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OCANZ Written Exam | 100% Correct
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What is Stargardt disease - ✔✔is the most common form of inherited juvenile macular degeneration. Wife calls requesting details on husbands eye test. Do you: get verbal consent, refuse call, get written consent - ✔✔get written consent Diabetic recently diagnosed unstable. Refraction reveals significant myopic shift compared to last visit 12 months ago. Which is the most appropriate course of action: a/ prescribe specs & report to GP b/ Refer to Ophthalmologist, c/ Discuss findings with GP before prescribing Rx, d/ Obtain info on current blood glucose levels - ✔✔c/ Discuss findings with GP before prescribing Rx, The main cause of amblyopia in a child: anisometropia >2, accommodative eso, intermittent exo - ✔✔anisometropia >2, Which of the following can match Illuminant c: Incandescent, Halogen, Flourescent, sodium - ✔✔Fluorescent 25 years old enquiring her suitability for laser refractive surgery. Which of the following is NOT essential pre-operatively: a/ Tonometry, b/ Tear film stability c/ pupil size, d/ Gonio - ✔✔d/ Gonio
What is Kolleners rule in relation to colour vision? - ✔✔outer retinal diseases and media changes result in blue-yellow color defects inner retina, optic nerve, visual pathway, and visual cortex will result in red-green defects. (increased susceptibility of S-cones and rods to ischaemia and oxidative damage, although S-cone loss is more noticeable due to their lower density and their higher metabolic rate) (Kollners rule, retinal disease will give a blue yellow defect and optic nerve disease will give a red green defect but the exceptions are glaucoma which will give a blue yellow defect and central cone degeneration which will give a red green defect) Which causes a red defect- red cap test: optic neuritis, Amd - ✔✔Optic neuritis Lissamine green; what does it stain? - ✔✔Lissamine green stains dead and degenerate cells, yet does not stain healthy epithelial cells. (NaFl permeates into the intercellular space associated with any epithelial cellular disruption) Is gonio indicated with Hyphaema? - ✔✔no What is prenticies rule? - ✔✔P (prism dioptres =c (decentration in cm) x F(power of lens in dioptres) What is the most preventable cause of AMD? - ✔✔Smoking 15 years old attends eye examination, best Va's R6/6, L 6/24 (told ambloypic). Which occuptation should he NOT pursue: a/ Train driver, B/ construction worker, c/ Electrician, d/ Dentist - ✔✔a/ Train driver
evaluating visual acuity, pupils (looking for a relative afferent defect), intraocular pressures, anterior segment examination, motility examination (looking for ocular misalignment and/or evidence of cranial neuropathies), and a dilated fundus examination (evaluating for signs of optic nerve or retinal ischemia) Visual fields testing ESR (erythrocyte sedimentation rate), high then indicated inflamation CRP (C reactive protein) - produced by liver with inflamation platelets temporal artery biopsy prog good if no CRAO or AAION, better prognosis the sooenr steroids are started Patient burnt with laser. Management - ✔✔NSAID or Anti VEGF depending on severity Name of drops post cataract and percentages post op. - ✔✔Different ophthals do different things. Ideally you want an antibiotic eg chloramphenicol for 1 month qid and a steroid eg maxidex for 1 month qid start tapering after 1 week ie 4 then 3 then 2 then 1 drop then an NSAID eg voltaren bid for a month Visual fields: inferior nasal step, what other defects cause this effect, management. - ✔✔Glaucaom or disc druse, if arcuate consider BRVO Tree branch hit the patient in the eye, diagnosed as RCE which is failing to heal and is uncomfortable. What to do? (Bandage contact lens, debridement and 2 others) - ✔✔Punctal occlusion>bandage contact lens> Patient with a prescription of +4.50, PD of 60mm, seg height of 20mm each eye. Spectacles arrive from the lab with optical centers cut at 62mm and a seg height in the right eye of 21mm. What would be the prismatic effect and in what direction? - ✔✔ How many times a day would you dose a prostaglandin for glaucoma? (One a day, twice a day, three times a day or four times a day) - ✔✔od
