Funny-looking optic discs are a "fun" diversion in an ophthalmology clinic (sarcasm implied here). What was initially a routine exam immediately turns into an agonizing "is this normal or not" exercise. Part of the angst that comes from seeing anomalous optic discs is that some of the congenital disc anomalies are associated with systemic diseases. If there is concurrent visual field loss or decreased visual acuity, the challenge becomes deciding if those defects in the visual system are due to the anomalous nerve, or if there is some other ophthalmic cause that we don't want to miss.
Optociliary shunt vessels (retinochoroidal shunts), are normal congenital collaterals between the retinal and choroidal venous circulation. In conditions that cause chronic central retinal vein obstruction, venous outflow becomes redirected to the choroidal venous circulation, resulting in dilation of these collateral vessels.
Neuro-ophthalmology tends to have some of the more challenging questions, depending on your level of knowledge or comfort with these topics. One of the important things to recognize and evaluate is the swollen optic nerve.
To be honest, I wasn't completely sure whether to categorize this topic under oculoplastics or ophthalmic pathology. Arguments definitely could be made for either, or both.
In any case, there are 3 major tumors that affect the lacrimal gland: orbital lymphoma, pleomorphic adenoma of the lacrimal gland, and adenoid cystic carcinoma of the lacrimal gland. If you see a test question about a tumor of the lacrimal gland, it is going to be one of those three conditions (probably).
There are a lot of practice questions on molluscum contagiosum. Although its clinical appearance and histopathology are fairly distinctive, I often confuse this with keratoacanthoma.
I'm going to shift gears a little bit and start reviews on some of the other sections. I originally had planned to go in order of the BCSC sections and follow the OKAP content outline, but I realized that of all the sections to cover, General Medicine is one of the smallest sections in terms of content to know. So while I will likely get back to it sometime in the future, I wanted to make sure the key subjects were discussed prior to the test.
There are many facts in the Fundamentals and Principles of Ophthalmology section of the BCSC that will likely be tested as quick recall. I promise, I will eventually provide numerous resources and tools to help remember these facts; for this article, I will try to cover the most important concepts. I am intentionally leaving out details that may be more challenging to test (meaning I have a hard time coming up with a practice question about it).
Keratoacanthomas are very characteristic-appearing lesions on the skin that also look very distinctive on histopathology. I get these confused on histopathology with molluscum contagiosum, so I think this is an important condition to know.
As you can probably tell, I'm starting to skip around a little bit while I put together these OKAP review articles. I have a fairly large list of topics to cover, but hopefully these will all be helpful pieces of information. I decided to skip to aniridia, because it is one of those conditions that seems to be very popular in practice questions.
I received this link in my AAO e-mail blast the other day: 5 Resources to Get Ready for the 2016 OKAPs.
It lists some important dates to know for the OKAP and provides links to several helpful resources for people who are trying to get more information about the OKAP and how to prepare for the exam, which is coming up in about a month and a half.
For those people who are wanting to get some nuts and bolts info about dates, test day FAQs, etc., you should definitely check out this article! I will eventually have some more specific-type information about my experiences taking the OKAP during residency, but in order to keep writing as many review articles as I can before the OKAP and written board exam, I may have to put that on the slate for the next academic year.
I admit, this one may be a bit more ambitious than is possible to cover in the span of just one article. Obviously, there are TONS of medications, many of them with very vague side effects. Throughout your career you will most likely see many people referred by another doctor for an eye exam because they were placed on a medication that listed "blurred vision" or "eye problem" as a side effect. Your patients may ask you about this. You also may prescribe some medications that need systemic monitoring. While the OKAP probably won't quiz you over some obscure side effect of some uncommonly used medication, there are definitely some ophthalmic and systemic side effects that we need to know very well. While I will try to discuss the salient points in a coherent manner, detailed information will have to be addressed in other articles. This article will also have overlapping information with the Fundamentals section.
It seems like a large percentage of our patients have some semblance of hypertension. For most ophthalmologists, the majority of what used to keep us up late at night in medical school - treating hypertensive urgency, adjusting long-term meds, counseling patients about sodium intake, debating whether or not to work someone up for pheochromocytoma, etc. - no longer has any direct relevance. I don't mean this in any negative sense, of course, but the point is, management of hypertension is no longer our field of expertise. However, there are still some key things to remember about hypertension. After all, we're still medical doctors.
Carotid occlusive disease is another systemic condition that has some very significant ophthalmic manifestations. For the sake of brevity, this article will primarily highlight the systemic information we need to know for the OKAP, including transient ischemic attacks (TIAs). I will post other articles pertaining to some of the ophthalmic manifestations of carotid occlusive disease, such as ocular ischemic syndrome and transient monocular visual loss (specifically amaurosis fugax). Hopefully this will be a shorter one!
There are a ton of infectious diseases we have to know and recognize. While hopefully most of the following are a review of concepts learned in undergrad and medical school, there are some minutiae that I often will forget. Some of these infectious diseases will be addressed in later articles, pertaining to the specific eye condition it may cause. Not all infectious diseases will be discussed; only the ones where there were specific pathophysiology-related discussions listed.
I admit, most of the general medicine categories will be rather broad topics. Truth be told, the main things you need to know about HIV and AIDS are more geared towards the opportunistic illnesses that arise from the immunodeficient state present in the late stages. You'll likely see some of those opportunistic conditions pop up in other sections, as we work through each article.
It's review season! The OKAP exam and written board exam are coming soon, and to try and push out some useful reviews before the exam, I'm going to publish a series of articles covering some of the major concepts you should probably have mastered for the OKAP and for the written board exam. Because the OKAP and written board exam cover similar topics, you'll probably find some overlap if you read both sets of articles. However, there are some key differences, both in breadth of content and in depth of content, that will make these articles slightly different. For example, you will not be tested over any topics in General Medicine or Fundamentals and Principles of Ophthalmology on the WQE.
I may be a bit too ambitious, but my hope is to have these articles published with enough time for those who are hoping to use this site to help study for the OKAP or WQE in March. I know, my rate of publication hasn't been stellar this past year, but since these are all adaptations of previous material I made in residency, hopefully I won't have to do as much background research (typically each article takes me around 6-8 hours to research and assemble).
Before we get started with the individual techniques of measuring visual fields, it's important to understand some basic terms and principles. Entire books have been written about visual fields, so while this and similar articles are geared towards basic review, you may wish to check out some of the resources below to get more details.
Want a quick reference for vernal keratoconjunctivitis? Check out this article!
Here we are, at the end of September, and for those in residency and fellowship, hopefully you're starting to get used to the lifestyle of the trainee. By now, the routine of waking up at all hours of the day and night, working on minimal sleep, cramming in study time, etc. should be second nature.
It was around this point during my first year of ophthalmology residency that I began to question the effectiveness of my learning/studying strategies. It seemed like my peers always had a better grasp on the obscure facts, picking up on subtle clinical findings, or be able to answer questions in lecture while I sat there clueless.
The orbital roof separates the orbit from the anterior cranial fossa, which houses the frontal lobes of the brain. There are several structures and features regarding the orbital roof that we need to remember. While this article will try to list most of the important features of the orbital roof, it is by no means comprehensive.
There are 7 bones that comprise the orbit. It is our job as ophthalmologists to be able to readily identify these bones and know pretty much every bump, notch, hole, and contour of these bones and what structures pass through, travel along, and attach to these bones.