|I am Prakash Kumar Jain from Bangalore, India.
I appeared in Feb 2005 for FRCS (Glasgow) in Hyderabad. I have cleared
it by the grace of God and family prayers (little bit of my hard work too).
First day: clinical case interpretation (morning)
1.A 70 year old lady has priviuosly had complicated cataract
surgery to her right eye with an anteririor chamber implant and corneal
decompensation .she now has a brunescent cataract in the left eye causing
some shalowing of the anterior chamber and iridodonesis is noted. her vision
in counting fingers in right and6/36 in left.she has moderate respiratory
disease. What are your management options and how would you advice
2. A 50 year old presents with sudden loss of vision in both eyes .He
is an insulin dependent but rarely attends the hospital and on examination
his visual acquities rae 6/24 right and counting fingers left.there are
rubeosis iridis on both sides with some flares in AC and a vitrous haemorhage
on the left.The IOOP are 20 mmHg in rt ang 37 in left.
How would you manage the case?
3. A 22 year old woman who has toric contact lenses for 10 years presents
to her optician with a 2 month history of transient blurring of vision
and headaches. On examination shows vision is good but VF shows enlargement
of blind spots with a superotemporal defenc in the left eye. Fundoscopy
demonstrates congenital tilting of discs. She is referred to you for an
opinion. What are the possible causes of this woman;s symptoms and how
would u manage her?
If you read casually the questionslooks easy but I found them to be
demanding because time is short and you have to think and write too. Like
in diabetic retinopathy care I forgot to mention about NVG and management
like diode or cryopexy or glaucoma surgery like valve implant etc.
Another mistake was the question on scotoma (was in one eye) but
I read it as in both eye so I wrote down refractive scotoma in my
Ophthalmology related questions were easy but medical MCQs were tough.
Questions about atrial fibrillation, Friedrichs ataxia, DM, thyrotoxicosis,
pulmonary embolism, SLE, PAN etc.
I will advice reading the whole of Kanski but in particular the chapter
on systemic diseases. Harrison's Principle of medicine is also useful
because some information may come in useful for the viva.
1 day break before viva
The viva began with a clinical scenario of a patient with watering
eye and photophobia secondary to corneal abrasion. He was treated with
antibiotic ointment,cycloplegic and patching. 3 hours later the patient
called up to say he has a severe pain in the treated eye. What may be the
I answered probably developed infective keratitis, he said that
is too soon and disagreed. The answer he was after which I gave was
acute angle closure glaucoma caused by mydriatic.Questions on management
(including the side-effects of timolol and mannitol)
Next question was about dry eye, questions on diagnosis. How to perform
tear break up time and Schirmer's test.
Shown picture, a case of clinically significant macular oedema in a
diabeticc. Questions on treatment. Was asked what happens after laser and
how oedema and hard exudates disapear. I mentioned phagocytosis by astrocyte
or microglia. I dont remember the exact mechanisms but he agreed
and appeared happy.
Photo of central serous retinopathy. Asked about treatment. What are
the findings on FFA and how you treat this?
Photo showed retinitinis pigmentosa.
Showed hand of rheumatoid arthritis. D/D and what are the differences
between arthritis of RA and SLE, investigations of RA, SLE (percentage
of positive titres).What is the histological diff between synovial
fluid of RA and SLE ( Iwas getting more irritated than nervous) but i told
coolly U dont know sir for the first time in this exam). Then ask to treat
RA , I mentioned that I will refer to rheaumatologist, but the examiner
insisted and wanted to mention 1st line,2nd line etc. Then about steroid
dose, side effect.in post menopausal woman which complication you will
look for osteoporosis, he gave a big smile and told exactly.
Began with a clinical case: During retrobulbar block the patinet suddenly
became distressed , what might have happenen, I mentioned intracranial
extention of anaesthesia leading to respiratory distrees. He was happy.
How would you manage this patient. I mentioned shouting for help, CPR,
and intubation. I also mentioned respiratory stimulant like doxapram
can be tried (by thier reaction i could guess they had no idea about doxapram).Both
were very happy . Bell rang
Ophthalmic surgery and pathology
One eye 6/6 without cataract and another eye has poor vision with cataract.
The refraction was -11.00D in each eye. How would I advise the patient?
I mentioned the use of contact lens, monovision etc. but he was not happy
and the question went on for a long time.
Entropion photo. Questions on management. What is double brace technique?
I mentioned vertical incision of orbicularis oris and overlap themhorizontally.
I was not sure if I got this right as there was no responses from him.
Bullous keratopathy with AC IOL-asked possible mechanisms.
Atypical toxoplasmosis(active choroiditis involving macula). Investigations,
toxoplasma titures and HIV etc. Questions on medical management..
90D lens. Very old man, uncoperative I could see thick hemorhage at
macula, I gave a differential diagnosis of choroidal neovascular membrane.
Questions on investigations with FFA, ICG, differences between classic
and occult CNVM, PDT.
Pupillary examination. I asked for the room to be darkened which the
examiner did and passed torch. There was no anisocoria but there
is a RAPD. Fundoscopy revealed optic atrophy. Asked what I would do next,
I mentioned checking the IOP and performs visual field. The examiner asked
me to do the visual field, the patient was not able to fixate his eye but
the examination revealed only temporal island of visual field.
Small girl running here and there not opening her eyes, she appeared
to have hazy cornea., Asked about the diagnosis and I gave a list of D/D
for hazy cornea. Asked about managemnet: EUA,systemic evaluation, surgery
if glaucoma etc etc.
Bilateral obliteration of the infeior fornix. Asked about diagnosis.I
said I would like to take a history about drug use, asked for previous
signs of Steven-Johnson's syndrome, look for signs associated with ocular
cicatrical pemphigoid. i will take biopsy and mx accordingly.
Last case: perform cover uncover test.
You can mail me at firstname.lastname@example.org for further information.