MCQs

If you read Elkington cover to cover, and work the MCQs in this site, it's enough. Quite simple honestly.

OSEs

OSEs on this site are the best practice you can have for these. They can be qutie unpredictable, but not that hard if you work all the OSEs here.  These are the OSEs we had:

OSCEs

Can be very intimidating especially if examiners seem unfair. But on the whole was reasonable.

1.  Direct:  Tricky station because patient had atrophy and pigmentation of the macula, probably multifocal choroiditis (had no idea of the diagnosis!). asked about magnification and what other questions I'd ask in the history (had no idea).

2.  Indirect:  Macular scar. Wasn't asked diagnosis (and thankful for that!). Asked principles of indirect, and magnification of 20D, 28D and 30D.  Asked if I saw anything else. I didn't.

3.  Visual Fields:  Finally an easy station.  Constricted VFs, more severe on the left than on the right.  Asked what the diagnosis might be (glaucoma, RP, bilateral macular sparing occipital infarcts).  Asked how and why the red pin is used.

4.  Slit Lamp:  Bilateral corneal scars (surgical) for insertion of aniridia lenses.  Asked to demonstrate scleral scatter and specular reflection.  Asked to examine for anterior chamber reaction.  Very helpful examiners.

5.  Pupils:  No anisocoria.  Absent right sided direct and consensual light reflex.  Right RAPD (asked what grade, i said 4, he wasn't happy with that).  Normal near reaction.  I suggested Adie's even though there was no anisocoria. He seemed pleased. Asked loads of questions on Horners, pharmacological tests, pupillary pathways.

6.  Motility:  Left hypertropia but wasnt 4th nerve palsy as I did Parks' 3 step test and it was negative.  Asked about other possible diagnoses and to demonstrate the rest of motility examination, which apart from diplopia on right gaze, was normal.  Commented on chin elevation as well.  Normal convergence and saccades.  Was not asked about diagnosis (did not know it, but mentioned possible left superior oblique, inferior rectus, or right superior rectus or inferior oblique; she seemed pleased)

7.  Keratometer:  Usual station, can't get it wrong really. Asked to check both right and left eyes.  Instrument was very old and had to ask how to move it from right to left eye.  Asked about concepts and other keratometers. 

8. Focimetry:  Asked to read specs then without focimeter to look at varifocals and tell them about it.  Wasn't sure what he wanted to know and examiner was very unhelpful.  The other examiner then asked me principles of focimeter and couple more questions on telescopes.  The other consultant responsible for this station looked bored and did not ask anything else.  Puts you off.

Refraction.

I had failed refraction in the Edinburgh session and was very scared of this exam. Practiced a lot of retinoscopy at work and that did the trick. Was very lucky to get 2 friendly examiners and a very good patient.  He was a young doctor with -3.25/+0.25x135 and -3.50/+0.50x90.  6/4 after ret and practically nothing changed on subjective.  Duochrome and +1 blur test (to 6/12).  Maddox rod revealed small exophoria (1 prism dioptre) but did not prescribe any prism.  No BVD necessary. No reading add but checked range of reading (N5).  Finished in 20mins.

Refraction is the 'killer' in this exam. Practice this as much as possible.  If you get the ret right, 90% of the exam is done, so take your time on it and do it well.