1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh. These OSPE are dedicated to the postgraduate student who are decided to builds their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE

1. Objective Structured Practical
Question (OSPE)
Subject: Ophthalmology
According to the course curriculum of
Bangladesh College of Physician &
Surgeon (BCPS)

2. AUTHOR:
Dr Md Anisur Rahman Anjum.
MBBS (Dhaka Medical College). DO (Dhaka
University) FCPS (EYE)
Associate Professor
National Institute of Ophthalmology
Dhaka, Bangladesh.
Chamber: Mojibunnessa Eye Hospital
House: 18 Road: 6. Dhanmondi, Dhaka, 1205.
Bangladesh.
Email: anjumk38dmc@gmail.com
Cell: 01711-832397
7/15/2014 2anjumk38dmc@gmail.com

3. OSPE:1

4. Q:1(a)
• 1) What does the picture
show?
• 2) What is the most
likely underlying
medical condition?

5. Answer:1(a)
• 1) This is the right fundal FFA taken at the venous
phase. There are multiple areas of circular dots with
both hypo and hyperfluorescein.
• 2) This most likely underlying condition is diabetic
maculopathy which has been treated with
photocoagulation.

6. Q:1(b)
1) What is the name of
this investigation?
2) What does this picture
show?
3) What is your
diagnosis?

7. Answer: 1(b)
1) This is the Fluorescence angiography of the
right fundus taken at the venous phase.
2) There are multiple spots of fluorescence (dot
& blot haemorrhage).
3) The patient has background diabetic
retinopathy.

8. 3
Q: (1C)
1) What phase is this frame of fluorescein angiography?
2) What does the picture show? & 3) What is the diagnosis?

9. Answer(1c)
• 1) The late phase.
• 2) Area of hyperfluorescence with pooling. The area
with the most intense hyperfluorescence has a smoke
stack appearance. The diagnosis is CSCR.

10. OSPE:2

12. Q:2
• The picture and fluorescein angiography are taken
from a patient complaining of distorted right vision.
• a. What phase is the fluorescein angiography?
• b. What is the diagnosis?
• c. What underlying medical condition may be present
in this patient?

13. ANSWER:2
 Venous phase
 Macroaneurysm. The colour picture shows circinate
exudates surrounding an area of haemorrhage. FA
shows local dilatation of the superior retinal artery
corresponding to the area of haemorrhage. The
feature is that of Macroaneurysm.
 Hypertension..

14. OSPE:3

15. Q:3
Answer the following
questions with reference
to the fluorescein
angiography.
1) What abnormality is
seen in the above
picture?
2) Suggest two possible
causes

16. Answer:3
1) Optic disc swelling. (The fluorescence which is
taken at venous phase shows hyper fluorescence of
the optic disc)
2)
i. Raised intracranial pressure
ii. Acute AION.

17. OSPE:4

18. Q:4
1) What imaging is
shown?
2) What does it show?
3) Name two ocular signs
which may be present?

19. Answer:4
1) A transverse CT scan of the brain.
2) The CT scan shows hydrocephalus.
3) 6 th nerve palsy & papillodema.

20. OSPE:5

21. This 70 year-old man suffered from progressive
left exophthalmos. His CT scan is shown as
1) What does the CT scan
show?
2) What is the most likely
diagnosis?
3) What are the
advantages of CT scan
over MRI in orbital
imaging?
Q:5

22. 1) Hyperostosis of the left lateral portion of the
sphenoid with left proptosis.
2) Sphenoid wing meningioma.
3)
Better bony definition than MRI especially in
detecting orbital fractures and bony metastasis
Detecting metallic foreign body within the orbit
or globe (contraindicated in MRI)
Shorter running time than MRI
Less expensive than MRI
Answer:5

23. OSPE:6

24. This 70 year-old man suffered from progressive left
exophthalmos. His CT scan is shown as below
• a. What does the CT
scan show? =2
• b. What is the most
likely diagnosis? =2
• c. What are the
advantages of CT scan
over MRI in orbital
imaging? Mention 3
points =6
Q:6

25. Answer:6
• a. Hyperostosis of the left lateral portion of the
sphenoid with left proptosis.
• b. Sphenoid wing meningioma.
• c.
• Better bony definition than MRI especially in
detecting orbital fractures and bony metastasis
• Detecting metallic foreign body within the orbit or
globe (contraindicated in MRI)
• Shorter running time than MRI
• Less expensive than MRI

26. OSPE:7

27. ThisistheCTscanofa65year-old
womanwithunilateralproptosis.
a.WhatorientationisthisCTscan?
b.Whatabnormalitiesareshown?
c.Whatisthemostlikelydiagnosis?
d.Whatabnormalitiesmayoccurwhen
testingherocularmovement?
2.5 x 4=10

28. Answer:7
 a. Coronal section.
 b. Enlargement of the muscles in the right eyes
especially the inferior rectus.
 c. Right thyroid eye disease.
 d. Any of the following abnormalities may occur:
i. lid lag
ii. restricted eye movement in all directions
especially up gaze

29. OSPE:8

30. This is the CT scan of a 65 year-old woman with
unilateral (R/E) proptosis
• a. What orientation is this
CT scan?
• b. What abnormalities are
shown?
• c. What is the most likely
diagnosis?
• d. What abnormalities
may occur when testing
her ocular movement?

