Blurred central vision in an older adult - GP

CurtinYear 510 min + 2 min readingENT & ophthalmologyStandardPre-internship
  • Focused examination (visual acuity (Snellen, pinhole, near), pupils, visual fields and Amsler grid)
  • Dx + differentials
  • Initial Mx
  • Summary to examiner

Ready

2 min reading, 10 min station, warning at 2 min

Focus the timer and press Space to start or pause.

Station - Instructions for candidate

You are a junior doctor working in a general practice in Perth.

Mei Lim, a 76-year-old retired landscaper, has come to see you because the vision in her right eye has become blurry over the past four months and she is finding it hard to read. She has no eye pain. A Snellen chart is on the wall at 6 metres and an Amsler grid, pinhole occluder, near-vision card and pen torch are on the table.

From the triage noteRight eye blurry for about four months, worse recently. No pain, no redness. Wears reading glasses only. No known diabetes.

Your tasks are to:

  1. Perform a focused examination of her vision, including visual acuity, pupils, visual fields and an Amsler grid. Verbalise each step to the examiner; findings will be provided as you perform them.
  2. Summarise your findings to the examiner and state your most likely diagnosis and the differential diagnoses.
  3. Outline your initial management plan to the examiner.
  • You do NOT need to take a history; the relevant history is in the triage note and the patient will answer brief clarifying questions.
  • Please verbalise your examination to the examiner. You are not required to perform fundoscopy, but you may ask the examiner for the findings if you would look.
  • You do not need to write a referral letter in this station.

This is a 10-minute station, with 2 minutes of reading time.

Ask the examiner

Say what you want out loud, then open it below. Each result stays hidden until you reveal it.

Investigations

Ask for a category the way you would in the station: β€œCan I have the obs and a set of bloods?”

Examination

Say what you would examine and how; the examiner reports what you would find.

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