Return to Diagnosis ListShow Learning Points most relevant to Phase 1:


Clinical Discipline(s)/Organ System(s)
Neurology, Ophthalmology, Endocrinology
Progress Test Topic(s)
A 66 year old Māori woman presents with intermittent double vision which has been gradual in onset, but steadily worsening and has now become constant. She had cataract surgery 2 years ago with good vision in each eye postoperatively and she has had reasonably controlled type 2 diabetes for 10 years.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy and function of each of the extraocular muscles
   - Cranial nerves III, IV, VI and their innervation of extraocular muscles
   - Pathogenesis of diplopia
   - Common causes of acquired diplopia
Clinical and Communication Skills 
   - History of diplopia: type (e.g. intermittent vs constant, monocular vs binocular, vertical vs horizontal), history of previous strabismus surgery, variation of diplopia for near and distance gaze, variation of diplopia for primary position and other gaze positions, variation of diplopia during day (worsening by the end of the day, worsening with fatigue)
   - Associated symptoms and signs: headache, pain on eye movements, ptosis or proptosis
   - Recognise abnormal head posture; perform cover test, eye movement examination (ductions and versions)
   - Differential diagnosis of diplopia in adult
   - Role of neuroimaging and other investigations (erythrocyte sedimentation rate (ESR), C reactive protein, blood glucose; orthoptic workup such as Hess Chart
   - Management of diplopia - treatment options for diplopia in acute phase, role for strabismus surgery, role for prismatic correction of diplopia, management of underlying medical conditions
   - Discuss effect of diplopia in limitation of personal physical activities such as housework, driving, climbing stairs
Personal and Professional Skills 
   - Ability to work in a team
   - Involvement in teaching, supervision, leadership
Hauora Māori 
   - Sensitivity in use language with different cultural/ethnic groups: e.g. 'eye turning in' is preferable to 'crossed eye' when describing esotropia
   - Awareness of differing risk profiles for diplopia between Māori (and other disadvantaged populations) compared with non-Māori in New Zealand
Population Health 
   - Access to public hospital specialist eye care
Conditions to be considered relating to this scenario
diabetes mellitus, intracranial aneurysm, thyroid eye disease, myasthenia gravis
Less common but 'important not to miss'
herpes zoster ophthalmicus, intracranial trauma (cranial nerve IV particularly), orbital trauma/blow-out fracture