Dear everyone,

I am Dr Jyothsna and I cleared my FRCS on Feb 2010 in the first attempt. This was the first sitting of the new pattern of examination and after reading past candidates' experience I thought the written essays part 2 and part 3 clinical examinations were easier this time.
I have attached a file on the answers i wrote for part 2 and these were my questions in part 3
 

VIVA - 3 tables of 2 examiners each

Table 1

• What is sight-threatening uveitis?

• Causes of uveitis and classification.

• Picture of slit lamp section of cornea showed a localised opacity--the examiner wanted keratoconus with acute hydrops but honestly it was not easy to asess the depth of lesion on 2 D picture ..management

• How can diabetes affect macula ?

• Causes for sudden obscuration of vision and investigations ..if he has headache and diplopia -- wanted GCA

• Picture with madarosis..and trichiasis .. causes and complications.. seriously i could think of 4-5 causes apart from corneal ulceration could think of no other complication and only... finally said radiation as a cause and examiner seemed pleased.

Table 2.

• How to manage flat AC post trab

• Immediate post op comp of trab

• Lid reconst surgeries ..he gave me a scenario and i had to name procedure ..like Cutler-Beard ,Mustarde etc etc

• Picture of BCC and management

• Patient with floaters ,inferior field loss, then sudden loss of vision ..what do u think is happening.. PVD superior RD involving macula ..management

Table 3

• Management of unconscious patient

• How to do CPR ...where to place your hands and the rate

• Complications of systemic streoids and immunosuppressants

• Which is worse immunosuppresive or steroids ..tricky !!!

• Level of lesion in different field defects and prosopagnosia.

• Complication of hypertension
   

Clinicals
We had four rooms -ocular motility, anterior segment, retina and neuoro-ophthalmology. Each room had 3 patients and 2 examiners. 5 to 10 minutes allocated for  each room. We were told that we had to examine 2 patients and if we had time then procced to the third. Contrary to what I had read about other candidates experiences posted on this website we were given clear instructions to just do the test examiner told us to. No need to introduce, greet, shake hands, adjust Slit lamp etc.

Ocular motiity room
Case 1.

Do alternate prism cover test. Both loose prisms and a prism bar were kept. I said i would start with Hirschbergs corneal reflex test and then with alternate cover test. The patient had a left exophoria and I mentioned i would place the prism with apex towards deviation and repeated the cover test .it was neutralized by at 25 prims dioptres.
Frankly i was nervous as this was my first room and it did not go as smoothly as i would have liked . during feed back session most candidates felt that this was unfair as alternated PBCT was a sub speciality skill
 

Case 2

Check extra ocular movement. Examiner said start with observation. I mentioned a mild ptosis of the RE . scar on the forehead . said i would liek to look at pupils. he said no go ahead . I did duction then versions . patient had limited adduction and depression. Time was running out and he hustled me on. I said partial 3 N palsy. He said can it be aberrant regeneration . And I realized it was an obvious pseudo von Graefes sign . Mentioned it and also added no inverse Dunaes seen more as a feeble attempt at salvaging what I thought i had messed up big time !!!!! bell rang
 

Anterior segment
Case 1

Young lady at slit lamp. Asked to examine the left eye which had a clear full thickness corneal graft 8 mm in diameter with interrupted sutures. Mild opacification at graft host junction. no loose sutures or vascn at sutures. Superior vascularization of the host bed at 2 clock hours but not encroaching on donor cornea. AC quiet, pupil round regular. examiner asked causes of graft at this age, rejection, management , types of suture .Fairly routine predictable questions.. said examine the other eye. macular dystrophy. smiled and asked any other possibility . said opacities seem superficial . dould it be resi bucklers but am nor sure as ia hd not seen too many of those. bell rang
 

Case 2.

Again hydrops and keratoconus. Same examiner and same Qs as viva
 

Retina

My sub-speciality ..so it was a breeze :-).
case 1

Young patient. Indirect ophthalmoscopy showed PRP scars, sheathed vessles and pale disc. Discussion on vasculitis. history,work up, Eales, Bechets etc
 

Case 2

90 D on an elderly male. Had NVD with CRVO and freshly lasered. Diagnosis: ischaemic CRVO versus non-ischaemic CRVO. Clinical features and FFA. Management. Aetiology of CRVO and investigations
.

Neuro-ophthalmology
Case 1

DO young man bilateral temporal pallor. causes. pituitary tumour and the file defects. some bit on toxic amblyopia.

Case 2

90 D of glaucomatous cupping 0.8 C/D and inferior notch . Discussion on work up and managment

Case 3

Exmaine pupils of young lady. Had a LE RAPD. Subtle but was definite. Had to do direct ophthalmoscopy of RE showed mild blurring od superior and nasal disc margins. Asked DD of pappiledema and disc edema. How to work up disc edema. discussion on MRI in MS. What if she had poor color vision with centrocecal scotoma .I said i would treat as optic neuritis . asked investigation in optic neuritis and ONTT etc etc .

I would like to thank everyone who helped me especially Dr Muthusamy and his faculty. My main resources were the Chua web page, Wills, Oxford Handbook of ophthalmology and Dr Muthuswamys questions. For clinicals no substitute to attending a tertiary care hospital and seeing maximum cases for at least 2 months esp if you are already in a sub specialty like me and not too much in touch with other subspecialty skills
In India unfortunately there are no organized classes or training programs for the clinicals unlike in the mid east or UK which is surprising considering how many Indians take it.!!!
So till then u have to rely on the websites and discussion forums !!!!

Regards
Dr Jyothsna
MS DNB FRCS
Consultant Vitreo Retinal surgeon
 

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