| MCQ’S and OSE’s were quite easy. Straight from Elkington and
AAO. I could not though diagnose the CT scan which appeared to be a contrast
enhanced CT with AVM in the parietal and occipital lobes with dragging
of the falx cerebri. Magnification=16x, power=??, prismatic effect of lenses
OSCE
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Pupil exam- young lady, examiner switched off the lights mentioned anisocoria
with left pupil larger. Wanted to examine in bright light when examiner
remarked that I should not waste time. Similar in light. Checked pupils
with indirect ophthalmoscope, left RAPD noted. Questions on site of lesion
and pharmacological tests for Horner’s
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Ocular motility exam- elderly lady with left hypotropia and elevation equally
restricted in adduction and abduction. Good saccades below the midline.
Pupils- WNL and no ptosis. Asked for DD- said if FDT+ve teo and if –ve
monocular elevation deficit. Examiners appeared satisfied.
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Keratometry- javal schiotz. Examiner asked me questions about the principle
in the beginning and made me do for both eyes. Forgot to cover the fellow
eye in the first eye.The focimeter I had never seen before, told the examiner
thus- was very helpful. Forgot to focus the eyepiece in my tension, so
took out the lens and did again-examiner smiled!! Made me do for both eyes.
Told I would save time by not drawing any power crosses.
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Slit lamp exam- perfectly set with the patient aligned with the lateral
canthal marker. Bilateral aphakia with nystagmus and left divergent squint
with vitreous in AC. Asked about differential diagnosis ?said childhood
cataract surgery which seemed to satisfy the examiners
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visual fields- Bitemporal hemianopia, noted it by counting fingers only.
Question ?when do you get macular sparing. Mentioned only occipital lobe
lesions with homonymous hemianopia. Did not mention about LGB etc
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Direct ophthalmoscopy- middle aged lady. Had lasered PRP with NVD.
Asked about different filters
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Indirect ophthalmoscopy very cooperative patient with myelinated
nerve fibers. No questions asked.
Refraction
Very cooperative
30 year old student. Said was wearing glasses since 4 years of age. That
set my pulse racing as he was likely to be a high myope. Unaided visual
acuity counting fingers at 1 meter. Near- <N36. Neutralised at OD :
-13.00D/-0.5 x 180, OS: -13.0/-0.75 x 180-15 minutes over Thankfully read
6/9 OU with the above. Minor modifications in sphere and cylinder with
subjective and jacksons?and he read 6/6 OU, red better-25minutes over.
I did something very foolish now. Put the pinhole and asked if he could
read anything better- thankfully he did not!! But my friends told it was
suicidal to do such things. Hurried through Maddox rod- exophoria with
small R/L. No time to measure. Measured Back vertex distance and wrote
final prescription. Examiner asked anything else said would like to neutralize
but will not prescribe. Had no time for binocular balancing , binocular
visual acuity and binocular duochrome. Don’t know how I passed. Good luck
guys work hard and pray hard. I was lucky to have had very nice examiners
and very cooperative patients.
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