بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. These are the slides that dr.yasser al-faki revises every cycle, if you memorize & understand them, you will have no problem identifying & answering most of the O.S.C.E. Questions. • The exam is formed of 20 stations , Each has 1 photo with 1 M.C.Q. that you have to Answer in 1 minute. • It’s not as hard as it sound if you give it the time to see these slide again & again. • GOOD LUCK

4. TEST # 1

5. Lower Lid Ectropion (cicatrical) N.B. Involutional is the most common cause Tx: Release the Scar or Graft Complication : Exposure Keratitis. • Arcus Senalis

6. Upper Lid Entropion & 2ry Trachiasis Most common cause is Trachoma (Cicatrical) Involutional Entropion Never Affects the Upper lid Rx: Sugery

7. Stye (External Hardiolum) : Inflamation of the Upper Lid With Pus Formation Tx: Antibiotics + Drainage + Remove eye lashes + Hot Compressors.

8. Painless Swelling of the Lower Lid with pus formation • Chalazion (Meibomian Cyst) • Common • Tx: Surgical Evacuation • NO ANTIBIOTICS (it is Sterile) • If Recurrent : Think of Tumer of the Gland • N.B. AcuteChalazion = Internal Hardiolum

9. Painless Swelling for 1 year Then regressing • Capillary Haemagioma • No Tx unless there is obstruction of vision wich may lead to amblyopia (Give intralesional long acting steroid).

10. Aggressive Tumer in a 70 y.o. patient • Melanoma (Usually black color) • Metastasize Early • Tx: Ramoval or at least Debulk.

11. Medial Rectus → No • Superior Rectus → No • Levator Palpepre Superioris → No • 3rd Nerve Palsy (Occulomotor) Right Side • Tx: if there is involvment of the introcular muscles → Surgical Tx. -If not → medical • Lareral Rectus → YES • Inferior Rectus → No

12. Bilateral Severe ptosis (With compensatory chin left)congenital • Tx: Depends on the Levator Function : • If ok then resect (shorten) • If severe use a graft (Fascia lata) • Time of Tx is after 1 year if bilatral but before 2 years to prevent C-spine deformety (becase of the constant chin lefting) • If Unilatral → Amblyopia

13. Flurocena Dye (Green) Uses : 1- Corneal Abrasion/scar 2- Tear film → Lacrimal system assesment. 3- I.O.P. 4- Detect Leaking.?

14. Dentritic Ulcer (Herpetc Keratits) • Caused by HSV, HZV & Tyrosinemia • Tx: Antiviral (Acyclovir) • NEVER GIVE STEROIDS (Sarhani notes page 91)

15. Corneal Ulcer Stained by Flurocene + Entropion & 2ry Trichiasis • Tx: Tx Entropion 1st • Scraping the ulcer for a sample • Embirical Broad spectrum Antibiotics (Cipro) (Topical) Because the cornea is avascular -NEVER GIVE STEROIDS in corneal Ulcer with infection

16. Slit lamp examination showing very shallow anterior chamber. Iris touching the cornea • After glucoma surgery? : Trabelectomy • Mesure I.O.P. : if low → Leak or over drainage If high → Malignant Glucoma

17. Rose Bengal Stain : Kerato conjectivitis Sicca = Dry Eye Syndrome • Why Not to use Flurocene?: Becaue it is hydrophilic & the epithelium will take hydrophobic (rose Bengal) so, -Dentritic : if infected →rose Bengal ? -If desquamated → Flurocene

18. Swelling with tightly closed eye in a child • DDx: • Angiorretic edema • Preseptal cellulites → Give Antibiotics. • Cavernous Sinus Thrombosis (bilateral) • Orbital Cellulitis • Tx: • Admetion • I.V. Broad spectrum antibiotics. • Temperature Chart. • CT Scan

19. Orbital Cellulitis

20. Orbital Cellulitis:?? • Signs: • Connectival injection. • Disharge seen near the lowr lid. • Protrusion.

21. Hx of: Fever , Sinusitis, Very ill patient • Rt. Orbital Cellulitis.

22. Unilateral (Left) Proptosis & Lid Retraction (most common cause in adults is Dysthyroid) • Tx: • Treat the thryoid. • Thyroid Function & CT are the most important investigations

