Week 12 Homestretch!

Great job on finals so far, everyone! We're past the half way point--almost there!! 

Updates on finals

Case Analysis:

1. 30 multiple choice questions (10 questions from my material, 10 questions from Dr. Myung Lee's material, and 10 questions from Dr. Lee's material)
   Anything is fair game
2. There will be 4 written cases that will exactly resemble what you did on the homework except for different data.
   I will start to post the answers to the homework this week on moodle
3. There will be 5 written extra credit questions regarding packet #3 (Ocular side effects of medications, systemic pathologies, etc)

OHP

(email from Dr. Lu) 

Hi class,

As Dr. Comer mentioned, there will be approximately 15 or 16 questions from my lectures on the final exam: DPA's, slit lamp biomicroscopy, slit lamp evaluation, vital dyes, comp exam.

I'm attaching a very broad review sheet for those of you who are totally lost as to what to study for my portion of the exam (but I'll admit, it pretty much says to study everything).

I'd prefer that you contact me via email if you have questions. I like to text (and I'm probably faster at texting than Dr. Comer is -- maybe we should have a text-off one of these days) but not about OHP I. I'll be able to give a much better explanation via email and send it to the entire class. If you email me after 9 pm, don't expect a response until the following day (at the earliest). Old ladies need their sleep.

Best of luck in studying (almost done!)

Dr. Lu

2014 OHP 1 Final Exam Info

When? Thursday, 11/6/2014 12:30 pm to 3:00 pm (2-1/2 hours)

IMPORTANT: Please be in your seats a couple of minutes before 12:30 so that we can distribute the tests. If you arrive while we are distributing the test then get a seating card from the table in the front and wait in the front until we bring the test down.

Weighting?  The weighting of the final exam in your final weighted Course 660 grade is 41% of the total final weighted course grade. See the syllabus for the other components e.g. Midterm 1 is18%, Midterm 2 is 21%.  Note: the lab is 20% of the total course grade and the lab must be passed in order to pass the course 

Total questions: ~64-70 Why so many? Because the Final is worth 41% the fewer the questions the greater the impact of any one on your final grade.  With say only 40 questions that is great if you know the material really well but if not … Lets play it safe – more is safer. 

Questions from Dr. Comer ~ 50-55

Questions from Dr. Lu ~15-16

Overall weighting of questions: ~ 50 to 55% of all questions/points are on new material since Midterm 2 (VFs) and ~45 to 50% of all questions/points are on material that was previously covered on Midterm 1 or Midterm 2.

Format of questions: Multiple choice

Approximate breakdown of questions on Dr. Comer’s material:

• Section B, Indirect Ophthalmoscopy and OPTOS: ~6
• Section F, Pupil Evaluation: ~7
• Section G, Intraocular Pressure Evaluation: ~5
• New VF material: ~33-35
• Powerpoint handouts (there were 2 that I put on Moodle) on VFs
• Section I in Manual 2, VF Screening in the Primary Care Service – we did not go over this section of the manual specifically in class. It goes along with the stuff on VF screening that we covered in class so you don’t really need to go over it for the Final.
• VFs from Chapter 1 of Bajandas’ Neuro-ophthalmology Review Manual. There will be 3 or 4 of these VFs on the test. You do not need to read the chapter; just go over the VFs and the sample VFs. 

Info relating to the VF material only

Material on the Final: 

• Both of the power point handouts on VFs are on the Final exam.  Here are some comments about the material.

• Visual Field Testing Strategies (pages 16 thru 21 in the 1^st VF handout) You should be familiar with the different testing strategies and the advantages/disadvantages of each, though in screening we really only use one strategy currently, the threshold-related suprathreshold, eccentricity-compensated strategy.  Also go over the slides on page 18 on the borders of a VF defect, types of steep-bordered VFs defects, characteristics of VF defects and general types of VF defects (scotoma, depression, contraction) at the top of page 19.
• You should go over confrontations (pages 22 to the top of page 25 of the 1^st VF handout) and be very familiar with it since confrontations is used very commonly in clinical practice. Know the different types of confrontations and sensitivity of the various types of confrontations and what the different types are useful and not so useful for. 
• Go over the section on FDT and Matrix pages 28 to 34 very well since we use these instruments so much for screening.
• No need to go over the material on Strategies to Determine Appropriate Testing Level on Threshold-Related Screening at the bottom of page 36  and top of page 37 since we input the patients age or birthdate.  But do know the potential effect of inputing the wrong age – effect on sensivity and specificity the VF test.
• Go over the Perimetrist’s Duties from page 37 to page 40 at the very end of the 1^st VF handout very well.  This material describes your job when you are running a VF screening test in ECC or on rotations – it is VERY important.  So go over it very well and know how to do proper VF screening.  You must know why entering the correct age (or birthdate) iscritical, why the first several seconds of the test is critical, the lens to use on various instruments (you saw these in lab and in clinic such as the FDT, Matrix and the Humphrey Field Analyzer (HFA)).   Know and be able to use the rules on trial lens use for various perimeters (specifically HFA, FDT and Matrix).  This is very important to your being able to properly use these instruments in VF screening in clinic. 

• In the 2^nd powerpoint VF handout that I gave.  It is titled Visual Field Screening & Analysis Part 2, A Systematic Approach to Interpretation:

• Pages 1 thru page 9 in the 2^nd handout on Systematic Approach to Interpretation  - this is material that you should use to make decisions any time you screen a VF. So go over this section with emphasis on fixation losses (what are they, how does the instrument check for them, what may show as “fixation losses” on the blindspot monitor but not actually be fixation losses), false positives, false negatives and interpretation including what to do if there are misses on the VF screening, what is more likely to be real, organic VF loss versus artifactuous (not due to real VF loss) misses.  

• Section I in the manual, that is titled VF Screening in the Primary Eye Care Service

This is really the practical application and, in many cases, repetition or elaboration of the material in the powerpoint handout on when and how to perform VF screening in the PC Service at ECC. Questions are based on what was covered in class but this section of the manual is text, unlike the powerpoint handout, and is much easier to read and is the ECC application of what we learned in class.

What about Bajandas’ Neuro-ophthalmology Review Manual, chapter 1?

You don’t need to read this chapter (we covered the important info in class) though you might find it helpful. But there will be 3 or 4 VFs directly from Bajandas’ Neuro-ophthalmology Review Manual, chapter 1.  So it is wise to go over the VF defect examples in this chapter.  They are easier to put on the test than real screening VFs since they take only a small part of a page and they are easier to interpret though they are really not what you will encounter in clinic. There will also be some VFs on the test from the Humphrey, the FDT and the Matrix like those that are in your VF Screening and Analysis, Part 2 handout.  There will not be any on the Dicon perimeter though there are a couple of Dicon VFs in the handout. 

• Sample Questions and Clinical Applications of VFs and Other 660 Material

This was placed on Moodle last week.  This has sample questions that are excellent examples of what you may have on the final exam.  They are in short answer format so that you should work through the questions, try to answer on your own and finally read the key at the end.  Note that some of the questions require more than knowledge of the material. They often require you to use the material as we would in a clinical situation – correlating the VF info with VAs, color, pupils, ophthalmoscopy or other clinic info as well as using all of the info to make clinical decisions.