Ophthalmology - OSCE questions

Question 1

Diabetic retinopathy - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 1

1. Symptoms of condition
   - Usually asymptomatic
2. Fundoscope appearance
   - Haemorrhages
   - Microaneurysms
   - Hard exudates
   - Cotton wool spots
   - Venous beading
   - Neovascularisation (if proliferative)
3. Treatment options
   - Optimise diabetes control
   - Pan-retinal photocoagulation
   - Focal photocoagulation if macular

Question 2

Retinal vein occlusion - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 2

1. Symptoms of condition
   - Sudden PAINLESS loss of vision (whole or part)
2. Fundoscope appearance
   - ‘Stormy sunset’
   - Optic disc oedema
   - Tortuous dilated vessels
3. Treatment options
   - No specific treatment
   - Photocoagulation for neovascularisation

Question 3

Retinal artery occlusion - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 3

1. Symptoms of condition
   - Sudden PAINLESS loss of vision (whole or part)
2. Fundoscope appearance
   - ‘Cherry red spot’ with pale macula
3. Treatment options
   - Reduce intraocular pressure within 6 hours

Question 4

Retinal detachment - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 4

1. Symptoms of condition
   4 F’s
   - Flashers
   - Floaters
   - Fall in acuity
   - Field loss
   + curtain falling over vision
2. Fundoscope appearance
   - Wallpaper falling forward (grey retina, ballooning forwards)
3. Treatment options
   - Surgical vitrectomy / scleral buckle surgery
   - Laser retinoplexy to secure the rip

Question 5

Vitreous haemorrhage - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 5

1. Symptoms of condition
   - Sudden painful loss of vision / haze
   - Loss of red light reflex
2. Fundoscope appearance
   - Impossible to visualise retina
3. Treatment options
   - Treat underlying causes e.g. diabetic retinopathy, retinal detachment

Question 6

Retina pigmentosa - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 6

1. Symptoms of condition
   - Deterioration visual acuity, particularly at night
   - Tunnel vision
2. Fundoscope appearance
   - Spicule-shaped pigment
   - Vessel narrowing
   - Waxy pallor of disc
3. Treatment options
   - Symptom management
   - Counselling / support
   - Genetic counselling

Question 7

Severe hypertensive retinopathy - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 7

1. Symptoms of condition
   - Usually asymptomatic
2. Fundoscope appearance
   - Haemorrhages
   - Hard exudates
   - Cotton wool spots
   - Papilloedema
3. Treatment options
   - Treat underlying hypertension

Question 8

Age-related macular degeneration - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 8

1. Symptoms of condition
   - Gradual loss of central vision
2. Fundoscope appearance
   - Drusen (white/yellow deposits)
   - Haemorrhages & retinal oedema in wet AMD
3. Treatment options
   Dry
   - No treatment
   - Stop smoking
   - Antioxidants
   Wet
   - Anti-VEGF intravitreal injections

Question 9

Optic neuritis - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 9

1. Symptoms of condition
   - Reduced visual acuity
   - Enlargement of blind spot (scotoma)
   - RAPD
2. Fundoscope appearance
   - Unilateral swollen optic disc
3. Treatment options
   - If caused by MS, Methylprednisolone

Question 10

Papilloedema - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 10

1. Symptoms of condition
   - Other signs of raised ICP e.g. headache, double vision
2. Fundoscope appearance
   - BILATERAL swollen discs
3. Treatment options
   - Treat underlying cause of raised ICP

Question 11

Acute (closed angle) glaucoma - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 11

1. Symptoms of condition
   - Painful red eye
   - Reduced visual acuity / halos
   - Mid-dilated irregular pupil
2. Fundoscope appearance
   - Ciliary flush
3. Treatment options
   - Acetolazide (oral/IV)
   - Alpha agonists
   - Beta blockers
   - Laser iridotomy

Question 12

Chronic (open angle) glaucoma - state the following:
1. Symptoms of condition
2. Fundoscope appearance
3. Treatment options

Answer 12

1. Symptoms of condition
   - Usually asymptomatic until vision severely impaired
2. Fundoscope appearance
   - Optic disc cupping
   - Optic disc atropy
3. Treatment options
   - Alpha agonist eye drops
   - Beta blocker eye drops
   - Carbonic anhydrase inhibitor eye drops
   - Prostaglandins
   - Laser trabeculoplasty (2nd line)