Candidate 168

FRCOphth Part 2

Centre:   Brighton

   Date:    April 2013

Viva :

1- Hess chart with SO palsy- discussion regarding management

2- diagnosis and management of aqueous misdirection

3- IFIS- preoperative risk factors, intra-op and post-op management

4- off licence and off label medication difference, management of c diff outbreak in department, universal precautions for surgery on high risk cases

5- sight impaired and severely sight impaired registration, consent in patient with downs syndrome


Clinical :

Ant segment

1-young pt with keratoconus and bilateral PKP. Questions regarding graft survival rates and systemic associations of KC

2-Subtle deep stromal corneal dystrophy- did not pick this up.

3- FED with DSAEK


Glaucoma and lids

1- unilateral ptosis in elderly pt.

2- pigment dispersion syndrome

3- POAG with previous trabeculectomy



1- Rheumatoid hands- discussion regarding RA management.

2- Horizontal diplopia- likely 6th nerve palsy (elderly pt). Emphasis on cover/ AC test and ocular movement. Discussion regarding differential.

3- Vertical diplopia- emphasis on parks three step test. I diagnosed 4th nerve palsy likely longstanding as the three step test showed no characteristic findings.



1- young pt with CRVO- discussion regarding diferential and tests.

2- indirect and 20 D- peripheral silicone band indent due to prior RD repair.

3- bilateral dry ARMD - refractile drusen


Ocular motility

1- proptosis: intraconal mass due to lymphoma. Did not expect diagnosis but interested in clinical approach and differential. Asked to use exophthalmometer.

2- 4th nerve palsy: asked about harada ito procedure.


Communication skills

Pt with POAG and advanced VF loss- discussion around stopping driving and telling DVLA. pt very upset and angry on this news.


Uploaded after result out.


All the best!


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