|I am Dr.M.Ram Prakash from Chennai, India.I appeared
for and passed the FRCS (Glasgow) part B examination held in February 2005
(Hyderabad).Here is my experience on the examination.
Before the examination I talked with a number of my friends who had
taken the exam before (with both successful and unsuccessful candidates)
and their guidance was valuable.I also did group study with 3-4 Doctors
and practiced the Clinical techniques with them.It was of much help as
I found during the exam.
Viva 1: Ophthalmic Surgery & Pathology
Picture of Mass lower lid (Basal Cell Carcinoma)-Diagnosis, Differential
Diagnosis, how will you manage, mentioned about biopsy: asked what you
will find on biopsy and Surgical plan
3year old child with Posterior Chamber Intra-ocular Lens. Indications
for IOL, Type of IOL you prefer, Can you use foldable IOL, what type of
Acrylic IOL will you use, Will you prefer an IOL in a 1 year old child
& how will you manage this child
Lattice Degeneration of Retina. Will you treat? What are the indications
for treatment? What if you have a Horse shoe tear in the lesion? How will
you treat? (Laser photo coagulation around the break)? How will you do
the procedure? (asked mainly about the Laser parameters and end-point for
the photocoagulation ) Which will you choose between a laser & cryotherapy
A person comes with a history of Tennis ball injury half hour ago and
complains of Diplopia.What will you do? Started with evaluation of the
patient but was cut short and asked about the possible causes of Diplopia
in the patient. How will you investigate? Forced Duction test, CT Scan
of the orbit.What instructions will you give the Radiologist taking CT
Scan? (Ask for Coronal section also, with 1mm cuts.)How will you manage?
What are the indications for Surgery? When will you consider Surgical intervention
? (2 weeks)
A person from a workshop comes to you with history of a particle hitting
his eye while at work and complains of blurred vision? What will you do?
(Started with History, went on to Clinical evaluation and discussion went
into Retained Intra-ocular Foreign body with endophthalmitis and its management.
Do not forget to mention about the IOFB removal !!! )
Viva 2: General Medicine And Neurology
Facial Nerve Palsy ( Right sided): What are the different causes? How
will you differentiate between Lower and Upper Motor Neuron Palsy? How
will you manage?
A young patient in the Post-Operative period complains of Breathlesness.
What are the possibilities? Discussion went into Management of Acute Severe
Asthma and Pulmonary Embolism(including Clinical signs and findings on
40 year old black patient presents with acute onset of fever,arthralgia
, myalgia & ocular symptoms. What conditions can you think of? (mentioned
the different causes but the examiner wanted Tuberculosis as the 1st differential).Discussion
went into Sarcoidosis: Systemic features, Ocular features, Diagnosis, Investigations(more
questions on skin tests, CT guided biopsy of lymph nodes, transbronchial
lavage,how common is it to find hypercalcemia, raised ACE level in sarcoidosis?).Treatment
with Steroids and its complications, indications for other immunosuppressives
& drug of choice. Was also asked about ocular manifestations of tuberculosis.
Viva 3: Ophthalmic Medicine
FFA- Juxta-foveal Sub-retinal neovascular membrane.What are the types
of AMRD? How do you classify SRNVM? How will you manage? Which of the two
is better –Laser photocoagulation or Photodynamic therapy? Can you support
with any studies?
FFA- Disc hyperfluroscence with blocked fluorescence suggestive of
Splinter haemorhage. What is the Differential diagnosis? How will you differentiate
between papillitis and papilloedema? (Started with history and proceeded)
Dendritic ulcer of the cornea (fluoroscein stained).What will you do?
(thorough evaluation to look for other features of viral infection).How
will you treat? Treatment of Disciform Keratits (examiner was impressed
when I mentioned that not all cases need to be treated)
Corneal entry wound with Iris sphincter tears with Hypophyon and Traumatic
Retinal capillay haemangimoa. What are the Systemic associations? Do
all cases need treatment & how will you treat? Describe the Laser technique.
Middle aged female with glasses. I was asked to about her refractive
status by just looking (myopic).
I was questioned about the incidence and management of Glaucoma and complications
of Glaucoma Surgery in this patient.
Slit lamp examination:
RE - Pigments back of Cornea : what can be the causes? As I also mentioned
about drugs, I was asked the drugs causing endothelial deposits.
LE - Irido-Corneal Endothelial Syndrome.
Fundus examination with +90D:
LE – 90% Glaucomatous cup
Indirect Ophthalmoscopy – Typical Retinitis Pigmentosa.
After the diagnosis,I mentioned that I would look for associated Ocular
& Systemic signs.I ended up by saying that I would like to examine
the family members.Asked about the significance of family history and the
prognosis based on mode of inheritance.Asked in brief about prognosis
after Cataract surgery and what I would tell the patient before Surgery.
Extra-ocular Motility – Duane’s Retraction Syndrome (Type I)
Perform Cover test
Brief analysis of my knowledge on types of Duane’s Syndrome and the
features in each type and the Management of this patient.
Direct Ophthalmoscopy – Dry ARMD
What do you expect this patients Vision to be? What will you tell him?
How will you treat him? What are the types & Management of Sub-retinal
Slit lamp examination – Disciform Keratitis (central and visually significant)
How will you treat this patient? Examiners were happy when I mentioned
that I would explain to the patient about need for long term treatment
and the chance of faint opacity with visual impairment even after treatment.
Then went on to describe the treatment.
My e-mail ID is email@example.com do contact me if you want any help.