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
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.
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.