I am Dr Srinivas vegesna from Bhimavaram, Andhra Pradesh, India. I cleared FRCS Glasgow in New Delhi in September 2008.

I want to thank this website for the excellent tutorials, which has been of immense help, it is like, as one of the old candidate has put aptly " a examination at hand"

My heartfelt thanks to my wife Dr Madhuri, my parents and my family for their support and encouragement at every step of this exam. I also would like to express my gratitude to Dr.Neeraj Sinha and Dr V.A.R.Raju [my father] expert anaesthesiologists [Doha,qatar] for upgrading me on the current protocols in emergency management.

Last but not the least I would like to thank Dr Ranjith Kumar FRCS an excellent strabismologist and a close friend for all the input he has given to prepare for this exam.

The show went on like this:

Day 1
ESSAYS

1. A 57 yr old man presents with a one week history of severe headache and has also become aware of afield defect in both eyes. He has a history of atrial fibrillation and is taking warfarin. On examination, the visual acuity is 6/9 in the right eye and 6/18 in the left with a possoble RAPD in the left eye. Give possible dd for this presentation and describe how you would investigate and manage this patient.

Answer: I gave dd of possible subarachnoid heamorrhage (pt on anticoagulants), evolving GCA, ICSOL, compressive lesion of 3rd nerve, malignant hypertension etc and discussed on those lines.

2. A 40 yr old woman attends your clinic enquiring about refractive surgery .her acuities are 6/18 with -9D in right eye and 6/6 with -4.00d in left eye. She had previous retinal detachment surgery20years before .you note she has an early cataract in right eye and clear lens in left. How would you manage this case and what risks and possibel problems would u specifically discuss with the patient?

Answer: I discussed about risk of retinal detachment and all refractive procedures with a special emphasis on refractive lens exchange with multifocals.

3. A 75 yr old woman presents with inermittent diplopia. She has a previously been seen at the clinic with right sided epiphora. On examination there is some limitation of abduction of right eye which is displaced laterally. She has lost a considerable amount of weight recently with recurrent chest infections. What are possible causes of these symptoms and how would you manage the case?

Answer: I discussed possibility of orbital secondary from carcinoma breast, paraneoplastic syndrome such as Lambert-Eaton syndrome or Wegeners granulomatis and other dd.


The next day I was free.

Day 3

VIVA:[3 sessions with 2 examiners each ,18 mts at one session]

Ophthalmic pathology/surgery
First examiner

• I was shown ultra sound of a choroidal detachment and asked management if it were to be of a post opreative trab patient?

• Next a picture of posterior pole with a mass lesion :i gave a dd of retinoblastoma and amelanotic melanoma.

• A histology slide of choroidal melanoma epitheloid type , was asked about prognosis.

• A photo of anterior capsule contraction syndrome was also asked about treatment.

• A photo of phakic AC IOLS possible complications.

• A histology of a enucleated eye with intravitreal traction bands may be secondary to diabetic retinopathy.

• A corneal topography of keratoconus, asked about collagen crosslinking and treatment.

Second examiner

• Shown a picture of rhegmatogenous RD with horse shoe tear,asked about surgical management and buckles, intra ocular tamponade silicone oil and gas, adv/disadvatages/

• PDR post PRP with extensive epiretinal membranes ,management vitrectomy with membrane exscion,intra vitreal avastin in such scenario.

• Post operative endophthalmitis picture, EVS study.

• How would culture growth of different organisms can be identified?

