Play Doctor My Eyes by Jackson Browne

© 1999, 2000, Mounir Bashour

This is an addition to the site that I hope will help everyone get into the frame of mind appropriate for the orals.

The main thing is DON'T FORGET YOUR NAME!  -- Kidding aside we are all at a stage where I don't think any of us will have difficulty in remembering to dress conservatively, shave (for those of us who have to), stay formal, and be polite in introducing ourselves and putting the examiner at his or her ease :-)

TIP #1, #2, #3,  ... #n -- BE SYSTEMATIC !!!!
Having written this, I will concede that it is my personal greatest weakness.   All of you who know me, know that I can appear unorthodox and "original" in my thinking and approach (witness this web site), while that may produce wonderful clinical results I am well aware that in the oral exams it is the kiss of death.  So I empathize with those in my situation, but I also emphasize "it will not do."

So how does one go about being systematic?  Classification and Mnemonics are the key I believe.  So lets start --

You are presented with a case history or photograph -- even if you think you know what it is, start at the begining.

Hx -- Onset, duration, progression, agg/alleviating factors?  POHx, FOHx, PMHx, FMHx?  Meds?  Social/travel contacts?

Px -- Adnexal exam including lymph nodes, if systemic associations for what you are suspecting can ask those (usually the CTD -- ulcers (genital, mucosal), joint/back pain, IBD.

PUPILS -- put on top of the list because people always forget this check for RAPD!!!!

Va -- DON'T EVER FORGET THIS!!  With this add MR and the all important CR (do not forget to cycloplege especially if <25 yo, in peds or optics sections).  PH vision?  PAM?

EOMs -- versions and ductions (any neuro, peds sections buty also plastics and optics).   Cover/Uncover -- Cross Cover.

SLE -- be systematic again from outside in, lids, lashes --> tears --> conj --> cornea --> AC --> iris --> lens --> vitreous  (STATE WHAT YOU ARE LOOKING FOR IF YOU CAN)

DFE -- always dilate for the exam (even if you don't in real life) be systematic ON --> vessels --> macula --> periphery

LABS -- there are not a lot of labs in Ophtho and one subspecialty orders the whole lot, so if stuck think posterior uveitis of unknown etiology and it will all come back to you (actually think that whenever you are stuck -- it helps :-)  (always remember do an ESR)

IMAGING -- be systematic less invasive --> more  U/S (A/B Scan. dopplers, UBM) --> Xray --> CT/MRI --> MRA/angiogram --> Gallium Scan

OK with all that you should have the Dx.  But again don't say it, well say it, but at the top of a DDx.  Here I will say that if you know the disease subject cold just say a list of the most important/common 5 DDx (I really don't think it ever needs to be more than 5 -- don't forget they are using a checking off system to grade you and I doubt they will assign more than 5 checks for this section).  "Easily said" you say, and again you are right under the stress you will be experiencing on the day, it will be lucky if you can continuously mutter in an undertone "ARMD, ARMD, ARMD, ARMD, ARMD ..... did I mention ARMD...."   So what happens if you fall into that situation -- SUPER MNEMONIC TO THE RESCUE.  You can use your own favorite mnemonic or method of remembering the ultimate etiology/ddx list, or use this one.  I VINDICATE.

IDIOPATHIC

VASCULAR (DM/HTN/ TEMPORAL ARTERITIS)
INFECTIOUS -- (always add/don't forget the great mimickers SYPHILIS, TB, SARCOID, HSV/HZV)
NEOPLASTIC (always remember LYMPHOMA/LEUKEMIA)
DEGENERATIVE
INFLAMMATORY (always remember TEMPORAL ARTERITIS)
CONGENITAL/DEVELOPMENTAL/GENETIC
ALLERGIC
TRAUMA/SURGERY/IATROGENIC
EXTERIOR/ENVIRONMENTAL/DRUGS/MEDS/TOXIC

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This page was last modified: Tuesday, May 06, 2003
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© 1999 2000, Mounir Bashour