Candidate 78                                                  Centre: Edinburgh
Final MRCSEd                                                                Date: November, 2005
.. Was ok I thought it was easier than the twos..old ones did come up may be 15 % .. 


Clinical ophthalmology and neurology and medicine

  • Start off with picutre of swollen red eye ... differential diagnosis and how to examine clinically, treat as pre-septal cellulitist, what IV antibiotics to use.
  • Axial and non axial proptosis ,, differentials. what blood test, what imaging... show CT scan next with extraconocal mass... again differential  eventually led up to Wegner's granulomatosis... what other organs does it affect .. what medicines to give..
  • Then ask about what was Glascow coma scale !!!.. got a bit stuck... manage to get thru
  • Next was shown ... fundus pictures of vasculitis and NVE and scattered intraretinal hem, but vitreous was clear.. differential ... infective and inflammatory causes..
  • when I mentioned TB .. examiner asked whether I thought this case was infective or not... said yes and roceed to investigations, when mentioned CXR .. ask what I expect to see on CXR..then how to treat TB ...!
  • Then examiner said the patient was from Africa ...penny dropped I said CMV retinitis also likely..Then ask about treatment ... not much detail needed here
  • Next bilateral proliferative DM .. straight forward 

Had a good feel about this one ... later found out I got 6.

Next viva bombed... surgery and pathology 

  • Asked about squint.. types of surgery for to manage 4 yr old eso.. first time in clinic.. I mentioned cycloplegic refraction and orthoptist assessment.. examineer seemed unhappy when I said send the patient for refraction... 'you mean you dont do it yourself ?" accomodative esotropias.. diagnosis and management.
  • Steps of phaco... easy Qs... but they expect a very smooth and fluent answer.. was unhappy if you cannotmake yourself sound like a tect book ... may be question too easy ..
  • Next how to perform PRP, macular laser..different types of CSMO .. how would you  choosewhether to use focal laser or grid laser.. how does FFA aid in treating CSME.. dangers of capillary drop out... difinition of CSME...
  • Next papilloedema.. differentials.. examiner wanted GCA,how to differ between GCA and other condition, the discs are white..
  • Blood tests.. investigations .. how to perform temp artery biopsy.. treatment

At the end I got a 5 for  this one but was allow to proceeed to the final 2 days of clinical... 


Case 1
Bilateral RD .. laser marks in one eye and explant seen in periphery  in the other , ask to use 78D..also myopic fundus..seem like a case of bilateral RD secondary to pathological myopia.. 

Case 2
?? anterior segment dysgenesis.. changes seen in both eyes .. seton tube implant seen..

Case 3
6th nerve palsy seen for diplopia and what surgery for 6th ..

Case 4
Left pthisical eye with band K cant really tell why?

Case 5
Bilateral psedophakic .. be superior limbal wound .. irregular pupils.. asked why the surgeries were difficult.. why the pupils were small, examiners were looking for some type of anterior uveitis...

Didn't get through to the second clinical

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