Candidate 33
Date: November, 2004
Centre: Plymouth
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Yet again like previous years no questions requiring any calculations. There were obviously quite a no. of questions on optics and they were very tricky as there was word play involved i.e. refraction instead of reflection or another example; 20D has a magnification of 5x (which is true BTW as it wasn't stated that this was with using the BIO) etc. Probably about 10-15 stem questions on clinical ophthalmology. Overall MCQ's were harder and trickier than before.

Station 1: 
Calculate the new lens power of a +10D moved from 12mm to 10mm 
Ans: * New power = +10.2D *

Station 2 : 

Calculate the AC/A ratio with the following figures: 15D eso distance, 5D eso with +3D for near - use gradient method
Ans: * AC/A = 10/3 *
Station 3: 

B Scan ultrasound - Name Ix & Principles. Describe findings and possible diagnosis
Ans: * High initial reflectivity with high echogenicity of multiple lesions at optic nerve head - Optic disc drusens *
Station 4: 

FFA with colour photos - Name Ix & principles. Describe findings
Ans: * Say what is seen in colour photo and then on FFA, there was an area of initial hypoflourescence with progressive hyperflourescence of a lesion of contant size - PED *
Station 5: 

Axial CT of orbit - Describe findings and possible clinical signs
Ans: * Intraorbital mass of high density in Left orbit, appeared well circumscribed with no bony involvement, also another lesion of high density adjacent to lateral wall possibly IOFB or bony artefact in same eye- proptosis, diplopia, EOM movement restriction, conjunctival hyperaemia etc. *
Station 6: 

20D lens - Name it and draw ray diagram - many drew ray diagram with BIO but essentially 20D is a convex lens hence possibly 3 types of ray diagram
Station 7: 

Humphreys visual field of left eye (if i remember) SITA Fast - Name Ix and describe findings
              - Was the test reliably performed 
              - where is the lesion
Ans: * Inferior altitudinal VF defect, describe parameters for reliability, superior retina or superior optic nerve loss *
Station 8: 

Hess chart - Name it and describe principles
               - Describe findings
Ans: * Underaction of depressors Left eye - mechanical picture *
Station 1   
Direct: look at both fundi and describe findings and talk through different apparatus/functions of the direct ophthalmoscope * looked like mild RP *
Indirect Ophthalmolscopy: look at both fundi and describe findings and name advantages of BIO and diffence between 20D and 28D * looked like unilateral chorioretinal atrophy 270 degrees with no macula involvement, possibly secondary to cryotherapy *
Station 2
Bausch & Lomb (Von Helmholtz keratometer): Name instrument and describe findings (unfortunately I never used before which I told examiners but explained I knew principles, attempted to get rings into focus but I found it impossible,therefore no readings given) So was then asked to describe what Javal Shiotz readings were like and asked about 'with the rule' astigmatism. Was not asked about principles of keratometer
Focimetry: Bifocals - both lenses, Asked to describe principles of focimetry
Station 3
Ant Segments: Describe findings of left eye- Acne Rosacea, Ant. Blephritis, inferior corneal scarring with new vessels, superior limbal scar post ECCE with retained suture material, ACIOL,  dysmorphic pupil which was reactive, no post. capsule evident but vitreous strands evident, 2 x peripheral iridectomies.Asked to describe and show different types of illumination
Visual fields: Asked to perform confrontational VF - bilateral constricted VF with possible unilateral Left superotemporal quadrantinopia. Had to use white pins for both eyes, stopped before getting to red pins and was asked diff. diagnoses (advance glaucoma, PRP, RP), then asked uses of red pins and where the lesions are possibly when isolating with red pins
Station 4 
Pupils: Left RAPD. Asked why perform accommodation. Possible sites of lesion causing RAPD. Asked if possible to check for RAPD in a dilated pupil.
Ocular motility: Bil. proptosis secondary to TED. Asked to perform Cover test and then EOM. Asked if patient will c/o blurred vision on upgaze. The trick for this dreaded station is to describe everything seen while performing the test and obviously try to tie everything in for a diff. diagnosis while doing so. Remember stay calm and take your time, don't rush.
Overall the examiners were very nice but some were poker faced, not indicating how well I did. Anyway, I felt it went well after the exam
38 y/o gentleman (who was actually showing how the buttons worked for the snellen chart...horror of horrors when I first met him before knowing he was an optician from the hospital) Specifically asked to write down retinoscopy results before checking VA (!!!) Luckily got him 6/6+1 BE objectively and subjectively 6/4 BE. Performed +1D blur test and Duochrome. Then did near adds. Managed Maddox rod for horizontal and vertical. Asked to leave room 3 mins before time, was not asked any questions!
Ret : R  -3.25/+0.25 x 90 (6/6+1)      L -3.00 DS (6/6+1)
Sub: R  -2.75 DS (6/4)                     L - 2.50/ +0.25 x 110 (6/4)
No near adds required
Maddox rod - Orthophoric for horizontal and Right hyperphoria 0.5 prism dioptre - NOT PRESCRIBED!!


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