Candidate 102                                           Centre: Singapore
Final MRCS                                                               Date: April, 2007

 

I use Kanski, this website, Chua's & Wong’s book. Only 4 out of all 20 candidates passed. 2 failed in MCQs and viva. 14 who failed in clinical included 5 Hong Kong candidates who passed their MRCSEd Ophthalmology Part 3 in Hong Kong just a week before this exam!

 

19 April 2007 MCQs 

There is no negative marking. But the passing mark is predetermined. For this exam, the passing mark was set at 79%. Most of the candidates agreed that the MCQs were quite difficult. They even suggested the webeditors of www.mrcophth.com to write a new MCQs book. Can’t remember much about the MCQs, there were no statistics question, nothing on basic part1 & part 2 Qs. All are clinical MCQs.

 

19 April 2007 VIVA

This exam is totally different from the pre-exam courses taken in Moorfield and Singapore. The examiners were holding a set of standardized questions. There was no lap-top computer to show us any pathology or clinical pictures. We were just given scenarios and printed histology pictures (good quality).

 

  1. Medicine& Neurology
    1. 65/F sudden onset BOV. Carotid emboli CVS examination
    2. Scleritis RA Rx differential and investigation.
    3. Anaphylaxis after the FFA. Signs and symptoms. How to treat?

     

  2. Clinical Ophthalmology
    1. Local Anesthesia-eg retrobulbar block: Non-ocular emergency? How to prevent?
    2. Painful BOV: differential diagnosis? Phacomorphic glaucoma, NVG. Treatment of each in detail.
    3. How do you give subtenon LA?
    4. How do you do laser PI? (in detail)

     

  3. Ocular pathology
    1. Lattice dystrophy describe the pathology pictures
    2. RB Flexner Wintersteiner
    3. Squamous cell Ca keratin pearl
    4. Iris nevus? Melanotic? Complication? He want me to mentioned hyphema.

     

  4. Good medical practice
    1. After a complicated squint surgery (perforated globe), how do you tell the parent post op?
    2. How do you take consent for cataract op
    3. How do you advice patient with cornea-sclera laceration wound? How do you get consent? They expect you will tell patient he may loss his eye.
    4. What do you do if you missed a retina tear? Tell your senior and consultant. Hospital Director?

 

After the viva at around 3pm, we waited for announcement at 5pm. You need to pass both MCQs and Viva to get through to clinical. But some marks from viva can covered MCQs. As I only got 78% for my MCQs. I managed to get through to clinical. Praise the Lord!

 

20 April 2007 OSCE

We have 10 minutes rest stations in between. We are divided into two groups. There are two set of examiners and patients for each station. Some candidates end up getting similar examiner for few stations.

 

Anterior segment (Failed)

Slit lamp examination of anterior segment examination. Examiners are actually watching what you see by attached 32 inch TV-real time connection! I saw three patients

  1. A patient with peaked pupil, IOL and both temporal and nasal limbus wound with sutures. Asked to explain the likely events. I missed the hyperoleon. ALWAYS ASK PERMISSION TO LIFT UP THE LID TO EXAMINE THE UPPER AC.
  2. A young lady with keratoconus. I manage to elicit all the signs for keratoconus but examination do not stop there. Examiner prompted me on cornea pathology: superior pannus and punctate epitheliopathy. Patient may be atopic or wearing the CL!
  3. An elderly lady with shallow AC (I used Von Herrick) and iris atrophy. Both eyes guttata. The feedback I got “Poor assessment of anterior chamber angle and KP” I missed the KP!

                                                                    

Neuro-Ophthalmology and Motility (Failed)

  1. A lady with left partial ptosis and left eye turn out. Pupil normal. EOM: Limited Abd, Up and Down. I suggested recovering Third CN palsy with pupil sparing. Missed fatigability! Is actually MG. Then, I was asked to demonstrated fatigability. Feedback I got “ Did not lift up lid during motility testing”
  2. A lady with LMN 7th CN palsy. My mistake here is I STARTED PRESENTING MY FINDING BEFORE I FINISHED ALL MY EXAMINATION. I didn’t look for the causes ie examine the ear etc.
  3. Visual Field defect. ? Right homonymous hemianopia. Feedback “Poor technique in Visual Field Testing”!

 

Communications Skills:

  1. I only get one case which is a young lady actress with choroidal melanoma. Some of the candidates get two cases. You may miss something in the first case if you offered second case.  My “patient” is a sale girl who needs to drive around (worry about can she still drives after possible enucleation). When I first entered the room, the are two actress in there, one of them holding a paper keep reading (must be preparing for next candidates).

Then I started by asking for the patient name. I want to make sure she is the correct patient I am going to break the bad news to. To my surprise, both of the examiners do not know either! I think I gain marks here. Other good learning points are: eye contact, ask is she need a relative around, use “BUT” etc i forgot to give f/up appt, explain my role in the beginning as a junior doctor, showed that I make patient at ease, ask if patient understand what I said, I didn’t refer patient to support group and I didn’t give more information about the condition eg in leaflet or internet website.  

 

Cataract & Glaucoma (Failed)           

  1. A gentleman with both eyes IK. I was asked to look at the glaucomatous vertically notched disc. I missed the pigments on the anterior capsule. Patient has uveitic glaucoma.
  2. Another gentleman with unilateral asymmetrical cupping. Pupil is dilated without sphincter rupture. Offered the differential of traumatic angle recession glaucoma and neurological causes to be ruled out. Examiners not happy. Did not get any feedback on this one.

 

Clinical Ophthalmology related to Medicine

  1. I was asked to use a torch light to examine the anterior segment of a middle age gentleman. He had Band Keratopathy. Asked to look at patient, noted he appeared pigmented. On his left arm there is a AV fistula. Confirm by palpation for bruit.
  2. Slit lamp examination of anterior segment, noted both eyes vortex keratopathy. Patient is on Amiodarone.
  3. Limbal dermoid- Goldenhar syndrome
  4. Direct Ophthalmoscopy on fundus. Noted hard exudates in both eyes. Diabetes Retinopathy
  5. An elderly lady with hand deformity consistent with RA, noted both eyes are red.
  6. A lady with both eyes ACIOL, ask about the cause? Complicated cataract surgery. Why both eyes? Think of symmetrical lens pathology. Patient have very subtle signs of Marfan. On denture, offer to take out to examine the high arch palate. Examiner was irritated “ Do you need to take out denture to see the sign?”

Examiners of this station are very professional. They are very helpful and only want to hear keywords. Most of the candidates managed to see all cases in the room. 

 

Posterior segment ( Failed)

  1. I was asked to look at the fundus with a direct ophthalmoscope. I was too concentrated on the disc without looking at the periphery. Missed all the prominent spicules! Feedback wrote “confused PRP scars with bone spicule pigmentation” what a silly mistakes here.
  2. A gentleman with bull’s eye maculopathy and macular hole. I demonstrated the Watzke's sign test. It was positive but the feedback wrote “Unable to recognize macular hole.”??
  3. A patient with inferior retinal detachment. I missed quite a number of signs according to the feedback. Signs of  Vogt-Koyanagi-Harada, Dalen-Fuchs nodules.

 

Generally examiners are helpful and fair.