ospe 25 march 2017
TRANSCRIPT
Objective Structured Practical Examination
Dr Md Anisur Rahman (Anjum)Professor & Head of the Department
Dhaka Medical College. Dhaka
OSPE: 1
Rapidly progressive unilateral proptosis is
usual, Average age of onset is 7 years. The
tumour is derived from undifferentiated
mesenchymal cells. Various genetic
predispositions have been identified, including
variants of the RB1 gene.
Question
1) What is the probable diagnosis?
2) What is the most common site in the orbit?
3) Which type is the worse prognosis?
4) Which is the most confirmatory diagnosis?
Answer
1) Rhabdomyosarcoma
2) Most commonly superonasal or superior orbit
3) Alveolar
4) Incisional biopsy followed by histopathology
• Kanski 8th edition p 109
OSPE: 2
Do the Schirmer test 2 & write down your
interpretation
1) Excess tears are delicately dried. If topical
anaesthesia is applied the excess should be
removed from the inferior fornix with filter
paper.
2) The filter paper is folded 5 mm from one end
and inserted at the junction of the middle and
outer third of the lower lid, taking care not to
touch the cornea or lashes.
3) The patient is asked to keep the eyes gently
closed.
4) After 5 minutes the filter paper is removed
and the amount of wetting from the fold
measured.
Interpretation: Less than 10 mm of wetting
after 5 minutes without anaesthesia or less
than 6 mm with anaesthesia is considered
abnormal.
• Kanski 8th edition p 124
OSPE 3
A patient came to you with corneal opacity.
What history should you take from that patient
mention with explanation for the relevant
histories?
Answer
• History of onset: Age of onset. If early onset
best possible treatment could not help
satisfactorily because of amblyopia
• History of trauma: If so, there may be cataract,
retain foreign body in presence trauma. And B-
Scan should be done before surgery
• H/O Associated pain, redness, watering,
discharge to exclude any corneal ulcer,
aphakic/pseudophakic bullous keratopathy
• H/O past surgeries
• H/O associated frequent change of glass
keratoconus
• H/O associated systemic problem
Hyperlipidaemia/Hypercalcemia
• Sankara Nethralaya 124
OSPE: 4. History taking R.P
1) Age of onset of symptoms.
2) Duration of night blindness.
3) Duration of progressive loss of visual field.
4) Duration of dimness of vision . Is it
progressive?
5) Family history of R.P.Wednesday, February 05, 2014 [email protected]
6) H/O consanguinity.
7) H/O trauma.
8) H/O drug intake.
9) H/O hearing disorder, ataxia, nystagmus.
10)H/O mental retardation.
History taking R.P
11)H/O heart disease.
12)H/O hypogenitalism, obesity, polydactyly.
13)H/O diarrhea, skeletal deformity.
Wednesday, February 05, 2014 [email protected]
17
OSPE=5
Q: History taking of a patient suffering from
recurrent uveitis
A: Following points to be noted during history
taking:
19 FEB 2014 [email protected]
1) PATIENT DETAILS:
1) Age: Juvenile rheumatoid arthritis (JRA) is
common in patients less than 15 years.
2) Sex: JRA is common in females, HLA – B 27
associated uveitis in males. (but during
history taking you should not asked about
gender)
2) OCULAR HISTORY:
Is the disease unilateral or bilateral ?When was the first attack?When was the last/current attack?What was the approximate frequency of the
attacks between the first and the last attack?Details of prior ocular treatment.Any previous history of rise IOP or use any
antiglaucoma agents.
19 FEB 2014
3) SYSTEMIC HISTORY:
H/O arthritis or low backache (JRA, HLA –B27
related uveitis).
H/O fever or respiratory symptoms, gastro-
intestinal, neurological symptoms, genital
lesions.
H/O DM, HTN, TB.19 FEB 2014
H/O exposure/ IV drug abuse/ blood
transfusions.
H/O skin lesions (HZO, Psoriasis)
Details of prior systemic treatment.
OSPE: 6
When performing cycloplegic retinoscopy on an
anxious 7-year-old boy, you notice that the
central reflex shows with movement while the
peripheral reflex shows against movement.
Question
1) What is the most likely physiological cause?
2) Why there are different central and peripheral
reflexes?
3) If it is physiological how will you overcome of
it?
4) What is the most likely pathological cause?
Answer
1) Spherical aberration
2) The periphery of the human lens is more curved than
the center, so the incoming light rays show increased
refraction compared with the light rays that strike the
central lens. In retinoscopy, this can result in the
appearance of different central and peripheral
reflexes.
Answer
3) Concentrate on the central light reflex when
performing retinoscopy.
4) Keratoconus
• (AAO Vol 3 p 207)
OSPE: 7
• You are planning cataract surgery to achieve
emmetropia for a patient with the following
measurements:
• Refraction: -3.00 +2.00 x 120
• K: 42.50 D/42.75 D @ 120deg
Question
1) Which IOL will you prefer to achieve
emmetropia?
