|EXTENDED MATCHING QUESTIONS
Difficult to prepare for as they are actually very much based on clinical
judgement. I spent more time thinking of what I would do if I saw this
patient in clinic rather than trying to remember what I’d read in textbooks.
A surprising number of surgical questions particularly retinal surgery.
Nothing too unexpected. Subjects covered included: Chlamydia; retinoblastoma
and its genetics; preparing patient with MRSA for theatre; actinomycoses;
BCC; SCC; OCP (ocular cicatricial pemphigoid) etc.
STATION1: Neuro-ophthalmology and Motility
Examine EOM. Patient had restriction of abduction of left eye in horizontal
plane but apparently good laevodepression and laevoelevation. Reason for
narrowing of the interpalpebral fissure on adduction. Commented on this.
Asked for diagnosis. I said I thought Duane’s most likely but the normal
laevodepression and laevoelevation was atypical. I was told that it was
a complex case with no simple answer and could I give any other differentials.
Mentioned left 6th and some restrictive causes.
Inspect this patient. Noted bilateral ptosis. Examine as you think
appropriate. Did full ptosis exam without interruption from examiners.
Noted lid scars of previous surgery. On testing EOM patient had restriction
of almost all movements. Differential? Offered Myasthenia, CPEO, oculopharyngeal
dystrophy and Kearnes Sayres
Was told at the end of this station that I should be very pleased and
that I had done well
STATION 2: Ophthalmology and Medicine
Measure this lady’s BP. Hypertensive at 160/90 but said I would like
to recheck after 10 minutes. Examine fundi with indirect. Multiple macular
and peripapillary chorioretinal scars. Differential? Took a bit of a blank
here: POHS, multifocal choroiditis, PIC, MEWDS etc. What treatments would
you offer her for choroiditis? Steroids. Any concerns re this treatment?
Yes – she’s hypertensive. I would like to consult general physician re
Scleral thinning. Differential. Systemic associations of scleritis
and of anterior uveitis. Other causes of scleral thinning. Should have
been straight forward but somehow wasn’t.
STATION 3: Posterior segment
Superfield and indirect. Heavy peripheral pigmentation. Differential?
Looked like old cryo for RD
Peripheral lattice and some areas of bone spicule type pigmentaion.
Unilateral pale optic disc. Differential. Generally attenuated vessels.
STATION 4: Glaucoma, cataract and visual fields
Given history of patient having been referred years ago by optician
concerned re something and kept under review but then sudden loss of vision
right eye 1 year ago. On examination bilaterally cupped discs. Right macula
showed some fibrosis, oedema and haemorrhage. Asked to put it together:
said glaucoma complicated by macular BRVO. Examiners happy. Shown Humphrey
VF and asked to comment. Did the full description. Arcuate scotoma.
Visual fields by confrontation. Bilateral constricted fields. Differential:
glaucoma; PRP; RP; bilateral occipital infarcts etc. Examine discs. Both
3rd case which I can’t remember
STATION 5: Communiction Skills
7 minutes taking history from pateint with migraine. 7 minutes counselling
regarding diagnosis, management, ocular features, driving and employment.
STATION 6: Anterior segment
Bilateral penetrating keratoplasty. Peripheral host cornea showed lattice
changes. Questions re diagnosis, genetics and presentation.
Unilateral penetrating keratoplasty. Fellow cornea thinned with stromal
scar. Said it was keratoconus. Told to loook again. Said pellucid marginal
degeneration. Asked re different types of and indications for grafts. Took
ages for examiners to drag the words “tectonic graft” out of me.
3rd case which I can’t remember.
By this stage examiners were clearly tired and bored and there was
lots of laughing and joking between everyone. Which was unexpected.