Candidate 178


Centre:   Hyderabad

   Date:    2014

This is Dr.Srilakshmi from India . I cleared FRCS part 3 in first attempt from Hyderabad .

 I want to thank my family for their support , your website for immense amount of information it holds and its total utility for exam preparation .

 I want to share my experience for use of future  candidates .

 I studied kanski ,yanoff , wills eye manual , oxford hand book . I practiced clinical examination repeatedly for last month in the steps detailed in this web site . This is very important  to arrive at a diagnosis with in 6 min in the examination . They look at the techiniques that we follow ( they appreciated that I wanted the patient to lie down for indirect , I did monocular examination in ocular motility , started with observation then measurements in ptosis etc ) and question further based on what answer you say . I'd suggest all to write down all the questions asked in the past candidate experience ( you will find there is quite a bit of repetition after a while ) and answer them  or find their answers .  This when done deligently will secure a pass along with practice of clinical techniques . In viva examiners have a set of 3 questions each and they have answers given to them . They will question with in the purview of these questions to understand the depth of candidates knowledge . This is why past candidate experience matters .

 My cases were

Orbit and oculoplasty

1.Thyroid ophthalmopathy-   lid signs , problems with thyroid ophthalomopathy , what to do for optic  nerve involvement .

2. simple ptosis - all  questions on examination  techniques and clinical significance of  each tests.

3. Anopthalmic socket .


Anterior segment

1. Healed corneal ulcer - management of infected corneal ulcer , conditions not responding to regular antibiotic treatment , organisams causing contact lens related corneal ulcer .

2 .Sclerokeratouveities with total cataract - had seclusiopupillend PI. Causes.

3. Neurotrophic keratitis - tarsorraphy. , BCL and  ulcer . Missed BCL but told it is an option when questioned . I asked to look again but time us up . I was worried a bit .


Posterior segment

1 .Postvitrectomy for RD  with emulsified  silicone oil in the anterior chamber and tube implant in the PC. There was an ERM as well . Asked about management of ERM . Was not significant so no intervention .

2. Case of bilateral red lesions in foveae.  Did not fit into any one particular diagnosis. Gave a DD of pattern dystrophy and atypical Bests disease . They wanted to know if it could be photic retinopathy ?

3. Just asked me to see the third case .


Neuro ophthalmology -

1. Sixth nerve palsy - secondary changes in the other muscles , treatment for diplopia , when will you consider surgery ?

2.Bilateral optic atrophy - patient also had a homonymous hemianopia denser in the superior quadrant , localizing the lesion to the left temporal lobe patient also had difficulty in talking , wanted to take history of seizures time up .


Viva -

Medicine - Most fantastic table ( one I was worried Most )

History taking in unilateral headache - duration , onset , severity , DD . Treatment of trigeminal neuralgia -carbamazepine.

Post exposure prophylaxis - virus transmitted via needle prick , which is the most common ? Why ACE inhibitors in DM ? (seems to be a pet question )

 immunocompromised patient with lymphoma with vitritis  has yellowish white lesion in the peripheral retina what are the causes?  - intraocular lymphoma - wanted to know possibilities of causes like ARN, PORN ect - Told them features of these lesions and why they are less likely .

Papilledema - causes

Pseudotumour  cerebri - causes ,

Other complication of oral contraceptives .

Picture of Diabetic macular edema - what are the possibilitis what do you do , what are the systemic implications .


Ophthalmic medicine -

 A child with 40 degree esotropia .They asked what do you do ? I started with refractive correction but he asked me what before refractive correction? They expected  full ophthalmic examination.I Thought they are giving me the actual diagnosis after  complete evaluation. The lesson is always start with history and evaluation they will stop you if they don't want it .

AC/A ratio .

Picture of corneal infiltrate with hypopyon  history of injury . What will you do ?what is the most important complication ? what are the findings in the B Scan ?

Picture of keratoplasty with infiltrate at graft host junction - What are the causes and complications .

Picture with drusen and CNVM - Asked me to describe the picture and asked what will you do next ? OCT what are the findings in the OCT ?


Ophthalmic surgery - Please answer what you have seen and done first . They will ask questions on that . More likely to pass .

Petrygium - causes of pseudo pterigyum , surgeries ( bare sclera , with auto graft , with glue ) what will you do ?

Complications of MMC

What cataract surgery will  you do ? what will you do if there is a central rent ? what are the complications of incomplete anterior vitrectomy ?


PK with endon view - asked me multiple times weather it is a full thickness or lamellar ( I insisted I cant answer with this picture , but I can see that graft is edematous and is eccentric ). Causes of corneal edema in a patient with PK . (rejection , graft failure , high IOP). Treatment of graft rejection .


3 month old with epiphora( seemed to be a favourite question ) .What are the causes ?What will instruct mother for massage ? Massage till when , when probing ? When repeat probing ? What next? Precautions before DCT(  ENT clearance ) .


Drugs used in endophthalmitis .Resaon for choice of drugs .


All the Best . Contact me is you have any queries






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