Problem solving question:

1. A 60-year old sailor with poor vision and pale disc. How do you investigate and manage the patient. (Answers: The usual of taking a history, medication, nutritional history, smoking and systemic enquiry. As the patient is a sailor, one needs to consider syphilis otherwise the rest as of other cases of optic atrophy).

2. Post-operative trabeculectomy, the patient complained of pain. Examination revealed shallow AC, corneal haze. How do you proceed?
(Answers: The answers should include pupillary block with incompetent PI and malignant glaucoma.)

3. A young girl with head injury developed sixth palsy and left side head tilt. How do you proceed with the patient?
(Answers: Answer should consists of fourth nerve palsy and  raised intracranial pressure.)
 

Viva

1. Medical viva (most candidate failed in this section)

• Names of the systemic disease and drugs affecting eyes.
• How myotonic dystrophica 
• Arrhythmias and cornea (amiodarone vortex keratopathy)
• Causes of post subcapsular cataract
• What are the real emergencies in ophthalmic department (Answers: CRAO and chemical burns, GCA).
• Management of status epilepticus, hypoglycaemic coma.
• How do you treat anaphylaxis during FFA, the exact dose of various medications to give.
• How do you investigate carotid artery emboli (carotid duplex US, transoesophageal ecocardiogram)

2. Surgery and pathology viva

• All possible complications of squint surgery. If sclera perforated in squint surgery and vitreous comes out how to handle.
• Suprachoroidal hemorrhage and  its mgt. 
• Lasek,epilasek,epikeratomes,new techniques for flap like intralase and microjet.
• To draw diagram of RD and holes as of Lincoff's rule.
• How to diagnose angle closure with B-scan ultrasound,setting of laser PI, how to manage plateau iris(iridoplasty with PI). Asked in details with diagrams.
• Shown a photo of trachoma and asked what lid surgeries will you do. Asked to draw how to operate upper lid entropion.
• Some candidates were asked about silicon oil injection in vitreoretinal surgery (procedure).

3. Ophthalmology viva

• Shown a FFA picture of cystoid macular oedema. Asked about its management, action of steroids and NSAIDs(asked to draw the arachidoinic acid pathway).
• Then went on about topical, systemic, subtenon, intravitreal drugs(routes and dose), insert implant.
• Asked new modalities for diagnosis mainly OCT.
• FFAs of proliferative diabetic retinopathy and non-proliferative diabetic retinopathy. PRP settings, all major studies in diabetes. Why was argon green not blue green laser used. Questions but not in details on subthreshold micropulse concept, role of intravitreal triamcelone and macugen in endstage high PDR with many PRP's.
• Shown a picture of Eales' disease with secondary BRVO.

All examiners were kind and helping

Clinicals

1. Old retinal detachment with proliferative vitreoretinopathy (PVR) grade C2-3 with a blind exotropic eye. Asked about the pathology of PVR, management and how to manage the exotropic eye cosmetically.

2. Pathologic myopia with left esotropia. Questions on management of the refractive problems including phakic IOL. How to manage lattice and holes(also had to give the exact lase and cryo settings).

3. Corneal macular dystrophy with penetrating keratoplasty in the other eye. Asked about the management, endothelial dystrophies, PKP and deep lamellar keratoplasty.

4. Right complete 3rd nerve palsy with pupil involvement. I forgot to perform the action of the levator.

5. Old lady with cataract,pterygium and CRVO. How would you manage the patient and also study done on CRVO.

6. Left carotid-cavernous fistula with unilateral proptosis. pusatile and bruit on auscultation.

I like to thank the webeditors of this website which is a great help in my success. If you have any questions about the examination, please email me waris_eye@yahoo.co.in.