23. Exophthalmus

24. Exophthalmometer

25. TEST # 2

26. In Any Retinal Slide , You have to see & comment on the following: • Optic Disc : Atrophy?, Cupping?, New Vessels?. • Is there any Exudate? • The Macula : Is there any Lesion? • The Retinal Background : Is There Any Hemorrhages? • Veins : Congested?, A-V Crossing? • Is there any Vitreous Hemorrhage? ( the wool picture would be blocked by it)

27. Non-Prolifarative Diabetic Retinopathy (No New vascular Formation) • Tx: Focal Laser (Not Sure?) • Hard Exudate. • Congested Veins. • Heamorrages

28. Proliferative Diabetic Retinopathy. • Fan-shaped New Vascular Formation Around the Disc • Tx: P.R.P. (Pan Retinal Photocoagulation).

29. Vitreous Heamorrage -Tx: Vetrotomy & P.R.P. -But In Type II DM ; we can wait for 3/12 because it may resolve spontaneously.

30. Post-P.R.P.

31. Disc Cupping: Chronic Open Angle Glaucoma. Most likely Primary. - In Closed angle Glaucoma: there is no time for cupping to develop.

32. Optic Nerve Edema. • Exudates. • Cotton wool. • Blurring of optic disc (you can’t say where the disc ends & the Retina Starts). • Flame-Shaped Hemorrhage. • DDx: • Optic Neuritis: (↓ Visual Acuity) Systemic Steroids? , HTN, ↑ I.C.P., Nutritional, Syphlis. • Papilledema: BILATERAL, 2ry to ↑I.C.P. With Enlarged Blinad Spot.

33. Papilledema: Same Previous Picture but Bilateral.

34. Optic Nerve Edema: (With Marked Venous Congestion). • Hemorrhages. • Cotton Wool.

35. The Same patient of the previous picture; with↑↑ E.S.R. & Hx of Headache • Giant cell Arteritis (Temporal Arteritis). • These Engorged Vessels are sign of poor prognosis. • We must Give High Doses of Systemic Steroids to Preserve the other eye but not to treat this eye.

36. Central Retinal Artery Occlusion. • Severe Loss of Vesion, Poor Prognosis. • Segmentation of the Blood Vessels & Marked Edema with Chari-red spot • Ischemia of the inner 2/3 of the retina (White/Yellow color) • But the Fovia is preserveed (Supplied by the choroidal artery)

37. Flame-Shaped Hemorrhage but without Cotton wool, no Exudate. • HemiRetinal Vein occlusion (Branch). • Tx: Observation & Medical Assesment. • Complications: the most serious is New vessels formation → Neovascular Glucoma. • So, If anyNew Vessels = P.R.P.

38. Robiosis Iridis. (new Vessels in the iris) • Complicated by neovascular glaucoma. • Tx: By Treating Retina Ischemia & P.R.P. if Any New Vessels. • Cataract???????

39. Regmatogenous Retinal Detachment. • Because of the U-shaped (Horse-shoe) Tear • The macula is still intact but may detach soon. (Emergency)

40. 25 y.o. female with depigmentation of the eye lashes, eye brow (poliosis) , vitiligo & Hearing loss • V.K.H. disease • She will also have : Uveitis & Exudative Retinal detachment.

41. Vitiligo

42. Macroglossia → Acromegally → Pituitary Tumer→ Chiasmal Lesion → Bitemporal Hemianopia

43. Confrontation Test : Visual Field testing method.

44. Pinhole Test : If improve → Refractive error

45. Regmatogenous Retinal Detachment - U-shaped Tear

46. Optic Disc Atrophy: Milky white optic head (شمس)

47. TEST # 3

48. Conjunctiva • Identify the area of maximum Injection. • Usually starts Unilateral then become Bilateral. • Conjunctivitis: • Bacterial : Purulent or Mucoid Discharge. • Viral Watery Discharge. • Allergic: Watery then Mucoid, Asymptomatic or itching. • Follicular conjunctivitis is Caused by: 1- Viral : Preauricular L.N. involvement. 2- Active Trachoma : Most common. 3- Medication side effect.

49. Bacterial Conjunctivitis: - Red conjunctiva & Mucopurulent.

50. Viral Conjunctivitis: - Watery & L.N.?