Candidate 55
Date:  November 2005
Centre: Manchester
Result: Pass
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1) Synaptophore ray diagram. Contrary to people saying it was a difficult one, it's even easier than the mirror/ lens diagrams. Do it from Kanski-that's the simplest one- it's in the chapter on paed. ophthalmology.
2) MRI -coronal scan of TED- my sincerest advise- DONOT confuse MRI with a CT scan
3) Ray diagram of convex mirror-again better than getting a concave, coz only one type of image formed, wherever the object
4) Hess chart - Mechanical restriction-that's the most important thing to mention plus what is under/overacting. It was a blow out fracture with entrapment of Inferior Rectus. I know a lot of people thought it was TED. Doesn't matter! The important thing is that they don't want the diagnosis, just a good description of findings and that you can distinguish between palsy and restriction.
5) Visual field- know what's good for screening vs follow up once diagnosed.
6) FFA- again a good description is all that's needed. I thought it was CSR, but there was no serous elevation, and my knowledgeable friend thought it was idiopathic retinal telangiectasia(!!!!). The point is I passed just by describing it, so can u,and  unless they don't SPECIFICALLY ask for a diagnosis, say things like 'maybe', 'could be'.
7) B-scan- RD or choroidal. I put choroidal. I think the best thing is to say could be CD/RD, needs other views, blah, blah
8) Calculate prismatic effect: best to do this from American Academy book- elkington doesn't have enough info on it.
1) Direct- cupping. Usual question about filters and magnification, and how it differs in myopes, etc. When I said that 'I'm dialling up a high plus lens to look at the anterior segment', stopped me and asked me 'how high?'. I said +8, seemed satisfied. I know some books say +10-doesn't matter!
2) Indirect- Geographic atrophy and angioid streaks- This (D & ID) was my first station- examiners were lovely. Very sweet and helpful and said well done in the end.
3) Motility- Nystagmus-should have said pendular due to congenital cataract. My mistake that didn't pay attention to glasses before they were removed. I thought it was jerk so hesitated too long before venturing forth a diagnosis when asked. I asked for VA right in the beginning-examiner said very poor OU. I said than cover test will not give much info-he asked me to still carry on with it. I hated this station!!!!! 
4) Pupils- I said Adie's- don't know what it was.Asked Q's about pharm. tests of Adie's and Horner's. Then asked if  complete CNIII palsy pupil would react to pilocarpine- I said yes, asked me 'are u sure?' twice. I stuck to my guns and said YES! (By the way not only will it constrict to pilo but should also demonstrate denervation hypersensitivity- try not to let examiners confuse u-know your basics)
5) VF- started checking periph. vision with white pin, examiner stopped me half way through and asked me if that was the only pin I'll use- I said no, will use red pin for central. He asked patient to relax and pulled out a humphrey printout and started asking me Q's on it, like reliability, PSD, MD, etc. Then asked me to draw anatomy of visual pathway- I loved this station coz I didn't actually have to do the whole VF. I think the patient probably didn't have anything, so they decided to quiz me.
6) SLE: Corneal leukoma- Although I didn't know it was called that (my friend told me again later). I just described the opacity properly and that iris was adhering to it. Asked me what can cause it. I said trauma, said what else? I said perforated corneal ulcer-seemed happy.
Again station 5 & 6 had nice examiners.Bless them! Oh yeah, I was also asked about the red line on the tonometer- what it's used for ( astigmatism above 4 D, etc., etc.) and filters on SL.
7) Keratometry- von Helmholtz. Finished quickly and was asked lots and lots of questions coz a lot of time was left. Usual optical principles, how wave front analyzer works, where to remove suture from post PKP if auto refraction known, etc. This was my best station. Advice to those who haven't used von Helmholtz/ B&Ll- check at the optician's in town- they usually have it and are usually happy to teach you and let u practise. That's what I did.
8) Focimetry- was asked to check right eye of single vision lenses- don't know why I checked both- don't do what I did- just stick to what examiner tells u to do. Asked usual questions about principles and what other methods to check lens power.
Lovely examiners- all smiles and 'please relax' etc. My retinoscope died even before I started- had to use examiner's who was very nice about it (trick is don't freak out due to technical failure). Low hyperope. Did all steps and finished on time. My advice - if a bit confused on cylinder during objective- don't waste time- leave it and you can refine during subjective. It's more important to finish all steps and finish on time anf FINAL VA than getting cyl accurate on retinoscopy.
P.S.: Examiners DO matter! A nice pleasant one just makes u remember your answers so much better and vice versa!
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