31. Answer:8
• a. Coronal section.
• b. Enlargement of the muscles in the right eyes
especially the inferior rectus.
• c. Right thyroid eye disease.
• d. Any of the following abnormalities may occur:
• lid lag
• restricted eye movement in all directions
especially up gaze

32. OSPE:9

33. Q:9
• This one year baby
was referred to the
eye clinic because of
suspected failure of
visual development.
Following
fundoscopy an
urgent CT scan was
ordered.

34. Q:9
• a. What does the CT scan show? =2.5
• b. What is the most likely diagnosis? =2.5
• c. Write 3 factors will determine the prognosis
of this patient? =3
• d. What is the chance of his offspring getting
the same condition? =2

35. Answer:9
a) The CT scan shows bilateral solid masses within the
globes with the density of the bone i.e. calcification.
b) Retinoblastoma
c)
i. Optic nerve involvement = 1
ii. Tumour size and location = 1
iii. Tumour differentiation = 1
iv. Age of the patient = 0.5
v. Secondary tumour = 0.5
d) 40%

36. OSPE:10

37. Q:10
Suppose you are working in a primary eye care hospital
at upo jilla level. A boy of 7 years old came to you
with penetrating corneal injury & iris prolapse.
Q=1
Before referring the boy at tertiary eye care centre, give
him 2 treatment.
If you are working at tertiary eye care centre, you will
manage the patient by repairing of cornea under G/A.

38. Q:10
• Q 2. What minimum instruments are required
to repair.=4
• Q 3. What will be your instruction to
anesthetist.=1
• Q 4. How you will decide to reposition of the
iris. Mention 2 points=3

39. Answer:10
ANS=1.
 Light Pad & bandage of the eye (no drop or
ointment inside the eye).
 Systemic analgesic & antibiotics.
ANS=2.
 Eye speculum.
 Barraquer needle holder
 Corneal forceps/St Martin
 2 tying forceps

40. Ans:10
ANS=3.
Please caring about raised IOP (avoid
Suxamethonium)
ANS=4
If iris is viable then it will reposited.
If there is a fibrinious coating over the iris
then it is sterile and can be reposited.

41. OSPE:11

42. Question
Counsel the patient
undergoing FFA.

43. Answer
 CHECKLIST
A. Greetings--------------------0.5
B. explanation of procedure:
i. Inj. Na Fluoride--------1.0
ii. Taking of picture----- 1.0
C. Prerequisite:
i. Dilated pupil---------1.0
ii. Renal function test—1.0
iii. Any hypersensitivity of Fluoride—1.0

44. Answer
D. Possible side effects:
i. Nausea/vomiting---1.0
ii. Yellow urine---------1.0
iii. Anaphylaxis /syncope—1.0
E. Talk about cost----------1.0
i. Thanks & Feedback----0.5
ii. Total-----------------------10

45. OSPE:11

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

47. Check 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

48. Assessor 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

49. OSPE: 12

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

51. Check list for the observer
MARKS Done Not done
Greetings
VA
Pupil exam :
Direct
Indirect
RAPD
Colour Vision
Fundus Exam

52. Assessor 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

53. OSPE:13

54. Question
 Examine the simulating patient of
Keratoconus with the supplied instruments(pen
torch, ophthalmoscope, retinoscope) and
mention
1) 2 signs with pen torch.
2) 1 sign with ophthalmoscope.
3) 1 sign with retinoscope.

55. Answer
i. Greetings-& permission---- 1.0
ii. Rizuti reflex by torch ----1.0.
iii. Munsen sign by torch-----1.0.
iv. Oil drop reflex by ophthalmoscope—1.5.
v. Scissors reflex by retinoscope----1.5

56. Answer
Or if slit lamp is given then
I. -Greetings----------------0.25
II. -Positioning of patient-----0.25
III. -Positioning of slit lamp---0.5
IV. -Munsen sign( by looking down & holding the upper
lids)-------1.0
V. Diffuse illumination( see hydropic scar & volks
striae)-1.0
VI. -Oblique illumination(corneal thining/ steepening)-1.0
VII.-Fleischer ring (using cobalt blue filter)---1.0

57. OSPE:14

58. Usually BCC form a
nodule in the eyelid
but here in the picture
does not make a
nodule and grows
within the eyelid, it
induce pulling of the
eyelid.
Q:1. What is the name of this variant?
Q:2 Why this is more difficult to treat?
Q:3. Write one D/D.
Q:4. Which is the most common site in the eye?
Q:5. In which location of the eye it has the worst prognosis?
Q:6 Which will you prefer? Excisional biopsy or incisional
biopsy and why?

59. Answer
1) Sclerosing BCC or Morpheaform variant. = 2
2) Much more difficult to treat because its edges
are harder to define. = 2
3) Chronic blepharitis. = 1
4) Lower eyelid.= 1
5) Medial canthus. = 1
6) Excisional biopsy. Because tumours that recur
following incomplete treatment tend to be more
aggressive. = 1 + 2 = 3

60. OSPE:15

61. This is the picture of a
50 year old man who
came to you with
the painless diffuse
violet nodule in the left
lower lid. On previous
medical report you have
noted that he is
suffering from AIDS.

62. Question
1) What is the diagnosis of the nodule?
2) What type of tumour is this?
3) What is the causative organism?
4) In this condition, what will be the CD+4 cell
count?

63. 1) Kaposi sarcoma.
2) This is a malignant vascular tumour
3) caused by Human Herpes Virus 8 (HHV-8)4.
4) Below 500

64. THANK’S A LOT FOR YOUR
PATIENCE HEARING