I use Kanski, this website, Chua's & Wong’s book. Only 4
out of all 20 candidates passed. 2 failed in MCQs and viva. 14 who failed in
clinical included 5 Hong Kong candidates who passed their MRCSEd Ophthalmology
Part 3 in Hong Kong just a week before this exam!
19 April 2007 MCQs
There is no negative marking. But the passing mark is
predetermined. For this exam, the passing mark was set at 79%. Most of the
candidates agreed that the MCQs were quite difficult. They even suggested the
webeditors of www.mrcophth.com to write a
new MCQs book. Can’t remember much about the MCQs, there were no statistics
question, nothing on basic part1 & part 2 Qs. All are clinical MCQs.
19 April 2007 VIVA
This exam is totally different from the pre-exam courses
taken in Moorfield and Singapore. The examiners were holding a set of
standardized questions. There was no lap-top computer to show us any pathology
or clinical pictures. We were just given scenarios and printed histology
pictures (good quality).
- Medicine& Neurology
- 65/F sudden onset BOV. Carotid embolià
à differential and
- Anaphylaxis after the FFA. Signs and symptoms. How
- Clinical Ophthalmology
- Local Anesthesia-eg retrobulbar block: Non-ocular
emergency? How to prevent?
- Painful BOV: differential diagnosis? Phacomorphic
glaucoma, NVG. Treatment of each in detail.
- How do you give subtenon LA?
- How do you do laser PI? (in detail)
- Ocular pathology
- Lattice dystrophyà
describe the pathology pictures
- Squamous cell Caà
- Iris nevus? Melanotic? Complication? He want me to
- Good medical practice
- After a complicated squint surgery (perforated
globe), how do you tell the parent post op?
- How do you take consent for cataract op
- How do you advice patient with cornea-sclera
laceration wound? How do you get consent? They expect you will tell
patient he may loss his eye.
- What do you do if you missed a retina tear? Tell
your senior and consultant. Hospital Director?
After the viva at around 3pm, we waited for announcement at
5pm. You need to pass both MCQs and Viva to get through to clinical. But some
marks from viva can covered MCQs. As I only got 78% for my MCQs. I managed to
get through to clinical. Praise the Lord!
20 April 2007 OSCE
We have 10 minutes rest stations in between. We are divided
into two groups. There are two set of examiners and patients for each station.
Some candidates end up getting similar examiner for few stations.
Anterior segment (Failed)
Slit lamp examination of anterior segment examination. Examiners are actually
watching what you see by attached 32 inch TV-real time connection! I saw three
- A patient with peaked pupil, IOL and both temporal and
nasal limbus wound with sutures. Asked to explain the likely events. I
missed the hyperoleon. ALWAYS ASK PERMISSION TO LIFT UP THE LID TO EXAMINE
THE UPPER AC.
- A young lady with keratoconus. I manage to elicit all
the signs for keratoconus but examination do not stop there. Examiner
prompted me on cornea pathology: superior pannus and punctate epitheliopathy.
Patient may be atopic or wearing the CL!
- An elderly lady with shallow AC (I used Von Herrick)
and iris atrophy. Both eyes guttata. The feedback I got “Poor assessment of
anterior chamber angle and KP” I missed the KP!
Neuro-Ophthalmology and Motility (Failed)
- A lady with left partial ptosis and left eye turn out.
Pupil normal. EOM: Limited Abd, Up and Down. I suggested recovering Third CN
palsy with pupil sparing. Missed fatigability! Is actually MG. Then, I was
asked to demonstrated fatigability. Feedback I got “ Did not lift up lid
during motility testing”
- A lady with LMN 7th CN palsy. My mistake
here is I STARTED PRESENTING MY FINDING BEFORE I FINISHED ALL MY
EXAMINATION. I didn’t look for the causes ie examine the ear etc.
- Visual Field defect. ? Right homonymous hemianopia.
Feedback “Poor technique in Visual Field Testing”!
- I only get one case which is a young lady actress with
choroidal melanoma. Some of the candidates get two cases. You may miss
something in the first case if you offered second case. My “patient” is a
sale girl who needs to drive around (worry about can she still drives after
possible enucleation). When I first entered the room, the are two actress in
there, one of them holding a paper keep reading (must be preparing for next
Then I started by asking for the patient name. I want to make sure she is the
correct patient I am going to break the bad news to. To my surprise, both of the
examiners do not know either! I think I gain marks here. Other good learning
points are: eye contact, ask is she need a relative around, use “BUT” etc i
forgot to give f/up appt, explain my role in the beginning as a junior doctor,
showed that I make patient at ease, ask if patient understand what I said, I
didn’t refer patient to support group and I didn’t give more information about
the condition eg in leaflet or internet website.
Cataract & Glaucoma (Failed)
- A gentleman with both eyes IK. I was asked to look at
the glaucomatous vertically notched disc. I missed the pigments on the
anterior capsule. Patient has uveitic glaucoma.
- Another gentleman with unilateral asymmetrical
cupping. Pupil is dilated without sphincter rupture. Offered the
differential of traumatic angle recession glaucoma and neurological causes
to be ruled out. Examiners not happy. Did not get any feedback on this one.
Clinical Ophthalmology related to Medicine
- I was asked to use a torch light to examine the
anterior segment of a middle age gentleman. He had Band Keratopathy. Asked
to look at patient, noted he appeared pigmented. On his left arm there is a
AV fistula. Confirm by palpation for bruit.
- Slit lamp examination of anterior segment, noted both
eyes vortex keratopathy. Patient is on Amiodarone.
- Limbal dermoid- Goldenhar syndrome
- Direct Ophthalmoscopy on fundus. Noted hard exudates
in both eyes. Diabetes Retinopathy
- An elderly lady with hand deformity consistent with
RA, noted both eyes are red.
- A lady with both eyes ACIOL, ask about the cause?
Complicated cataract surgery. Why both eyes? Think of symmetrical lens
pathology. Patient have very subtle signs of Marfan. On denture, offer to
take out to examine the high arch palate. Examiner was irritated “ Do you
need to take out denture to see the sign?”
Examiners of this station are very professional. They are very helpful and
only want to hear keywords. Most of the candidates managed to see all cases in
Posterior segment ( Failed)
- I was asked to look at the fundus with a direct
ophthalmoscope. I was too concentrated on the disc without looking at the
periphery. Missed all the prominent spicules! Feedback wrote “confused PRP
scars with bone spicule pigmentation” what a silly mistakes here.
- A gentleman with bull’s eye maculopathy and macular
hole. I demonstrated the Watzke's sign test. It was positive but the
feedback wrote “Unable to recognize macular hole.”??
- A patient with inferior retinal detachment. I missed
quite a number of signs according to the feedback. Signs of Vogt-Koyanagi-Harada,
Generally examiners are helpful and fair.