|My name is Dr. Mohan Kumar. I cleared my FRSC
B in Hyderabad, India in February, 2006. This site has helped me a lot
in passing the examination. I like to share my experience with other potential
candidates. My email is firstname.lastname@example.org.
Problem solving question(Day-1, 2 hrs):
(Please read the questions carefully and repeatedly)
1. A 60-year old sailor with poor vision and pale disc.He has completed
course of antiTB drugs 5 yrs back. How do you investigate and manage the
Answer: Glaucoma, AMD, drug optic neuropathy ,cataract, ref. error
came into my mind. As the patient is a sailor, one needs to consider syphilis.
2. Post-operative trabeculectomy, the patient complained of pain. Examination
revealed shallow AC, corneal haze. How do you proceed?
Answer: It can be pupillary block with incompetent PI, malignant glaucoma,
excessive drainage with shallow AC.
3. A young girl with head injury(1 year back) developed R/E sixth palsy
and left side head tilt. Patient wants surgery. What are the risk factors
you would explain to the patient. How do you proceed with the patient?
Answer: This was a tricky question-PT. is having R/E 6th ner. with
R/E 4th nerve palsy and I discussed management of these together.
Afternoon( 2 hrs)
MCQs relating to eye were ok but medical ophthalmology were difficult
because we usually don’t read medicine topics. Read all the disease in
medicine with ocular association and the MCQ books by Chua et al.
(Most stressful 60 mints of my life- never had that feeling before)
General medicine and neurology related to ophthalmology
(most failures occurred in this viva and in the MCQs)
Tell me field defects in lesions from chiasma backwards. Why pupil is not
involved in cortical lesions. Common causes of above.
How do you assess clinically the severity of CRVO(RAPD and cotton wool
spots - as these indicates capillary closure).
How do you test RAPD? What is Adie pupil? How will you test for poor dilatation
after constriction? (ask the patient to read some magazine for 15-20 minutes
When will you treat CRVO if its your eye- I mentioned laser if there were
significant capillary dropout on FFA (5 DD) and I won’t wait for NVD or
NVE to appear- he smiled, agreed- bell- and told well done.
How will you go about a 51 yrs old hypertensive male complaining of attacks
of blurring of vision- I told in detail the investigation of CVS
and carotid system for the source of thrombosis and emboli. He was satisfied,
then he asked how to go about the same patient if he is having a clot in
the heart shown by the tests- I mentioned prophylactic anticoagulation
and he asked for details on this. I said iv low molecular weight heparin
and oral warfarin to start with then shift to warfarin only based on INR
(can be found in Oxford Medical Handbook ) – examiner was very happy with
my answer. He asked me what is INR? International Normalized Ratio - prothrombin
time was my answer.
Your patient collapses in your clinic- what will you do — I regarded this
as a cardiac arrest and mentioned checking the vital signs (ABC),
call the physician and go for CPR and along with this try to
find out any history of diabetes mellitus, hypertension, cerebrovascular
accident from the records. He agreed and asked me the procedure of CPR—
I told him the procedure and half way through the bell rang and I was the
most relieved person in the universe.
Ophthalmic surgery and pathology
Tell me the type of anaesthesia in cataract surgery—I mentioned all –he
asked me about the techniques of peribulbar and subtenons anaesthesia.
What will happen if more fluid is injected during anaesthesia. I said an
increase in vitreous pressure with increase chances of posterior capsular
rupture during operation. He asked in detail the treatment of
posterior capsular rupture (machine settings for vitreous cutter, separate
irrigation probe to maintain the anterior chamber, avoid hydrating the
vitreous etc) and the choice of implants after anterior vitrectomy.
Next, he showed a photo of ptosis and asked for causes. Also questions
on the mechanism of postoperative ptosis (levator dehiscence). Asked to
demonstrate the method of testing levator function.Then the thing came
for which I was waiting— the sweet sound of bell.
2 days post cataract surgery. A patient complained of decreased vision,
pain and examination showed hypopyon. I mentioned endophthalmitis.
How do you differentiate between infection and inflammation, treatment
pertaining to this case, complications of amikacin (maculopathy).
Shown a photo of BCC involving the medial canthus - asked me the special
feature of this site. Answers: risk of orbital invasion and the spreading
down the nasolacrimal route. The examiner was happy with the answers. Types
of flaps in trabeculectomy ie. limbal versus fornix based, their advantages
and disadvantages, name of the punch used to remove the sclera.
What is histopathology of capillary and cavernous haemangioma? What is
pathology of chalazion and its treatment?--- Bell rang and I ran.
First question was what are the macular studies I know—I told the names
of four studies, then asked me the recommendations of MPS ( Macular Photocoagulation
Study) - I mentioned FFA—extra, juxta, subfoveal in detail— examiner was
Then he showed me the colour photos and FFA of CRVO and BRVO—he asked me
the findings and diagnosis. How would you advise the patient with regard
to prognosis in CRVO I mentioned the presence of RAPD and other signs of
ischaemia will determine the prognosis and complications. He was happy
and the BELL rang.
