|My name is Abdul
Kabeer,I am from Kerala, India: I have appeared FRCS Glasgow
(OPH) part B exam in New Delhi in September 2005. AL HAMDULLILLAH,with
the help of ALLAH, I have passed the above exam in the first attempt .
FRCS Glasgow Part B Ophthalmology exam
Exam Shedule is as follows;
3 days exams; Written, Viva and Clinical
1st day ; Morning 9.30 to 11.30 am ,
A problem solving paper
Clinical case interpretation in relation
to ophthalmology of three questions:
1. An 85 year old man has had advanced
primary open angle glaucoma for 30 years. He had a trabeculectomy performed
on the left many years ago but the vision has been poor in this eye
ever since the operation.Visual acuities are 6/12 right and Hand Movements
left and despite being on maximum medical treatment to his right
eye the pressures are 28mmHg right and 10 left. His visual fields are grossly
restricted in both eyes and he is on Warfarin tablets for atrial fibrillation.
Discuss this patient's management
and explain the risks to his vision.
2. A 30 year old General surgical colleague
presents to your clinic complaining of redness and blurring in his right
eye for 1 week. He had had bilateral laser refractive surgery 4 weeks back
and although his vision had initially been good it is now reduced to 6/36
right and 6/6 left unaided. He is busy and just wants you to give
him some drops.
Describe how you would deal with this
situation and what possible investigation and treatment would you recommend.
3. A 10 year old boy is found by his optician
to have reduced vision in his right eye. On examination acuity in the eye
is 6/36,there is a relative afferent papillary defect and fundoscopy shows
Discuss the possible diagnosis and explain
how you would manage the case.
First day, 12.30pm to 2.30pm
MCQ paper encompassing the topics of ophthalmic
medicine, surgery, general medicine and neurology with particular reference
2nd Day Oral Exams: Three Stations
First Station :
For me it was Ophth.Surgery & Histopathology
Two examinors (a British & an Indian)
in all stations:
I greeted them before sitting down.
First question was from British doctor,
it was a picture of prolif.diabet.retinopathy(PDR) in labtop with NVE only,
then asked all about classfication of DR,treatment strategy,laser parameters,complications
of laser Rx, about choroidal effusion.
Then he asked one patient with h/o DM
>10 years duration with severe eye pain and IOP > 50, what was DDs, answer
was NVG, then all about NVG, it's Rx option.
Then question was Rx of painful blind
eyes including laser cyclocryo, intraocular implant.
Now Indian doctor showed a picture
of psuedoexfoliation syndrome, then it's diagnosis, diff. from true exfoliation,
eye findings, gonioscopy features,glauc.capsulare, complications during
cataract surgery,management during PC rent etc...
Indian Doctor asked the causes of shallow
AC after trabeculectomy, it's diagnosis, management, then Rx details of
Then he showed histopath.specimen of eye
ball showing large ant.segment like congenital galucoma and asked all about
He took DCR Kerrison ronguers for enlarging
osteotomy in DCR, then type of anasthesia in DCR, procedure,bones removed
in DCR, indications.
Then he showed a colour photo of dark
person with big ulcer of lower lid, asked diagnosis,replied BCC ,then bell
was rang to finish the section.
Ophthalmic Medicine &Peadiatric oph.
Indian doctor ,showed a picture of vernal
conjunctivitis, asked its diagnosis,Rx,complicatons of steriod Rx, instructions
to the patient &parents that it is a long standing disease &
don't over treate this condition.
British doctor asked the management of
a 50 year old man refered from optometist with high IOP, asked DDs, causes
of high iop, about ocular hypertension (OHTN), glaucoma, target IOP, max.tolerated
Indian doctor asked about 2 year old child
with squint, DDs, management, retinoscopy, full cycloplegic refraction,
class.of accomm.esotropia,use of bifocals, role of surgery in acc.esotropia.
British doctor; Asked a 60 year
old man presented with blurring of vision ,then how to manage this case;
In the history taking, examiner said no
DM, HTN , NO SYSTEMIC DISEASES.
I listed DDS like ARMDS, Macular hole
,Choroidal melanoma, Intermediate Uveitis with macular oedema.
Then asked all details of ARMD , it's
classifications, investigations, management with Amsler grid assesssment.
Neurophthalmology & Medical Emergencies:
British Doctor asked 24 year old lady
came with defective vision ; how to manage this case:
In the history taking , no significant
In eye examination , RAPD is present
but fundus is normal and ocular examination showed INO . Then asked the
all details of Multple sclerosis as age , associated symptoms, signs like
Pulfrich phenomenon, Uthoff's phenomenon, nystagmus, MRI findings , treatment
schedule ,importance of neurology consultation.
British doctor asked 3 year old child
brought by parents with history of abnormal eye movements with a short
duration, then how to manage:
In the history taking , examiner drowed
the type of eye movement like very bizzare pattern , then I
answered that I will take detailed history of CNS diseases, detailed eye
examination, then he asked the site of lesion of abnormal eye movements
, I answered chiasmal lesion then he was happy.
