MCQs:

More squint stuff than expected (particularly gadgets such as Bagolini glasses etc). Went pretty well and reading Elkington x (almost) 2, doing a few chapters from Bahn and reading the squint chapter from Kanski more than enough.

 

OSE:

Entirely predictable. Know the principles, pass the exam. Oculus course very helpful hear – really don’t need to know much detail about tests.

• Humphrey visual field = homonymous hemianopia with predictable questions about reliability indices etc
• CT orbits = calcified lesion; didn’y know what it was, but then again wasn’t asked. Questions re test and possibility clinical signs from lesion
• Hess = Brown’s; principles etc. Not actually asked for diagnosis.
• Ray diagram = slit lamp (i.e. compound microscope) – had to make he light bend a bit for the diagram to work!
• IOL calculation = which formula to use, etc. I didn’t notice that the eye had short axial length, so should have mentioned that I guess (i.e. SRK-T etc)
• Ultrasound = RD (I think – can’t remember!). Principles….yada yada yada
• Induced prismatic effect from decentration
• FFA; wasn’t entirely sure about diagnosis, but again they didn’t ask!

 

OSCE:

I had been on the Opticus course in Bradford, so this felt familiar to me despite it being my 1^st attempt at the exam.

• Visual fields station was a bit odd – found a small, nasal scotoma but didn’t map it very well.
• Slit lamp OK – patient had PI and shallow AC (only had to describe techniques – Friday’s tutorial a great help here!)
• Keratometer – took a while to switch the thing on. Found a horizontal reading OK, but struggled a little with the vertical meridian (image seemed to be very inferior on the cornea and not possible to centre) – I got a reading in the end ~ the first, but apparently lots of people couldn’t get a second at all, which led to the diagnosis of keratoconus being revealed! Questions about principles of keratometer and other ways to assess corneal curvature (topography etc)
• Focimeter - wobbly machine so I had to hold the specs against the lens rest. Bifocals – seemed straight forward (-1.25 + 2.00 x 175 with a +3.00 add), but the chap then asked ‘how did you find the axis’, which got me worried and, after theoretical bit, gave me a simple +2.00 spherical lens to do.…
• Direct – was quite straightforward. One cupped disc – asked differential… ‘is macula normal?’
• Indirect – struggled as I expected, but found treated lesion ?MM. Predictable questions, but wasn’t sure if I looked slick enough.
• Pupils – R RAPD. Had to do reverse as looked like trauma to R eye. The examiner was asking if I could like the patient having ‘2 pupils’ and RAPD – I couldn’t think of anything else, but is there a syndrome he was getting at? Random question re Horner’s and pharmacological tests, which was fine and entirely predictable.
• Motility – teenage girl with accommodative eso. A little frustrating because she clearly had a L/R that they weren’t interested in! Seemed to go OK, though

 

Refraction:

Couldn’t have gone better. 50 yo chap; 6/36 BE to 6/5 after ret (very clear reflex and decent size pupils). Leisurely subjective and did Maddox Rod before reading add. Finished after 20 minutes. I had practised for this a lot (lucky to work in a department with friendly optoms with plenty of time to teach and all cataract patients refracted at 4 weeks); I think you need to be able to do a pretty tricky patient comfortably in 28ish minutes, so there is margin for error. I was lucky to get a really good patient, but as lots of people had said that the refraction is the ‘killer’ I put much more time in here than on the OSCE and made sure I understood what I was doing (not as simple as doing n refractions). Get the ret accurate and then subjective etc is easy – no skill to that bit, just need to look slick.