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OSPE: 1Cornea: Refractive SurgeryOSPE 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 BANGLADESHTHERE 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.

dranisurar@yahoo.comanjumk38dmc@gmail.com01711-832397OSPE: 1Cornea: Refractive Surgery

QuestionWhat two procedures are carried out in fig A & fig BWrite 2 difference between these two procedureWhich procedure can correct astigmatism more?Write 2 other treatment option for this conditionWrite two common adverse effect of procedure B. which can be corrected within 3 to 6 months

Answer1.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 corneaAnswerQ=3)Which procedure can correct astigmatism more? LASIKQ=4) Write 2 other treatment option for this conditionA)Spectacle B) Contact lens Q=5. Write two common adverse effect of procedure B. which can be corrected within 3 to 6 monthsDry eye Halos around the light

OSPE: 2Scenario of a systemic disease: SarcoidosisQuestion It is an idiopathic multisystem disorder Characterised by non-caseating granulomata. More common in women 20-50 yrs More common in blacks and AsiansAnswer 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 findingQ=4. Write 3 posterior segment findings

AnswerAnswer: 1 SARCOIDOSIS Answer: 2LungSkinEye.Answer: 3Any twoConjunctival granulomaLacrimal gland involvement/dry eyeAcute or chronic uveitis AnswerAnswer: 4 PeriphlebitisChoroidal infiltratesMultifocal ChoroiditisRetinal granulomaPeripheral retinal neovascularizationOptic nerve involvement.

OSPE: 3Amniotic MembraneQuestionSupplied sample is oven dried amniotic membrane Answer the following questionsFrom where it was collectedHow it was collected?How it was sterilized?In which temperature it is preserved?Mention 4 important properties?Enumerate 2 important ophthalmic uses?

Answer1. From human placenta.2. Elective C/S 3. Gamma radiation4. 4 to 8 degree centigrade temperature.5.Anti inflammatory Anti fibroblastic Anti angiogenesis Acts as an scalped for epithelization

Answer6) Any twoa) Chemical injury of the cornea.b) Persistent epithelial defectc) Symblepharon release & fornix reconstructiond) Excision of pterygium with AMT

OSPE: 4ProcedureQuestionMake 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)

AnswerMarks Distribution:Wearing gloves _________________________2Draw 5 ml gentamycin and discard ______________ 3Mixed the whole ing gentamycin into the vial ______3Leveling of the vial___________________________ 2

OSPE: 5Optics: Contact lensQuestionAn 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

AnswerQ: 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: 6Optics: Retinoscopy

Retinoscopic findingQuestiona) Convert them into spectacle forms with minus cylinder notation (assuming that you performed the retinoscopy at a workingdistance 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 achieveda working distance of 50cm from the patient)

AnswerThe 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 90Answerb. 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 180OSPE:7Glaucoma: Optic disc

QuestionQ 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.AnswerAnswer no 1 Any 3 a) Increase CDR, b) Narrow Neuro Retinal Rim (NRR) c) Peri Papillary Atrophy (PPA), d) Vascular signsAnswer no 2 Suspicious disc.Physiological cup.Glaucomatous cuppingAnswer no 3 (any 4) IOP.CCT.VF.OCT.HRT

OSPE: 8History TakingQuestionThis 40 - yr male suffering from double vision. Please take the relevant history.

Greetings & self introductionWhether double vision is monocular or binocular.Direction of double vision: whether the diplopia is horizontal, vertical or torsional.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.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) Thanks

OSPE: 9CounselingQuestionCounsel this pregnant lady about the management who has severe NPDR in her R/E and high risk PDR in her L/E

1) GreetingsDoneNot Done2) Explanation about the diseaseDoneNot3) Information regarding Management3a) Strict control of blood glucose, BP, renal function, anaemiaDoneNot done3b) Mention the modalities of Rx of DRDoneNot done3c) Limitations of anti VEGF in pregnancyDoneNot done3d) Both eye should be treated with PRP

DoneNot Done3e) Mode of delivery must be elective Caesarian sectionDoneNot done3f) Inform about adverse effect and cost DoneNot done4) Feedback from the patientDoneNot done5) ThanksDoneNot doneOSPE: 10VIDEO CLIP

QuestionWhat is the name of the surgery?What is the name of the step?Name the instrument which has been entered into the eyeball?This step can be performed by another instrument. Mention it.In addition to BSS, Mention 2 liquid substances have entered into the eye.Mention one common complication during this step.What is the next step (not shown in the video)AnswerPhacoemulsification with PC IOL _ =1+1Continuous Curvilinear Capsulorhexis _0.5+0.5+1.0=2Rexis forcep =1Cystitome =1Viscoelastic substance & bluerex 1 + 1=2Radial tear = 1.5Hydrodessection & Hydrodeleanation__1+0.5=1.5