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OSPE: 1 Cornea: Refractive Surgery

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OSPE: 1

Cornea: Refractive Surgery

OSPE MOCK TEST HELD ON 8 NOVEMBER 2014 AT NIO&H.

DHAKA BANGLADESH, THE FULL EXAMINATION WAS

CONDUCTED BY DR MD ANISUR RAHMAN ANJUM, ASSOCIATE

PROFESSOR. NATIONAL INSTITUTE OF OPHTHALMOLOGY.

DHAKA BANGLADESH

THERE WERE TEN STATIONS, I HAVE UP LOADED ALL THE

OSPE WITH THEIR ANSWER FOR ALL OF MY STUDENT. I

HOPE THAT THESE WILL HELP THEM TO TAKE

PREPARATION IN THEIR FINAL EXAM. IF YOU HAVE ANY

QUARRY LET ME INFORM IN THE FOLLOWING MAIL &

MOBILE.

OSPE: 1

Cornea: Refractive Surgery

Question

1) What two procedures are carried out in fig A &

fig B

2) Write 2 difference between these two procedure

3) Which procedure can correct astigmatism more?

4) Write 2 other treatment option for this condition

5) Write two common adverse effect of procedure

B. which can be corrected within 3 to 6 months

Answer

1.What two procedure are carried out in fig A & fig B

Fig A: Radial Keratotomy

Fig B:LASIK

2 Write 2 difference between these two procedure

a) In fig A, we use keratome. In fig : B we use LASER

b) In fig A central cornea is spare, incision given in peripheral cornea.

• But in LASIK we treat the central 4 to 5 mm of the cornea

Answer

Q=3)Which procedure can correct astigmatism more?

LASIK

Q=4) Write 2 other treatment option for this condition

A)Spectacle

B) Contact lens

Q=5. Write two common adverse effect of procedure B. which can be corrected within 3 to 6 months

Dry eye

Halos around the light

OSPE: 2

Scenario of a systemic disease:

Sarcoidosis

Question

It is an idiopathic multisystem disorder Characterised by non-

caseating granulomata. More common in women 20-50 yrs

More common in blacks and Asians

Answer the following question:

Q=1. What is the name of the disease?

Q=2. Name the 3 major organs it affected.

Q=3.Write 2 anterior segment finding

Q=4. Write 3 posterior segment findings

Answer

Answer: 1 SARCOIDOSIS

Answer: 2

Lung

Skin

Eye.

Answer: 3

Any two

Conjunctival granuloma

Lacrimal gland involvement/dry eye

Acute or chronic uveitis

Answer

Answer: 4

i. Periphlebitis

ii. Choroidal infiltrates

iii. Multifocal Choroiditis

iv. Retinal granuloma

v. Peripheral retinal neovascularization

vi. Optic nerve involvement.

OSPE: 3

Amniotic Membrane

Question

Supplied sample is oven dried amniotic membrane

Answer the following questions

1) From where it was collected

2) How it was collected?

3) How it was sterilized?

4) In which temperature it is preserved?

5) Mention 4 important properties?

6) Enumerate 2 important ophthalmic uses?

Answer

1. From human placenta.

2. Elective C/S

3. Gamma radiation

4. 4 to 8 degree centigrade temperature.

5.

Anti inflammatory

Anti fibroblastic

Anti angiogenesis

Acts as an scalped for epithelization

Answer

• 6) Any two

a) Chemical injury of the cornea.

b) Persistent epithelial defect

c) Symblepharon release & fornix reconstruction

d) Excision of pterygium with AMT

OSPE: 4

Procedure

Question

• Make fortified Gentamycin eye drop for bacterial

corneal ulcer with the supplied materials.

• (Gentamycin eye drop, 10 cc syringe, inj gentamycin,

Signature pen, Micropore)

• Check list:

• Wearing gloves (Done)_(Not Done)

• Draw 5 ml gentamycin and discard __(Done) (Not Done)

• Mixed the whole ing gentamycin into the vial (Done) (Not

Done)

• Leveling of the vial_________ (Done) ____ (Not Done)

Answer

Marks Distribution:

• Wearing gloves _________________________2

• Draw 5 ml gentamycin and discard ______________ 3

• Mixed the whole ing gentamycin into the vial ______3

• Leveling of the vial___________________________ 2

OSPE: 5

Optics: Contact lens

Question

An aphakic patient who wears 8.6/13.5/+10.00 soft contact lenses consulted you for a pair of back up glasses.

