment for choroidal melanoma.
Slit-lamp examination of the anterior segment. There was a right pseudo-phakia and keratic precipitates (mutton-fat appearance). The examiner asked for the possible causes of granulomatous uveitis and the investigations that I will carry out.
Anterior segment examination with a slit-lamp. The right eye was pseudophakic and the left eye had pseudo-exfoliation. Posterior segment examination showed increased cup/disc ratio in both eyes. Questions on the management of glaucoma in pseudo-exfoliation vs primary open angle glaucoma and the potential complications during cataract examination in this patient.
I was asked to perform a cover/uncover tests on a patient with Down's syndrome. There was a right exotropia which was worse for distance than near. Ocular motility was normal. Slit-lamp revealed a right cataract.
Neurology / Medical Ophthalmology
The patient had bilateral ptosis and 'myotonic' facies. The examiner asked me what I would like to do next. I chose to shake his hand but there was no evidence of delayed relaxation as would be expected in myotonic dystrophy. I then asked to examine the ocular motility. He had restricted eye movement in both eyes and the right diagnosis was chronic progressive external ophthalmoplegia.
Direct ophthalmoscopy. The patient had a right branch retinal vein occlusion with macular oedema. Questions on the management and the findings of Branch Retinal Vein Occlusion Study.
Examination of the lenses with a direct ophthalmoscope. There was bilateral cataract and a right ectopia lentis. This was confirmed on the slit-lamp. Questions on the differential diagnosis of ectopia lentis.
Pupillary examination. The patient had a left relative afferent pupillary defect. I was asked what clinical test I would like to do next. I chose to perform the visual field test (in hindsight I should have asked to examine the posterior segment). The patient appeared to have a left supero-temporal field defect. I was asked to give a differential diagnosis for the field defect.
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