Candidate six Date: Nov, 1999Location: Edinburgh
Ophthalmology
Case one
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.
Case two
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.
Case three
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.
Case four
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.
Case five
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
Case one
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.
Case two
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.
Case three
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.
Case four
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.