Candidate 87                                             Centre: Glasgow
Final MRCOphth (Glasgow)                                        Date: Sept, 2006

Station 1 – Slit-lamp Examionation of the Anterior Segment. 

Helpful examiners. One patient with operated pterygium, recurrence and a fresh one on the fellow eye. Asked about differential diagnosis and differences from pseudopterygium. Various modes of surgical approach. Then the other Consultant told me to examine a pt with what looked like Seborrhoeic lesions on the skin and acne rosacea. Ocular manifestations of rosacea. Felt I did ok in this one. The first station boosted my morale. 

Station 2 – Neuro-ophthalmology. 

Pupillary examination. RAPD and optic atrophy and causes. Went into vascular and demyelinating causes of optic atrophy and also into infectious and parainfectious causes such as Lyme disease. Examiner did not like the fact I went into these uncommon causes and then pushed me on Lyme disease!. I expected it anyway. At least I got the impression that I knew something. Then the same station, told to examine a young teenager. She had bilateral ptosis and EOM seemed to be decreased in all positions of gaze. I mentioned myasthenia. Time up and a sigh of relief because I did not feel I excelled in this.

Station 3  - Posterior segment.

Dilated pt with what looked like an RD or Schisis. Demarcation line visible. Looked like barrier laser. Then asked about the different forms of RD and causes. Another pt in the same station with CRAO. Differentials and management. Acute management in the clinic with a couple of hours history of loss of vision. Felt I did quite well in this. 

Station 4 - Medicine and Ophthalmology.

Easy station with RA hands and differential diagnosis. Ocular complications of RA treatment – hydroxychloroquinine, gold and steroid. Another pt with café-au-lait lesions, axillary freckles. Patient looked mentally retarded. Examiner asked me why the patient was referred to the eye people. Mentioned glaucoma, cataract but he wanted optic nerve glioma. Asked a bit about the genetics of the condition and genetic counselling. Felt I did ok with this.

Station 5 - Anterior Segment and Glaucoma

Easy station. One pt with optic atrophy, aphakia and fellow eye cataracts. Straightforward cases. Then asked to observe a man with what would like iris coloboma. But on slit lamp I discovered that this was a traumatic loss of iris. Asked to take history and patient mentioned trauma. Asked to look into the fundus which I found optic atrophy. Causes of optic atrophy in this cases. Mentioned steroids post-op, examiner hinted angle recession glaucoma which I elaborated and ghost cell and hyphaema giving a secondary open angle glaucoma. Felt I did well.

Station 6 

Comminication skills. This is a dreaded station for me but it turned out to be a simple case of background diabetic retinopathy and consent of focal laser and CSMO. Examiner didn’t mentioned anything but then I met the patient in the canteen who told me I did well!

All in all I think I did well. Ironically, the written exam was more tasking. This was my first try.

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