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 build there carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE

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
dranisurar@yahoo.comdranisurar@yahoo.com
anjumk38dmc@gmail.comanjumk38dmc@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