OSCE
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DNB practical examination takes place for two days .It can be considered a little different from MD/MS examinations as you are giving exam in a entirely unknown place which adds to the pre exam anxiety. The examination consists of two days. First day is the cases and the next day, the OSCE .Both days are worth 150 marks each.
On the first day our clinical skills and knowledge are tested basically .we will have to have present 2 sets of cases each set consisting of one anterior and one posterior segment cases. There are 4 examiners in total .They divide themselves over 2 tables and we’ll be presenting one set of cases to each set of examiners .Usually there is a group of 25 students and are divided into 2 groups.
There are 50 patients already sitting in pairs on numbered beds. So we all are allotted cases according to our numbers. Posterior segment cases are dilated. One can prepare a list of cases that can be kept in different subspecialties and read relevant theory. That’s it about case presentation we will go to the most important part the “OSCE “. OSCE is conducted as follows.
There are 25 stations with each station carrying 6 marks.
Out of 25 stations, we have two stations meant for table viva with the examiners.
Three observer stations for refraction, keratometry, lensometry, IDO or any other procedure. Refraction is compulsory. Other stations depend, changing each year.
Slit lamp photographs, fundus photographs, gonio photographs, colour photographs form the rest of the stations.
There are two photographs per table with around three –four questions for each photograph, this means around 6-8 questions per table in 5 minutes which means not much time to think.
A clinical history is provided along with photograph to help in the diagnosis.
Every table we will be given a separate sheet to write the answers and they will be taken away at the end of five minutes.
In every photograph, there will be only few questions directly related to the picture, the rest are all theory. For example, we had a colour fundus photograph of depigmented fundus of ocular albinism but the questions were what the causes of decreased vision are in this patient, so we need to have sound theory knowledge too.
A systematic detailed preparation for OSCE would include the following as per the pattern followed till now: I have just tried to enumerate a few possible important sections in each subspecialty but not the complete list.
1. OCULOPLASTY
Colour photographs of ptosis, Marcus Gunn phenomenon, lid tumours, benign lid lesions like keratoacanthoma and orbital lesions like lymphangioma, port wine stain and orbital varix. Kanski pictures help a lot.
Ptosis, thyroid related orbitopathy, entropion, ectropion, s/p corneal tear repair, blunt trauma and proptosis are common cases kept in the examination
Diagnostic procedures: Hertels exopthalmometer, videos of ptosis surgeries, orbitotomies, lid reconstruction procedures are the probabilities
CT/MRI scans: TRO, Lacrimal gland tumours, dermoid, lymphangioma
2. CORNEA
Colour photographs of Keratitis, Dystrophies and degenerations, Ectactic disorders like keratoconus, pellucid marginal degeneration, TMD, S/P PK, failed graft etc.
Diagnostic procedures: Dyes- fluorescein, rosebengal concentration in percentage and their uses, schirmers strip, corneal topography, pentacam etc.
3. GLAUCOMA
A lot of things that can be asked in this section. Goniolenses, Tonometers: applanation tonometer, dynamic contour tonometer, perkins, tonopen
Diagnostic procedures:
- Humphrey visual field : any glaucoumatous or nonglaucomatous field defect can be kept
- Gdx printout
- OCT
- HRT
One can concentrate on the principle, various indices along with knowledge of how a printout is read. Goniophotographs showing various conditions like CD cleft, emulsified silicone oil can be kept. Photographs of glaucoma drainage implants, blebitis, encysted bleb, congenital glaucoma, pseudoexfoliation to name a few.
Videos: Trabeculectomy, trabeculotomy, valve surgery, NPDS
Table viva: Antiglaucoma medications, antimetabolites –MMC, 5-FU
4. UVEA
Colour fundus photographs of all anterior, intermediate, posterior uveitic conditions can be asked commonly.FFA findings can be asked.
5. PAEDIATRIC OPHTHALMOLOGY
Photographs in nine gazes: esotropia, exotropia, DRS, Browns syndromes, A V patterns, Hess charting, diplopia charting
Videos: Squint surgeries, lensectomy
Charts: Vision testing charts like kay pictures, teller acuity cards, stereoacuity test charts : TNO, frisby, lang, randot
Instruments: Maddox rod, wing, RAF rule, bagolini striated glasses to enumerate a few
6. LENS
IOLS: Toric, multifocal, accomadative to name a few, one should be familiar with all newer IOLS, CTR
A scan with knowledge of IOL power calculation formulae is also essential. Videos: cataract surgeries
7. NEUROOPHTHALMOLOGY
Photographs: congenital optic disc anomalies, disc oedema, neuroretinitis, NAION, AION .Basically all photographs from Kanski. Neurocutaneous syndromes is another important topic commonly asked
Diagnostic procedures: CT/MRI: in multiple sclerosis, optic nerve glioma, meningioma, cavernous sinus lesions etc
HVF: in lesions at different levels of visual pathway: e.g. chiasmal lesion causing bitemporal hemianopia
Colour vision plates: HRR, Ishihara, FM-100
8. RETINA:
This section is very important as a lot of things can be asked
Photographs: Identification of various retinal disorders Is commonly asked .ocular tumours topic is indispensible .
Diagnostic procedures:
USG: both A and B scans can be kept .e.g. choroidal melanoma with collar stud appearance, retinal detachment, ONH drusen.
OCT: e.g. we were asked to identify subfoveal CNVM, VMT with macular oedema
FFA: Can be kept with clinical photographs, we were asked to write FFA findings
Retcam: can be asked
9. OPTICS AND REFRACTION:
Problems can be asked in this section like simple transposition, toric transposition,calculation of contact lens power from spectacle power and vice versa, prismatic effect of spectacles ,magnification power of Galilean telescope. Principles of working of direct ophthalmoscope, indirect ophthalmoscope ,keratometer ,lensometer ,90D lens are also very important .In the table viva, one can be questioned regarding identification and uses of various lenses used for lasers ,orthoptic instruments .
10. COMMUNITY OPHTHALMOLOGY:
There is one station which has questions pertaining only to community ophthalmology. So it is essential to go prepared with this topic. NPCB , DBCS, childhood blindness , VISION 2020 , WHO classification of blindness are couple of things usually asked. Like we were asked to define cataract surgical rate, measures to prevent childhood blindness ,DBCS .I have not tried to cover the entire OSCE questions in this write up .it is basically an attempt to give you all guys an idea before you begin your practical preparation. So good luck and get set GOOOOOOOOOO
Contributors: Dr Harsha, Dr Vishal Nigam, Dr V.Subhasini
Please write your experience of OSCE exam along with question asked in the examination to us: eophtha@gmail.com
