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IP Revision Session 2023: Clinical Insights and Exam Tips

Jun 14, 2024

IP Revision Session

Introduction

  • Date: Recorded lecture/presentation in 2023
  • **Speakers: Victoria from Vision Scotland, Mr. Sanjay Mantry (Consultant Ophthalmologist), and Claire Lower (Optometrist who recently passed her IP exam)
  • **Agenda: Clinical insights by Sanjay, hints, and exam tips by Claire.
  • Setup: Technical issues with Sanjay's connection; started with Claire's presentation instead.

Clinical Session by Sanjay Mantry

Marginal Keratitis

  • Cause: Hypersensitivity to staph toxin, typically due to blepharitis.
  • **Management: **Manage blepharitis (mabomitis or simple blepharitis), concurrent approach needed involving doxycycline or azithromycin, topical antibiotics, followed by topical steroids.

Herpetic Keratitis

  • Types of HSV: HSV1 (above the waist – lips, face, eyes), HSV2 (below the waist).
  • **Primary infection usually in childhood, recurrent disease involving trigeminal ganglion.
  • Affected Areas: Lids, conjunctiva, cornea (all layers).
  • Presentations: Vesicles, dendritic ulcers (fluorescein staining important), stromal keratitis, immune-mediated conditions.
  • Management: Topical antivirals (acyclovir), systemic treatment for stromal involvement (oral acyclovir with steroids), non-epithelial disease – systemic antiviral cover.**

Zoster Keratitis

  • **Affects ophthalmic division, possible flu-like symptoms.
  • Management: Systemic acyclovir for non-eye involving zoster. For eye involvement – check corneal sensation.**

Allergic and Conjunctivitis Conditions

  • **Pattern: ** Seasonal or perennial, differential for unilateral cases might include chlamydial conjunctivitis.
  • Management: Avoid allergens, lubrication, anti-allergenic drops (acute – olopatadine, chronic – mast cell stabilizers), sometimes steroids.

Uveitis and Acute Anterior Uveitis

  • Presentation: Red eye, photophobia, pain, and cells/flare in anterior chamber inflammation.
  • Management Protocol: Dilated examination, cycloplegics, steroids (Fred Forte, dexamethasone), regular review.

Recurrent Corneal Erosions (RCE)

  • Common Causes: Epithelial corneal dystrophy, trauma.
  • Symptoms: Pain upon awakening, recurrent.
  • Management: Daytime lubrication, overnight gels, bandage contact lenses, surgical options if severe (PTK).

Fuchs' Endothelial Dystrophy

  • Age: More common in 40-50s age group due to endothelial cell drop-out.
  • Management: Early cataract intervention to protect endothelium, potential for DSEK or DMEK if corneal edema is present.

Scenario-Based Learning

Scenario 1: Red Eye

  • Initial symptoms: Red eye, photophobia, slightly blurred vision.
  • Differential Diagnosis: Marginal keratitis, herpes simplex keratitis, contact lens-related epithelial etiology, uveitis.
  • Further examination and management given the symptoms.

Scenario 2: Uveitis in Young Patient

  • Differential: Based on clinical findings and history, correct management of acute anterior uveitis.

Scenario 3: Allergic Conjunctivitis in Children

  • Management: Based on age and symptoms considering exam guidelines for acute and chronic care.

Practical Exam Tips by Claire Lower

Preparation

  • Test Reach: Install software beforehand, familiarize with guidelines and restrictions.
  • Materials Needed: Physical BNF, blank paper, ID (photographic).
  • Exam Environment: Tidy room, show 360-degree view with a mirror, remove all notes and wearables.

Time Management

  • Total Questions: 85 (75 graded, 10 pilot), 102 minutes (approx. 1.2 minutes/question).
  • Strategy: Move swiftly but carefully; remember no negative marking.

After Exam Protocol

  • Results Timing: Notify about early results release, past marks variable based on the exam committee.
  • Continuous Learning: Familiarize thoroughly with CMGs and refer updated materials sent by the college.

Study Tips and Techniques

  • CMGs: Memorize inside out, particularly scenarios and medication details.
  • Helpful Resources: Flashcards for drugs, nice guidelines for glaucoma.
  • Support Systems: Peer testing, forming study groups for scenario practice.

Closing: Encouragement to stay confident and congratulations on preparing for the IP exam. Best of luck!

Full transcript