Candidate 185


FRCS Glasgow

Centre: New Dehli


Date: September 2014

Neuro and int med
1.Description of INO asked where lesion is and what side rt MLF and causes if it were a young female (MS) and old person (CVA tumour)
2.Pic with anisocoria to say what is most obvious finding. Possible causes - given scenario if tested in light and dark. Tests for horner's and adies including doses of drops
3. Pic with swollen disc, 80y male with headache - most likely cause: GCA. Give other symptoms and investigations and treatment. Side effects of steroids, dosing of steroids and what other drugs to give with steroids to prevent these complications. Definitive investigation temp art biopsy. If biopsy negative will u still treat: yes bc of skip lesions.
4. Known epileptic with seizure- call for help check abc, left lat decubitus, o2, protect airway, treat precipitating causes eghypoglyc, alcoholism with thiamine. Lorazepam 2-4mg and if no help arrives yet do phenytoin incision. Check diascan anticonvulsant levels and toxicology
5. Needle stick. What infections concerned about HIV hep b and c. What to do - encourage bleeding, take blood samples from you and patient, inform infection control, if high risk then start PEP. For how long: 4 weeks. How many drugs: 3. What test to do immediately
6. Right and left VFT with sup temp quadrantanopia - where is lesion, what symptoms, investigations

Ophthalmic med
1. Amaurosisfugax list causes: emoblic and artherotic and migraine.Investigations for sources of emboli and also artherotic including temp art biopsy.
2. Pic with cicatrizing eye disease to list causes to state eye findings and how to treat specifically eye findings.
3. Pt with papillae in palp conj - possible causes - akc, vkc, glaucoma gtt ?Which, giant papillary conj.write a prescription for treatment, if it were an old man possible diag: floppy eyelid and a young girl what would u advise - no contacts but then if she is not happy with her vision without contacts when what would u think: keratoconus
4. Picture with corneal dystrophy ? Granules how to treat types if surgery
5. Pt with IOP 28 - what are the immediate thoughts - glaucoma suspect. What investigations - disc, pachy, VFT, gonio

Opthalmic surgery and pathology

1. Pic with ectropion, ptosis, medial canthus cutaneous horn. Types of ectropion which is most likely this case- senile.Surgical options. Would u be worried about cutaneous horn - yes bc of risk of squamous cell ca in this age group ( older man)
2. Post cataract patient with inf alt scotoma and floaters - RD. Ways to treat and how to counsel patient
3. Pic of Pterygium and ways to decrease recurrence
4. Post op refractive surprise - possible causes, treatment and protection of endothelium by dispersive viscoelastic and to give an example
5. Retrobulbar hg pic, give diagnosis and treatment


1.Pupil exam female pt
Slit lamp for nerves - rt temporal pallor but left complete pallor - most likely cause in a young patient optic neuritis
2. Old man with right exodeviation
Motility exam
Only Able to do elevation and depression on abduction. Most likely cause CN 3 palsy partial. What else to look for:
Look for ptosis and pupil
Pupil mid dilated but not fully and fixed - most likely cause : vascular

1. Bilateral ptosis R>>L
Ptosis exam and measurements
Other obvious finding - dermatochalasis both upper and lower lids-
causes of ptosis
most likely cause: aponeurotic

2. Young boy with diagonal right corneal scar and opacification and vascularization
Most likely trauma
What else? ? Ptosis
Use torch to look at reflexes - ? Phthysical.
What is the difference between phthisical and enophthalmos
Which does this patient have.
How to proceed, Pt is NLP:
Counsel poor prognosis. Use contact lenses ? What else

Ant seg
1. Right looks like correctopia, with IOL ant capsular fibrosis, sup scar with vasc and crystal like opacities. Left with same iris defect but ectropion uvea and not much else
Diag: iris colobomas.
Congenital or aquired? Congenital bc it bilateral and inf nasal position
What type of surgery - ecce bc of size of wound and suture marks.
Adv and disadvantage of scleral ecce wound vs corneal - axis and astig
2. Man with endothelial dusting, pigment on ant capsule, and bulging of inf temp sclera- coloboma from ruptured globe avoid this by doing peritomy and looking for scleral rupture. Most likely site for rupture - just post to insertion of recti
3. Young boy with temp corneal scar, inf old hyphaema, fibrovascularmemb over lens, lens dislocated, tube shunt sup nasally. Most likeu traumatic glaucoma

Post seg
1. Man with right macular exudates, prp scars, dot n blot hgs and left periph pre retinal hg.
List differentials - DM htn BRVO radiation, anaemia
Why can prpbe done in one area only- sectoralprp for BRVO
Why do prp for BRVO - BVOS study
2. Young man with nvd, tortuous vessels fibrosis at sup temp disc and ERM - most likely cause sup tmp BRVO. Acute or chronic? - chronic. What findings would he have in the acute stage. What is ERM most likey due to - long standing macula oedema
Suppose he had a complete vit hg what to do? B scan to rule out RRD, then anti vegf if no traction. monitor how often? Monthly, then prp after view clears.



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