Final MRCOphth Date: March, 2007
Patient with bilateral macular scars and satellite
lesions in the periphery. Mention DDX as ARMD, myopic macular degeneration,
posterior uveitis, POHS.... Asked in details of POHS, including where does it
from, should be from Mississipi, not Middle East as I said.
Patient with RP fundus and pale disc. Ask for a
Ask to comment on an FFA picture of patient with
Ask to comment on an FFA picture of patient with a
choroidal mass(?). The bell rang before I could say something.
Ask to exam patient's RE and talk about
positive findings. Can only see a dilated pupil with nuclear cataract and some
AC cells. Then asked to exam LE, which shows a trabeculectomy bleb. Asked what
to do if operate for cataract on eye with small pupil. What to do if RE has a
failed bleb? Say would do a combined phaco+ trabeculectomy with MMC, or can
consider drainage device.
Ask to comment on Humphrey VF which showed left
incongruous homonymous hemianopia. Talk about various parameters.
Ask to comment on a Goldmann perimetry showed
tunnel vision of only central 10 degree. Ask for possible causes, say RP,
end-stage glaucoma, extensive PRP etc.
Ask to see a patient with enlarged CDR on both
sides. Show the pachymeter machine and tell what is this? What is normal corneal
thickness? What is the
Ask to calibrate the tonometer (like in Part 2)
Ask about the disposable tonometer tip. What
organism could be transmitted by using the ordinary tip? Bell rang.
Patient with BE PKP. RE graft is oedematous.
Thought there is an ACIOL in RE anterior chamber. But the examiner was quite
surprise to hear I mentioned the presence of ACIOL, and one of the examiner go
to take a second look on the patient! After that, he asked what did I think? I
said pseudophakic bullous keratopathy, and he asked me about the management.
Thought it should be something wrong with this case, as I could see the examiner
started writing 'essays' on the marking sheet!!!
An elderly patient with BE aphakia and PI, some
vitreous strands in AC. Ask to exam the endothelium. Perform specular microscopy
and found some corneal guttata. Say Fuch's dystrophy, but also mention could be
age-related degeneration like Henle-Hassell bodies. The examiner asked can diet
cause this condition? I said yes, then asked how? I said it can cause some
abnormal deposition on endothelium. He then asked can surgery cause this? I said
A young girl with BE crystalline deposits in the
anterior stroma, extend to the periperal cornea. Said could be Schnyder
dystrophy, DDX include Biette dystropy, other mineral deposit or post-infection
like streptococcal crystalline keratopathy, etc.
Ask to examine an old lady with some striae in
the LE cornea. Bell rang before I can say anything.
Ask to observe an elderly man and tell what is
abnormal(?) Then examiner asked the man to walk in the room, I said he has
wide-based gait(?) The examiner then asked to exam patient's hand. On inspection
there was resting tremor, and cogwheel rigidity on testing tone. Then said I
would like to test for Parkinson associated ocular features, such as decreased
gabella tap, impaired vertical gaze. Asked to examine ocular motility. Said I
would start with cover and uncover test. Examiner seemed agitated and said do
you think it's useful to do cover & uncover test in this patient? I stammered
and said no and went straightly to test eye movement and saccades. He had
impaired vertical saccade. Then I tested infranuclear supply by doing Doll's eye
reflex. The examiner seemed happy with these and he asked what would I like to
do? I said do a brain scan to look for pathology in the
Ask to examine pupil response in an old man. One
of the examiner seemed agitated when I used my torch to elicit the light
reflex. He even asked is this the right setting to do pupil test? I immediately
said oh please dim down the light. He was still unhappy and came to grab the
indirect ophthalmoscope on the ground to shine the light on the pupil. I was
very scared by his action, but still said there was no direct, consensual and RAPD
detected. He then asked me to examine patient's VF, which showed right
homonymous hemianopia. Then I used a white pin to delineate the VF defect, which
is congruous in nature. He then asked me where is the lesion, I said should
cause by stroke in the left occipital lobe, and would like to test for
macular sparing... Bell rang. I was really scared by this 2 examiners. Made me
sweat a lot!!!
An old man present with painless sudden onset of
LE decreased vision.Said DDX: CRAO/BRAO/AION/NAION. Asked to take history from
patient. Patient said he had surgery on his heart valves, and taking digoxin.
Asked to perform CVS exam. Heard a mechanical heart sound on 1st heart sound,
and diastolic murmur. Asked which heart valve is abnormal? Said Mitral valve.
Asked if patient on warfarin what should be checked? Said INR. Asked if INR now
is 1.4? Said it's too low, should increase to 2 to 4.
An middle age lady with proptosed RE, went to A&E
on Saturday night complaining of decreased VA. You're the house officer on duty,
what should you do? Said I'll look for optic neuropathy related to TED. Asked to
take history from patient for thyroid symptoms. Then asked to perform EOM
testing. Then asked how to manage thyroid optic neuropathy. Said would give high
dose methylprednisolone for medical decompression. Asked in detail the dosage (I
think have given wrong numbers as later checked in the book!!). Then mentioned
about surgical orbital decompression. Examiner finally asked what could you do
if you are alone by yourself on Saturday night? I said oh I would like to
perform a lateral cantholysis to relieve the intraorbital pressure! Bell rang.