Candidate 29                                          Centre: Hyderabad
FRCS (Glasgow)                                                    Date: Feb, 2003

Table 1- General medicine and Neuroophth

Question 1. 
A patient in your ward complains of chest pain . The ward sister calls you up 
and asks you to come and have a look at the patient. How will you proceed and 
manage the patient. (Answer expected: start from history-does the pain radiate 
to the arm? ….. D/D,…. findings expected in ECG..,etc.) How do you manage 
unstable angina?

Question 2
A patient collapsed when you are doing FFA. How do you manage?

Question 3 
A patient waiting for you in your OPD suddenly fell unconscious. He is 
a diabetic. What are the possibilities? How do you manage hypoglycemia?

Question 4
A patient in your OPD suddenly developed seizures. How do you manage?

Question 5 
A patient complains of transient visual loss of vision of 5 minutes. How do you 
investgate and manage. ( answer expected- examine CVS, carotid thrill & bruit; 
fundus for emboli-types; echo heart, Duplex scanning of carotid, CT/MR angio; 
was asked if any investigation in blood if the above tests are negative- expected 
to check for polycythemia, Protein S & C deficiency and most importantly 
antiphospholipid  antibody syndrome.

Table 2:Ophthalmic surgery and Pathology.

Question 1
Fundus photo of a macular hole:  How do you differentiate from pseudohole? 
Mechanism of macular hole formation. How do you manage macular hole. 
Describe the procedure. Do you use expansile concentration of gas? What 
postop precautions should be taken? A 75 year old woman with arthritis has 
vision 6/24 in RE with macular hole. LE vision 6/6. What do you advise? 
Will you do surgery on this patient? What do you look for in LE of the patient.

Question 2 
Instruments: corneal marker- What are its uses( Wanted PK & RK).

Question 3
A 25 year old man with (RE) –12 D sph does not want spectacles/contact 
lenses. What will you advise him? What options are available.

Question 4
Advantages of LASIK over PRK and vice versa.

Question 5
A patient with bilateral cataract; BCVA (RE) FCCF and (LE) 6/9. Refraction 
–8.00 D sph in both eyes. How do you manage? What will you do if 
this patient refuses any form of refractive keratoplasty?
Question 6 
Photo of an upper lid tumour- Describe, give D/D. How do you manage? 
How do you suture the lid margins?

Table 3: Ophthalmic medicine

Question 1 
FFA photos-  NPDR with macular leak. VA in both eyes-6/6. 
How do you manage? How is grid photocoagulation given? If new 
vessels begin to appear, what you will do? What are the complications of PRP?

Question 2 
How do you manage a 1 year old child with bilateral corneal haze?
Detailed management if this is congenital glaucoma.
Does corneal diameter has anything to do with prognosis?

Question 3 
A 16 year old boy presents to you with headache. Give D/D. 
On examination this boy had –1.5 D myopia. Examination revealed exotropia. 
What will you do? After correcting myopia , exotropia persists. How will you 
manage? Describe the tests you will do? Will you do PBCT in any other 
positions of gaze?- ( wanted to check for A & V pattern) What are A & V 
patterns? When are A & V patterns significant? What associated muscle actions 
you will check? Which pattern is more common? How do you manage V pattern 
exotropia ?


Case 1
Slit lamp :
(RE) Failed PK- vascularisation+ , Aphakia with complete iridectomy. 
Remnant of BSK present in the recipient ( was strongly expected to tell this).  
What may be the causes of this condition? (wanted JRA).

Case 2
Do cover tests on this patient-  patient had (RE) exotropia.

Case 3
 Do extraocular movemnt on this patient- EOM were normal. The patient had 
saccade abnormality and defective convergence.

Case 4
Do confrontation fields-  patient had restricted fields.

Case 5
Check pupillary reactions of this patient (patient had normal pupils- 
only the technique was noted). The patient had heterochromia ( Later I was 
asked to do slit lamp examination and I came to know this was due to 
Fuch’s heterochromic iridocyclitis)

Case 6  
Indirect ophthalmoscopy: case of pseudophakia with posterior capsule opacity 
(was expected to tell this). Examination of the periphery showed that scleral 
buckling was done for this patient.

Case 7
+90 D examination of both eyes (Pupil was only 4 mm)- severe NPDR- 
what do cottonwool spots indicate? How important are they regarding follow up?

Case 8:
Slitlamp: Pseudophakia- with pigments on back of cornea and on IOL. 
Posterior capsule was absent (expected this answer most). ( may be scleral 
fixated IOL).

Case 9
 Limbal dermoid with lipodermoid at outer canthus, ear tag present 
– Goldenhar syndrome-  What other examinations you will do on this patient?

Case 10
Slit lamp examination: Patient had fresh white fine, medium and large KPs back 
of cornea. Flare 1+ and cells 1+. Iris had atrophic patches and washed out 
appearance. Anterior and posterior subcapsular cataracts were present.  The 
patient had heterochromia. ( My answer: But for the large KPs, this is suggestive 
of Fuch’s hetrochromic iridocyclitis)


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