Candidate 108 

Final FRCS (passed)                          

Centre: Muscat                               

Date:    December, 2007 

I am Dr. Rao Muhamad Rashad Qmar from Bahawalpur, Pakistan .I passed my FRCS (Glasg.) in Dec. 2007 in Muscat in first attempt (ALHUMDULILLAH). It’s all due to grace of Allah Almighty and prayers of my parents and all my patients. I do acknowledge the constant patience and support of my lovely wife, FOUZIA, and surprising eyes and praying little hands of my young little sons, SHAKAIB RAO & SHEHAK RAO.I think, if you go with confidence and behave like working in your clinic, it’s not a big deal. Go for pass. I got a lot guidance from CHUA site and read KANSKI, WILLS MANUAL, SECRETS, KEY TOPICS and internet on and off.



Read Question twice and think what you will do if such a patients is sitting in your office in front of you. Think, plan, organize and start writing with short sentences, clarity, headings in different colors, and spacing. Do encircle and underline important note.

 Q 1: A 24-years old man attends as an emergency with a history of sudden loss of vision in his right eye. The day before he had been working in his garage repairing his car. On examination, he has a hyphema and IOP in his right eye is 5mmHg.How would you investigate and manage this case?

ANS: I gave major consideration to ruptured globe and gave a differential diagnosis of hypotony and hyphaema. Do underline avoidance to gonioscopy, indentation and use of succinylcholine etc.

Q 2: A 74years old man is referred to your clinic with a two week history of a painful left eye with reduced vision. He has not had any previous eye problem but is on medication for hypertension, ischemic heart disease and smokes 20 cigarettes per day. On examination vision in his left eye is 6/36 with some corneal edema and an IOP of 38mmHg. There is low grade anterior uveitis with dilated iris vessel and a moderate cataract .His right eye is healthy with 6/6 vision. What is D/D and how will you manage this case?

ANS: I explained Ocular Ischemic syndrome as major and D/D of sudden raised IOP with all major things regarding carotid steno sis.

Q 3: The parents of a 2-year baby girl bring her to you complaining that left eye look larger than right. What are possible cause and how will you investigate and manage this case?

ANS: patient mentioned as girl confused me but as I have seen many girls with buphthalmos, so I did major consideration to infantile Glaucoma and DD of Big eye as well regarding proptosis and contralaterlal ptosis. Do mention refractive correction and amblyopia in larger eye.



Tick at question paper which are T/F/? in fist GO for which you don’t have to give second thought. Do mark where you want to give 2nd thought. If you have done above 200 in 1st GO, don’t attempt further and mark on answer sheet. If you are below 180, do consider marked for 2nd thought. Between 180 and 200, its your own choice, I might hold myself as 2nd thoughts are usually wrong. I did 226 I first GO and marked them on answer sheet. Job done in 85 minutes.

This is the part which needs thorough and deep study along with good memory and repetition. I advice to study in short sessions and have some peers to discuss. Do go through MCQ POOL and all chua MCQs( both FRCS & MRCS).Do not expect that MCQs will be from this pool or site but it does give you good sense, rhythm and dynamics of doing MCQs  which is really important , otherwise you rely more on your knowledge.



It is here where you must be very composed and integrated. Be confident that you can answer any question. Listen to question carefully and answer while looking into eyes of examiner. Answer must be well composed and short but comprehensive. Do not create doubt in your answer. If you are not clear, don’t keep on digging a trench for tour burial, but simply say I do not know.

Try to describe clearly and confidently any picture, photo on lap top, FFA, ICG, OCT, HESS chart and /or VF, Topography etc in detail. Mostly you have to start by saying; I will take detailed history, then clinical signs and symptoms, all ophthalmic, systemic. During your answer you have to go by answering little questions which mostly check your depth of knowledge but not by and large to decide your pass or failure. I will advise to spend good time in causality department with some frank physician and some in neurology and cardiology. Do discuss some disease with concerned consultant like, RA, Thyroid, MI, Breathless ness, chest pain, Hypercoagulable and hyperviscisity states, blood dyscrasias etc. Do concentrate at least three times on Pathology section in Chua site. All minor surgeries must be discussed in detail along with Cataract and glaucoma surgeries. Go through sterilization, and pharmacology concerned including NSAIDs and vitamins.


Medicine & Neurology (One British/one Arab Examiner)

British Examiner:

He showed me a fundus photograph on lap top of patient 52-years old that was hypertensive. It was swollen disc. I explained all. He asked me what DD is if vision is reduced. I told its ischemic neuropathy. He asked me type, I asked him level of vision. He told Counting fingers, I told its arteritic type most likely. He asked how to proceed? I started with history, symptoms and signs .he asked me reason of jaw claudication, I told him masseteric ischemia. At this point probably, he was impressed and keep on saying good/excellent on each answer and his eyes were admiring and I was flying and showing confidence and was getting feeling that FRCS is mine today .He asked me about ESR/CRP, when to do TAB and why, How to perform TAB, what are pathological fin dings, why long piece. At the end he asked me about Granuloma, when bell rang, he said well and smiling with impressed eyes. Thanks god, it was the fist viva of the day and excellent of my life where no question was drop and every thing was so organized and rhythmic.