Q: 1) What do the numbers mean?

8.6________________________

13.5________________________

10.00 ________________________

Q: 2) What is the spectacle power required if the vertex distance is 10 mm?

Q:3) What problems can occur with aphakic spectacle? Mention 4

Answer

Q: 1)

8.6 = base curve. 13.5 = diameter . 10.00 = lens power

Q: 2) 9.09 D

Q: 3) Any 4

Ring scotoma .

Pincushion effect.

excessive magnification.

altered depth perception.

weight of the glasses

OSPE: 6

Optics: Retinoscopy

Retinoscopic finding

Question

• a) Convert them into spectacle forms with minus cylinder

notation (assuming that you performed the retinoscopy at a

working distance of 67 cm from the patient).

• b) Convert them into spectacle forms with positive cylinder

notation (assuming that your consultant had an elbow injury

and can only achieved a working distance of 50cm from the

patient)

Answer

a. The power crosses translate to spherocylindrical corrections

(with minus cylinder) of

RE +1.50 / - 4.00 X 135

LE -0.75 / -1.25 X 90

As the working distance is 2/3 meter, -1.50 D is subtracted from the above

giving

RE PL / -4.00 X 135

LE -2.25 / -1.25 X 90

Answer

b. The power crosses translate to spherocylindrical corrections

(with positive cylinder) of

RE -2.50 / +4.00 X 45

LE -2.00 / +1.25 X 180

As the working distance is now 1/2 meter, -2.00D is subtracted from the

above

RE -4.50 / +4.00 X 45

LE -4.00 / +1.25 X 180

OSPE:7

Glaucoma: Optic disc

Question

Q no 1 What are the disc findings present here? Mention 3

Q no 2 Write 3 the provisional diagnosis depend upon

findings.

Q no 3 Write the name of 4 investigations for clinical

diagnosis.

Answer

Answer no 1 Any 3

a) Increase CDR, b) Narrow Neuro Retinal Rim (NRR)

c) Peri Papillary Atrophy (PPA), d) Vascular signs

Answer no 2

Suspicious disc.

Physiological cup.

Glaucomatous cupping

Answer no 3 (any 4)

IOP.

CCT.

VF.

OCT.

HRT

OSPE: 8

History Taking

Question

• This 40 - yr male suffering from double

vision. Please take the relevant history.

1) Greetings & self introduction

2) Whether double vision is monocular or binocular.

3) Direction of double vision: whether the diplopia is

horizontal, vertical or torsional.

4) Ask the patient in which direction of gaze the diplopia is

worse→ right, left, up, down, right and up, right and down,

left and up, left and down, or distance or near.

5) Ask for diurnal variability and fatigability of diplopia

6) Detailed history about :

mode of onset,

duration of onset,

associated pain,

history of strabismus in childhood,

history of trauma,

neurological symptoms such as dysphagia or weakness,

7) Underlying systemic illness:

hypertension,

diabetes,

cerebrovascular disease,

cardiac atherosclerotic disease

multiple sclerosis.

8) History of smoking or alcohol intake should be elicited.

9) Thank’s

OSPE: 9

Counseling

Question

• Counsel this pregnant lady about the

management who has severe NPDR in her R/E

and high risk PDR in her L/E

1) Greetings Done Not Done

2) Explanation about the disease Done Not

3) Information regarding Management

3a) Strict control of blood glucose, BP, renal

function, anaemia

Done Not done

3b) Mention the modalities of Rx of DR Done Not done

3c) Limitations of anti VEGF in pregnancy Done Not done

3d) Both eye should be treated with PRP Done Not Done

3e) Mode of delivery must be elective

Caesarian section

Done Not done

3f) Inform about adverse effect and cost Done Not done

4) Feedback from the patient Done Not done

5) Thank’s Done Not done

OSPE: 10

VIDEO CLIP

Question

1) What is the name of the surgery?

2) What is the name of the step?

3) Name the instrument which has been entered into the eyeball?

4) This step can be performed by another instrument. Mention it.

5) In addition to BSS, Mention 2 liquid substances have entered

into the eye.

6) Mention one common complication during this step.

7) What is the next step (not shown in the video)

Answer

Phacoemulsification with PC IOL _ =1+1

Continuous Curvilinear Capsulorhexis

_0.5+0.5+1.0=2

Rexis forcep =1

Cystitome =1

Viscoelastic substance & bluerex 1 + 1=2

Radial tear = 1.5

Hydrodessection & Hydrodeleanation__1+0.5=1.5