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
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
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
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
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
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.
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:
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.
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.
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.
He was a young man, smiling, probably trying to compensate his companion’s
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
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.
Drawn on paper various levels of SRF distributions and I have to locate
break (Lincoffs Rules). Questions on lattice and its prophylaxis, chances of
Extra ocular movements. How to do cover/uncover test in up gaze and down
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
Dr. Rao Muhammad Rashad Qamar
Quaid-e-azam Medical College,
Bahawalpur, Punjab, Pakistan