Neuroophthal and general medicine

I WOULD STRONGLY SUGGEST THAT CANDIDATE SHOULD DISCUSS ALL PROTOCOLS FOR ACUTE CARE WITH A EMERGENCY CARE SPECIALIST
[excellently conducted ,my best viva]

First examiner

• a 22 yr old young lady is driving a car she noticed she has transient blurred vision for distance and clear vision for near. What could be the cause and what will u ask the patient for? I told I will ask her for flashes ,any associated headache to rule out migraine. He said the patinet has no flashes. I was wondering what could be the cause, any drugs? Is it pseudo accommodation? but it is not continuous and not associated with excessive near work suddenly it struck me, I told him,the patient has diabetes, when the patient has hyperglycemia her lens is swelling and she is becoming myope, Iwould have her blood sugar examined. He was very much impressed with my answer.Next he asked what would you advice her extra than other diabetics about diabetic retinopathy? I said I will counsell her possible worsening of diabetic retinopathy during pregnancy. What are systemic manifestations of Diabetes?

• He next showed optic disc drusen and asked DD?

• I was also asked about CRVO/BRVO?

• Lastly it ended with discussion on beningn intra cranial hypertension?

Second examiner

• It started with a patient who has epileptic attack in my clinic and asked what will I do? What tumours may cause epilepsy? What is status epilepticus?

• He showed picture of tortuous temporal artery and was asked diagnosis? I discussed gaint cell arteritis in detail. What other vasclitis is associated with GCA? I discussed polymyalgica rheumatica.

• Picture of butterfly rash? SLE, I was asked about ANA and dsdna

Ophthalmic medicine [was tough]

First examiner

• What are the criteria for low vision with regard to the visual fields. Next he asked what is the most simple low vision aid I know of. I mentioned high plus lens, hand magnifiers he was not happy with the answer. I racked my brains and came out with walking stick which is helpful for people with poor vision so that they would not bump into objects. He was irritated with the answer, the answer he wanted was sunlight.

• He then asked about accommodative esotropia.

• He gave retinoscopy readings and asked for spectacle prescription. Asked about the rules of transposition.

• He drew new vessels of the optic disc on a paper and asked for treatment? I told about PRP, settings, greyish white burn, number of burns, no of sittings. Why do I need to be cautious with a patient with a 6/9 vision before PRP. I said there might be a drop in vision due macular oedema post PRP. He agreed with my answer.

Second examiner,

• She showed me a picture of old man with facial nerve palsy and asked whether this is upper or lower motor neurone lesion  and why? What associated features would I expect and what are the branches of the facial nerve. How would I localize the lesion. What is the syndrome with recurrent facial nerve palsy? It is given in this site i.e. Mekerson Rosenthal syndrome but tragically for me, I could not remember it when it mattered.

• A video of blepharospasm. What is the differential diagnosis? How does botox work in this condition and what are the contraindications. Any alternative to Botox in treating this condition.

• Choroidal rupture, direct and indirect injury how to differentiate retinitis scopltera in relation to trauma. Is it associated with RD and why?
  that was last viva.
   

I clear the viva to enter the clinical.

Clinical with 2 examiners a total 45 minutes and at least 4 cases.

The following are the cases I got:

• Conjunctival neavus. I was asked to describe the lesion and also when to suspect malignancy. The whole examination was with a torch light only.

• A child with bilateral micro cornea and microophthalmos, colobomas, nystagmus. I was asked about findings and possible vision.

• Slit lamp examination, I was asked about the various filters, lens and mark on the patient face rest for lateral canthus.
  90D of a patient with cystoid macular oedema seondary to diabetes and discuss about the management.

• Visual prognosis in patient with cataract and macular pathology. Discussion on the use of laser interferometer, potential acuity meter and maddox rod in this situation.

• Next was ocular motility examination in a young lady with abduction restriction.

• I diagnosed 6th nerve palsy, he asked to see once more and it turned out to be type 1 Duane's syndrome.

• A patient with exophthalmos from thyroid eye disease and was asked to perform visual field test on her.

• Last case was central retinal vein occlusion. I was asked to examine with an indirect. Questions about the optics of indirect ophthalmoscope and magnification with various lenses. Also asked about the various filters in the direct ophthalmoscope.

I could answer most of questions

I wish all the candidates who are appearing for the exam good luck. I am available at  kasi_ind@yahoo.co.in, and am happy to answer any queries.