Posterior Segment:

Case 1: 

Slit-lamp with 66 D .Young patient ( ?early 40s) with very poor vision (white stick ) with bilateral macular scars which were heavily pigmented and suggestive of choroidal neovascular scar tissue. Also noted subtle disc drusen and mild angioid streaks. Asked for most likely diagnosis. I suggested pseudoxanthoma elasticum. Examiners asked for several  differentials and let me ramble on a bit…. They then smiled and said I was right the first time and quizzed me on systemic complications

Case 2: 

Indirect with 20D. Young patient (30 ish) with bilateral PRP scars and epiretinal membrane in one eye. Asked for differentials. Asked about  complications of PRP as you would describe them to a patient. Loads of questions on indications for PRP, Macular grid etc. Fairly predictable stuff.

Case 3: 

Ask to comment on a FFA of patient with ischaemic maculopathy & NVD.

Case 4: 

Ask to comment on an FFA picture of patient with a classic SRNVM. 

Glaucoma Station:

Case 1:

Describe this patient’s right optic disc. Very cupped (0.8), with central baring of pores of lamina cribrosa, rim disobeying the ISNT rule. Inferior notch with adjacent haemorrhage. Lots of  questions on normal tension glaucoma. 
 

Case 2: 

Examine this lady’s left eye. Large cystic overhanging bleb. PI. PXF, pseudophakia, cupped disc 0.9. Many questions on bleb morphology, microcysts etc . Dynamic discussion on the management of PXF glaucoma, including pros and cons of combined phaco-trab vs staged surgery. Discussed anterior chamber fluid dynamics via the trabeculoectomy.

Case 3: 

Asked to discuss HFT reliability indices in general

Case 4: 

Shown an HFT of a superior homonymous quadrantanopia which was incongruous. Describe the defect. Where is the lesion and why? What other clinical features of pariental lobe lesions do you know?

Case 5:

Asked to discuss grading scales for cataracts.

Communication Station:

Furious patient (actress), had been seen by a junior colleague who had apparently diagnosed iritis with secondary raised pressure and had started topical beta-blockers,cyclo and intensive steroid drops. Patient has now returned to clinic with a massive painful dendritic ulcer, and has exacerbated asthma. She is very upset and angry :wants to sue the hospital, and have the previous doctor sacked for incompetence. She has been using the drops in both eyes which are now sore and blurred, doesn’t want any more drops and demands to see the consultant.

Anterior Segment:

Case 1: 

Adult patient with congenital glaucoma( Trabeculectomy, Large corneal diameters- asked to measure these with SL!, Haab’s striae, goniotomy scars)  . How does goniotomy help? General management of congential glaucoma.  LE has a PKP . Asked why-- I mentioned descemet’s rupture and corneal oedema. Why has only one eye been grafted?  Other indications for grafts. What types of grafts do you know? Lots of questions on poor prognostic factors in graft surgery.

Case 2: 

An elderly gentleman with  with LE aphakia and PI. Looked like he has had pars plana vitrectomy from the conj and scleral scars Asked causes of aphakia. Complications of aphakia. Management of aphakia in children and adults.

Ocular motility and neuro-ophthalmology

Case 1: 

Asked to describe my findings in a patient with thyroid ophthalmopathy. Cover test, Ocular motility , and optic nerve function tests. Investigations and management including that of euthyroid patients. 

Case 2: 

Asked to assess a ptosis including pupils. A fairly standard post-cataract aponeurotic ptosis. I had also had  noticed a brow scar and some brow ptosis- looked like trauma. The examiner said no initially. Then the patient said that yes she had been in an RTA previously with consequent brow trauma! The examiner said sorry and well spotted !

Case 3:

Lots of photos of lid things including rhabdomyoscarcoma-was asked about conclusive investigations and management

Medicine Station:

Case 1: 

Physician: Please examine this lady’s fundus using the 90D lens!! She had optic nerve head drusen and large angioid streaks. Asked for differential. Asked to examine her systemically to reach a diagnosis – pseudoxanthoma elasticum

Case 2: 

Ophthalmologists : Examine this gentleman’s fundi with the indirect . He had a treated melanoma in the RE and a non-suspicious naevus in the LE. Long discussion on treatment modalities and survival. 

Summary :.Pathology was tricky. EMQs were reasonable OSCE Questions were fair and unambiguous. Very pleasant examiners.