He again asked different sites of neurological
lesions with visual field defects to localize the lesion.
Another question was how to manage nystagmus.
I started with Ocular & Neurological
classification of nystagmus.
I narrated diff.types of ocular nystagmus
Then Nystagmus of infant with normal eye
examinations like congenital stationary night blindness, rod monochromatism
& Leber's congenital amaurosis.
Kastanbaum surgery of nystagmus also mentioned
in it's aim.
Now Indian doctor (may be medicine consultant)
Started medical emergency section like,
a 60 year old man came to your eye clinic for eye check up and when you
started vision checking , patient suddenly became collapsed, how will you
manage this case:
I started the answer with details of ABC
care , then examiner said the BP was normal , I started with details ECG
for cardiogenic shock in different leads , then he said ECG is normal.
Now the DD is shock with normal BP &
normal ECG, then I started features of septic shock like common sites of
focus of infection like UTI, RTI, abdominal etc….
Then examiner asked how to manage septic
shock from lung in detail, then I started common cause is pneumonia like
Klebsiella , then asked management in detail, answered blood culture &
3:Then asked how to manage cardiogenic
shock in detail , I explained in detail because I have 4 or 5 very good
classes from cardiology friend before exam .
Examiner insisted the details of adrenaline
Clinical Exams: ( One Indian doctor
& One UK doctor)
Slit lamp examination of 25 year old lady:
Examination showed circum corneal congestion,
descement's folds, and AC shallow, peripheral ant. Synechiae, posterior
Synechiae, seccusio pupillae, complicated cataract & hypotony,
Asked me how to manage, answered that
the diagnosis was chronic uveitis with complicated cataract with hypotony.
Treatment depends on visual acuity, IOP,
B scan to check status of retina & patient complaints like eye pain.
Potential visual acuity meter (PAM) to
check the prognosis before cataract surgery.
Asked me the causes of low IOP , answered
like ciliary damage, secondary RD , going for phthisis bulbi.
Asked me how to manage phthisis bulbi,
answered for cosmetic treatment is enucleation with intraocular implant.
Another S/L examination of 18 year old
Examination showed prominent eye ball
with opaque cornea with lipid degeneration with tense eye ball and further
details of iris & other structures are not possible.
My diagnosis was absolute glaucoma with
Asked me causes of glaucoma in this age
group, answered like congenital glaucoma (primary) , trauma, uveitis, complicated
corneal ulcer, Sturge weber syndrome.
Asked me the details of cong.glaucoma.
Asked me the management of absolute glaucoma.
For the pain , cyclocryopexy or cyclophotocoagulation
to make eye phthisic, then put ocular pristhesis if no touch sensation
of eye ball.
For still painful blaind eye &cosmetic
, enucleation & intraocular implant.
Asked the causes of secondary glaucoma
Ocular movement examination:
Examination needs cover and un cover test;
Examination showed 6th nerve palsy of
Asked the management , in history DM,
HTN ,blood disorders etc….
Eye examination to rule out RAPD, Papilloedema
or optic atrophy, DR, HTN retinopathy
For diplopia, patching or prisms for temporary
Botulinum injection of MR to decrease
For permanent esotropia after 6to 9 months,
maximum recession of MR or Jensen's procedure of transposition of LR with
Asked the importance of Botulinum injection
than prism or patching, then answered prevention of contraction fibrosis
Fundus examination of 40 year male with
I/O & D/O:
Media was clear, disc was pale, margins
are not clear, c/d ratio was .3, veins showed sheathing , diffuse areas
of pigmentary hypertrophy and
some areas of hypopigmentation like post
laser marks and the entire retina is pale.
My diagnosis was consecutive optic atrophy.
Answer was correct.
Asked the management.
History of uveitis & associated systemic
diseases like TB, Eeal's,
Sarcoidosis, Syphilis, Behcet's, AIDS,
Herpes, Toxoplasmosis , autoimmune diseases etc…
Investigations of all the above diseases.
Role of topical steroid, subtenon, systemic
Drug of choice of Behcet' (Chlorambucil)
Role of immune modulating druge like methotrixate,
cyclophosmide, vincristine etc….
Role of photocoagulation in Uveitis
for new vessels.
Fundus Examination of 34 year male:
Media was clear, disc was normal, c/d
ratio .4, vessels were normal, macula showed subretinal fibrosis ( retinal
vessels passing over the whitish lesion of the retina).
Asked the diagnosis, answer was traumatic
Management depends on the BCVA.
Asked the other findings of ocular trauma
from conjunctiva to retina in detail.
Asked the management of macular hole.
Asked the membrane peeling in EPRM formation
in ocular inflammation
Another Ocular movement examination:
Examination showed alternate exotropia
of 26 year old lady.
Asked the management of this case.
In history , mentioned history of eye
glass usage or any surgery.
Examination to rule out myopia ,preference
of eye etc…
Surgical management is bilateral LR recession
Then time was finished , so no more questions.
Wish you a happy exam & happy life.