Candidate 64                                                  Centre: Edinburgh
Final MRCS                                                                    Date: April, 2005
MCQs appeared to be very difficult, about 15% of the questions appear in the past paper pool, however I didn't have time to study them, therefore although they looked familiar, I didn't know the answer ... I answered 80% of the question 

Day 2 morning
I had viva in pathology and surgery:

  • Change seen in histology of bullous keratopathy and treatment of bullous keratopathy
  • shown a photo a choroidal nevus and ask about management
  • ECCE: compare pros and cons of limbal wound and cornea wound
  • Intra-ocular lens: what is the size? what material ? ask to draw the typical lens on a piece of paper 
  • A photo of herpetic stromal keratits (with fluorescein stain) asked what to do in examination (sensation !) what are the Ddx and treatment

On the same day  I had the second viva (medicine and neurology)

  • Question began with a 50 years old thin male smoker present with gradual blur of vision, ask me about differential diagnosis .. discussion on the optic neuropathy the examiner keep on asking for causes of optic neuropathy, include ethanol, methanol, the clinical presentation, investigation, what blood test would I order and the treatment and prognosis. 
  • Another examiner ask me about myasthenia gravis, the diagnostic test I know of , how to perform ice-pad test, how to perform tensilon test.
  • Picture of  a face with Sturge-Weber syndrome, ddx, eye problem, investigation and examination and management.
Short cases:
  • Slit lamp exam:  macula drusen with pigment epithelial detachment. Questions on ddx ? Investigation ?
  • Indirect: middle age female with posterior pole scarring. No hx of eye disease and vision were normal, Ix, ddx (that was probably congenital toxoplasmosis)
  • Slit lamp examination: left eye PKP done, right eye had Fuch endothelial dystrophy
  • Middle age male: bilateral ptosis with limited bilateral adduction and limited R elevation.  Questions: ddx ? ( I think that should be CPEO, since it did not look like thyroid eye disease and no evidence of fatigue to suggest myasthenia gravis)
  • Confrontation test: right superior quadrantinopia
  • Cover test: Left  hypotropia then 3-step test => Right congenital IV nerve palsy
  • Direct ophthalmoscope: disc pallor: possible diagnosis ? 
Final day was neurology short cases:
  • First case was a middle age male. History of unstable gait and clumsy hand, I looked for cerebellar sign which appeared to be present though the patient turn out to have Wilson's disease. Asked to perform pupil examintion on the same pateint (both eye were dilated and sluggish to light), the examiner asked me look at the pupil on slit lamp (I kept on looking for Adies pupil but could not find any associated signs) the other examiner reminded me "look at the lens" I found green sunflower cataract after she also asked me to examine the cornea and there was a definite Kayser Fleischer ring (before looking at the cornea, I thought the cataract was stellate cataract i.e. myotonic dystrophy). The examiner asked me to take history from the same patient to see what drug he is taking .. I can only figure out he was on D-penicillamine (that's all I know !) and he asked me to take the history again about the side effect of the drug . It was then I realized he was also taking  b-blocker to control the tremour
  • Second case was a Horner syndrome with muscle wasting of the hand, I was shown a CXR and asked to comment (there was some fibrosis with deviated trahea and also pulmonary effusion)
  • Confrontation field test showed a junctional scotoma, asked for the differential diagnosis. The CT scan of the brain was shown which showed a mass with calcification. I gave meningioma as the most likely diagnosis. More questions on management.
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