I am Dr Darakhshanda  Khurram from Pakistan Karachi. I appeared in FRCS Glasgow and ALHAMDULILLAH passed with the grace of God. I dedicate my success to my family for their support and prayers without which I would not have been possible. I found this exam to be a constant battle of nerves, you have to keep yourself calm and confident. Here is my experience , I would like to thank Dr Ayman Elghonemy and Dr Ahmed Sallam for running a teaching course on the FRCOphth.yahoogroups.com.

 

DAY ONE: WRITTEN PAPER AND MCQS

 

Q1.

A 74 yr old man is referred by his optician with suspected glaucoma. He is a smoker and has a history of ischaemic heart disease and peripheral vascular disease. On examination visual acuities are good but the intraocular pressure is 24mmHg in each eye. There is a relative papillary defect in the left eye with a pale, cupped disc in this eye. The right disc looks healthy. What are the possible diagnoses in this case and how would you investigate and manage him.

 

Q2.

A 45yr old dentist has vision of 6/6 bilaterally with a prescription of:

  -16.00DS/-1.50 C90DC right and –14.00DS/-2.50 C100DC left

she has previously worn contact lenses but now has developed an intolerance to them and has heard about refractive surgery. The right eye previously had successful detachment surgery 10 years earlier.

Explain all the possible treatments available for this patient and decide on the best option, giving your reasons.

 

Q3.

A 23 yr old man has severe bilateral pan-uveitis, with macular oedema, and evidence of retinal vasculitis. What is the differential diagnosis what is your management of this patient.

 

MCQs  read all that are available from Chua website.

 

 

DAY TWO:  I had my vivas the very next day which was a good thing.

 

Ophthalmic medicine:

Conducted by a British examiner and a Dr Gupta.

• What are anti-inflammatory drugs? (Recited the list from Wong's book.) How do you use anti-inflammatory drugs in eye diseases? How would you manage a patient with scleritis? What is the treatment of anterior non-necrotizing scleritis? Name the conditions in which you would give intraocular injections of drugs (endophthalmitis, macular oedema….) What is ARMD? What are the available treatments for ARMD? What is PDT? Name the conditions causing macular oedema? How do you treat macular oedema? How do you laser the macula? What do you know about CRVO? As I was answering when the bell rang

• Dr Gupta was the next examiner and wanted us to stay on the same topic ie. CRVO. I told him the BRVO and types of CRVO. How do you differentiate between non-ischaemic and ischaemic CRVO? When do you do FFA on the patient with vein occlusion? What are the indications of starting the treatment? What type of laser will you do in BRVO and CRVO? What are BRVO and CRVO trials? What are the complications of retinal vein occlusion? What is hemi-retinal vein occlusion? How will you treat it like either like BRVO or CRVO (I said BRVO) and thank God bell rang….cause I was sick of vein occlusion by that time.

 

General medicine and neuro-ophthalmology:

Two British examiners

• First one, after greeting me showed me an ECG (typical saw shaped) asked me to comment on it. I started with describing the rate and rhythm and said it shows supraventricular trachycardia, which one he said I said atrial fibrillation he was happy, asked me that one of my staff nurse has reported that a patient with this ECG is on the list of cataract operation what are you going to do. I answered that I will take this patient off the list counsel him about his condition since it is an elective procedure postpone it and ask him to seek medical assistance from his cardiac physician and get a cardiac fitness.What are the ocular complications of atrial fibrillations? (CRAO) asked about the mechanism.

• Your patient is diabetic, at what level of his blood sugar will you operate? I said around 11mmole/l asked me why not less said because of the chances of hypoglycemia, asked why not more (said because hyperglycemia induces stress and increases the chances of infections. Your patient is on insulin what will you do preoperatively? (make a sliding scale chart for my staff nurse a night before and would like to know his FBS in the morning). Would you keep the patient after the surgery or discharge him? (I will keep him over night).

Then bell rang….

 

Second examiner started with

• How do you examine a patient with anisocoria ( started with telling him that I would like to examine his pupil in light and then dark to establish which pupil is faulty.asked how so told him the pupil which is dilated in light is the faulty and the pupil  which is miosed in dark is faulty.

• Asked me to name the conditions in which there is a dilated pupil…told him the list drugs , 3^rd n, sphincter damage…interrupted me what is the most common cause said adies. Asked what is adie  what are the ocular features and how will you confirm your diagnosis. What is the cause of painful dilated pupil( said 3^rd n, aneurysm) asked me to differentiate between the surgical and medical lesion.

