IP Exam Preparation - November 2021

General Experience

• Passed IP exam in November 2021.
• Felt different from any university exam.
• Unique experience, with need for hindsight on exam conduct.

Presentation Overview

• Quick presentation on exam expectations and tips.
• Review of five patient scenarios (discussive approach).
• Final refresher for next week's exam.

Exam Preparation

Exam Platform

• Conducted on TestReach platform.
• Download and run through a tutorial before exam day.

Exam Format

• 85 questions (75 real, 10 pilot).
• Duration: 102 minutes (Approx. 1 minute per question).
• Questions based on patient scenarios.
• Pass or fail, with varying pass marks each year.

Content and Guidelines

• Based on CMGs; answer as per guidelines, not personal practice.
• Glaucoma questions reduced to 10% (Sign/Nice guidelines).
• No conflicting questions between Scottish and English guidelines.

Exam Location

• Choosing exam location: prefer quiet, undisturbed space.
• Online invigilation involves showing full surroundings.
• Must show front of the screen using a mirror.

Exam Allowances and Restrictions

• Allowed paper copy of BNF (no digital version), with sticky notes but no scribbles.
• One A4 sheet for notes (checked post-exam).
• Need photographic ID for the exam.

Invigilation Experience

• Constant monitoring; can see you, but you can't see them.
• Must stay within the window on camera.
• Warnings for moving out of the camera's view.
• Exam invigilators check surroundings thoroughly.

Managing Timing and Technique

• Be attentive to on-screen timer (allotted ample time).
• Focus on 'pick the top three' type questions.
• Cannot go back to previous questions.
• Treat potentially wrong questions as pilot questions.

After the Exam

• Results released about two weeks post-exam.
• Pass mark set against the competence of an average optometrist.

Patient Scenarios

Patient 1: Herpes Simplex Keratitis

• 33-year-old male, red, painful, watery eye, disturbance in the vision, past similar episodes.
• Diagnostic: Stellate pattern, corneal ulcer - herpes simplex.

Management

• Prescribe: Virgan Ophthalmic Gel (aciclovir).
• Reviewing: If worsening, refer same day to hospital.
• Management by Ophthalmologist: Antivirals + Steroid for stromal keratitis.

Patient 2: Anterior Uveitis

• 25-year-old woman, red, painful eye, light-sensitive, non-reactive pupil.
• Diagnose: Anterior uveitis on the left eye.

Essential Assessments

• Check pressures (Tonometry).
• Dilated fundus exam.

Management

• Prescribe: Cyclopentolate + Pred (Minims Prednisolone 0.5%) Eye Drops.
• Return visit: If recurring, refer for systemic review and possible onward referral to rheumatology.

Patient 3: Acute Dacryocystitis

• 8-year-old boy with red, swollen eye, purulent discharge.
• Differentiate: Rule out other causes.
• Management: Same-day referral to hospital.

Adult Scenario

• For adults, consider prescribing levofloxacin or ofloxacin after BNF reference.

Patient 4: Angle Closure Glaucoma

• 55-year-old woman, hypermetropia, red, painful eye, blurred vision, severe symptoms.
• Diagnose: Angle closure.

Immediate Management

• Administer: Pilocarpine (blue eyes 2%, brown eyes 4%), single dose Acetazolamide 500mg.
• Refer same day to hospital, inform the partner for accompaniment.

Side Effects

• Acetazolamide: Common - tingling, metallic taste.

Patient 5: Rosacea Keratitis

• 58-year-old diagnosed with rosacea, ocular discomfort, lid abnormalities, corneal punctate staining observed.

Non-Pharmacological Advice

• Avoid triggers, Omega-3, manage associated conditions, consider IPL therapy.

Pharmacological Management

• First-line: Lubricants.
• If severe or unresponsive: Oral antibiotics (Doxycycline or alternatives for contraindications).