Shown a colour fundus photograph- ask about findings and diagnosis. It
was the wet type of AMD (greenish gray membrane at the macula). She agreed
and asked me what to do next — I mentioned FFA and she showed me
the FFA of same patient and asked about findings and management. I mentioned
laser as membrane is not at the fovea – she agreed.
Then she showed me colour photograph of diabetic retinopathy—findings and
diagnosis, then FFA of the same patient. The FFA showed macular ischemia
and asked the treatment. I mentioned the use of scatter laser for the ischaemia
but not for the macula because of the ischaemia. Questions on what constitute
clinically significant macular oedema in diabetes mellitus.
Next she showed me FFA and colour photograph of of a 35 year-old female
complaining of decreased vision and there was a membrane in the macular
area. I said there is some inflammatory pathology, she said may be and
asked what I thoug it is. I went for macroaneurysm as there was haemorrhage,
she said no and gave me a hint 'There is inflammation as you mentioned
earlier.' Before I could answer the bell rang, this was the only question
which I could not answer but as soon as I got up the answer struck me and
I think histoplasmosis was the answer because the FFA showed lacy pattern
with haemorrhagic membrane. I was very relieved at this point as all the
viva were over and I felt I did ok in all.
In viva they ask a lot of questions because they want to cover as
much as possible, so one has to answer fast. Don't waste your time by thinking
a long time if you don't know the answer, admit to the examiners you don't
know the answers (hopefully not the important ones like clinically significant
mauclar oedema) so that they can give you clues or move on to the next
question. In the evening we got the results and I made it into the
clinicals. I was one of the 15 candidates who made it through out of a
total of 34 candidates.
The 3rd day was a rest day but it was very stressful to have to wait
another 24 hours.
Clinical ( 4th day )
1. First case – Demonstrate confrontation visual field test ( one should
be quick in performing all types of ophthalmic procedures because time
is very short and you have to see more than four cases to pass).
The patient had tubular (tunnel) vision. She asked about the cause. I mentioned
a few causes and then examined the fundus with a 78D lens, the patient
had an advanced glaucomatous disc.
2. Next, she told me to examine the anterior segment -- patient had
trabeculectomy with bleb (don’t forget to examine the conjunctiva and the
fornix which is very common mistake ), peripheral iridectomy, pseudophakia,
posterior capsule opacities. The other eye had shallow anterior chamber
with RAPD — she asked for diagnosis. The answer was narrow angle glaucoma,
then questions on posterior capsular opacification and pseudophakia.
3. She told me to look at the macula of both eyes with a 78D — the patient
had bilateral well defined lesions with yellow deposits at the macula.
The lesions are larger than the optic disc. She asked for the diagnosis,
I mentioned heredity dystrophy, old central serous retinopathy (which she
did not agree ), might be hole (she was not happy with this either). I
asked and she showed me the FFA. The answer was Best vitelliform
4. The examiner asked me to use the slit lamp to look at the anterior
segment—I did everything and the eyes seemed to be normal. He asked me
to concentrate on the cornea and after struggling for a minute, I saw very
mild thinning of the cornea at the limbus both superiorly and inferiorly.
He asked for the diagnosis –I gave pellucidal or Terrian marginal degeneration.
He asked what else would I do? I said corneal topography. He asked about
the treatment and I mentioned contact lenses. He asked about the types
of contact lenses.
5. The first examiner asked me to perform the ocular motility and gave
a diagnosis. Patient had Type 1 Duanes retraction syndrome. With
up-shooting on adduction. She asked me the possible types of surgeries
6. Back to the second examiner again, he asked me to perform indirect
ophthalmoscopy on a patient in a sitting position. Patient had diabetic
retinopathy with laser marks at the mid-periphery (he asked about findings
in detail). He also wanted to know the risk factors that can exacerbate
diabetic retinopathy, treatment of ischemic maculopathy (I said I won't
touch the macula). He asked about new in drugs—I mentioned antiVEGF drugs
like macugen (pegabtanib sodium), lucentis and intravitreal triamcinolone—he
7. The male examiner again asked me to examine an upper lid growth.
I mentioned the findings and noticed that the time was running short.
I gave a differential diagnosis. He told me the diagnosis is a BCC and
how will I treat this. I mentioned Mohs micrographic techniques as the
gold standard for ensuring complete removal of the tumour and at the same
preserve the tissue. He asked about the methods of lid repair and I told
him that the method will depend on the size of the defect and gave him
all the possible methods. He was happy with the answers and the time was
I was satisfied with my performance. Then again the tense moment of
waiting for the result. Cases shown to other candidates include facial
nerve palsy, 3rd nerve palsy, carotid cavernous fistula and dissociated
The result was declared in the evening, I was very happy to see that
I cleared the examination. This site has helped me tremendously in passing