Ospe tutorial

OSPE TUTORIALOSPE TUTORIAL

Dr Md Anisur Rahman AnjumDr Md Anisur Rahman AnjumMBBS. DO. FCPSMBBS. DO. FCPSAssociate ProfessorAssociate Professor

National Institute of OphthalmologyNational Institute of Ophthalmology01711-83239701711-832397

[email protected]@[email protected]

mailto:[email protected]

STATION=1STATION=1

• A young patient come to you with the A young patient come to you with the complains of uniocular sudden loss of complains of uniocular sudden loss of vision. How will you examine the patient vision. How will you examine the patient with given instruments- (pen torch. with given instruments- (pen torch. Snellen chart. Ishihara chart. Snellen chart. Ishihara chart. Ophthalmoscope.) Ophthalmoscope.)

Check list for the observerCheck list for the observer

MARKS Done Not done

Greetings

VA

Pupil exam : Direct Indirect RAPD

Colour Vision

Fundus Exam

Assessor for markingAssessor for marking

MARKS Done Not done

Greetings 0.5

VA 1

Pupil exam Direct Indirect RAPD

1

1

2

Colour Vis 2

Fundus Exam 2

Thanks 0.5

Total 10

STATION=2STATION=2

• This is a case of corneal injury, Give This is a case of corneal injury, Give suture with 10/0 monofilament nylon suture with 10/0 monofilament nylon under microscope.under microscope.


Done Not Done

Wearing gloves

Adjustment microscope:HeightIPDFocus

Cutting suture

Proper instrument

Procedure of suturing


CORRECT WRONG

Wearing gloves 2

Adjustment microscope:HeightIPDFocus

111

Cutting suture 1

Proper instrument 1

Procedure of suturing

3

STATION=3STATION=3

• Show the examination of LPS muscle in Show the examination of LPS muscle in this simulated patient of congenital this simulated patient of congenital ptosis.ptosis.


DONE NOT DONE

Greetings

Ask to look primary position

Ask to look at extreme down gaze

Hold a transparent scale marking upper lid margin

Press thumb on eyebrows

Ask 4 look at upgaze

Fix scale

Mark the position

Thanks to patient


DONE NOT DONE

Greetings 0.5

Ask to look primary position

0.5

Ask to look at extreme down gaze

1.5

Hold a transparent scale marking upper lid margin

1.5

Press thumb on eyebrows 1

Ask 4 look at upgaze 1.5

Fix scale 1.5

Mark the position 1.5

Thanks to patient 0.5

STATION=4STATION=4

• You are given with Inj Vancomycin 500 You are given with Inj Vancomycin 500 mg vial. Show how will you make 1 mg mg vial. Show how will you make 1 mg in 0.1 ml.in 0.1 ml.


• Wearing of the gloves (if supplied)Wearing of the gloves (if supplied)

• Inject 10 ml D/W in the vial, so 10 ml contains 500 Inject 10 ml D/W in the vial, so 10 ml contains 500 mg.mg.

• Take 1 ml from the vial, it contains 50 mg of Take 1 ml from the vial, it contains 50 mg of vancomycin. Add 4 ml D/W, so 5 ml contain 50 mg vancomycin. Add 4 ml D/W, so 5 ml contain 50 mg of vancomycin.of vancomycin.

• Take 1 ml from 5 ml, now 1 ml contains 10 mg.Take 1 ml from 5 ml, now 1 ml contains 10 mg.

• Take 0.1 ml in insulin syringe which contains 1 mg of Take 0.1 ml in insulin syringe which contains 1 mg of vancomycin.vancomycin.


• Wearing of the gloves (if supplied)Wearing of the gloves (if supplied)

• Inject 10 ml D/W in the vial, so 10 ml contains 500 Inject 10 ml D/W in the vial, so 10 ml contains 500 mg.=mg.=2.52.5

• Take 1 ml from the vial, it contains 50 mg of Take 1 ml from the vial, it contains 50 mg of vancomycin. Add 4 ml D/W, so 5 ml contain 50 mg vancomycin. Add 4 ml D/W, so 5 ml contain 50 mg of vancomycin.=of vancomycin.=2.52.5

• Take 1 ml from 5 ml, now 1 ml contains 10 mg.=Take 1 ml from 5 ml, now 1 ml contains 10 mg.=2.52.5

• Take 0.1 ml in insulin syringe which contains 1 mg of Take 0.1 ml in insulin syringe which contains 1 mg of vancomycin.=vancomycin.=2.52.5

STATION=5STATION=5

• Take relevant history from this simulating Take relevant history from this simulating patient of 28 years old suffering from patient of 28 years old suffering from transient double vision.transient double vision.

Check list for observerCheck list for observer

DONE NOT DONE

Greetings

Duration

Uni/binocular

Diurnal variation

Ocular pain

Aggravating factor

Uses of glass

Weakness of extremities

Headache

Any systematic dis

Thanks


DONE NOT DONE

Greetings 0.5

Duration 1

Uni/binocular 1

Diurnal variation 1

Ocular pain 1

Aggravating factor 1

Uses of glass 1

Weakness of extremities 1

Headache 1

Any systematic dis 1

Thanks 0.5

STATION=6STATION=6

• A 50 years old lady came to you for A 50 years old lady came to you for routine eye examination. Incidentally, it routine eye examination. Incidentally, it was diagnosed as a case of POAG. How was diagnosed as a case of POAG. How will you counseling the lady?will you counseling the lady?


