Generally thought by all to be very tough.
Lots of stuff not from previous years and not on this website.
Lots of histopath and Lots of immunology!
Have to write fast just about enough time.
From what I remember:
Muscle stuff probably kearns sayre, ragged red fibres etc
Cornea - ? kertoconus from history but picture looked like something
else. At least a couple of graft related questions one herpetic ( ? also
Questions on cornea and immunology
Melanoma but not straight forward
Epidermoid/dermoid cyst Questions re other ORBITAL cysts.
Lymphoma ( I think ) again questions on immunology
Lots others the I can't remember ( maybe I'm psychologically blocking it
Some very hard questions, and at least six on statistics, lots on uveitis,
but overall fair. Lots of time, - finished with hour to spare.
Middle age lady look at fundus on slit lamp undilated - cupped
discs one eye was not clear could have been either fully cupped with
sloping edges or 0.3 - I went for 0.3 was wrong ! Questions on
how I would manage.
2nd patient is a slit lamp examination too. ' Look at ant segment and
post segment'. The right eye was prosthetic ! Left had bleb, ECCE scar,
two large surgical PIs and a stitch in iris between pupil and one of the
PIs. IOL and PCO. Disc was cupped. questions on how I would manage
a stuck down pupil. Examiner was trying to get to the fact you can cut
the pupil on purpose when doing an ECCE if it is not big enough.
Questions on would I do this under topical (he wanted me to say no as it
is an only eye and difficult surgery )
Then shown Humphrey field of a right eye with inferior defect. Described.
Examiner asked as bell went whether this could be from this patient I
said yes - he said you sure? Then he pointed to the fact it was a
right field? The patient had a right prosthetic eye. I laughed and
said that's not fair ! He smiled as I left the room
Easy. Had to consent somebody ( not an actor probably an observer
from clinic ) for cataract surgery. 55 yo librarian high myopic in both
eyes one eye still good vision. Plan is to leave him 3.00 and do the
other eye subsequently. Straight forward. Remember to assume NO knowledge
from patient. He didnt even know why he was here. Always ask them if
they have any questions.
Finished with 7 mins to spare.
Lady with trab, endothelial beaten metal appearance and pupil distortion:
said ICE asked about gonio appearance.
Guy with bilat corneal dystrophy looked like granular asked about
how I could tell said family history - pt said mother had it but
none of children. Examiner said can it still be granular I said yes as
autosomal dominant but doesnt mean half his children have to get it
just means each child has 50 % chance of getting it. Questions re how
it presents and treatment went on to talk about types of grafts and advantages
and disadvantages of the types. Then about complications.
Third patient marked posterior blepharitis but no obvious rosacea.
Pingeculum temporally but growing onto cornea.. pigment on endothelium
? old Kps also had some TI defects bell went.
Motility and Neuro-ophthalmology
Scenario of middle age lady with severe headache and unilateral ptosis.
how would you proceed? Was trying to get at a painful Horners and was
trying to get me to say carotid dissection. Took ages he really had to
draw it out of me.
Young guy with right exotropia. Cover test and motility. Then
questions of differentials. wanted basic principles.
Third patient 5-6 yo boy asked to fields! He had very very constricted
field in RE was told he was NPL in other eye and 6/36 in the right. Asked
for differentials. Again become very drawn out
Medicine and ophthalmology
Had the famous Liz Graham was actually very nice
Patient in chair asked to do indirect had a strange type of what
I thought was PRP no nvd/nve looked at other eye too looked same.
Then asked to do direct . no nvd but said it looked pale. Couldnt get
a view of left disc no matter how much I tried
Talked about diagnosis cut to the chase and said diabetes. Asked
about : causes of visual loss in diabetes, went on to how you would consent
for PRP and driving. Talked about management of Hypoglaecemia they
wanted specifics of doses of iv glucose and wanted complications of Glucagon
( the examiner told me as I left it makes you vomit ) . asked to examine
the same patients hands. did not go well but basically had peripheral
neuropathy and muscle wasting. Got me to test power in hands and got
asked about muscle innervation. Then asked to do upper limb reflexes
bell went half way thru
Indirect in one eye was not getting view of disc was starting to
get worried then got a fleeting glimpse had myelinated nerve fibres.
They didnt ask me to stop so I went to periphery and saw a big naevus
went through all the features. Asked to look no more. Asked about myelinated
nerve fibres and whether they have any consequence. Asked about features
of benignity vs malignity in naevus. Asked about management didnt even
get into specifics and ended up talking about looking for spread
Next patient ( slit lamp ) had hemiretinal vein occlusion and macular
oedema asked about how to work up patient. Got onto treatment and settings
of laser. Then on to management of CRVO and then onto how to tell between
ischaemic and non ischaemic. Said RAPD and vision and appearance. Asked
what else I made the mistake of saying electrodiagnistics then got
asked about them NOT GOOD !! apparently you can also do visual fields.
Asked about why you do PRP etc.
Then at end was asked about other treatments for macular oedema said
intravitreous triamcinolone asked about complications as I was leaving
said raised IOP.
I was no where near as bad as I thought. Quite a few times I said something
eg X for a differential and they kept pushing me and
at the end they said what about X - even though I had said
it earlier! I just stayed quite and said 'oh yeh !' .
General advice : just be really confident and keep it simple.
Not sure how I did? If I fail it will be on path fingers crossed.