Candidate 128

Final MRCSEd                       

Centre: UK                        

Date:    March 2008 

I tried to clear final MRCSEd since March 2008. I failed on 2 station : Neurology in relation to Ophthalmology and General Medicine in relation to Ophthalmology. I sat on re-sit on September 2008, managed to clear only the Neuro. Only recently, March 2009, I cleared the Gen-Med station.

Following are my list for revision :

1. Kanski, the last edition (red cover).
2. Wong TY, examination review book. read it cover to cover. it has only summaries. make sure you finish at least Kanski before starting this (better also if you can finish no.3 before starting on this).
3. AAO series : Pathology, Peads and strabismus, Neuro-Ophthlamology and Glaucoma.
4. Oxford handbook of ophthalmology.
5. Previous MCQs banks. Lots of them.
6. this website. tremendous help for me.
7. Kanski essentials (red, small), it has 120 clinical scenarios.

But nothing beats seeing signs in the clinic, disturb my seniors with questions and asked them to give us tutorials after-hours. Especially practicing on answering questions with your colleagues. Be mean (I mean really mean) to each other.

MCQs :
at the most only 40% were repetition and passing mark was quite high. 75%.
Vivas : passing mark 50%, can make up your MCQs if you were doing well.


1. What if a patient was not happy with your management. What is your management. Answer : referral, 2nd opinion, etc.
2. Take consent for cataract surgery, what are you going to explain to patient. Know the percentage well of most common and most devastating complication.
3. Patient with low vision due to AMD. Management : LVA, Support group etc. Save your avastin, TA, PDT et al for other station..


1. Squamous Cell Ca
2. Cornea Dystrophies. Remember : MARLYN MONROE ALWAYS GET HER MAN IN LA CITY.
3. GCA. Know your other type of giant cells.

Gen-Ophth :
(as far as I can recall)
1. Paeds referred to your clinic. They were looking for JIA.
2. How would you follow up an glaucoma suspect's optic disc.
3. a patient with altitudinal field defects, what are your thoughts.

Neuro :
(as fas as I can recall)
1. N III palsy.
2. N VI palsy.


Neuro I
(failed) :
1. an elderly gentleman who does not speak english. very uncooperative for visual field examination. examiner said he had homonimous hemianopia. asked possible location of lesion and features to distinguish.
2. was asked to examine confrontational VF again, same type of cooperation and english inability. examiners showed me wernicke's pupil.
3. pupil for RAPD examination.

Neuro II
(passed, 6 month later) :
1. a gentleman with bitemporal hemianopia. questions on what part of history you want to cover (careful of saying decrease libido), systemic features and of course possible pathology..
2. a young girl for motility test. She has Brown's. asked of differential of Brown's and how to distinguish with it with IO palsy.
3. Cranial nerve examination for an elderly gentle man with ET. Patient had N VI palsy. Discussion on management.
4. An middleaged gentleman with ptosis and downbeat nystagmus.

General Medicine
Gen Med I
(failed) :
1. An elderly gentleman with N VII LMN palsy. what examinations you want to proceed and causes.
2. a 20 something man with bilateral disc swelling. Rumble about papilloedema, but forgot to mention cerebral venous sinus thrombosis, infact couldn't say it although examiners tried to help.
3. Thyroid eye disease.
4. Motility : traumatic Brown's.
5. An elderly lady with deafness, anterior segment sign : pseudophakic with YAG capsulotomy, PAS and pigments on endothelium. Asked of possible causes, at the end I only understood they meant the relation between deafness AND the uveitis....

Gen Med II (failed again) :
1. An middle aged gentleman with bilateral lid retraction and proptosis, and lid lag. I said it was TED and would proceed to investigate for TED. Was criticized for my technique of examining EOM : they said like examining pursuit. Until now I don't exactly know what was the diagnosis.
2. A lady with CSME. Was asked possible macular pathology in relation to DM causing visual loss. I answered : ischemic maculopathy, diffuse macular edema, CSME, Tractional detachment, ERM, Pre retinal h'ge. Did not satisfy examiner as he wanted cystoid macular edema.

Gen Med III
1. Acute anterior uveitis. I was rumbling about HLA B27 related since patient is a young male. Asked to examine joints, honestly I did not how, but told them patient should lie down and test like testing for long tract sign but without the power and more to direction of movement of particular joints rather than dermatomal distribution. Somehow the examiners were impressed...
2. A middle aged gentleman with Thyroid Eye Disease. Whatever I offer examiners wanted me to proceed : EOM and pupils : restrictions found and patient had RAPD. was asked on management : remember to apply to any of the classifications ; be it NOSPECS or VISA or whatever. just be constant towards your answer.
3. A middle aged lady with macroaneurysm. discussions about differentials, causes and management.

Communication :
scenario : a patient whom I treated for conjunctivitis and almost recovered, but culture shows Chlamydia.

Retina :
1. Optociliary Shunt. causes etc.
2. BRVO. discussions on causes and investigations.
3. Bilateral macular coloboma-like lesion. Asked differentials, went by infective and non-infective.
4. Macular hole on direct ophthalmoscopy.

Anterior Segment :
1. Penetrating Keratoplasty, clear host + donor button. offered to look at other eye to look for causes etc. Asked for signs of rejections.
2. Aniridia. Asked if I only had 1 questions to asked, what is the most important question it would be : I answered family history.
3. Morcher's IOL. asked indications.
4. central cornea scar. looks like traumatic. examiners did not complain..

Cataract and Glaucoma :

l the Secondary glaucoma :
1. Pseudoexfoliation
2. Pigment Dispersion
3. Fuch's heterochromic uveitis.
4. a gentleman in 30s with operating theatre robe post tube implant.

The exam is very tiring.. mentally and physically. No matter how much you have prepared yourself, it will all rely on 1 thing : your calmness. Just be cool and do exactly the same thing as you were in the clinic.

In general, all the examiners are really professional and helpful. They do understand your anxiety and inhibition. But this is in generally speaking...