Directed clinical answers and station rehearsal

Match the answer to the question

Part II assesses data acquisition, diagnosis and treatment across the four published stations. These are EBO's stated domains, not a guarantee that each domain carries an identical number of points. In each case, specific questions are marked against model answers. Onsite responses are spoken; online responses are entered as free text and reviewed against the scoring grid. A memorised account of an entire disease does not necessarily answer the question being marked.

Read the verb in the question. Describe calls for observations in the supplied material. Interpret asks what the findings mean. Diagnose requires a justified conclusion or a narrowed differential. Investigate asks for the next information and its purpose. Manage requires a plan appropriate to the patient's condition, urgency and circumstances. Giving a correct operation when the question asks for image findings leaves the requested work unfinished.

EBO explicitly advises answering the question asked, keeping the answer directed and acknowledging uncertainty when the information does not allow a single diagnosis. Content belonging to a later question is not rewarded earlier simply because it is correct. Marks depend on correct content rather than answer length. These principles favour specific reasoning over an exhaustive list of every cause of a symptom.

Recognise before naming

An image-description answer should separate visible findings from inferences. For a field printout, first check which eye is tested, the strategy, reliability information and the pattern of loss. Describe a reproducible superior arcuate defect rather than announcing glaucoma before considering the disc, pressure, history or possible artefact. For a slit-lamp photograph, locate the opacity, describe its relation to the epithelium and stroma and state what cannot be assessed from a still image.

State an unavailable finding as unavailable. A photograph cannot establish corneal sensation, a static image does not measure visual acuity, and a reported normal pressure does not establish lifelong absence of glaucoma. A precise limitation often identifies the investigation needed next and prevents unjustified certainty.

Build a differential that changes decisions

After naming the most likely diagnosis, give brief supporting findings. Include credible alternatives that remain possible and serious diagnoses that must be excluded because they threaten sight or life. The alternatives should fit the actual case. A painless gradual blur after cataract surgery does not require the same differential as acute pain, inflammation and profound visual loss.

For each uncertainty, identify a discriminator. If reduced vision might arise from refractive error or macular disease, refraction and macular examination/OCT answer different parts of the uncertainty. If proptosis might reflect infection or inflammation, systemic illness, vision, motility and appropriately selected imaging influence urgency. Naming a test without its purpose is less useful than explaining what result would change management.

Do not withhold an urgent action until every differential diagnosis is settled. A newly acquired third-nerve palsy requires urgent assessment including vascular imaging irrespective of apparently spared pupils. A possible open globe requires protection and urgent surgical assessment without pressure measurement. These examples illustrate how a time-critical possibility changes the plan; they are not invented promises of particular examination penalties or marks.

A numerical station C rehearsal

Suppose a question supplies a spectacle prescription of $-10.00\text{ D}$ at a 12 mm vertex distance and asks for its equivalent at the corneal plane. Show the units and calculation rather than merely recalling that contact lenses use less minus:

$$F_c=\frac{F_s}{1-dF_s}=\frac{-10.00}{1-(0.012\times-10.00)}=\frac{-10.00}{1.12}\approx-8.93\text{ D}.$$

The requested optical equivalent is approximately $-8.93\text{ D}$; practical lens selection would also depend on available powers, fitting and over-refraction. The negative sign must be preserved, and distance must be converted from millimetres to metres. If the next question asks whether the patient is a suitable refractive-surgery candidate, the calculation alone does not answer it: corneal shape, stability, ocular surface, age, expectations and procedure-specific eligibility are then relevant.

For a toric-IOL question, identify the plane in which cylinder is expressed before calculating residual astigmatism. If a toric correction of 3 D is misaligned by $30^\circ$ in the same reference plane, the vector residual magnitude is $2C\sin\theta=2\times3\times0.5=3\text{ D}$. This does not mean that the IOL's intrinsic cylinder power has disappeared. A later management question would require confirmation of the cause, postoperative timing, stability and the risks of repositioning.

Present an appropriate treatment plan

When management is requested, begin with the urgent action if one is needed, then explain definitive treatment and follow-up. Link medication choice to the diagnosis and check relevant contraindications. For example, a pressure-lowering drug choice may change with asthma, heart block, renal dysfunction or pregnancy; a steroid plan changes if infection has not been excluded. Name monitoring and a return threshold appropriate to the problem rather than giving an unsupported universal visit schedule.

Surgical answers should identify the aim, relevant anatomy and important alternatives. A procedure is not automatically appropriate because it appears in a mnemonic. In cataract surgery with lost capsular support, the remaining support and lens design determine fixation; in glaucoma, disease severity, pressure target, progression and conjunctival status affect the choice. State what additional information is needed if the question omits a decisive feature.

Include consent, prevention and systemic coordination where relevant to the requested plan. Explain benefits, meaningful risks, alternatives and what happens if treatment is deferred. A patient with a visual disability may need rehabilitation despite anatomically successful treatment. A child with an ocular finding may need safeguarding assessment or genetic counselling. These are clinical decisions within the curriculum, not decorative closing phrases for every answer.

Practise within the available time

Eight cases in 60 minutes onsite give a mean of 7.5 minutes per case; eight in 80 minutes online give a mean of 10 minutes. These are arithmetic averages, not published fixed limits for every individual question. Rehearse using the supplied schedule and interface. Typed practice should test whether essential observations and reasoning can be expressed clearly without spending the case time polishing prose.

After rehearsal, review whether each response answered its particular prompt, used the supplied evidence, resolved uncertainty where possible and proposed a safe plan when asked. Recheck arithmetic independently and review omitted findings. Do not score yourself using an invented ten-point model grid or claim a guaranteed result from a checklist. The exact case marking grids are not published in this guide.

Official reference: EBO examination structure and guidance on answering questions. This section's rehearsal examples are original educational examples, not reproduced examination cases.