Examiners Report: S2009 Semester 2 RACE OSCE

Station No

Examiners Comment
Retinoscopy of one eye in a patient with +4.0/+1.0 x 90 correction. Candidates asked to provide the full correction based on their retinoscopy with no adjustment given for the cycloplegic dilation.

Satisfactory Grades

The answer was required to be +/- 1.00 Sphere, +/- 0.5 cyl, and axis of cyl+/- 15 deg. This was a simple refraction station done well by the better candidates and poorly overall. Refraction will be continued to be examined in this exam as it continues to remain an important clinical tool. A young girls optic nerve function was presented, listing VA, colour vision, subjective brightness assessment. The candidate was asked to further assess the optic nerve function clinically. The assessment of visual fields by confrontation and the pupil responses was expected. A clear bitemporal hemianopia was present and a Left RAPD was present. The most likely cause was that of a craniopharyngioma. On the slit lamp candidates were asked to examine the cornea of a patient with prominent corneal nerves. A differential diagnosis was asked for and a history of thyroid cancer given. The cause was Multiple Endocrine Neoplasia. Recognition of the corneal nerves and a reasonable differential are required. A manned station with a photograph of a patient with severe facial bruising and proptosis. The scenario of an acutely developing proptotic eye and a loss of vision following trauma, was given.

28%

89%

61%

4 The candidates were told the globe was intact. A discussion of the management of this eye was then undertaken. It was expected that candidates recognised the urgency of treatment and how to do a lateral canthotomy. Examine the anterior segment of a patient with aniridia. Candidates expected to recognise aniridia, the Morcher artificial iris, and signs of limbal cell deficiency. A manned station in which the candidates were given a scenario suggesting the likely hood of a systemic fungal infection and a candida endophthalmitis. A photograph of the ocular candidiasis was used. A discussion of recognition and treatment was then undertaken. A slit lamp station showing a patient with a granular 9corneal dystrophy. One eye showed a recurrence in a 9d10eep anterior lamellar keratoplasty. 8 Candidates were expected to recognise the dystrophy, the recurrence and the presence of the corneal graft. A manned station in which a slide showing a CRAO was presented. When a temporal artery biopsy was suggested the candidates were asked to describe exactly how they would perform this surgery.

100%

72%

61%

94%

94%

2009 Semester 2 Examiners Report on OSCE

10

A slit lamp station showing a patient with ICE syndrome. All the signs present were expected to be accurately described and the condition diagnosed and a recognition of glaucoma as a major problem in this eye. A slit lamp case showing a Fuchs corneal dystrophy and Descments stripping endothelial keratoplasty. Recognition of all the signs was expected. A manned station. A patient showing a large angle concomitant hypertropia and no supraduction on one side. The candidates were asked to perform a cover test in the primary position, and then examine the eye movements. A satisfactory grade required an accurate description of the vertical tropia, and the demonstration of the unilateral failure of supraduction. A patient was shown with dilated episcleral vessels unilaterally. An unobserved station. An elderly man with an INO was presented with the history of horizontal diplopia on Right gaze. The candidates were asked to examine the eye movements and record the medial rectus underaction and the leading eye nystagmus. An unobserved station. A patient with See-Saw nystagmus. The signs were classical and needed to be described and the nystagmus named. An unobserved station with retinal photographs and a FFA. The signs of retinal crystals and the juxtafoveolar retinal telangectasia were required. A manned station. A patient with a partial third CN palsy, and signs of aberrant regeneration (classic lid synkinesis). Candidate had to recognise and describe all these signs. Those candidates who held the upper eyelid throughout the whole examination missed the obvious lid signs. An unobserved patient with forniceal lymphoma. Candidates were expected to detect the conjunctival lesions and recognise that a biopsy was required. A manned station. Retinal photographs and FFA showing active toxoplasmosis and macula oedema were shown and discussed. Recognition and treatment was required. Marfans Syndrome and subluxed crystalline lenses. An unmanned station. Candidates were asked to examine the patients anterior segment on the slit lamp. The bilateral subluxation and the characteristic patient signs were required. An unmanned station with probable congenital rubella signs on the retina. Candidates were asked to examine the posterior poles and record their findings and give a differential diagnosis. An unmanned station on a slit lamp requesting examination of the anterior segment. The signs of congenital glaucoma including buphthalmos were required, and the recognition of the ectropion uveae present. A photograph of gross proptosis and the accompanying MRI was shown. Candidates were expected to describe the findings and recognise that a biopsy

94%

11

100%

12

61%

13

83%

15

72%

16

94%

17

94%

18

50%

19

67%

20

78%

22

100%

23

56%

24

22%

25

83%

2009 Semester 2 Examiners Report on OSCE

was required, and provide a differential diagnosis. A manned station with a patient with known hyperthyroidism and diplopia was shown. The candidates were asked to examine the vertical eye movements and were expected to recognise the restriction of elevation and correlate this with an MRI shown. Unobserved retinal case with Stargardts disease. Accurate recognition and recording of signs was required.

26

94%

27

94%