Done Not done

Greetings

Give idea of POAG

Rx Medical

Rx Surgical

Complications of surgery

Fate if untreated

Follow up after surgery

Advice

Thanks


Done Not done

Greetings 0.50

Give idea of POAG 2.50

Rx Medical 1.50

Rx Surgical 1.50

Complications of surgery

1.00

Fate if untreated 1.50

Follow up after surgery

1,00

Thanks 0.50

STATION=7STATION=7

• Take the measurement of anterior Take the measurement of anterior posterior displacement of right eye.posterior displacement of right eye.


Greetings

Patient set up

Examinee position

Instrument placement

Bar reading adjustment

Occlusion of pt’s one eye

Measurement of pt’s both eyes

Thanks


Done Not Done

Greetings 0.50

Patient set up 1.00

Examinee position 1.00

Instrument placement 2.00

Bar reading adjustment 2.00

Occlusion of pt’s one eye

1.50

Measurement of pt’s both eyes

1.50

Thanks 0.50

STATION=8

This is the chest X-ray of a patient who suffered from a sudden uniocular visual loss. The heart is enlarged with calcification of the left ventricle. He had a previous history of myocardial infarction.

• What does the Chest X-ray show? Write one finding.• What another investigation of heart you do for

diagnosis.• What could be the cause of his sudden visual loss? • How would you manage this patient?

1) The heart is enlarged with calcification of the left ventricle. This is seen in left ventricular aneurysm.

2) This can be confirmed with echocardiogram.

3) What could be the cause of his sudden visual loss?

The most likely cause of his sudden visual loss is arterial emboli arising from left ventricular thrombus.

4How would you manage this patient? The patient should be referred to cardiologists

for anti-coagulation treatment.

Surgical removal of the aneurysm (aneurysmetomy) is indicated if the patient is fit.

1) Is it T1 or T2 weighted?2) What does the scan show?

3) What ocular signs may be present?

ANSWER

• This is an axial T1 weighted MRI scans of the brain stem, because CSF in the ventricle is black. There is a large tumour in the cerebellopontine angle which pushed the ventricle.

• Reduced corneal sensation.• Nystagmus• Sixth nerve palsy.• Facial Nerve palsy.

QUESTION This is the corneal topography of a patient pre-cataract

surgery. a. What does the picture show? = 2 b. The patient's refraction can be corrected with -3.00DS to 6/6.

Give a reason why he does not require cylindrical correction. = 4

c. A temporal clear corneal incision was performed because the patient has deep set eye. What is the effect on:

• i. the cornea tissue = 2 ii. the cornea astigmatism = 2

ANSWER

With the rule astigmatism.

• There is a vertical bow tie appearance of the cornea which corresponds to that part of cornea with the steepest meridian.

The patient may have against the rule lenticular astigmatism which exactly neutralize the corneal astigmatism.

• The refraction of the eye is contributed by the cornea & the lens. The astigmatism of the cornea can be neutralized by lenticular astigmatism if its axis is opposite to that of the cornea. For this reason, astigmatic keratometry reading during cataract surgery should be based on the corneal topography and not on the glass prescription.

A temporal clear corneal incision will flatten the cornea in the meridian of the incision.

Because of the “coupling” the cornea will be steepened at 90 degree away. In this case, the with-the-rule-astigmatism will increased.

STATION=8STATION=8

• A 40 year-old myopic woman is recently prescribed A 40 year-old myopic woman is recently prescribed soft contact lenses for the first time. She returned two soft contact lenses for the first time. She returned two weeks later and complains that her reading vision weeks later and complains that her reading vision is not as good as with her glasses. Retest shows her is not as good as with her glasses. Retest shows her visual acuity to be 6/6 in both eyes with the contact visual acuity to be 6/6 in both eyes with the contact lenses and the lenses were of the right prescription lenses and the lenses were of the right prescription and well-fitted. Why does she have problem reading and well-fitted. Why does she have problem reading with her contact lenses but not with her glasses?with her contact lenses but not with her glasses?

ANSWERANSWER

• The patient is pre-presbyopic. Myopes require The patient is pre-presbyopic. Myopes require less accommodation with glasses than contact less accommodation with glasses than contact lenses. In addition, the prismatic effect (base-lenses. In addition, the prismatic effect (base-in prism) offered by the concave glasses assist in prism) offered by the concave glasses assist convergence during reading.convergence during reading.

OSPE=9OSPE=9

• Calculate the binocular prismatic effects of the following:

• a. Right eye 4 prism dioptres, base-out Left eye 3 prism dioptres, base-out

• b. Right eye 5 prism dioptres, base-out Left eye 6 prism dioptres, base-in

• c. Right eye 3 prism dioptres, base-up Left eye 4 prism dioptres, base-down

• d. Right eye 2 prism dioptres, base-up Left eye 3 prism dioptres, base-up

•

ANS OSPE=9ANS OSPE=9

• 7 prism dioptres, base-out 7 prism dioptres, base-out

• 1 prism dioptre, base-in 1 prism dioptre, base-in

• 7 prism dioptre, base-down 7 prism dioptre, base-down

• 1 prism dioptre, base-up 1 prism dioptre, base-up

Ospe tutorial

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