• Then he moved on to ask me the effects of vitamin deficiency in eye.(told him that vitamin A causes dry eye , and pigmentary changes in the retina and also Bitot's spots. Vitamin B deficiency causes toxic neuropathy and Wernicke's encephalopathy asked me about it, said it causes said nystagmus, diplopia and ophthalmoplegia in eyes…bell rang (my best viva)

 

OPHTHALMIC SURGERY AND PATHOLOGY:

British examiner and an Asian examiner

 

British examiner:

• A young man presents with an exotropia how will you manage him? I started with telling him about checking the pts visual acuity, ph, refractive status, cover and un cover test prism measurements, extra ocular movements and optic nerve tests, counsel the patient if he is amblyopic that eye can deviate again if surgery is undertaken .then I will perform medial rectus resection and lateral rectus recession. Then he asked me about the complications of the surgery.

• What are the possible causes of uniocular proptosis in a boy of 7 years old. I gave a list including dermoid cyst ,orbital cellulitis, optic nerve glioma, rhabdomyosarcoma etc. Asked me what is rhabdomyosarcoma ,said malignancy of the connective tissue in the eye , said what connective tissue said the one that may differentiate into the extraocular muscles…asked what are the pathological types and which has the worse prognosis, (embryonal, alveolar and pleomorphic)….asked me how will u treat it.

• Then he asked me the complications of the cataract surgery …..told him the intraocular and then post op complications ….asked me the late complications said late endophthalmitis and PCO and Irvine gass syndrome asked me how will you treat it.

Then the bell rang….

 

Asian examiner:

(Showed me lots of pictures on the laptop and asked only few questions just kept asking what is it and how will you treat it.)

 

• First he showed me a visual field of pituitary adenoma bitemporal  loss of visual field it was bitemporal quadrantinopia, asked me where the lesion is  and treatment

• Then he showed me fundus photograph of disc edema with macular involvement and BRVO….asked me what is it and comment on the disc

• Then he showed me on laptop a sunflower cataract asked me the cause …

• Then he showed me anterior segment hyphema how will u treat…

• Picture of the patient with herpes zoster ophthalmicus

• Picture of the patient with dacryocystitis  with preseptal cellulitis

• Picture of the limbal dermoid

• Patient with bilateral disc edema …what is BIH and how will u treat it

And then bell rang (whao what a relief). Results were announced after an hour and we were given a schedule for our clinical examination….mine was at Gartnavel hospital.

 

 

CLINICALS:

Clinicals were the smoothest both of my examiners were very good , one was Indian and other was British. We are given 35 minutes and have to see as many as we can , I saw 7 patients in this station.

 

First one

A middle aged lady who was waiting for me by the slit-lamp. I was asked to examine her anterior segment….she had bilateral aniridia…as I said it both the examiners nodded and looked pleased.

 

Second patient

A middle aged man , iwas asked to perform ocular motility test and also did cover uncover test … findings were alternating exotropia with left eye dominant ..British examiner asked me what would be his refractive error I said he will probably be a myope.

 

Third patient

An old lady, I was asked to examine her anterior segment.she had symblepharon in both eyes asked me what can be the condition said OCP…asked me the treatment.

 

Fourth patient

A middle aged lady with iris coloboma asked to do an indirect ophthalmoscopy on her …not much dilated ..she had bilateral chorioretinal coloboma as well. Asked me what could be her visual acuity said 6/60.

 

Fifth patient

Examine him on the slit-lamp had a polycystic bleb , patent PI, fundus with 90 D showed cupped disc and laser burn marks…asked me what could be the reason said initially  CRVO  then developed neovascularization for which laser was done .

 

Sixth patient

Patient had iris new vessels;  fundus had heamorrahges in all the quadrants.

 

Seventh patient

A middle aged lady walking with a stick…had a scar on the neck …British examiner showed me her fingers they were stained yellow and had clubbing asked me what could it be I said patient is a smoker and had a neck scar was from the endarterctomy procedure.

 

Examiners looked happy and the time was up.

 

Results were posted on the website and was the happiest day of my life. I studied from the Kanski and Wong and Wills…and surgery from Collins and Stallard. Also Chua website is a goldmine for anyone preparing for this exam. My email is drdk74@yahoo.com . please contact me if you need my help for the exams.