1) Patient investigations
Lead in paragraph given
regarding 32 yr old male with 2/52 Hx of vertical diplopia.Asked for
Said MG,TED,CN 4 palsy
Given Hess chart of CN 4
palsy-Asked about muscle sequelaeetc, management and surgical options.
Then given BSV asked whether
significant diplopia.(Neither examiners sure if this was the same
2) Patient management1
Lead in paragrapgh given.
Hyperopic female had trabeculectomy 1/7 ago. AC is flat post
operative. How would you manage?
Subdivided answer into -low
IOP (overdrainage or leaking bleb)
-normal to high IOP
(aqueous misdirection, choroidal effusion)
Discussion on Mx of aqueous
misdirection, leaky blebs etc.
3) Patient management 2
Lead in statement of Gentleman
62 yr with HT,DM and BPH on Tamsulosin.Shown a picture with mid
dilated pupil and nuclear sclerosis. Discuss issues regarding photo:
non dilating pupil from DM + tamsulosin. Management of pupil + IFIS -
Approached pre-op, intra-op and post-op.
4) Attitudes, Ethics
Consent for cataract surgery.
What would you mention?
Down syndrome patient of 62 yr
of age in clinic, family present.Consent?
Same patient who’s parents
pass away and not mentally capable of looking after their estate.
Consent for cataract surgery.
5) Audit, research and EBM
Treatment options for CNVM
Discussion around licenced,
off licence and off label.Asked about the evidence for Avastin at
How would you address
sterility in your unit! Broad question, discussed theatre air flow,
autoclave etc. Asked me about gloves and mask wearing. Had a brief
discussion about the difficulty of treating C. Diff
This was a 5 minute waffle,
not sure wat was plotting here.
Given 10 minutes to prepare.
Statement starting: DVLA is
the authority in charge of licensing drivers in UK. 62 yr old female
with glaucoma comes to clinic her HVF of the RE total upper field loss
LE complete loss of field with only central island.VA is 6/6 BE. You
see this patient,she may have a few questions for you.
Started off with brief history
of surgery and topicals.Patient delighted with her vision. Nothing
volunteered regarding driving, so I popped the question. Said she was
driving of course, no hassles. Said we had to do Esterman binocular
field, but prepped the patient that it was highly unlikely that she
would pass for driving. Patient emotional but eventually accepted
1) Medicine and neurology
30 minute combined
Patient with vertical diplopia, AHP to the right.Asked to take
brief history and examine. Pt had surgery while ago for vertical
diplopia. Had no diplopia on Parks 3 step, only illicited on
dextroversion and elevation. Thought patient had bilateral IOOA and
right SOOA. Only discussed the signs,wasn’t asked diagnosis. Examiner
suggested Right SR underaction. Wasn’t quite sure.
Pupil involving 3rd nerve palsy
Patient with RA-discussion regarding her meds (plaquenil).
Looked for ocular side effects of drug, management in clinic. Wanted
RCOphth guidelines for screening. RA’s ocular manifestations
Patient with torsional nystagmus and cerebellar signs. Asked to
illicit some of the signs.
2) Strabismus + Orbit
-8 year old girl with
hyperopic correction, attending with mom.Asked to examine eye
movements.Duane’s type 1 with small left esophoria for near without
specs.Orthophoric with specs.Asked management. Do nothing!
-60 year old female with TED.
Asked to examine orbits,DO NOT examine eye movements. Faffed around
palpating orbital rim and commenting on periorbital swelling and
xanthelasma. Eventually decided that Hertel’s, Colour vision, red
saturation and RAPD should be tested! Then a discussion around
treatment options. Role of steroids, orbital decomp, radio Rx and I
3) Posterior segment
-Examine posterior segment of
right eye. Silicone oil filled eye, no indentation. Macular scar with
apparent traction from temporal periphery. Asked to describe, not
asked. Possibly FEVR though
-Examine Posterior segment of
BE. Vitelliform dystrophy Right- vitelliform stage Left- atrophic
phase. Asked about making diagnosis and electrodiagnostics
-Examine posterior pole of BE.
Discs slightly pale.At first glance appeared NAD pretty much. Asked to
examine foveas closely, had a subtle grainy appearance with
loss of foveal reflex. Told patient has very poor VA. Said might be
early Stargardts or cone dystrophy. Discussed electrodiagnostics AGAIN
4) Glaucoma and lid
-Glaucoma drainage device with
scarring of conjunctiva. Asked indications for tubes.
-Asked to examine and comment
on a glaucomatous disc.Give important positive and negative findings.
Asked about NTG and about field changes typical of NTG?Not aware of
any relating to just NTG.
-Lash ptosis and entropion of
upper lid-Asked questions regarding cicatricial causes of entropion.
Discussion around SJS/TEN and OCP.How would I treat?
5 ) Cataract and anterior
-Right decompensated cornea,
bullous keratopathy with BCL in situ. Had old large ECCE corneal
incision. No guttatae in the other eye.Quietpseudophakia
-Right scleral tunnel phaco
(looked recent) and Lasik flap scar.Discussion around Phaco post
corneal refractive procedures and current formulae
heterochromiciridocyclitis. Had right phaco and trab.
Thanks again for all
previous feedback. This does help tremendously, especially for the
non-UK candidates like myself.