Viva 1 

Medicine and neurology
One British and one Indian examiner. I was what I would do if during FFA of a diabetic patient he suddenly feels uneasy, breathless and falls unconscious. Also questions on the differential diagnosis: hypoglycaemia, anaphylaxis, syncope and cardiac arrest. How to differentiate syncope from anaphylaxis? How to rule out hypoglycaemia. Management of anaphylaxis and hypoglycaemia. 

Another case scenario: 40 year old female complains of weakness of one side and difficulty in reading. What test will you do?  Visual fields for a homonymous hemianopia.

Question on cataract surgery in a patient on warfarin.

Bell ……

Neurology

What are the causes oh hypercoagulable blood states. Gave the congenital causes such as thrombin 3 deficiency, protein C protein S defects etc. Also asked about acquired cases such as antiphospholipid antibody syndrome…. Went into detail about antiphospholipid disease. The examiners seem happy with the answers.

Asked about the manifestations of pituitary disease including post-fixational blindness and hemifield slip. Investigations for a pituitary mass. Treatment of prolactinoma including bromocriptine and surgery. What is meant by empty sellar syndrome?

Ocular associations of HLA B27 and HLA and eye.

Bell.. 
 

Viva 2 ophthalmic medicine

One British and Indian. Lots of photos and slit lamp and FFA on the laptop. Here are some that I remembered:

• Myelinated nerve fibre
• Optic disc coloboma
• Cilioretinal artery occlusion with AION. Questions about arteritic AION and history
• diagnostic of GCA
• Mooren's ulcer
• Siderosis bulbi. Investigation of choice for a retained IOFB. The usefulness of ERG.
• Choroidal folds. Causes. Scleritis and T-signs on ultrasound.
• Lisch's nodules and what else to look for in the diagnosis of neurofibromatosis type 1.

2nd half of the photos were of very poor quality.

• Corneal ulcer. How will you investigate? What are the current anti-fungals available? How do you do KOH test for fungal infection?
• FFA of a superotemporal BRVO with collaterals.
• Fundus photo of disseminated healed choroiditis. Possible causes.
• Fundus photo of bulls eye maculopathy. Causes. Hydroxychloroquine toxicity.
• FFA of wet ARMD. Juxtafoveal choroidal neovascular membrane with discussion on management.
• Traumatic cataract with iris sphincteric tear and iris hole and hypopyon.
• Fundus photo of neovascularization with serous elevation at the macula.

Viva 3 

Ophthalmology and surgery

Laptop photo of lattice degeneration. How do you know it is a lattice degeneration? What are the indications for treatment? What are the modalities of treatment? Which is better: laser or cryotherapy? I mentioned laser as cryotherapy releases RPE cell into the vitreous and may cause macular pucker.

Cataract surgery. What are the risks when doing surgery in a case of pseudoexfoliation syndrome? How do you manage a case of zonular dialysis?

How do you manage a case of dropped nucleus.  What are the complications of dropped nucleus?

Management of a case of post-operative shallow anterior chamber after trabeculectomy. What happened if the IOP is low and what if it is high?

Fundus photo of a case of ROP. What are the risk factors and how do you manage it?

Bell....
 

Pathology

• What is a granuloma?
• What is an epitheloid cell? What are the different types of giant cells?
• What is a pannus?
• What is a follicle?  and the differences between follicle and papillae.
• How do you evaluate a case of cloudy cornea in a 3-month old. Discussion on congenital glaucoma. What type of gonio lens would you use? What is the effect of general anaesthesia on IOP? What are the types of surgeries used in congenital glaucoma?
• Slit lamp photo of IOL with pupil capture. Complications that may occur.
• Entropion surgeries. Ask to describe some procedures. I described Weiss and Jones procedures. 
• Evaluation of a case of involutional ptosis. I mentioned VA, refraction and if the pupil is covered. Before I could go further the bell went.

Day 3 Clinical examination.

Case 1
Middle aged woman with thick glasses. I was asked to about her refractive status just by looking. She appeared myopic. Slit-lamp examination revealed pigments on endothelium with corectopia; iris stromal hypoplasia; pseudo-polycoria and ectropia uvea and the presence of iris nodules. The diagnosis was ICE syndrome. Questions on glaucoma in this patient and its management: medications and surgical option.

Case 2 
Limbal dermoid with the presence of hair. Systemic association: Goldenharg's syndrome.

Case 3
Type 1 Duane's syndrome.

Case 4
Dry ARMD. Treatment and advise to the patient.

Case 5 
Peripheral ulcerative keratitis with scleritis. What investigations: rheumatoid factors , ANCA for Wegeners, clinical features of SLE etc. How to manage perforation including the use of glue , bandage contact lens and keratoplasty.

Case 6 
Peripheral retinal angioma with laser spots around it. The diagnosis is von Hippel tumour.

Case 7 
Macular hole and its staging.

 For any queries contact me at ryancosta1@yahoo.com