2) Give one reason in favour of your IOL choice
3) What are the options to correct astigmatism
during cataract surgery? Mention 2
Answer
1) Mono focal2) The astigmatism is due to cataractous lens3) .a) toric lens implants b) relaxing incisions
OSPE: 8
Motivate a person for eye donation
1 Greetings2 Eye donation is donating one’s eye after his/her
death3 Only corneal blind people are benefited from
donated eye4 Anyone can donate eyes irrespective of
•Age•Gender•Blood group
5 The cornea should be removed as early as possible after death (6 hr)
6 Eyes of donated person can save vision of 2
corneal blind person
7 Donated eye is not for sale
8 Help regarding registration eye donor
9 The donor name will be remembered with respect
by the recipient and their family forever
10 Thank’s
OSPE: 9
A 60 years old male patient having uneventful
phacoemulsification with PC- IOL
implantation under topical anesthesia in his
right eye. Prepare a discharge certificate for
the patient.
Identification of the patient
NameAge 0.50Gender 0.25Address 0.50Mobile no 0.25
Operation Note
Date & time 0.50Name of surgery 0.50Name of anesthesia 0.50Name of surgeon 0.50
Post operative findings
Visual acuity 1.00Anterior segment 1.00Posterior segment 0.50
Post operative treatment
Topical antibiotic 0.50Topical steroid 0.50
Advice No water to eye 0.25Use dark glass 0.25Regular use of medicine 0.25Any problem come to doctor 0.25Follow up 0.25
Identification of certificate preparatory
Signature with date 0.50Name of the doctor with designation
0.50
Seal of the department 0.50
OSPE: 10
A 45 years school teacher having – 2.50
diopter myopia in both eyes and using the
same specs for last 20 years comfortably. Now
come to you for difficulties in reading. Do
retinoscopy at 2/3rd meter & give specs.
01 Greetings02 Visual acuity Unaided
Pin holeWith existing specs
03 Setting trial frame
04 Occlude one eye05 Check
retinoscope
06 Retinoscopy with – 1.00 DS lens
Subjective test
6.a Horizontal meridian 6.b Vertical meridian7.1 Distance with – 2.50 DS
7.2 Near with add + 1.50 DS
08 Ocular motility09 Pupillary reaction10 Proper replacing of
used instruments11 Thank’s
07
OSPE: 11
• A patient of 70 year came to you with ARC (B/E)
R>L for surgery. He came with some medicine which
he is taking for last 5 to 7 years for his different
systemic diseases. You found the medicine are
Metformin 500 twice daily and an adrenergic
antagonists 0.8mg once daily.
QUESTION• A) Now what precaution (preoperative) should you
take for cataract surgery?
• B) What complication may arise during surgery?
• C) How will you overcome of it?
A) What precaution (preoperative) should you take for
cataract surgery?
• a).Control DM
• b) Maximum dilatation of the pupil as far as can even
with atropine 1% eye drop
• B) What complication may arise during surgery?
a) Pupil may constrict during cataract surgery.
b) The iris may billow and prolapsed through the
incision.
c) The risk of capsule rupture and vitreous loss is
increased.
C) How will you overcome of it?
Strategies for management include the
a) Use of Healon 5,
b) preoperative pupillary dilatation with atropine,
c) intracameral epinephrine,
d) iris hooks, and
e) low aspiration flow rates.
OSPE: 12
What is the use of this spectacle?
Ptosis props which are used to lift droopy eyelid
OSPE: 13
A B C
QUESTION
a i. How far should the Amsler's chart be placed in
front of the patients?
ii. How many degree(s) does each square subtend in
the macula when placed in the recommended
position?
• b.
i. What is the advantage of chart b over chart a?
ii. What is the advantage of chart c over chart a?
ANSWER
a)
i. The chart is placed 30 cm from the patient
ii. 1 degree
b)
• Chart b contains two diagonal lines, that cross at the
central black point. In patient who can not see the
black spot because of central scotoma, the lines help
to maintain fixation and allows the patient to outline
the limits of scotoma.
• The red lines on a black background in chart c is
useful for patient with neuro-logical disorder such as
optic nerve or chiasmal lesion or toxic amblyopia
OSPE: 14
H/O DOUBLE VISION
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) Thank’s to patient
OSPE: 15For the detection of ROP you have to dilate the pupil
of pre mature infant with 2.5% Phenylephrine and
0.75% Tropicamide, but which is commercially not
available
Prepare above concentration with the supplied
materials
CHECK LIST
1) Discard 2 ml from the tropicamide
2) Take 1 ml from phenylephrine
3) Mix the phenylephrine with tropicamide
4) Discard disposals
MARK DISTRIBUTION
Discard 2 ml from the tropicamide--------------------3.0
• Take 1 ml from phenylephrine----------------------3.0
• Mix the phenylephrine with tropicamide-----------3.0
• Discard disposals--------------------------------------1.0