Arab Examiner:

He was serious man and it was difficult to understand his accent. After a long scenario, he told that patient fell down near pharmacy. I was so concentrating on his difficult English that I forgot most of scenario and still cannot re call, any way I started rescuing patient with call for help and ABC (airway, breathing, circulation) approach. He asked me how to do CPR, I explained all. He asked now patient is taken to emergency room, he has noisy breathing, I told he has attack of bronchial asthma, he reminded me that patient has taken some medicine (long scenario earlier), I told he might have taken some beta blocker. He said OK but what if his BP is low, I told it can be Anaphylactic shock. He asked how to manage. I again started with ABC approach and told to give Epinephrine. He asked me dose, I told him 0.5mg, he asked me route , I told him I/M. He asked me can you give I/V, I said, you can give but in diluted form and in the presence of expert personnel. He was relaxed now. Asked me about RA, treatment, complications. told him smoothly. Lastly again a long scenario that a patient with ptosis with Diabetes/hypertension well controlled, having some chest disease not well controlled, smoker. Bell rang, and he smiled. I told I will check anisocoria and movements; it is either Horner’s due to pan coast or 3rd nerve paralysis due to aneurysm (HTN) or vasculopathy (DM/HTN). He smiled openly and said thank you and v good. I was the last to leave hall and feeling like every thing under my feet.


Pathology & Ophthalmic surgery:


British examiner:

Extremely polite personality. I really love him, wonderful examiner; I hope I will be like him as examiner. He showed me pictures of cross sections of GCA, Retinoblastoma, Malignant Melanoma, Fuchs endothelial Dystrophy, Chalazia, deremoid. Purely pathological discussion and some management questions of Fuchs dystrophy, PK and about endothelial transplantation. Felt like there was friendly meeting on a cup of tea.


Indian Examiner:

Showed various things on lap top and some photographs and questions on surgical management. There was a picture of Pseudoexfoliation syndrome with small pupil and cataract. Qs on difficulties in cataract surgery, pupil dilatation, zonular dehiscence, capsular tension ring, glaucoma capsulare,  photograph of non-penetrating filtration procedure and success rates. A picture of inferior iridectomy and silicon oil in AC, a photograph of Laser iridotomy and Qs on various indications, laser settings, complications and comparison B/W YAG and ARGON.A photo of nodule near lower lid margin, I explained the lesion, he asked what if he is young boy, I told molluscum, asked about treatment options and complications, I was explaining, bell rang, I thanked them and my confidence to get through further strengthened.


Ophthalmic Medicine:


British examiner:

Very serious examiner. I could not see smile on his face. He showed me a photo on lap top. I explained all; it was AMD with soft drusens and CNV. He showed me sequence of FFA and I described all, then stage of CNV and its Definition, Treatment, Names, dosages and complications of anti-VEFG, comparison with PDT. A long discussion, all one way as I was not getting any response from him except a new question. Finally he said OK lets change the topic and asked an open question to tell about vasculitis. I started with definitions, ophthalmic and systemic manifestations, and investigations. He was sitting with expressionless face. Then he started with a scenario regarding vasculitis and bell rang. He said ok, bell saved you. I just thanked him without smile. Boring viva.


Indian Examiner:

He was a young man, smiling, probably trying to compensate his companion’s dryness.

He started with corneal abrasion; I started with history, asked about all antibiotics, cycloplegics and their concentrations, protocol of smears and cultures and all cultures media. He asked me that patient came next morning with more pain. I told that he suffering from angle closure glaucoma due to use of cycloplegics.Indian examiner smiled with larger open eyes and looked towards English examiner who started writing on paper.

Then treatment of angle closure glaucoma, dosages and complications of various anti-glaucoma drugs. Then Dry  eyes, details of schirmers test and break up time. Finally he asked about Chronic Allergies and anti allergic drugs and NSAIDS. Bell rang and I came out with confidence that I am going for clinicals tomorrow and it happened, Thanks to Allah.




It is here your time spent with patients is checked. No body helps you here except your integrated clinical work in last few years and your ability to describe lesion and integrated approach to handle the situation. Do not forget to introduce yourself and take permission and say thanks to patient and examiners as well. Keep on describing your findings while examining the patient, it will save your time and also release stress. Do not let your bad performance to affect your subsequent event as its not one question or one patient but whole performance which is considered. I went like this.



Examine Right eye with 90D. It was Superior temporal BRVO with macular edema. Questions were level of presence of Hemorrhage, exudates, edema and cotton wools. What are cotton wools? Treatment based on BRVO study, when and why to do FFA, FFA findings, Laser settings, type of lasers, complications and prognosis. Referral to physician and his approach especially investigations.



Cover and uncover test on young girl around 15years. It was alternating Exotropia with V-pattern. I started with general observation and Hirschberg test. Questions on Cover/uncover test, how to quantify, treatment options, treatment of A&V patterns



Slit lamp examination. It was Nasal pterygium.Its path physiology, treatment indications, recurrence. Major questions were on Slit lamp. How to examine flare, count cells, scleral scatter, and retro illumination; examine vitreous, uses of different filters and lights. Happy with the answers quickly and orderly manner.



Slit lamp examination. It was Aphakia with inferior iridectomy. Questions on various iridotomies, aphakia problems, management, Biometry, complications.



Indirect ophthalmoscopic examination of a patient. It was 360 encirclement. Questions on various types of treatment options, indications of eccirclement, complications of silicon oil, percentage of 2nd eye involvement. Happy with the answers.


Case 6:

Drawn on paper various levels of SRF distributions and I have to locate break (Lincoffs Rules). Questions on lattice and its prophylaxis, chances of RD



Extra ocular movements. How to do cover/uncover test in up gaze and down gaze?

Questions on DVD and its management.


Result was happy ending. Thanks to Allah.


Do contact me if I can be of any help to you. My contact detail is as follow:


Dr. Rao Muhammad Rashad Qamar

Assistant Professor,

Quaid-e-azam Medical College,

Bahawalpur, Punjab, Pakistan

Cell: 00923009687434