OSCE: May, 2008
1. First Viva table: Imaging (CT, USG etc.). All actual plates or photographs.
Also refraction instruments including gonio, lenses, Maddox wing etc are on this table itself. I was handed a CT with orbital metastasis and an Abraham lens.
2. Second Viva table: Surgical instruments including suture materials and a brief viva about a surgical procedure. For example I was asked about viscoelastics & the DCR incision, where it’s made and why.
3. Video: It’s a two minute video .We got a video of Limbal stem cell transplantation . just look at it carefully . The only thing you can be ready for is that in many centres you are only allowed to see the video once. No replays. We were allowed to replay it, but in five minutes if you see a two minute video twice… you do the math. Especially if you spend 15 seconds every spot writing your roll number on the sheet. So the best thing to do is first read the questions when you sit down, then start the video. It might give you a small hint what it is,and you’ll know what to look for. Our video: Limbal stem cell transplantation.
Questions:
a. Indications
b. Contraindications
c. Dimensions of the graft
4. Questions:
a. Gonio photo of angle recession glaucoma – findings, possible injury
b. GDX photograph – Identify, indications
5. Indirect ophthalmoscopy – Three marks for the examiner observing how you do the procedure. We had a patient with a normal fundus which is the normal procedure in most centres. The spot is for how you do your I/O, not for how good your fundus findings are. But remember, you still have questions to answer so the moment you reach the spot, start putting on the I/O while continuously talking about where the patient will be and how you’ll stand and so on. Always helps to explain to the patient what you’re about to do, even if you’re the 50th person to do it. Most of us were stopped the moment we shone the light into the patients’ eye, but depends on the examiner.
Questions:
- Which has more magnification, 20D or 28D
- Two indications of 28D
- What would you do to overcome glare
- The rectangular portion of light falls on?
6. Keratometry – Again the same as I/O. An observer will be sitting for the spot seeing how you do it. My suggestion is don’t fiddle with the dials. But either way, this time you’ll have to note down your exact findings. Questions:
- Note down your findings (one eye only)
- Principle
7. Pathology slides;
- Rhinosporidiosis
- Acanthamoeba cyst
8. Microbiology Slides:
- Gram +ve bacilli
- Gram –ve diplococci
9. PSM questions: Don’t forget about this spot when you prepare because there is always one PSM spot. Questions:
a. Vision 20/20 objectives, management levels.
b. Legal, economic and social blindness
c. Leading cause of blindness and how many according to the last survey
10. Alternating Exotropia: photograph of a child with AXT
11. Refraction:
You have to refract only one eye. Explain the procedure briefly , take the patients vision. Just keep talking aloud whatever you’re doing, and be clear about your steps.
- Vision, no pin hole.
- Then retinoscopy, write it down.
- Then subjective refraction, no JCC or duochrome unless it’s asked.
Keep in mind the questions asked. Examiner is there to see you’re doing everything properly.Also, a lot of people get marks for doing the procedure properly, even if you don’t get the exact value. Three questions to answer:
- Retinoscopy finding
- Subjective refraction
- Glass prescription
12. Refraction questions: This is completely unrelated to the previous spot. One big question which requires calculation and 4-5 smaller ones. For the long one we were given that a patient wears -8 D spectacles, what would the contact lens power be? Other questions included optical cross from glass prescription, transposition, types of bifocals and ideal fit of RGP lenses.
13. Cornea:
a. Corneal Topography: Status post myopic LASIK
b. Photograph of Collagen Cross Linking: prerequisites, contraindication
.
14. Sturge Weber Syndrome photograph: systemic findings, ocular findings, problems during cataract surgery
15. Cionnis endocapsular ring: Indications
16. Recurrent epithelial erosions: A photograph was given which appeared like epithelial roughening with a brief history that the patient woke up with pain, blurred vision. Questions asked included predisposing conditions, management options.
17. Fundus photograph of Subhyaloid haemorrhage (large boat shaped).
- Few causes in young adult (rest of the retina was normal)
- Management options
18. Fundus photo of CNVM with OCT and FFA
- Diagnosis (complete)
- Is it active?
- Three findings on OCT
19. Clinical picture of a young adult with non axial proptosis with CT picture showing extraconal mass
- Identify
- DD’s
- Management options
- Cosmetic treatment options
20. Lenses: Abraham, Yag PI, Panfundoscopic lens.
21. DCG photograph:
- Indications
- Other advance procedures after this
- Jones test
22. Pharmacology:
- Drugs with doses for diagnosis of
- Horners syndrome
- Aedes pupil
- Drugs for Toxoplasmosis
- Chemotherapy for Retinoblastoma
23. Bagolinis glasses photograph
- Identify
- Principle
- Diagnosis
24. Amslers grid
- How many squares in the chart
- Angle which each square subtends
- How many types
- Difference between first and second type
25. Clinical picture and FFA of NPDR with CSME
- Diagnosis
- Is FFA required for diagnosis of CSME
26. Fundus photo with FFA of CRAO (cherry red spot), other eye normal.
- Diagnosis
- Two findings
27. Persistent epithelial defect photograph
- Diagnosis
- Drugs causing this
- Management
28. A-scan (aphakia, silicon oil)
- What is the 4th and 5th spike
- Refractive status of the eye