Tear film calculation. Given a contact lens (RGP) of - 2.00D, the patient needs - 3.50D, the over-refraction is - 0.50D. What is the fit? - ✔✔0.2 too flat? Same contact lens as above in question as above, What would you order if the BC is 7.5mm and the over- refraction is - 0.50D? - ✔✔ What is the most contagious condition of the conditions listed below? (Adenovirus, chlamydia and two others) - ✔✔Adenovirus Given a monovision presbyope of +5.00D (OU). The patient wants to be able to see the computer at 67cm, what would the contact lens script be for this patient? - ✔✔+6.50 one eye How do you manage convergence excess, accomodative spasm? - ✔✔Issue plus RX vision therapy, dot card Leukocoria is one sign of retinoblastoma in children, what is the next most indicative sign? (Strabismus, cataract and two others) - ✔✔Strabismus An 85 year old patient wants to see the TV better, this patient has ARMD, what would you advise? (Move 2x closer to the TV, move 2x further away from the TV, 2x telescope or 2x reverse telescope) - ✔✔Move 2x closer to the TV Which low vision device offers the largest working distance? (Microscope, hand held telescope, stand magnifier or telemicroscope) - ✔✔hand held telescope Treatment for pseudomonas? - ✔✔ Which is the following occurs due to the normal ageing process of the eye? (ILM thinning, ILM thickening, cell loss in the retina, cell proliferation) - ✔✔
Which of the following is a dry eye sign? Hyperosmolarity, lysozyme decrease - ✔✔Hyperosmorality What can tear film hyperosmorality cause? - ✔✔hyperosmolarity can induce tear film instability by modifying the interaction between tear film lipids and proteins, damaging the epithelial cell membranes, triggering inflammation, and stimulating corneal nerves Who is most appropriate to refer a px with a conjunctival lymphoid tumour to Ophthalmologist Oncologist Haematologist GP - ✔✔ophthalmologist What is Hutchinson's sign and what is it a sign of? - ✔✔nasociliary skin lesions for ocular inflammation and corneal sensory denervation in acute herpes zoster ophthalmicus. Pressures of 22mmHg in each eye, what else is needed in order to manage the patient? (Pachymetry, gonioscopy, visual fields and OCT) - ✔✔Pachymetry One pupil (OD) bigger than the other, what is wrong? (Sympathetic pathway of OD, sympathetic pathway of OS, parasympathetic pathway of OD and parasympathetic pathway of OS) - ✔✔one or both pupils to be abnormally dilated with delayed constriction disorder of the parasympathetic nervous system innervation to the iris sphincter and ciliary muscle Causes include viral infection, trauma, vasospasm due to migraine, ocular surgery, tumors, and possibly chronic cough Hypersensitivity to pilocarpine What is the most common cause of proptosis? - ✔✔Graves disease
- What is the biggest complication of thyroid eye disease? - ✔✔Exposure keratitis In which patient is diabetic retinopathy more common? (Type 1 for 4 years, type 2 non-insulin for 4 years, type 2 insulin defendant for 10 years and one other? - ✔✔ All the following cause vortex keratopathy except for? (Wilsons disease, chloroquine, fabry's disease and amiodarone) - ✔✔ What is Fabrys disease? - ✔✔Fabry disease is a lysosomal enzyme (alpha-galactosidase A) deficienc causing Cornea verticillata, the most typical ocular sign in Fabry disease What is Wilsons disease? - ✔✔Wilson's disease is a genetic disorder in which copper builds up in the body and cause fleichers ring Which would be the most common cause of amblyopia? (Accommodative eso, alternating eso, anisometropia of more than 2D and one other) - ✔✔anisometropia
- Which colour vision test determines the type and severity? - ✔✔Farnsworth Munsell Fm Signs of primary open angle glaucoma - ✔✔IOP High cup:disc ratio Cup:disc ratio asymmetry between eyes (usually considered significant if greater than 0.2) Vertical elongation of cup Focal neuro-retinal rim thinning or notching Vessel bayonetingBeta-zone peripapillary atrophy Disc hemorrhage 6 week post cataract op, visual acuity has decreased. What could the cause be? - ✔✔CMO
What is your diagnosis, what are the differential diagnoses and how would you manage this condition? - ✔✔GPC Infectious conjunctivitis Blepharitis Dry Eyes Syndrome Toxic conjunctivitis Ocular rosacea Keratitis Episcleritis/scleritis Angle Closure glaucoma Phlyctenular conjunctivitis improve lens hygeine Increase lens replacement frequency DD if possible Reduce modulus of lens material (Swap to hydrogel lens, be aware more difficult to handle) Manage lid margin disease If sever - topical Mast cell stabalisers
- Patient presents for a cataract check up. Cataracts were notes 12 months ago. The prescription is now 2D more minus and cataracts were observed using a slitlamp. Visual acuities are 6/12 (OD) and 6/9 (OS) with the new prescription. What would you consider when referring to an ophthalmologist, what type of cataract is this according to the history given, explain cataract surgery in lay mans terms, what are the post surgical complications to look out for? - ✔✔Cataract Cause of visual complaint Compramising Lifestyle Driver Anisometropia Visual Acuity
Other Ocular Pathology General Health and Medications Patient wants to have operation Year old with high plus anisometropia. Explain 5 reasons why contact lenses are a better option than spectacles. In spectacles - RE +0.50DS LE +7.50DS in contact lenses RE +1.00DS LE +9.00DS - ✔✔1. cosmesis/comfort/weight
- spectacle magnification
- field of view (no ring scotoma)
- Less convergence needed in contact lenses (opposite of myope) 5 Less accomodation neeed in contact lenses ((opposite of myope))
