Past Essay Questions for FRCS Glasgow
The following questions are contributed by past candidates of FRCS (Glasgow). Answer plans are given below for reference only. Refer to essays for MRCOphth for advice regarding answering essay questions. If you like to contribute, please e-mail me.
  • A 70 year old man with a long-standing history of rheumatoid arthritis presents with a right red eye. Examination reveals a peripheral corneal ulcer and a shallow anterior chamber with positive Siddles' test. How will you manage the patient?          

    • Answer plans: 
    Treat as an emergency, patient should be admitted, exclude infection even though most likely to be associated with rheumatoid arthritis (list the different manifestations of external eye associated with rheumatoid arthritis such as corneal melt, dry eyes, episcleritis, scleritis etc), antibiotic cover, contact lens as temporary measure, tectonic graft with cornea + scleral patch), immunosuppressant treatment both topical and systemic, physician monitoring of systemic drug and control of rheumatoid arthritis)
a
  • A 52 year old woman with a past history of left mastectomy and underwent a course of chemotherapy complains of blurred vision. Examination reveals blurring of the optic disc margins. How will you manage the patient?

    • Answer plans: 
    History (what does she mean by blurred vision? visual obscuration, central scotoma or distorted vision ? What chemotherapy has been given? Get note from the oncologist and look for histology report such as type of tumour (aggressive? any evidence of lymph node involvement? any bone scan results or other tests to look for metastasis?) Blurring of discs may be related to raised intracranial pressure, optic nerve infiltration or the side effects of chemotherapy (less likely) causing benign raised intracranial pressures. Detailed ocular examination for orbital metastasis, uveal metastasis, macular for signs of tamoxifen toxicity. Brain and orbital scans important for infiltration. If metastasis refers to oncologist for more chemotherapy and radiotherapy.)
a
  • A 60 year old man who had had a right squint surgery in childhood complains of blurred vision in his right eye. His right eye was known to be amblyopic. Examination reveals the right vision to be 6/60 and that of the left 6/6. Ocular movement shows the right eye to be deviating outwards. How will you manage the case ?

    • Answer plans: 
    History and old note (previous visual acuity, why vision poor? recurrence of exotropia? consecutive exotropia? deprivation exotropia?) Examination (detailed ocular examination for possible causes of decreased vision: cataract glaucoma, maculopathy etc; orthoptic examination) If the exotropia is caused by cataract, removal may decrease the exotropia however risk of post-op diplopia (discuss with patient), residual exotropia if cosmetically unacceptable can be treated either surgically or use of botulinum toxins. If no causes found for poor vision, consider squint surgery (orthoptic test for post op diplopia) or use of botulinum toxins.
a
  • A 36 year old woman has difficulty driving her car and tends to veer to her left hand side. She also complains of parasthesia of her left hand. How will you manage the patient?

    • Answer plans:
    The most likely diagnosis is multiple sclerosis as the question implies a right homonymous hemianopia but left parasthesia (signs separated in space). In the answer look for history of neurological signs which are separated in time.
    History (problems with vision? diplopia? visual field defect? history of parasthesia? poor vision with exercise? difficulty getting out of hot bath?) Examination (detailed ocular examination: RAPD, optic disc pallor, visual field defect? ocular movement for internuclear ophthalmoplegia, saccade abnormality? neurological examination for cerebellar signs, hyperreflexia, positive Babinski's sign?) Investigation (perimetry, VEP, brain scan for plaques, vascular lesion or neoplastic conditions; refer to physician for management if signs suggestive of multiple sclerosis) Patient should stop driving if visual field fails the driving criteria. Implication for patient if MS the diagnosis.
Return to the main page