Candidate 93                                        Centre: New Dehli
Final FRCS (Glasgow)                                                Date: Sept, 2006
 I am Dr Khaleel Ahmed .By the Grace of God I managed to clear my FRCS exams in the first attempt at Delhi (Sept 2006). Dr Prof. Muthusamy’s coaching for the problem solving questions  was very useful.His website is Other than Kanski ,Wong was quite useful.Though not too accurate it gives a good orientation to the exam type of questions & answers.

Clinical solving questions
1. A patient with history of dry eye & joint pains presents with a perforated corneal ulcer & flat AC.Investigation & management?
I wrote about rheumatoid arthritis,..

2. Three year old boy with recurrent attacks of acute dacryocystitis right side. Has underwent two probings. Left side symptoms subsided , right side probe passed “easily” both times.Parents are angry & want a second opinion. How will you manage this situation.Write a letter to the family physician explaining the problem.
Must be false passage.I mentioned DCG & DCR

3. An 56 year old artist with retinoschisis recently noticed distortion of his central vision RE & also his colour vision.The referring optometrist feels that his Schisis has extended to his macula.How will you manage him.
I wrote about AMD & mentioned CSR.Schisis unlikely to extend to macula.

Surgery & Pathology Station

English examiner:
1. Picture of hyphaema on laptop:
Features of blunt trauma of the globe?
Features & management of rupture globe? IOP low, AC depth altered, ?? B-Scan.
2.He gave me Bowman’s lacrimal probe. Asked it’s uses?
3.Glaucomatous cupping, field changes but IOP 14 mm Hg .What will you  do? History of medications. He said –no medications . Ans: Congenital disc abnormality, methanol poisoning. What else? May be he wanted pachymetry.
4.Post trab- IOP 32 mm Hg ,no bleb- management?
Gonio to check blocked ostium, Argon laser suturolysis. 
Procedure of argon laser suturolysis?

Indian examiner:
1.Which cataract procedure do you perform ?
SICS & Phaco.
Asked about PCR management & vitrectomy procedure. 
2.Drew RD on paper .Asked where could be the primary break.
Management? Principle of buckling & encirclage? To relieve traction.

Medical Ophthal  station

Indian Examiner
1.HFA print out : Grey scale showed tubular vision.Pattern deviation plot showed only early glaucomatous change.
False negatives : N/A . Asked what is N/A ??
If pupil small ,patient on pilocarpine what you will do? Ans:Stop pilo for about 2 weeks?.Replace with another drug.
2.Refraction .Power cross OD: plano, OS: high cyl.,transposition, If in child what possibility. Ans: Amblyopia.

Jordanian examiner 
1.Fundus photograph of diabetic retinopathy ,CSME, 
Signs of macular ischemia ?
FA picture of same patient showed leakage. Management?

Neurology & Medicine 

English examiner(neurologist)
1.Photograph of young lady with anisocoria.
Anisocoria increasing in dim light.
Horner’s pharmacological tests & it’s basis.
2.Fundus Photo of HT retinopathy.BP 200/120 mmHg  Management?
HT drugs. Gradual reduction of BP.
Causes of secondary HT?

Indian Examiner
Unilateral Proptosis. 
Signs of hyperthyroidism?
GCA management? Complications of steroids ?
What will you prescribe with steroids? Ranitidine ,antacids.
Observer Medical student faints in theatre . Que on syncope.
How will you perform CPR?
During FA Patient breathless ,management?


1. Slit lamp examination: Superficial stromal  paracentral coneal opacity. I said healed corneal ulcer.What other exam ? IDO ,gonio for foreign body .What else? Lid eversion to look for scarring ,FB. What else? May be he wanted giant pappilae.

2.RE esotropia with nystagmus on extreme adduction.Asked to perform motility & cover test. I also did hirschberg test.

3.IDO (indirect ophthalmoscopy) :  Young girl semi dilated pupil. Managed to see pale optic disc.I said I suspected optic nerve glioma & will request CT Scan.

4. IDO of coloboma choroids involving disc.

5. SLE of disorganized globe with iridodialysis .I said post traumatic endophthalmitis.

6. Young man with subluxated lens. Asked about other ocular features of marfans.

7. Band keratopathy treated with epithelial defect.pthysical globe.

Questions to other candidates:

- Gram staining
- Procedure of wearing gloves
- Proptosis management
- Herpes  simplex management
- Angiod streaks- ocular & systemic associations.
- Young man with unilateral dilated pupil & headache- management?
- Sutures & needles
- Lid reconstruction
- Patient with fever – management ?
- DCR –procedure & method of block, bones removed during osteotomy? Must start with nasal packing. 

They can just ask anything!

All the best.