Candidate 38                                     Centre: Dundee
MRCOphth                                                        Date: September 2003

EMQ (Extended matching questions)

Accessible. I struggled a bit on one question which was about the pathologies that alter ERG (achromatopsia, x linked schisis, CSNB etc.) I relied on the gender of the "patient" and other details as I honestly did not remember when is the a wave altered etc. Another whopper was a question re: surgical options of cicatricial entropion. I never heard before a Totan (? something like that) procedure (something like ant lamella repositioning + horizontal split + lateral tarsal rotation). A lot of questions on neuroophthalmology and VF defects, the predictable question re: Bassen, Batten and the other RP syndromes, not less than 3 stems (i.e. 8-9 questions) on ptosis. That's all I can remember.

Pathology Viva

3 very straightforward cases:

  1. Anteroposterior view of the globe with a ciliary body melanoma. Asked to identify the location of the lesion, gave a list of differentials, mention the risk factors for malignancy. 
  2. Clinical photo + 2 slides of basal cell carcinoma
  3. Pterygium (clinical + slide) but the bell rang in between

Microbiology viva 1. Given a short story re: suspected chlamydia conjunctivitis, photograph of follicles. Questions about what investigations would you order, differential diagnosis etc.

Microbiology viva 2. Orbital cellulitis versus preseptal cellulitis: questions about what signs to look out for, antibiotic therapy etc

Pathology slides 1. 2 slides of retinoblastoma (gross specimen + high power). Asked to describe both pictures + other questions. I found unfair that they asked  "describe" questions on top of other 3 questions, as I barely had time to scribble something ( and I was very quick!).

Pathology slides 2. slide of a granuloma, story suggestive of sarcoidosis, asked the diagnosis (easy peasy), the test I would require etc.

Clinical Cases

Communication skills: consenting a patient for a cataract. She was a myope with a -8 diopters. Questions about balancing the refraction etc. She had a lot of questions to ask! Then I was asked to explain the difference between general and local anaesthetics.

Anterior segment: cicatricial conjunctivitis (I think it was a pemphigoid) with episcleritis

Neuroophthalmology: 14 year old. Asked to check the visual acuity in the left eye (NPL) and the visual field in the right (superior junctional scotoma). Asked which investigation I would order. Examiner happy with my diagnosis (space occupying lesion involving the  Willenbrandt's knee) and CT scan. 

Strabismus: 60 year old with IV nerve palsy. Biggest give-away was prism over the right eye base down. Asked about length of recovery, investigations etc

Posterior segment: choroidal melanoma and BRVO. Usual questions on treatment. BRVO also had a PVD with avulsed vessel but I had no time to discuss.

Glaucoma: 1 case of congenital glaucoma. Questions about ant segment dysgenesis, differences between Axenfeld and Rieger's etc. Second case was a patient with cupped discs. A visual field was presented and the examiner asked about the criteria for diagnosis of NTG (normal tension glaucoma) and why the field is called 24-2 Humphrey ("what does the 2 stand for?").

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