Fundoscopy Quiz

Wuchereria got this for his PACES Singapore exam last year.

What is your diagnosis?

Fundoscopy Quiz

Yesterday, a consultant neurologist came to my hospital and took one of the PACES candidates for a mock.

This was what the patient had(picture above). It was Station 5 Fundoscopy.

Quiz :

1) What is your diagnosis ?

2) What else would you look for ?

3) What are the common causes ?

4) What would you look for in the other eye ?

The patient was a young lady.

What is your complete diagnosis ?

PACES Window!

One of the station that most PACES candidate fear is fundus station. In this station, our fate is dependent on the small window i.e. pupil. I had a bad experience during PACES exam as the patient's pupils were not well dilated during my PM session. Later, I only learnt that the pupils will only be dilated once in PACES. So, if you do get a "small window", remember to commend that your examination of the fundus is suboptimal.

I found a visual guide on fundocopic examination by California State University. Hope it helps.

Tips for Fundoscopy

One of the tough station in PACES as you need to complete your examination within 3 mins ( another 2 mins for discussion). If you are unlucky, you might need to examine via a small pupil (normally last candidate of the day).

There are several tips to get the correct diagnosis:

1. Prepare the patient by giving a clear instruction. Here is my suggestion.

Mr. X, I am going to come near you and examine your R/L eye with this light. It might be uncomfortable. Please bear with me. Now, look straight and keep your eyes still. Don't move your eyes but you can blink as you wish.

2. Always check the macula area before presenting your findings.

Mr. X, please look into my light now.

3. Think of 3 main diagnosis you need to know for PACES

Diabetic eye, retinitis pigmentosa, optic atrophy.

Good luck!

Retinitis Pigmentosa

One of the common case in eye station. Be sure that you can recognise this classic case i.e. widespread scattering of black pigment in a pattern resembling bone corpucles.
Don't forget to check for optic atrophy! The examiner will definitely ask you about the optic disc.

Then, proceed to check for visual field looking for tunnel vision.

Remember these few systemic disorders associated with RP.

1. Laurence-Moon-Bardet-Biedl syndrome

** Autosomal recessive

** Polydactyly ( or check for amputation scar over the hands)

2. Refsum's disease

** Autosomal recessive

3. Hereditary ataxias

4. Familial neuropathies

5. Neuronal lipidoses

6. Kearns-Sayre syndrome