MCQs appeared to be very difficult, about 15%
of the questions appear in the past paper pool, however I didn't have time
to study them, therefore although they looked familiar, I didn't know the
answer ... I answered 80% of the question
Day 2 morning
I had viva in pathology and surgery:
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Change seen in histology of bullous keratopathy and treatment of bullous
keratopathy
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shown a photo a choroidal nevus and ask about management
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ECCE: compare pros and cons of limbal wound and cornea wound
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Intra-ocular lens: what is the size? what material ? ask to draw the typical
lens on a piece of paper
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A photo of herpetic stromal keratits (with fluorescein stain) asked what
to do in examination (sensation !) what are the Ddx and treatment
On the same day I had the second viva (medicine and neurology)
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Question began with a 50 years old thin male smoker present with gradual
blur of vision, ask me about differential diagnosis .. discussion on the
optic neuropathy the examiner keep on asking for causes of optic neuropathy,
include ethanol, methanol, the clinical presentation, investigation, what
blood test would I order and the treatment and prognosis.
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Another examiner ask me about myasthenia gravis, the diagnostic test I
know of , how to perform ice-pad test, how to perform tensilon test.
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Picture of a face with Sturge-Weber syndrome, ddx, eye problem, investigation
and examination and management.
Short cases:
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Slit lamp exam: macula drusen with pigment epithelial detachment.
Questions on ddx ? Investigation ?
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Indirect: middle age female with posterior pole scarring. No hx of eye
disease and vision were normal, Ix, ddx (that was probably congenital toxoplasmosis)
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Slit lamp examination: left eye PKP done, right eye had Fuch endothelial
dystrophy
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Middle age male: bilateral ptosis with limited bilateral adduction and
limited R elevation. Questions: ddx ? ( I think that should be CPEO,
since it did not look like thyroid eye disease and no evidence of fatigue
to suggest myasthenia gravis)
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Confrontation test: right superior quadrantinopia
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Cover test: Left hypotropia then 3-step test => Right congenital
IV nerve palsy
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Direct ophthalmoscope: disc pallor: possible diagnosis ?
Final day was neurology short cases:
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First case was a middle age male. History of unstable gait and clumsy hand,
I looked for cerebellar sign which appeared to be present though the patient
turn out to have Wilson's disease. Asked to perform pupil examintion on
the same pateint (both eye were dilated and sluggish to light), the examiner
asked me look at the pupil on slit lamp (I kept on looking for Adies pupil
but could not find any associated signs) the other examiner reminded me
"look at the lens" I found green sunflower cataract after she also asked
me to examine the cornea and there was a definite Kayser Fleischer ring
(before looking at the cornea, I thought the cataract was stellate cataract
i.e. myotonic dystrophy). The examiner asked me to take history from the
same patient to see what drug he is taking .. I can only figure out he
was on D-penicillamine (that's all I know !) and he asked me to take the
history again about the side effect of the drug . It was then I realized
he was also taking b-blocker to control
the tremour
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Second case was a Horner syndrome with muscle wasting of the hand, I was
shown a CXR and asked to comment (there was some fibrosis with deviated
trahea and also pulmonary effusion)
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Confrontation field test showed a junctional scotoma, asked for the differential
diagnosis. The CT scan of the brain was shown which showed a mass with
calcification. I gave meningioma as the most likely diagnosis. More questions
on management.
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