At least 1/3 of MCQ paper 1 is "pure pathology"
GCA and discussion on American College of Rheumatology criteria for
Retinoblastoma (undifferentiated no rosettes) invading a blood vessel
necrosis. Gave history that it was an enucleation specimen from a 4
year old boy.
Discussion on genetics, management, histological features, associated
Discussion on age-related macular degeneration of all types. No picture
shown but asked
to draw pictures showing pathogenesis. Discussion on treatment (medical/surgical)
- extremely detailed questioning (so candidates must study this very
Case 1: EXAMINE THE FUNDI
Noted Preproliferative diabetic retinopathy. Not allowed to examine
the other eye.
Questions on the various studies that have been done on diabetes including
and laser studies, UKPDS, DCCT, definition of clinically significant
Case 2: EXAMINE THE ANTERIOR SEGMENT AND LIDS
Struggled to pre-empt some diagnostic correlation. Began thinking about
Horners (because medicine section). On first examination I found only
and some minimal SPK but did not think much of it and chose to ignore
it. Reported to
the examiners that I could not find any significant pathology. He then
told me that the
patient was on 2 hourly drops and would that give me any ideas. I then
report the findings of the SPK and suggested dry eyes with artificial
Discussion on causes of dry eyes - local and systemic. (Even
dry eyes come in the exams
so don't rule it out especially if no opportunity to take history is
Case 3: EXAMINE THE FUNDI
Bilateral dry AMD. Questions on FFA features, clinic advice given to
the patient (including
registration and LVA). Asked about management of collapse during FFA.
Case 4: TAKE HISTORY AND EXAMINE RE FUNDUS
History of line developing across vision with progressive decrease
in VF inferiorly.
I offered vascular causes . Also said would rule out ocular causes
like retinal detachment.
O/E Pale disc. Was shown a disc photo of the acute stage. Swollen margins.
on diagnosis and management of GCA (including ACR crietria)
10 min viva:
Discussion on collapse in various situations (clinic, theatre, lignocaine
allergy, atropine toxicity
Case 1: EXAMINE THE ANTERIOR SEGMENTS
LE recent corneal graft with ACIOL. Discussion on pseudophakic bullous
Don't forget to examine the other eye for any clues to the corneal
Case 2: EXAMINE THE RETINA AND ANTERIOR SEGMENTS
Bilateral prolifeative diabetic retinopathy with loose scatter laser
scars. Discussion on
adequacy of laser. The patient was black and examiner wanted blood
test for sickle
cell anaemia to be included. Look for rubeosis in the anterior segment.
Case 3: TAKE HISTORY & EXAMINE THE ANTERIOR SEGMENTS
AND POSTERIOR SEGMENT
Bilateral posterior polymorphous dystrophy (PPD). Unilateral RCES (recurrent
erosion syndrome from previous trauma) with anterior stromal puncture
HISTORY). Asked if they were connected - said unlikely as PPD is not
with RCES. Discussion on management of PPD and RCES. LE choroidal naevus
discussion on risk factors of malignancy.
Case 4: EXAMINE THE ANTERIOR SEGMENTS
Young lady with pseudopahakia. Discussion on presenile cataracts. It
turns out that she
had recurrent attacks of iritis. Mention both uveitis and steroids
Case 5: EXAMINE THE ANTERIOR SEGMENTS
Young asian man with stable unilateral PK with a single retained suture
and an astigmatic
keratotomy scar. Fine corneoscleral scar as well. Other eye showed
a pigment epithelial
line but no other evidence of keratoconus. Offered trauma as a cause
but suggested a
corneal topography for the other eye because of the pigment line (??
keratoconic - since
I didn't have history). Examiner led me down the trauma path as he
said that the fine scar
was indeed from a penetrating injury. Discussion on methods of dealing
with post PK
Case 6: EXAMINE THE ANTERIOR SEGMENTS
Bilateral megalocornea with Haab's striae, RE Goniotomy scar and trabeculectomy.
LE Implant tube. Discussion on congenital glaucoma and management options.
Case 7: EXAMINE THE DISCS
Bilateral cupping. Discussion on management options. Had to interpret
a Humphrey 24-2
with arcuate defects (go through all parameters of the field carefully).
Asked on special
problems faced in black races in glaucoma management.