Ospe tutorial
- 1. OSPE TUTORIALOSPE TUTORIAL Dr Md Anisur Rahman AnjumDr Md Anisur Rahman Anjum MBBS. DO. FCPSMBBS. DO. FCPS Associate ProfessorAssociate Professor National Institute of OphthalmologyNational Institute of Ophthalmology 01711-83239701711-832397 [email protected]@yahoo.com [email protected]@gmail.com
- 2. STATION=1STATION=1 • A young patient come to you with theA young patient come to you with the complains of uniocular sudden loss ofcomplains of uniocular sudden loss of vision. How will you examine the patientvision. 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.)
- 3. Check list for the observerCheck list for the observer MARKS Done Not done Greetings VA Pupil exam : Direct Indirect RAPD Colour Vision Fundus Exam
- 4. 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
- 5. STATION=2STATION=2 • This is a case of corneal injury, GiveThis is a case of corneal injury, Give suture with 10/0 monofilament nylonsuture with 10/0 monofilament nylon under microscope.under microscope.
- 6. Check list for the observerCheck list for the observer Done Not Done Wearing gloves Adjustment microscope: Height IPD Focus Cutting suture Proper instrument Procedure of suturing
- 7. Assessor for markingAssessor for marking CORRECT WRONG Wearing gloves 2 Adjustment microscope: Height IPD Focus 1 1 1 Cutting suture 1 Proper instrument 1 Procedure of suturing 3
- 8. STATION=3STATION=3 • Show the examination of LPS muscle inShow the examination of LPS muscle in this simulated patient of congenitalthis simulated patient of congenital ptosis.ptosis.
- 9. Check list for the observerCheck list for the observer 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
- 10. Assessor for markingAssessor for marking 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
- 11. STATION=4STATION=4 • You are given with Inj Vancomycin 500You are given with Inj Vancomycin 500 mg vial. Show how will you make 1 mgmg vial. Show how will you make 1 mg in 0.1 ml.in 0.1 ml.
- 12. Check list for the observerCheck list for the observer • Wearing of the gloves (if supplied)Wearing of the gloves (if supplied) • Inject 10 ml D/W in the vial, so 10 ml contains 500Inject 10 ml D/W in the vial, so 10 ml contains 500 mg.mg. • Take 1 ml from the vial, it contains 50 mg ofTake 1 ml from the vial, it contains 50 mg of vancomycin. Add 4 ml D/W, so 5 ml contain 50 mgvancomycin. 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 ofTake 0.1 ml in insulin syringe which contains 1 mg of vancomycin.vancomycin.
- 13. Assessor for markingAssessor for marking • Wearing of the gloves (if supplied)Wearing of the gloves (if supplied) • Inject 10 ml D/W in the vial, so 10 ml contains 500Inject 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 ofTake 1 ml from the vial, it contains 50 mg of vancomycin. Add 4 ml D/W, so 5 ml contain 50 mgvancomycin. 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 ofTake 0.1 ml in insulin syringe which contains 1 mg of vancomycin.=vancomycin.=2.52.5
- 14. STATION=5STATION=5 • Take relevant history from this simulatingTake relevant history from this simulating patient of 28 years old suffering frompatient of 28 years old suffering from transient double vision.transient double vision.
- 15. 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
- 16. Assessor for markingAssessor for marking 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
- 17. STATION=6STATION=6 • A 50 years old lady came to you forA 50 years old lady came to you for routine eye examination. Incidentally, itroutine eye examination. Incidentally, it was diagnosed as a case of POAG. Howwas diagnosed as a case of POAG. How will you counseling the lady?will you counseling the lady?
- 18. Check list for observerCheck list for observer Done Not done Greetings Give idea of POAG Rx Medical Rx Surgical Complications of surgery Fate if untreated Follow up after surgery Advice Thanks
- 19. Assessor for markingAssessor for marking 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
- 20. STATION=7STATION=7 • Take the measurement of anteriorTake the measurement of anterior posterior displacement of right eye.posterior displacement of right eye.
- 21. Check list for observerCheck list for observer Greetings Patient set up Examinee position Instrument placement Bar reading adjustment Occlusion of pt’s one eye Measurement of pt’s both eyes Thanks
- 22. Assessor for markingAssessor for marking 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
- 23. STATION=8
- 24. 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?
- 25. 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.
- 26. 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.
- 27. 1) Is it T1 or T2 weighted? 2) What does the scan show? 3) What ocular signs may be present?
- 28. 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.
- 30. 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
- 31. 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.
- 32. 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.
- 33. STATION=8STATION=8 • A 40 year-old myopic woman is recently prescribedA 40 year-old myopic woman is recently prescribed soft contact lenses for the first time. She returned twosoft contact lenses for the first time. She returned two weeks later and complains that her reading visionweeks later and complains that her reading vision is not as good as with her glasses. Retest shows heris not as good as with her glasses. Retest shows her visual acuity to be 6/6 in both eyes with the contactvisual acuity to be 6/6 in both eyes with the contact lenses and the lenses were of the right prescriptionlenses and the lenses were of the right prescription and well-fitted. Why does she have problem readingand 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?
- 34. ANSWERANSWER • The patient is pre-presbyopic. Myopes requireThe patient is pre-presbyopic. Myopes require less accommodation with glasses than contactless 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 assistin prism) offered by the concave glasses assist convergence during reading.convergence during reading.
- 35. 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 •
- 36. ANS OSPE=9ANS OSPE=9 • 7 prism dioptres, base-out7 prism dioptres, base-out • 1 prism dioptre, base-in1 prism dioptre, base-in • 7 prism dioptre, base-down7 prism dioptre, base-down • 1 prism dioptre, base-up1 prism dioptre, base-up