Candidate 94                                             Centre: Edinburgh
Final MRCSEd                                                           Date: November, 2006

Day 1 MCQ’s…… negative marking so keep on marking happily without undue stress. I shall try to gather as much as I can remember and will post these later on onto the site maybe by the end of this week.

Day 2
Extremely well organized. A fantastic official of the Royal college cracks jokes with you and by the time you reach the viva tables his input takes away a lot of the stress. Each table has a booklet with (I guess) suggested question scenarios and the examiners ask questions based on that only. Only one examiner asks questions while the other keeps on marking. At some tables there were more than 2 examiners and I guess they were just observers.

Table 1) Ethics and good medical practice

• What is audit?
• How will you audit your own cataract list?
• How would you analyse the data?
• Which specific guidelines are you supposed to follow?
• If you note that you have had 3 endophthalmitis within a span of 1 montn what steps are you going to undertake
• What would you do if you find that you have had much more PC tears than the recommended guidelines? ( the examiners wanted to find out whether the candidates say that “ I would go for retraining” )
• What is NICE?
• What are the guidelines issued by NICE for ARMD?
• A patient comes back after removal of pituitary tumour by a nerusurgery colleague and is aghast that she has lost the sight…..what would you do?
• What makes a good legal case against this surgeon?
• If you find out that this surgeon is at fault what will be your role?

Table 2) Clinical Ophthalmology

• How would you proceed if a patient comes to you on a Friday evening oncall with a blunt trauma to the eye?
• What are the various investigations you would do?
• If you find that this person has a RAPD what are your main concerns?
• How would you tackle a haematoma compressing the optic nerve? ( was keen on me saying lateral canthotomy )
• What are the things you look for when a patient with cornea graft comes to the clinic?
• How would you manage a child of 12 months being brought by the mum with unilateral epiphora.
• Some questions on endophthalmitis

Table 3) Pathology

• Picture of amelanotic melanoma
• How I arrived at the conclusion?
• What are the features
• D/D
• Management plan
• Prognostic indicators, including histological features
• Was shown 3 slides- melanoma with epitheloid cell histology, melanoma with mixed cell histology and melanoma with spindle cell histology
• Was shown a histological section of a Normal artery and asked to identify the structures and some questions on Giant cells and which layers get affected in GCA

Table 4) Ophthalmology with relevance to medicine

• How would you manage a patient with uveitis who also has developed cataracts
• Featuers in rheumatoid arthritic patient and what are the various ophthalmological manifestations
• Ophthalmological features of HIV
• Complications with HAART therapy

This was a difficult station particularly because the examiner (a lady with a difficult accent) did not seem to be particularly happy with any of my answers. I found out later on that she was unhappy with everybody. Thank goodness it was my last table!!!!

WAIT FOR A COUPLE OF HRS AND THE RESULTS WERE GIVEN BACK TO US ON THE SAME DAY DURING 4.30 pm alongwith a time for attending the clinicals maybe the next day or the day after.

CLINICALS held at Princess Alexandra Hospital

You are given a time and advised to attend for the clinicals NOT prior to the time mentioned. Usually the clinicals run 1 hr behind schedule and thus if you are allotted to attend the hospital after 14.15, it is most likely that your actual clinicals do not begin until 15.00


The examiners give you the scenario when you enter the room and there were 3 different actors in the room. I was given a scenario wherein a patient attends the clinic after a cataract surgery and he is extremely disappointed since he has diplopia. It transpired that due to refractive surprise he has ended up being anisometrope. Some candidates have been asked to examine 2 patients but I was just given 1. Other scenarios were Melanoma with or without metastasis and you have to break the bad news and discuss management options. There were also consenting for cataract surgery and stuff like that. No unknown or funny scenarios were given. The actors are extremely professional and answers your questions to the point and sometimes gives you a leading edge to pick up upon a thread which you might have missed.

Anterior segment

• Ptosis examination, measurement, this patient had an apparent hypotropia which was due to the ptosis. The ptosis was due to the aponeurotic disinsertion post trabeculectomy and I wa asked questions regarding the management , complications of the surgery.
• Rheumatoid arthritis related corneal thinning and she had some strange graft.
• Asked abt D/d
• Corneal graft with Fuch’s. Was asked abt suture removal, graft f/u, complications, management of astigmatism-LASIK etc

Cataract and glaucoma

• Was asked to do a initial inspection without even looking at the slit lamp. The gentle man had LLL ectropion with increased lacrimal lake. Asked abt whether I should contemplate cataract surgery in this person.
• Trabeculectomised eye….asked abt patency, type of graft, whether functioning, how I arrived at the conclusion of a functioning bleb.
• Was asked to evaluate the fundus ( undilated pupil ) asked abt whetrher I should go for combined procedure or not……and what risks the trabeculectomised eye has post cataract surgery
Quite a straight forward station

Medicine and Ophthalmology

• Asked to take history from a patient who has lost sight recently.
• Asked to examine and carotids and evaluate for bruit.
• Asked to advise a patient who has recently been diagnosed as a diabetic.
• Asked to evaluate a patient with 7th and 8th cranial palsy and questions on CP angle tumour.
Extremely nice examiners……a million thanks to Mrs Dhar and Mr Singh


• 6th cranial nerve palsy post depressed skull fracture.
• Acoustic neuroma.
I am glad I passed this station because I thought I messed this up completely.

Medical retina
• BRVO with BRAO and scatter laser questions related to this. Some candidates were actually asked abt how you would do laser and the nittygritties.

• Post-segment evaluation ……I saw a laser retinopexy at the superotemporal quadrant, but later the examiner showed me that this patient was actually very high hypermetropic … I am not quite sure whether I missed a retinoscisis. However I was asked abt retinal holes and when to treat.

Although the pass rate has not been encouraging ( 33 % ) most of the examiners are extremely helpful and would give you intelligent leads.