Candidate 46                                                  Centre: York
MRCOphth (Passed)                                                          Date: March, 2004
EMQ paper:

VERY small print stuff, I recall questions on pigmentary retinopathy, origins of immunosuppressants, which types of VR surgery for different types of detatchment. 

Viva on diabetic retinopathy and rubeosis slides. Stations with slides on conjunctival lymphoma  (management, which stain used). Toxoplasmosis and management. 


Station 1

Case 1
Old Intracapsular cataract extraction. I thought it was traumatic. I really messed this up as I mistook vitreous for an IOL behind the pupil!! Questions on cataract surgery. 

Case 2
Iridectomy, corneal graft and pseudophakia. questions on causes, I could only think of trauma. then asked to look at other eye which had iridoschisis, leading to corneal opacification and anterior synechiae. 

Station 2: Communiaction skills

Made a dogs dinner of this... had to consent a pateint with ptosis for levator aponeurosis repair. Pt was not keen for LA. I failed to pick up on the fact that LA is needed for accurate adjustment and failed to offer LA with sedation. There were about three minutes of silence where I had finished and had nothing further to say!! Communicated well though, asking for questions, summarising etc.. 

Station 3: Ant segment 

Case 1
Corneal scar, broad iridectomy, and aphakia with vitreous herniation - a clear traumatic injury. questions on principles of trauma management. 

Case 2
Adenoviral subepithelial deposits. Asked about differential diagnosis and adenovirus infections. 

Station 4: Neurology/ EM

Case 1
Asked to tak a history from a patient with hemifacial pain. They seemed impressed by differential of trigeminal neuralgia, cavernous sinus carotid aneurysm, thalamic syndrome. 

Case 2
*Really bizarre nystagmus* appeared to be a left jerk nystagmus with left gaze palsy. I simply described the direction, waveform etc. I thought it must be a brainstem lesion affecting PPRF and inferior cerebellar peduncle to give a jerk nystagmus and gaze palsy. The examiner then said that this was a case of nystagmus from congenital cone dysrophy?! I then said that I would expect a pendular mystagmus if sensory deprivation. At this point the other examiner interjected and backed up my version to that of the other examiner. 

Station 5 - medicine 

Case 1
Rheumation hands. questions of management, side effects of steroid, eye complications and managemt. 

Case 2
Saddle nose and petechial rash on foot. gave differential of congenital syphilis or Wegeners. questions on managent of Wegenrs and side effects of treatment and how it affects the eye. 

Station 6: 

Case 1 
Macular toxoplasmosis scar. (slitlamp) - questions on differential diagnosis and when to treat 

Case 2 
Angioid streaks (slitlamp) - barn door. 

Case 3 
Circumscribed choroidal haemangioma (indirect). Very peripheral and hard to see. questions on associations. examiner seemed to think it was associated with sturge weber (only diffuse hamangioma assoc with SW), so I played along rather than argue and sound like a smartasrse. 

Really thought I had failed because of poor show in first two stations, but thankfully could compensate.

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