(can't remember all questions - its all a blur now):
1) Scenario of cases of endophthalmitis in your dept - how would you
investigate? who should be involved etc?
2) Photo of post PK cornea with multiple satellite opacities - I thought it
was a bacterial keratopahthy that was modified by the post op steroids the
patient was on (looked like a crystalline type keratopathy) but gave a
differential of other organisms.
3) The usual gram stain slide - -though at present can't remember what it
was? (think a mirco slide is very common in the exam)
Bitemporal hemianopia - realted questions on
where/what lesion/what investigation
Next case was I think a traumatic caratact.
One other case that I can't remember
Cornea and external eye diseases
PRP with NVE (they looked perfused and there
was a pre-retinal haem) - got questions on how would you manage this pt.
Stage 3 macular hole - questions on macular
hole surgery - what gases/why ILM peel/how to deal with post op
complications e.g. raised IOP (+when is the peak time for this/peak
Melanoma which looked like it had been
treated with plaque brachytherapy (questions on progostic indicators of
Pendular nystagmus - fortnately saw an
inferior PI - pt had had RD repairs BE as a child.
Abberent regeneration following CN VII palsy
- was subtle - pt didn't blink as much on affected side + has twitching
movements of the lip of the affected side on opening mouth
Blue sclera - osteogenesis imperfecta!!!
was tricky as examiner showed me a list of drugs with bisphosphonates on
it - asked me what they were for and what situations would an
ophthalmologist use them (i.e long term steroid use to prevent
osteoporosis). On slit-lamp pt had mild anterio uveitis in the right eye
with post synechiae in both. Initially I thought she was either on
steroids for uveitis or maybe related to RA (with scleral thining etc)
couldn't really tie it all together so described what I was thinking and
gave a differential for blue sclerea - examiner seemed to like that (at
the end the examiner told me the uveitis was a red herring).
RAPD - that was easy bit patient also has a
VP shunt - examiner got me to feel the reservoir in her scalp. Pale
discs with ?shunt ? collateral vessels - I can never get the terminology
correct - we had a discussion on what the communication was.
Scenario was that a child was due to have
convergent squint operatio but due to an extra case on the list/reshuffling
of list when he got back to the ward mum noticed the other eye had been
operated on. The mum wanted to speak to you (consultant has left and cannot
be contacted as yet).
The actress was really very good- important to try and ignore the examiner -
just do what you normally do and be nice to the patient & the usual things
such allow them to voice their concerns/eye contact/comment you understand
etc. I think I got across that it may not necessary be that he needs another
operation or squint is worse as eyes work as a unit/sometimes we need to
operate on the other eye for a squint but made sure she knew that we would
have to re-assess the squint with orthoptics (do didn't give false
expectations but gave her some hope not all was lost). told her what we
would do next & what mechanisms were in place to make complaint/incident
form/prevent this from happening again.
Felt it went very well as initially she was very angry/thumpping
table/crying /etc but started to calm down. Think the best thing I did was
to offer a cup of tea and biscuit at the end - made her laugh (and come out
of character) - examiners laughed too - she said thank you that is very
nice! Which brought it all to a very nice conclusion. (cup of tea
always makes things better
Sorry can't remember everything. Managed to pass - must say I'm really
surprised - at the time thought I had done really badly as examiners really
push you with their questions and play games to make you doubt your
diagnosis (e.g. one guy kept saying "Really doc is that what you think it
is" to every differential I gave him!) It all goes very quickly and makes
you feel that you really didn't get to show what you know and all that hard
work was for nothing. All i can say is you never know what the result will
be - just try to keep calm and not let examiners to get to you or it will
affect the other stations.