I’ve been humbled by the many people who have had the courage to contact me over the past few years to ask my advice on preparing for various exams. I don’t claim to be an expert at the various exams, but I do want to help my fellow colleagues succeed in any way possible, and if this website helps more people fare better on their tests and also become better ophthalmologists, that’s great.
Here are some of the "most common" things I found in the subjects of general ocular disease and trauma:
One of the things I want to do on this site is to provide more finished "products" for you, in addition to the subject/literature reviews, test preparation and study ideas, and book reviews. These will hopefully include charts, outlines, and other media that will help augment your studies. I am working on several book-length projects for the site as well, including a mnemonics-style cheat book and a "textbook" of ophthalmology, with the goal of bridging the gap between the traditional high-academic works of the highly reputable textbooks and shorter-length review books. Since those books are going to take me a considerable time to write and prepare (probably several years at the rate I'm going now), I plan to publish those for sale. However, I still want to make the bulk of the content free, so the articles won't be hidden behind a paywall.
Phakomatoses are a multidisciplinary category of systemic diseases that is often tested for a multitude of reasons. Although the incidence of these conditions is fairly low (though chances are you will see at least 1 case of many of these conditions), there are many ocular findings that need to be considered.
I've been debating how to organize this information in a useful manner for review for quite some time. The subject material is pretty massive, and each condition could easily take several articles (and probably eventually will). But I wanted to make sure there was a useful review out there on this subject before the written board exam, in case the test covers one of these conditions.
This review is somewhat multi-disciplinary in nature. As you wrap up your reviews, one of the things I found useful was to create tons of different lists. Regardless of which test you're studying for, there are many questions that are organized differently than how one might go about learning a particular disease. As such, I started making lists of different ways to group otherwise disparate diseases that might show up as a test question, or at least help me remember a specific feature of the disease.
Follicular conjunctivitis is one of those topics that always seems to pop up on exams. Because questions can be asked about the pathology and differential diagnosis, this is a topic that probably should be very familiar to you.
In light of the Centers for Disease Control's very broad statements about alcohol use in women, perhaps this topic is somewhat appropriate. Like I alluded to in the OKAP review article on embryology, there are many ocular findings associated with fetal alcohol syndrome, which are important to know, both for clinical recognition, and also for ongoing monitoring. For further reference, the CDC has a pretty useful web portal on fetal alcohol spectrum disorders.
Symblepharon is an external eye finding in which an adhesion forms between the palpebral conjunctiva and bulbar conjunctiva (1). There are many causes of symblepharon, which is typically a response to trauma or inflammation.
Truth be told, there is not very much detail that needs to be learned about embryology; after all, we've already learned embryology in medical school. At the same time, there are some key embryology concepts that are very helpful to understanding ocular disease, and may also show up on test questions. There usually seems to be at least one question that addresses embryology, and there are tons of practice questions that test your knowledge of embryology.
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.
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!