Candidate 22                                           Date: March, 2002
                                                             Centre: Singapore
The viva

VIVA..... as far as I can still recall...



1.  60 yo / POAG / On Xalatan.  IOP 28.  What are you going to do?
- Can you add Pilocarpine?
- What do you monitor?
- What if still not controlled?

2.  NTG

- What features are there?  Besides fundoscopic 
   findings besides disc changes?
- How do you monitor?
- If IOP 18, progressive VF loss, what to do?

3. Pt had penetrating injury.

- IOP 25.  What are your thoughts? (higher? lower?)
   Here he continues with 2 very obvious, simple
   follow-ups, hence I think my earlier answer was 
- What if corneal oedema?
- What if corneal thinning?

4. What are the factors affecting Goldmann Applanation Tonometry? 
     (He wanted "amount of fluorescein")

- What do you do if pt cannot do GAT?

5. What other objective methods are there for monitoring glaucoma?


1. Gives a pair of glasses - (one power higher than the other). 
    39 yo / c/o tiredness at end of day. 
    What are your thoughts?
- Asthenopia, Presbyopia, Incorrect power,
- What problems are there with anisometropia?
- How to correct? 

2. What kinds of refractive surgery is practised nowadays?


3.  What would you tell pt of the common problems of LASIK?

- most feared infection, glare, haloes, dry eyes..
  epithelial problems...
- What happened if patient has worsening visual acuity? 
- What parameters will you monitor? 
- If you're doing a QA, what will you record down?

4. Tell me how you do vitreous tap? 

- So will you do under loupes? microscope? 



1. Pt has amenorrhea, galactorrhea,  progressive visual loss in 1-eye. 
What are you thoughts?
- How will you manage?
- It's a macroadenoma.  Who else will you refer to
   besides Endocrinologist? 
- What VF problems can she have?
- Draw me junctional scotoma
- If she has no visual BOV, but has RAPD, is that

2.  Pt has bilateral optic disc swelling, BOV. What are the causes?

- Papilloedema, Malignant hypertension, consecutive 
   AION/optic neuritis etc..
- If it's Papillodema, what are the causes for BOV?
- What about the blood vessels? 
1. 70 year old with progressive loss of vision.  Causes?
- What kind of ARMD if pt gets progressive worse VA?
- What the pathogenesis of ARMD? 
- Why are there Bruch's breaks for CNV to form?
- Is location important?
- What is defn of extrafoveal?
- What treatment modalities?
- What do you know about TTT? 
- How do you advise a pt going for laser Rx?
- Pt is afraid of going blind?  What will you tell him?
2.  Diabetic patient.  Has progressive poor vision (6/60, 6/36).  What 
     are the causes?
- CME, CSME, cataract, glaucoma
- Which is more important?
- Can you tell if LOV is due to cataract or CSME?
- What would you do?
- How do you perform focal / grid?



1.  ROP
- How do you stage ROP?
- Which kids are you more wary of?
- Why do you need to F/U on kids with ROP?

2.  3/12 old has white reflex?

- What is this?
- What are your differentials? What infection do you 
- Suspicious of Rb.  What do you do?
- How to manage?

3.  1 yo. Mother notices 6/12 of esotropia.

- What are your differentials?
- What will you do?
- What are your management principles?


1. DCR

- How to categorise causes of NLD block? 
- What acquired causes? (infxn, mucocoele, stones,tumours...)
- What tumours? (sinus, epithelial, bony)
- What else?
- How to perform DCR? 
- What size coin is the size of the osteotomy compared to? 
- OK then, what dimensions roughly?
- Complications.  How would you manage bleeding intra-op? What 
    instructions will you tell the anaesthetist? 
- Post-op?  Will you give the patient a hot drink?
My clinical  cases :

1.  ACIOL with inferior decompensation.  Incidental bilateral myelinated NF

2.  Granular dystrophy

3.  Terrien's

4.  Traumatic ERM 

5.  CSR 

6.  Bilateral central corneal scarring, lid disease, symblepharon, peripheral corneal / 
     stromal vascularisation.  Some think it's Trachoma.  I thought IK..

7.  BIO - abnormal blood vessels.  (Thought it was Optociliary shunt, but couldn't 
     be sure on BIO).  Didn't get to see on 78D.  Asked to hazard guess.  Said OC 
     shunt, but no apparent cause seen. ? resolved non-ischaemic CRVO

8.  Bilateral subluxed lens - she was seated at the slit lamp, but didn't 'look'
     Marfanoid (altho' didn't need to go into that).  The examiner kept asking why 
     the patient was getting progressively more myopic.

Other cases seen by candidates:

1.  Myopic & Lattice degeneration with a hole. 

2.  Retinitis pigmentosa (apparently asked to see with direct) - has bone spiculation 
    & epiretinal membrane

3.  Macula hole (direct)

4.  Down-&-out non-axial(obviously) proptosed eye with telangiectatic vsls on the 
     cheek - asked to examine & surmise a guess : ? Ethmoidal tumour with 
     radiotherapy done

5.  Old CRVO with sclerosed vessels

6.  Lisch's nodules - patient was wearing long sleeves, no nodules seen on face.

7.  Granular dystrophy (again)

8.  Mooren's ulcer

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