Ishihara Color Blindness Test Plate 1

Ishihara Color Blindness Test Plate 2

Ishihara Color Blindness Test Plate 3

Neuro ISCE station

You are an F2 doctor on your GP rotation. Miss Linda Charles, 31, presents with blurry vision and eye
pain. Please perform an eye examination. You have 7 minutes, at which time the examiner will stop
you and ask some questions.

Patient briefing

You are Miss Linda Charles, 31. For 3 days now your vision has been blurry, especially your left eye
and it hurts to move your left eye as well. You also feel that you are not seeing colours as well as you
could.

On examination, you can read the full list of letters with your right eye, but with your left eye you
can only count fingers.

You have normal visual fields, and the examiner will interrupt during pupillary reflex testing.

When your eye movements are tested, say that it hurts to move your eye but you are still able to do
it.

When presented with the colour plates, you can read the first one but have difficulty with the
second and third, say that the 2 nd is a 0 or an 8 and with the third- the first number is either a 2 or a 5
and the second number is either a 9 or a 3.

Examiner notes

 Use blue book for examination

 When swinging lift test- dilation of the left pupil when shining a light into it

1. Ask for summary (and how they would complete the examination if not offered)
a. Fundoscopy
2. Differential diagnosis and main diagnosis
a. Main= optic neuritis
b. Others= ischaemic optic neuropathy (due to diabetes/ giant cell arteritis),
neuromyelitis Optica, inflammatory (sarcoidosis, vasculitis), trauma/
compression, hereditary, nutritional deficiency, infectious, papilloedema
3. Investigations and Management?
a. First line investigations= MRI, FBC (infection), ESR (GCA)/ CRP, VDRL (syphilis),
uric acid (low in MS), Serum ACE (sarcoid), ANA (SLE)
b. Consider: Lyme titre, B12 & folate, CSF (oligo-clonal bands), APQ4 antibody &
anti-MOG antibody (NMO)
c. Management= IV methylprednisolone
4. Data interpretation: You do an MRI scan and find this. Please interpret what this means
and state your most likely diagnosis.
a. MS
5. How do you manage this condition in general?
a. MDT approach
b. Methylprednisolone for acute relapses
c. Disease modifying agents to prevent relapses:
i. Highly effective= monoclonal antibodies
ii. Good= dimethyl fumerate, fingolimod
iii. Moderate= glatiramer, beta interferon, teriflunomide
d. Symptomatic=
i. TCA/ gabapentin for neuropathic pain
ii. Diet/ exercise/ amantadine for fatigue
iii. Physiotherapy/ baclofen for spasticity
iv. Self-catheterisation/ anticholinergics for incontinence