- Picture of an eye with blepharitis (collorettes along the lashes and mucous discharge). What would you diagnose, give differential diagnoses, what is the general cause of this condition and what is the management of this condition? - ✔✔Lid hygiene Warm compresses avoidance of cosmetics, especially eye liner and mascara Weak evidence to suggest antibacterials help. DD- conjunctivitus's, eyelid traumas Given a visual field plot indicating a left temporal quadrantic defect. Asked whether the test was reliable or not, asked what the scientific name for the defect would be, name 2 conditions that would cause this type of defect, management of these conditions? - ✔✔left superior homonymous quadrantanoipa indicating legion in optical radiations (meyers loop) Female presents with a dilated pupil (OD) which doesn't respond to direct or consensual pupil tests. The deep tendon reflex is also absent. What pupil abnormality would you diagnose, give differential diagnoses, what additional tests would you want to perform to confirm the diagnosis. - ✔✔one or both pupils to be abnormally dilated with delayed constriction
c)What caused this to occur? d)What is your management? - ✔✔Recurrent Bacterial Conjunctivitis DD - epidemic keratoconjunctivitis (e.g. adenovirus) Herpes (simplex or zoster) Chlamydial infection, allergy Contamination of the conjunctival surface with bacteria Bleph Bathing lids and lid hygiene Low evidence to suggest antibacterials can help. If corneal involvement or no resolution refer to ophthalmology.
- Photo of bilateral swollen discs a) What is it? b) What tests would you do? c) What is your management? looked like papilloedema - ✔✔Visual fields Pupils Colour Vision Motility Stereo Disc images Primary concern Papilloedema due to raised intercranial pressure, caused by sub arachnoid haemorrhage or space occupying legion, Refer emergency HES tests - Urgent neuro imaging (MRI CT) and CBC count, blood sugar, angiotensin-converting enzyme, erythrocyte sedimentation rate
24year old male with reduced VA in LE to 6/24 and RE 6/6. there is pain behind LE and disc appears slightly hyperaemic. a) What is your diagnosis? b) What tests would you do? c) What is your management? I thought it was Optic neuritis - ✔✔a - optic neuritis b - RAPD?, Colour vision, VF, Motility, contrast c - Refer urgent to Ophthalmolgy for MRI and MS investigations ON more likely in males 3:2, 20 to 40 yo RGP lens with bubbles centrally and pooling and peripheral bubbles. Appears large diameter and lid attached. What is wrong and what would you change? patient has 7.40/-4.00/10. over refraction is - 0.75DS Write new order for RGP - ✔✔ Patient is a pilot, VA is 6/6 and 6/9 do they meet standards? a) What tests you do to determine is patient is pass or fail? b) What visual field test required if fails Ishihara? - ✔✔6/9 corrected, 6/6 or better when tested with both eyes, no greater than +/-5D, N5 with correction, N14 without correction OCcupational lantern test. What does BRÜCKNER TEST allow? and how is it done? - ✔✔Early detection of amblyopia in very young children that is not possible to perform other tests on. Looking at the difference in retinal transillumination using a direct ophthalmosocope at a distance ~0.5m Describe Hirchberg Test - ✔✔using pupil reflexes to determine if strabismus is present
C showing an abnormal finding on their file to a practitioner outside of the clinic/store - ✔✔???? What is the leading cause of blindness in Australia A cataract B DR C ARMD D RP - ✔✔ARMD Which part of the optic nerve is thinnest A temporal B superior C inferior D nasal - ✔✔Temporal Recent onset of Diplopia suspected 4th nerve palsy. Action required Immediate referral to ophthalmologist Treat with prism Review in 1 month Refer for squint surgery - ✔✔Immediate referral to ophthalmologist 4th nerve (trochlear)- superior oblique
- Slight Diplopia on R lateral gaze and restriction of RE looking temporally. Which nerve is affected? II VII VI III - ✔✔VI
What is most likely in children Astigmatism is likely to increase over 3yrs Moves to against astigmatism with development Is likely to have oblique axis Astigmatism reduces in children over 3 - ✔✔ Optic disc pathology is most likely to cause colour vision problems with Red green Blue yellow Atypical - ✔✔Red/Green Type 2 D15 colour vision does the following Classifies type and severity of congenital types Classifies type and not severity of congenital type - ✔✔Classifies type and not severity of congenital type Corneal brown swirl like deposits noted what is least likely to be cause Amiodarone Fabrys Wilsons Chloroquine - ✔✔Chloroquine If px is non-responsive to cold compress with allergic conjunctivitis what is next option? Chloramphenicol Antihistamine Antiviral - ✔✔Anti histamine What is with the rule astigmatism - ✔✔When the steepers meridian is vertical - the minus cyl axis is @180 degrees
