Date: November, 2004
|Day one MCQ:
Lot's of “repeats” from the very few past paper available, however, since there is not reliable answer for those past paper, the MCQ become quite difficult (we have seen the question before, but no answer for them…), esp there are 3-4 MCQ (among the 60 MCQ) on statistic. I think that it is worth to study the past paper and also to find out the answer since there is only a few past paper available at the moment, study them won’t waste too much time.
Day two am is OSE:
can't remember station eight ...
sorry for that …. But I think that others have noted down that already
I think that the only advice is to
practice more refraction. It is extremely traumatic to fail in the refraction
part while you have spent lots of time on the bookwork and clinical exam.
Some of my colleague including me experience failure to refract others
within a week before the exam. Therefore, the advice is you must be 100%
sure the you can refract on every patient both eye completely within 15
minutes before exam. Esp if you are going to have part II and III altogether,
failing part II refraction means "let's have EVERYTHING later AGAIN" it
is very unfair and traumatic. So, practice and practice for refraction
and make no regret.
My patient was a 62 years old lady (she is a very very nice lady), receptionist with no contact lens wear with spectacles of varifocal lens and hobby of bowling. I was very nervous at the beginning and I keep on asking question and didn't start refraction. Then I start refraction and found that the room light is completely darkness if I turn off the light. And that was my first time using the light box although I have seen that in HKE before. I place the lens into the trail frame in the darkness (after the exam, others told me that there is a light switch for dim light for me to work .... certainly no one told me about that before exam). Anyway, she was hypermetropia (with against the rule astigmatism) and because I used to have myopia in HK, in the middle of the exam when I found "with" movement, I reduce the plus lens ...later on I found that I am on the wrong track and put in more plus again, I found that the lens in the box set is already in the wrong order ... I cannot find the +3.50 I wanted !!! therefore I spend a few seconds to correct the order and continue to refract ... while using the retinoscope, all I thought was "I must fail .... sigh.... I must fail.." as I thought that I would have no time to complete the refraction within 15 minutes, sweat keep on coming from my palm and after done the retinoscope part, the lady remind me that "oh, the image is a bit distorted" you know, how panic at that moment .... but then miracle happen to me, I do the refinement within seconds since her respond is so accurate and quick !!! and she can achieve 6/6 for both eye ! (after noticing 6/6 of her second eye, I said "oh, good, I am less panic now" may be the lady found me interesting therefore she look at me and laugh "oh, you was very panic" and I said "yes... but can you look back the mirror" luckily she is over 60 yo and hypermetropia, no accommodation problem arise). When the examiner come in, I have JUST complete distant vision for both eye
they ask me how to use Maddox rod and wind and I demonstrate to them I keep on asking if I can proceed to near vision and they allow me to do so then day two is done
Day three morning is the Viva part
I met Prof Adam and another Caucasian doctor (named doctor A) at the very beginning, doctor A asked me "why do you think myopia is so common in HK?"
Good question !!! How do I know Why ?
I then told him that’s multifactorial, in HK, crowding environment and intense exam may be one of the factor, but study (I didn’t study “study” for part II, just happen that I remember what I was told when I was a medical student) show that in similar environment (new york) there was no such population of myopia, therefore genetic play a role but no genetic region was isolated …
Then he ask me “ what treatment for myopia”
I ask all including LASIK then he ask “tell me something about LASIK” when I mention about the flap, he asked “how deep can we cut the cornea” I don’t know the answer therefore I told him the factor in consideration of depth, advantage and disadvantage of too deep and too shallow, he keep on asking me “ then how deep is the limit” I told him don’t know but guess should not be more than half of the thickness, he ask me about IOP and ask me how LASIK would affect applanation…. He also asked me lasers, use of it, and particularly ask about Yag laser
Adams ask me about pachymetry and parallax
He also ask if a manifest squint patient can use Maddox Wing, I said yes ….. but then he told me that I was wrong and also explained the reason to me “they cannot have binocular vision” ….
Sorry, it is already 10 days after exam, can’t remember the questions that much
But I was very sad after the viva, cause I thought that I perform very badly
I was too nervous and answer very in a rush way and even I myself do not understand what I was talking about, I could not explain concept very clearly
Therefore I went back to my room and slept a bit, despite of my planning of study a bit short cases. I was too sad to study
Then in the afternoon, I went to the venue for short cases
The first case was an old lady, I was asked to check cover and uncover test, there was only mild phoria and then he ask me test her EOM, that was VI, examiner ask me examine her glass, there was frenel prism on the right side. He ask me about ddx and he was satisfied in that station
Then I come to a men for confrontation. He has very obvious left hemianopia, I told the examiner about the site of lesion and he ask me what is further Ix, I told him Goldmann perimetry and also whether conguate or not is most important … he then ask me the cause of his VF loss, I said that he do not look like a patient recovered from stroke then sudden I notice a scar on right forehead and told him about it saying that previous brain operation… he was satisfied
Then I was asked to examine pupil reaction of a man, I comment on his anisocoria and examiner told me that right eye was dialted with medication, I then perform direct and indirect and accomodation reflex, I also told him that there was no reverse RAPD, he then ask me about reverse RAPD, I answer correctly and he ask me to examine again, oh, there was reverse RAPD (actually I forgot about what is reverse RAPD, only by answering his question, I remember it again therefore when I look for it again, it appear ^_^
I came to a men with guide dog and was asked to examin fundi with direct, I firstly comment about the guide dog saying that the men probably suffer from very poor vision of both eye, the examiner was very happen and I go on for exam, the men was RP (dilated pupil)
Then we come to a man lying on bed and I was asked to look at temporal fundus with indirect, there was laser mark, cryo mark and elevated scleral buckle mark, I mention those to examinr and then he ask me look at posterior pole, that was a myopic fundi, I then correlate the two and examiner was again very happy
Then I came to a men on slit lamp, using 90D for RE fundi,, that was a pale disc, I told him that the CDR was 0.5, not too definite for guclomatous change, he was a bit disappointed I think but he still want to help me “ but the disc is pale, right” “yes, it is pale” “OK then” well, may be the CDR was more than 0.5 ? I don’t know
Then I came to an old lady with BE superficial scarring, I describe the scarring and was thinking of the ddx the examinor then told me “ if I told you that she found sudden pain when wake up in the morning …” I then mention mad-dog-finger print immediately, he was happy was it
And the clinical exam finished, my
examiners were very nice as you can tell.