Pathology viva:

Question 1
GCA and discussion on American College of Rheumatology criteria for diagnosis 
and management.

Question 2
Retinoblastoma (undifferentiated no rosettes) invading a blood vessel with associated 
necrosis. Gave history that it was an enucleation specimen from a 4 year old boy. 
Discussion on genetics, management, histological features, associated osteogenic sarcoma.

Question 3
Discussion on age-related macular degeneration of all types. No picture shown but asked 
to draw pictures showing pathogenesis. Discussion on treatment (medical/surgical) 
- extremely detailed questioning (so candidates must study this very well).
 

Medicine clinical

Case 1: EXAMINE THE FUNDI
Noted Preproliferative diabetic retinopathy. Not allowed to examine the other eye. 
Questions on the various studies that have been done on diabetes including vitrectomy 
and laser studies, UKPDS, DCCT, definition of clinically significant macular oedema.

Case 2: EXAMINE THE ANTERIOR SEGMENT AND LIDS
Struggled to pre-empt some diagnostic correlation. Began thinking about possible 
Horners (because medicine section). On first examination I found only mild blepharitis 
and some minimal SPK but did not think much of it and chose to ignore it. Reported to 
the examiners that I could not find any significant pathology. He then told me that the 
patient was on 2 hourly drops and would that give me any ideas. I then decided to 
report the findings of the SPK and suggested dry eyes with artificial tear supplementation. 
Discussion on causes of dry  eyes - local and systemic. (Even dry eyes come in the exams 
so don't rule it out especially if no opportunity to take history is given)

Case 3: EXAMINE THE FUNDI
Bilateral dry AMD. Questions on FFA features, clinic advice given to the patient (including 
registration and LVA). Asked about management of collapse during FFA.

Case 4: TAKE HISTORY AND EXAMINE RE FUNDUS
History of line developing across vision with progressive decrease in VF inferiorly. 
I offered vascular causes . Also said would rule out ocular causes like retinal detachment. 
O/E Pale disc. Was shown a disc photo of the acute stage. Swollen margins. Discussion 
on diagnosis and management of GCA (including ACR crietria)

10 min viva: 
Discussion on collapse in various situations (clinic, theatre, lignocaine allergy, atropine toxicity 
and treatment)
 

Ophthalmology clinical:

Case 1: EXAMINE THE ANTERIOR SEGMENTS
LE recent corneal graft with ACIOL. Discussion on pseudophakic bullous keratopathy. 
Don't forget to examine the other eye for any clues to the corneal health.
 

Case 2: EXAMINE THE RETINA AND ANTERIOR SEGMENTS
Bilateral prolifeative diabetic retinopathy with loose scatter laser scars. Discussion on 
adequacy of laser. The patient was black and examiner wanted blood test for sickle 
cell anaemia to be included. Look for rubeosis in the anterior segment.

Case 3: TAKE HISTORY & EXAMINE THE ANTERIOR SEGMENTS 
AND POSTERIOR SEGMENT
Bilateral posterior polymorphous dystrophy (PPD). Unilateral RCES (recurrent corneal 
erosion syndrome from previous trauma) with anterior stromal puncture scars (FROM 
HISTORY). Asked if they were connected - said unlikely as PPD is not often associated 
with RCES. Discussion on management of PPD and RCES. LE choroidal naevus and 
discussion on risk factors of malignancy.

Case 4: EXAMINE THE ANTERIOR SEGMENTS
Young lady with pseudopahakia. Discussion on presenile cataracts. It turns out that she 
had recurrent attacks of iritis. Mention both uveitis and steroids as aetiology.

Case 5: EXAMINE THE ANTERIOR SEGMENTS
Young asian man with stable unilateral PK with a single retained suture and an astigmatic 
keratotomy scar. Fine corneoscleral scar as well. Other eye showed a pigment epithelial 
line but no other evidence of keratoconus. Offered trauma as a cause but suggested a 
corneal topography for the other eye because of the pigment line (?? keratoconic - since 
I didn't have history). Examiner led me down the trauma path as he said that the fine scar 
was indeed from a penetrating injury. Discussion on methods of dealing with post PK 
astigmatism

Case 6: EXAMINE THE ANTERIOR SEGMENTS
Bilateral megalocornea with Haab's striae, RE Goniotomy scar and trabeculectomy. 
LE Implant tube. Discussion on congenital glaucoma and management options.

Case 7: EXAMINE THE DISCS
Bilateral cupping. Discussion on management options. Had to interpret a Humphrey 24-2 
with arcuate defects (go through all parameters of the field carefully). Asked on special 
problems faced in black races in glaucoma management.